scholarly journals The effect of arthroscopic capsulotomy and repair on native resting hip joint forces using a non-destructive extra-articular method

2019 ◽  
Author(s):  
Joseph C Schaffer ◽  
Daniel Vasconcellos ◽  
Meghan Kelly ◽  
Nathan B Kaplan ◽  
Noorullah Maqsoodi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hip Joint ◽  
Native State ◽  
Joint Force ◽  
Soft Tissue Envelope ◽  
Capsular Repair ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Fresh Frozen ◽  
Hip Approach

Abstract Previous methods for measuring intra-articular forces require significant soft tissue dissection and intra-articular insertion of sensory instruments. This study demonstrates a minimally invasive method of measuring native resting hip joint force without disrupting the soft tissue envelope. This method is then utilized to determine the effect of capsulotomy and repair on these forces. Twenty fresh-frozen human cadaver hemipelves were percutaneously instrumented with an iliac crest locking plate and retrograde femoral nail to allow for testing using a distracting force. Force–displacement curves were generated in the native state, and after joint venting, an anterior hip approach, capsulotomy, capsular repair and soft tissue dissections. Mean native resting hip joint force was 110.5 N (SD 54.3 N). Capsular venting resulted in a significant decrease in hip joint force compared with the native state (100.2 N, SD 45.2 N, P = 0.026). A further decrease in hip joint force was observed with a T-capsulotomy (79.9 N, SD 40.1 N, P < 0.001 compared with anterior hip approach), with restoration of these forces after capsular repair (84.8 N, SD 40.5, P = 0.014 versus T-capsulotomy and P = 0.67 versus anterior hip approach). Soft tissue dissection resulted in a large decrease in hip joint force compared with the hip’s native state (59.7 N, SD 28.4 N, P = 0.002). Taken together, the findings suggest that this method is effective in measuring hip joint force and may be more accurate than those requiring significant soft tissue dissection. Furthermore, the data suggest that capsular repair likely plays an important role in the restoration of biomechanical forces in the hip after capsulotomy.

scholarly journals Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
In Vitro Study ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Iliotibial Band ◽  
Soft Tissue Envelope ◽  
Medial Side ◽  
Fresh Frozen

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.

scholarly journals Craniotomy Revisited: Techniques for Improved Access and Reconstruction

2000 ◽  
Vol 27 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Michael D. Cusimano ◽  
Agustinus S. Suhardja
Keyword(s):  
Soft Tissue ◽  
Operating Time ◽  
Additional Cost ◽  
Bone Flap ◽  
Temporalis Muscle ◽  
Native Bone ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Orbital Rim ◽  
Additional Operating Time

ABSTRACT:Objective:To describe simple modifications of the technique of opening and closure of the craniotomy to improve basal exposure and reconstruction.Methods:The modifications involve: a) additional soft-tissue dissection which is carried downward to the base of the ear and to the orbital rim, exposing the orbital rim and malar eminence without removing the bone; b) cutting the bone flap so that ‘bridges’ of bone remain that help to stabilize the flap when it is returned to the cranium at the end of the operation; c) the wedging of bone chips between the bone flap and native cranium at the time the bone is being reaffixed so as to provide firm stability by diminishing movement of the bone flap; d) the use of bone dust and bone chips mixed with the patient's blood to seal and bridge the gap between the bone flap and the native bone; e) reattachment of the temporalis muscle with the bone flap sutures. An ‘inlay’ technique of duraplasty is also described.Results and Conclusion:These simple modifications of craniotomy provide better basal exposure and reconstruction with little additional operating time at no additional cost.

Video-Assisted Thoracoscopic Dissection Of The Brachial Plexus:Cadaveric Study And Illustrative Case

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-287-ONS-291 ◽  
Author(s):  
Chad J. Morgan ◽  
Jefferson Lyons ◽  
Benjamin C. Ling ◽  
P. Colby Maher ◽  
Robert J. Bohinski ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Thoracoscopic Surgery ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Lower Trunk ◽  
Video Assisted ◽  
First Rib ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

Abstract Objective: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. Methods: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root. Results: The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS. Conclusion: VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.

scholarly journals Energized soft tissue dissection in surgery simulation

2016 ◽  
Vol 27 (3-4) ◽  
pp. 280-289 ◽  
Author(s):  
Kun Qian ◽  
Tao Jiang ◽  
Meili Wang ◽  
Xiaosong Yang ◽  
Jianjun Zhang
Keyword(s):  
Soft Tissue ◽  
Surgery Simulation ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

scholarly journals Functional outcome following external fixator (JESS) application for proximal humeral fractures

2016 ◽  
Vol 2 (4) ◽  
pp. 303
Author(s):  
Om P. Gupta ◽  
Arun Vashisht ◽  
Avinash Rastogi ◽  
Naman Gupta ◽  
Utkarsh Shahi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Scoring System ◽  
Young Patients ◽  
High Energy ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Average Score ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

<p class="abstract"><strong>Background:</strong> Proximal humeral fractures account for 5% of all fractures. Observed frequently in older osteoporotic patients but found in young patients with high-energy trauma.About 80% of these fractures are undisplaced or minimally displaced. Non-operative method requiring immobilization of shoulder often leads to a stiff shoulder, whereas surgical procedures such as plating need excessive soft tissue dissection. It was overcome in this study by less soft tissue dissection by use of external fixator application and early mobilization.</p><p class="abstract"><strong>Methods:</strong> Total of 18 patients mean age 40.5 years, predominantly male (16/18) treated with external fixator - JESS (Joshi’s external immobilization system) for Neer’s two, three and four part proximal humeral fractures. Vehicular accidents were the most common mode of injury followed by fall. There were 8 cases each of Neer's two and three part fractures. Shoulder mobilization started within a week as postoperativelyas pain allowed. Patients followed up at 3, 6, 12 and 18 weeks for pain, function, range of motion and anatomy with check X-ray. After radiological union at 8-10 weeks JESS was removed. Cases were evaluated for functional result by constant scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average score on constant scoring system was 72 after a mean follow-up of 6 months. All fractures united in mean duration of 9.33 weeks. The complications included shoulder stiffness in one case and pin tract infection in two cases.</p><strong>Conclusions:</strong> Early shoulder mobilization a prerequisite for good results can be achieved without compromising fracture union. Less soft tissue dissection required and significant cost effective.

The Blood Supply of the Tendon with a Paratenon

HAND ◽  
1983 ◽  
Vol os-15 (1) ◽  
pp. 9-14 ◽  
Author(s):  
M. Naito ◽  
K. Ogata
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Achilles Tendon ◽  
Blood Supply ◽  
Flow Rate ◽  
Vascular System ◽  
Blood Flow Rate ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Before And After

The blood supply to the central third of the Achilles tendon was studied in adult rabbits using the hydrogen washout technique before and after soft tissue dissection including paratenon. The soft tissue dissection caused a decrease of the blood flow rate in the Achilles tendon by approximately 35 per cent. These results may indicate that the central third of the tendon with a paratenon receives its blood supply from the extrinsic vascular system by approximately 35 per cent and from the intrinsic vascular system by approximately 65 per cent.

Application of Subcutaneous Talc After Soft Tissue Dissection in A Rat Model Is Not Associated With Systemic or Pulmonary Side Effects

2012 ◽  
Vol 172 (2) ◽  
pp. 339
Author(s):  
D.A. Klima ◽  
P.D. Colavita ◽  
E.H. Lipford ◽  
A.L. Walters ◽  
A.E. Lincourt ◽  
...  
Keyword(s):  
Side Effects ◽  
Soft Tissue ◽  
Rat Model ◽  
Soft Tissue Dissection ◽  
Tissue Dissection

Retrosigmoid craniotomy for cerebellopontine angle/petroclival epidermoid cyst

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1
Author(s):  
Shaan M. Raza ◽  
Franco DeMonte
Keyword(s):  
Soft Tissue ◽  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Total Resection ◽  
Vertebrobasilar System ◽  
System A ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Key Steps

This video describes the surgical management of an epidermoid cyst within the cerebellopontine angle and petroclival region with involvement of cranial nerves V through XI and the vertebrobasilar system. A retrosigmoid craniotomy was performed for gross total resection of the lesion. The key steps of the procedure are discussed, including: positioning, soft tissue dissection, craniotomy, microsurgical dissection/resection, closure. Additionally, surgical nuances with regards to the safe maximal resection of such lesions are detailed.The video can be found here: http://youtu.be/VEROVO5cYdU.

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