Objective results at 1 year of a new ultracongruent postero-stabilized total knee arthroplasty

Introduction: A new ultra congruent, postero-stabilized total knee arthroplasty (TKA) with a mobile bearing, the FIRST knee prosthesis (Free Insert in Rotation Stabilized in Translation, Symbios SA), was designed and expected to significantly reduce polyethylene wear, to improve the range of motion and the overall stability of the knee while ensuring a physiological ligament balance. Gait analysis has proven to give really objective outcome parameters after lower limb surgery. The goal of our study was to compare the subjective and really objective results of this new TKA with two other widespread models of TKA. Methods: A clinical prospective monocentric cohort study of 100 consecutive patients (47-88 yrs) undergoing a FIRST TKA for primary osteoarthritis is currently being done. Pre- and post-operative follow-ups (6 weeks, 4 months and 1 year) were done with well-recognized subjective evaluations (EQ-5D and WOMAC scores) and semi-objective questionnaires (KSS score and radiography evaluation) as well as with a really objective evaluation using gait parameters from 6 walking trials, performed at different speeds (slow, normal and fast) with an ambulatory gait analysis system (Physilog®, BioAGM CH). The outcomes of the first 32 new TKA after one year of follow-up were compared to the results after 1 year of a randomized controlled clinical trial comparing 29 NexGen® postero-stabilized TKA (Zimmer Inc) with a fixed bearing and 26 NexGen® TKA with a mobile bearing using the same methods. Results: Subjective and semi-objective results were similar for the three types of TKA. As for the really objective parameters, the gait cycle time of the FIRST TKA was statistically significantly shorter at normal speed of walk, as well as double-support periods, as compared to both standard models. The extension (in terms of range of motion when walking) of the operated knee was significantly improved for all three types of walk in favour of the FIRST TKAs compared to both NexGen TKAs. The normal walking speed was significantly higher with faster swing speed and stride lengths for the new TKA. Significantly better coordination scores were observed at normal walking speed for the FIRST TKA as compared to the fixed-bearing TKAs. Conclusion: The FIRST TKAs showed statistically significantly better objective outcomes in terms of gait after one year of follow-up with similar subjective and semi-objective results in comparison with widespread TKA designs. These encouraging short-terms results will have to be confirmed at a 5 years follow-up of the FIRST TKAs.

Avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal: report of a case.

Isolated avulsion fracture of the peroneus longus tendon insertion at the base of the first metatarsal is very rare. Similar to most avulsion fractures that result from excessive strain at a tendon or ligament insertion, this type of injury is caused by the strong tension exerted by the peroneus longus tendon. The mechanisms leading to this lesion and treatment options are not clearly defined. We present the case of an isolated minimally displaced intra-articular avulsion fracture at the plantar lateral base of the first metatarsal. Faced with a painful non-union following conservative treatment we considered excision of the bony fragment and first tarsometatarsal arthrodesis. This leads to a favourable functional outcome.

Mutations in B3GALT6, which encodes a glycosaminoglycan linker region enzyme, cause a spectrum of skeletal and connective tissue disorders.

Proteoglycans (PGs) are a major component of the extracellular matrix in many tissues and function as structural and regulatory molecules. PGs are composed of core proteins and glycosaminoglycan (GAG) side chains. The biosynthesis of GAGs starts with the linker region that consists of four sugar residues and is followed by repeating disaccharide units. By exome sequencing, we found that B3GALT6 encoding an enzyme involved in the biosynthesis of the GAG linker region is responsible for a severe skeletal dysplasia, spondyloepimetaphyseal dysplasia with joint laxity type 1 (SEMD-JL1). B3GALT6 loss-of-function mutations were found in individuals with SEMD-JL1 from seven families. In a subsequent candidate gene study based on the phenotypic similarity, we found that B3GALT6 is also responsible for a connective tissue disease, Ehlers-Danlos syndrome (progeroid form). Recessive loss-of-function mutations in B3GALT6 result in a spectrum of disorders affecting a broad range of skeletal and connective tissues characterized by lax skin, muscle hypotonia, joint dislocation, and spinal deformity. The pleiotropic phenotypes of the disorders indicate that B3GALT6 plays a critical role in a wide range of biological processes in various tissues, including skin, bone, cartilage, tendon, and ligament.

In vitro evaluation of the temperature increment at the external root surface after Er,Cr: YSGG laser irradiation of the root canal

Objectives: A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. Design. Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 μm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. Results: At the 1 W power setting, the mean temperature increment was 3.84ºC versus 5.01ºC at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p< 0.05). Conclusions: Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth

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In the past 2 decades, there has been an increase in both basic science research detailing the anatomy and biomechanics of the native posterior cruciate ligament (PCL) and outcome studies evaluating manage- ment of the ruptured PCL. While the methodology of the latter continues to improve, results based on the current level of evidence must be interpreted cautiously (18). The focus of many recent studies has been double-bundle versus single-bundle reconstruction techniques. The theoretical advantage goes to double-bundle techniques, but a clinical difference in outcome has not been consistently demonstrated (8,17). Some biomechanical studies have reported improved control of posterior laxity with double-bundle reconstruc- tion; however, results appear to be more dependent on tunnel position and graft tensioning (13). In acute isolated symptomatic PCL injuries in which the posteromedial bundle and the meniscofemoral ligament remain intact, a single-bundle augmentation procedure may be the preferred surgical technique. In more complex PCL ruptures with associated injuries involving the posterolateral structures (PLS) or medial collateral ligament, more benefit may be derived from double-bundle reconstruction. Again, cadaveric testing of double-bundle PCL reconstruction has not consistently outperformed single-bundle techniques in combined PCL/PLS injury (3). Multi-ligamentous injuries are commonly associated with PCL rupture (15), and their management should be considered carefully in the decision to reconstruct one or both of the functionally dis- tinct PCL bundles. However, the technical complexity of double-bundle reconstruction, the longer surgical time required, as well as the inconclusive clinical outcome are all factors that must be weighed carefully.

Eficacia del kinesiotape en el tratamiento de los esguinces crónicos de tobillo en el baloncesto

Es un estudio experimental de tipo ensayo clínico aleatorizado. El objetivo principal de este estudio es comprobar si hay una mejora en el esguince crónico del ligamento lateral externo del tobillo en jugadores de baloncesto con la aplicación de Kinesiotape. El estudio que se lleva a cabo tendrá una muestra de 28 individuos que pertenecen al Club Bàsquet Lliçà d’Amunt de entre 12 y 31 años y que tengan un esguince crónico de tobillo de más de 6 meses de evolución. Se harán dos grupos de 14 individuos cada uno de forma aleatorizada, el primero será el grupo intervención y el segundo el grupo control. Se valorará el dolor de los jugadores cada dos semanas mediante una escala EVA y un algómetro y la funcionalidad mediante la goniometría. Posteriormente se analizarán los resultados con el programa estadístico SPSS 19.0 (Ilinois, Chicago) y se elaborarán las conclusiones y un informe. Las principales limitaciones que podemos encontrar en este estudio son la pérdida de jugadores por diferentes motivos, que sufran alguna lesión de gravedad, que el calendario de competición nos afecte a la continuidad del estudio y la caída del kinesiotape antes de lo previsto y que no se informe al fisioterapeuta.

Hérnia perineal após disjunçao da sínfise púbica: apresentação de caso e técnica para correção

Traunatic perineal hernia remains a rare clinical entity despite an overall increase in blunt trauma. Because of the incidence of other associated injuries, the mortality is high. Most of the perineal defects are repaired during the orthopaedics surgery to reconstitute the pelvis and few patients develop a true perineal hernia without pelvic instability. A 80-year-old woman was involved in a running over accident with disjunction of pubic symphysis, dislocation of sacrum-iliac junction and fracture of pubis and ischium. The patient was submitted to an orthopaedic surgery and latter development an perineal hernia through the genitalia. The diagnosis could be established with physical examination alone. Conventional radiology, computadorized tomography, and ultrasound should also be done to progran the surgery. The repair approach was performed using a marlex mesh, fixed in the pelvic bones, Cooper ligament, and the abdominal wall. The mesh was stood in a retro- peritoneal position, rebuilding the pelvic floor without reconstruction the pelvic bones. We conclude that this is an efficient approach to repair of traumatic postoperative perineal hernia, mainly in patients with high operative risk, when the osseous repair is not necessary.

Leiomioma perfurado do intestino delgado

A perforated jejunal leiomyoma is a rare condition; only seven cases have been described in the literature. We report a case of a 45 years old man with a perforate acute abdomen. At laparotomy, a 12 cm multilobulated firm mass, located 20 cm distal from Treitz ligament, was removed. Histological sections disclosed a jejunal leiomyoma. The benign pattern of the lesion was confirmed with no mitosis and no atypical cellurarity. Five years later, the patient is free of the disease.

Impact of Sacrospinous Colpopexy Associated with Anterior Colporrhaphy for the Treatment of Dome Prolapse on all Three Vaginal Compartments

Objective To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of women with post-hysterectomy vaginal vault prolapse. Methods This prospective study included 20women with vault prolapse, PelvicOrgan Prolapse Quantification System (POP-Q) stage≥2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Results Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. Conclusions In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associatedwith anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system.

Acetabular deepening in the treatment of severe canine hip dysplasia

A technique to restore acetabular anatomy by deepening the acetabular cavity and reconstructing the femoral head ligament and the joint capsule was tested on nine large breed dogs with severe hip dysplasia and acute subdislocation or dislocation. The technique consisted of two phases. First, all dogs were submitted to bilateral pectinotomy. In a second surgical intervention on the same dogs the acetabulum was approached and deepened, and the femoral head ligament and the joint capsule were reconstructed. In general, within 30 days of the surgery dogs could stand on the operated member to walk. Except for two dogs, all the others recovered pelvic member locomotive ability within 60-90 days after surgery. It is concluded that acetabuloplasty is a good alternative for treatment of severe canine hip dysplasia.

Evaluation of a model for induction of periodontal disease in dogs

There are several methods for inducing periodontal disease in animal models, being the bone defect one of the most reported. This study aimed to evaluate this model, through clinical, radiographic, tomographic and histological analyzes, thus providing standardized data for future regenerative works. Twelve dogs were subjected to the induction protocol. In a first surgical procedure, a mucoperiosteal flap was made on the buccal aspect of the right third and fourth premolars and a defect was produced exposing the furcation and mesial and distal roots, with dimensions: 5mm coronoapical, 5mm mesiodistal, and 3mm buccolingual. Periodontal ligament and cementum were curetted and the defect was filled with molding polyester, which was removed after 21 days on new surgical procedure. Clinical and radiographic examinations were performed after the two surgeries and before the collection of parts for dental tomography and histological analysis. All animals showed grade II furcation exposure in both teeth. Clinical attachment level increased after induction. Defect size did not change for coronoapical and buccolingual measurements, while mesiodistal size was significantly higher than at the time of defect production. Radiographic analysis showed decreased radiopacity and discontinuity of lamina dura in every tooth in the furcation area. The horizontal progression of the disease was evident in micro-computed tomography and defect content in the histological analysis. Therefore, it is concluded that this method promotes the induction of periodontal disease in dogs in a standardized way, thus being a good model for future work.

Bone morphogenetic proteins: from structure to clinical use

Bone morphogenetic proteins (BMPs) are multi-functional growth factors belonging to the transforming growth factor ß superfamily. Family members are expressed during limb development, endochondral ossification, early fracture, and cartilage repair. The activity of BMPs was first identified in the 1960s but the proteins responsible for bone induction were unknown until the purification and cloning of human BMPs in the 1980s. To date, about 15 BMP family members have been identified and characterized. The signal triggered by BMPs is transduced through serine/threonine kinase receptors, type I and II subtypes. Three type I receptors have been shown to bind BMP ligands, namely: type IA and IB BMP receptors and type IA activin receptors. BMPs seem to be involved in the regulation of cell proliferation, survival, differentiation and apoptosis, but their hallmark is their ability to induce bone, cartilage, ligament, and tendon formation at both heterotopic and orthotopic sites. This suggests that, in the future, they may play a major role in the treatment of bone diseases. Several animal studies have illustrated the potential of BMPs to enhance spinal fusion, repair critical-size defects, accelerate union, and heal articular cartilage lesions. Difficulties in producing and purifying BMPs from bone tissue have prompted the attempts made by several laboratories, including ours, to express these proteins in the recombinant form in heterologous systems. This review focuses on BMP structure, molecular mechanisms of action and significance and potential applications in medical, dental and veterinary practice for the treatment of cartilage and bone-related diseases.

Protective effects of tumor necrosis factor-α blockade by adalimumab on articular cartilage and subchondral bone in a rat model of osteoarthritis

We aimed to investigate the effects of an anti-tumor necrosis factor-α antibody (ATNF) on cartilage and subchondral bone in a rat model of osteoarthritis. Twenty-four rats were randomly divided into three groups: sham-operated group (n=8); anterior cruciate ligament transection (ACLT)+normal saline (NS) group (n=8); and ACLT+ATNF group (n=8). The rats in the ACLT+ATNF group received subcutaneous injections of ATNF (20 μg/kg) for 12 weeks, while those in the ACLT+NS group received NS at the same dose for 12 weeks. All rats were euthanized at 12 weeks after surgery and specimens from the affected knees were harvested. Hematoxylin and eosin staining, Masson's trichrome staining, and Mankin score assessment were carried out to evaluate the cartilage status and cartilage matrix degradation. Matrix metalloproteinase (MMP)-13 immunohistochemistry was performed to assess the cartilage molecular metabolism. Bone histomorphometry was used to observe the subchondral trabecular microstructure. Compared with the rats in the ACLT+NS group, histological and Mankin score analyses showed that ATNF treatment reduced the severity of the cartilage lesions and led to a lower Mankin score. Immunohistochemical and histomorphometric analyses revealed that ATNF treatment reduced the ACLT-induced destruction of the subchondral trabecular microstructure, and decreased MMP-13 expression. ATNF treatment may delay degradation of the extracellular matrix via a decrease in MMP-13 expression. ATNF treatment probably protects articular cartilage by improving the structure of the subchondral bone and reducing the degradation of the cartilage matrix.

Caractérisation d'un modèle animal de douleur articulaire associée à l'arthrose du genou chez le rat Sprague-Dawley

La douleur articulaire associée à l’arthrose est un problème clinique majeur, spécialement chez les personnes âgées. L’intensité de la douleur est souvent amplifiée lors de mouvement de l’articulation et principalement lors du soutien de la charge corporelle sur le membre lésé. Malheureusement, les traitements pharmacologiques proposés sont trop souvent associés à des effets secondaires néfastes et à une inefficacité pour le soulagement de la douleur à long terme. Divers modèles murins sont utilisés en laboratoire de recherche pour des études précliniques de molécules aux propriétés analgésiques. Une évaluation comparative de la réponse comportementale douloureuse des animaux d’un modèle d’instabilité articulaire induit par le sectionnement du ligament croisé antérieur accompagné d’une méniscectomie partielle (le modèle ACLT+pMMx) et d’un modèle de dégénérescence articulaire induite par le monoiodoacetate (le modèle MIA) a permis de sélectionner un modèle approprié pour la continuité du projet. Les deux modèles ont démontré des lésions tissulaires, mais le modèle MIA a démontré une réponse douloureuse plus prononcée que le modèle ACLT+pMMx. Par l’analyse de la démarche, le modèle MIA a démontré une boiterie claire dans le patron de la démarche des animaux qui est associée à une lésion unilatérale. Le modèle MIA a donc été choisi pour la suite du projet. La problématique principale dans la recherche sur la douleur associée à l’arthrose est une compréhension incomplète des mécanismes de douleur responsables de l’induction et du maintien de l’état de douleur. Il devient donc nécessaire d’améliorer nos connaissances de ces mécanismes en effectuant une caractérisation plus approfondie des modèles animaux employés pour l’évaluation de stratégies pharmacologiques analgésiantes. Afin de bien comprendre le modèle MIA, une caractérisation des événements moléculaires centraux lors de la progression du processus dégénératif des structures articulaires de ce modèle s’est effectuée aux jours 3, 7, 14, 21 et 28 post injection. Des mécanismes hétérogènes qui modulent l’information nociceptive en fonction de la progression temporelle de la pathologie ont été observés. Les changements du contenu i spinal des neuropeptides sélectionnés (substance P, CGRP, dynorphine A et Big dynorphine) ont débuté sept jours suivant l’injection de MIA. L’observation histologique a démontré que les dommages structuraux les plus importants surviennent entre les jours 14 et 21. C’est entre les jours 7 et 21 que les lésions démontrent le plus de similarités à la pathologie humaine. Cela suggère que lors d’une évaluation préclinique d’un traitement pharmacologique pour pallier la douleur articulaire utilisant le modèle MIA, l’étude doit tenir compte de ces événements afin de maximiser l’évaluation de son efficacité. Puisque les traitements pharmacologiques conventionnels proposés pour le soulagement de la douleur ne font pas l’unanimité en terme d’efficacité, d’effets non désirés et de coûts monétaires parfois onéreux, les molécules de dérivés de plante deviennent une alternative intéressante. L’eugénol, le principal constituant de l’huile de clou de girofle, a été administré oralement pour une période de 28 jours chez des rats ayant reçu l’injection intra-articulaire de MIA afin d’évaluer son efficacité pour le traitement de la douleur articulaire. L’eugénol à une dose de 40 mg/kg s’est révélé efficace pour l’amélioration du patron de la démarche des animaux ainsi que pour la diminution de l’allodynie mécanique secondaire. De plus, les concentrations spinales de neuropeptides pronocicepteurs ont diminué chez les animaux traités. Par une évaluation histopathologique, l’eugénol n’a démontré aucune évidence d’effets toxiques suite à une administration per os quotidienne pour une période prolongée. Ces résultats suggèrent le potentiel thérapeutique complémentaire de la molécule d’eugénol pour le traitement de la douleur articulaire.