Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft / Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p= 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p= 0,001; p= 0,005; e p= 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p= 0,003; 30 a 60°, p= 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.

Anatomic Evaluation of the Interportal Capsulotomy Made with the Modified Anterior Portal versus Standard Anterior Portal: Comparable Utility with Decreased Capsule Morbidity / 대한고관절학회지

PURPOSE: To identify potential differences in interportal capsulotomy size and cross-sectional area (CSA) using the anterolateral portal (ALP) and either the: (i) standard anterior portal (SAP) or (ii) modified anterior portal (MAP).MATERIALS AND METHODS: Ten cadaveric hemi pelvis specimens were included. A standard arthroscopic ALP was created. Hips were randomized to SAP (n=5) or MAP (n=5) groups. The spinal needle was placed at the center of the anterior triangle or directly adjacent to the ALP in the SAP and MAP groups, respectively. A capsulotomy was created by inserting the knife through the SAP or MAP. The length and width of each capsulotomy was measured using digital calipers under direct visualization. The CSA and length of the capsulotomy as a percentage of total iliofemoral ligament (IFL) side-to-side width were calculated.RESULTS: There were no differences in mean cadaveric age, weight or IFL dimensions between the groups. Capsulotomy CSA was significantly larger in the SAP group compared with the MAP group (SAP 2.16±0.64 cm2 vs. MAP 0.65±0.17 cm2, P=0.008). Capsulotomy length as a percentage of total IFL width was significantly longer in the SAP group compared with the MAP group (SAP 74.2±14.1% vs. MAP 32.4±3.7%, P=0.008).CONCLUSION: The CSA of the capsulotomy and the percentage of the total IFL width disrupted are significantly smaller when the interportal capsulotomy is performed between the ALP and MAP portals, compared to the one created between the ALP and SAP. Surgeons should be aware of this fact when performing hip arthroscopy.

Anatomical and tensile mechanical analysis of hip joint capsule repair in total hip replacement / 中国骨伤

OBJECTIVE@#To explore the tensile mechanics and anatomical characteristics of the posterior hip capsule, and provide biomechanical and anatomical evidence for capsule repair in total hip replacement.@*METHODS@#Six bone-capsule-bone specimens were obtained from posterior hip joint of fresh frozen cadavers. The maximum strain, load, elastic modulus and load strain curves of the capsule ligament complex specimens were recorded by Instron Universal Material Testing Machine. Twelve cadaveric hip specimens were dissected to the capsule. The tensile strain of normal capsule and conventionally reconstructed capsule at 90 degrees of hip flexion were documented. The suture area of the posterior capsule was divided into nine sections, and the thicknessof different sections was measured and compared. Posterior capsule of the cadavers was repaired in conventionally way and anatomical way separately and simulated rehabilitation was conducted. The effect of rehabilitation on the repaired capsule was observed.@*RESULTS@#The load-strain curve of capsule ligament complex conforms to rheological and viscoelastic characteristics. The maximum tensile strain of the complex was (39.21±5.23)%, the maximum load was (142.06± 34.15) N, the tensile strength was (1.65±0.38) MPa, and the elastic modulus is (14.23±5.62) MPa. At 90 ° hip flexion, the tensile strain of repaired capsule was higher than that of normal capsule, and the difference was statistically significant (< 0.05). Tensile strain of conventionally reconstructed capsule is:upper part (37.0±4.9)%, middle part ( 53.3±1.1)%, lower part (68.3±6.2)%, tensile strain of normal capsule is:upper part (17.0±2.6)%, middle part (24.1±1.4)%, lower part (26.0± 4.3)% . The thickness of the posterior joint capsulein different sections is statistically significant (<0.05), and capsule at 0.5cm proximal to the femoral insertion is suitable for suture. There the average thickness of capsule is:upper part (3.48 ± 0.11) mm, middle part (2.36 ± 0.09) mm, lower part (1. 59±0.24) mm. The posterior inferior joint capsule is thinnest at (1.42± 0.02) cm proximal to the femoral insertion, and sutures should be avoided here. After simulating rehabilitation, avulsion occurred in the lower part of the posterior capsule repaired conventionally (10/12), and the anatomically repaired capsule remained intact.@*CONCLUSION@#The lower part of conventionally repaired capsule is overstretched and tends to fail. Anatomically repaired capsule conforms to tensile mechanics and is helpful to reduce the failure rate of repair.

Research advances in pathomechanism and treatment of joint contracture / 中国骨伤

Joint contracture is one of the common musculoskeletal disorders. It has seriously disturbed patients' activities of daily living in various aspects. The pathogenesis of it is eager to explore to distinct degree. Nowadays the thickeness and fibrosis of joint capsular is redarded as the major reason to joint contracture. It is reported that excessive fibroblasts and myofibroblasts activity, collagen hyperplasia, and extracellular matrix (ECM) deposition in these fibrotic condtions lead to the contracture. In addition, upregulators of myofibroblast and collagen synthesis, transforming growth factor-beta 1 (TGF-β1), and connective tissue growth factor (CTGF) were shown to be increased. Altered levels of cytokines were also thought to play a role in this process as elevated levelsof tumor necrosis factor-α(TNF-α), matrix metalloproteinases(MMPs) and abnormal distribution tissue inhibitors of MMPs(TIMPs) were demonstrated in contracted capsules. At present, the methods for clinical treatment of joint contracture mainly include two major categories:stretching therapy, physical factor therapy, exercise therapy, botulinum toxin injection and other non-surgical treatments, arthroscopic lysis, open lysis, and other surgical treatments. Surgical treatment is performed when non-surgical treatment is difficult to achieve further improvement. It has a good effect on mild to moderate joint contracture, but it is difficult to completely restore joint activity for serious joint contracture. Although clinical treatment methods are diverse, the clinical effects are staggered and the effectiveness of their treatment is controversial. Joint contracture is an important challenge faced by orthopedics and rehabilitation physicians, therapists and patients. The review summarized the pathogenesisand treatment of joint contracture and provided a theoretical basis for clinical diagnosis and treatment.

An unusual complication during arthrocentesis: N. facialis paralysis, with N. lingualis and N. alveolaris inferior anesthesia

This case report aims to review complications that can occur during arthrocentesis and report an unusual complication observed in a 55-year-old man. The patient received arthrocentesis in an attempt to treat painful locking episodes of his right temporomandibular joint (TMJ). One hour after the operation, the patient experienced temporary facial paralysis in the area of the facial nerve and anesthesia of the lingual and alveolar inferior nerves. No persistent complications were detected during the postoperative follow-up. We suspected this complication occurred after anesthetic solution overflowed from a traumatic perforation in the joint capsule to the infratemporal area during the operation. To our knowledge, this complication has not been previously reported in the literature.

Bankart lesion repair: biomechanical and anatomical analysis of Mason-Allen and simple sutures in a swine model / Reparo da lesão de Bankart: análise biomecânica e anatômica das suturas tipo Mason-Allen e simples em modelo suíno

ABSTRACT Objective: To evaluate the labral height and pullout resistance after the repair of Bankart lesions in the glenohumeral joint of swine models, using double-loaded anchors with two suture configurations: simple and Mason-Allen. Methods: Ten swine shoulders were used, in which Bankart lesions were created. For each specimen, the lesion was sutured randomly with Mason-Allen sutures or simple sutures. The labral height was measured before the lesion was created and after the labral repair. The specimens were submitted to a tensile test for biomechanical evaluation. Results: In specimens submitted to simple suture (n = 5), the mean labral height observed before the lesion was 3.86 mm, and after suturing, 3.33 mm. In specimens submitted to Mason-Allen suture (n = 5), it was observed that the mean labral height before the lesion was 3.92 mm, and after suturing, 3.48 mm. When comparing the labral height after simple suture and Mason-Allen suture, no significant difference was observed. The pullout force at the end of the tensile test on specimens with single suture was 130 N, and in specimens with Mason-Allen suture, 128.6 N. No statistically significant differences were observed between the shoulders treated with single suture and Mason-Allen suture; p = 0.885. Conclusions: Repair of Bankart lesions with Mason-Allen suture provides increased labrum height; however, it does not increase the pullout strength.

RESUMO Objetivo: Avaliar a altura labral e a resistência ao arrancamento do reparo da lesão de Bankart em articulação glenoumeral de suínos, com âncoras duplamente carregadas com duas configurações de sutura: simples e tipo Mason-Allen. Métodos: Foram usados dez ombros suínos, nos quais foram criadas as lesões de Bankart. Para cada espécime foi feita a sutura da lesão com suturas tipo Mason-Allen e simples de forma aleatória. A altura labral foi mensurada previamente à confecção da lesão e após o reparo labral. Os espécimes foram submetidos ao ensaio de tração para avaliação biomecânica. Resultados: Nos espécimes submetidos a sutura simples (n = 5), observou-se altura média previamente à confecção da lesão de 3,86 mm e após a sutura, de 3,33 mm. Nos espécimes submetidos a sutura Mason-Allen (n = 5), observou-se que a altura média previamente à confecção da lesão era de 3,92 mm e após a sutura, de 3,48 mm. Ao comparar a altura labral após a sutura simples e Mason-Allen, não foram observadas diferenças significantes. A força de arrancamento no fim do ensaio de tração nos espécimes com sutura simples foi de 130 N e nos espécimes com sutura Mason-Allen, 128,6 N. Não houve diferença estatisticamente significante entre os ombros com suturas simples e Mason-Allen, p = 0,885. Conclusões: O reparo das lesões de Bankart com sutura Mason-Allen proporciona aumento da altura do labrum, mas não eleva a força de resistência ao arrancamento.

Posterior Interosseous Nerve Palsy Caused by a Ganglion of the Arcade of Frohse

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient's fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

The Therapeutic Effect of Hydraulic Distension with Pumping Technique on the Patient with Frozen Shoulder: Case Report

Frozen shoulder is a disease characterized by shoulder pain and limited range of motion. Conservative treatment is preceded by surgical treatment to reduce pain and recover range of motion. Hydraulic distention is a procedure in which a sufficient amount of solution is injected into the shoulder joint to rupture the rigid joint capsule. Recently, the method of continuously maintaining the expanded capsular state after injection without the process of rupturing the rigid joint has also been used. However, in order to obtain the maximal stretching effect, we proposed a ‘pumping technique’ that inflates and shrinks the rigid joint capsule by repeating the process of infusion and regurgitation of the injection fluid into the capsule. Our proposed ‘pumping technique’ was shown to be more effective in increasing range of motion than the conventional hydraulic distension. This ‘pumping technique’ can be suggested as an effective therapeutic option for frozen shoulder.

Uso de los sistemas de presión negativa en el tratamiento de infecciones asociadas a dispositivos: ''una vieja terapia con un uso novedoso'' / Use of negative pressure systems for the management of infections associated to devices: ''an old therapy with a new use''

Resumen Introducción: El cuidado de los pacientes con infecciones asociadas al dispositivo sin endocarditis, incluye: la extracción completa y la realización de capsulectomía para evitar la reinfección. El uso de nuevos elementos como el sistema de la presión negativa es una terapia novedosa que ha demostrado disminuir: los tiempos de recuperación, el tiempo de estancia intrahospitalaria, la necesidad de nuevas intervenciones por sangrado o lavado y el tiempo de espera para un nuevo implante. Nuestro objetivo es describir la experiencia de un centro de cuarto nivel, en el manejo de las infecciones asociadas a los dispositivos sin endocarditis, con el uso de la terapia de presión negativa como parte del manejo. Metodología: Se realizó una descripción retrospectiva de la experiencia en el manejo de la terapia de presión negativa en pacientes con infecciones asociadas a dispositivo, en un centro de cuarto nivel. Se exponen cinco casos, a los que se les realizó: la extracción completa del dispositivo, la capsulectomía anterior y posterior, el lavado quirúrgico y el implante de la terapia con presión negativa. Conclusión: La experiencia presentada demuestra que el uso de la terapia de presión negativa es un protocolo de tratamiento novedoso, que en nuestros pacientes con infección asociada a dispositivo sin endocarditis, es segura y de fácil utilización.

Abstract Introduction: Care for patients with infections associated to the device without endocarditis include complete extraction and performing a capsulectomy to avoid reinfection. The use of new elements, such as the negative pressure system, is a new therapy that has shown to reduce recovery time, inpatient stay, need of new interventions due to bleeding or washing and waiting time for a new implant. The goal is to describe the experience of a fourth level centre for managing infections associated with devices without endocarditis using a negative pressure system as part of the therapy. Methods: Descriptive retrospective study of the experience of negative pressure therapy for managing patients with device-related infections at a fourth level centre. Five cases are exposed where complete removal of the device, anterior and posterior capsulectomy, surgical washing and negative pressure therapy were performed. Conclusion: Presented experience shows that the use of negative pressure therapy is a new therapy protocol that is safe and easy for managing our patients with an infection associated to the device without endocarditis.

Functional evaluation of repairs to circumferential labral lesions of the glenoid - Case series / Avaliação funcional do reparo de lesões labrais circunferenciais da glenoide - Série de casos

ABSTRACT OBJECTIVE: To evaluate the clinical results among patients undergoing arthroscopic repair of circumferential labral lesions. METHODS: This was a retrospective study on 10 patients who underwent arthroscopic repair to circumferential labral lesions of the shoulder, between September 2012 and September 2015. The patients were evaluated by means of the Carter-Rowe score, DASH score, UCLA score, visual analog scale (VAS) for pain and Short-Form 36 (SF36). The average age at surgery was 29.6 years. The mean follow-up was 27.44 months (range: 12-41.3). RESULTS: The mean score was 16 points for DASH; 32 points for UCLA, among which six patients (60%) had excellent results, three (30%) good and one (10%) poor; 1.8 points for VAS, among which nine patients (90%) had minor pain and one (10%) moderate pain; 79.47 for SF-36; and 92.5 for Carter-Rowe, among which nine patients (90%) had excellent results and one (10%) good. Joint degeneration was present in one case (10%), of grade 1. We did not observe any significant complications, except for grade 1 glenohumeral arthrosis, which one patient developed after the operation. CONCLUSION: Arthroscopic repair of circumferential labral lesions of the shoulder through use of absorbable anchors is effective, with improvements in all scores applied, and it presents low complication rates. Cases associated with glenohumeral dislocation have lower long-term residual pain.

RESUMO OBJETIVO: Avaliar os resultados clínicos dos pacientes submetidos a reparo artroscópico de lesão labral circunferencial. MÉTODOS: Estudo retrospectivo de 10 pacientes submetidos ao reparo artroscópico de lesão labral circunferencial do ombro de setembro de 2012 a setembro de 2015. Os pacientes foram avaliados pelo escore de Carter-Rowe, pelo escore de Dash, pelo escore de Ucla, pela classificação visual analógica de dor (EVA) e pelo Short-Form 36 (SF36). A média de idade na cirurgia foi de 29,6 anos. O seguimento médio foi de 27,44 (variação de 12-41,3) meses. RESULTADOS: A média dos escores foi de 16 pontos no Dash; 32 pontos no Ucla, seis (60%) resultados excelentes, três (30%) bons e um ruim (10%); 1,8 ponto na EVA, nove (90%) dores leves e um (10%) dores moderadas; SF-36 de 79,47; e na escala de Rowe 92,5 pontos, nove (90%) resultados excelentes e um (10%) bom. Degeneração articular esteve presente em um (10%) caso, de grau 1. Não observamos complicações significativas, a não ser a artrose glenoumeral grau 1, desenvolvida no pós-operatório de um paciente. CONCLUSÃO: O reparo artroscópico da lesão labral circunferencial do ombro com o uso de âncoras absorvíveis é eficaz, com melhoria de todos escores aplicados, e apresenta baixos índices de complicação. Os casos associados a luxação glenoumeral apresentam menor dor residual em longo prazo.

Análisis de los términos utilizados en la literatura científica para referirse a la cápsula articular y ligamentos articulares de la articulación temporomandibular / Analysis of terms used in the literature to refer to temporomandibular joint capsule and joint ligaments

La identificación de las estructuras anatómicas con un término único, informativo y con ausencia de homónimos, entre otros principios, es la tarea primordial que lleva adelante la Federación Internacional de Programas de Terminologia Anatomica (FIPAT) perteneciente a la International Federation of Anatomical Associations (IFAA). Sin embargo, en la literatura científica, sobre todo con orientación clínica y quirúrgica, existen aún dificultades para adoptar la Terminologia Anatomica Internacional (TAI), generándose múltiples denominaciones para una misma estructura anatómica, complicando la comunicación científica. El objetivo de este trabajo fue analizar los términos utilizados en la literatura científica en relación a la cápsula articular y los ligamentos articulares de la articulación temporomandibular. Se revisaron artículos científicos y también libros de texto de anatomía general y específicos de la articulación temporomandibular. Se compararon los términos adoptados en la literatura especializada con la establecida en la TAI, identificándose los términos de la TAI más utilizados, como así también aquellos mencionados en artículos científicos y libros de texto pero no presentes en la TAI. El análisis realizado en esta investigación permitió identificar el uso de términos presentes y ausentes en la TAI, analizando su denominación, origen, inserción y función específica.

The identification of anatomical structures with a single, informative term and absence of homonyms, among other principles, the primary task is being conducted by the International Federation of programs Anatomical Terminology (FIPAT) belonging to the International Federation of Anatomical Associations (IFAA). However, in the literature, particularly with clinical and surgical direction, there is still difficulty in adopting the Terminologia Anatomica Internacional (TAI), generating multiple names for the same anatomical structure, complicating scientific communication. The aim of this study was to analyze the terms used in the literature in relation to the joint capsule and joint ligaments of the temporomandibular joint. Scientific papers and textbooks on general and specific anatomy, of the temporomandibular joint is reviewed. We compared the terms adopted with TAI literature specialized terms, identifying the TAI terms most used, as well as those mentioned in scientific and textbook literature, but not present in the TAI. The analysis in this study identified the use of terms present and absent in TAI, analyzing their name, origin, insertion and specific function.

A Rare Case of an Epidermal Inclusion Cyst in the Joint Capsule of the Thumb

No abstract available.

Double-Layered Medial Meniscus / 대한정형외과학회잡지

We report on the case of double-layered medial meniscus, which was overlying anterior to mid portion of the medial meniscus. The upper accessory meniscus was connected to the anterior portion of the normal medial meniscus. And its periphery was connected to the joint capsule. The posterior portion of the upper accessory meniscus was connected to the joint capsule. This case demonstrates an interesting and rare anatomical abnormality of the medial meniscus. We report on the case with a review of the literature.

Synovial tissue morphology of the cricoarytenoid joint in the elderly: a histological comparison with the cricothyroid joint / 대한해부학회지

We compared the age-related morphology of the cricothyroid (CT) joint with that of the cricoarytenoid (CA) joint using 18 specimens from elderly cadavers in terms of their elastic fiber contents as well as the cells composing the joint capsule and synovial tissues. In contrast to an almost flat-flat interface in the CT joint, the CA joint was similar to a saddle joint. The CA joint capsule was thin and contained few elastic fibers, and in contrast to the CT joint, external fibrous tissues were not exposed to the joint cavity, there being no injury to the CA joint capsule. The lateral and posterior aspects of the CA joint were covered by the lateral and posterior CA muscles, respectively, and the fascia of the latter muscle was sometimes thick with abundant elastic fibers. However, due to possible muscle degeneration, loose connective tissue was often interposed between the fascia and the capsule. The medial and anterior aspects of the CA joint faced loose tissue that was continuous with the laryngeal submucosal tissue. Therefore, in contrast to the CT joint, a definite supporting ligament was usually absent in the CA joint. Synovial folds were always seen in the CA joint, comprising a short triangular mass on the posterior side and long laminar folds on the anterior side. The synovial folds usually contained multiple capillaries and a few CD68-positive macrophages. High congruity of the CA joint surfaces as well as strong muscle support to the arytenoid cartilage appeared to provide the specific synovial morphology.

Biomechanics of Degenerative Spinal Disorders

The spine has several important functions including load transmission, permission of limited motion, and protection of the spinal cord. The vertebrae form functional spinal units, which represent the smallest segment that has characteristics of the entire spinal column. Discs and paired facet joints within each functional unit form a three-joint complex between which loads are transmitted. Surrounding the spinal motion segment are ligaments, composed of elastin and collagen, and joint capsules which restrict motion to within normal limits. Ligaments have variable strengths and act via different lever arm lengths to contribute to spinal stability. As a consequence of the longer moment arm from the spinous process to the instantaneous axis of rotation, inherently weaker ligaments (interspinous and supraspinous) are able to provide resistance to excessive flexion. Degenerative processes of the spine are a normal result of aging and occur on a spectrum. During the second decade of life, the intervertebral disc demonstrates histologic evidence of nucleus pulposus degradation caused by reduced end plate blood supply. As disc height decreases, the functional unit is capable of an increased range of axial rotation which subjects the posterior facet capsules to greater mechanical loads. A concurrent change in load transmission across the end plates and translation of the instantaneous axis of rotation further increase the degenerative processes at adjacent structures. The behavior of the functional unit is impacted by these processes and is reflected by changes in the stress-strain relationship. Back pain and other clinical symptoms may occur as a result of the biomechanical alterations of degeneration.

Isolated Traumatic Radial Head Anterior Dislocation Treated with Open Reduction in Children / 대한정형외과학회잡지

Isolated traumatic radial head anterior dislocation without associated injuries is uncommon in pediatric patients. If diagnosed on time, most cases can be reduced by closed reduction. In some cases, the radial head was found to be trapped between annular ligament, anterior joint capsule and a buttonhole tear of the brachialis muscle, preventing closed reduction. This is a very uncommon injury and the diagnosis can be overlooked. We report a case of a 7-year-old girl who sustained an irreducible isolated dislocation of the radial head which was reduced with open reduction.

Anatomical study on the innervation of the elbow capsule / Estudo anatômico da inervação da cápsula do cotovelo

To put forward an anatomical description of the innervation of the elbow capsule, illustrated through morphological analysis on dissections. METHODS: Thirty elbows from fresh fixed adult cadavers aged 32-74 years, of both sexes, were dissected. RESULTS: Among the dissected arms, we observed that the median nerve did not have any branches in two arms, while it had one branch in five arms, two branches in two arms, three branches in ten arms, four branches in nine arms and five branches in two arms. The radial nerve did not have any branches in two arms, while it had one branch in two arms, two branches in nine arms, three branches in ten arms, four branches in five arms and five branches in two arms. The ulnar nerve did not have any branches in three arms, while it had one branch in six arms, two branches in four arms, three branches in five arms, four branches in seven arms, five branches in four arms and six branches in one arm. CONCLUSIONS: We observed branches of the radial, ulnar and medial nerves in the elbow joint, and a close relationship between their capsular and motor branches.

Promover a descrição anatômica da inervação da cápsula do cotovelo com ilustração por meio da morfologia das dissecações. MÉTODOS: Foram dissecados 30 cotovelos de cadáveres adultos frescos e fixados, com idade entre 32 e 74 anos, de ambos os sexos. RESULTADOS: Observamos, dentre os braços dissecados, dois com nenhum ramo do nervo mediano, cinco com um ramo, dois com dois ramos, 10 com três ramos, nove com quatro ramos e dois com cinco ramos. Quando se trata do nervo radial, dois braços não apresentaram ramos, dois mostraram dois ramos, nove continham dois ramos, 10 contaram com três ramos, cinco tinham quatro ramos e dois tinham cinco ramos. Em relação ao nervo ulnar, tivemos três braços sem ramos articulares, seis com um ramo, quatro com dois ramos, cinco com três ramos, sete com quatro ramos, quatro com cinco ramos e um com seis ramos. CONCLUSÕES: Constatamos ramos do nervo radial, ulnar e medial na articulação do cotovelo, assim como a relação próxima entre os seus ramos capsulares e motores.

The FasT-Fix Repair Technique for Ramp Lesion of the Medial Meniscus

INTRODUCTION: This technical note describes a new arthroscopic technique to repair the peripheral attachment lesion of the posterior horn of the medial meniscus. The operation was performed under arthroscopy using a standard anterior portal. SURGICAL TECHNIQUE: A FasT-Fix needle was inserted obliquely close to the tibial plateau and the first implant was inserted into the joint capsule depending on its bending angle underneath the meniscus. The second implant was inserted through 1/3 periphery of the meniscus into the meniscocapsular area. The pre-tied self-sliding knot was tensioned to achieve secure fixation of the posterior meniscal peripheral attachment at the original attachment point. MATERIALS AND METHODS: From August 2011 to February 2014, 23 knees were diagnosed as ramp lesion, underwent meniscal repair using FasT-Fix technique. RESULTS: All patients were followed up for average 14 months. The Lysholm score improved from preoperative 64.4+/-4.52 to postoperative 91.2+/-4.60. CONCLUSIONS: We believe that the FasT-Fix technique via the standard anterior portal can be a more convenient and less traumatic alternative for repair of the peripheral attachment lesion of the posterior horn of the medial meniscus in the anterior cruciate ligament deficient knee.

Localized Pigmented Villonodular Synovitis in an Unusual Location in the Knee: A Case Report / 대한정형외과연구학회지

Localized pigmented villonodular synovitis (LPVNS) is a rare lesion that can affect any joint, although it is most frequently found in the knee. When LPVNS affects the knee, it is usually a single mass of pedunculated appearance. We present a LPVNS occurred from the junction of the anterior horn of the lateral meniscus and the joint capsule in the knee. It detached and then moved at an unusual location, which caused pain, limitation of knee flexion and locking.

Profile of collagen gene expression in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder / Perfil de expressão de genes do colágeno na cápsula glenoumeral de pacientes com instabilidade traumática anterior do ombro

Objective: To evaluate the expression of the genes COL1A1, COL1A2, COL3A1 and COL5A1 in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder. Methods: Samples from the glenohumeral capsule of 18 patients with traumatic anterior instability of the shoulder were evaluated. Male patients with a positive grip test and a Bankart lesion seen on magnetic resonance imaging were included. All the patients had suffered more than one episode of shoulder dislocation. Samples were collected from the injured glenohumeral capsule (anteroinferior region) and from the macroscopically unaffected region (anterosuperior region) of each patient. The expression of collagen genes was evaluated using the polymerase chain reaction after reverse transcription with quantitative analysis (qRT-PCR). Results: The expression of COL1A1, COL1A2 and COL3A1 did not differ between the two regions of the shoulder capsule. However, it was observed that the expression of COL5A1 was significantly lower in the anteroinferior region than in the anterosuperior region (median ± interquartile range: 0.057 ±0.052 vs. 0.155 ±0.398; p = 0.028) of the glenohumeral capsule. Conclusion: The affected region of the glenohumeral capsule in patients with shoulder instability presented reduced expression of COL5A1...

Objetivo: Avaliar a expressão dos genes COL1A1, COL1A2, COL3A1 e COL5A1 na cápsula glenoumeral de pacientes com instabilidade anterior traumática do ombro. Métodos: Foram avaliadas amostras de cápsula glenoumeral de 18 pacientes com instabilidade anterior traumática do ombro. Foram incluídos pacientes masculinos, com teste de apreensão positivo e lesão de Bankart no exame de ressonância magnética. Todos os pacientes sofreram mais de um episódio de luxação do ombro. Foram coletadas amostras da cápsula glenoumeral lesionada (região anteroinferior) e da região macroscopicamente não afetada (região anterossuperior) de cada paciente. A expressão dos genes de colágeno foi avaliada por reação em cadeia da polimerase após transcrição reversa com análise quantitativa (qRT-PCR). Resultados: A expressão de COL1A1, COL1A2 e COL3A1 não diferiu entre as duas regiões da cápsula do ombro. No entanto, foi observado que a expressão de COL5A1 estava significantemente reduzida na região anteroinferior em relação à região anterossuperior (mediana ± intervalo interquartílico: 0,057 ± 0,052 vs 0,155 ± 0,398; p = 0,028) da cápsula glenoumeral. Conclusão: A região afetada da cápsula glenoumeral de pacientes com instabilidade do ombro apresentou uma expressão reduzida de COL5A1...