Differentiation of strains in the lateral and medial bands of the iliofemoral ligament: A segmental approach.

Iliofemoral ligament strains have been assessed in a circumscribed portion, limiting the information regarding the strains in the proximal, mid and distal portions. The purpose of this study is to describe the longitudinal and transversal strain within the proximal, mid and distal portions of the lateral and medial bands of the iliofemoral ligament. Ten fresh cadaveric specimens were assessed. The iliofemoral ligaments were divided into medial and lateral bands. Hemispherical beads (2.6 mm) were placed on the lateral and medial borders of each band. Four positions were assessed: abduction, extension, internal and external rotations combined with extension. The hemispherical beads were scanned at the end range of motion using a laser scanner. The three-dimensional position of each bead was used to estimate longitudinal and transversal strains. A three-factor ANOVA was used to compare movements, borders, and portions within each ligament for longitudinal strains. A one-way ANOVA was used to compare transversal strains between portions. This technique showed mean reliability (ICC: 2, 1) of 0.90 ± 0.06. The external rotation showed the highest strains in both ligaments (p < 0.05). Abduction showed a significant difference between the lateral and medial borders in both bands (p = 0.001). Eight movement-border combinations showed a significant difference between proximal, medial, and lateral portions (p < 0.005). According to our results, there is a clear effect of portions (proximal, mid and distal) within the ligament and movements. Abduction shows the lowest strains longitudinally but the largest strains transversally. Although we do not know the impact of this phenomenon, future studies should assess the strains following hip arthroscopies. The latter might improve the impact of this procedure on hip biomechanics. Lastly, the iliofemoral ligament should be assessed using a segmental approach rather than as a complete unit.

Ilio-femoral ligament strains during the flexion-abduction-external rotation test: A cadaveric study.

BACKGROUND: Flexion-abduction-external-rotation (FABER) test is one of the most used tests during the clinical assessment of the hip joint. The limited range of motions reached could be due to iliofemoral ligament tightness, but no study has assessed capsular ligament strain during this test. The main objective of this study is to report strains within the iliofemoral ligament during the FABER test using a segmental approach. METHODS: 9 hips were harvested, and all muscles were removed. Hemispherical markers (∅ 2.6 mm) were glued on the lateral and medial borders of both the medial and lateral iliofemoral bands, separating each border into proximal, mid, and distal portions. The lower limb was placed in a FABER test position. A laser scanner allowed to digitize the 3D surface of the capsule. A Kruskal-Wallis test was performed to assess the effect of ligaments, borders, and portions. FINDINGS: The lateral band of the iliofemoral ligament showed greater strains (14.6 ± 11.4%) compared to the medial band (-8.7 ± 14.2%) (p < 0.001). The greatest strains were observed in the distal portion of the lateral border of the lateral band (51.1 ± 21.5%). A decrease in strain was observed in the mid-portion of the medial border of the medial iliofemoral ligament (-27.9 ± 8.9%). INTERPRETATION: The FABER test is used to assess pain at the hip. Our results show that the limited range of motion at the hip during this test might be caused by increased strains in the lateral band. These results demonstrate that a limitation of joint range of motion during the FABER could be due to an excessive tension of the lateral band of the iliofemoral ligament.

Effect of lacertus fibrosus release on perineural pressure of the median nerve at the elbow: a cadaveric study.

PURPOSE: The lacertus fibrosus (or bicipital aponeurosis) is a potential site of proximal median neuropathy at the elbow. Lacertus syndrome with motor and/or sensory symptoms has been addressed with a minimally invasive surgical lacertus release. This study evaluates if a lacertus release alters the maximal perineural pressure (Pmax) of the median nerve at the level of the lacertus fibrosus during elbow flexion. METHODS: Seven upper limbs from four fresh cadavers were included. Perineural pressure of the median nerve at the level of the lacertus fibrosus was measured continuously during automated elbow flexions by the biceps brachii muscle. RESULTS: The mean Pmax before the lacertus release was significantly different than the mean Pmax after the lacertus release (669.15 mmHg vs 77.01 mmHg, p = 0.0180). The mean Pmax after the lacertus release decreased with an average 81.41%. CONCLUSION: A simple surgical release of the lacertus fibrosus significantly decreases the maximal perineural pressure of the median nerve at the level of the lacertus fibrosus during elbow flexion.

Application of Ultrasound in Spine Kinematic Determination: A Systemic Review.

Spine kinematic determination is required to diagnose or rehabilitate back pain due to spinal instability. Ultrasound imaging, as a less harmful and cost-effective method, has been recently applied to kinematic analysis. This study reviews all available published articles to see how much progress has been made in spine kinematic measurement by ultrasound. In this regard, we searched PubMed, Scopus, and Google Scholar among all available studies until 2021, using keywords such as ultrasound, spine, kinematics, rotation, twist, flexion, and bending. Finally, after identifying and scanning 183 articles, only nine articles were included, which analyzed spine kinematics by ultrasound. Among these nine articles, three reported axial displacements, three reported flexion/extension, and three reported axial rotation. Although ultrasound is a suitable alternative to other kinematic measurement methods, very little research and progress have been made in this area. Today, this method is still not used practically for spine kinematic measurement because the bone scans via ultrasound imaging are challenging to understand, and no three-dimensional kinematic measurement technique has been reported. However, recent advances in converting ultrasound images into three-dimensional images can pave the way for further improvements.

Appraising efficiency of OpSite as coolant in drilling of bone.

BACKGROUND: During drilling of bone, which is common in clinical surgeries, heat generation increases local temperature in the drilling site. Transmission of excessive heat to the surrounding bone tissue can cause thermal osteonecrosis. Consequently, it may lead to failure of implants and fixation screws or delay in healing process. Using cooling is a method for limiting temperature elevation. MATERIALS AND METHODS: In this study, through comparing three conditions of drilling without cooling, external cooling with normal saline, and external cooling with OpSite spray, the efficiency of OpSite as coolant is studied. In this regard, 2 drill bit diameters, 3 drilling speeds, and 3 drilling feed-rates are considered as drilling variables in the experiments. RESULTS: For the whole experiments, while cooling with normal saline resulted in lower maximum temperatures than without cooling condition, OpSite had even better results and limited the temperature elevation during drilling of bone efficiently. CONCLUSION: OpSite spray, which has lower infection risks than normal saline on one hand and lower maximum temperature rise with all combinations of drilling parameters on the other hand, can be considered in clinical surgeries for cooling applications.

Detecting reasons for recurrent deformity in treatment of patients with vitamin D-resistant rickets using diagnostic imaging.

PURPOSE: To assess age related manifestations of the femur and tibia in patients with vitamin D-resistant rickets (VDR) and explore causes for recurrent deformity using imaging modalities. METHODS: Computed tomography (CT), magnetic resonance imaging (MRI) and dual energy X-ray densitometry (DEXA) were used to assess conditions of long bones of lower limbs in patients with vitamin D-resistant rickets aged from 4 years to 30 years preoperatively and after limb lengthening. RESULTS: Age related MRI findings showed specific structure of the femur and tibia in patients with VDR preoperatively and after operative treatment. Abundant irregular osteoid formed in femoral and tibial physes was shown to reveal complicated nature of bone deformity causing recurrence in patients with VDR at childhood. CT findings allowed us to detect early cortical injury, measure its length with forming Looser's zones, examine significant differences in density measurements of Looser's zones preoperatively and after deformity correction using transosseous osteosynthesis. CONCLUSION: Recurrent deformity can develop in patients with VDR due to progression of the disease, irregular osteoid deposited in the medial and lateral metaepiphysis, osteoid area measuring over 50% of epiphyseal cross section, insufficient regenerate mineralization, and formation of Looser's zones.