RESUMEN

BACKGROUND: Lower limb coronal alignment was thought to be a predictive factor for Unicompartmental Knee Arthroplasty (UKA) result. The tibial bony resection and implant position lead to joint line change postoperatively. Analysis was done to find out the correlation between these factors. METHODS: From 2019 to 2021, 90 medial Oxford UKA were implanted by a single surgeon. Hip Knee Ankle Angle (HKAA), Lateral Distal Femoral Angle (LDFA), Medial Proximal Tibial Angle (MPTA), and intraoperative bony resection thickness were measured. The medial joint line change was calculated. The correlation between joint line change and alignment change was evaluated. RESULTS: The mean tibial resection thickness was 4.3 mm. The mean tibial joint line was elevated by 2.3 mm, while the mean femoral joint line proximalized by 0.8 mm. HKAA changed from 8.4° varus preoperatively to 3.6° varus postoperatively. LDFA changed from 89.0° to 86.7°. MPTA changed from 85.6° to 86.6°. Preoperative HKAA showed a strong correlation with postoperative HKAA (p < 0.001), and preoperative MPTA showed a positive correlation with postoperative HKAA (p < 0.001). While preoperative LDFA had a negative correlation with postoperative HKAA (p < 0.001). The femoral joint line change and LDFA change had a significant correlation with HKAA change (p < 0.05). CONCLUSION: The change of joint line had no correlation with postoperative HKAA in Oxford UKA. Preoperative HKAA strongly correlated with postoperative HKAA; while preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA. The femoral joint line change and LDFA change had a weak to moderate correlation with HKAA change.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Articulación de la Rodilla/cirugía , Tibia/cirugía , Estudios Retrospectivos , Fémur/cirugía , Prótesis de la Rodilla , Periodo Posoperatorio , Resultado del Tratamiento , Anciano de 80 o más Años , Osteoartritis de la Rodilla/cirugía

RESUMEN

Pure vascularized periosteal transplants have been shown to be extremely effective at achieving rapid bone healing in children with biologically complex non-union. Free tibial and fibular periosteal transplants are generally indicated when large periosteal flaps are necessary. We report using a vascularized femoral myo-periosteal graft (VFMPG) to treat distal tibial osteotomy non-union in a six-year-old boy with congenital pseudarthrosis of the tibia. The graft consisted of a 9 cm myo-periosteal flap (after 50% of elastic retraction) that incorporated the vastus intermedius muscle and diaphyseal femoral periosteum nourished by the descending branch of the lateral circumflex femoral vessels. Plantaris medialis was used as a recipient vessel. Healing occurred 10 weeks after surgery. The patient resumed gait and sports activity without orthosis. No donor or recipient site complications occurred 17 months after surgery. Employing a VFMPG might be an alternative to other free or large vascularized periosteal flaps currently in use for complex pediatric non-unions.

Asunto(s)

Fémur , Periostio , Seudoartrosis , Colgajos Quirúrgicos , Humanos , Masculino , Seudoartrosis/cirugía , Seudoartrosis/congénito , Periostio/trasplante , Niño , Fémur/trasplante , Fémur/irrigación sanguínea , Fémur/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Osteotomía/métodos , Tibia/cirugía , Tibia/trasplante , Fracturas de la Tibia/cirugía

RESUMEN

Utilizing fresh distal tibia allograft in anterior glenoid reconstruction has emerged as a highly advantageous approach in addressing instances of failed anterior shoulder stabilization with glenoid bone loss. This procedure offers several benefits, including the absence of donor-site morbidity, restoration of significant glenoid defects, reestablishment of joint congruity with the humeral head, restoration of glenoid biomechanics, and the addition of cartilage to the glenoid. Furthermore, it provides a robust and reliable alternative for managing failed stabilization procedures, leading to improved clinical outcomes and a high graft healing rate, while maintaining a low occurrence of recurrent instability.

Asunto(s)

Trasplante Óseo , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/cirugía , Trasplante Óseo/métodos , Articulación del Hombro/cirugía , Tibia/cirugía , Insuficiencia del Tratamiento

RESUMEN

The use of a filling block can improve the initial stability of the fixation plate in the open wedge high tibial osteotomy (OWHTO), and promote bone healing. However, the biomechanical effects of filling block structures and materials on OWHTO remain unclear. OWHTO anatomical filling block model was designed and built. The finite element analysis method was adopted to study the influence of six filling block structure designs and four different materials on the stress of the fixed plate, tibia, screw, and filling block, and the micro-displacement at the wedge gap of the OWHTO fixation system. After the filling block was introduced in the OWHTO, the maximum von Mises stress of the fixation plate was reduced by more than 30%, the maximum von Mises stress of the tibia decreased by more than 15%, and the lateral hinge decreased by 81%. When the filling block was designed to be filled in the posterior position of the wedge gap, the maximum von Mises stress of the fixation system was 97.8 MPa, which was smaller than other filling methods. The minimum micro-displacement of osteotomy space was -2.9 µm, which was larger than that of other filling methods. Compared with titanium alloy and tantalum metal materials, porous hydroxyapatite material could obtain larger micro-displacement in the osteotomy cavity, which is conducive to stimulating bone healing. The results demonstrate that OWHTO with a filling block can better balance the stress distribution of the fixation system, and a better fixation effect can be obtained by using a filling block filled in the posterior position. Porous HA used as the material of the filling block can obtain a better bone healing effect.

Asunto(s)

Placas Óseas , Análisis de Elementos Finitos , Osteotomía , Impresión Tridimensional , Tibia , Osteotomía/métodos , Tibia/cirugía , Humanos , Fenómenos Biomecánicos , Estrés Mecánico , Tornillos Óseos

RESUMEN

BACKGROUND: Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes, often leading to amputation and decreased quality of life. Current treatment methods have limited success rates, highlighting the need for new approaches. This study investigates the potential of tibial transverse transport (TTT) to promote wound healing in DFUs. METHODS: To test this hypothesis, the study used New Zealand White rabbits to establish a diabetic model and simulate foot ulcers, followed by the treatment of unilateral TTT or bilateral TTT. The study employed histological analysis, flow cytometry, ELISA, and qPCR to assess the impact of TTT on tissue repair and endothelial progenitor cell (EPC) mobilization and homing, aiming to understand the underlying biological processes in wound healing. RESULTS: TTT significantly enhanced wound healing in diabetic rabbit foot ulcers. Specifically, bilateral TTT led to complete wound healing by day 19, faster than the unilateral TTT group, which healed by day 26, and the sham operation group, which nearly healed by day 37. Histological analysis showed improved tissue architecture, collagen deposition, and neovascularization in TTT-treated groups. Furthermore, TTT treatment resulted in a significant increase in VEGFR2 expression and VEGFR2/Tie-2 positive cells, particularly in the bilateral group. These findings were corroborated by qPCR results, which showed increased expression of VEGFA and CXCL12 by TTT. Conclusions: TTT may be a promising treatment for DFUs, significantly enhancing wound healing by stimulating EPC mobilization and homing mediated angiogenesis. This novel approach could substantially improve treatment outcomes for diabetic patients with chronic foot ulcers.

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TTT accelerates wound healing in diabetic rabbit instep ulcers, with both unilateral and bilateral surgeries effective, and bilateral TTT showing enhanced efficacy.TTT boosts angiogenesis and collagen fiber formation, leading to increased granulation tissue and re-epithelialization of wounds.TTT induces the mobilization and homing of endothelial progenitor cells to promote angiogenesis and wound healing.

Asunto(s)

Pie Diabético , Células Progenitoras Endoteliales , Neovascularización Fisiológica , Cicatrización de Heridas , Animales , Pie Diabético/terapia , Pie Diabético/fisiopatología , Pie Diabético/patología , Conejos , Células Progenitoras Endoteliales/metabolismo , Tibia/patología , Modelos Animales de Enfermedad , Masculino , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/fisiopatología , Movimiento Celular

RESUMEN

This study focuses on evaluating the failure resistance of a previously reduced tibia with internal fixation implants as PLate (PL) or InterMedullary Nail (IMN), subjected later to a tibial lateral trauma. To replicate this type of trauma, which can be caused by a road accident, a three-point bending test is considered using experimental tests and numerical simulations. The withstand evaluation of the tibia-PL and tibia-IMN structures was conducted by following the load transfer through, the bone and the used implants. The analysis, up to tibia failure, required the use of an elasto-plastic behavior law coupled to damage. The model parameters were identified using experimental tests. Il was shown that the tibia-IMN structure provided a bending resistant load up to three-times higher than the tibia-PL. In fact, the used screws for plate fixation induced a high level of stress in the vicinity of threaded region, leading to a crack initiation and a damage propagation. However, in tibia-IMN structure the highest stress was generated in the trapped zone between the loader and the nail, promoting crack formation. From a biomechanical point of view, the structure with IMN is safer than the structure with PL, whose fixation induces earlier damage in bone.

Asunto(s)

Ensayo de Materiales , Tibia , Fracturas de la Tibia , Tibia/cirugía , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/fisiopatología , Humanos , Placas Óseas , Fenómenos Biomecánicos , Pruebas Mecánicas , Estrés Mecánico , Fijación Interna de Fracturas/instrumentación , Análisis de Elementos Finitos , Clavos Ortopédicos

RESUMEN

Tunnel widening is a frequent problem following arthroscopic ligament reconstruction surgery that may primarily arise from a graft-tunnel mismatch caused by errors in surgical instruments and methods. The present study aimed to observe the influence of current surgical instruments and methods on graft-tunnel matching. We established an in vitro model using porcine Achilles tendons and tibias, and compared traditional surgical instruments (control group) with custom instruments (experimental group). Graft measurements, bone-tunnel creation, and measurements of the maximum pullout force of the graft from the bone tunnel were performed. Results indicated that the measuring gauge developed by our research group (capable of accurate measurement of graft diameters) may mitigate errors arising from graft-diameter measurement using traditional measuring cylinders. Therefore, errors caused by current surgical instruments and surgical methods led to an increase in graft-tunnel mismatches. The degree of mismatch was greater at the tibial end than at the femoral end.

Asunto(s)

Procedimientos de Cirugía Plástica , Tibia , Animales , Porcinos , Fenómenos Biomecánicos , Tibia/cirugía , Procedimientos de Cirugía Plástica/métodos , Tendón Calcáneo/cirugía , Ligamentos/cirugía , Fémur/cirugía

RESUMEN

Osgood Schlatter's disease (OSD) is characterized by pain at the tibial tuberosity provoked during knee-loading activities, and is common in adolescent athletes. The aim of this study was to characterize clinical, pain and ultrasound imaging characteristics in participants with OSD compared to controls. This cross-sectional study included adolescents diagnosed with OSD and matched controls. Following baseline evaluation including ultrasound, participants completed the following aggravating activities in a randomized order: single-leg isometric knee hold, single-leg squat, single-leg vertical jump, hopping, running, cutting, lunges, and walking. Participants rated pain intensity on a numeric rating scale (0-10; no pain to worst pain imaginable) and localization during activities. We included 35 participants with OSD (48.5% females, age 13.0 [SD 1.5]) and 21 controls (47.6% females, age 13.4 [SD1.4]). Doppler signal was more prevalent in OSD participants at the tendon (77% vs. 30%) and tuberosity (29% vs. 10%). Tendon thickness was greater in OSD at distal (mean difference = 4.5 mm 95% CI 1.5-7.5) and proximal sites (mean difference = 4.2 95% CI 0.1-8.3). Aggravating activities induced higher pain in OSD. The greatest differences between OSD and control were the dynamic single-leg squat (mean difference = 4.2 (95% CI 3.22-5.1)). Pain was localized at the tibial tuberosity and patellar tendon during activities. Sex, sports participation, bilateral pain, and Doppler were associated with greater pain during aggravating activities. Single-leg activities loading the tibial tuberosity through the tendon appear to provoke OSD-related pain more than other sports specific movements. This may be useful to guide adolescents on which activities are likely to aggravate pain.

Asunto(s)

Osteocondrosis , Humanos , Estudios Transversales , Femenino , Masculino , Adolescente , Osteocondrosis/diagnóstico por imagen , Osteocondrosis/fisiopatología , Dimensión del Dolor , Niño , Estudios de Casos y Controles , Ultrasonografía , Ultrasonografía Doppler , Tibia/diagnóstico por imagen , Dolor/fisiopatología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Soporte de Peso/fisiología

RESUMEN

Congenital posteromedial bowing of the tibia is a rare structural deformity of the lower extremity. This severe deformity may be discovered on ultrasound prenatally but is more commonly evident immediately after birth. Prognostically, congenital posteromedial bowing of the tibia ranges from a self-resolving condition to the development of a significant limb-length discrepancy with functional deficits. This condition can be treated conservatively but may require surgical correction in adolescence or at skeletal maturity. This case study presents a pediatric patient who underwent early conservative treatment with casting and bracing in a podiatric medical clinic setting.

Asunto(s)

Tirantes , Moldes Quirúrgicos , Tibia , Humanos , Tibia/anomalías , Tibia/diagnóstico por imagen , Tratamiento Conservador/métodos , Femenino , Masculino , Niño

RESUMEN

Genetic variants in the zone of polarizing activity regulatory sequence (ZRS) that induce ectopic expression of the SHH gene have been associated with different ZRS-related phenotypes. We report the first patient with a de novo variant, c.423+4916 T>C, in ZRS (previously classified as a variant of uncertain significance) that causes tibial hemimelia-polysyndactyly-triphalangeal thumb syndrome (THPTTS). A two-month-old male patient presented with bilateral preaxial polydactyly, triphalangeal thumb, and tibial agenesis and was heterozygous for the variant c.423+4916T>C (neither of his parents was a carrier). The findings obtained from the family study were sufficient to reclassify the variant from "uncertain significance" to "likely pathogenic" according to three criteria from the American College of Medical Genetics and Genomics guidelines, as follows: (1) absence of gnomAD, (2) confirmation of paternity and maternity, and (3) strong phenotype-genotype association. In ZRS-associated syndromes, a wide clinical spectrum has been observed, ranging from polydactyly to THPTTS; our patient has the most severe and rare phenotype. We did not perform functional assays. However, the c.423+4916T>C variant is flanked by three variants, which have been proven not only to cause the phenotype but also to increase the expression of SHH. Through all this data gathering, we consider the c.423+4916T>C variant to be causative of THPTTS.

Asunto(s)

Pulgar , Humanos , Masculino , Pulgar/anomalías , Lactante , Tibia/anomalías , Polidactilia/genética , Fenotipo , Ectromelia/genética , Proteínas Hedgehog/genética , Dedos/anomalías , Anomalías Múltiples/genética , Deformidades Congénitas de la Mano/genética , Dedos del Pie/anomalías , Mutación , Estudios de Asociación Genética , Anomalías Congénitas , Disostosis Mandibulofacial

RESUMEN

BACKGROUND: An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient reported outcomes. METHODS: A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, sex, and follow-up time. Recurrent instability (including re-dislocation and subluxation), visual analog scale (VAS) for pain score, Kujala score, and satisfaction were evaluated. RESULTS: There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311), or revision surgeries (10.2% vs. 10.2%) between groups. CONCLUSION: There was a low complication rate, excellent patient reported outcomes, and a low rate of recurrent patellar instability following TTO and MPFLR with allograft.

Asunto(s)

Inestabilidad de la Articulación , Osteotomía , Articulación Patelofemoral , Tibia , Humanos , Femenino , Osteotomía/métodos , Osteotomía/efectos adversos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Masculino , Estudios Retrospectivos , Adulto , Tibia/cirugía , Articulación Patelofemoral/cirugía , Articulación Patelofemoral/fisiopatología , Articulación Patelofemoral/diagnóstico por imagen , Adulto Joven , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Adolescente , Luxación de la Rótula/cirugía , Luxación de la Rótula/fisiopatología , Luxación de la Rótula/diagnóstico por imagen , Recurrencia , Ligamentos Articulares/cirugía , Ligamento Rotuliano/cirugía

Asunto(s)

Neoplasias Óseas , Tumor Óseo de Células Gigantes , Neoplasias Pulmonares , Tibia , Humanos , Femenino , Tumor Óseo de Células Gigantes/secundario , Tumor Óseo de Células Gigantes/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Neoplasias Óseas/secundario , Adulto , Tibia/cirugía

RESUMEN

The aim of this study was to develop a novel surgical technique for stifle arthrodesis in dogs using a semicircular saw for tibial and femoral ostectomies through a medial approach. Ten pelvic limbs from five canine cadavers underwent stifle arthrodesis. Prior to the surgical procedure, the limbs were radiographed to rule out musculoskeletal abnormalities. Additionally, the radiographs were used for surgical planning. For the tibial ostectomy, the center of the intercondylar eminences, the cranial limit of the tibial plateau, and the caudal cortex of the tibia were used as landmarks. In the femur, the groove of the insertion of the long digital extensor tendon and the caudal portion of the femoral cortex served as references. The most significant iatrogenic injury during the surgical procedures was the complete rupture of the long digital extensor tendon during the tibial cut in one of the stifles. Dome ostectomies facilitated interfragmentary contact, allowing for adjustment of the angulation between the fragments without the need for additional ostectomies or osteotomies. The medial approach provided a clear view of intra-articular structures without causing extensive damage to surrounding tissues. After the procedures, the limbs were radiographed to calculate angular measurements, and the final angulation (mean) of the knee joints was 134.7 ± 11°.

Asunto(s)

Artrodesis , Cadáver , Rodilla de Cuadrúpedos , Animales , Perros/cirugía , Artrodesis/veterinaria , Artrodesis/métodos , Rodilla de Cuadrúpedos/cirugía , Rodilla de Cuadrúpedos/diagnóstico por imagen , Tibia/cirugía , Osteotomía/veterinaria , Osteotomía/métodos , Fémur/cirugía

RESUMEN

OBJECTIVES: The study focused on the ability to predict the need and size of femoral and tibial augmentation using standard two-dimensional (2D) templates and models created with three-dimensional (3D) printing in surgical planning. PATIENTS AND METHODS: This observational cohort study included 28 consecutive patients (22 females, 6 males; mean age: 71±7.3 years; range, 54 to 82 years) with periprosthetic joint infection recruited between March 2021 and September 2023 undergoing revision total knee arthroplasty revision (TKA). Standard planning was made using calibrated X-ray images. The 3D planning started with computed tomography scans to generate a 3D template of the distal femur and proximal tibia. The model was exported to a 3D printer to produce a patient-specific phantom. The surgery was then simulated on the 3D phantom using revision knee arthroplasty instrumentation to evaluate the appropriate augmentation to use until a correct alignment was obtained. RESULTS: Three-dimensional planning predicted the need for femoral and tibial augments in 22 (78.6%) cases at both the tibial and femoral components, while 2D planning correctly predicted the need for augmentation in 17 (60.7%) for the tibial side and 18 (64.3%) for the femoral side. The Cohen's kappa demonstrated a significant agreement between the 3D planning for the femoral metal block and the intraoperative requirement (kappa=0.553), whereas 2D planning showed only nonsignificant poor agreement (kappa=0.083). In contrast, the agreement between 2D or 3D preoperative planning for tibial augment and the intraoperative requirement was nonsignificant (kappa=0.130 and kappa=0.158, respectively). On the femoral side, 2D planning showed only a fair nonsignificant correlation (r=0.35, p=0.069), whereas 3D planning exhibited substantial agreement with the actual thickness of the implanted augment (r=0.65, p<0.001). On the tibial side, 3D and 2D planning showed substantial agreement with the actual size of implanted augments (3D planning, r=0.73, p<0.001; 2D planning, r=0.69, p<0.001). CONCLUSION: Prediction based on 3D computed tomography segmentation showed significant agreement with the intraoperative need for augmentations in revision TKA. The results suggest that planning with 3D printed models represents a stronger aid in this kind of surgery rather than standard 2D planning, providing greater accuracy in the prediction of the required augmentation in revision TKA.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Impresión Tridimensional , Reoperación , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/instrumentación , Femenino , Masculino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Tomografía Computarizada por Rayos X , Diseño de Prótesis , Tibia/cirugía , Tibia/diagnóstico por imagen , Fémur/cirugía , Fémur/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/cirugía

RESUMEN

This comprehensive systematic review critically analyzes the current progress and challenges in automating transtibial prosthesis alignment. The manual identification of alignment changes in prostheses has been found to lack reliability, necessitating the development of automated processes. Through a rigorous systematic search across major electronic databases, this review includes the highly relevant studies out of an initial pool of 2111 records. The findings highlight the urgent need for automated alignment systems in individuals with transtibial amputation. The selected studies represent cutting-edge research, employing diverse approaches such as advanced machine learning algorithms and innovative alignment tools, to automate the detection and adjustment of prosthesis alignment. Collectively, this review emphasizes the immense potential of automated transtibial prosthesis alignment systems to enhance alignment accuracy and significantly reduce human error. Furthermore, it identifies important limitations in the reviewed studies, serving as a catalyst for future research to address these gaps and explore alternative machine learning algorithms. The insights derived from this systematic review provide valuable guidance for researchers, clinicians, and developers aiming to propel the field of automated transtibial prosthesis alignment forward.

Asunto(s)

Miembros Artificiales , Aprendizaje Automático , Tibia , Humanos , Tibia/cirugía , Diseño de Prótesis , Ajuste de Prótesis/métodos , Algoritmos

RESUMEN

Tartrate-resistant acid phosphatase (TRAP) serum levels reflect osteoclast number, bone remodeling activity, and fracture risk. Deletion or loss of function of TRAP results in short stature in mice and man. Yet, the impact and mechanisms of TRAP for the site- and sex-specific development of bone and cartilage is not well understood. Here, we use a global TRAP knockout (TRAPKO) and wildtype littermate control (WT) mice of both sexes to investigate TRAP as a possible sex- and site-specific regulator of bone and growth plate development. TRAPKO mice of both sexes weighed less and had shorter tibial length than their WT, features that were more accentuated in male than female TRAPKO mice. These changes were not associated with a general reduction in growth as not all organs displayed a proportionally lower mass, and serum IGF-1 was unchanged. Using µCT and site-specificity analysis of the cortical bone revealed wider proximal tibia, a higher trabecular thickness, and lower trabecular separation in male TRAPKO compared to WT mice, an effect not seen in female mice. Histomorphometric analysis revealed that the growth plate height as well as height of terminal hypertrophic chondrocytes were markedly increased, and the number of columns was decreased in TRAPKO mice of both sexes. These effects were more accentuated in female mice. Proliferation and differentiation of bone marrow derived macrophages into osteoclasts, as well as C-terminal cross links were normal in TRAPKO mice of both sexes. Collectively, our results show that TRAP regulates bone and cartilage development in a sex-and site-specific manner in mice.

Asunto(s)

Hueso Esponjoso , Hueso Cortical , Placa de Crecimiento , Ratones Noqueados , Caracteres Sexuales , Fosfatasa Ácida Tartratorresistente , Animales , Fosfatasa Ácida Tartratorresistente/metabolismo , Femenino , Masculino , Ratones , Osteoclastos/metabolismo , Tamaño de los Órganos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Tibia/metabolismo , Microtomografía por Rayos X , Ratones Endogámicos C57BL

RESUMEN

Bone stress injuries (BSIs) frequently occur in the leg and foot long bones of female distance runners. A potential means of preventing BSIs is to participate in multidirectional sports when younger to build a more robust skeleton. The current cross-sectional study compared differences in tibia, fibula, and second metatarsal diaphysis size, shape, and strength between female collegiate-level athletes specialized in cross-country running (RUN, n = 16) and soccer (SOC, n = 16). Assessments were performed using high-resolution peripheral quantitative computed tomography and outcomes corrected for measures at the radius diaphysis to control for selection bias and systemic differences between groups. The tibia in SOC had a 7.5 % larger total area than RUN, with a 29.4 % greater minimum second moment of area (IMIN) and 8.2 % greater estimated failure load (all p ≤ 0.02). Tibial values in SOC exceeded reference data indicating positive adaptation. In contrast, values in RUN were similar to reference data suggesting running induced limited tibial adaptation. RUN did have a larger ratio between their maximum second moment of area (IMAX) and IMIN than both SOC and reference values. This suggests the unidirectional loading associated with running altered tibial shape with material distributed more in the anteroposterior (IMAX) direction as opposed to the mediolateral (IMIN) direction. Comparatively, SOC had a similar IMAX/IMIN ratio to reference data suggesting the larger tibia in SOC resulted from multiplane adaptation. In addition to enhanced size and strength of their tibia, SOC had enhanced structure and strength of their fibula and second metatarsal. At both sites, polar moment of inertia was approximately 25 % larger in SOC compared to RUN (all p = 0.03). These data support calls for young female athletes to delay specialization in running and participate in multidirectional sports, like soccer, to build a more robust skeleton that is potentially more protected against BSIs.

Asunto(s)

Peroné , Huesos Metatarsianos , Carrera , Fútbol , Tibia , Humanos , Femenino , Peroné/anatomía & histología , Peroné/diagnóstico por imagen , Peroné/fisiología , Fútbol/fisiología , Carrera/fisiología , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/anatomía & histología , Huesos Metatarsianos/fisiología , Tibia/anatomía & histología , Tibia/fisiología , Tibia/diagnóstico por imagen , Adulto Joven , Atletas , Estudios Transversales , Adolescente , Adulto

RESUMEN

This prospective bi-center study aimed to analyze the outcomes of primary total knee arthroplasty using the Stemmable Tibia Attune system. A total of 100 patients who underwent primary total knee arthroplasty with Stemmable Tibia from January 2019 to December 2021 were enrolled in the study. Radiological outcomes (hip-knee-ankle axis and medial proximal tibial angle) were assessed preoperatively and postoperatively. Clinical outcomes (visual analog scale score, Hospital for Special Surgery score, Knee Society function score, Knee Society knee score, flexion contracture, further flexion, and range of motion) were analyzed preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Complications (periprosthetic joint infection and aseptic loosening) were examined. The hip-knee-ankle axis decreased (preoperative: 9.5° ± 6.3°, postoperative: 1.1° ± 2.7°), whereas the medial proximal tibial angle increased (preoperative: 84.6° ± 4.1°, postoperative: 89.8° ± 1.9°). The visual analog scale score, Hospital for Special Surgery score, Knee Society knee score, and Knee Society function score increased postoperatively. The Knee Society knee score indicated above good outcomes (100.0% and 99.0% at 1 and 2 years postoperatively, respectively). The Knee Society function score also showed above good results (98.0% and 93.0% at 1 and 2 years postoperatively, respectively). The range of motion significantly improved (p < 0.001): flexion contracture decreased from 9.10° ± 7.23° to 2.15° ± 2.87°, whereas further flexion increased from 136.05° ± 14.78° to 139.80° ± 10.02°. One patient developed periprosthetic joint infection; no early loosening was observed. In conclusion, Attune primary total knee arthroplasty with Stemmable Tibia not only is safe and effective but also leads to radiological and clinical improvements.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Rango del Movimiento Articular , Tibia , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Masculino , Femenino , Anciano , Estudios Prospectivos , Persona de Mediana Edad , Estudios de Seguimiento , Tibia/cirugía , Tibia/diagnóstico por imagen , Resultado del Tratamiento , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Prótesis de la Rodilla

RESUMEN

Objective: To investigate the clinical and radiologic characteristics of children with congenital pseudarthrosis of the tibia (CPT) in a single center. Methods: This is a retrospective case series study. According to inclusion and exclusion criteria, clinical data of 497 children(507 limbs) with CPT who were treated at Department of Orthopedics, the Children's Hospital Affiliated to Xiangya School of Medicine, Central South University from January 2011 to December 2020 were collected. Baseline data included gender, age at initial visit, age at onset of symptoms, accompanying symptoms, domicile, whether first treated at our hospital, and treatment-related information such as surgical or conservative treatment, surgical complications, etc., were extracted and analyzed using the health information system. Imaging data of the children, including Crawford classification, bilateral leg lengths, presence of fibular pseudarthrosis, and location of pseudarthrosis along the tibia segment, were analyzed using the Picture Archiving and Communication System. Data were compared using independent sample t test or χ2 tests. Results: Among 497 children with CPT, there were 305 males (61.4%) and 192 females (38.6%). The age at initial visit was (3.6±3.2) years (range: 0.1 to 16.2 years). Neurofibromatosis type 1 (NF1) symptoms were positive in 340 children (68.4%), and negative in 157 children (31.6%). Among NF1-positive children, those with symptoms onset before 1 year of age were significantly more than NF1-negative children (74.1%(252/340) vs. 66.2%(104/157);χ2=9.24, P=0.001), and the proportion of fractures (92.9%,316/340) was significantly higher than that in the NF1-negative group (84.7%,133/157) (χ2=8.33, P=0.004). According to imaging data, Crawford type Ⅳ was the most common type, with 321 limbs (63.3%), followed by type Ⅱ in 100 limbs (19.7%), type Ⅲ in 54 limbs (10.7%) and type Ⅰ in 32 limbs (6.3%). Pseudarthrosis occurred in the proximal third of the tibia in 14 limbs (2.8%), in the middle third in 185 limbs (36.5%), and in the distal third in 308 limbs (60.8%). Seventy-four children (14.9 %) had associated fibular pseudarthrosis. The lateral proximal tibial angle was 86.91°±5.21°(range: 72.17° to 102.08°), and the lateral distal tibial angle was 87.27°±10.73°(range: 51.07° to 128.17°). A total of 421 children (84.7%) underwent surgical treatment with (3.1±2.4) surgeries performed per child (range:0 to 12 surgeries); 76 children (15.3%) received conservative treatment. Postoperative complications mainly included ankle valgus (77 cases), leg length discrepancy (71 cases),refracture (48 cases), osteomyelitis (11 cases), and hardware failure (10 cases). NF1-positive children underwent more surgeries than NF1-negative children ((5.1±2.2)times vs.(2.1±1.8)times;t=14.93,P<0.01). Conclusions: Crawford type Ⅳ is the most common type of CPT in children in this study. CPT predominantly occurs in the middle or distal third of the tibia. The majority of children with CPT experienced symptoms and were seen at outpatient clinics before the age of 3 years. The main surgical complications currently associated with CPT treatment are ankle valgus and leg length discrepancy. Compared with CPT without NF1, children with NF1-positive CPT tend to have earlier symptom onset and may require more frequent treatments.

Asunto(s)

Seudoartrosis , Tibia , Humanos , Estudios Retrospectivos , Femenino , Masculino , Seudoartrosis/congénito , Seudoartrosis/diagnóstico , Tibia/anomalías , Tibia/cirugía , Preescolar , Niño , Lactante

RESUMEN

Total knee arthroplasty (TKA) is a well-established and successful treatment option for patients with end-stage osteoarthritis of the knee, providing high patient satisfaction. Robotic systems have been widely adopted to perform TKA in orthopaedic centres. The exact spatial positions of the femur and tibia are usually determined through pinned trackers, providing the surgeon with an exact illustration of the axis of the lower limb. The drilling of holes required for mounting the trackers creates weak spots, causing adverse events such as bone fracture. In the presented computational feasibility study, time differential electrical impedance tomography is used to locate the femur positions, thereby the difference in conductivity distribution between two distinct states s0 and s1 of the measured object is reconstructed. The overall approach was tested by simulating five different configurations of thigh shape and considered tissue conductivity distributions. For the cylinder models used for verification and reference, the reconstructed position deviated by about ≈1 mm from the actual bone centre. In case of models mimicking a realistic cross section of the femur position deviated between 7.9 mm 24.8 mm. For all models, the bone axis was off by about φ=1.50° from its actual position.

Asunto(s)

Artroplastia de Reemplazo de Rodilla , Estudios de Factibilidad , Fémur , Procedimientos Quirúrgicos Robotizados , Tibia , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Fémur/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Tibia/cirugía , Impedancia Eléctrica