Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 9 Articles
Background: This study evaluated the application of a layered cell free poly (L-lactic acid) (PLLA) scaffold to\r\nregenerate an infraspinatus tendon defect in a rabbit model. We hypothesized that PLLA scaffold without\r\ncultivated cells would lead to regeneration of tissue with mechanical properties similar to reattached infraspinatus\r\nwithout tendon defects.\r\nMethods: Layered PLLA fabric with a smooth surface on one side and a pile-finished surface on the other side\r\nwas used. Novel form of layered PLLA scaffold was created by superimposing 2 PLLA fabrics. Defects of the\r\ninfraspinatus tendon were created in 32 rabbits and the PLLA scaffolds were transplanted, four rabbits were used\r\nas normal control. Contralateral infraspinatus tendons were reattached to humeral head without scaffold\r\nimplantation. Histological and mechanical evaluations were performed at 4, 8, and 16 weeks after operation.\r\nResults: At 4 weeks postoperatively, cell migration was observed in the interstice of the PLLA fibers. Regenerated\r\ntissue was directly connected to the bone composed mainly of type III collagen, at 16 weeks postoperatively. The\r\nultimate failure load increased in a time-dependent manner and no statistical difference was seen between normal\r\ninfraspinatus tendon and scaffold group at 8 and 16 weeks postoperatively. There were no differences between\r\nscaffold group and reattach group at each time of point. The stiffness did not improve significantly in both groups.\r\nConclusions: A novel form of layered PLLA scaffold has the potential to induce cell migration into the scaffold\r\nand to bridge the tendon defect with mechanical properties similar to reattached infraspinatus tendon model....
Background: Falls remain a major cause of childhood morbidity and mortality. It is suggested that backward\r\nwalking (BW) may offer some benefits especially in balance and motor control ability beyond those experienced\r\nthrough forward walking (FW), and may be a potential intervention for prevention of falls. The objective of this\r\nstudy was to investigate the effects of BW on balance in boys.\r\nMethods: Sixteen healthy boys (age: 7.19 �± 0.40 y) were randomly assigned to either an experimental or a control\r\ngroup. The experimental group participated in a BW training program (12-week, 2 times weekly, and 25-min each\r\ntime) but not the control group. Both groups had five dynamic balance assessments with a Biodex Stability System\r\n(anterior/posterior, medial/lateral, and overall balance index) before, during and after the training (week- 0, 4, 8, 12,\r\n24). Six control and six experimental boys participated in a study comparing kinematics of lower limbs between\r\nFW and BW after the training (week-12).\r\nResults: The balance of experimental group was better than that of control group after 8 weeks of training (P <\r\n0.01), and was still better than that of control group (P < 0.05), when the BW training program had finished for 12\r\nweeks. The kinematic analysis indicated that there was no difference between control and experimental groups in\r\nthe kinematics of both FW and BW gaits after the BW training (P > 0.05). Compared to FW, the duration of stance\r\nphase of BW tended to be longer, while the swing phase, stride length, walking speed, and moving ranges of the\r\nthigh, calf and foot of BW decreased (P < 0.01).\r\nConclusion: Backward walking training in school-aged boys can improve balance....
Background: We developed a novel technique to improve tendon-bone attachment by hybridizing calcium\r\nphosphate (CaP) with a tendon graft using an alternate soaking process. However, the long-term result with regard\r\nto the interface between the tendon graft and the bone is unclear.\r\nMethods: We analyzed bone tunnel enlargement by computed tomography and histological observation of the\r\ninterface and the tendon graft with and without the CaP hybridization 2 years after anterior cruciate ligament\r\n(ACL) reconstruction in goats using EndoButton and the postscrew technique (CaP, n = 4; control, n = 4).\r\nResults: The tibial bone tunnel enlargement rates in the CaP group were lower than those in the control group (p\r\n< 0.05). In the CaP group, in the femoral and tibial bone tunnels at the anterior and posterior of the joint aperture\r\nsite, direct insertion-like formation that contained a cartilage layer without tidemarks was more observed at the\r\ntendon-bone interface than in the control group (p < 0.05). Moreover, the gap area between the tendon graft and\r\nthe bone was more observed at the femoral bone tunnel of the joint aperture site in the control group than in\r\nthe CaP group (p < 0.05). The maturation of the tendon grafts determined using the ligament tissue maturation\r\nindex was similar in both groups.\r\nConclusions: The CaP-hybridized tendon graft enhanced the tendon-bone healing 2 years after ACL reconstruction\r\nin goats. The use of CaP-hybridized tendon grafts can reduce the bone tunnel enlargement and gap area\r\nassociated with the direct insertion-like formation in the interface near the joint....
Introduction: With evolutions in surgical techniques, minimally invasive surgical (MIS) repair with Achillon\r\napplicator has been introduced. However, there is still a lack of literature to investigate into the clinical merits of\r\nMIS over open surgery. This study aims to investigate the correlation between clinical outcome, gait analysis and\r\nbiomechanical properties comparing both surgical methods.\r\nMaterials and methods: A single centre retrospective review on all the consecutive operated patients between\r\nJanuary 2004 and December 2008 was performed. Twenty-six patients (19 male and 7 female; age 40.4 �± 9.2 years)\r\nhad experienced a complete Achilles tendon rupture with operative repair. Nineteen of the patients, 10 MIS versus\r\n9 open repairs (13 men with a mean age of 40.54 �± 10.43 (range 23-62 yrs) and 6 women with a mean age of\r\n45.33 �± 7.71 (range 35-57 yrs) were further invited to attend a thorough clinical assessment using Holzâ��s scale and\r\nbiomechanical evaluation at a mean of 25.3 months after operation. This study utilized the Cybex II isokinetic\r\ndynamometer to assess the isokinetic peak force of plantar-flexion and dorsiflexion of both ankles. The patients\r\nwere also invited to return to our Gait Laboratory for analysis. The eight-infrared camera motion capture system\r\n(VICON, UK) was utilized for the acquisition of kinematic variables. Their anthropometric data was measured\r\naccording to the Davis and coworkersâ�� standard.\r\nResults: The mean operative time and length of hospital stay were shorter in the MIS group. The operative time\r\nwas 54.55 �± 15.15 minutes versus 68.80 �± 18.23 minutes of the MIS group and Open group respectively (p =\r\n0.045), whereas length of stay was 3.36 �± 1.21 days versus 6.40 �± 3.70 days respectively (p = 0.039). There is\r\nstatistically significant decrease (p = 0.005) in incision length in MIS group than the open surgery group, 3.23 �±\r\n1.10 cm versus 9.64 �± 2.55 cm respectively. Both groups attained similar Holzâ��s scores, 11.70 �± 0.95 versus 12.0 �±\r\n1.50 respectively (p = 0.262). The mean percentage stance time of the injured leg for MIS patient was 58.44%\r\nwhile the mean percentage stance time of the injured leg for patients with open repair was 56.57%. T-test has\r\nshown there were no significance differences between the results of the two groups of patients. The loss of\r\npeak torque and total work done with respect to the injured side were similar between the MIS and open\r\ngroup.\r\nDiscussion and conclusion: MIS using Achillon method can achieve smaller incisions, shorter operative time\r\nand hospital stay. There is no statistical significance difference in clinical outcome, the stance time to strike time\r\nratio and biomechanical properties on the leg receiving Achilles tendon repair using MIS method and open\r\nsurgery....
The clinical evaluation of the knee is a fundamental tool to correctly address diagnosis and treatment, and should\r\nnever be replaced by the findings retrieved by the imaging studies carried on the patient.\r\nEvery surgeon has his own series of exams with whom he is more confident and on whom he relies on for\r\ndiagnosis. Usually, three sets of series are used: one for patello-femoral/extensor mechanism pathologies; one for\r\nmeniscal and chondral (articular) lesions; and one for instability evaluation.\r\nThis review analyses the most commonly used tests and signs for knee examination, outlining the correct way to\r\nperform the test, the correct interpretation of a positive test and the best management for evaluating an injured\r\nknee both in the acute and delayed timing....
Background: Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point\r\nof view as it enhances revascularization, and preserves the proprioceptive function of the graft construct.\r\nAdditionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to\r\nbetter replicate the native ACL anatomy and results in better restoration of the rotational stability than single\r\nbundle reconstruction.\r\nMethods: We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique\r\nfor its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to\r\nmake a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical\r\ncreation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of\r\nthe wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby,\r\nguarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the\r\nintercondylar notch.\r\nConclusion: Our technique allows for anatomical double bundle reconstruction of the ACL while maximally\r\npreserving the ACL remnant without the use of intra-operative image intensifier....
Background: Boiogito (Japanese herbal medicine, Tsumura Co. Tokyo, Japan) contains sinomenin which inhibits\r\ninflammatory reactions. Since sinomenine is a principle component of the Boiogito, there is a possibility of it being\r\neffective on osteoarthritis (OA) of the knee with joint effusion. However, there is no report concerning the effectiveness\r\nof Boiogito on knee OA. The objective of the present study is to investigate the therapeutic effect of Boiogito on OA of\r\nthe knee associated with joint effusion in a comparative study among randomly assigned groups.\r\nMethods: Study was performed using 50 patients who were diagnosed with primary osteoarthritis of the knee\r\nwith joint effusion. The patients were randomly assigned to two groups: one group (25 patients) using both\r\nloxoprofen (2-{4-[(2-oxocyclopentyl) methyl]} propanoic acid) and Boiogito and the other group (25 patients) using\r\nloxoprofen, and were evaluated during a 12 week observation period. The assessment parameters including knee\r\nscores in the Knee Society Rating System including Knee score and Functional scores, amount of joint effusion by\r\njoint puncture in clinically detected cases, the 36-items short form of the Medical Outcome Study Questionnaire\r\n(SF-36) as a measurement of health related quality of life were used.\r\nResults: The knee scores based on the Knee Society Rating System were improved in both groups. The staircase\r\nclimbing up and down ability in the Knee society rating system functional score was significantly improved in the\r\ngroup using Boiogito and loxoprofen compared to the loxoprofen group. In the evaluation using SF-36, significant\r\nimprovements were found in the scores in both groups in physical functioning after 12 weeks. The amount of\r\njoint fluid was significantly decreased at 4, 8 and 12 weeks compared to pre-administration baseline in the group\r\nusing Boiogito and loxoprofen. A side effect of Boiogito, dry mouth, was found in one case. The symptom was\r\nmild and improved immediately after discontinuation of administration.\r\nConclusion: The results indicated that Boiogito have a possibility for a treatment modality for joint effusion with\r\nosteoarthritis of the knee....
Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent\r\nstudies have shown little difference in outcome between the techniques of open and non-operative treatment\r\nusing an early active rehabilitation programme. Meta-analyses have shown that non-operative management has\r\nincreased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and\r\niatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and\r\nwound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and\r\noutcomes of percutaneous and minimally invasive repairs of the Achilles tendon....
An implicit approach to motor learning suggests that relatively complex movement skills may be better acquired\r\nin environments that constrain errors during the initial stages of practice. This current concept paper proposes that\r\nreducing the number of errors committed during motor learning leads to stable performance when attention\r\ndemands are increased by concurrent cognitive tasks. While it appears that this approach to practice may be\r\nbeneficial for motor learning, further studies are needed to both confirm this advantage and better understand the\r\nunderlying mechanisms. An approach involving error minimization during early learning may have important\r\napplications in paediatric rehabilitation....
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