Hamstring Anterior Cruciate Ligament Autograft Contributes to a Delayed Symptomatic Cyclops Lesion: A Case Report.

Cyclops lesions are characterized as fibroid nodules with granulation tissue that looks similar to a cyclops eye during arthroscopy. These are rare postoperative complications following anterior cruciate ligament reconstruction (ACLR), presenting typically within six months of their reconstruction. This case report presents a 21-year-old male, three years following hamstring autograft ACLR, with a symptomatic cyclops lesion. Contrary to the reported literature, this delayed presentation showed a painful flexion contracture of the knee and intraoperative findings consistent with a cyclops lesion. The treatment consisted of surgical debridement and notchplasty with subsequent posterior medial and lateral meniscal horn repairs. This case report presents a lesson to indicate that cyclops lesions can occur in a delayed setting following ACLR and to show a technique for successful surgical management of the lesion.

Ultrasonography for the Busy Orthopaedic Surgeon: The Upper Extremity.

Ultrasonography is increasingly used in the diagnosis and treatment of musculoskeletal conditions and injuries. Ultrasonography possesses multiple advantages compared with other methods of imaging, including low cost, lack of radiation exposure, speed, and means for dynamic examination. Because of these advantages, many orthopaedic surgeons are routinely using ultrasonography to diagnose musculoskeletal conditions of the upper extremity. Musculoskeletal ultrasonography is technically challenging, but with proper guidance and practice, every orthopaedic surgeon can confidently integrate ultrasonography into their clinical practice.

Ultrasonography for the Busy Orthopaedic Surgeon: The Lower Extremity.

Ultrasonography has the potential to become a fundamental component of the diagnosis and management of musculoskeletal conditions and injuries. Moreover, in the context of modern healthcare systems that are focused on optimizing value, ultrasonography has the advantage of minimizing costs when compared with other advanced imaging modalities. Because of its low cost, lack of radiation exposure, speed, and capability to diagnose dynamic conditions, more orthopaedic surgeons are routinely integrating musculoskeletal ultrasonography into their daily practice. It is important to provide a comprehensive review of and approach to common musculoskeletal conditions of the lower extremity for the busy orthopaedic surgeon.

A Real-Time EMG-Based Fixed-Bandwidth Frequency-Domain Embedded System for Robotic Hand.

The signals from electromyography (EMG) have been used for volitional control of robotic assistive devices with the challenges of performance improvement. Currently, the most common method of EMG signal processing for robot control is RMS (root mean square)-based algorithm, but system performance accuracy can be affected by noise or artifacts. This study hypothesized that the frequency bandwidths of noise and artifacts are beyond the main EMG signal frequency bandwidth, hence the fixed-bandwidth frequency-domain signal processing methods can filter off the noise and artifacts only by processing the main frequency bandwidth of EMG signals for robot control. The purpose of this study was to develop a cost-effective embedded system and short-time Fourier transform (STFT) method for an EMG-controlled robotic hand. Healthy volunteers were recruited in this study to identify the optimal myoelectric signal frequency bandwidth of muscle contractions. The STFT embedded system was developed using the STM32 microcontroller unit (MCU). The performance of the STFT embedded system was compared with RMS embedded system. The results showed that the optimal myoelectric signal frequency band responding to muscle contractions was between 60 and 80 Hz. The STFT embedded system was more stable than the RMS embedded system in detecting muscle contraction. Onsite calibration was required for RMS embedded system. The average accuracy of the STFT embedded system is 91.55%. This study presents a novel approach for developing a cost-effective and less complex embedded myoelectric signal processing system for robot control.

Medial Femoral Condyle Cartilage Defect Biomechanics: Effect of Obesity, Defect Size, and Cartilage Thickness.

BACKGROUND: Medial femoral condyle (MFC) chondral defects cause knee pain. Clinical studies have shown worse functional outcomes and cartilage defect fill rates after microfracture in obese patients (BMI ≥30) and for defects with size ≥2 cm(2). PURPOSE: To determine the effect of obesity, defect size, and cartilage thickness on the force sustained at the base of full-thickness MFC cartilage defects during weightbearing. STUDY DESIGN: Controlled laboratory study. METHODS: Eight human cadaveric knees were loaded in 15° of flexion. A sensor measured force across the medial compartment. The area at the base of the defect protected from load, termed the "area of containment," was quantified, and loads simulating weightbearing for BMIs of 20, 30, and 40 were applied. A full-thickness cartilage defect was created on the MFC. Cycles of loads were applied for defect sizes with diameters of 6, 8, 10, 12, 14, 16, 18, and 20 mm. A second sensor recorded force at the base of the defect for defects with diameters of 14, 16, 18, and 20 mm. RESULTS: Loads simulating BMI ≥30 led to a decrease in the area of containment for all defects ≥14 mm in diameter (P ≤ .038). Base of defect force increased for defects ≥16 mm in diameter (area, ≥2 cm(2)) between loaded and unloaded states (P ≤ .042) and for loads simulating BMI ≥30 (P ≤ .045). Cartilage rim thickness <2 mm showed higher base of defect force than did thickness ≥2 mm, for all BMI groups (P ≤ .025). CONCLUSION: Increased force at the base of MFC cartilage defects was observed for weightbearing loads simulating BMI ≥30, for defect size ≥2 cm(2), and for rim thickness <2 mm. This may lead to a biomechanically unfavorable environment after microfracture in these patient subsets. CLINICAL RELEVANCE: These biomechanical findings corroborate clinical studies that have noted worse outcomes after microfracture in patients with BMI ≥30 and cartilage defects of size ≥2 cm(2). Further clinical studies are needed to compare microfracture with other cartilage restoration procedures in these patient subsets.

Anterior horn lateral meniscus tear, repair, and meniscectomy.

The purpose of this study was to describe the effect of anterior horn of the lateral meniscus (AHLM) tears on tibiofemoral contact pressures and the ability to restore normal parameters with repair. Eight fresh-frozen cadaveric knees were used. The specimens were subjected to a load of 1,000 N at 0 and 30 degrees of flexion and peak pressure, force and contact area were recorded. The test was repeated for four different instances. Peak force in the lateral compartment was significantly increased at 0 degrees of knee flexion from 37 N intact to 47 N after the tear and 56 N postmeniscectomy. At 0 degrees of knee flexion, the peak pressure of the lateral meniscus was significantly increased from 1.1 MPa in the intact state to 1.9 MPa after meniscectomy. The peak pressure in the nontraumatized medial compartment was significantly increased after partial lateral meniscectomy (p < 0.05). This cadaveric study demonstrated a significant increase in tibiofemoral peak forces in both the medial and lateral compartments with a tear of the AHLM. It also showed an increase in peak contact pressure after meniscectomy. With repair, the preinjury condition peak forces were restored to normal, suggesting the importance of repairing tears of the AHLM.

Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain.

INTRODUCTION: The pain of patellar tendinopathy (PT) may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch) in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. METHODS: Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0-10 scale) enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2-4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA]) scores from baseline to day 14 were assessed. No statistical inference testing was performed. RESULTS: Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation) at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30%) was demonstrated by 54% of patients. CONCLUSION: The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT.

Lesiones proximales y distales del tendón del bíceps braquial: Revisión clínica y ecográfica / Proximal and distal biceps brachii tendon injuries: Clinical and ultrasound review

Las características anatómicas especiales del tendón del bíceps se relacionan con su doble origen tendinoso, que confluye para formar un músculo con una inserción tendinosa distal única. En general, las roturas proximales se producen de forma traumática en varones de edad media, cuando realizan un movimiento excéntrico con el codo en flexión. Sin embargo, mientras que las roturas del bíceps proximal son mas frecuentes y requieren un tratamiento habitualmente conservador, las disrupciones del tendón distal son menos comunes y por el contrario requieren un tratamiento quirúrgico. La ecografía tiene muchas ventajas en el examen de la mayoría de los tendones, como el bíceps braquial proximal. Sin embargo, la disposición anatómica del bíceps distal, hace que la visualización del tendón conjunto y de su inserción radial a menudo sea poco fiable. Las lesiones proximales representan más del 90%de las que se producen en el bíceps braquial. Los procesos patológicos que se pueden observar ultrasonográficamente en este tendón son la tendinosis, tenosinovitis, roturas y luxaciones y el tratamiento sigue siendo un desafío. La dificultad radica en determinar si la lesión es aislada o es concomitante con patología del manguito rotador o con inestabilidad. Las roturas sintomáticas del tendón del bíceps pueden someterse a desbridamiento, tenotomía, o tenodesis si las medidas conservadoras no proporcionan alivio. En la porción distal se producen tendinosis, bursitis y roturas parciales o totales. El tratamiento conservador, está típicamente reservado para las lesiones parciales con poco compromiso funcional, y para los pacientes no aptos para la cirugía, aunque el tratamiento de las roturas completasen los atletas es principalmente quirúrgico y la decisión de cuándo tratar los desgarros parciales no está muy clara (AU)

The special anatomical features of the biceps tendon are the result of its dual original tendon, which converge to form a muscle with a single distal tendon attachment. In general, the proximal breaks are produced traumatic middle-aged men, when they perform an eccentric movement with the elbow flexed. However, while the proximal biceps tears are more common and usually require conservative treatment, distal tendon disruptions are less common and instead require surgical treatment. Ultrasound has many advantages in the examination of most of the tendons, and proximal brachial biceps. However, the anatomical arrangement of the distal biceps, makes viewing the radial insertion is often unreliable. Proximal lesions over 90% of which occur in the biceps brachii. Pathological processes that can be observed ultrasonographically in this tendon are tendinosis, tenosynovitis, ruptures and dislocations and treatment remains a challenge. The difficulty is in determining if the injury is isolated or is concomitant with rotator cuff pathology or with instability. Symptomatic ruptures of the biceps tendon may be treated debridement, tenotomy, or tenodesis if conservative measures fail to provide relief. In the distal portion occurring tendinosis, bursitis and partial or total tear. Conservative treatment is typically reserved for partial injuries with little functional compromise, and for patients unfit for surgery but the treatment of complete ruptures in athletes is primarily surgical, although the decision of when to treat partial tears is not so clear (AU)

Utilization of sonography and a stress device in the assessment of partial tears of the ulnar collateral ligament in throwers.

The non-invasive assessment of medial elbow pain in throwers can be challenging. Valgus stress transmitted to the elbow during the late cocking and acceleration phases of the throwing motion can result in injury to the medial ligamentous structures of the elbow, bony surfaces, and common tendon of the forearm flexors. The utilization of musculoskeletal (MSK) ultrasound in combination with the Telos Stress Device (TSD) (Austin & Associates Fallston, MD) can be an alternate quick assessment when radiography is not be available.

Diagnóstico clínico y ecográfico de las lesiones musculares / Ultrasound and clinical diagnosis of muscle injuries

Dentro de los accidentes deportivos, las lesiones musculares son muy frecuentes, con una incidencia que varía entre el 10% y el 55% de todas ellas. Los mecanismos de producción son variados e incluyen la contusión, el estiramiento o la laceración. Clásicamente se han utilizado cuatro diferentes tipos de clasificación atendiendo a diferentes criterios clínicos. En todos los casos de lesión muscular en los que no se haya realizado ningún estudio por la imagen (ecografía ni resonancia magnética), se puede identificar de forma completa la lesión considerando la localización del hematoma, su mecanismo etiopatogénico, sus rasgos clínicos y finalmente su carácter evolutivo. La ecografía de alta resolución se ha convertido en el método de elección para la evaluación de las lesiones musculares. Además de su uso en la etapa diagnóstica, es útil para el seguimiento evolutivo de estas lesiones y por lo tanto, para decidir el momento exacto de retorno a la actividad deportiva. Aunque la clasificación ecográfica de los desgarros musculares en grados 1, 2 y 3 presenta deficiencias, puesto que no define con precisión el tamaño y forma de la lesión, y tampoco permite establecer un pronóstico preciso de la misma, sigue siendo de utilidad para identificar con exactitud las características de la rotura. Por ello, en el ámbito de la traumatología del deporte, consideramos de gran utilidad esta clasificación, pues facilita y simplifica la terminología, permitiendo además comprender al equipo técnico y al deportista lesionado, el alcance de la rotura. Por este motivo, se propone en esta revisión, la clasificación de las lesiones musculares agudas y de sus complicaciones, describiendo los diferentes tipos de lesión comprendidos en cada grupo (AU)

Whit in the sports injuries, muscle injuries are common, with an incidence ranging between 10% and 55% of them all. The production mechanisms are diverse and include contusion, stretching or laceration. Classically used four different types of classification about of different clinical criteria. In all cases of muscle damage without the imaging studies (Ultrasound or MRI), we can completely identify the injury considering the location of the hematoma, the pathogenic mechanism, it´s clinical features and finally their evolution. The high-resolution ultrasound has become the preferred method for evaluating muscle injuries. Besides its use in the diagnostic stage, it is useful for the follow up of these lesions and thus to decide exactly when to return to sports. Although the sonographic classification of muscle tears in grades 1, 2 and 3 may fail because it does not accurately define the size and shape of the lesion, or assess the evolution, it is still useful to accurately identify the characteristics of the rupture. Therefore, in the sports traumatology, we consider this classification useful, allowing for simplified terminology to understand the extent of the break, the technical team and the injured athlete. For this reason, it is proposed in this rewiew the classification of acute muscle injury and its complications, examining the different types of injury within each group (AU)