BIOMECHANICAL STUDY ON CADAVER KNEE FOR THE EVALUATION OF CRUCIATE KNEE LIGAMENT RECONSTRUCTIONS

INTRODUCTION: Ruptures of the anterior and posterior cruciate knee ligament (ACL and PCL), alone or combined, are some of the most frequent joint injuries, especially in sports. The long-term unsatisfactory results and lack of systematic evaluation of surgical reconstructions have led us to undergo an evaluation on cadaver knees. MATERIAL AND METHOD: A preliminary study was performed on one cadaver knee. The femur was fixed on a holder and magnetic sensors “BirdsTM” were attached to the tibia and the femur, which tracked the knee’s movement. A threedimensional knee analyzer GENI(1) was used to calculate kinematic parameters (tibial internal and external rotation and ab/adduction), as well as ligament combined deformation (elongation / bending / torsion) during knee flexion. This experiment was performed on an intact knee and a knee where the PCL has been cut and reconstructed using a synthetic Trevia ligament. Finally the knee was dissected to produce a combined postero-lateral instability and reconstructed with and without postero-lateral corner reconstruction. The effect of different reconstruction methods on kinematics and ligament deformation were compared. RESULTS AND DISCUSSION: Kinematic parameters changed significantly when PCl and postero-lateral corner were dissected. The reconstruction of the PCL alone, using an “Over-the-Bottom” method described by Krudwig(2), shifted the curves back to the initial situation and decreased the variability of the movement. Ligament deformation was 3 mm elongation, 50o femoral flexion and 90o torsion. These values are in accordance with material properties and should lead to good long-term biofunctionnality. CONCLUSION: This study proposes an in vitro protocol for a better understanding of the clinical success or failure of different procedures. Preliminary results showed that the system and the protocol setup are sensitive to changes in kinematics following posterior cruciate ligament dissection and reconstruction. Experiments are performed at this time on several cadaver knees, in order to compare different reconstruction methods. REFERENCES: Sati, M. et al. (1997). Computer Assisted Knee Surgery: Diagnostics and Planning of Knee Surgery. Computer Aided Surgery 2, 108-123. Krudwig, W. (1997). In L'H. Yahia (Ed.), Ligaments and Ligamentoplasties. Heidelberg: Springer Verlag

Online Deliberation in Academia: Evaluating the Quality and Legitimacy of Cooperatively Developed University Regulations

This article focuses on the potential of online participation to enable the cooperative development of norms by affected stakeholders, investigating whether such processes can produce norms of both high quality and legitimacy. To answer this question, we designed, implemented, and evaluated an online norm setting process that goes beyond the scope of those usually described in the literature. Taking as a case study a process to redraft the examination regulations for doctoral degrees at a science faculty of a German university, we show that such instances of online deliberation can integrate the diversity of opinions of all affected stakeholders. The result was a norm that implemented previously controversial external recommendations for doctoral dissertation procedures and that was met with high satisfaction from both those who participated as well as those who remained passive. While we believe that the university context in which this process was conducted is particularly promising for such efforts because of its organization, its members, and the issue that was at stake, we argue that similar conducive conditions exist, for example, for political parties. As such, the findings can be instructive for understanding the potential and limits of successful online participation in other contexts

Inefficacy of different strategies to improve guideline awareness – 5-year follow-up of the hypertension evaluation project (HEP)

<p>Abstract</p> <p>Background</p> <p>In spite of numerous guidelines for evidence based diagnostic and therapy adequate knowledge of current recommendations is disappointingly low. In the Hypertension Evaluation Project (HEP I) we showed that awareness of national hypertension guidelines under German practitioners was less than 25% in the year 2000. This indicates the need for efficient strategies to relevantly improve guideline awareness.</p> <p>Methods</p> <p>To asses different tools for amending guideline knowledge we used three strategies (guideline in print, interactive guideline, expert seminars) to train 8325 randomised physicians, who had participated in the HEP I trial. Guideline knowledge of the trained physicians was again tested with the HEP questionnaire and compared to a control group of HEP I physicians.</p> <p>Results</p> <p>The return rate of questionnaires was 57.9% without a significant distinction between the groups. Overall guideline awareness was still low but remarkably improved compared to the results of HEP I (37.1% vs. 23.7%, p < 0.0001). There was no difference between the trained physicians and the control group (35.8% and 35.9% vs. 39.7%, p = n.s.).</p> <p>Conclusion</p> <p>We investigated the influence of different strategies to improve guideline awareness among German physicians. None of our interventions (guideline in print, interactive guideline, expert seminars) brought a notable benefit compared to control group. However, overall knowledge of guideline contents increased from 23.7% to 37.1% over five years. Therefore, other probably multimodal interventions are necessary to significantly improve guideline awareness beyond spontaneous advancement.</p> <p>Trial Registration</p> <p>ISRCTN53383289</p

3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation.

Background Alterations of the scapular kinematics in different pathologic conditions have been widely studied. However, results have shown considerable discrepancies concerning the direction and the amplitude of scapular movement. The lack of consistency in the literature probably has several explanations. The purpose of this study was to analyze scapular orientation with the arm at rest and with 90° lateral elevation in healthy and pathologic subjects by use of stereoradiographs. Materials and methods All participants (n = 65) underwent a clinical examination and magnetic resonance imaging of the shoulder to assess rotator cuff status. Participants were separated into 3 groups: healthy, rotator cuff tear (RCT), and RCT and subacromial impingement syndrome (RCT+ SIS). A 3-dimensional model of the scapula was fitted to each low-dose stereoradiograph acquired with the arm at rest and 90° arm elevation. Results Orientation of the scapula with the arm at rest was not significantly different between groups. During lateral elevation, scapular orientation was not significantly different between the healthy group and the RCT group. However, upward rotation was significantly reduced in the RCT + SIS group. Conclusion Alterations of scapular kinematics in symptomatic subjects are multifactorial. We observed a link between clinically assessed subacromial impingement and scapular orientation during lateral elevation of the arm.Funding: IRSST, ParisTech BiomecAM Chair, Société Générale, and Covea

Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial

Background: Conventional radiography is commonly used to diagnose knee osteoarthritis (OA), but also to guide clinical decision-making, despite a well-established discordance between radiographic severity and patient symptoms. The incidence and progression of OA is driven, in part, by biomechanical markers. Therefore, these dynamic markers may be a good metric of functional status and actionable targets for clinicians when developing conservative treatment plans. The aim of this study was to assess the associations between biomechanical markers and self-reported knee function compared to radiographic severity. Methods: This was a secondary analysis of data from a randomized controlled trial (RCT) conducted in primary care clinics with knee OA participants. Correlation coefficients (canonical (ρ) and structural (Corr)) were assessed between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and both, radiographic OA severity using the Kellgren-Lawrence grade, and three-dimensional biomechanical markers quantified by a knee kinesiography exam. Significant differences between coefficients were assessed using Fischer’s z-transformation method to compare correlations from dependent samples. Results: KOOS and biomechanical data were significantly more associated than KOOS and X-ray grading (ρ: 0.41 vs 0.20; p  36% variance explained), while X-ray grading was most associated with Symptoms subscale (21% explained; all p ≤ 0.001). Conclusions: Knee biomechanical markers are associated with patient-reported knee function to a greater extent than X-ray grading, but both provide complementary information in the assessment of OA patients. Understanding how dynamic markers relate to function compared to radiographic severity is a valuable step towards precision medicine, allowing clinicians to refine and tailor therapeutic measures by prioritizing and targeting modifiable biomechanical markers linked to pain and function