scholarly journals Multiple iliopsoas tendons: a cadaveric study and treatment implications for internal snapping hip syndrome

2021 ◽  
Author(s):  
Benjamin Lin ◽  
Jonathan Bartlett ◽  
Thomas D. Lloyd ◽  
Dimitris Challoumas ◽  
Cecilia Brassett ◽  
...  
Keyword(s):  
Average Length ◽  
Average Distance ◽  
Femoral Shaft ◽  
Cadaveric Study ◽  
Total Width ◽  
Anterior Surface ◽  
Anatomical Variant ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Psoas Major

Abstract Purpose This cadaveric study aimed at describing the anatomical variations of the iliopsoas complex. Methods The iliopsoas complex was dissected unilaterally in 28 formalin-embalmed cadavers—13 males and 15 females with a mean age of 85.6 years. The number, courses and widths of the iliacus and psoas major tendons were determined. Patients with previous hip surgery were excluded. The following measurements were taken from the mid-inguinal point: the distance to the point of union of the psoas major and iliacus tendon; and the distance to the most distal insertion of iliopsoas. Results The presence of single, double and triple tendon insertions of iliopsoas were found in 12, 12 and 4 of the 28 specimens, respectively. When present, double and triple tendons inserted separately onto the lesser trochanter. The average length of the iliopsoas tendon from the mid-inguinal point to the most distal attachment at the lesser trochanter was 122.3 ± 13.0 mm. The iliacus muscle bulk merged with psoas major at an average distance of 24.9 ± 17.9 mm proximal to the mid-inguinal point. In all cases, the lateral-most fibres of iliacus yielded a non-tendinous, muscular insertion on to the anterior surface of the lesser trochanter and the femoral shaft, rather than joining onto the main iliopsoas tendon(s). The average total width of the psoas major tendon decreased with an increasing number of tendons: 14.6 ± 2.2 mm (single tendon), 8.2 ± 3.0 mm (2 tendons present) and 5.9 ± 1.1 mm (3 tendons present) (P < 0.001). Conclusions The results of this study suggest that multiple tendinous insertions of iliopsoas are present as an anatomical variant in more than 50% of the population. The non-tendinous muscular insertion of the iliopsoas on to the anterior surface of the lesser trochanter and femoral shaft found represents a novel anatomical variant not previously described. Level of evidence Level V

Central Compartment Release Versus Lesser Trochanter Release of the Iliopsoas Tendon for the Treatment of Internal Snapping Hip: A Comparative Study

2014 ◽  
Vol 30 (7) ◽  
pp. 790-795 ◽  
Author(s):  
Victor M. Ilizaliturri ◽  
Martín Buganza-Tepole ◽  
Anell Olivos-Meza ◽  
Marco Acuna ◽  
Eduardo Acosta-Rodriguez
Keyword(s):  
Comparative Study ◽  
Central Compartment ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Snapping Hip

scholarly journals Endoscopic Lesser Trochanter Resection With Refixation of the Iliopsoas Tendon for Treatment of Ischiofemoral Impingement

2018 ◽  
Vol 7 (4) ◽  
pp. e321-e325 ◽  
Author(s):  
Rafael Corrales ◽  
Iñaki Mediavilla ◽  
Eric Margalet ◽  
Mikel Aramberri ◽  
Jorge A. Murillo-González ◽  
...  
Keyword(s):  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Ischiofemoral Impingement

scholarly journals A cadaveric study of the location and morphology of the central patellar ridge for bone-patellar tendon-bone graft

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Thanathep Tanpowpong ◽  
Thun Itthipanichpong ◽  
Thanasil Huanmanop ◽  
Nonn Jaruthien ◽  
Nattapat Tangchitcharoen
Keyword(s):  
Patellar Tendon ◽  
Cancellous Bone ◽  
Average Distance ◽  
Cadaveric Study ◽  
Anterior Cortex ◽  
Length Width ◽  
Central Ridge ◽  
The Mean ◽  
Bone Patellar Tendon ◽  
And Cartilage

Abstract Introduction The central ridge of the patella is the thickest area of patella and varies among patients. This cadaveric study identified the location and thickness of the bone at the central patella ridge for bone-patellar tendon-bone (BPTB) harvesting. Materials and methods Fifty cadaveric knees were assessed. First, the morphology, length, width, and location of the central patellar ridge were recorded. Then, we transversely cut the patella 25 mm from the lower pole and measured the thickness of the anterior cortex, cancellous bone, and cartilage from both the mid-patella and the central ridge location. Finally, the depth of the remaining cancellous bone at the mid-patella was compared to the bone at the central ridge. Results The location of the central-patellar ridge deviated medially from the mid-patella in 46 samples with an average distance of 4.36 ± 1 mm. Only 4 samples deviated laterally. The mean patella length was 41.19 ± 4.73 mm, and the width was 42.8 ± 5.25 mm. After a transverse cut, the remaining cancellous bone was significantly thicker at the central ridge compared to the bone at the mid-patella. Conclusions Most of the central patellar ridge deviated medially, approximately 4 mm from the mid-patella. Harvesting the graft from the central ridge would have more remaining bone compared to the mid-patella.

Zone 2 Flexor Hallucis Longus Tendoscopy: A Cadaveric Study

2009 ◽  
Vol 30 (5) ◽  
pp. 447-451 ◽  
Author(s):  
Tun Hing Lui ◽  
Kwok Bill Chan ◽  
Lap Ki Chan
Keyword(s):  
Tibial Nerve ◽  
Average Distance ◽  
Cadaveric Study ◽  
Flexor Hallucis Longus ◽  
Posterior Tibial Nerve ◽  
Medial Plantar Nerve ◽  
Endoscopic Findings ◽  
Posterior Tibial ◽  
Anatomic Dissection ◽  
The Relationship

Background: The purpose of this study was to verify the safety and efficacy of zone 2 flexor hallucis longus tendoscopy with the patient in the prone position. Materials and Methods: The technique was performed in 12 cadaver feet (6 pairs). The endoscopic findings were compared to an anatomic dissection. The locations of the posteromedial and plantar portals were studied. The relationship between the medial plantar nerve and the tract of FHL tendoscopy was also studied. Result: The average distance of the posteromedial portal above the medial malleolar tip was 10.3 mm. The average distance between the posteromedial portal and the posterior tibial nerve was 9.9 mm. The average distance between the plantar portal and the intermalleolar line was 41.5 mm. The average distance between the rod simulating the tenoscope and the nerve was 4.8 mm. The nerve was medial to the rod in 4 specimens and lateral to the rod in 8 specimens. Conclusion: Zone 2 flexor hallucis longus tendoscopy was a feasible approach to the deep portion of the flexor hallucis longus tendon in this cadaveric study. There is potential risk of damage to the medial plantar nerve. Clinical Relevance: These findings can help guide a surgeon who is considering trying this clinically.

Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome

2018 ◽  
Vol 35 (02) ◽  
pp. 156-162 ◽  
Author(s):  
Magdy Sherbiny ◽  
Nehal Kamal ◽  
Ahmed Ghoneimy
Keyword(s):  
Functional Outcome ◽  
Free Flap ◽  
Average Length ◽  
Femoral Shaft ◽  
Wide Resection ◽  
Level Of Evidence ◽  
Bone Sarcomas ◽  
Fibular Free Flap ◽  
The Mean ◽  
Resected Femoral

Background Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. Methods Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome. Results The mean follow-up period was 48.7 months (12–104 months). The mean age at presentation was 10.3 years (5–17 years). The average length of the resected femoral shaft was 19.2 cm (15–24 cm) and the average length of the harvested fibula was 17.4 cm (15–21 cm). The mean time to union was 4.8 months (1–6 months) and the mean hypertrophy index was 78% (15.5–184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56–100%) and the mean limb length inequality was 4.75 cm (3–11 cm). Conclusion Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting. Level of Evidence IV.

Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study

2018 ◽  
Vol 39 (12) ◽  
pp. 1497-1501 ◽  
Author(s):  
Kar Hao Teoh ◽  
Esten Konstad Haanaes ◽  
Saud Alshalawi ◽  
Hiro Tanaka ◽  
Kartik Hariharan
Keyword(s):  
Minimally Invasive ◽  
Average Distance ◽  
Cadaveric Study ◽  
Invasive Technique ◽  
Optimal Position ◽  
First Metatarsal ◽  
Below The Knee ◽  
Fresh Frozen ◽  
Stab Incision ◽  
Relationship Of

Background: Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. Methods: A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. Conclusion: The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. Clinical Relevance: We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.

A MATHEMATICAL TREATMENT OF A THEORY OF RUBBER STRUCTURE

1934 ◽  
Vol 10 (5) ◽  
pp. 486-520 ◽  
Author(s):  
T. R. Griffith
Keyword(s):  
Average Length ◽  
Average Distance ◽  
Strain Curve ◽  
Molecular Chain ◽  
Mathematical Work ◽  
Mathematical Treatment ◽  
Stress Strain Curve ◽  
Stress Strain ◽  
Starting Point ◽  
Junction Points

The theory that the elasticity of rubber is due to the heat vibrations of very long chain molecules, bound to one another at occasional points along their length, but able to move freely relatively to one another at all other points, is susceptible of mathematical treatment. In the present treatment it is assumed that the rubber molecule has a restricted rotation about the axis formed by joining two adjacent junction points.A stress-strain curve has been developed mathematically on this assumption, and this curve, which is a reasonably close approximation to the curve obtained experimentally, serves as a standard with which to compare the rubber stress-strain curve and as a starting point for further mathematical work on the structure of rubber. The discrepancy between the mathematical and the experimental curve is explained on the very probable assumption that there is a wave motion or other vibration along the length of the rotating chain, as well as a rotation of the chain as a whole.An explanation of the peculiar S-shape of the beginning of the experimental stress-strain curve develops automatically from the mathematically deduced relation between stress and strain, and it is also shown why the S-shape appears to vanish when the calculation of the stress is based on the actual cross section of the stretched rubber.In addition, the following values, calculated from the above assumption and X-ray data, of certain constants, were obtained:(i) The average distance between junction points.(ii) The average length of molecular chain between junction points and, incidentally, the ratio between the number of freely swinging carbon atoms and those bound at junction points. This gives the number of freely swinging carbon atoms on the molecular chain between junction points and an idea of the length of the rubber molecule.(iii) The quantity of kinetic energy per cubic centimetre causing the elastic effect in rubber.(iv) The percentage of sulphur necessary to form the junction points in vulcanized rubber and, consequently, the minimum quantity of sulphur needed for vulcanization, both for hard and soft rubber. This minimum agrees closely with practical experiment.

scholarly journals Biomechanical Comparison of Anterograde and Retrograde Lesser Trochanter Avulsion Repair

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989228
Author(s):  
Alexander Otto ◽  
Joshua B. Baldino ◽  
Alyssa M. DiCosmo ◽  
Katherine Coyner ◽  
Jeremiah D. Johnson ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Suture Anchors ◽  
Retrograde Approach ◽  
Avulsion Fractures ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Cortical Button ◽  
Load To Failure ◽  
Biomechanical Comparison ◽  
Lesser Trochanter Avulsion

Background: Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach is available in the literature. Operative techniques are presently limited to anterograde fixations. A new retrograde approach to reduce operative difficulty and postoperative morbidity has been proposed. So far, no biomechanical comparison of these techniques is available. Hypothesis: Retrograde repair of the lesser trochanter with a titanium cortical button will produce superior stability under load to failure and similar displacement under cyclic loading compared with anterograde fixation with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen paired hemipelvic cadaveric specimens (mean age, 62.5 ± 10.7 years) were dissected to isolate the lesser trochanter and iliopsoas muscle. After repair of a simulated lesser trochanter avulsion, specimens were tested under cyclic loading between 10 and 125 N at 1 Hz for 1500 cycles before finally being loaded to failure at a rate of 120 mm/min in a material testing machine. Motion tracking was used to assess displacement at the superior and inferior aspects of the iliopsoas tendon under cyclic loading. Results: Load to failure was significantly greater for the retrograde repair compared with the anterograde repair (1075.24 ± 179.39 vs 321.85 ± 62.45 N; P = .012). Mean displacement at the superior repair aspect (retrograde vs anterograde: 3.29 ± 1.84 vs 4.39 ± 4.50 mm; P = .779) and mean displacement at the inferior aspect (3.54 ± 2.13 vs 4.22 ± 4.48 mm; P = .779) of the iliopsoas tendon did not significantly differ by the type of repair. Mode of failure was tendon tearing by the sutures for each retrograde repair and anchor pullout for each anterograde repair. Conclusion: Surgical repair of lesser trochanter avulsion fractures with retrograde fixation using a titanium cortical button demonstrated superior load to failure and similar displacement under cyclic loading compared with anterograde fixation using suture anchors. Clinical Relevance: The retrograde approach provides a biomechanically validated alternative to other surgical techniques for this injury.

Sign in / Sign up

Export Citation Format

Share Document