Längsschnittliche Veränderungen von Muskelfunktionsvariablen vor dem Hintergrund bewegungstherapeutischer Interventionen nach operativer Rekonstruktion des vorderen Kreuzbandes

Anterior cruciate ligament; physical therapy; muscle function variables; longitudinal; m. quadriceps femoris; postoperative

Teaching clinical anatomy of the female pelvic floor to undergraduate students: A critical review of nevralgic points

Pelvic floor anatomy is complex and its three-dimensional organization is often difficult to understand for both undergrad- uate and postgraduate students. Here, we focused on several critical points that need to be considered when teaching the perineum. We have to deal with a mixed population of students and with a variety of interest. Yet, a perfect knowledge of the pelvic floor is the basis for any gynecologist and for any surgical intervention. Our objectives are several-fold; i) to estab- lish the objectives and the best way of teaching, ii) to identify and localize areas in the female pelvic floor that are suscepti- ble to generate problems in understanding the three-dimensional organization, iii) to create novel approaches by respecting the anatomical surroundings, and iv) prospectively, to identify elements that may create problems during surgery i.e. to have a closer look at nerve trajectories and on compression sites that may cause neuralgia or postoperative pain. A feedback from students concludes that they have difficulties to assimilate this much information, especially the different imaging tech- niques. Eventually, this will lead to a severe selection of what has to be taught and included in lectures or practicals. Another consequence is that more time to study prosected pelves needs to be given.

Neotropical monogenoidea. 25. Anacanthorus penilabiatus n. sp. (Dactylogyridae, Anacanthorinae) from Piaractus mesopotamicus (Osteichthyes, Serrasalmidae), cultivated in the State of São Paulo, Brazil

Anacanthorus penilabiatus n. sp. is described from the serrasalmid fish, Piaractus mesopotamicus (Holmberg, 1887), cultivated in the Centro de Aqüicultura, Universidade Estadual Paulista. The new species is characterized by having a relatively straight copulatory organ with a long "lip" on the distal margin and a median longitudinal flap, and a copulatory ligament. The large size of the infrapopulations of this species of parasite indicates that it should be considered a potential agent causing losses in aquaculture of the fish host.

Evaluation of the 3D symmetry of the knees when walking using na ambulatory inertia system: results 14 months after ACL Plasty.

Purpose of the study: Reconstruction of the anterior cruciate ligament (ACL) controls laxity but does not enable restoration of strictly normal 3D kinematics. The purpose of this study was to compare the kinematics of the pathological knee with that of the healthy knee after ACL plasty. This study applied a new ambulatory system using miniature captors. Material and method: Five patients with an isolated injury of the ACL participated in this study. The patients were assessed after injury (T1), at five months (T2), and at 14 months (T3) after surgery. The assessment included laxity (KT-1000), the IKDC score and the Lysholm score. The 3D angles of the knees were measured when walking 30 m on flat ground using a system composed of to small inertia units (3D accelerometer and 3D gyroscope) and a portable recorder. Functional settings were optimised and validating to ensure easy precise measurement of the 3D angles. Symmetry of the two knees was quantified using a symmetry index (SI) (difference in amplitude normalised in relation to mean amplitude) and the correlation coefficient CC. Results: Clinical indicators improved during the follow-up (IKDC T1: 3C, 2C; T2: 5B; T3: 2A, 3B; subjective IKD: 53-95; Lysholm 67-96). Mean laxity improved from 8.6m to 2.5 mm. The gait analysis showed increased symmetry in terms of amplitude for flexion-extension (SI: −17% at T1, −1% at T2, 1% at T3), and an increase in symmetry in terms of the rotation signature (CC: 0.16 at T1, 0.99 at T2, 0.99 at T3). There was no trend to varus-valgus. Discussion: This study demonstrates the clinical application of the new ambulatory system for measuring 3D angles of the knee joint. Joint symmetry increased after ACL plasty but still showed some perturbation at 14 months. The results observed here are in agreement with the literature. Other patients and other types of gait are being analysed. Conclusion: This portable system allows gait analysis outside the laboratory, before and after ACL injury. It is very useful for follow-up after surgery.

Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion.

PURPOSE: To document the neurological outcome, spinal alignment and segmental range of movement after oblique cervical corpectomy (OCC) for cervical compressive myelopathy. METHODS: This retrospective study included 109 patients--93 with cervical spondylotic myelopathy and 16 with ossified posterior longitudinal ligament in whom spinal curvature and range of segmental movements were assessed on neutral and dynamic cervical radiographs. Neurological function was measured by Nurick's grade and modified Japanese Orthopedic Association (JOA) scores. Eighty-eight patients (81%) underwent either a single- or two-level corpectomy; the remaining (19%) undergoing three- or four-level corpectomies. The average duration of follow-up was 30.52 months. RESULTS: The Nurick's grade and the JOA scores showed statistically significant improvements after surgery (p < 0.001). The mean postoperative segmental angle in the neutral position straightened by 4.7 ± 6.5°. The residual segmental range of movement for a single-level corpectomy was 16.7° (59.7% of the preoperative value), for two-level corpectomy it was 20.0° (67.2%) and for three-level corpectomies it was 22.9° (74.3%). 63% of patients with lordotic spines continued to have lordosis postoperatively while only one became kyphotic without clinical worsening. Four patients with preoperative kyphotic spines showed no change in spine curvature. None developed spinal instability. CONCLUSIONS: The OCC preserves segmental motion in the short-term, however, the tendency towards straightening of the spine, albeit without clinical worsening, warrants serial follow-up imaging to determine whether this motion preservation is long lasting.

Stress radiography and posterior pathological laxity of knee: comparison between two different techniques.

Stress radiographs have been recommended in order to obtain a better objective quantification of abnormal compartment knee motion. This tool has showed to be superior in quantifying a posterior cruciate ligament (PCL) lesion compared to clinical or arthrometer evaluation. Different radiographic techniques have been described in literature to quantify posterior pathological laxity. In this study we evaluated the total amount of posterior displacement (PTD) and side to side difference (SSD), before and after surgical reconstruction of PCL or PCL and posterolateral complex (PLC), using two different stress radiography techniques (Telos stress and kneeling view). Twenty patients were included in this study. We found a statistical significant difference about both total PTD and SSD among the two techniques preoperatively and at follow-up, with greatest values occurring using the kneeling view. Although stress radiographies has been introduced to allow an objective quantification of laxity in ligamentous injured knee, we believe that further studies on a large numbers of subjects are required to define the relationship between PTD values, measured with stress knee radiography, particularly using kneeling view, and ligamentous knee injury, in order to obtain a real useful tool in the decision making process, as well as to evaluate the outcome after ligamentous surgery.

Pseudoaneurisma de la arteria geniculada descendiente medial tras reconstrucción astroscópica del ligamento cruzado anterior

Today, reconstructive arthroscopic knee surgery of the anterior cruciate ligament is a widely used technique. In addition to the usual complications of arthroscopic techniques, the extraction of the piece must be taken into consideration, with vascular complications being the rarest and most serious of them all. We present the case of a patient who suffered an arterial pseudoaneurysm during this procedure. The management and treatment are discussed and the current bibliography reviewed.

¿Es posible tratar una fractura supraintercondilea de codo por artroscopia?

This paper presents a new approach to the treatment of acute fractures in the elbow area, with the support of arthroscopic equipment. There are only a few studies that describe the indications, techniques and results of the arthroscopy-assisted treatment of these pathologies. The authors believe that this tool can be useful for achieving a precise definition of the type of bone-ligament injuries in an elbow joint, thus optimizing treatment and supporting early functional recovery.

Estudio comparativo del aloinjerto hth vs autoinjerto de isquiotibiales en la reparación del LCA. Presentacion de resultados de nuestra serie

Objective: To present and compare the functional outcomes and degree of satisfaction of patients operated on in the Knee Unit of our hospital, using bank BTB or Hamstring Autograft. Material and Methods: There were 96 patients included in the study who were operated on between 2001 and 2009 using bank BTB, and 104 patients operated on between 2007 and 2009 using Hamstring Autograft. All of them completed the IKDC questionnaire by telephone. Results: No significant differences were found between both groups regarding the onset of pain, inflammation, or instability of the knee. A large majority of patients in both groups were satisfied or very satisfied with the results obtained (81% of the BTB, and 90 % of the hamstring group). Conclusions: There are no sound reasons to proscribe either of the two techniques; the surgeon must decide the most appropriate intervention depending on the case, personal experience, the economic situation and especially the needs of the patient.

Controversias en artroplastia total de rodilla

Total knee replacement (TKR) is an operation that has radically improved the quality of life of millions of people during the last decades. However, some technical details, concerning the surgical procedure, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, related to TKR surgery like the use of tourniquet during operation, patellar resufacing, all-polyethilene tibial component, cemented or cementless fixation, mobile bearings, or posterior-stabilized versus cruciate-retaining prosthesis.

Arthroskopie bei Hüftdysplasie [Arthroscopy in hip dysplasia]

[The causal treatment of a residual hip dysplasia consists of an acetabular reorientation osteotomy, the results of which, however, strongly depend on concomitant intra-articular lesions. The most important prognostic factor is the cartilage status. However, tears in the labrum and the ligament of the head of the femur may also be responsible for symptoms. Hip arthroscopy is a valuable tool for a precise diagnosis and simultaneous treatment of these lesions. However, as yet no results supporting this treatment algorithm have been published.]

Type II and IIIA thumb hypoplasia reconstruction.

Thumb hypoplasia treatment requires considering every component of the maldevelopment. Types II and IIIA hypoplasia share common features such as first web space narrowing, hypoplasia or absence of thenar muscles and metacarpophalangeal joint instability. Many surgical techniques to correct the malformation have been described. We report our surgical strategy that includes modifications of the usual technique that we found useful in reducing morbidity while optimizing the results. A diamond-shape kite flap was used to widen the first web space. Its design allowed primary closure of the donor site using a Dufourmentel flap. The ring finger flexor digitorum superficialis was transferred for opposition transfer, and the same tendon was used to stabilize the metacarpophalangeal joint on its ulnar and/or radial side depending on a uniplanar or more global instability. An omega-shaped K-wire was placed between the first and second metacarpals to maintain a wide opening of the first web space without stressing the reconstructed ulnar collateral ligament of the MCP joint. We report a clinical series of 15 patients (18 thumbs) who had this reconstructive program.

A strange foot not far from CRPS I

Introduction.- Since the work of the "International Association for the Study of Pain" (IASP), complex regional pain syndrome type 1 (CRPS I) or algodystrophy includes motor disorders (tremor, dystony, myoclony) as diagnosis criterion. This can lead to confusion with some neurologic disorders which can wrongly be considered as CRPS I. The following observation illustrates this problem.Observation.- A 31-year-old man was hospitalised in a rehabilitation clinic in April 2007 with suspected CRPS I with persistent pain in the left leg. In 2005, the patient underwent ligament reconstruction at the right ankle. In May 2006, a recurrence of his ankle sprain was treated conservatively. The course of this pathology was unfavourable with an extension of the pain areas (leg and foot) as well as an appearance of abnormal motion. Toe motion in abduction was observed (especially T5) followed by a flexion cramp; an hypoesthesia in the sural nerve area, a scar allodynia and discrete vasomotor disorders. The scintigraphy was compatible with a stage 2 algodystrophy. Lower limb electromyography was normal; measurement of pseudo periodic activity of the motor unit at the foot level (abductor of the 5th toe, 4th interosseous). A "Painful legs and moving toes syndrome" was diagnosed which was treated with gabapentin and carbamazepine with a partial improvement.Discussion.- The "Painful legs and moving toes syndrome" is a rare pathology rehabilitation specialists should recognize. The origin is often peripheral nerve damage. The medullar interneuron activation (between the dorsal and ventral horn) is considered as the source of the efferent motor nerves which are responsible for the abnormal movements. This observation illustrates the need for a demanding approach before establishing the diagnosis of CRPS I and the respect of the 4th criterion of the ASP (exclusion of this syndrome when another pathology may explain pain and dysfunction).

The effect of femoral component rotation on the five-year outcome of cemented mobile bearing total knee arthroplasty.

PURPOSE: Performing total knee replacement, accurate alignment and neutral rotation of the femoral component are widely believed to be crucial for the ultimate success. Contrary to absolute bone referenced alignment, using a ligament balancing technique does not automatically rotate the femoral component parallel to the transepicondylar axis. In this context we established the hypothesis that rotational alignment of the femoral component parallel to the transepicondylar axis (0° ± 3°) results in better outcome than alignment outside of this range. METHODS: We analysed 204 primary cemented mobile bearing total knee replacements five years postoperatively. Femoral component rotation was measured on axial radiographs using the condylar twist angle (CTA). Knee society score, range of motion as well as subjective rating documented outcome. RESULTS: In 96 knees the femoral component rotation was within the range 0 ± 3° (neutral rotation group), and in 108 knees the five-year postoperative rotational alignment of the femoral component was outside of this range (outlier group). Postoperative CTA showed a mean of 2.8° (±3.4°) internal rotation (IR) with a range between 6° external rotation (ER) and 15° IR (CI 95). No difference with regard to subjective and objective outcome could be detected. CONCLUSION: The present work shows that there is a large given natural variability in optimal rotational orientation, in this study between 6° ER and 15° IR, with numerous co-factors determining correct positioning of the femoral component. Further studies substantiating pre- and postoperative determinants are required to complete the understanding of resulting biomechanics in primary TKA.

Trait decoupling promotes evolutionary diversification of the trophic and acoustic system of damselfishes.

Trait decoupling, wherein evolutionary release of constraints permits specialization of formerly integrated structures, represents a major conceptual framework for interpreting patterns of organismal diversity. However, few empirical tests of this hypothesis exist. A central prediction, that the tempo of morphological evolution and ecological diversification should increase following decoupling events, remains inadequately tested. In damselfishes (Pomacentridae), a ceratomandibular ligament links the hyoid bar and lower jaws, coupling two main morphofunctional units directly involved in both feeding and sound production. Here, we test the decoupling hypothesis by examining the evolutionary consequences of the loss of the ceratomandibular ligament in multiple damselfish lineages. As predicted, we find that rates of morphological evolution of trophic structures increased following the loss of the ligament. However, this increase in evolutionary rate is not associated with an increase in trophic breadth, but rather with morphofunctional specialization for the capture of zooplanktonic prey. Lineages lacking the ceratomandibular ligament also shows different acoustic signals (i.e. higher variation of pulse periods) from others, resulting in an increase of the acoustic diversity across the family. Our results support the idea that trait decoupling can increase morphological and behavioural diversity through increased specialization rather than the generation of novel ecotypes.