Clinical implications of clubfoot histopathology.

Ipsilateral peroneus brevis muscle histopathology was studied in 64 children with idiopathic rigid equinovarus at the setting of initial posteromedial-lateral release. Fifty percent of biopsies demonstrated abnormal muscle fiber morphology, classified as congenital fiber-type disproportion or fiber-size variation. Forty-one infants (59 feet) underwent initial surgical intervention within the first year of life with a minimum 2-year follow-up. Feet with abnormal muscle histology had a significantly greater incidence of recurrent equinovarus deformity requiring reoperation; the relative risk of clubfoot recurrence in children with fiber abnormalities was 5.6. Male patients with bilateral deformity and abnormal peroneus brevis histology had a particularly high incidence of recurrent equinovarus. Developmental internal tibial torsion requiring surgical intervention was also greater in the abnormal-fiber histology group. The incidence of postoperative metatarsus adductus/varus necessitating surgery was comparable despite histologic findings. Thus muscle-fiber abnormalities are prevalent in idiopathic equinovarus. Such fiber-type anomalies may predict recurrent limb deformities.

Human wrist motors: biomechanical design and application to tendon transfers.

Moment arm, muscle architecture, and tendon compliance in cadaveric human forearms were determined and used to model the wrist torque-joint angle relation (i.e. wrist torque profile). Instantaneous moment arms were calculated by differentiating tendon excursion with respect to joint rotation. Maximum isometric tension of each wrist muscle-tendon unit was predicted based on muscle physiological cross-sectional area. Muscle forces were subsequently adjusted for sarcomere length changes resulting from joint rotation and tendon strain. Torque profiles were then calculated for each prime wrist motor (i.e. muscle-tendon unit operating through the corresponding moment arm). Influences of moment arm, muscle force, and tendon compliance on the torque profile of each motor were quantified. Wrist extensor motor torque varied considerably throughout the range of motion. The contours of the extensor torque profiles were determined primarily by the moment arm-joint angle relations. In contrast, wrist flexor motors produced near-maximal torque over the entire range of motion. Flexor torque profiles were less influenced by moment arm and more dependent on muscle force variations with wrist rotation and with tendon strain. These data indicate that interactions between the joint, muscle, and tendon yield a unique torque profile for each wrist motor. This information has significant implications for biomechanical modeling and surgical tendon transfer.

Tendon biomechanical properties enhance human wrist muscle specialization.

Biomechanical properties of human wrist tendons were measured under loads predicted to be experienced by those tendons under physiological conditions. This was accomplished by measuring the architectural properties of the five prime wrist movers--extensors carpi radialis brevis (ECRB), extensor carpi radialis longus (ECRL), extensor carpi ulnaris (ECU), flexor carpi radials (FCR), flexor carpi ulnaris (FCU)--and predicting their maximum tension (P0) using a specific tension value (22.5 N cm-2. Loading the corresponding tendons to P0 resulted in significantly different strain among tendons (p < 0.01) with the largest strain observed in the FCU (3.68 +/- 0.31%) and the smallest strain observed in the ECRL (1.78 +/- 0.14%). Further, strain magnitude was significantly positively correlated with the tendon length-to-fiber length ratio of the muscle-tendon unit, a measure of the intrinsic compliance of the muscle-tendon unit. Theoretical modeling of the magnitude of muscle sarcomere shortening expected based on the measured biomechanical properties revealed a maximum sarcomere length decrease of about 0.6 micron for the FCU to a minimum of about 0.2 micron for the ECRB at P0. Thus, tendon compliance may, but does not necessarily, result in significant modification of muscle force generation. The significant variation in tendon biomechanical properties was not observed using traditional elongation-to-failure methods on the same specimens. Thus, the use of elongation-to-failure experiments for determination of tendon properties may not be reasonable when the purpose of such studies is to infer physiological function. These data indicate that muscle-tendon units show remarkable specialization and that tendon intrinsic properties accentuate the muscle architectural specialization already present.

In vivo measurement of human wrist extensor muscle sarcomere length changes.

1. Human extensor carpi radialis brevis (ECRB) sarcomere length was measured intraoperatively in five subjects using laser diffraction. 2. In a separate cadaveric study, ECRB tendons were loaded to the muscle's predicted maximum tetanic tension, and tendon strain was measured to estimate active sarcomere shortening at the expense of tendon lengthening. 3. As the wrist joint was passively flexed from full extension to full flexion, ECRB sarcomere length increased from 2.6 to 3.4 microns at a rate of 7.6 nm/deg joint angle rotation. Correcting for tendon elongation during muscle activation yielded an active sarcomere length range of 2.44 to 3.33 microns. Maximal predicted sarcomere shortening accompanying muscle activation was dependent on initial sarcomere length and was always < 0.15 microns, suggesting a minimal effect of tendon compliance. 4. Thin filament lengths measured from electron micrographs of muscle biopsies obtained from the same region of the ECRB muscles were 1.30 +/- .027 (SE) microns whereas thick filaments were 1.66 +/- .027 microns long, suggesting an optimal sarcomere length of 2.80 microns and a maximum sarcomere length for active force generation of 4.26 microns. 5. These experiments demonstrate that human skeletal muscles can function on the descending limb of their sarcomere length-tension relationship under physiological conditions. Thus, muscle force changes during joint rotation are an important component of the motor control system.

Serial thallium-201 scintigraphy in osteosarcoma. Correlation with tumor necrosis after preoperative chemotherapy.

In 27 patients with extremity lesions (24 osteosarcoma, three malignant fibrous histiocytoma), a notable decrease in thallium-201 uptake was correlated with a good response to preoperative chemotherapy of the primary tumor. A good response is indicated by a greater than 95% tumor necrosis. Serial quantitative thallium-201 uptake of malignant bone tumors in patients receiving preoperative chemotherapy therefore can accurately predict a good histologic response and prognosis. Serial thallium scintigraphy can furthermore identify poor responses within two weeks after the initiation of treatment, or can prompt an early change in preoperative chemotherapy and facilitate limb salvage surgery.