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The anterior cruciate ligament (ACL) is one of the most frequently studied structures of the musculoskeletal system and continues to stimulate debate and challenges among researchers and surgeons. The ultimate goal of anatomic reconstruction surgery is to restore the native anatomy as much as possible. However, this requires thorough knowledge of its anatomy. The aim of this article is to review the current knowledge of the anatomy of ACL along with its macrostructural and ultrastructural properties.

Summary Introduction Intraoperative fractures are a reported complication during the course of primary total knee replacement. Major ligament disruptions can also occur. Clinical data are lacking to tell how much these incidents affect implantation quality and outcome. Hypothesis A thorough knowledge of these occasional incidents helps proper decision making when confronted to such situations at surgery. Materials and methods This report is based on a series of primary, posterostabilized total knee arthroplasties (posterostabilized, mobile bearing TKA with a third median condyle from Tornier Laboratory). We studied all possible mechanical complications that developed during the course of arthroplasty and analyzed their cause. We compared the functional results of patients presenting these complications to those of the total series and to data from the literature. The entire operative reports for the 1795 TKA performed during this study were available and evaluated. A clinical and radiological review was performed for 1624 patients at an average follow-up time of 36.8 ± 34 (2–193) months. Results At this last follow-up, the average International Knee Society (IKS) score was 91.2 (19–100) and the function score was 77.76 (0–100). One hundred and thirty-two patients were deceased (unrelated to TKA) at this last follow-up evaluation. A total of 69 mechanical complications were accounted for at the time of surgery (3.8%): 40 definite fractures or fissures around the knee (2.2%), 29 tendon or ligament disruptions or attenuations (1.6%). The risk of tibial cracks was statistically more significant, with the smaller sizes tibial trays (size 1) (p = 0.019) or when an anterior tibial tuberosity elevation had been performed (p = 0.02). Survival curve analysis (at an average seven and a half-years postoperative follow-up) showed that all prosthetic components were still present in 93.3% of cases in the series of patients with these peroperative complications, and in 93.8% of cases in the series of patients without these intraoperative complications; this survival rate amounted to 91.9% of cases at an average 16-years postoperative follow-up. Conclusion This large, homogeneous series of primary, posterostabilized TKA took on 3.8% of intraoperative bone or ligament complications. All these complications could be prevented by a rigorous surgical technique. The improvement of ancillary materials, the saws, and good knowledge of such complications by the surgeon are essential. Level of evidence: Level IV. Therapeutic Study.

International audience; Collagen XVI is a homotrimeric molecule harbouring similarities to the FACIT (fibril-associated collagens with interrupted triple helices) family of collagens (Grassel et al., 1996). Collagen XVI is expressed in skin and cartilage where it is integrated into tissue specific aggregates (Grassel et al., 1999; Kassner et al., 2003). In the nervous system, collagen XVI has been detected at lowlevel in the brain and a strong expression was also reported in spinal root fibers during development (Lai and Chu, 1996). In dorsal root ganglia (DRG), analysis of SAGE banks performed by our group during development and after nerve injury (Mechaly et al., 2006) shows a fluctuation of collagen XVI expression between the different conditions and prompted us to study it further. DRGs contain the cell bodies of neurons, the axons of which transmit sensory information from the periphery to the central nervous system. While it is well known that during development and regeneration, neurites require extracellular matrix molecules for growth and guidance (Hari et al., 2004), the composition and the role of the matrix surrounding neurons in the ganglia itself have solicited little interest. Here, we show that collagen XVI is a component of the developingDRG extracellular matrix, that following nerve injury, its expression is increased around neuronal cell bodies and that neurons express collagen XVI in the peripheral nervous system.

(IF : 3,54); International audience; Gap junctional intercellular communication (GJIC) permits coordinated cellular activities during developmental and differentiation processes. In bone, the involvement of the gap junctional protein, connexin-43 (Cx43), and of GJIC in osteoblastic differentiation and mineralization of the extracellular matrix has been previously demonstrated. Former studies have shown that endothelin-1 (ET-1) was also implicated in the control of osteoblastic proliferation and differentiation. However, depending on the cellular models, ET-1 has been shown to decrease or increase osteoblastic differentiation markers. As no data were available on the ET-1 effect on GJIC and Cx43 expression in osteoblastic cells, we analyzed here the possible crosstalk between Cx43 and ET-1 in a human cell line (hFOB 1.19) which displays different Cx43 expression levels and phenotypes when cultured at 33.5 or 39 degrees C. The presence of ET-1 (10(-8) M) for 2-12 days of culture did not significantly alter the proliferation rate of hFOB cells whatever their phenotype. In contrast, ET-1 induced a differential inhibitory effect on the biochemical differentiation markers (alkaline phosphatase activity and osteocalcin expression) with a significant reduction in the differentiated phenotype at 39 degrees C, whereas no effects were measured at 33.5 degrees C. The inhibitory effect was linked to a decrease of GJIC and of Cx43 both at transcriptional and protein levels. Altogether, our results suggest that Cx43 expression level could influence the action of ET-1 on human osteoblastic cell differentiation. Our data also indicate that the gap junctional protein could play a pivotal role in the response of osteoblasts to mitogenic factors implicated in bone pathologies.

XXV Congress of the International Society of Biomechanics, GLASGOW, ROYAUME-UNI, 12-/07/2015 - 16/07/2015; Joint moments and joint powers during gait are widely used to determine the effects of rehabilitation programs as well as prosthetic fitting. Following the definition of power (dot product of joint moment and joint angular velocity) it has been previously proposed to analyse the 3D angle between both vectors, ?Mw. Basically, joint power is maximised when both vectors are parallel and cancelled when both vectors are orthogonal. In other words, ?Mw < 60° reveals a propulsion configuration (more than 50% of the moment contribute to positive power) while ?Mw > 120° reveals a resistance configuration (more than 50% of the moment contribute to negative power). A stabilisation configuration (less than 50% of the moment contribute to power) corresponds to 60° < ?Mw < 120°. Previous studies demonstrated that hip joints of able - bodied adults (AB) are mainly in a stabilisation configuration (?Mw about 90°) during the stance phase of gait. Individuals with transfemoral amputation (TFA) need to maximise joint power at the hip while controlling the prosthetic knee during stance. Therefore, we tested the hypothesis that TFAs should adopt a strategy that is different from a continuous stabilisation. The objective of this study was to compute joint power and ?Mw for TFA and to compare them with AB

International audience; Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. OPEN ACCESS Toxins 2015, 7 1630 Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.

PubMed: 26422349 Objective: Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. The most common complaints due to this condition are inability to walk, delayed walking, and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity. Methods: Fourteen knees of 9 patients operated on by a single surgeon between 2009-2012 were included in the study. The tensor fascia was divided into 2 strips, and these strips were passed via the joint and sutured to themselves. The combined procedure additionally includes lateral capsular release, vastus lateralis (VL) resection, medial capsular plication, and Z-plasty of the rectus femoris (RF) tendon. Results: Mean age at the time of surgery was 6.9±3.3 years (range: 4-13 years). The mean follow-up was 37.6±0.9 months (range: 26-49 months). Patellofemoral instability was restored for all patients by using combined surgical technique. Patellar lateralization developed in 2 patients, in whom stability was obtained via secondary medial plication. Conclusion: Our results show that this combined surgical procedure stabilizes the knee and treats patellar dislocation accompanying ligamentous laxity in pediatric patients. © 2015 Turkish Association of Orthopaedics and Traumatology.

Dear Sir or Madam, I read with great interest the article by Murphy et al. [1] entitled “Pediatric orthopaedic lower extremity trauma and venous thromboembolism.” The authors performed extensive research on the incidence of a relatively rare complication seen in children. They conclude in their final paragraph that, according to their analysis, adolescents older than 12 years of age appear to experience a higher incidence of venous thromboembolism (VTE) than infants and children do. However, they do not give any data in support of this conclusion. Furthermore, in the “Results” section, they give the average age of the patients as 12.9 years with a range of 0–19 years. Was there VTE in an infant less than 1 year of age due to lower extremity trauma, or was that a mistake? Given this asymmetric distribution, I wonder what the median age was in their study population? The authors underline that adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis were more commonly affected. It would be interesting to know more about the data that they did not include in the manuscript but which helped to lead them to these conclusions. Only 15 % of the VTE patients suffered polytrauma. How did the authors draw such a conclusion from the given data? Was a denominator available for the incidence of all polytrauma patients versus that of nonpolytrauma patients with lower extremity trauma? In polytrauma patients, additional organ injuries should be given as well as mentioning the number of diagnoses (in the range between 2 and 4). There is inconsistency in the manuscript regarding the number of patients who had at least one anticoagulant and were simultaneously coded with VTE and lower extremity orthopedic trauma. The number is given as 121 of 167 patients in the last paragraph of the “Results” section. However, if the number of patients who were treated with low-molecular-weight heparin, warfarin, or aspirin is added to the 24 patients who had more than one anticoagulant coded during the encounter, the total is 174 patients. In addition, all of the percentages of patients treated with individual anticoagulants were calculated using a denominator of 167, which should be 121 according to the first sentence of the last paragraph of the “Results” section. The authors provide a comprehensive review of the previous publications in the “Discussion,” but some of the reference citations are erroneous. The second paragraph of the “Discussion” starts by focusing on Georgopoulos et al.’s article [2], which is the ninth reference in the reference list at the end of the paper, whereas it is cited in the text as the eighth reference in the list. Also, Georgopoulos et al. found 74 cases, not 71, corresponding to an incidence of 0.0515 %, not 0.015 % as Murphy et al. mention in their article. The first sentence on page 383 starts with a discussion of Greenwald et al.’s article [3], which is the sixth reference in the reference list but is cited in the text as the fourth reference in the list. The third paragraph of the “Discussion” also contains mismatched reference citations. An article by Sabharwal and coauthors [4] surveying members of the Pediatric Orthopaedic Society of North America is the seventh reference in the reference list at the end of the paper but is cited in the text as the fifth reference in the list. The follow-up survey by Sabharwal et al. [5] is given as the eighth reference in the list, but is cited as the sixth. Finally, the last sentence of the fourth paragraph of the “Discussion” reports a survey by Sabharwal et al. [4] on using low-molecular-weight heparin to treat VTE; this is the seventh reference in the list but is cited as the ninth. It would be better if these citation errors had been corrected and brought to the reader’s attention through a clarification. To summarize, I think that Murphy et al. investigated a rare but important complication, but our understanding of the relevant pathophysiology would have been aided by providing more detailed clinical and demographic data along with the statistics included in the manuscript.

38ième congrès de la Société de Biomécanique francophone, MARSEILLE, FRANCE, 06-/09/2013 - 09/09/2013; Measuring hip joint centre (HJC) for seated posture in an automotive environment is a difficult task, because only a very limited number of anatomical landmarks (ALs) can be measured. There exist two classes of methods for estimating HJC location (see Bull et al. 2012 for a short review): regression method and functional method. However, they are not well suited to be directly applied to automotive seated posture. Recently, Bull et al. (2012) showed that the uncertainty in HJC by these two methods applied to automotive seated posture could be up to 4 cm due to errors in AL manual palpation and soft tissue artefacts. Interestingly, Bush and Gutowski (2003) proposed a method of locating HJCs for seated postures only using the right and left anterior superior iliac spines ([R/L]IAS) and the right or left femoral lateral epicondyles of the knee by assuming that the distances between HJC and these three ALs remained constant when changing posture. These distances needed to be firstly determined in an initial reference posture by Seidel's method. However, one strong limitation of Seidel's method is that the palpation of the pubic joint landmark (IPJ) is required, which usually causes volunteers to feel uncomfortable. Similar to the method by Bush and Gutowski, the aim of this study was to explore other ALs than IPJ for determining HJC. More specifically, the ilium ischial tuberosity (IIT) could be an alternative candidate as it can be indirectly estimated with the help of a pressure map by assuming that the highest pressure point corresponds to IIT when seated on a flat hard surface. In this study, data collected by Universite ?Libre de Bruxelles (ULB) from 48 adult cadaveric specimens were used for establishing regression equations. The proposed equations were compared with other existing bony landmark-based methods

We propose an optical-inertial tracking system for a servo-controlled handheld tool in a computer-assisted surgery system. We present a mathematical system description and a data fusion algorithm which integrates data from optical and inertial sensors. The algorithm is a right-invariant Extended Kalman Filter (EKF) which takes into account system symmetries to improve the filter convergence. The tracking system has a high bandwidth thanks to the inertial sensors and a low latency thanks to a direct approach where sensor data is used directly in the data fusion algorithm without previous computations. Experimental data show that the optical-inertial system can indeed track a moving object.

International audience; This chapter is focused on the specific phenomenon of wear (friction and fretting) and corrosion related to orthopedic implants. Both fields are closely linked through mechanical (wear) and chemical (corrosion) factors, and by mutual synergism. After defining differences between wear corrosion and fretting corrosion, we focus our attention on the synergism that exists between mechanical wear and corrosion. Careful characterization of synergistic effects has proved to be the key factor in determining the rates of tribological degradation of metals and alloys. Indeed, an insulating material, such as poly(methylmethacrylate) (PMMA), which is not susceptible to corrosion, is subjected to mechanical damage during wear or fretting. However, in the case of a metal fretting against a soft material like PMMA, the surface does not suffer purely mechanical degradation, as it is too hard and its mechanical properties (Young's modulus, yield strength, etc.) are far superior to those of PMMA. Thus, metals do suffer degradation under these circumstances when in contact with an aqueous solution, because of the conjoint action of corrosion and mechanics. Thus, this chapter is mainly focused on describing wear and fretting in a corrosive medium, their differences, and determining the effects of corrosion, mechanics and the synergistic interactions between them.

International audience; Apelin and its receptor APJ are expressed in fetal tissues but their function and regulation remain largely unknown. In rat, maternal treatment with a nitric oxide synthase inhibitor inducing hypertension was used to investigate apelin plasma levels in mother/fetus pairs and on the gene expression level of the apelin/APJ system in fetal tissues and placenta. At term, plasma levels of apelin were not modulated but APJ expression was increased in placenta and lung but reduced in heart. Apelin expression was increased only in the heart. We postulate that the apelinergic system may control fetal growth and cardiovascular functions in utero.

International audience; BackgroundThe purpose of this study was to investigate participation and performance changes in the multistage ultramarathon 'Marathon des Sables' from 2003 to 2012.MethodsParticipation and performance trends in the four- or six-stage running event covering approximately 250 km were analyzed with special emphasis on the nationality and age of the athletes. The relations between gender, age, and nationality of finishers and performance were investigated using regression analyses and analysis of variance.ResultsBetween 2003 and 2012, a number of 7,275 athletes with 938 women (12.9%) and 6,337 men (87.1%) finished the Marathon des Sables. The finisher rate in both women (r 2 = 0.62) and men (r 2 = 0.60) increased across years (p < 0.01). Men were significantly (p < 0.01) faster than women for overall finishers (5.9 ± 1.6 km*h−1 versus 5.1 ± 1.3 km*h−1) and for the top three finishers (12.2 ± 0.4 km*h−1 versus 8.3 ± 0.6 km*h−1). The gender difference in running speed of the top three athletes decreased (r 2 = 0.72; p < 0.01) from 39.5% in 2003 to 24.1% in 2012 with a mean gender difference of 31.7 ± 2.0%. In men, Moroccans won nine of ten competitions, and one edition was won by a Jordanian athlete. In women, eight races were won by Europeans (France five, Luxembourg two, and Spain one, respectively), and two events were won by Moroccan runners.ConclusionsThe finisher rate in the Marathon des Sables increased this last decade. Men were significantly faster than women with a higher gender difference in performance compared to previous reports. Social or cultural inhibitions may determine the outcome in this event. Future studies need to investigate participation trends regarding nationalities and socioeconomic background, as well as the motivation to compete in ultramarathons.

International audience; ABSTRACT: INTRODUCTION: Chronic inflammation is a profound systemic modification of the cellular microenvironment which could affect survival, repair and maintenance of muscle stem cells. The aim of this study was to define the role of chronic inflammation on the regenerative potential of satellite cells in human muscle. METHODS: As a model for chronic inflammation, 11 patients suffering from rheumatoid arthritis (RA) were included together with 16 patients with osteoarthritis (OA) as controls. The mean age of both groups was 64 years, with more females in the RA group compared to the OA group. During elective knee replacement surgery, a muscle biopsy was taken from the distal musculus vastus medialis. Cell populations from four RA and eight OA patients were used for extensive phenotyping because these cell populations showed no spontaneous differentiation and myogenic purity greater than 75% after explantation. RESULTS: After mononuclear cell explantation, myogenic purity, viability, proliferation index, number of colonies, myogenic colonies, growth speed, maximum number of population doublings and fusion index were not different between RA and OA patients. Furthermore, the expression of proteins involved in replicative and stress-induced premature senescence and apoptosis, including p16, p21, p53, hTERT and cleaved caspase-3, was not different between RA and OA patients. Mean telomere length was shorter in the RA group compared to the OA group. CONCLUSIONS: In the present study we found evidence that chronic inflammation in RA does not affect the in vitro regenerative potential of human satellite cells. Identification of mechanisms influencing muscle regeneration by modulation of its microenvironment may, therefore, be more appropriate.

International audience; We present an optical-inertial tracking system for tracking a handheld tool in a computer-assisted surgery system. Tracking is fast enough for servo-control of the handheld tool. We show that commercially available optical tracking systems which are suitable for use in computer-assisted surgery systems are not suitable for this application. A modified Extended Kalman Filter is used to fuse optical and inertial data. Our approach is a direct one which uses marker image data instead of triangulated position data, thus reducing latencies. Experimental data show that the optical-inertial system can track a moving object at a high bandwidth.

Methods and systems for object tracking are disclosed in which the bandwidth of a "slow" tracking system (e.g., an optical tracking system) is augmented with sensor data generated by a "fast" tracking system (e.g., an inertial tracking system). The tracking data generated by the respective systems can be used to estimate and/or predict a position, velocity, and orientation of a tracked object that can be updated at the sample rate of the "fast" tracking system. The methods and systems disclosed herein generally involve an estimation algorithm that operates on raw sensor data (e.g., two-dimensional pixel coordinates in a captured image) as opposed to first processing and/or calculating object position and orientation using a triangulation or "back projection" algorithm.

International audience; Handheld tools could be a valuable improvement to today's computer-assisted surgery systems. For tracking such a tool, we propose a high-bandwidth optical-inertial tracking system which is lightweight and low-cost. In a simulation, we show the impact of the bandwidth of the tracking system and the use of inertial sensors on the performance of the servo-control. We present an Extended Kalman Filter to fuse sensor data with a low-latency approach. A test with an experimental setup shows that the optical-inertial system does indeed follow human motion correctly and faster than an optical tracking system with a low bandwidth as found in commercially available systems.

Across-trial averaging is a widely used approach to enhance the signal-to-noise ratio (SNR) of event-related potentials (ERPs). However, across-trial variability of ERP latency and amplitude may contain physiologically relevant information that is lost by across-trial averaging. Hence, we aimed to develop a novel method that uses 1) wavelet filtering (WF) to enhance the SNR of ERPs and 2) a multiple linear regression with a dispersion term (MLRd) that takes into account shape distortions to estimate the single-trial latency and amplitude of ERP peaks. Using simulated ERP data sets containing different levels of noise, we provide evidence that, compared with other approaches, the proposed WF+MLRd method yields the most accurate estimate of single-trial ERP features. When applied to a real laser-evoked potential data set, the WF+MLRd approach provides reliable estimation of single-trial latency, amplitude, and morphology of ERPs and thereby allows performing meaningful correlations at single-trial level. We obtained three main findings. First, WF significantly enhances the SNR of single-trial ERPs. Second, MLRd effectively captures and measures the variability in the morphology of single-trial ERPs, thus providing an accurate and unbiased estimate of their peak latency and amplitude. Third, intensity of pain perception significantly correlates with the single-trial estimates of N2 and P2 amplitude. These results indicate that WF+MLRd can be used to explore the dynamics between different ERP features, behavioral variables, and other neuroimaging measures of brain activity, thus providing new insights into the functional significance of the different brain processes underlying the brain responses to sensory stimuli.

Import JabRef | WosArea Orthopedics; Rheumatology; International audience; Objective: To assess the pain and functional disability levels corresponding to an indication for total joint replacement (TJR) in hip and knee osteoarthritis (OA). Methods: Design: International cross-sectional study in 10 countries. Patients: Consecutive outpatients with definite hip or knee OA attending an orthopaedic outpatient clinic. Gold standard measure for recommendation for TJR: Surgeon's decision that TJR is justified. Outcome measures: Pain (ICOAP: intermittent and constant osteoarthritis pain, 0-100) and functional impairment (HOOS-PS/KOOS-PS: Hip/Knee injury and Osteoarthritis Outcome Score Physical function Short-form, 0-100). Analyses: Comparison of patients with vs without surgeons' indication for TJR. Receiver Operating Characteristic (ROC) curve analyses and logistic regression were applied to determine cut points of pain and disability defining recommendation for TJR. Results: In all, 1909 patients were included (1130 knee/779 hip OA). Mean age was 66.4 [standard deviation (SD) 10.9] years, 58.1% were women; 628/1130 (55.6%) knee OA and 574/779 (73.7%) hip OA patients were recommended for TJR. Although patients recommended for TJR (yes vs no) had worse symptom levels [pain, 55.5 (95% confidence interval 54.2, 56.8) vs. 44.9 (43.2, 46.6), and functional impairment, 59.8 (58.7, 60.9) vs. 50.9 (49.3, 52.4), respectively, both P inf 0.0001]. there was substantial overlap in symptom levels between groups, even when adjusting for radiographic joint status. Thus, it was not possible to determine cut points for pain and function defining 'requirement for TJR'. Conclusion: Although symptom levels were higher in patients recommended for TJR, pain and functional disability alone did not discriminate between those who were and were not considered to need TJR by the orthopaedic surgeon. (C) 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Background: Brachial plexus birth palsy (BPBP) most often occurs as a result of foetal-maternal disproportion. The C5 and C6 nerve roots of the brachial plexus are most frequently affected. In contrast, roots from the C7 to Th1 that result in total injury together with C5 and C6 injury, are affected in fewer than half of the patients. BPBP was first described by Smellie in 1764. Erb published his classical description of the injury in 1874 and his name became linked with the paralysis that is associated with upper root injury. Since then, early results of brachial plexus surgery have been reasonably well documented. However, from a clinical point of view not all primary results are maintained and there is also a need for later follow-up results. In addition most of the studies that are published emanate from highly specialized clinics and no nation wide epidemiological reports are available. One of the plexus injuries is the avulsion type, in which the nerve root or roots are ruptured at the neural cord. It has been speculated whether this might cause injury to the whole neural system or whether shoulder asymmetry and upper limb inequality results in postural deformities of the spine. Alternatively, avulsion could manifest as other signs and symptoms of the whole musculoskeletal system. In addition, there is no available information covering activities of daily living after obstetric brachial plexus surgery. Patients and methods: This was a population-based cross-sectional study on all patients who had undergone brachial plexus surgery with at least 5 years of follow-up. An incidence of 3.05/1000 for BPBP was obtained from the registers for this study period. A total of 1706 BPBP patients needing hospital treatment out of 1 717 057 newborns were registered in Finland between 1971 and 1997 inclusive. Of these BPBP patients, 124 (7.3%) underwent brachial plexus surgery at a mean age of 2.8 months (range: 0.4―13.2 months). Surgery was most often performed by direct neuroraphy after neuroma resection (53%). Depending on the phase of the study, 105 to 112 patients (85-90%) participated in a clinical and radiological follow-up assessment. The mean follow up time exceeded 13 years (range: 5.0―31.5 years). Functional status of the upper extremity was evaluated using Mallet, Gilbert and Raimondi scales. Isometric strength of the upper limb, sensation of the hand and stereognosis were evaluated for both the affected and unaffected sides then the differences and their ratios were calculated and recorded. In addition to the upper extremity, assessment of the spine and lower extremities were performed. Activities of daily living (ADL), participation in normal physical activities, and the use of physiotherapy and occupational therapy were recorded in a questionnaire. Results: The unaffected limb functioned as the dominant hand in all, except four patients. The mean length of the affected upper limb was 6 cm (range: 1-13.5 cm) shorter in 106 (95%) patients. Shoulder function was recorded as a mean Mallet score of 3 (range: 2―4) which was moderate. Both elbow function and hand function were good. The mean Gilbert elbow scale value was 3 (range: -1―5) and the mean Raimondi hand scale was 4 (range:1―5). One-third of the patients experienced pain in the affected limb including all those patients (n=9) who had clavicular non-union resulting from surgery. A total of 61 patients (57%) had an active shoulder external rotation of less than 0° and an active elbow extension deficiency was noted in 82 patients (77%) giving a mean of 26° (range: 5°―80°). In all, expect two patients, shoulder external rotation strength at a mean ratio 35% (range: 0―83%) and in all patients elbow flexion strength at a mean ratio of 41% (range: 0―79%) were impaired compared to the unaffected side. According to radiographs, incongruence of the glenohumeral joint was noted in 15 (16%) patients, whereas incongruence of the radiohumeral joint was found in 20 (21%) patients. Fine sensation was normal for 34/49 (69%) patients with C5-6 injury, for 15/31 (48%) with C5-7 and for only 8/25 (32%) of patients with total injury. Loss of protective sensation or absent sensation was noted in some palmar areas of the hand for 12/105 patients (11%). Normal stereognosis was recorded for 88/105 patients (84%). No significant inequalities in leg length were found and the incidence of structural scoliosis (1.7%) did not differ from that of the reference population. Nearly half of the patients (43%) had asynchronous motion of the upper limbs during gait, which was associated with impaired upper limb function. Data obtained from the completed questionnaires indicated that two thirds (63%) of the patients were satisfied with the functional outcome of the affected hand although one third of all patients needed help with ADL. Only a few patients were unable to participate in physical activities such as: bicycling, cross-country skiing or swimming. However, 71% of the patients reported problems related to the affected upper limb, such as muscle weakness and/or joint stiffness during the aforementioned activities. Incongruity of the radiohumeral joints, extent of the injury, avulsion type injury, age less than three months of age at the time of plexus surgery and inexperience of the surgeon was related to poor results as determined by multivariate analyses. Conclusions: Most of the patients had persistent sequelae, especially of shoulder function. Almost all measurements for the total injury group were poorer compared with those of the C5-6 type injury group. Most of the patients had asymmetry of the shoulder region and a shorter affected upper limb, which is a probable reason for having an abnormal gait. However, BPBP did not have an effect on normal growth of the lower extremities or the spine. Although, participation in physical activities was similar to that of the normal population, two-thirds of the patients reported problems. One-third of the patients needed help with ADL. During the period covered by this study, 7.3% BPBP of patients that needed hospital treatment had a brachial plexus operation, which amounts to fewer than 10 operations per year in Finland. It seems that better results of obstetric plexus surgery and more careful follow-up including opportunities for late reconstructive procedures will be expected, if the treatment is solely concentrated on by a few specialised teams. Olkahermopunos koostuu viidestä hermojuuresta (C5-C8 ja Th1), jotka lähtevät kaularangan alueen selkäytimestä ja hermottavat yläraajan lihaksia ja tuntoa. Lapsen olkahermopunos voi vaurioitua synnytyksen yhteydessä, jos hermorakenteisiin kohdistuu liiallinen venytys lapsen hartioiden ja äidin synnytyskanavan epäsuhteen seurauksena. Olkahermopunoksen syntymävauriota kutsutaan usein Erbin pareesiksi. Erb kuvasi vuonna 1874 hermovaurion sijainnin olkahermopunoksen C5 ja C6 hermojuurten risteämiskohdassa. Sittemmin Erbin pareesi ja olkahermopunoksen syntymävaurio ovat muodostuneet synonyymeiksi arkikielessä; osin virheellisesti, sillä Erbin pareesissahan on kyse olkahermopunoksen yläosan vauriosta eikä laajemmasta C5-C7 juurten tai ns. totaalivauriosta (C5-C8/Th1). Vaurio voidaan lisäksi luokitella yksittäisen hermon lievästä venyttymästä aina sen irtirepeytymiseen selkäytimestä. Vaikeammat hermon repeytymät aiheuttavat pysyviä muutoksia hartian ja yläraajan lihasten toimintaan ja raajan tuntoon. Lihastoiminnan epätasapaino johtaa nivelten liikerajoituksiin ja virheasentoihin. Joillakin potilailla esiintyy myös kipuja yläraajassa. Suomessa syntyy vuosittain noin 200 lasta, joilla todetaan olkahermopunoksen syntymävaurio. Keskimäärin alle kymmenellä vaurio on niin vaikea, että hermopunoksen leikkaus on perusteltu 3-9 kk. iässä. Suomessa ensimmäinen vastasyntyneen/ imeväisen olkahermopunoksen korjausleikkaus tehtiin vuonna 1971. Vasta 1980-luvun aikana leikkaushoito vakiintui ja samaan aikaan julkaistiin korjausleikkauksesta myönteisiä tuloksia. Toistaiseksi ei ole julkaistu yhtään epidemiologista, väestöön pohjautuvaa yli viiden vuoden seurantatutkimusta. Mahdollisia kasvun myötä kehittyviä ja aikuisikään vaikuttavia pysyviä haittoja ei ole voitu arvioida aikaisemmissa tutkimuksissa lyhyiden seuranta-aikojen vuoksi. Tutkimuksen tavoite oli saada kattava käsitys Suomessa leikattujen potilaiden nykyisestä tilasta sekä selvittää hoidon lopputulokseen vaikuttavia tekijöitä. Pyrin saamaan tutkimukseen kaikki ne potilaat, joilla seuranta-aika olkahermopunoksen korjausleikkauksen jälkeen oli yli viisi vuotta. Potilaita oli yhteensä 124, joista tutkimukseen osallistui 112 (90%). Seuranta-aika leikkauksesta oli keskimäärin 13,5 vuotta, pisimmillään 31,5 vuotta. Potilaiden vaurioituneen puolen yläraajan toiminta, lihasvoimat, nivelten liikelaajuudet ja käden tunto tutkittiin ja näistä saatuja mittaustuloksia verrattiin terveeseen raajaan. Vanhemmat kysyvät usein, vaikuttaako hermovaurio mahdollisesti muutenkin lapsen kehitykseen. Tätä asiaa selvitettiin tutkimalla potilaiden selän ryhtiä, alaraajojen ja kävelyn mahdollisia poikkeavuuksia, liikunnallista aktiivisuutta ja kipujen esiintyvyyttä. Osalla potilaista vamma oli niin vaikea, että päivittäisten asioiden hoito oli hankalaa. Päivittäisistä askareista selviytymistä arvioitiin kyselytutkimuksella. Noin puolella potilaista olkahermopunoksen vaurio sijoittui kahteen ylimpään olkahermopunoksen hermojuureen (C5-6), vajaalla kolmanneksella kolmeen ylimpään (C5-7) ja neljänneksellä kaikkiin hermopunoksen hermojuuriin (totaalivaurio). Kolmasosalla koko tutkimusryhmästä todettiin hermojuuren irtirepeytymä selkäytimestä. Leikkaukset tehtiin keskimäärin kolmen kuukauden iässä. Leikanneita lääkäreitä oli kymmenen, joista kaksi oli tehnyt yli puolet kaikista leikkauksista. Yleisin toimenpide oli hermoarven poisto ja hermojen päiden yhdistäminen toisiinsa joko suoralla ompelulla tai alaraajasta otetulla hermosiirteellä. Reilun 13 vuoden seurannan aikana 63 potilaalle tehtiin raajan korjausleikkaus, joista yleisimpiä olivat olkanivelet liikelaajuutta vapauttavat leikkaukset. Potilaan kätisyys määräytyi vahvasti vamman mukaan - vain neljällä potilaalla kätisyys oli vaurioituneella puolella. Vammautunut raaja oli keskimäärin 6 cm tervettä raajaa lyhyempi. Olkanivelen aktiiviset liikkeet olivat rajoittuneet noin 50% terveeseen puoleen verrattuna ja noin 30% kyynärnivelen ja käden liikelaajuuksien osalta. Potilaat, joilla vaurio käsitti koko olkahermopunoksen, liikelaajuus oli tätäkin huonompi. Näistä potilaista noin kolmasosalla käden puristusvoima oli nolla. Havaitsin saman jakauman potilasryhmien välillä myös tuntomittauksissa. Potilaista, joilla oli kahden ylimmän hermojuuren vaurio, kolmanneksella havaittiin poikkeava tunto. Sen sijaan potilailla, joilla oli todettu koko hermopunoksen vaurio, poikkeava tunto oli kaksi kertaa yleisempää. Tahattomia vammoja, kuten palovammat, estävä suojatunto puuttui jopa kolmannekselta näistä potilaista. Kolmannes kaikista potilaista tarvitsi apua päivittäisissä askareissaan, kuten pukeutumisessa ja ruoan paloittelussa. He harrastivat kuitenkin liikuntaa yhtä paljon kuin saman ikäiset terveet henkilöt, mutta suurella osalla (71%) vammautuneen puolen yläraajan heikkous tai liikerajoitus aiheutti ongelmia. Yli puolet (56%) tutkituista oli saanut fysioterapiaa seurannan aikana. Kolmannes potilaista valitti kipua joko leikkausalueella tai yläraajassa. Tutkimukseni mukaan olkahermopunoksen syntymävaurio ei aiheuttanut muutoksia potilaiden selän tai alaraajojen kehitykseen. Kaiken kaikkiaan laajempi vaurio, yksittäisen hermon irtirepeytymä selkäytimestä ja leikanneen kirurgin kokemattomuus heikensivät lopputulosta. Olkahermopunoksen syntymävaurio on suhteellisen harvinainen vamma. Sen vaikeampi, leikkausta vaativa muoto aiheuttaa pysyvän haitan, vaikka varhaisvaiheen leikkaus onnistuisikin. Vaikeiden vaurioiden keskittäminen 1-2 yksikköön Suomessa todennäköisesti parantaisi hoidon tuloksia ja potilaiden elämänlaatua.

(IF : 2,74); International audience; Bone is a dynamic tissue that undergoes a precise remodeling process involving resorptive osteoclastic cells and bone-forming osteoblastic (OB) cells. The functional imbalance of either of these cell types can lead to severe skeletal diseases. The proliferation and differentiation of OB cells play a major role in bone development and turnover. These cellular processes are coordinated by connexin43 (Cx43)-based gap-junctional intercellular communication (GJIC) and by soluble factors such as endothelin-1 (ET-1). We have used the Cx43 heterozygous (Cx43(+/-)) murine model to study the possible cross-talk between Cx43 and ET-1 in cultured calvarial OB cells. On microcomputed tomographic analysis of 3-day-old pups, Cx43(+/-) mice showed hypomineralized calvaria in comparison with their Cx43(+/+) littermates. Characterization of cultured OB cells clearly demonstrated the effect of the partial deletion of the Cx43 gene on its expression, on GJIC, and subsequently on OB differentiation. In this model, ET-1 (10(-8) M) lost its mitogenic action in Cx43(+/-) OB cells compared with Cx43(+/+) cells. Moreover, a correlation between the inhibition of cell differentiation by ET-1 and the decreased amount and function of Cx43 was found in Cx43(+/+) OB cells but not in their Cx43(+/-) counterparts. Thus, as Cx43 is linked to OB differentiation, our data indicate that this mitogenic ET-1 peptide has pronounced effects on fully differentiated OB cells. With respect to roles in mechanotransduction and OB differentiation, Cx43 might modulate osteoblastic sensitivity to soluble factors.

The flexion of the femoral component in the sagittal plane in unicompartmental knee arthroplasty (UKA) was analyzed radiographically in this study. Thirty medial and 30 lateral UKAs were included. The sagittal flexion angles were measured both relative to the posterior femoral cortex and midline sagittal distal femoral axis. Both of the measurement methods revealed that the femoral components were inserted in a significantly more flexed fashion in the medial UKA group. Neither preoperative nor postoperative tibial slope did have any significant effect on the sagittal flexion angle. To the best of our knowledge, this is the first study demonstrating an angular difference in the sagittal flexion of the femoral components between medial and lateral UKAs.

International audience; We report the case of a 13-year-old boy with an abrupt onset of leg pain and muscle weakness, incapability of deambulation and a laboratory picture of exercise-induced acute rhabdomyolysis. Intravenous hyperhydration and forced diuresis were adopted to avoid renal complications. No evidence of articular or residual muscular damage was appreciated in the short-term. The recurrence of rhabdomyolysis required a muscular biopsy showing a disturbance of fatty acid β-oxidation pathway.

Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with intraarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up period was 25.3 months. All fractures were type C according to the AO/ASIF fracture classification system. Chevron type olecranon osteotomy was performed within 12- 24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appropriate range checks were made. Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in patients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complications were seen as 2 (9.6%) transient neuropraxia of the ulnar nerve, 2 (9.6%) failure of fixation, 1 (4.8%) heterotopic ossification and 1 (4.8%) olecranon non-union. Fracture type (C1) and time from occurrence of injury to surgery (, Amaç: Distal humerusun eklem içi kırıklarında olekranon osteotomisi yöntemiyle açık redüksiyon ve internal tesbit yapılan hastalarda tedavi sonuçlarının degerlendirilmesi. Gereç ve yöntem: Distal humerusta eklem içi kırıgı olan 21 hastaya olekranon osteotomisi yapılarak açık redüksiyon ve internal tesbit uygulandı. Hastaların ortalama yası 41.6 yıl ortalama takip süresi 25.3 ay idi. Kırıkların tamamı AO/ASIF kırık sınıflandırma sistemine göre tip-C idi. Chevron tipi olekranon osteotomisi yapılan hastaların dördü hariç digerleri yaralanmadan sonraki ilk 12-24 saat içerisinde ameliyata alındı. Uygun aralıklarla hastaların fizik muayene ve radyolojik kontrolleri yapıldı. Bulgular: Kırıkların tamamı ortalama 3.2 ayda kaynadı. Bayanlarda, 50 yasın altında, yaralanmayla ameliyata alınma arasındaki süre 12 saatin altında olan ve erken hareket baslanan hastalarda mükemmel ve iyi sonuçlar elde edildi. Komplikasyon olarak 2 (9.6%) hastada geçici unlar sinir nöropatisi, 2 (9.6%) hastada tesbit yetersizligi, 1 (4.8%) hastada heterotopik ossifikasyon, 1 (4.8%) hastada da olekranonda kaynamama görüldü. Kırıgın tipi (C1) ve yaralanmayla ameliyata alınma arasında geçen zaman (12 saat) mükemmel ve iyi fonksiyonel sonuçlar elde etmede ana belirleyici faktörlerdi. Sonuçlar: Dikkatli ve titiz cerrahi teknik, stabil internal tesbit, cerrahi tecrübe ve ameliyat sonrası erken kontrollü hareket distal humerusun eklem içi kırıklarının basarılı sonuçları için kritik faktörlerdir.

Sormen koukistajajännevamman korjauksen jälkeisen aktiivisen mobilisaation on todettu johtavan parempaan toiminnalliseen lopputulokseen kuin nykyisin yleisesti käytetyn dynaamisen mobilisaation. Aktiivisen mobilisaation ongelma on jännekorjauksen pettämisriskin lisääntyminen nykyisten ommeltekniikoiden riittämättömän vahvuuden vuoksi. Jännekorjauksen lujuutta on parannettu kehittämällä monisäieommeltekniikoita, joissa jänteeseen tehdään useita rinnakkaisia ydinompeleita. Niiden kliinistä käyttöä rajoittaa kuitenkin monimutkainen ja aikaa vievä tekninen suoritus. Käden koukistajajännekorjauksessa käytetään yleisesti sulamattomia ommelmateriaaleja. Nykyiset käytössä olevat biohajoavat langat heikkenevät liian nopeasti jänteen paranemiseen nähden. Biohajoavan laktidistereokopolymeeri (PLDLA) 96/4 – langan vetolujuuden puoliintumisajan sekä kudosominaisuuksien on aiemmin todettu soveltuvan koukistajajännekorjaukseen. Tutkimuksen tavoitteena oli kehittää välittömän aktiivisen mobilisaation kestävä ja toteutukseltaan yksinkertainen käden koukistajajännekorjausmenetelmä biohajoavaa PLDLA 96/4 –materiaalia käyttäen. Tutkimuksessa analysoitiin viiden eri yleisesti käytetyn koukistajajänneompeleen biomekaanisia ominaisuuksia staattisessa vetolujuustestauksessa ydinompeleen rakenteellisten ominaisuuksien – 1) säikeiden (lankojen) lukumäärän, 2) langan paksuuden ja 3) ompeleen konfiguraation – vaikutuksen selvittämiseksi jännekorjauksen pettämiseen ja vahvuuteen. Jännekorjausten näkyvän avautumisen todettiin alkavan perifeerisen ompeleen pettäessä voima-venymäkäyrän myötöpisteessä. Ydinompeleen lankojen lukumäärän lisääminen paransi ompeleen pitokykyä jänteessä ja suurensi korjauksen myötövoimaa. Sen sijaan paksumman (vahvemman) langan käyttäminen tai ompeleen konfiguraatio eivät vaikuttaneet myötövoimaan. Tulosten perusteella tutkittiin mahdollisuuksia lisätä ompeleen pitokykyä jänteestä yksinkertaisella monisäieompeleella, jossa ydinommel tehtiin kolmen säikeen polyesterilangalla tai nauhamaisen rakenteen omaavalla kolmen säikeen polyesterilangalla. Nauhamainen rakenne lisäsi merkitsevästi ompeleen pitokykyä jänteessä parantaen myötövoimaa sekä maksimivoimaa. Korjauksen vahvuus ylitti aktiivisen mobilisaation jännekorjaukseen kohdistaman kuormitustason. PLDLA 96/4 –langan soveltuvuutta koukistajajännekorjaukseen selvitettiin tutkimalla langan biomekaanisia ominaisuuksia ja solmujen pito-ominaisuuksia staattisessa vetolujuustestauksessa verrattuna yleisimmin jännekorjauksessa käytettävään punottuun polyesterilankaan (Ticron®). PLDLA –langan todettiin soveltuvan hyvin koukistajajännekorjaukseen, sillä se on polyesterilankaa venymättömämpi ja solmujen pitävyys on parempi. Viimeisessä vaiheessa tutkittiin PLDLA 96/4 –langasta valmistetulla kolmisäikeisellä, nauhamaisella jännekorjausvälineellä tehdyn jännekorjauksen kestävyyttä staattisessa vetolujuustestauksessa sekä syklisessä kuormituksessa, joka simuloi staattista testausta paremmin mobilisaation toistuvaa kuormitusta. PLDLA-korjauksen vahvuus ylitti sekä staattisessa että syklisessä kuormituksessa aktiivisen mobilisaation edellyttämän vahvuuden. Nauhamaista litteää ommelmateriaalia ei aiemmin ole tutkittu tai käytetty käden koukistajajännekorjauksessa. Tässä tutkimuksessa ommelmateriaalin nauhamainen rakenne paransi merkitsevästi jännekorjauksen vahvuutta, minkä arvioidaan johtuvan lisääntyneestä kontaktipinnasta jänteen ja ommelmateriaalin välillä estäen ompeleen läpileikkautumista jänteessä. Tutkimuksessa biohajoavasta PLDLA –materiaalista valmistetulla rakenteeltaan nauhamaisella kolmisäikeisellä langalla tehdyn jännekorjauksen vahvuus saavutti aktiivisen mobilisaation edellyttämän tason. Lisäksi uusi menetelmä on helppokäyttöinen ja sillä vältetään perinteisten monisäieompeleiden tekniseen suoritukseen liittyvät ongelmat. Early active motion improves the outcome after flexor tendon repair in the hand compared to passive mobilization, but increases the biomechanical demands on the tendon repair to resist gap formation and rupture. Previously, multi-strand core sutures have been developed to withstand the forces of active motion, but they are technically demanding and increase tendon handling which limits their clinical use. Non-absorbable suture materials are generally used in flexor tendon repair. The advantage of bioabsorbable suture material is gradual absorption from the tissue, but current absorbable sutures lack sufficient tensile strength half-life considering flexor tendon healing. The bioabsorbable poly-L/D-lactide (PLDLA) 96/4 suture has experimentally demonstrated a tensile strength half-life sufficient for flexor tendon healing and good biocompatibility in the flexor tendon in vivo. The present biomechanical experiments ex vivo were performed to develop a novel, strong, and yet simple flexor tendon core suture technique using the bioabsorbable PLDLA 96/4 suture to meet the biomechanical requirements of early active mobilization. The influence of the different structural properties of the core suture – 1) the suture grasp configuration, 2) suture calibre, and 3) number of strands crossing the cut tendon ends – on the disruption and biomechanical properties of the tendon repair in static tensile testing were investigated in five core sutures which were variations of the Pennington modified Kessler and Savage techniques. Each tendon repair included the simple running peripheral suture. In all repairs visible failure was initiated by rupture of the peripheral suture in the proximity of the yield point of the load-deformation curve. Thus, the yield force can be regarded as the maximum strength of the visually intact tendon repair. The suture grasp configuration and thicker suture calibre did not influence the strength and stiffness of the intact repair in the studied techniques. Increasing the number of strands by performing multiple similar but separate core sutures with single-stranded suture improved the strength and stiffness of the visually intact repair. Thus, the possibilities to improve the strength of the visually intact tendon repair more simply with multiple concomitantly passing suture strands were investigated. Two different coated braided polyester triple-stranded sutures with the strands either remaining free (triple-stranded suture) or bound together parallel to each other (triple-stranded bound suture) were compared in the Pennington modified Kessler configuration in static testing. The strength of the visually intact repair was higher in both these 6-strand techniques compared to the 2-strand Pennington modified Kessler repair. The repair performed with the triple-stranded bound suture was significantly stronger compared to the triple-stranded suture repair, and the yield force exceeded the estimated forces of active mobilization. The suitability of the bioabsorbable PLDLA 96/4 suture for flexor tendon repair was evaluated by investigating the biomechanical material and knot properties in static tensile testing compared to the widely used coated braided polyester (Ticron®). The PLDLA 96/4 suture demonstrated higher stiffness and better knot holding capacity with a secure knot achieved with fewer throws and smaller knot size than in Ticron® suture. Finally, the triple-stranded bound suture of the bioabsorbable PLDLA was investigated with static and cyclic tensile testing in the Pennington modified Kessler configuration. In static testing the yield force of the PLDLA repair exceeded the estimated forces of active rehabilitation. In cyclic testing PLDLA repair demonstrated significantly better gap resistance compared to the 6-strand Savage repair which has previously been developed for active mobilization and has successfully been used clinically with active rehabilitation. Broader, flat suture has not previously been investigated or used in flexor tendon repair in the hand. In the present study the strength of the Pennington modified Kessler repair performed with coated braided polyester or PLDLA triple-stranded bound suture exceeded the needed strength to withstand active rehabilitation. The biomechanical improvements are considered to be a consequence of the enhanced holding capacity of the locking loops due to the increased tendon-suture interface provided by the broader flat structure of the triple-stranded bound suture. The repair is easy to perform, producing a multi-strand repair with the technical performance of a 2-strand repair avoiding the problems associated with traditional multi-strand techniques.

There is an ongoing controversy as to which methods in total hip arthroplasty (THA) could provide young patients with best long-term results. THA is an especially demanding operation in patients with severely dysplastic hips. The optimal surgical treatment for these patients also remains controversial. The aim of this study was to evaluate the long-term survival of THA in young patients (90% survival rates at 10 years. The Biomet Bi-Metric stem had a 95% (95% CI 93-97) survival rate even at 15 years. When the end point was defined as any revision, 10 year survival rates of all uncemented cup designs except the Harris-Galante II decreased to

The purpose of the present study was to investigate the effects of low-intensity ultrasound on bioabsorbable self-reinforced poly-L-lactide (SR-PLLA) screws and on fracture healing after SR-PLLA device fixation in experimental and clinical cancellous bone fracture. In the first experimental study, the assessment of the mechanical strengths of the SR-PLLA screws was performed after 12 weeks of daily 20-minute ultrasound exposure in vitro. In the second experimental study, 32 male Wistar rats with an experimental distal femur osteotomy fixed with an SR-PLLA rod were exposed for daily low-intensity ultrasound treatment for 21 days. The effects on the healing bone were assessed. The clinical studies consist of three prospective, randomized, and placebo-controlled series of dislocated lateral malleolar fractures fixed with one SR-PLLA screw. The total number of the patients in these series was 52. Half of the patients were provided randomly with a sham ultrasound device. The patients underwent ultrasound therapy 20 minutes daily for six weeks. Radiological bone healing was assessed both by radiographs at two, six, nine, and 12 weeks and by multidetector computed tomography (MDCT) scans at two weeks, nine weeks, and 18 months. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA). The clinical outcome was assessed by both Olerud-Molander scoring and clinical examination of the ankle. Low-intensity ultrasound had no effects on the mechanical properties and degradation behaviour of the SR-PLLA screws in vitro. There were no obvious signs of low-intensity ultrasound-induced enhancement in the bone healing in SR-PLLA-rod-fixed metaphyseal distal femur osteotomy in rats. The biocompatibility of low-intensity ultrasound treatment and SR-PLLA was found to be good. In the clinical series low-intensity ultrasound was observed to have no obvious effects on the bone mineral density of the fractured lateral malleolus. There were no obvious differences in the radiological bone healing times of the SR-PLLA-screw-fixed lateral malleolar fractures after low-intensity ultrasound treatment. Low-intensity ultrasound did not have any effects on radiological bone morphology, bone mineral density or clinical outcome 18 months after the injury. There were no obvious findings in the present study to support the hypothesis that low-intensity pulsed ultrasound enhances bone healing in SR-PLLA-rod-fixed experimental metaphyseal distal femur osteotomy in rats or in clinical SR-PLLA-screw-fixed lateral malleolar fractures. It is important to limit the conclusions of the present set of studies only to lateral malleolar fractures fixed with an SR-PLLA screw. Tutkimuksessa selvitettiin matala-intensiteettisen ultraäänihoidon vaikutusta liukenevalla luunkiinnittimellä kiinnitetyn hohkaluun murtuman paranemiseen. Tutkimus koostui viidestä osatyöstä, joista kaksi ensimmäistä oli kokeellisia ja seuraavat kolme kliinisiä. Liukenevista materiaaleista valmistettuja luunkiinnittimiä käytetään erilaisten murtumien kiinnittämiseen. Tässä tutkimuksessa käytetyt sauvat ja ruuvit olivat valmistettu elimistössä liukenevasta polylaktidista. 20 minuuttia kestävän päivittäisen matala-intensiteettisen ultraäänihoidon on eräissä tutkimuksissa esitetty nopeuttavan luunmurtuman paranemista. Tämän tutkimuksen tarkoituksena oli selvittää ultraäänihoidon yhteensopivuus liukenevien luunkiinnittimien kanssa sekä ultraäänihoidon vaikutukset hohkaluun murtuman paranemiseen. Ensimmäisessä kokeellisessa työssä polylaktidi-ruuveja altistettiin päivittäiselle ultraäänelle 12 viikon ajan. Ultraäänen ei todettu vaikuttavan heikentävästi polylaktidin mekaanisiin ominaisuuksiin. Toisessa kokeellisessa työssä kiinnitettiin 32 rotan katkaistu reisiluun alaosa polylaktidi-sauvalla ja tälle alueelle annettiin päivittäin ultraäänihoitoa kolmen viikon ajan. Ultraäänen ei todettu selvästi vaikuttavan paranevassa luussa tapahtuviin normaaleihin muutoksiin. Kliinisissä töissä paikaltaan siirtynyt nilkan ulkokehräksen murtuma kiinnitettiin operatiivisesti polylaktidi-ruuvilla ja murtumaa hoidettiin leikkauksen jälkeen kuuden viikon ajan päivittäin ultraäänellä. Ensimmäisessä kliinisessä työssä selvitettiin ultraäänihoidon vaikutusta ulkokehräksen luuntiheyteen 12 viikon kohdalla leikkauksesta 30 potilaalla. Ultraäänellä ei todettu olevan vaikutusta vamman ja leikkauksen jälkeiseen luuntiheyden muutokseen. Toisessa kliinisessä työssä selvitettiin ultraäänihoidon vaikutusta ulkokehräksen murtuman radiologiseen luutumiseen 22 potilaalla yhdeksän viikon kohdalla tehdyllä tietokonekuvauksella. Ultraäänihoidolla ei todettu olevan selvää radiologista luutumista nopeuttavaa vaikutusta. Viimeisessä kliinisessä työssä tutkittiin ultraäänihoidon mahdollisia pitkäaikaisvaikutuksia leikatussa nilkassa puolitoista vuotta vamman jälkeen 16 potilaan aineistossa. Kaikki murtumat olivat parantuneet hyvin, ultraäänihoidolla ei todettu olevan vaikutusta kliiniseen tulokseen tai luuntiheyden muutokseen leikatussa nilkassa. Tässä väitöskirjatutkimuksessa todettiin matala-intensiteettisen ultraäänihoidon soveltuvan käytettäväksi liukenevilla luunkiinnittimillä kiinnitetyissä murtumissa. Toisaalta, poiketen aikaisemmin julkaistuista tuloksista, ultraäänihoidolla ei tässä tutkimuksessa todettu olevan selviä hohkaluun murtuman paranemista edistäviä vaikutuksia.

The aim of the present experimental study was to find out if the applications of coralline hydroxyapatite (HA) can be improved by using bioabsorbable containment or binding substance with particulate HA in mandibular contour augmentation and by using bioabsorbable fibre-reinforced HA blocks in filling bone defects and in anterior lumbar interbody fusion. The use of a separate curved polyglycolide (PGA) containment alone or together with a fast resorbing polyglycolide/polylactide (PGA/PLA) binding substance were compared to the conventional non-contained method in ridge augmentation in sheep. The contained methods decreased HA migration, but the augmentations did not differ significantly. The use of the containment caused a risk for wound dehiscence and infection. Histologically there was a rapid connective tissue ingrowth into the HA graft and it was more abundant with the PGA containment compared to the non-contained augmentation and even additionally rich when the HA particles were bound with PGA/PLA copolymer. However, the bone ingrowth was best in the non-contained augmentation exceeding 10-12 % of the total graft area at 24 weeks. Negligible or no bone ingrowth was seen in the cases where the polymer composite was added to the HA particles and, related to that, foreign-body type cells were seen at the interface between the HA and host bone. The PGA and poly-dl/l-lactide (PDLLA) fibre-reinforced coralline HA blocks were studied in the metaphyseal and in the diaphyseal defects in rabbits. A rapid bone ingrowth was seen inside the both types of implants. Both PGA and PDLLA fibres induced an inflammatory fibrous reaction around themselves but it did not hinder the bone ingrowth. The bone ingrowth pattern was directed according to the loading conditions so that the load-carrying cortical ends of the implants as well as the implants sited in the diaphyseal defects were the most ossified. The fibre-reinforced coralline HA implants were further studied as stand-alone grafts in the lumbar anterior interbody implantation in pigs. The strength of the HA implants proved not to be adequate, the implants fractured in six weeks and the disc space was gradually lost similarly to that of the discectomized spaces. Histologically, small quantities of bone ingrowth was seen in some of the PGA and PDLLA reinforced coralline implants while no bone formation was identified in any of the PDLLA reinforced synthetic porous HA implants. While fragmented, the inner structure of the implants was lost, the bone ingrowth was minimal, and the disc was replaced by the fibrous connective tissue. When evaluated radiologically the grade of ossification was assessed as better than histologically, and, when related to the histologic findings, CT was more dependable than the plain films to show ossification of the implanted disc space. Local kyphosis was a frequent finding along with anterior bone bridging and ligament ossification as a consequence of instability of the implanted segment. Kokeellinen tutkimus biohajoavalla materiaalilla päällystetyn ja vahvistetun korallipohjaisen hydroksiapatiitin käytöstä luunkorvikkeena. Hydroksiapatiittia (HA) käytetään synteettisenä, ei resorboituvana luunkorvikkeena atrofioituneen ienharjanteen nostossa, luukystien tai luupuutosten täytteenä ja selkärangan luudutuksissa. Tutkimuksen tarkoituksena oli selvittää miten jauhemaisen tai kappalemuotoisen HA:n käyttöä luunkorvikkeena voitaisiin parantaa käyttämällä HA-siirrettä yhdessä elimistössä liukenevan, siirteen muotoa ylläpitävän tai sen mekaanista lujuutta vahvistavan päällysteen kanssa. Jauhemaisen HA-siirteen pysyvyyttä ja kudosten sisäänkasvua tutkittiin lampaan alaleuan luuharjanteessa vertaamalla HA-siirteen annostelua limakalvon alaiseen "taskuun" ilman muottia, siirteen muotoa ylläpitävän biohajoavan polyglycolidi(PGA)-muotin kanssa, ja sekä muotin että HA-jauhetta sitovan biohajoavan polyglycolidi/polylaktidi (PGA/PLA)-sideaineen kanssa. PGA-muotti ja PGA/PLA-sideaine paransivat HA-siirteen pysyvyyttä leukaluuharjanteen päällä mutta niiden käyttö altisti limakalvohaavaumille ja infektioille. Biohajoava muotti ja sideaine lisäsivät HA:n sisään kasvaneen sidekudoksen määrää mutta vähensivät luun muodostumista siirteen sisällä. Luun sisäänkasvu onnistui parhaiten annosteltaessa HA:a ilman muottia tai sideainetta. Biohajoava sideaine HA-siirteessä esti luutumisen lähes kokonaan ja siirteessä tavattiin monitumaisia vierasesinetyyppisiä soluja. Tutkimus osoitti, että jauhemaisen HA:n pysyvyyttä leukaluuharjanteen päällä voidaan parantaa PGA-muotin avulla mutta sen käyttö huonontaa siirteen luutumista ja lisää riskiä leikkausalueen limakalvohaavaumille ja siirteen infektoitumiselle. Kappalemuotoisia, korallipohjaisia HA-implantteja vahvistettiin niiden mekaanisen lujuuden parantamiseksi pinnoittamalla ne osittain PGA- tai poly-l-laktidi/poly-dl-laktidikomposiitti(PDLLA)-kuiduilla. Kuituvahvisteisteiset HA-implantit luutuivat kokeellisissa kanin sääriluudefekteissä nopeasti. Sekä implantin sisään kasvaneen sidekudoksen että luun määrät olivat yhtä suuret pinnoitustyypistä riippumatta eikä kuituvahvisteilla ollut histologisesti luutumisen kannalta haitallisia vaikutuksia. Implantin sisälle muodostuvan luun määrä jakautui luun kuormitusolosuhteiden mukaisesti; muodostuneen luun määrä oli suurempi korteksin alueella ja kortikaalisissa defekteissä kuin hohkaluualueen defekteissä. Kuituvahvisteisia HA-implantteja tutkittiin myös kokeellisessa nikamasolmukkeiden välisessä anterioorisessa luudutuksessa minisioilla ja kasvavilla sioilla. Implantit asetettiin välilevytilaan "stand alone" ylläpitämään välilevytilaa niin, että ne samalla mahdollistaisivat nikamakorpusten välisen luutumisen. Seurannassa PGA- ja PDLLA vahvisteiset HA-implantit murtuivat ja tila ahtautui samalla tavalla kuin välilevyn poiston jälkeen. Natiiviröntgentutkimuksen perusteella nikamavälin luutumisaste arvioitiin paremmaksi verrattuna histologiseen luutumiseen, sen sijaan CT-tutkimuksen perusteella arvioitu luutuminen korreloi hyvin todellisen histologisen luutumisen kanssa. Histologista luunmuodostusta todettiin vahvistetuissa korallipohjaisissa implanteissa vain vähän, pääasiassa 16-24 viikon seurannan jälkeen, mutta yhtenäistä luusiltaa yli koko implantin ei muodostunut. Vertailuna tutkituissa synteettisestä HA:sta valmistetuissa implanteissa ei ollut lainkaan luunmuodostusta. HA-implanttien murtuminen, nikamavälin ahtautuminen ja sekundaariset muutokset kuten nikamien edessä kulkevan ligamentin luutuminen, anterioriset ja posterioriset osteofyytit sekä paikallinen kyfooosi osoittivat että nikamaväli jäi instabiiliksi eikä myöskään HA-implantin ja verestetyn päätelevyn välinen kontakti ei pysynyt stabiilina. Yhteenvetona tutkimus osoitti, että korallipohjaista hydroksiapatiittia voidaan käyttää luunkorvikkeena silloin kun siirteeseen ei kohdistu merkittävää ulkoista kuormitusta. HA-siirteiden pinnoitus PGA- tai PDLLA-kuiduilla tai PGA-muotilla ei estä HA:n luutumista jos pinnoitteet on tehty niin että ne ainakin osittain mahdollistavat HA:n ja isäntäluun suoran ja stabiilin kontaktin.

International audience; Objective. To study the mechanisms responsible for the cross-talk between lipoxygenase (LOX) andcyclooxygenase (COX) pathways in human osteoarthritic (OA) synovial explants, and to confirm thearachidonic acid (AA) shunting phenomenon and its influence on interleukin 1ß (IL-1ß) synthesis.Methods. Synovial membrane explants were cultured in the absence or presence of different drugsthat inhibit COX and/or LOX activities. Concentrations of prostaglandin E2 (PGE2), leukotriene B4(LTB4), lipoxin A4 (LXA4), and IL-1ß were measured.Results. When membrane explants were incubated with naproxen (COX inhibitor) under unstimulatedconditions, the production of LTB4 was dose-dependently enhanced, reaching a 5-fold increaseover the control. This shunt could be partially reversed by the addition of exogenous PGE2. Underlipopolysaccharide (LPS) stimulation, both licofelone (COX/LOX inhibitor) at therapeutic concentrationsand NDGA (LOX inhibitor) inhibited LTB4 production, whereas naproxen did not amplifythe LPS-induced LTB4 production. Conversely, using NDGA, it was found that a shunt of AA fromthe LOX to the COX pathway did not occur. Under LPS conditions, both naproxen and licofeloneinhibited LXA4, inducing an increase in the LTB4/LXA4 ratio with naproxen treatment but not withlicofelone. Under these conditions, naproxen treatment induced a higher level of IL-1ß production.Conclusion. We demonstrated in OA synovium that a shunt from AA to the LOX pathway occurredand that treatment with a nonselective COX inhibitor could increase the production of LTB4 and secondarilythe synthesis of IL-1ß. Therefore treatment with licofelone, which can act on both COX andLOX pathways, may have some interesting properties in the treatment of OA.

International audience; Objective: Collagenase-3 is a metalloprotease that plays a role in tissue remodeling and pathological processes including arthritis. The human gene is transcribed into major (3.0 and 2.5 kb) and minor (2.2/2.0 kb) transcripts, as seen in Northern blot assays. We investigated the possibility that other transcripts, not detectable by Northern blot, were synthesized as either coding or regulatory RNAs that would modulate collagenase-3 expression and function/activity.Design: We screened a cDNA library and total RNA from human chondrocytes by plaque hybridization and RT-PCR, and expressed the transcripts in a cellular environment. The levels of expression of each transcript in normal and osteoarthritic joint cells and cartilage were monitored by RT-PCR.Results: We identified five different collagenase-3 RNA species derived from alternative polyadenylation sites (COL3-APS), internal deletion (COL3-DEL), alternative splicing (COL3-9B/COL3-9B-2), and different transcription initiation site (COL3-ATS and COL3-ATS-INT). Each transcript could be translated in a cellular environment. Interestingly, the proteins translated from the COL3-DEL and COL3-9B-2 transcripts had a modified hemopexin-like domain, suggesting altered collagenolytic activities. The transcript types COL3-APS, COL3-9B-2, and COL3-ATS were up-regulated in the osteoarthritic samples and expressed in the chondrosarcoma cell line SW1353.Conclusion: Our data show that the human collagenase-3 gene is subjected to different levels of regulation and constitutes a more complex system than was originally thought.

In this study a total of 305 adult fibulae were examined to determine the number and location of the nutrient foramina in the shafts of bones. Of 305 fibulae, 281 had one foramen, 12 had two and the remaining 12 had no foramen. The foramina were seen primarily on the posterior surface (48.36%) and in the middle third (98.00%) of the bone. The mean foraminal index of the fibula was found to be 48.14 +/- 0.46.

SummaryIntroductionTotal knee prostheses with a mobile-bearing insert were developed to provide nonconstrained joint range of motion while reducing friction forces. The purpose of this study was, based on weightbearing X-rays, to evaluate the mobility of the polyethylene tibial insert in relation to the femoral and tibial components. We studied the results of a cementless total knee arthroplasty (TKA) retaining the posterior cruciate ligament (PCL), with a mobile-bearing platform in rotation and anteroposterior translation (Innex® Anterior-Posterior Glide, Zimmer) with a mean 23-month follow-up duration after surgery.HypothesisBoth anterior-posterior tibiofemoral translation and intraprosthetic axial rotation occur between the mobile polyethylene insert and the tibial endplate.Material and methodIn a series of 51 primary TKA, the three-dimensional (3D) kinematics of the femoral, tibial, and mobile insert components were determined using a computerized matching system between the prosthetic 3D models and the radiographic images of the implants on three lateral follow-up weightbearing knee X-rays: films were taken in full extension, at 45° flexion, and at maximum flexion.ResultsThere was a statistically significant increase in the internal rotation of the mobile tray with flexion, (up to a mean −3±3° between the femoral box and the mobile tray [p

Although the positive health benefits of physical activity (PA) are well established, most of the evidence is linked with one of the sub-domains of PA, which is leisure-time physical activity (LTPA). The other domains besides LTPA (performed during free time) are occupational physical activity (OPA) (performed while working), transportation physical activity (TPA) (purpose to go somewhere), household physical activity (HPA) (engaging in housework), and sitting (such as while at work, at home, or studying). The role of the different domains of PA and their relations to different indicators of health or functioning, such as health-related quality-of-life (HRQoL) and work ability, have been minimally examined and are poorly understood. The aim of this study was to examine how different sub-domains of PA relate to HRQoL or work ability in different work requirements among the Finnish male population between 20 and 40 years of age. Data were obtained from 5000 male participants (born in 1969, 1974, 1979, 1984, or 1989) that were randomly selected from the population register as a population sample. Self-reported questions and questionnaires were used in the studies. Out of all domains of PA, LTPA was the only one that was positively related to mental and physical aspects of HRQoL or work ability. Furthermore, the results indicate that different domains were related differently between physical or mental aspects of HRQoL. More accurately, relatively high LTPA was related to better quality-of-life in both mental and physical aspects of HRQoL, whereas OPA was negatively related to physical health indicators and higher daily sitting was negatively related to mental-health indicators. Moreover, this study indicates the importance of LTPA among workers, particularly those with higher work-related physical strain, to endure the demands of daily work chores. Although the results of this study indicate that higher LTPA is related to better work ability in workers without depressive symptoms, the workers with depressive symptoms may need more than exercise to improve work ability, particularly if their job description included higher physical or mental demands. In addition, the findings reveal that regardless of whether the work is mainly physical or mental, LTPA could possibly compensate for the negative relations associated with lower work ability. Tutkimusnäyttöä fyysisen aktiivisuuden (physical activity, PA) terveyttä edistävistä ja ylläpitävistä hyödyistä on runsaasti, mutta suurin osa näytöstä liittyy vapaa-ajalla tapahtuvan fyysisen aktiivisuuden (leisure-time physical activity, LTPA) mittaamiseen. Muita PA:n osa-alueita ovat työssä (occupational physical acitivity, OPA), siirtymisissä (transportation physical activity, TPA) ja kotitaloustöissä tapahtuva fyysinen aktiivisuus (household physical activity (HPA). PA:n osa-alueiden roolia ja suhdetta erilaisiin terveyden tai toiminnan indikaattoreihin, kuten terveyteen liittyvään elämänlaatuun (health-related quality of life, HRQoL) ja työkykyyn on tutkittu vähemmän, minkä vuoksi näitä yhteyksiä tunnetaan myös heikommin. Tämän tutkimuksen tavoitteena oli tutkia miten 20-40-vuotiailla suomalaisilla miehillä PA:n eri osa-alueet vaikuttavat elämänlaatuun tai työkykyyn työn eri kuormituksissa. Tutkimusaineistona oli väestörekisteristä satunnaisotannalla valitut 5000 miehestä, jotka jaettiin 1000 miehen ikäkohortteihin syntymävuosien (1969, 1974, 1979, 1984 ja 1989) mukaan. Tutkittavien liikunnallista aktiviteettia, työkykyä ja henkilökohtaisia taustatietoja selvitettiin kyselylomaketutkimuksella. Kaikista PA:n osa-alueista LTPA oli ainoa, jolla oli positiivinen yhteys HRQoL:n tai työkyvyn henkisiin ja fyysisiin osatekijöihin. Tarkemmin ilmaistuna suhteellisen korkealla LTPA:lla oli yhteys parempaan elämänlaatuun HRQoL:n henkisissä ja fyysisissä osatekijöissä, kun taas OPA:lla oli negatiivinen yhteys HRQoL:n fyysisen terveyden indikaattoreihin. Lisäksi korkeampi päivittäinen istumisaika yhdistyi negatiivisesti HRQoL:n henkisen terveyden indikaattoreihin. Tutkimuksen tulokset korostavat LTPA:n tärkeyttä, etenkin työntekijöillä, joiden työ on fyysisesti raskasta. Tulokset myös osoittavat, että korkeammalla LTPA:lla oli mahdollisesti yhteys parempaan työkykyyn henkilöillä, joilla ei ollut masennusoireita, mutta masennusoireista kärsivät saattavat tarvita muutakin kuin liikuntaa työkyvyn parantamiseksi, etenkin jos heidän työnkuvaansa sisältyi reilusti fyysisiä tai henkisiä vaatimuksia. Lisäksi tulokset osoittavat, että riippumatta siitä, oliko työ enemmän fyysistä tai henkistä, korkeampi LTPA mahdollisesti vähentää huonommasta työkyvystä aiheutuvia negatiivisia assosiaatioita.

To comprehend the most detrimental characteristics behind bone fractures, it is key to understand the material and tissue level strain limits and their relation to failure sites. The aim of this study was to investigate the three-dimensional strain distribution and its evolution during loading at the sub-trabecular level in trabecular bone tissue. Human cadaver trabecular bone samples were compressed in situ until failure, while imaging with high-resolution synchrotron radiation X-ray tomography. Digital volume correlation was used to determine the strains inside the trabeculae. Regions without emerging damage were compared to those about to crack. Local strains in close vicinity of developing cracks were higher than previously reported for a whole trabecular structure and similar to those reported for single isolated trabeculae. Early literature on bone fracture strain thresholds at the tissue level seem to underestimate the maximum strain magnitudes in trabecular bone. Furthermore, we found lower strain levels and a reduced ability to capture detailed crack-paths with increased image voxel size. This highlights the dependence between the observed strain levels and the voxel size and that high-resolution is needed to investigate behavior of individual trabeculae. Furthermore, low trabecular thickness appears to be one predictor of developing cracks. In summary, this study investigated the local strains in whole trabecular structure at sub-trabecular resolution in human bone and confirmed the high strain magnitudes reported for single trabeculae under loading and, importantly extends its translation to the whole trabecular structure.