Mechanoreceptors of the ligaments and tendons around the knee

WOS: 000380947700016PubMed ID: 27376635Proprioceptive inputs from the joints and limbs arise from mechanoreceptors in the muscles, ligaments and tendons. The knee joint has a wide range of movements, and proper neuroanatomical organization is critical for knee stability. Four ligaments (the anterior (ACL) and posterior (PCL) cruciate ligaments and the medial (MCL) and lateral (LCL) collateral ligaments) and four tendons (the semitendinosus (STT), gracilis (GT), popliteal (PoT), and patellar (PaT) tendons) from eight fresh frozen cadavers were harvested. Each harvested tissue was divided into its bone insertion side and its tendinous part for immunohistochemical examination using S100 staining. Freeman-Wyke's classification was used to identify the mechanoreceptors. The mechanoreceptors were usually located close to the bone insertion. Free nerve endings followed by Ruffini endings were the most common mechanoreceptors overall. No Pacini corpuscles were observed; free nerve endings and Golgi-like endings were most frequent in the PCL (PCL-PaT: P=0.0.1, PCL-STT: P=0.00), and Ruffini endings in the popliteal tendon (PoT-PaT: P=0.00, Pot-STT: P=0.00, PoT-LCL: P=0.00, PoT-GT: P=0.00, PoT-ACL: P=0.09). The cruciate ligaments had more mechanoreceptors than the medial structures (MS) or the patellar tendon (CR-Pat: P=0.000, CR-MS: P=0.01). The differences in mechanoreceptor distributions between the ligaments and tendons could reflect the different roles of these structures in the dynamic coordination of knee motion. Clin. Anat. 29:789-795, 2016. (c) 2016 Wiley Periodicals, Inc

The effect of diclofenac on matrix metalloproteinase levels in the rotator cuff

Introduction Matrix metalloproteinases (MMPs) are involved in physiological events such as restructuring of the tissue, morphogenesis, wound healing and normal developmental process. Use of diclofenac sodium following rotator cuff repair can disrupt healing of tendon through acting on MMPs

Lower numbers of mechanoreceptors in the posterior cruciate ligament and anterior capsule of the osteoarthritic knees

WOS: 000411176000022PubMed ID: 27338958Impaired proprioception accuracy of the knee has been proposed as a local factor in the onset and progression of knee osteoarthritis. Patients with decreased numbers of mechanoreceptors could be more likely to develop arthrosis due to a loss in proprioception of the joint. We aimed to identify and quantify the mechanoreceptors of the posterior cruciate ligament (PCL), the anterior capsule (AC) and the medial meniscocapsular junction (MCJ) in knee arthrosis. PCLs, ACs and MCJs were harvested from 30 patients with Kellgren and Lawrence grades 3 and 4 osteoarthritis (OA), and ten knees taken from five cadavers without OA were used as a control group. PCL degeneration was evaluated with haematoxylin & eosin, and the types and numbers of mechanoreceptors were evaluated using S100 immunostaining. The patient ages in the OA and control groups (n.s.) did not differ. PCL degeneration was more severe in the gonarthrosis group than in the control group (p = 0.04). The numbers of Golgi corpuscles, Ruffini corpuscles, free nerve endings, total nerve endings and small vessels of the PCL were low in the OA group, as were the numbers of Golgi corpuscles, free nerve endings and total nerve endings of the AC. No significant correlation was found regarding the mechanoreceptors of the MCJ between the two groups. The numbers of mechanoreceptors in patients with OA were low in the PCLs and ACs. A loss in proprioception could be a local risk factor in OA. The proprioceptive impact of preserving PCL while performing total knee arthroplasty may not be exaggerated as its thought. Prognostic study, Level I

Mid-term functional results of surgically treated acetabulum fractures

The aim of the study was to evaluate the type of trauma, additional injury, age, additional diseases, need for ICU and blood transfusion, postoperative complications, mid-term patient satisfaction and hip functions of the patients who underwent surgical treatment for acetabulum fracture in our clinic. A total of 17 patients (15 males, 2 females, mean age 40,7 years ) who admitted to the emergency department between 2013 and 2016, and treated surgically due to acetabulum fractures were included in the study. According to Judet Letournel classification, 7 anterior wall fractures, 4 anterior column fractures, 3 posterior column fractures and 3 both column fractures were determined. Mean hospital stay was 14.5 days (range 3-45 days) and mean follow-up was 26 months (14 to 57 months). ICU needed in 3 (17.6%) cases, mean stay was 10.3 days (range 1-29 days). 6 (35.2%) patients required blood transfusion, mean amount was 4.1 units (range 2-6 units). Harris hip scores were excellent - good in 12 cases (70.5%) and 5 cases (29.5%) had moderate - poor results at 12th month. There was no statistically significant relationship between severity of trauma, type of injury, age, additional diseases, intensive care and blood transfusion requirements, postoperative complications and patient satisfaction (p> 0.05). In selected acetabular fracture cases with proper planning according to fracture type, in early period, surgery may lead to satisfactory results in terms of patient satisfaction and hip functions. [Med-Science 2018; 7(3.000): 668-71

Fluoroscopy improves femoral stem placement in cementless total hip arthroplasty

Fluoroscopy is routinely used in trauma cases to evaluate alignment and reduction quality. Because conventional templating has a high mismatch rate, we sought to explore whether we could use intraoperative fluoroscopy while implanting the femoral stem. Sixty patients with Croft 3-4 coxarthrosis were included in this study. No preoperative templating was performed in either of the two groups. The final conformations of the stem sizes and positions were achieved freehand intraoperatively using anatomic landmarks. In the second group, after surgeons intraoperatively agreed on the final stem size, C-arm fluoroscopy images are obtained with the last rasp size before the stem implantation. The alignment of femoral stem according to the femoral canal, the lower leg discrepancy (LLD) and the lateral offsets were evaluated with X ray. The stem/endosteal areas at 2 cm above the trochanter minor (T+2) and 2 cm below the trochanter minor (T-2) and the deviation of the stem tip from the center of the femoral canal were evaluated in CT images. The stems that were implanted under fluoroscopic control filled the medullary cavity better at both the T+2 and T-2 levels. On fluoroscopy, in the control group, the malpositioning of the femoral stems were less, the centralizations were better, and the restorations of the lateral offset and LLD were more accurate. The use of fluoroscopy while rasping the femoral canal leads to proper alignment and press fitting of the stem and provides the opportunity to intraoperatively correct malpositionings of the stem. [Med-Science 2017; 6(2.000): 264-9

Risk factors for mortality in delayed intertrochanteric fractures

We aimed to figured out the risk factors of one year mortality in intertrochanteric hip fractures with delayed operation more than 72 hours. 96 out of 226 patients with proximal femoral fracture included in this study. Hemogram, blood urine nitrogen (BUN), creatinine, sodium, potassium and serum albumin levels are recorded from their blood test at administration of hospital. Time to theatre and postoperative needs for intensive care are recorded. Mobility functions before fracture and after 3 months of operation are assessed by mobility part of Barthel index. Multiple logistic regression analysis was performed to estimate the simultaneous effects of important covariates. In univariate model, age(p=0.0027), ASA(p=0.00), loss of mobility(p=0.00), bone union time(p=0.001), blood transfusion(p=0.026), albumin(p=0.004) and mobility after operation (p=0.001) were associated with mortality but in the final model for multivariate regression analysis loss of mobility level (p=0.001) and bone union time (p=0.02) were found to be independent risk factors of mortality. In postoperative period mobilization is the most important variable that we could changed in intertrochanteric fractures to decrease mortality. Whatever the timing of operation, gaining the mobility as soon as possible should be the goal of our treatment. [Med-Science 2017; 6(3.000): 521-5

Effects of Sleeping Positions on the Rotator Cuff Pathology

The rotator cuff tear aetiology is still unclear. Especially for atraumatic ruptures, degenerative processes come into prominence. This study aims to correlate between four most commonly-seen sleeping positions and patients with rotator cuff pathology. 87 patients who applied to the institute for suffering from shoulder pain for more than 6 months without a trauma and 93 voluntary people (as control group) above the age of 50 who applied to the institution for reasons other than shoulder pain included in the study. Rotator cuff ruptures and acromion types of the patients are diagnosed via magnetic resonance imaging. In face-to-face interviews, all the patients are asked to show their favourite sleeping positions on the visual cards and also questioned about their smoking habits and overhead activities. There is not any statistically substantive parameters between the patients and the control group in terms of age and sex. 83.9% of the patients with rotator cuff rupture have stated prefering lateral decubitus position while this rate is %61.3 among the control group (p=0.003). Atraumatic rotator cuff tears are increase with age. The increase pressure in the subacromial space can lead distribution in microvascular circulation of rotator cuff. Decrease in the microvascular circulation also affect the regeneration potential of rotator cuff. Laboratory studies demonstrated that lateral decubitus position has the most prominent increase in the subacromial pressure over all sleeping positions. We consider that sleeping in the lateral decubitus position causes long-term high subacromial pressure, leading to a microcirculatory disorder in the rotator cuff, which is a risk factor for the rotator cuff aetiology. [Med-Science 2015; 4(4.000): 2825-33