Anterior cruciate ligament reconstruction with suture tape augmentation

The advent of suture tape augmentation has led to increased use in knee, elbow, and ankle ligament repairs and reconstructions. Recent biomechanical analysis of the use of suture tape augmentation have shown superior strength characteristics compared with repair or reconstruction alone. Despite its increased use in extra-articular ligament procedures, its use as an augment to anterior cruciate ligament reconstruction has not been widely described. This article details a simple technique to incorporate the use of suture tape augmentation during concurrent anterior cruciate ligament reconstruction using hamstring autograft

Granulite facies metamorphism and partial melting processes in the Ivrea Zone, Northern Italy

The Ivrea Zone in northern Italy has been the focus of numerous petrological, geochemical and structural studies. It is commonly inferred to represent an almost complete section through the mid to lower continental crust, in which metamorphism and partial melting of the abundant metapelites was the result of magmatic underplating by a large volume of mantle-derived magma. This study concerns amphibolite and granulite facies metamorphism in the Ivrea Zone with focus on metapelites and metapsammites/ metagreywackes from Val Strona di Omegna and metapelites from Val Sesia and Val Strona di Postua, with the aim to better constrain their metamorphic evolution as well as their pressure and temperature conditions via phase equilibria modelling.rnrnIn Val Strona di Omegna, the metapelites show a structural and mineralogical change from mica-schists with the common assemblage bi-mu-sill-pl-q-ilm ± liq at the lowest grades, through metatexitic migmatites (g-sill-bi-ksp-pl-q-ilm-liq) at intermediate grades, to complex diatexitic migmatites (g-sill-ru-bi-ksp-pl-q-ilm-liq) at the highest grades. Within this section several mappable isograds occur, including the first appearance of K-feldspar in the metapelites, the first appearance of orthopyroxene in the metabasites and the disappearance of prograde biotite from the metapelites. The inferred onset of partial melting in the metapelites occurs around Massiola. The prograde suprasolidus evolution of the metapelites is consistent with melting via the breakdown of first muscovite then biotite. Maximum modelled melt fractions of 30–40 % are predicted at the highest grade. The regional metamorphic field gradient in Val Strona di Omegna is constrained to range from conditions of 3.5–6.5 kbar at T = 650–730 °C to P > 9 kbar at T > 900 °C. The peak P–T estimates, particularly for granulite facies conditions, are significantly higher (around 100 °C) than those of most previous studies. In Val Sesia and Val Strona di Postua to the south the exposure is more restricted. P–T estimates for the metapelites are 750–850 °C and 5–6.5 kbar in Val Sesia and approximately 800–900 °C and 5.5–7 kbar in Val Strona di Postua. These results show similar temperatures but lower pressure than metapelites in Val Strona di Omegna. Metapelites in Val Sesia in contact with the Mafic Complex exhibit a metatexitic structure, while in Val Strona di Postua diatexitic structures occur. Further, metapelites at the contact with the Mafic Complex contain cordierite (± spinel) that overprint the regional metamorphic assemblages and are interpreted to have formed during contact metamorphism related to intrusion of the Mafic Complex. The lower pressures in the high-grade rocks in Val Sesia and Val Strona di Postua are consistent with some decompression from the regional metamorphic peak prior to the intrusion of the Mafic Complex, suggesting the rocks followed a clockwise P–T path. In contrast, the metapelites in Val Strona di Omegna, especially in the granulite facies, do not contain any cordierite or any evidence for a contact metamorphic overprint. The extrapolated granulite facies mineral isograds are cut by the rocks of the Mafic Complex to the south. Therefore, the Mafic Complex cannot have caused the regional metamorphism and it is unlikely that the Mafic Complex occurs in Val Strona di Omegna.Die vorliegende Dissertation beschäftigt sich mit amphibolit- und granulitfaziellen Metasedimenten (unterteilt in Metapelite und Metapsammite/Metagrauwacken) des Val Strona di Omegna, des Val Sesia und des Val Strona di Postua (Ivrea Zone), wobei erstgenanntes den Schwerpunkt der Arbeit bildet. Ziel der Arbeit ist es, die Druck- und Temperaturbedingungen der Metamorphose und Gesteinsaufschmelzung anhand von Mineral- bzw. Phasengleichgewichtsmodellierung, im vergleich zu vorherigen Arbeiten, weiter einzugrenzen und Aussagen über den Grad der Teilschmelzenbildung treffen zu können. Des Weiteren soll die Frage geklärt werden, inwiefern der „Mafische Komplex“, speziell im Val Strona di Omegna, tatsächlich als Auslöser für die Metamorphose und die Aufschmelzung der Gesteine in Frage kommen kann. rnrnDie Metapelite im Val Strona di Omegna zeigen, von Südost nach Nordwest, welches dem Übergang von niedrig- zu hochgradigen metamorphen Bedingungen entspricht, eine kontinuierliche Entwicklung von Glimmerschiefern (generell bi-mu-sill-pl-q-ilm ± liq) über metatexitische Migmatite (g-sill-bi-ksp-pl-q-ilm-liq) hin zu komplexen diatexitischen Migmatiten (g-sill-ru-bi-ksp-pl-q-ilm-liq). Innerhalb der Gesteinsabfolge war es möglich Isograden von Mineralstabilitäten auszukartieren, wie zum Beispiel die Isograde, die das Verschwinden von Muskovit, einhergehend mit dem ersten regulären Auftreten von Alkalifeldspat, abbildet. Weitere Isograden, welche die Granulitfazies kennzeichnen, sind die des ersten Auftretens von Orthopyroxen in Metabasiten und die des Verschwindens von Biotit in den Metapeliten. Die ersten Anzeichen der Schmelzbildung, welche einher geht mit dem Zerfall und dem Verschwinden von zunächst Muskovit und später Biotit aus der peak Mineralparagenese, sind im Gelände in der Gegend um Massiola zu beobachten; dadurch werden in den höchstgradigen Metapeliten Schmelzgrade von 30–40 % erreicht, während die Metapsammite/Metagrauwacken Schmelzgrade von weniger als 10 % aufweisen. Die resultieren Druck- und Temperaturwerte im Val Strona di Omegna zeigen einen regionalmetamorphen Trend und eine kontinuierliche Zunahme von 3.5–6.5 kbar mit T = 650–730 °C unter niedriggradigen Bedingungen bis hin zu P > 12 kbar und T > 950 °C unter höchstgradigen Bedingungen. Die Druck- und Temperaturbedingungen, speziell in der Granulitfazies sind somit deutlich höher (ca. 100 °C) als jene der meisten bisherigen Studien. Die Modellierung von Metapsammiten/Metagrauwacken bestätigt den ermittelten regionalmetamorphen Trend. In den beiden südlicher gelegenen Tälern, Val Sesia und Val Strona di Postua, hingegen zeigen die modellierten Druck- und Temperaturwerte keinen regionalmetamorphen Trend; die Werte reichen im Val Sesia von 750–850 °C und 5–6.5 kbar und von 800–900 °C und 5.5–7 kbar im Val Strona di Postua und spiegeln somit ähnliche Temperaturen, aber niedrigere Drücke als im Val Strona di Omegna wider. Die Metapelite im direkten Kontakt zum „Mafischen Komplex“ zeigen im Val Sesia metatexitische, im Val Strona di Postua diatexitische Strukturen und sind bis in einen Umkreis von 2–3 km rund um den Komplex Cordierit-führend, wobei sie im Val Strona di Postua noch zusätzlich geringe Mengen Spinell enthalten. Beides deutet darauf hin, dass die Gesteine im Val Sesia und Val Strona di Postua durch die Intrusion des „Mafischen Komplexes“ kontaktmetamorph überprägt wurden und es nachträglich zu einer Druckentlastung in Folge der Regionalmetamorphose kam, wodurch in diesem Bereich der Ivrea Zone ein clockwise P–T Pfad beschrieben wird. Im Gegensatz dazu enthalten die Gesteine im Val Strona di Omegna keinen Cordierit und auch sonst sind keinerlei Anzeichen für eine nachträgliche Überprägung der regional metamorphen Mineralparagenesen erkennbar. Des Weiteren werden die zuvor erwähnten Isograden von Orthopyroxen und Biotit im Süden des Val Strona di Omegna durch die Einheit des „Mafischen Komplexes“ abgeschnitten. rnrnDie Frage, ob der „Mafische Komplex“ als Auslöser für Metamorphose und Teilschmelzenbildung verantwortlich ist, kann dahingehend beantwortet werden, dass die Intrusion nachträglich zur Regionalmetamorphose und Teilschmelzenbildung erfolgte und lediglich eine kontaktmetamorphe Überprägung der vorhandenen Paragenesen auslöste, aber nicht generell für die Metamorphose in der Ivrea Zone verantwortlich ist. Zudem is es unwahrscheinlich, dass der „Mafische Komplex“ im Val Strona di Omegna lokalisiert ist; diese Einheit ist wahrscheinlich auf den südlichen Teil der Ivrea Zone begrenzt und die im Val Strona di Omegna bei Campello Monti vorliegenden Metabasite können der Kinzigit Formation zugeordnet werden.getr. Zählun

Eigenarbeits- und Reparaturzentren: Ökologische Qualität der Eigenarbeit

Eigenarbei t in öffentlichen Zentren ist ein innovatives Angebot, eine Einladung zum Tätigwerden für den eigenen Bedarf. Eigenarbeit schafft Erlebnisse, Kompetenzen und Produkte. Sie ist ein Stück Lebensqualität, für die Menschen bereit sind, Zeit, Geld und Anstrengung aufzuwenden. Angebote und die Nutzungsstruktur des 1987 in München gegründeten Hauses der Eigenarbeit, an dem sich Projekte und Initiativen in anderen Städten orientieren, zeigen, daß hier die Förderung nachhaltiger Lebensstile tägliche Praxis ist. Die NutzerInnen begegnen den ökologischen Aspekten der Eigenarbeit bei der Auseinandersetzung mit Werkstoffen und Verarbeitungsverfahren, bei der Nutzung von Reparaturangeboten und indem sie, statt schnell zu kaufen, langsam produzieren und dabei eine Beziehung zu den Gütern entwickeln, die die Langlebigkeit fördert. Die Ökobilanz öffentlicher Eigenarbeit ist günstiger als privates Heimwerken, da Ressourcen geschont werden durch die gemeinsame Nutzung von Räumen, Maschinen und Werkstoffen und durch die von Fachberatern gesicherte Qualität der Produkte. Soll Ernst gemacht werden mit der langfristigen Aufwertung informeller Arbeit in innovativen Arbeitsverteilungsmodellen, so bedarf es entsprechender Bildungs-, Motivations- und Praxisorte. Eigenarbeitszentren sind Verbindungsorte zwischen formellem und informellem Arbeitssektor, kein Ghetto der Erwerbslosen. -- Giving the opportunity to work in a self-determined way (Eigenarbeit) in neighbourhood centres, is an innovative program. Eigenarbeit gives people excitement, competence and useful products. Thus Eigenarbeit is a piece of quality-of-life, in which peopIe are willing to invest time, money, and effort. The first Cent re of Eigenarbeit, founded in Munich in 1987, has become a model for several projects in other cities. In its every-day practice it is a place to make sustainable lifestyle attractive. Users get implicitly in touch with ecological aspects of Eigenarbeit, learning about materials and methods of finishing and repairing, and last but not least because they prefer their own slow production to quick shopping. A deep emotional relation to the products guarantees their longevity as well as a high quality, which results from professional assistance to lays in the workshops. Compared to private do-it-yourself, public Eigenarbeit is more compatible to ecological norms because of an economical use of natural resources, resul ting from the common use of rooms, technical equipment and material. A new model of work, based on a revaluation of informal work, needs attractive pIaces of motivation, learning and practice. Cent res of Eigenarbeit are meeting points of working and jobless people. They are not a social ghetto, but connect the formal and informal sectors of work and economy.

Evaluation of the accuracy of a patient-specific instrumentation

Patient-specific instruments (PSI) has been introduced with the aim to reduce the overall costs of the implants, minimizing the size and number of instruments required, and also reducing surgery time. The aim of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability and accuracy of patient specific instrument system in total knee arthroplasty (TKA). A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications. Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%. PSI seem not to be able to result in the same degree of accuracy as for the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers

In-out versus out-in technique for ACL reconstruction. a prospective clinical and radiological comparison

Background: Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out–in (OI) technique. Materials and methods: Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed. Results: In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups. Conclusions: The OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise. Level of evidence: II, prospective study

OASIS: a coupling software for next generation earth system modelling

In this article we present a new version of the Ocean Atmosphere Sea Ice Soil coupling software (OASIS4). With this new fully parallel OASIS4 coupler we target the needs of Earth system modelling in its full complexity. The primary focus of this article is to describe the design of the OASIS4 software and how the coupling software drives the whole coupled model system ensuring the synchronization of the different component models. The application programmer interface (API) manages the coupling exchanges between arbitrary climate component models, as well as the input and output from and to files of each individual component. The OASIS4 Transformer instance performs the parallel interpolation and transfer of the coupling data between source and target model components. As a new core technology for the software, the fully parallel search algorithm of OASIS4 is described in detail. First benchmark results are discussed with simple test configurations to demonstrate the efficiency and scalability of the software when applied to Earth system model components. Typically the compute time needed to perform the search is in the order of a few seconds and is only weakly dependant on the grid size

Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players

PURPOSE: The growing popularity of elite soccer among female participants has led to increased incidents of anterior cruciate ligament (ACL) ruptures. Many authors underline a positive glide after ACL reconstruction (ACLR), especially in women. In fact, an isolated intra-articular ACLR may be inadequate to control rotational instability after a combined injury of the ACL and the peripheral structures of the knee. Extra-articular procedures are sometimes used in primary cases displaying excessive antero-lateral rotatory instability. The purpose of this case series was to report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis (LET) with a minimum 4-year follow-up in a selected high-risk population of elite female football players. METHODS: Between January 2007 and December 2010, 16 elite Italian female football players were included in the study. All patients underwent the same surgical technique: anatomical ACLR with autogenous semitendinosus and gracilis tendons. After the intra-articular reconstruction was performed, an additional extra-articular MacIntosh modified Coker-Arnold procedure was carried out. Patients were assessed pre- and post-operatively with the subjective and objective International Knee Documentation Committee (IKDC) evaluation form, Tegner activity scale (TAS) and Lysholm score. Joint laxity was assessed with KT-1000 by measuring the side-to-side (S/S) differences in displacement at manual maximum (mm) testing. RESULTS: At a mean follow-up of 72.6 ± 8.1 months, two independent examiners reviewed all players. All of the patients had a fully recovered range of motion. Lachman test was negative in all patients (100 %). The evaluation of joint laxity and clinical evaluation showed a statistically significant improvement. No patients experienced complication or a re-rupture. DISCUSSION: The rationale of combining extra-articular procedures with ACLR is to restrict the internal rotation of the reconstructed knee, taking advantage of its long lever arm and thus providing more stability in the rotational axis and preventing the ACL graft from undergoing further excessive strain. CONCLUSIONS: The combination of an LET with ACLR in elite female football players demonstrated excellent results in terms of subjective scales, post-operative residual laxity and re-rupture rate with no complication, and a complete return to sport activity