Width Of Insertion Research Articles

Evaluation of the relationship between the anatomical characteristics of the vastus medialis obliquus muscle and the patella chondral lesion occurrence.

The study aims to investigate the relationship between the vastus medialis obliquus (VMO) muscle distal insertion features and patellar chondral lesion presence. This cross-sectional study included a total of 100 patients (18 males, 82 females, mean age 67.2±7.1 years; range, 50 to 86 years) who underwent total knee arthroplasty (TKA). Radiological assessments, including merchant view and standing orthoroentgenograms, were conducted. The current osteoarthritis stage, varus angle, quadriceps angle (Q angle), patella-patellar tendon angle (P-PT angle), congruence angle, and sulcus angle were calculated. The VMO tendon length, muscle fiber angle, tendon insertion width measurements, and patellar chondral lesion localization data were obtained intraoperatively. Grouping was done according to the distal insertion width of the VMO tendon to the medial edge of the patella. The medial rim of the patella was divided into three equal-sized sectors. The first group (Group 1, n=31) consisted of patients who had an insertion from the quadriceps tendon into the upper one-third of the patella. The second group (Group 1, n=48) consisted of patients with a distal insertion expanding into the middle one-third of the patella. The third group (Group 3, n=21) consisted of patients who had a distal insertion extending into the distal third region of the medial patella margin. The patella joint surface was divided into sectors, and the presence and location of cartilage lesions were noted in detail. The mean tendon insertion width rate was 45.99±16.886% (range, 16.7 to 83.3%). The mean muscle fiber insertion angle was 51.85±11.67º (range, 20º to 80º). The mean tendon length was 12.45±3.289 (range, 4 to 20) mm. There was no significant difference between the mean age, weight, height, body mass index, BMI, fiber angle, tendon length, varus angle, Q angle, sulcus angle, and congruence angle data among the groups. In terms of the P-PT angle, Groups 1 and 2 had a significant relationship (p=0.008). No relationship was found between the mean fiber insertion angle, mean tendon length, or the presence of chondral lesions. There was a statistically significant difference among the groups regarding the presence of chondral lesions. The highest percentage of chondral lesion frequency was observed in Group 3 (95.24%), followed by Group 1 (90.3%) and Group 2 (89.6%), respectively. Compared to the other two groups, Group 3 had a higher average ratio of lesion areas per patient. Our study results demonstrate that the formation and localization of the patellar chondral lesions are affected by the insertion width type of the VMO muscle into the patella. Group 2-type insertion is associated with a lower lesion frequency rate than Groups 1 and 3.

Conformation of Horizontal Extraocular Muscle Insertions in Acute Acquired Concomitant Esotropia Induced by Excessive Digital Device Usage.

Acute acquired concomitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. Convergence spasm induced by excessive near work has been suggested as a mechanism. Anatomical differences could also potentially contribute to SAACE onset. The present study investigated the conformation of horizontal recti between SAACE patients and normal subjects. In 15 SAACE patients (SAACE group), the distances between the limbus and insertion of the horizontal recti (LI distance) and the widths of horizontal recti on the insertion (insertion width) were measured. The control group consisted of 30 patients who underwent retinal detachment surgery. Differences in LI distances and insertion widths were compared between SAACE and control groups. While there were no differences between the two groups for LI distances and insertion widths of lateral recti, there were significantly shorter LI distances for the medial recti in the SAACE group (P<0.05). Moreover, the SAACE group tended to exhibit larger insertion widths of the medial recti. Medial/lateral ratio of LI distances were significantly lower and insertion widths were significantly higher in the SAACE compared to the control group (P<0.05). Based on the observations of more anterior insertion and larger muscle widths, this suggests there are stronger forces of medial recti in SAACE. In addition to excessive accommodation followed by increases in medial recti tonus, the results also suggest that an anatomical imbalance between lateral and medial recti contributes to esotropia onset following excessive near work.

Histological differences in cartilage layer growth at various tendon and ligament insertions in rabbits.

Objectives: Histological differences in cartilage layer growth in Achilles tendon (AT), quadriceps tendon (QT), patellar tendon (PT), and anterior cruciate ligament (ACL) insertion are unclear. Therefore, this study aimed to investigate the differences in cartilage layer growth in AT, QT, PT, and ACL insertions. Materials and Methods: Forty-eight male Japanese white rabbits were used. Six animals were euthanized at different stages (day 1 and 1, 2, 4, 6, 8, 12, and 24 weeks). Safranin O-stained glycosaminoglycan (GAG) production area, chondrocyte count, and insertion width were investigated. Results: A two-way analysis of variance (ANOVA) revealed a significant difference in the main effects of time and insertion for all parameters. In addition, the time × insertion interaction was significant. Multiple comparisons showed a significant difference between the ACL insertion and all other variables; however, the GAG production area was not significantly different for the QT, PT, and AT insertions. AT insertions were significantly different from all other groups; however, the number of chondrocytes and insertion width were not significantly different for ACL, QT, and PT insertions. Conclusion: Cartilage layer growth differed between the AT, QT, PT, and ACL insertions. The differences between the insertions may also be due to the differences in their structures, locations, and mechanical environments.

Flexor hallucis longus. A cadaveric study of its distal insertion

Objective: Describe flexor hallucis longus (FHL) distal insertion. Methods: Ten cadaver feet were dissected to evaluate FHL distal insertion, the width of insertion, and the distance between insertion borders and medial-lateral phalangeal borders. Results: All specimens showed a lateral tendon fascicle inserted more lateral and distal than the main insertion. The mean lateral and medial insertion distance to the phalangeal border was 3 mm and 5.2 mm. The FHL long axis was 12.36% laterally deviated at the metatarsophalangeal (MTP) joint and 14.07% at the interphalangeal (IP) joint. Conclusion: The FHL has a closer insertion to the lateral phalanx border, and its long-axis midpoint is laterally located in relation to the IP and MTP joint. The detailed knowledge of the FHL true anatomy. The discovery of a lateral deviated axis, a lateral fascicle, and a lateral footprint.

Influence de la protéine périostine sur le développement des couches de fibrocartilage de l’insertion du ligament croisé antérieur

BackgroundPeriostin (Postn) is thought to play a role in the formation of anterior cruciate ligament (ACL) insertion. However, the influence of Postn on the development of ACL insertion requires further understanding. This study aimed to clarify the influence of Postn on the development of fibrocartilage layers of ACL insertion. HypothesisWe hypothesized that Postn would influence the development of fibrocartilage layers of ACL insertion. Materials and methodsC57BL/6N wild-type (Postn+/+; n=54) and Postn knockout (Postn−/−; n=54) mice were used in this study. Six animals were euthanized at 1 d and 1, 2, 3, 4, 6, 8, 10, and 12 weeks of age in each group. The chondrocyte number, proliferation, apoptosis, safranin O-stained glycosaminoglycan (GAG) area, type II collagen staining area, tidemark length, and insertion width were evaluated. ResultsChondrocyte proliferation was high up to 2 weeks in Postn+/+, while low at age 1 d; it was, especially lower in Postn−/− than in Postn+/+ at age 1 d and 1 week. Chondrocyte apoptosis was high up to age 8 weeks in Postn+/+ and at 6 weeks in Postn−/−; it was especially higher in Postn−/− than in Postn+/+ at age 1 week. The GAG stained area was thickest for age 1 d to 4 weeks in Postn+/+ and for age 2 to 6 weeks in Postn−/−. The type II collagen staining area in Postn+/+ was thicker than that in Postn−/− at age 6 and 8 weeks. The tidemark length in Postn+/+ was longer than that in Postn−/− from age 8 to 12 weeks. The insertion width in Postn+/+ was longer than that in Postn−/− from age 1 to 3 weeks. DiscussionPostn decreased cell proliferation in the early postnatal phase and influenced the development of the fibrocartilage layer extracellular matrix of ACL insertion in mice. Postn may contribute to the development of methods for regeneration of the ACL insertion. Level of evidenceV; controlled laboratory study.

Anatomy of Flexor Hallucis Longus and Its Relationship with Hallux Valgus: A Cadaveric Study

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: The first ray is an inherently unstable structure that relies on a fine balance between its static and dynamic stabilizers to maintain its alignment. Multiple risk factors have been associated with hallux valgus development. The dynamic stabilizers, particularly the flexor hallucis longus (FHL), has been mentioned as a potential deforming force that could contribute and accentuate hallux valgus deformity due to its spatial situation and insertion morphology. The aim of this study is to describe FHL distal insertion morphology and it spatial relationship with interphalangeal (IP) and metatarso-phalangeal (MTTP) joint. Methods: 10 fresh frozen cadaver hallux were dissected up to the MTT-F joint, exposing FHL and bony structures, leaving in situ ligamentous attachments. We evaluated FHL distal insertion morphology in terms of width of insertion and distance between insertion borders of the FHL and medial-lateral phalangeal borders. The spatial relationship of the FHL with IP and MTTP joint was measured by the position of the FHL long axis width midpoint in relation to the phalangeal and metatarsal width 1cm proximal to the joint. Results: The FHL mean width of insertion was 12,1mm (range 10-15) SD (+-1,5). All specimens showed a lateral tendon fascicle that was inserted more lateral and distal than the tendon main insertion. Mean lateral distance of insertion to phalangeal border was 3mm (range3-4) SD (+-0,7), mean medial distance of insertion to phalangeal border 5,2mm (range 4-7) SD (+-1,1). FHL long axis width midpoint was on average 12.36% laterally deviated from the osseous midpoint at MTTP joint and 14.07% lateral deviated at IP joint. Conclusion: The FHL has a closer insertion to the lateral phalanx border and it long axis midpoint is laterally located in relation to IP and MTTP joint, creating a laterally directed force vector over both joints that could be involved in the pathogenesis of hallux valgus.

ACL Graft Matching: Cadaveric Comparison of Microscopic Anatomy of Quadriceps and Patellar Tendon Grafts and the Femoral ACL Insertion Site

Background: The optimal graft choice between the bone–patellar tendon–bone (BPTB) and the quadriceps tendon remains controversial. Studies evaluating the microscopic anatomy of the quadriceps tendon–patellar bone (QTB) and BPTB grafts for anterior cruciate ligament (ACL) reconstruction are currently lacking. Hypothesis: The relationship between post–ACL reconstruction graft bending angle (GBA) and the angle corresponding to the GBA (cGBA) would indicate that the BPTB can bend more than the QTB at the femoral tunnel aperture. Study Design: Controlled laboratory study. Methods: Twenty paired human cadaveric knees fixed at <10° of knee joint flexion (mean age, 82.5 years) underwent histological sectioning and staining with Masson trichrome and toluidine blue. The femoral ACL insertion, QTB graft, and BPTB graft were microscopically analyzed. The width of the direct insertion, thickness of the uncalcified fibrocartilage and calcified fibrocartilage, ligament attachment angle, and cGBA for each group were measured. Eighteen patients who underwent ACL reconstruction with QTB or BPTB autograft were included for the evaluation of GBA using computed tomography images at 1 week postoperatively. Results: The mean insertion widths of the femoral ACL, QTB, and BPTB were 7.81, 9.07, and 6.54 mm, respectively. The QTB was 16% wider than the ACL, while the BPTB was 16% narrower than the ACL. The mean insertion thicknesses of the femoral ACL, QTB, and BPTB were 0.53, 0.94, and 0.38 mm, respectively. The QTB was 77% thicker than the ACL (P < .001), while the BPTB was 28% thinner than the ACL (P = .017). The mean ligament attachment angles of the femoral ACL, QTB, and BPTB were 20.3°, 30.2°, and 33.3°, respectively, and the QTB and the BPTB were 49% and 64% larger, respectively, than the ACL. The mean cGBAs of the femoral ACL, QTB, and BPTB were 33.9°, 35.1°, and 12.3°, respectively. The BPTB was 64% smaller than the ACL, while there was no significant difference between the QTB and the ACL. The mean GBA was 57.7°. Conclusion: The insertion width and thickness were significantly greater and smaller in the QTB and BPTB grafts, respectively, than in the ACL. The relationship between GBA after ACL reconstruction and cGBA in knee extension indicates that at the femoral tunnel aperture, the BPTB can bend more than the QTB. Clinical Relevance: QTB graft may allow more anatomic ACL reconstruction to be performed.

Age-Related Posterior Cruciate Ligament Surgical Anatomy in a Skeletally Immature Population: An MRI Study

Background: Magnetic resonance imaging (MRI) analysis of the developmental morphology of the anterior cruciate ligament (ACL) in pediatric and adult patients has led to the identification of anatomical risk factors for injury and optimization of surgical reconstruction. Similar work regarding the pediatric posterior cruciate ligament (PCL) is limited. The aim of this study was to describe age-dependent changes in ligamentous and osseous anatomy of the pediatric PCL by comparison of MRI measurements. Methods: Sixty randomly selected patients were categorized into three skeletal age groups (ages 7-9 years, 10-12 years, and 13-15 years) with 20 patients in each. Twelve anatomical dimensions were measured on MRI by two independent reviewers. Pairwise comparisons were conducted between the youngest and intermediate, as well as the intermediate and oldest age groups. Results: Statistically significant growth in femoral physis width (p&lt;0.001), tibial physis width (p&lt;0.001), and medial femoral condyle (MFC) width (p&lt;0.001) and height (p&lt;0.001) was found across all skeletal age groups. Growth in femoral PCL height (p=0.02), femoral PCL footprint to femoral physis height (p=0.004), tibial PCL insertion width (p&lt;0.001), tibial PCL footprint to tibial physis distance (p&lt;0.001), and tibial epiphysis height (p=0.003) and width (p&lt;0.001) was only statistically significant between the youngest and intermediate groups. Only MFC height (p=0.03) and width (p=0.001), femoral PCL height (p=0.05), and tibial physis width (p=0.02) were significantly larger in the oldest compared to the intermediate group. Intrarater reliability for all measurements was excellent; interrater reliability was variable. Conclusions: Morphological changes of the pediatric PCL and associated surgical anatomy vary by skeletal age throughout childhood and adolescence. Differences were most evident between preadolescents with open physes compared to adolescents with closing physes, who demonstrated slowed or plateaued growth in most dimensions. The femoral physis was located proximal to the origin of the PCL in all age groups. The relationship of the distal PCL footprint to posterior proximal tibial physis varied. Young children (7-9 years) had footprints significantly more distal to the tibial physis, thus, native PCL reconstruction in this age group may be possible. Anatomical reconstruction in adolescents poses greater risk as the PCL footprint is closest to the tibial physis. Analysis of age-dependent transformations of the PCL and surrounding anatomy may inform surgical planning and enhance understanding of physeal location in this active population.

Can the Posterior Cruciate Ligament (Pcl) Predict Anterior Cruciate Ligament (Acl) Size For Planning During Acl Reconstruction?

Background:Pediatric Anterior Cruciate Ligament reconstruction (ACLR) has increased over the past several years. Estimating the native ACL size on pre-op imaging would ideally inform graft size during surgery and make it possible to individualize ACL graft size to each patient.Hypothesis/Purpose:To establish a correlation between the ACL and PCL size in normal pediatric knees, with the goal of informing appropriate graft size for ACL reconstruction.Methods:MRIs of 540 patients ages 8-18 years were assessed. Measurements included: ACL and PCL length, thickness and width (Figure 1). ACL footprint thickness and width at the tibial insertion was also measured. Inter-rater reliability was assessed with a random set of 25 patients. Pearson correlation coefficients were used to assess the correlation between ACL and PCL measurements. Linear regression models were used to test whether the relationship between ACL and PCL measurement differed by sex or age.Results:Demographic data for 540 patients are shown in Table 1. Inter-rater reliability was high for all measurements except PCL thickness at midsubstance. ACL length was most strongly correlated with PCL length (r=0.57, p<0.0001). ACL origin thickness was most strongly correlated with PCL mid-thickness (r=0.26, p<0.0001). ACL origin width was most strongly correlated with PCL insertion width (r=0.49, p<0.0001). ACL insertion thickness was most strongly correlated with PCL insertion thickness (r=0.27, p<0.0001). ACL insertion width was most strongly correlated with PCL mid-width (r=0.39, p<0.0001). Sample equations for estimating ACL size from each sex and age category are as follows: ACL Origin Thickness = 3.21 + 0.26PCL Origin Thickness (R2=0.07; 8-12yo males), ACL Origin Width = 1.35 + 0.15PCL Insert Width (R2=0.23; 8-12yo females), ACL Insert Thickness = 7.02 + 0.22PCL Mid Thickness – 0.17PCL Insert Width, (R2=0.10; 13-18yo males), ACL Insert Width = 2.31 – 0.09PCL Length + 0.39PCL Mid Thickness + 0.27PCL Mid Width + 0.25PCL Insert Width (R2=0.31; 13-18yo females).Conclusions:Correlations exist between ACL and PCL measurements with some moderated by sex and/or age. This study is the first step in potentially informing normal ACL size in pediatric patients based on an intact PCL on MRI.Table 1.Demographic data from 540 patients ages 8-18.Figure 1.Top row left to right: ACL length measured on sagittal view; ACL thickness – AP dimension at origin (femur), midpoint and insertion (tibia) measured on sagittal view; ACL width at ACL origin on femur – Transverse dimension on axial plane view; ACL width at ACL midpoint – Transverse dimension on axial plane view. Middle row left to right: ACL width at ACL tibia insertion – Transverse dimension on axial plane view; PCL length – measured on sagittal view – by adding 2 lines – one from origin to the PCL crimp and from PCL crimp to the tibia insertion; PCL thickness – AP dimension at origin (femur), midpoint and insertion (tibia) measured on sagittal view; PCL width at PCL origin on femur – Transverse dimension on axial plane view. Bottom row left to right: PCL width at PCL midpoint – Transverse dimension on axial plane view; PCL width at PCL tibia insertion – Transverse dimension on axial plane view; ACL thickness footprint – AP dimension on sagittal view; ACL footprint width at ACL origin on femur – Transverse dimension on axial plane view.

Age-Related Changes on Mri Of Posterior Cruciate Ligament Morphology in A Skeletally Immature Population

Background:Magnetic resonance imaging (MRI) analysis of the developmental morphology of the anterior cruciate ligament (ACL) in pediatric and adult patients has led to the identification of anatomical risk factors for injury and optimization of surgical reconstruction. Similar work regarding pediatric posterior cruciate ligament (PCL) morphology is limited despite increasing incidence of PCL injury and rising favorability of surgical reconstruction.Purpose:The aim of this study was to describe age-dependent changes in ligamentous and osseous anatomy of the pediatric PCL by comparison of MRI measurements across pre-adolescent and adolescent age groups.Methods:Sixty patients with a knee MRI and wrist radiographs who were seen from 2008 to 2018 at a single tertiary care center were randomly selected from a departmental database and categorized into skeletal age groups (ages 7-9 years, 10-12 years, and 13-15 years) with 20 patients in each group (Table 1). Skeletal age was determined from wrist radiographs and patients with a PCL injury or prior knee surgery were excluded. Twelve dimensions of the PCL substance or its osseous attachment sites were measured on MRI by two independent reviewers. Pairwise comparisons were conducted between the youngest and intermediate, as well as the intermediate and oldest skeletal age groups.Results:There was statistically significant growth across skeletal age groups in femoral physis width (p<0.001), tibial physis width (p<0.001), and medial femoral condyle (MFC) width (p<0.001) and height (p<0.001). Growth in femoral PCL height (p=0.02), femoral PCL footprint to femoral physis height (p=0.004), tibial PCL insertion width (p<0.001), tibial PCL footprint to tibial physis height (p<0.001), and tibial epiphysis height (p=0.003) and width (p<0.001) was only statistically significant between the youngest and intermediate groups. Only MFC height (p=0.03) and width (p=0.001), femoral PCL height (p=0.05), and tibial physis width (p=0.02) were significantly larger in the oldest compared to the intermediate group. Intrasubstance PCL width did not demonstrate significant age-related change (Table 2). Intrarater reliability for all measurements was excellent; interrater reliability was variable.Conclusions:Morphological changes of the pediatric PCL and associated osseous anatomy vary by skeletal age throughout childhood and adolescence. These changes were most pronounced in preadolescents with open physes (ages 7-12 years) compared to adolescents with closing physes (ages 13-15 years), who demonstrated slowed or plateaued growth in most dimensions. These skeletal age-dependent transformations of the PCL and surrounding osseous anatomy may guide surgical planning and inform injury risk prediction and prevention in this active population.Table 1.Cohort characteristics. (N=60)Table 2.MRI measurement summary by skeletal age group.

Influence of periostin on the development of fibrocartilage layers of anterior cruciate ligament insertion

BackgroundPeriostin (Postn) is thought to play a role in the formation of anterior cruciate ligament (ACL) insertion. However, the influence of Postn on the development of ACL insertion requires further understanding. This study aimed to clarify the influence of Postn on the development of fibrocartilage layers of ACL insertion. HypothesisWe hypothesized that Postn would influence the development of fibrocartilage layers of ACL insertion. Materials and methodsC57BL/6N wild-type (Postn+/+; n=54) and Postn knockout (Postn−/−; n=54) mice were used in this study. Six animals were euthanized at 1 d and 1, 2, 3, 4, 6, 8, 10, and 12 weeks of age in each group. The chondrocyte number, proliferation, apoptosis, safranin O-stained glycosaminoglycan (GAG) area, type II collagen staining area, tidemark length, and insertion width were evaluated. ResultsChondrocyte proliferation was high up to 2 weeks in Postn+/+, while low at age 1 d; it was, especially lower in Postn−/− than in Postn+/+ at age 1 d and 1 week. Chondrocyte apoptosis was high up to age 8 weeks in Postn+/+ and at 6 weeks in Postn−/−; it was especially higher in Postn−/− than in Postn+/+ at age 1 week. The GAG stained area was thickest for age 1 d to 4 weeks in Postn+/+ and for age 2 to 6 weeks in Postn−/−. The type II collagen staining area in Postn+/+ was thicker than that in Postn−/− at age 6 and 8 weeks. The tidemark length in Postn+/+ was longer than that in Postn−/− from age 8 to 12 weeks. The insertion width in Postn+/+ was longer than that in Postn−/− from age 1 to 3 weeks. DiscussionPostn decreased cell proliferation in the early postnatal phase and influenced the development of the fibrocartilage layer extracellular matrix of ACL insertion in mice. Postn may contribute to the development of methods for regeneration of the ACL insertion. Level of evidenceV; controlled laboratory study.

CARACTERIZACIÓN MORFOMÉTRICA Y CLASIFICACIÓN DE LOS ESPERMATOZOIDES DE VICUÑA (Vicugna vicugna) USANDO EL SISTEMA ISAS® CASA-Morph

The aim of the study was to determine the morphological and morphometric characteristics of the vicuña sperm (Vicugna vicugna), looking for possible subpopulations in its structure. Semen was collected by electroejaculation method from three adult male vicuñas weighing 50.33 ± 2.52 kg, once per animal. The volume, color and concentration, sperm morphology and morphometry were determined. The samples for the analysis of sperm morphology and morphometry were stained with Hemacolor®, and analyzed using the CASA-Morph, Integrated Semen Analysis System (ISAS®v1). Five forms of the vicuña sperm head were distinguished: normal, piriform, long, short and rounded. The morphometric parameters determined were the length, width, area, perimeter, ellipticity, elongation, regularity and rugosity of the vicuña sperm head, percentage of acrosome, head gray level, as well as the width, area, distance and angle of insertion of midpiece of the sperm. In relation to morphology, significant differences (P &lt;0.05) were found in the percentage distribution of head shapes, with the normal shape (55.7%) being the majority and different from the other shapes. Significant differences (P &lt;0.05) were found between animals in the morphometric variables of head, percentage of acrosome, ellipticity, rugosity, elongation and gray level; while the variables of the midpiece and regularity did not show differences (P&gt; 0.05). The morphometric variables were distributed in four main components (PCA) called elongation, area, circularity and midpiece width, which explained 84.59% of the total variance. The cluster analysis determined five subpopulations (SP): SP1 grouped small cells of low length, width and area (18.8%); SP2 of sperm of large size, both in area and width of the head (17.38%); SP3 of rounded cells with high values of percentage of acrosome and head gray level (24.04%); SP4 of spermatozoa of intermediate size and elongated, with greater ellipticities and elongation (23.61%); and SP5 of cells of intermediate size and short, with low values of area and length (16.71%).

Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population.

Introduction:The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes.Materials and methods:A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded.Results:Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females.Conclusion:The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.

P34. Cage placement is a predictor of postoperative subsidence in expandable and non-expandable cages

P34. Cage placement is a predictor of postoperative subsidence in expandable and non-expandable cages

Sonographic assessment of pediatric chest wall thickness and width of the intercostal space: correlation with anthropometric data and implications for needle decompression

BackgroundEmergent needle decompression in children is a rare event for emergency medicine and critical care providers. Hereby, risk of injury of intrathoracic structures is high and knowledge of age-specific values of chest wall thickness and width of the intercostal space (ICS) is crucial to avoid injuries. Investigation of the correlation of chest wall thickness and width of the intercostal space with age and body dimension like weight and height could provide guidance on depth of insertion and choice of the needle.MethodsWe performed a prospective observational clinical trial in a pediatric surgery operating room that included a convenient sample of children aged 0–10 years undergoing elective surgery. Chest wall thickness and width of the intercostal space were measured with ultrasound at 2nd ICS midclavicular line (MCL) and 4th ICS anterior axillary line (AAL). Correlation of these measures with age, height, weight, BMI and Broselow color was calculated. Furthermore, intra-class correlation coefficient was calculated as a measure of reproducibility and the presence of vital structures (e.g., heart, thymus gland, large pulmonary vessels) at the possible insertion sites for needle decompression was investigated.ResultsOf 410 potentially eligible patients, 300 were included in the study. Correlation of chest wall thickness was moderate with weight (2nd ICS MCL: r = 0.57; 4th ICS MCL: r = 0.64) and BMI (r = 0.44 and r = 0.6) and was lower with age (r = 0.38 for both intercostal spaces), height (r = 0.42 and r = 0.40) and Broselow color (r = 0.42 and r = 0.38). Correlation of width of the ICS with anthropometric data was generally stronger, with height showing the strongest, albeit not really strong, correlation (r = 0.71 and r = 0.62). Intra-class correlation was excellent with an ICC of 0.93. Vital structures were significantly more often present at 2nd ICS MCL then at 4th ICS AAL (14 vs. 2 patients; p = 0.0042).ConclusionsCorrelation of chest wall thickness and width of the intercostal space with anthropometric data is at most moderate. Insertion depth and width of the intercostal space can therefore not be predicted accurately from anthropometric data. Ultrasound assessment of the thoracic wall appears to be a reliable technique and could therefore assist in reducing the risk of injury and increasing decompression success.Trial registration German clinical trials register, DRKS00014973, Registered February 11th 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014973

Differences in the Development of Fibrocartilage Layers in the Quadriceps Tendon and Patellar Tendon Insertions in Rabbits: A Quantitative Study.

Background:Differences in the development of fibrocartilage layers in quadriceps tendon (QT) and patellar tendon (PT) insertion sites are unclear. Because the mechanical environments for the QT and PT are different, the development of the QT and PT insertions may differ.Purpose:To investigate differences in the development of fibrocartilage layers in the QT and PT insertion sites in rabbits through use of quantitative morphometric evaluations.Study Design:Descriptive laboratory study.Methods:This study included 54 male Japanese White rabbits. Animals were euthanized at ages 1 day and 1, 2, 3, 4, 6, 8, 12, and 24 weeks (n = 6 for each age). Chondrocyte number, proliferation, apoptosis, sex-determining region Y box 9 (Sox9)–positive rates, safranin O–stained glycosaminoglycan (GAG) areas, tidemark length, insertion width, and patellar length were evaluated and compared with the same parameters at age 24 weeks and between QT and PT insertion sites.Results:Chondrocyte proliferation was low up to age 2 weeks for QT insertion and low up to 1 week for PT insertion. Chondrocyte apoptosis was high at 1 day and Sox9 expression was low up to 1 week for PT insertion. Sox9 expression was higher in QT than in PT insertion at age 12 weeks. The high chondrocyte count continued to age 1 day in PT insertion and up to 6 weeks in QT insertion. The chondrocyte number was higher in QT than in PT insertion at age 2 weeks. The period of thicker GAG lasted from 2 to 8 weeks in PT insertion and from 1 to 12 weeks in QT insertion. GAG thickness in QT insertion was higher than in PT insertion at age 4 and 12 weeks.Conclusion:Development of fibrocartilage layers in QT and PT insertion sites was completed at age 24 weeks in rabbits. However, the period of high chondrocyte count and period of thicker GAG were longer in QT than in PT insertion up to 12 weeks.Clinical Relevance:Development of fibrocartilage layers in QT and PT insertions differed in rabbits. Our results may contribute to the development of appropriate treatments based on age and the development of methods for regeneration of the insertion.

Results of Theoretical Studies to Substantiate the Parameters of Multi-blade Rotary-type Working Bodies

The article presents the results of theoretical studies of the technological process of operation of multi-blade working bodies of rotary type, intended for the distribution of solid organic fertilizers. To determine the length of the blades of the last row of rotors, and accordingly the overall dimensions of the spreader, theoretical dependences of the range of fertilizer particles on the radius of the blades are obtained, which made it possible to determine the size of the blades that provide the required performance of the rotary spreader. Considering the uniform distribution of fertilizer particles over the sieving width, the dependences of the “limiting” zone of loading of the blades (the maximum thickness of the layer of fertilizers captured by one blade) on the angle of their inclination at different lengths of the blades were obtained, which showed that when applying fertilizers with medium and large doses, several rows of blades. Computational experiments were carried out, during which, the number of rows of blades and the ratio of the lengths of the blades of different rows were determined to obtain the smallest unevenness depending on different doses of fertilizer application. As a result of mathematical modeling, the dependences of the working insertion width on the angle of inclination of the blades of the rotor rows relative to the radial position are obtained for various second-time supply of material, using which rational values of the angle of inclination of the blades are found.

The Chinese ACL injury population has a higher proportion of small ACL tibial insertion sizes than Western patients

PurposeThe study purpose is to characterize the sizes of the anterior cruciate ligament (ACL) insertion site and intercondylar notch in Chinese patients undergoing ACL surgery. The findings will provide a reference for individualized clinical treatment of ACL rupture.MethodsFor this study, 137 patients (102 males, 35 females) with an average age of 30.3 ± 9.5 years (range 14–52 years) undergoing ACL reconstruction were included. The tibial ACL insertion site length and width and the intercondylar notch width were measured on MRI and arthroscopically using a ruler. Descriptive statistics of the patients, the distribution of the measurements and the differences between males and females were calculated.ResultsThe ACL tibial insertion size and intercondylar notch width in Chinese patients with ACL injuries, as obtained by MRI and intra-operatively, exhibited significant individual variability. The tibial ACL insertion site had a mean length of 13.5 ± 2.1 mm and width of 10.9 ± 1.5 mm as measured on MRI and a mean length of 13.3 ± 2.1 mm and width of 11.0 ± 1.6 mm as measured intra-operatively. The mean intercondylar notch width was 15.2 ± 2.4 mm on MRI and the mean length was 15.0 ± 2.5 mm intra-operatively. The inter-rater reliability between MRI and intra-operative measurements confirmed that the two methods were consistent. In 65.7% of individuals, the ACL tibial insertion length was < 14 mm.ConclusionThe distribution of tibial footprint size in Chinese patients is different from that in Western populations. There is a higher proportion of subjects with a tibial footprint size < 14 mm among Chinese patients with ACL injury. Therefore, great care should be taken when treating this population with the double-bundle technique or larger graft options.Level of evidence IV.

Development of fibrocartilage layers in the anterior cruciate ligament insertion in rabbits

BackgroundA detailed evaluation focusing on the fibrocartilage layers in the anterior cruciate ligament (ACL) insertion is necessary to consider regeneration of the insertion. This study examined the development of the fibrocartilage layers in the ACL tibial insertion in rabbits by quantitative morphometric evaluations based on histological and immunohistochemical analyses.MethodsMale Japanese white rabbits were used because of their history of use for histomorphometric analyses of the ACL insertion and to eliminate the influence of female hormones on the ACL. Six animals were euthanized at each age (1 day and 1, 2, 4, 6, 8, 12, and 24 weeks); in total, 48 animals were used. Proliferation rate, apoptosis rate, Sox9-positive rate, and chondrocyte number were evaluated. Safranin O-stained glycosaminoglycan (GAG) areas, tidemark length, ACL insertion width, and ACL length were also evaluated. All parameters were compared with those at age 24 weeks of age.ResultsHigh levels of chondrocyte proliferation and Sox9 expression continued until 4 and 8 weeks of age, respectively, and then gradually decreased. Chondrocyte apoptosis increased up to 8 weeks. The chondrocyte number, ACL insertion width, ACL length, safranin O-stained GAG areas, and tidemark length gradually increased up to 12 weeks.ConclusionChondrocytes that displayed chondrocyte proliferation and Sox9 expression increased until 12 weeks of age, in accordance with development of the ACL length and its insertion width. The GAG production and tidemark length also increased until 12 weeks of age. The development of fibrocartilage layers in the ACL insertion was complete at 12 weeks of age.

Insertion anatomy of the pectoralis major tendon

BackgroundPectoralis major tendon tears are encountered in young active patients. MethodsIn 10 fresh cadaveric shoulders we measured-1. Proximal to distal insertion width of the pectoralis major tendon.2. The distance of the superior border of the tendon from the supero-medial tip of the greater tuberosity (GT). ResultsThe average insertion width was 46 mm. The average distance between the superior border of the tendon and the tip of the GT was 48.5 mm. ConclusionThe superior border of the tendon should be repaired with two anchors at a distance of 48.5 mm from the tip of the GT so as to cover a width of 46 mm.