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[en] Highlights: • Two surgical techniques of ATFL and CFL reconstruction produce similar the strength and stiffness • The strength and stiffness of reconstructed ATFL and CFL are weaker than the intact, uninjured ATFL and CFL. • All arthroscopic remnant-preserving reconstruction of ATFL and CFL has good short-term clinical effect. Lateral ankle sprains are one of the most common injuries in sports. Recently, arthroscopic lateral ligament reconstruction has been recently advocated, however no biomechanical studies and clinical application of this technique are available. In this biomechanical study, eighteen fresh-frozen cadaveric ankles were randomized into three groups: (1) intact anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), (2) arthroscopic anatomic reconstruction of ATFL and CFL, and (3) all arthroscopic remnant-preserving reconstruction of ATFL and CFL. The specimens were then tested for stiffness and load to ultimate failure using a customized jig. In biomechanical test, the all arthroscopic remnant-preserving reconstruction of ATFL and CFL produced a reconstruction that could withstand loads to failure and stiffness similar to the arthroscopic anatomic reconstruction. However, both two reconstruction groups were much weaker than the intact, uninjured ATFL and CFL. Moreover, we used the technique of all arthroscopic remnant-preserving reconstruction of ATFL and CFL on 20 patients from September 2016 to September 2017. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Anterior Talar Translation (ATT) were applied for statistical collection at preoperative and postoperative 12 months to evaluate clinical efficacy. The differences of the preoperative and postoperative 12 months AOFAS scores and ATT of patients were both statistical significant (P < 0.01). We confirmed that all arthroscopic remnant-preserving reconstruction of ATFL and CFL exhibited positive effect, thus promoting the recovery of ankle function and had good short-term clinical effect.
[en] The double posterior cruciate ligament (PCL) sign is seen on a midline sagittal MR image of the knee as a low-signal-intensity linear band paralleling the antero-inferior part of the PCL. Although the sign has a high specificity for a displaced bucket-handle tear of the medial meniscus, it can be mimicked by several normal and abnormal structures in the intercondylar region. Familiarity with these variants and identifying the other features supportive of meniscal injury will help to make a confident diagnosis of bucket-handle tear of the medial meniscus. (orig.)
[en] Pseudocoarctation of the aorta is a rare congenital anomaly of the aortic arch, and it has been described as an elongation of the aortic arch with 'kinking' at the level of the ligamentum arteriosum without a pressure gradient across the lesion. The treatment for this condition is controversial. We report here on an unusual case of pseudocoarctation of the aorta associated with the anomalous origin of the left vertebral artery and we include a review of the medical literature
[en] The odontogenic myxoma is an infiltrative benign tumor of bone that occurs almost exclusively in the jaw bones and comprises 3% to 6% of odontogenic tumors. This neoplasm is thought to arise from the primitive mesenchymal structures of a developing tooth, including the dental follicle, dental papilla, or periodontal ligament. Radiographically the odontogenic myxoma may produce several patterns: unicystic, multilocular, pericoronal, and radiolucent-radiopaque, making the differential diagnosis difficult. In this report, two cases of the odontogenic myxoma in the jaw bones are presented. The first case involved only the mandible, while the second case involved the maxilla. Both cases presented extensive multilocular radiolucencies characteristic of odontogenic myxoma.
[en] Ankle arthrography, by direct puncture of joint cavity, is considered to be a simple and accurate diagnostic method for a precise evaluation of ligamentous injury. Forty-seven cases of ankle arthrography were successively performed in the patients of acute ankle sprains. The purpose of this study is to demonstrate how ankle arthrography can delineate the pathologic anatomy in such cases. The results are as follows: 1. Thirty cases among forty seven revealed the findings of ligament tears. 2. For better diagnostic accuracy, the arthrography should be performed within 72 hrs. after injury. 3. The anterior talofibular ligament tears were the most common (twenty-nine cases) of all and seventeen of them revealed tears without association of any other ligament tears. 4. There were ten cases of calcaneofibular ligament tears and nine of them were associated with anterior talofibular ligament tears. 5. Three cases of anterior tibiofibular and one deltoid ligament tears were demonstrated
[en] Highlights: • A new class of 3D cellular metamaterials introduced with tunable Poisson's ratio. • Wide range of Poisson's ratios, both positive and negative values, is achievable. • The behavior of the structure is governed by three geometrical parameters. • The design concept provides a framework to develop auxetic cellular materials. We constructed a new class of three-dimensional cellular metamaterials by connecting planar structure with anti-chiral topology. This was achieved by introducing a unique node design for connecting planar materials to enable constructing a three-dimensional architecture. This node design is based on linking the circular elements of the anti-chiral topology using oblique load-bearing ligaments. As the planar structure is subjected to loading, the circular elements rotate and the ligaments undergo bending, resulting in out-of-plane deformation of the three-dimensional cellular metamaterials. The node design, and specifically the ligaments' revolution angle govern the behavior of cellular metamaterials. This was demonstrated by designing cellular metamaterials with a wide range of positive and negative Poisson's ratio in the out-of-plane direction.
[en] Since calcification or ossification of the posterior longitudinal ligament of the spine was first described in Japan in 1960 by Tsukimoto, Terayama used the term of OPLL (Ossification of Posterior Longitudinal Ligament) in 1964 and mainly reported in Japanese. But recently, the incidence of the OPLL has been reported increasing among the non-Japanese. Because of the OPLL may be associated with severe neurologic symptoms, which need to have surgical decompression, exact diagnosis and analysis are necessary. The OPLL can be diagnosed by simple spine, conventional tomography, myelography and CT. Authors analysed radiologic findings of the OPLL in 8 patients, who were diagnosed by simple spine. conventional tomography, myelography and CT, and then performed spinal operation, at Hanyang University Hospital from March 1980 to June 1983. The results were as followings: 1. The age range was between 45 and 63 years and most prevent age was 6th decades (63%). 2. All of the patients were male. 3. All of the OPLL occurred in the cervical spine and predominant at the level of C3, 4 (48%). 4. The most common length of the OPLL was 2 vertebral level. 5. Except one, which was discontinuous at the level of disc space, all of the OPLL were continuous in length. 6. 7 of 8 OPLL were located in the midline, but one was in right. 7. The OPLL seemed to correlate with spondylotic changes. 8. Of all diagnostic procedure, CT provided better and exact visualization of the lesion with axial scan and sagittal reconstruction.
[en] To describe the magnetic resonance appearance of posterosuperior labral peel back and determine the reliability of MR in the abducted and externally rotated (ABER) position for the prospective diagnosis of arthroscopically proven cases of posterosuperior labral peel back. After approval by the institutional review board (IRB) of the University of Pittsburgh Medical Center, USA, databases of patients who underwent arthroscopy over a 2-year period for one of three clinical diagnoses [suspected type 2 superior labrum anterior to posterior (SLAP) tears, posterior instability, or multidirectional instability] were reviewed after anonymization by an honest broker. Sixty-three cases were selected by the following inclusion criteria: operative report documenting labral peel back in the ABER position, age <40 years, and preceding MR arthrogram evaluations with images in the ABER position (n = 34). Inclusion criteria for the control group differed from those for the case group insofar as the operative note documented the absence of posterosuperior labral peel back (n = 29). Cases and controls were randomized in one list and evaluated independently by two fellowship-trained musculoskeletal radiologists unaware of the surgical results and using a three-point grading system (0 = posterosuperior labrum normally positioned lateral/craniad to glenoid articular plane in ABER; 1 = posterosuperior labral tissue flush with the glenoid articular plane in ABER; 2 = posterosuperior labral tissue identified medial/caudal to glenoid articular plane in ABER). Only one image in ABER showing abnormal posterosuperior labral position was required for a grade of 1 or 2 to be assigned. Sensitivity, specificity, and positive and negative predictive value were calculated as well as the level of agreement between readers (kappa). Both readers assigned a grade of 2 to 25 of 34 patients with surgically proven labral peel back. Of the patients with surgically proven SLAP tears with peel back in ABER, reader A assigned a grade of 1 to seven patients and a grade of 0 to two patients, while reader B assigned a grade of 1 to eight patients and a grade of 0 to one patient. In the control group of 29 patients, reader A assigned 28 patients a grade of 0, one patient a grade 1, and no patients a grade 2. Reader B assigned 27 patients a grade of 0, two a grade 1, and no patients a grade 2. After the data had been dichotomized, with grade 1 and 0 cases both being regarded as negative, the MR criteria showed a sensitivity of 73%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 78%. The kappa coefficient of inter-rater agreement was excellent at 0.9, with disagreement in only four of 63 cases. In five of the 34 cases with peel back, a labral tear, defined by imbibition of contrast agent within a gap between labrum and underlying glenoid bone, could not be identified in standard planes in the neutral position. The use of the glenoid articular plane as a reference line to evaluate labral peel back in the abducted and externally rotated position is a fairly accurate and highly precise method for detection of posterosuperior labral peel back. Raising the possibility of labral peel back may help alert the arthroscopist to the presence of superior labral instability while the arm is abducted and externally rotated. (orig.)
[en] A total of 82 patients who underwent spinal computed tomographic scan, in an 8-month period at the King Khalid University Hospital, Riyadh, Saudi Arabia, were analyzed for age, sex, the presence/absence, site, and type of ossification of the ligamentum flavum (OLF) as well as associated diseases. The OLF was radiographically present (bilaterally or unilaterally) as linear (74.5%) or nodular types (25.5%). The linear type was especially seen at the inner aspects of the ligamentum flavum. OLF was present in 35.4% of patients, and was seen at single and multiple levels in 51% and 41% of them, respectively. OLF was identified in a total of 47 levels in the study group and was associated with other disease in the spine in 38 (81%) of these levels. In none of the patients was OLF the cause of myelopathy. The incidence of OLF and its pathogenesis and significance are discussed. This paper is the first report of OLF from the Middle East. OLF in this part of the world is usually asymptomatic