The relationship between the femoral artery and vastus medialis muscle coverage at the adductor hiatus during medial closed wedge distal femoral osteotomy in valgus knees.

Purpose: The purpose of this study was to examine the location where the femoral artery contacts the vastus medialis at the adductor tendon hiatus, which is important when using the subvastus approach in medial closed wedge distal femoral osteotomy. We evaluated the correlation between differences in height, vastus medialis morphology, and lower limb alignment. Methods: Sixty knees (16 male, 44 female) that underwent plain computer tomography (CT) were included. Using the radiographic hip-knee-ankle (HKA) angle as a reference, the knees were divided into three groups of 20 knees: valgus, varus, and neutral. The mechanical lateral distal femoral angle (mLDFA) and distance from the medial femoral epicondyle to the centre of the femoral head (D1) were measured on full-length weight-bearing anteroposterior radiographs. The first cross-section on CT where the vastus medialis muscle and femoral artery connect was defined as the cross-sectional image for measurement. The direct distance from the medial epicondyle to the measured cross-sectional image (D2) was measured in the coronal view. The ratio of the vastus medialis muscle width to the femoral posterior wall width was defined as the vastus medialis muscle coverage ratio (CR). Correlations between each measurement and group were evaluated. Results: There was a positive correlation between D1 and D2 in the overall, neutral, and varus groups; however, there was no correlation in the valgus group. A positive correlation was observed in terms of the relationship between CR and D2 in the overall and valgus groups. In addition, there was no statistically significant difference in the correlation between the mLDFA and D2, with patient height as a control variable overall and in all groups. Conclusion: In the valgus group, distance to the adductor hiatus was correlated with vastus medialis coverage. Overhang of the vastus medialis may be an important influencing factor of femoral and popliteus artery position. Level of Evidence: Level III, retrospective cohort study.

High Tibial Osteotomy with Posterior Medial Meniscal Root Reconstruction Yields Improved Radiographic and Functional Outcomes and Healing Rates Compared to Osteotomy Alone.

PURPOSE: To compare pre- and post-operative clinical and radiological outcomes between patients undergoing high tibial osteotomy (HTO) with medial meniscus posterior root tear (MMPRT) reconstruction using gracilis tendon graft versus those without reconstruction MMPRT. METHODS: Patients with MMPRT who underwent HTO between January 2018 and December 2021 with minimum 2-year follow-up were included. All the patients were divided into 2 groups based on whether underwent meniscus root reconstruction with tendon graft, HTO alone (33 cases) and HTO with reconstruction MMPRT (21 cases). Clinical evaluation included Lysholm score, international knee documentation committee (IKDC) score, and visual analogue scale (VAS) score. The functional recovery and radiologically outcome of the knee were evaluated preoperatively and at the latest follow-up. Meniscus root healing rates and medial meniscal extrusion (MME) according to the second MRI were compared between the two groups at the latest follow-up. RESULTS: The results showed a statistically significant improvement in the postoperative Lysholm score, IKDC score, and VAS score in both groups at the latest follow-up (P<0.001). The analysis of Minimal Clinically Important Difference (MCID) for postoperative outcomes revealed that the percentage of patients who reached MCID thresholds was 100% for Lysholm, 100% for IKDC, and 100% for VAS in the HTO with reconstruction MMPRT group. In comparison, the percentages were 87.9% for Lysholm, 90.9% for IKDC, and 100% for VAS in the HTO alone group. Additionally, compared with the HTO alone group, the HTO with medial meniscus posterior root reconstruction using gracilis tendon graft significantly improved the meniscus root healing rates (Complete healing 85.7% vs. 45.4%, 95%CI: 0.003-0.007, P=0.001) and functional recovery (P<0.005 ) at the final follow-up. Additionally, the HTO with reconstruction MMPRT had a significantly better change in K-L grade (improved knees K-L grade: 10/21 vs. 6/33, P=0.033) and MME (2.1±1.0mm vs. 3.1±1.6mm, 95%CI: 0.3-1.7, P=0.007) compared to the HTO alone group. CONCLUSIONS: HTO with reconstruction of the meniscal root using a tendon graft resulted in improved radiographic and patient-reported outcomes as well as improved healing rates compared to the HTO alone.

Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion.

Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture's proximity to the popliteal vascular-nervous elements. Badet's open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV.

Sex-specific loss of mitochondrial membrane integrity and mass in the auditory brainstem of a mouse model of Fragile X syndrome.

Sound sensitivity is one of the most common sensory complaints for people with autism spectrum disorders (ASDs). How and why sounds are perceived as overwhelming by affected people is unknown. To process sound information properly, the brain requires high activity and fast processing, as seen in areas like the medial nucleus of the trapezoid body (MNTB) of the auditory brainstem. Recent work has shown dysfunction in mitochondria, which are the primary source of energy in cells, in a genetic model of ASD, Fragile X syndrome (FXS). Whether mitochondrial functions are also altered in sound-processing neurons, has not been characterized yet. To address this question, we imaged the MNTB in a mouse model of FXS. We stained MNTB brain slices from wild-type and FXS mice with two mitochondrial markers, TOMM20 and PMPCB, located on the Outer Mitochondrial Membrane and in the matrix, respectively. These markers allow exploration of mitochondrial subcompartments. Our integrated imaging pipeline reveals significant sex-specific differences in the degree of mitochondrial length in FXS. Significant differences are also observable in the overall number of mitochondria in male FXS mice, however, colocalization analyses between TOMM20 and PMPCB reveal that the integrity of these compartments is most disrupted in female FXS mice. We highlight a quantitative fluorescence microscopy pipeline to monitor mitochondrial functions in the MNTB from control or FXS mice and provide four complementary readouts. Our approach paves the way to understanding how cellular mechanisms important to sound encoding are altered in ASDs.

Schatzker IV tibial plateau fractures: are they always unicondylar?

Objective: The objectives of this study were to describe the incidence and morphology of medial tibial plateau fractures that extend into the lateral articular surface and to describe trends in their management. Design: Retrospective. Setting: Level I Urban Trauma Center. Patients: Seventy consecutive patients sustaining OTA/AO 41 B1 and B3 fractures. Intervention: Open reduction internal fixation of medial tibial plateau fractures. Main Outcome Measurements: Incidence of medial tibial plateau fractures that extend into the lateral articular surface. Secondary outcomes include localization of lateral articular surface depression, neurovascular injury, and trends in surgical management. Results: Seventy patients were included with 9 fractures (12.9%) isolated to the medial condyle (MC) and 61 fractures (87.1%) extending to the lateral condyle (LC). Compartment syndrome was present in 2 patients (2.9%), peroneal nerve palsy in 2 (2.9%), and arterial injury in 1 (1.4%). Initial external fixation was used more frequently in the LC group compared with the MC group (P = 0.028). Of the 61 fractures in the LC group, 49 (80.3%) included lateral articular surface depression which localized to the posteromedial quadrant of the lateral articular surface in 36 of 49 fractures (73.5%). Lateral articular surface depression depth ≥10.6 mm was associated with the use of dual incisions (P < 0.001). Conclusions: Schatzker IV fractures frequently extend to the lateral condyle and often present with depression of the posteromedial lateral articular surface. Fractures with lateral articular surface depression depth ≥10.6 mm were more likely to undergo fixation with dual incisions. Level of Evidence: Therapeutic level IV.

Lidocaine-Associated CNS Toxicity at Therapeutic Dosage: A Case Report and Literature Review.

Lidocaine is a commonly used anesthetic. High doses or intravenous administration of lidocaine, as well as other local anesthetics, may result in systemic effects involving the cardiovascular and neurologic systems. Typically, effects are dependent on the serum concentrations of the offending agent. This is a case where a patient presented with symptoms of systemic lidocaine toxicity despite therapeutic dosage and an undetectable serum lidocaine concentration. A 47-year-old Caucasian male received a lumbar medial branch injection of lidocaine and presented with symptoms of perioral numbness, seizure-like activity, and confusion. The patient had a workup, including a CT head without acute findings and an undetectable serum lidocaine level. Due to symptoms consistent with systemic local anesthetic toxicity, intravenous lipid emulsion (ILE) was administered with resolution and without recurrence of symptoms. There should be a low threshold of suspicion for local anesthetic systemic toxicity when patients have neurologic or cardiovascular symptoms following exposure. Toxicity may be present despite therapeutic dosages and low serum concentrations. ILE may be beneficial and should be considered.

How I do it: Endoscopic endonasal resection of the medial wall of the cavernous sinus.

BACKGROUND: Resection of the medial wall of the cavernous sinus (MWCSR) is a growing surgical maneuver for the radical removal of pituitary adenomas. METHOD: We present a simple modification of the technique following the two dural layers of the floor of the sella turcica, allowing for early identification of the medial wall and simplifying dissection. We support this technique with an anatomical analysis on cadaveric specimens and clarifying dissection images. CONCLUSION: Recognition and dissection of the dural unfolding of the floor of the sella turcica are "key points" that lower the risk and facilitate the MWCSR.

Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes.

PURPOSE: This study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra-articular knee ligament reconstructions in elite athletes by reporting return-to-play (RTP) rates and levels, career longevity and complications. METHODS: A consecutive series of all extra-articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy-six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTP was defined as competing at professional level or national/international level in amateur sport. RESULTS: There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty-two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty-six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP. CONCLUSION: Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications. LEVEL OF EVIDENCE: Level IV.

Ketamine metabolism via hepatic CYP450 isoforms contributes to its sustained antidepressant actions.

(R,S)-ketamine (ketamine) has rapid and sustained antidepressant (AD) efficacy at sub-anesthetic doses in depressed patients. A metabolite of ketamine, including (2R,6R)-hydroxynorketamine ((6)-HNKs) has been reported to exert antidepressant actions in rodent model of anxiety/depression. To further understand the specific role of ketamine's metabolism in the AD actions of the drug, we evaluated the effects of inhibiting hepatic cytochrome P450 enzymes on AD responses. We assessed whether pre-treatment with fluconazole (10 and 20 mg/kg, i.p.) 1 hour prior to ketamine or HNKs (10 mg/kg, i.p.) administration would alter behavioral and neurochemical actions of the drugs in male BALB/cJ mice with a highly anxious phenotype. Extracellular microdialysate levels of glutamate and GABA (Gluext, GABAext) were also measured in the medial prefrontal cortex (mPFC). Pre-treatment with fluconazole altered the pharmacokinetic profile of ketamine, by increasing both plasma and brain levels of ketamine and (R,S)-norketamine, while robustly reducing those of (6)-HNKs. At 24 hours post-injection (t24h), fluconazole prevented the sustained AD-like response of ketamine responses in the forced swim test and splash test, as well as the enhanced cortical GABA levels produced by ketamine. A single (2R,6R)-HNK administration resulted in prevention of the effects of fluconazole on the antidepressant-like activity of ketamine in mice. Overall, these findings are consistent with an essential contribution of (6)-HNK to the sustained antidepressant-like effects of ketamine and suggest potential interactions between pharmacological CYPIs and ketamine during antidepressant treatment in patients.

Effects of aging on diaphragm hyperemia and blood flow distribution in male and female Fischer 344 rats.

Aging is associated with inspiratory muscle dysfunction, however, the impact of aging on diaphragm blood flow (BF) regulation, and whether sex-differences exist, is unknown. We tested the hypotheses in young animals, that diaphragm BF and vascular conductance (VC) would be greater in females and that aging would decrease the diaphragm's ability to increase BF with contractions. Young (4-6 months) and old (22-24 months) Fischer-344 rats were divided into four groups: Young Female (YF, n=7), Young Male (YM, n=8), Old Female (OF, n=9), and Old Male (OM, n=9). Diaphragm BF (ml/min/100g) and VC (ml/mmHg/min/100g) were determined, via fluorescent microspheres, at rest and during 1Hz contractions. In YF versus OF, aging blunted the increase in medial costal diaphragm BF (44 ± 5% vs. 16 ± 12%; P < 0.05) and VC (43 ± 7% vs. 21 ± 12%; P < 0.05). Similarly, in YM versus OM, aging blunted the increase in medial costal diaphragm BF (43 ± 6% vs. 24 ± 12%; P < 0.05) and VC (50 ± 6% vs. 34 ± 10%; P < 0.05). Compared to young, dorsal costal diaphragm BF was increased in OF while crural diaphragm BF was increased in OM (P < 0.05). Compared to age-matched females, dorsal costal diaphragm BF was lower in YM and OM (P < 0.05). Aging results in an inability to augment medial costal diaphragm BF and alters regional diaphragm BF distribution in response to muscular contractions. Further, sex differences in regional diaphragm BF are present in young and old animals.

Assessing the Effectiveness of Modified Tibial Plateau Leveling Osteotomy Plates for Treating Cranial Cruciate Ligament Rupture and Medial Patellar Luxation in Small-Breed Dogs.

In small-breed dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), correcting both disorders is are essential for restoring normal gait. However, the previously described surgical treatment, using two osteotomy technique, poses a high risk of fracture and instability. Addressing CCLR and MPL with a single osteotomy and implant was considered superior to the conventional method. Therefore, a pre-contoured modified tibial plateau leveling osteotomy (PCM-TPLO) plate facilitating medial shifting of the proximal tibia was developed. We compared postoperative alignment and strength between this novel plate group and a conventional tibial plateau leveling osteotomy (TPLO) plate group using eight small-breed dog cadavers each. Additionally, we investigated the potential of the novel plate as an alternative to tibial tuberosity transposition. Postoperative alignment and strength were assessed through radiographs and mechanical testing. Measurements including tibial plateau angle, mechanical medial proximal tibial angle, and number of screws within the joint were also analyzed. There were no significant differences in all measured parameters. For the novel plate, the medial displacement ratio of the proximal tibia was confirmed to be approximately 30%, and the result was thought to be appropriate. These findings suggest that the PCM-TPLO plate could be a promising alternative for treating concurrent CCLR and MPL in small-breed dogs.

Roadmap for maternal behavior research in domestic dogs: lessons from decades of laboratory rodent work.

Maternal behavior research in laboratory rats has revealed important behavioral and neurobiological mechanisms governing the onset, maintenance and decline of maternal behavior. However, the extent to which these mechanisms are evolutionarily conserved across species is less clear. This manuscript proposes that examining these mechanisms in dogs may be a viable approach to test their generality and help bridge the gap between rodent and human research, as domestic dogs show greater individual differences and exhibit more human-like maternal characteristics than rodents. These aspects represent advantages over rodent models, which in turn allow systems biological approaches not available in rodents. Additionally, domestic dogs share similar social environments with humans, suffer from the same mental disorders as humans, and can be treated with the same medications. This paper begins with a summary of key findings and theoretical developments from decades of rat maternal behavior research, followed by a literature review of the extant maternal behavior research on dogs and related methodology, highlighting the unique behavioral characteristics of dog maternal behavior and similarities and differences from rat maternal behavior. Finally, several knowledge gaps in dog maternal behavior research, as well as the future research in this area is discussed. It concludes that research on dog maternal behavior will not only advance our understanding of the universality of the neurobiological and behavioral mechanisms in maternal behavior, but also improve our understanding of risk factors associated with postpartum mental disorders.

Medial Rectus Muscle Injuries After Functional Endoscopic Sinus Surgery: A Case Study.

Functional endoscopic sinus surgery (FESS) is the preferred method for managing obstructive sinus disorders. However, its proximity to the orbit poses a risk of orbital complications. This study presents a case of a 61-year-old female who underwent FESS for chronic rhinosinusitis with nasal polyps and subsequently experienced a serious ophthalmic complication including retrobulbar hemorrhage and medial rectus muscle hematoma, leading to adduction deficit and diplopia. The patient's condition was evaluated through clinical assessment and imaging studies, to address the extent and nature of the injury to the medial rectus muscle. Management strategies included surgical exploration and resection along with botulinum toxin injection to the lateral rectus muscle in the affected eye done six months after observation and regular ophthalmic examination to ensure the stability of the angle of deviation. This case highlights the importance of proper preoperative assessment and personalized treatment plans to manage the complications associated with FESS and optimize patient outcomes.

Effects of three-dimensional femur and tibia postures on the parameters of standing long-leg radiographs for osteoarthritic knees in elderly female subjects.

BACKGROUND: Long-leg frontal radiographs of the lower extremities are used to assess knee osteoarthritis. Given the three-dimensional (3D) nature of alignment changes in osteoarthritis, postural alterations in the femur and tibia extend beyond the coronal plane (in-plane) to include the transverse and sagittal planes (out-of-plane). This study investigates the impact of these out-of-plane factors on in-plane knee alignment parameters observed in frontal radiographs. METHODS: A total of 97 osteoarthritic knees in women were examined. Using a 3D-to-two-dimensional (2D) image matching technique, we evaluated the 3D postures of the femur and tibia in the standing position as viewed from frontal radiographs in the world coordinate system. Statistical analyses were conducted to explore associations between these 3D postures and 2D alignment parameters obtained from frontal radiographs under identical conditions. FINDINGS: The femur exhibited a medial inclination of 2.7°, a posterior inclination of 3.9°, and an internal rotation of 4.2°, whereas the tibia showed a lateral inclination of 6.4°, an anterior inclination of 6.7°, and an internal rotation of 6.7°. Both coronal and rotational postures of femur and tibia influenced the hip-knee-ankle angle, mechanical axis percentage, and medial proximal tibial angle. However, only coronal factors of tibia impacted tibial joint line obliquity relative to the floor. INTERPRETATION: Attention should be paid to the potential impact of the out-of-plane postures of the femur and tibia on parameters assessed in plain frontal radiographs of the lower extremities.

Establishment and Validation of a Predictive Model for Sarcopenia Based on 2-D Ultrasound and Shear Wave Elastography in the Medial Gastrocnemius Muscle.

OBJECTIVE: To develop and validate a predictive model for sarcopenia. METHODS: A total of 240 subjects who visited our hospital between August 2021 and May 2023 were randomly divided by time of entry into a training set containing 2/3 of patients and a validation set containing 1/3 of patients. The muscle thickness (MT), echo intensity (EI), and shear wave velocity (SWV) of the medial gastrocnemius muscle were measured. Indicators that were meaningful in the univariate analysis in the training set were included in a binary logistic regression to derive a regression model, and the model was evaluated using a consistency index, calibration plot, and clinical validity curve. Diagnostic efficacy and clinical applicability were compared between the model and unifactorial indicators. RESULTS: Four meaningful variables, age, body mass index (BMI), MT, and SWV, were screened into the predictive model. The model was Logit Y = 21.292 + 0.065 × Age - 0.411 × BMI - 0.524 × MT - 3.072 × SWV. The model was well differentiated with an internally validated C-index of 0.924 and an external validation C-index of 0.914. The calibration plot predicted probabilities against actual probabilities showed excellent agreement. The specificity, sensitivity, and Youden's index of the model were 73.80%, 97.40%, and 71.20%, respectively, when using the diagnostic cut-off value of >0.279 for sarcopenia. The logistic model had higher diagnostic efficacy (p < 0.001) and higher net clinical benefit (p < 0.001) over the same threshold range compared to indicators. CONCLUSION: The logistic model of sarcopenia has been justified to have good discriminatory, calibrated, and clinical validity, and has higher diagnostic value than indicators.

Frequency-dependent seizure-suppressing effects of optogenetic activation of septal inhibitory cells in mesial temporal lobe epilepsy.

Mesial temporal lobe epilepsy (MTLE) is characterized by recurring focal seizures that arise from limbic areas and are often refractory to pharmacological interventions. We have reported that optogenetic stimulation of PV-positive cells in the medial septum at 0.5 Hz exerts seizure-suppressive effects. Therefore, we compared here these results with those obtained by optogenetic stimulation of medial septum PV-positive neurons at 8 Hz in male PV-ChR2 mice (P60-P100) undergoing an initial, pilocarpine-induced status epilepticus (SE). Optogenetic stimulation (5 min ON, 10 min OFF) was performed from day 8 to day 12 after SE at a frequency of 8 Hz (n = 6 animals) or 0.5 Hz (n = 8 animals). Surprisingly, in both groups, no effects were observed on the occurrence of interictal spikes and interictal high frequency oscillations (HFOs). However, 0.5 Hz stimulation induced a significant decrease of seizure occurrence (p < 0.05). Such anti-ictogenic effect was not observed in the 8 Hz protocol that instead triggered seizures (p < 0.05); these seizures were significantly longer under optogenetic stimulation compared to when optogenetic stimulation was not implemented (p < 0.05). Analysis of ictal HFOs revealed that in the 0.5 Hz group, but not in the 8 Hz group, seizures occurring under optogenetic stimulation were associated with significantly lower rates of fast ripples compared to when optogenetic stimulation was not performed (p < 0.05). Our results indicate that activation of GABAergic PV-positive neurons in the medial septum exerts seizure-suppressing effects that are frequency-dependent and associated with low rates of fast ripples. Optogenetic activation of medial septum PV-positive neurons at 0.5 Hz is efficient in blocking seizures in the pilocarpine model of MTLE, an effect that did not occur with 8 Hz stimulation.

Ultrasound detection of non-atherosclerotic intima-medial abnormalities of lower limbs arteries in amateur endurance runners.

BACKGROUND: Structural changes in the lower limb's arterial wall in amateur endurance runners are a rare incidental finding, represented just by several case reports. AIM: Study the incidence of non-atherosclerotic lower limb artery wall changes in defined group of amateur endurance runners and identify relationship with the training parameters and the relevant biochemical markers. METHODS: Amateur male athletes engaged in endurance running for more than 5 years were enrolled. Tibial and anterior popliteal arteries on each side were examined by ultrasound with focus on non-atherosclerotic structural wall changes: intima-medial border blurring, presence and character of non-atherosclerotic noduli. Subsequently the descriptive and correlation analysis were performed. RESULTS: The study enrolled 20 amateur male endurance runners from Black Swan Triathlon Club Slovakia. The low atherosclerotic risk was represented by normal lipid levels, BMI under 30 kg/m2 and non-smokers in all participants. At least one type of structural artery wall abnormality (noduli or intima-medial border blurring) was present in 19 of 20 participants (95%). The most present was the intima-medial blurring. (80% of participants). The noduli were present in 65% of study group, in almost 40% of these, they were considered as hyperechogenic. All these affections were predominantly in popliteal artery area (65%). The vast majority has bilateral affection. We find a mild correlation between these ultrasound findings and training load represented by annual kilometers and run hours. There was no association between these changes and lipid spectrum or CRP level. CONCLUSION: The subclinical lower limb artery changes, represented by intima-medial border blurring and non-atherosclerotic noduli were present in almost every amateur endurance runner. Despite the underlying mechanism is not understood, the increased training load seems to be one of the responsible factors.

Influence of different standing positions on anatomical parameters of coronal whole-leg weight-bearing radiographs in preoperative planning for high tibial osteotomy.

Purpose: The purpose of this study was to assess the differences in lower limb global alignment and anatomical parameters of coronal whole-leg radiographs, which were generally used in preoperative planning for high tibial osteotomy (HTO), according to different weight-bearing standing positions. Methods: Between April 2021 and December 2022, 176 patients (60 males and 116 females) were investigated. Full-weight-bearing coronal whole-leg radiographs were obtained with the patella centred on the femoral condyle. Patients were divided by Kellgren-Lawrence grade (KL-0, KL-I, KL-II and KL-III) and assessed in two standing positions: legs closed and legs spread. Patients with flexion contractures or those unable to stand with full weight bearing were excluded. The mechanical distal femoral angle, medial proximal tibial angle (MPTA), femorotibial angle, joint line convergence angle, percentage weight-bearing line (%WBL) and hip-knee-ankle angle (HKAA) were measured. The Student's t test was used to compare the two standing positions. A p value < 0.05 indicated a statistically significant difference. Results: The MPTAs of legs closed standing and legs spread standing were 84.9 ± 2.6° and 85.1 ± 2.4° in KL-0, 84.7 ± 2.0° and 84.9 ± 2.1° in KL-I and 85.0 ± 2.43° and 85.4 ± 2.4° in KL-II, respectively. There were statistically significant differences in the MPTA between the two standing positions in KL-0, KL-I and KL-II. In contrast, the %WBL and HKAA did not change regardless of the standing position. In the KL-III group, no statistical significance was observed for any of the anatomical parameters. Conclusion: Several anatomical parameters were changed between the legs closed standing and the legs spread standing positions. It was suggested that the standing position should be taken into consideration in the planning for HTO. Level of Evidence: Level IV, Case series with no comparison group.

Required force for distraction during medial opening wedge high tibial osteotomy may serve as a predictive indicator for lateral hinge fracture.

Introduction: Medial open wedge high tibial osteotomy is a biological procedure for treating unicompartmental knee osteoarthritis. The literature repeatedly highlights the significance of preserving an intact lateral hinge during this procedure. We investigated the temporal course of distraction forces during distraction at the osteotomy site, aiming to quantitatively measure and analyse temporal changes in distraction forces at different distraction points for intact and fractured lateral hinges. Materials and Methods: This biomechanical study was conducted on 10 human cadavers, which were divided into two groups: one with preserved 1 cm intact lateral cortexes (ILCs) and the other with completely osteotomised fractured lateral cortexes (FLCs). An experimental setup was custom designed to facilitate the required force measurement during distraction. The distraction forces were recorded with a force gauge at 0.5-mm intervals throughout the distraction. Results: There was a significant difference between the ILC and FLC groups in distraction forces at all points (8-15 mm). The ILC group consistently exhibited higher distraction force values, with FLC recording values ranging from 8.8% to 13.2% of ILC's. Lateral hinge fractures caused an 86.7% reduction in the initial required force for distraction, significantly impacting the force required for distraction. The ILC group displayed a linear increase in the required distraction force up to 12.5 mm of distraction, which reached 3.7 times the initial value at 12.5 mm of distraction. The FLC group had lower baseline required distraction forces, following a relatively linear trend with more limited increases. Conclusion: FLCs in medial opening wedge osteotomy are associated with significant reductions in the force required for distraction, and a sudden decrease in distraction force during distraction may indicate a lateral hinge fracture. Force measurement devices for use during distraction could offer valuable insights and provide surgeons with immediate warnings for LHFs. Level of Evidence: Level IV.

Medial swivel dislocation with impacted navicular bone into the talar head: A case report.

Medial swivel dislocation is a rare subtype of midtarsal bone dislocation, mostly associated with fracture rather than isolated dislocation. It is caused by medially or laterally direct forces to the midfoot. In case of failed closed reduction of the deformity, the patient should undergo open reduction and stabilization of the injury as soon as possible. We are presenting a 17-year-old, male, who sustained a left ankle injury and presented with a deformity, closed reduction of the deformity failed multiple times, and the patient was taken for open reduction and stabilization of the deformity in the operating theater. Intra-operatively, the dislocation was locked with the lateral process of the navicular being impacted into the taller head. Six months following the injury the patient was back to his pre-injury status and did not have any recurrent dislocation of the midfoot.