Current concepts on the morphology of popliteus tendon and its clinical implications

In this review we described the anatomy and biomechanics of popliteus muscle and its tendon. Furthermore, we combined the anatomy with clinics and discussed a wide spectrum of disorders regarding the popliteus and its musculotendinous complex. There are three main anatomical regions of the popliteus musculotendinous complex: the proximal origin, the mid-portion, the distal part on the tibia. The unique localisation and various origins of the tendon, connected with structures such as fibular head, Wrisberg, Humphrey and posterior cruciate ligament, lateral meniscus, medial collateral ligament, give an implication to diagnosis and treatment. Popliteus dysfunction is often overlooked, that is the reason why diagnosis and treatment of its injuries is mostly insufficient. Repetitive or acute direct varus forces, when the tibia is in external rotation, and knee hyperextension or flexion with forced external rotation of the tibia, are the main mechanisms of trauma. Popliteus injuries mainly affect the athletic population and lead to severe activity limitations. Chronic disorders of the popliteus tendon, less known, are often described as tendinopathy and are frequently seen in runners. Their symptoms can mimic the lateral meniscal tears. On the other hand, high-energy traumatic injuries of the popliteus tendon often accompany complex, multi ligamentous injuries seen in competitive sports. We also presented the implication of popliteus tendon in knee arthroplasty, due to its particular exposition to iatrogenic trauma during surgery. The issues such as proper tibial component location and well-designed cut systems are crucial to avoid the popliteus impingement and preserve its structure

A new fixation technique for phalangeal neck fracture in adults: Report of 2 cases

Several open and closed surgical techniques have been reported in the treatment of displaced phalangeal neck fractures. The most common fixation is provided by a Kirschner wire, which is placed in a retrograde manner through the interphalangeal joint in extension. Although it provides a stable fixation, it may lead to joint stiffness and cartilage damage. The purpose of this report is to describe a new fixation technique for phalangeal neck fractures in 2 cases, which may provide stable fixation and prevent cartilage damage and joint stiffness. © 2013 by Lippincott Williams & Wilkins

In vivo performance of poly(?-caprolactone) constructs loaded with gentamicin releasing composite microspheres for use in bone regeneration

For materials used in the production of dental and orthopedic implants or scaffolds for bone tissue regeneration, the properties such as capacity to enhance cell attachment and proliferation, and antimicrobial activity to prevent biofilm formation are very important to improve the clinical utility of the material. In this study, poly(py -caprolactone) (PCL) sponges with antimicrobial activity were prepared by incorporating gentamicin loaded er -tricalcium phosphate (he -TCP)-Gelatin microspheres, and in vivo performances were studied. These composite systems are expected to enhance bone regeneration due to /3-TCP and prevent a possible infection by releasing gentamicin in the host location. The effects of gentamicin and /3-TCP/Gelatin microspheres in the sponge structure were studied in vivo by applying them on iliac crest defects of rabbits. Histological analyses after 8 weeks of implantation showed that the composite constructs performed significantly better in bone healing than those with antibiotic-free microspheres. Also, the PCL constructs carrying /3-TCP/Gelatin microspheres led to better bone formation than the pristine PCL scaffolds. Push-out tests demonstrated better integration of the constructs with the tissue indicating high level of material-tissue integration. This study indicates the importance of the presence of antibiotics and /3-TCP/Gelatin in the scaffolds to achieve better and faster healing in bone defects than pristine scaffolds. © 2014 American Scientific Publishers All rights reserved

A biomimetic growth factor delivery strategy for enhanced regeneration of iliac crest defects

PubMedID: 23782488The importance of provision of growth factors in the engineering of tissues has long been shown to control the behavior of the cells within the construct and several approaches were applied toward this end. In nature, more than one type of growth factor is known to be effective during the healing of tissue defects and their peak concentrations are not always simultaneous. One of the most recent strategies includes the delivery of a combination of growth factors with the dose and timing to mimic the natural regeneration cascade. The sequential delivery of bone morphogenetic proteins BMP-2 and BMP-7 which are early and late appearing factors during bone regeneration, respectively, was shown in vitro to enhance osteoblastic differentiation of bone marrow derived mesenchymal stem cells. In the present study, the aim was to study the effectiveness of this delivery strategy in a rabbit iliac crest model. 3D plotted poly(?-caprolactone) scaffolds were loaded with BMP carrying nanoparticles to achieve: (a) single BMP-2 or BMP-7 delivery, and (b) their combined delivery in a simultaneous or (c) sequential (biomimetic) fashion. After eight weeks of implantation, computed tomography and biomechanical tests showed better mineralized matrix formation and bone-implant union strength at the defect site in the case of sequential delivery compared to single or simultaneous delivery modes. Bone mineral density (BMD) and push-out stress were: 33.65±2.25 g cm-3 and 14.5±2.28 MPa, respectively, and almost 2.5 fold higher in comparison to those without growth factors (BMD: 14.14±1.21 g cm-3; PS: 6.59±0.65 MPa). This study, therefore, supports those obtained in vitro and emphasizes the importance of mimicking the natural timing of bioavailability of osteogenic factors in improving the regeneration of critical-sized bone defects. © 2013 IOP Publishing Ltd

SLAP lesions

Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear. Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons. First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous. Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries. Third, SLAP lesions have no specific associated pain pattern. Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics. Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. , Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.PubMedWoSScopu

A unique rectus femoris injury in an adolescent professional soccer player: A case report

Case: A sixteen-year-old professional soccer player presented with persistent pain in the right thigh of two years' duration and the inability to return to play. Evaluation revealed a chronic rupture of the rectus femoris muscle. Because physiotherapy and rehabilitation failed to help, a surgical repair was performed. He returned to his previous activity level within nine months after surgery. Conclusion: Rupture of the proximal part of the rectus femoris should be acknowledged in the differential diagnosis, especially when presenting with persistent pain in the anterior aspect of the thigh lasting more than one year. Delayed repair might be recognized as a reasonable option for chronic rupture of the proximal part of the rectus femoris. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated

The effect of posterior distraction on vertebral growth in immature Pigs: An experimental simulation of growing rod technique

PubMedID: 20195208STUDY DESIGN.: Experimental study. OBJECTIVE.: The aim of this study is to evaluate the vertebral body growth under distraction forces in immature pigs treated with growing rod (GR) technique. SUMMARY OF BACKGROUND DATA.: Distraction forces applied on growth plate of appendicular skeleton stimulate longitudinal growth. However, the effect of distraction forces on axial skeletal growth has not been fully investigated yet. METHODS.: Twelve 10-week-old domestic pigs were used in this experimental model to simulate GR technique. Four of them were lost during postoperative period because of deep wound infection. Cranially T12-L1 and caudally L4-L5 vertebrae were instrumented by pedicle screws bilaterally, while L2 and L3 were skipped. Distraction between pedicle screws was applied at index surgery. The rods were then lengthened twice in a month interval. All subjects were evaluated with anteroposterior and lateral spinal radiograph before surgery, after surgery, and at the final follow-up. The vertebral body heights of distracted segments (HD = L2 and L3) and control segments (HC = T9, T10 and T11) were measured. Average vertebral body heights and the increase percentage in the vertebral body heights were compared among control segments and distracted segments. RESULTS.: The preoperative vertebral body height was similar in 2 groups (preHC: 10.81 mm, n = 19, preHD: 11.27 mm, n = 16, P > 0.05). At the final follow-up, the average vertebral body height in distraction group was significantly higher than the control group (postHC: 17.03 mm, postHD: 18.58 mm, P < 0.05). The increase percentage in vertebral body height was higher in distracted segments, but there was no statistically significant difference between the 2 groups. CONCLUSION.: The vertebral growth continues during GR instrumentation. Distraction forces might stimulate also apophyseal growth of axial skeleton. © 2010, Lippincott Williams & Wilkins