Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. MATERIALS AND METHODS: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. RESULTS: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. CONCLUSIONS: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

Modified bony landmark measurement to deal with leg length discrepancy during total hip arthroplasty / 中华创伤骨科杂志

Objective To evaluate the clinical application of modified bony landmark measurement ( MBLM ) to deal with leg length discrepancy ( LLD ) during total hip arthroplasty ( THA ). Methods We retrospectively analyzed the 36 patients in whom MBLM was used to deal with LLD during THA from January 2014 to May 2015 at Department of Orthopaedics, The Second Hospital of Fuzhou. They were 17 men and 19 women, aged from 42 to 78 years ( average, 68.7 ± 10.1 years ). They were divided into 3 groups according to their pre-operative LLD value ( d ) : 16 cases in group A with d≤10 mm, 11 cases in group B with 10 mm ＜d≤20 mm and 9 cases in group C with d ＞ 20 mm. After the sizes of prosthetic cup and femoral component and the location of implant were determined using preoperative X-ray, a special formula was used to calculate the prosthetic length of femoral head neck and the osteotomy area at the femoral neck. MBLM was used to measure the leg lengths before hip joint dislocation and after placement of the hip implant. The neck length and depth of the femoral component was adjusted according to the measurements. Post-operative X-ray was used to measure the LLD ( d'). The value of MBLM in judgment of LLD during THA was assessed by comparison of d and d' and analysis of distribution of d' . Results The postoperative d' ( 6.0 ± 3.0 mm) was signifi-cantly shorter than the preoperative d ( 11.0 ± 5.0 mm) ( t＝5.145, P ＜0.001 ). There were 30 cases with d' ≤ 10 mm, 6 cases with 10 mm ＜d'≤ 20 mm and 0 case with d' ＞ 20 mm. The cases with d'≤ 10 mm were significantly more than those with d ≤ 10 mm and the cases with d' ＞ 20 mm significantly fewer than those with d ＞ 20 mm ( χ2＝15.500, P＝0.000 ) . Conclusion MBLM used during THA is a reliable method to judge the leg lengths so that LLD can be effectively reduced after THA.

Bony Landmarks for Determining the Mechanical Axis of the Femur in the Sagittal Plane during Total Knee Arthroplasty

BACKGROUND: There is no accepted landmark for the mechanical axis of the femoral axis in sagittal plane in conventional total knee arthroplasty. METHODS: As palpable anatomic landmarks of the femur, lateral epicondyle, and anterior margin of the greater trochanter were identified. The line connecting these two landmarks was defined as the "palpable sagittal axis". The mechanical axis of the femur was compared with the palpable sagittal axis and the distal femoral anterior cortex axis. These axes were also compared with sagittal bowing of the femur. RESULTS: The distal femoral anterior cortex axis and the palpable sagittal axis were flexed by 4.1degrees and 2.4degrees more than the sagittal mechanical axes, respectively (p < 0.05). However, the palpable sagittal axis was not correlated with sagittal bowing of the femur (Spearman's rs, 0.17; p = 0.14). CONCLUSIONS: The palpable sagittal axis showed a consistent relationship with the sagittal mechanical femoral axes regardless of the severity of the sagittal bowing of the femur.

Anatomical Locations of the Motor Points of the Biceps Brachii and Brachialis Muscles

OBJECTIVE: To identify the range of the precise locations of the motor points of biceps brachii and brachialis muscles in relation to bony landmarks. METHOD: Nine upper limbs of five male cadavers were dissected. The number and location of the motor points from the musculocutaneous nerve to biceps brachii and brachialis muscles were identified in relation to the bony landmarks. Bony landmarks were coracoid process and lateral epicondyle of the humerus. The length of the arm was defined as the distance from the apex of the coracoid process to the lateral epicondyle of humerus. The locations of the motor points were expressed as the percentage ratio of the length from the coracoid process to the motor points in relation to the length of the arm. RESULTS: First proximal motor points of the long head, short head of biceps brachii, and brachialis were located in 47.5 5.6%, 53.0 4.6%, 64.3 3.4% and second proximal points of them were 51.8 2.9%, 57.7 3.5%, 68.5 4.4% respectively. CONCLUSION: The identification of the locations of motor points related to the bony landmarks would increase the accuracy and ease of the motor point blocks to elbow flexors such as biceps brachii and brachialis muscles.

A Review of Insertion Site for Lumbar Sympathetic Ganglion Block / 대한마취과학회지

BACKGROUND: Lumbar sympathetic ganglion block (LSGB) is one of the most frequently performed blocks in the field of interventional pain management. However, several complications can be expected if pain clinicians do not have a through understanding of radiological anatomy and current technique for locating block, landmarks are poor. Therefore, we devised a simple, safe, and patient tolerable block technique. METHODS: We selected patients scheduled for a LSGB with a body mass index of less than 25 kg/m2. After prone positioning, C-arm projection was adjusted obliquely until the tip of the L3 transverse process met the lateral margin of the corresponding vertebral body. Maintaining this angle, the skin entry point was determined at the lower one-third of the lateral margin of the vertebral body. We measured the distance from the mid-point of the spinous process to the skin entry point. A curved block needle was advanced using the tunnel vision technique, until the needle tip touched the lateral margin of the vertebral body. We also measured the position of the needle tip relative to the vertebral body in the lateral projection of the C-arm (lateral width percentage). Thereafter, the needle was slid along the lateral margin of the vertebral body to the anterior margin. RESULTS: The distance from the mid-point of the spinous process to the skin entry point was 6.5 +/- 1.0 cm. The angle of the C-arm projection was 22.0 +/- 3.8o. The depth from the skin entry point to the needle tip when touching the lateral margin of the vertebral body in the oblique projection of the C-arm was 8.5 +/- 0.9 cm. The lateral width percentage from the posterior margin of vertebral body was 49.0 +/- 7.0% and the entire depth of the curved needle from the skin entry point to the anterior margin of the vertebral body was 10.4 +/- 1.0 cm. CONCLUSIONS: This simple tunnel vision technique using a curved needle and an oblique C-arm projection is safe, simple and patient tolerable. In addition, it reduces block time and avoids repeated needle insertions. The tip of the L3 transverse process and the lateral margin of the corresponding vertebral body were found to be useful bony landmarks for the block. We believe that the provided depths and lateral width percentages may be useful for block in Koreans.