Radiological evaluation of patellofemoral instability and possible causes of assessment errors

Patellofemoral instability (PI) is the disruption of the patella's relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications

Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches

Interfascial plane blocks and associated nomenclature are currently popular topics in the field of anesthesia. While several novel plane blocks have been described, cadaveric studies on the spread of novel blocks are important for determining appropriate applications [1]. Recently, Tulgar et al. [2] defined the thoracoabdominal nerve block using a perichondral approach (TAPA). They reported that local anesthetic (LA) administered on the upper and lower aspect of the 9th through the 10th costal cartilages would block both the anterior and lateral cutaneous branches, thus providing abdominal analgesia. After describing the TAPA, the authors also redefined the approach, naming it the modified TAPA (M-TAPA). They reported that administering LA only to the lower surface of the costal cartilage would provide successful analgesia similar to that provided by the TAPA [3]. In the literature, there are some case reports and observational studies on the TAPA and M-TAPA [2,3]; however, to the best of our knowledge, no reliable cadaveric investigation has demonstrated the spread of these blocks. Therefore, in this cadaveric investigation, we aimed to evaluate the areas of spread associated with the TAPA and M-TAPA. This study was approved by the Istanbul Medipol University Ethics and Research Committee (Decision No. 36, 06.01.2022)

The magnetic resonance imaging evaluation of morphometry of the distal femur and proximal tibia on adult anatolian population

Introduction: It is widely known that the production of knee prostheses is based on the morphometric parameters of the distal femur and proximal tibia. Although there have been studies on this subject in different populations in the literature, such a study has not been found in the Turkish population. It is aimed to establish an index and also compare it with previous results of different populations, in this study. Material and Methods: This study was conducted on 200 patients (78 females, 122 males) aged between 18 and 65 years who had magnetic resonance imaging retrospectively. People with previous fractures, dislocations or ruptures, tears, or tensions in the anterior cruciate ligament, history of knee surgery, and trauma were excluded from the study. Various measurements were conducted on images of the distal femur and proximal tibia morphometry. Results: Mean values of the measurements made on the distal femur and proximal tibia were calculated, it was determined that all parameters were higher in males than females. A statistically significant difference was found between the sexes in all the parameters evaluated except for the intercondylar notch height parameter (P 0.05). Discussion and Conclusion: In this study, finally, intercondylar notch classification was done. According to this, in 46.5% of cases, notch type, which defined as type A and 53.5% of the notches were identified as U type. None of the cases was classified as W type. Studies in which normal morphometric data are presented due to differences in races between skeletal structures have crucial importance. Therefore, the data obtained from our study are thought to be useful to produce specific knee prostheses

Cadaveric investigation about the spread of peritibial fascial infiltration block

Recently, Ekinci et al. defined a novel lower extremity fascial plane block named peritibial fascial infiltration block (PFIB). They performed PFIB for analgesia management after tibia fracture surgery and reported successful pain control during the postoperative period.1 Following the description of PFIB by Ekinci et al., Altiparmak et al. performed PFIB with a saphenous nerve block (SNB) for a patient who underwent a bimalleolar fracture of the ankle.2 They combined two techniques for the reason that SN is responsible for the sensorial innervation of the lower leg. Due to fascial plane blocks being volume-related applications,3 we decided to investigate the spread of PFIB with different volumes in this cadaveric study. This study was approved by the Istanbul Medipol University Ethics and Research Committee (Decision no. 35; 06.01.2022)