Genioplasty

Genioplasty can enhance the esthetic features of the face. The operative procedure concerns mainly osteotomy of the lower border of the anterior region of the mandible. The commonly used types of osteotomies are discussed and subdivided in all planes of reference.</p

Genioplasty

Genioplasty can enhance the esthetic features of the face. The operative procedure concerns mainly osteotomy of the lower border of the anterior region of the mandible. The commonly used types of osteotomies are discussed and subdivided in all planes of reference.</p

Evaluation of laxity tests with a musculoskeletal model of total knee arthroplasty

Introduction Musculoskeletal models are emerging as potential tools for the use in many clinical applications. One important example is aid to the clinical decision in the orthopaedic field. Recently, a patient-specific model of Cruciate-Retaining Total Knee Arthroplasty (CR-TKA) was presented and validated with respect to knee joint forces and kinematics [1]. However, the ligament restraints were not calibrated and inaccuracies in knee kinematic predictions were present. The objective of this study was to evaluate the effect of ligament calibration on the performance of simulated laxity tests. Methods A musculoskeletal model of CR-TKA was previously described [1]. The model comprised the musculoskeletal architecture of a TKA patient and a force-dependent model of the prosthetic knee and patellofemoral joint. Ligament restraints were modelled using non-linear springs and contact was solved using a rigid formulation. To calibrate the ligament parameters we simulated anterior/posterior, valgus/varus and endo-/exorotation laxity tests. Each test was performed at four different knee flexion angles (0, 30, 60, 90 deg). The anterior (respectively posterior) laxity load consisted of a 35 N force applied on the tibia at a distance of approximately 15 cm from the surface of the tibial component, pointing anteriorly (respectively posteriorly). Valgus (respectively varus) test was simulated by applying a force on the tibia at a distance of approximately 15 cm from the ankle joint, pointing laterally (respectively medially) so that the resulting moment was equal to 10 Nm. For the endo- (respectively exo-) rotation a 1.5 Nm torque was applied to the longitudinal axis of the tibia. Laxity envelopes for each test were calculated as the difference between the values obtained in the two opposite directions of the test. Manual changes to ligament insertion site, stiffness, and reference strain were made iteratively in order to obtain laxity envelopes close to those reported in the literature for cadaveric tests on a CR-TKA [2]. All the laxity tests were eventually simulated with the same ligament configuration. Results The results for all simulated laxity tests and the reference values from the literature are summarized in Table 1. 0° 30° 60° 90° AP (M) 3.5mm 4.2mm 1.0mm 1.0mm AP (L) 1.5mm 5mm 4mm 4.5mm VV (M) 0.9° 4.3° 2.6° 1.5° VV (L) 3.0° 6.0° 7.0° 7.0° EE (M) 7.0° 16.5° 4.0° 5.5° EE (L) 6.5° 22.0° 21.0° 23.0° Table 1: AP: Anterior/Posterior, VV: Valgus/Varus, EE: Endo-/Exorotation, M: Model prediction, L: Literature value Discussion The laxity envelopes predicted by the model were in partial agreement with those reported in the literature. The largest differences were noted for 60-90 degrees of knee flexion for all laxity tests, where the model showed considerably less laxity. These deviations may be attributable to actual differences between the implant design and subject geometry currently simulated and those used in the cadaveric tests. In future studies we aim to simulate surgical variations such as implant size and positioning, joint line elevation and ligament restraint. This musculoskeletal model of TKA has potential as a pre-operative planning tool for orthopaedic interventions. References Marra et al, J Biomech Eng, 137, 2015 Saeki et al, Clin Orthop Relat Res, 392:184-189, 200

The economic and ecological effects of water management choices in the upper Niger river: Development of decision support methods

One million people in the Inner Niger Delta make a living from arable farming, fisheries and livestock. Upstream dams (one built for electricity generation and one for irrigation) affect this downstream multifunctional use of water. Additionally, the Inner Niger Delta, which is one of the largest Ramsar sites in the world, is a hotspot of biodiversity and accommodates two of the largest known breeding colonies of large wading birds in Africa and in addition, is a vital part of the eco-regional network, supporting up to 3 to 4 million staging waterbirds, residents and migrants from all over Europe and western Asia. The hydrological and related ecological conditions in the Inner Delta largely determine the population size of these waterbird species. The major aim of the three-year study was to develop a decision-support system for river management in the Upper Niger, in which ecological and socio-economical impacts and benefits of dams and irrigation systems can be analysed in relation to different water management scenarios. The study involves various components: hydrology, arable farming, livestock, fisheries, ecology and socio-economics. An economic analysis has been conducted to determine the role of dams in the economy of the Inner Niger Delta and the Upper Niger region. By innovatively combining the above information on hydrology, ecology, fisheries, and agriculture, the study shows that building new dams is not an efficient way to increase economic growth and reduce poverty in the region. In fact, such efforts are counter-effective. Instead, development efforts should be aimed at improving the efficiency of the existing infrastructure, as well as of current economic activities in the Inner Niger Delta itself. This approach will also provide greater certainty for the essential eco-regional network functioning of the Inner Delta. © 2006 Taylor & Francis

Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement

The anterior cruciate ligament (ACL) consists of an anteromedial bundle (AMB) and a posterolateral bundle (PLB). A reconstruction restoring the functional two-bundled nature should be able to approximate normal ACL function better than the most commonly used single-bundle reconstructions. Accurate tunnel positioning is important, but difficult. The purpose of this study was to provide a geometric description of the centre of the attachments relative to arthroscopically visible landmarks. The AMB and PLB attachment sites in 35 dissected cadaver knees were measured with a 3D system, as were anatomical landmarks of femur and tibia. At the femur, the mean ACL centre is positioned 7.9 ± 1.4 mm (mean ± 1 SD) shallow, along the notch roof, from the most lateral over-the-top position at the posterior edge of the intercondylar notch and from that point 4.0 ± 1.3 mm from the notch roof, low on the surface of the lateral condyle wall. The mean AMB centre is at 7.2 ± 1.8 and 1.4 ± 1.7 mm, and the mean PLB centre at 8.8 ± 1.6 and 6.7 ± 2.0 mm. At the tibia, the mean ACL centre is positioned 5.1 ± 1.7 mm lateral of the medial tibial spine and from that point 9.8 ± 2.1 mm anterior. The mean AMB centre is at 3.0 ± 1.6 and 9.4 ± 2.2 mm, and the mean PLB centre at 7.2 ± 1.8 and 10.1 ± 2.1 mm. The ACL attachment geometry is well defined relative to arthroscopically visible landmarks with respect to the AMB and PLB. With simple guidelines for the surgeon, the attachments centres can be found during arthroscopic single-bundle or double-bundle reconstructions