scholarly journals Efficacy of Video-Based Forearm Anatomy Model Instruction for a Virtual Education Environment

2022 ◽  
Vol 9 ◽  
pp. 238212052110632
Author(s):  
Miraal S. Dharamsi ◽  
D. Anthony Bastian ◽  
Heather A. Balsiger ◽  
Joel T. Cramer ◽  
Ricardo Belmares
Keyword(s):  
Student Perceptions ◽  
Online Teaching ◽  
Virtual Education ◽  
Muscle Model ◽  
Student Survey ◽  
Significant Difference ◽  
Wet Lab ◽  
Group 2 ◽  
The Impact ◽  
Group 1

INTRODUCTION As virtual education becomes more widespread, particularly considering the recent COVID-19 pandemic, studies that assess the impact of online teaching strategies are vital. Current anatomy curriculum at Paul L. Foster School of Medicine consists of self-taught PowerPoint material, clinical vignette-centered team-based learning (dry lab), and prosection-based instruction (wet lab). This study examined the impact of video-based muscle model (VBMM) instruction using a student-designed forearm muscle model on anatomy quiz scores and student perceptions of its effectiveness with regards to learning outcomes. METHODS Students divided into Group 1 (54 students) and Group 2 (53 students) were assessed prior to and following a 3.5-minute video on anterior forearm compartment musculature using the muscle model. Group 1 began by completing a pretest, then received VBMM instruction, and then completed a posttest prior to participating in the standard dry lab and 1 hour wet lab. Group 2 completed the wet lab, then received the pretest, VBMM instruction, and posttest prior to participating in the dry lab. Both groups took an identical five-question quiz covering locations and functions of various anterior forearm muscles each time. RESULTS Mean scores were higher than no formal intervention with exposure to VBMM instruction alone (0.73 points, P = .01), wet lab alone (0.88 points, P = .002), and wet lab plus VBMM instruction (1.35 points, P= <.001). No significant difference in scores was found between instruction with VBMM versus wet lab alone ( P = 1.00), or between either instruction method alone compared to a combination of the two methods ( P = .34, .09). Student survey opinions on the VBMM instruction method were positive. CONCLUSION VBMM instruction is comparable to prosection-based lab with regards to score outcomes and was well received by students as both an independent learning tool and as a supplement to cadaveric lab. When compared to either instruction method alone, the supplementation of VBMM with cadaveric prosection instruction was best. VBMM instruction may be valuable for institutions without access to cadaveric specimens, or those looking to supplement their current anatomy curriculum.

Patients Who Attend Alone at a First Memory Consultation: Are They a Specific Population,or Is It an Instance of Confounding Bias?

2019 ◽  
Vol 81 (1-2) ◽  
pp. 81-86
Author(s):  
Pierre Koskas ◽  
Mouna Romdhani ◽  
Olivier Drunat
Keyword(s):  
Selection Bias ◽  
Confounding Bias ◽  
Significant Difference ◽  
Comparison Groups ◽  
Methodological Problems ◽  
Group 2 ◽  
The Impact ◽  
First Time ◽  
State Examination ◽  
Group 1

As commonly happens in epidemiological research, none of the reported studies were totally free of methodological problems. Studies have considered the influence of social relationships on dementia, but the mechanisms underlying these associations are not perfectly understood. We look at the possible impact of selection bias. For their first memory consultation, patients may come alone or accompanied by a relative. Our objective is to better understand the impact of this factor by retrospective follow-up of geriatric memory outpatients over several years. All patients over 70 who were referred to Bretonneau Memory Clinic for the first time, between January 2006 and 2018, were included in the study. The patients who came alone formed group 1, the others, whatever type of relative accompanied them, formed group 2. We compared the Mini-Mental State Examination (MMSE) scores of patients; and for all patients who came twice for consultation with at least a 60-day interval, we compared their first MMSE with the MMSE performed at the second consultation. In total, 2,935 patients were included, aged 79.7 ± 8.4 years. Six hundred and twenty-five formed group 1 and 2,310 group 2. We found a significant difference in MMSE scores between the 2 groups of patients; and upon second consultation in group 2, but that difference was minor in group 1. Our finding of a possible confounding factor underlines the complexity of choosing comparison groups in order to minimize selection bias while maintaining clinical relevance.

scholarly journals The effects of interprofessional diabetes education on the knowledge of medical, dentistry and nursing students

2018 ◽  
Vol 46 (2) ◽  
pp. 145
Author(s):  
Maja Račić ◽  
Bojan N. Joksimović ◽  
Smiljka Cicmil ◽  
Srebrenka Kusmuk ◽  
Nedeljka Ivković ◽  
...  
Keyword(s):  
Interprofessional Education ◽  
Multiple Choice Questions ◽  
Self Assessment ◽  
Cross Sectional ◽  
Mean Values ◽  
Significant Difference ◽  
Teamwork Skills ◽  
Group 2 ◽  
The Impact ◽  
Group 1

<div class="WordSection1"><p><strong>Objectives</strong>. Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. <strong>Methods</strong>. The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants’ knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). <strong>Results</strong>. No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. <strong>Conclusion</strong>. The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.</p></div>

scholarly journals COVID-19 discharged patients in Hunan, China: correlation between early features and prognosis

2020 ◽  
Author(s):  
yeyu cai ◽  
jiayi liu ◽  
Haitao Yang ◽  
Taili Chen ◽  
Qizhi Yu ◽  
...  
Keyword(s):  
Chest Ct ◽  
Hunan Province ◽  
Impact Factors ◽  
Imaging Features ◽  
Persistent Symptoms ◽  
Significant Difference ◽  
Discharged Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Purpose To describe the correlation between the clinical, laboratory and radiological findings with hospitalization days in Coronavirus Infected Disease-19 (COVID-19) discharged patients. Method In this multicenter study, we retrospectively identified 153 discharged patients with COVID-19 pneumonia from Jan 16, 2020 to Feb 26, 2020 in Hunan province. Patients were grouped based on the hospitalization days: Group 1 (hospitalization days≦12 days) and Group 2((hospitalization days> 12days). Demographic, clinical characteristics and laboratory findings on admission and the imaging features of the first Chest CT on admission were analyzed. The differences between groups were analyzed using univariate logistic regression to find the impact factors. Results The cohort included 153 discharged patients (85 males and 68 females, with the mean age of 42.32±14.03 years old). 90(58.8%) patients had hospitalization days≦12 and 63(41.2%) patients had hospitalization days>12. 44(48.9%) patients in Group1 and 28(44.4%) in Group 2 had been to Wuhan. In both Group1 and Group2, most common symptoms at onset were fever (62.2%, 60.3%) and cough (33.3%, 50.8%). Cough was occurred more common in Group 2(50.8%) than Group 1(33.3%) with a significant difference (p=0.03). 6(6.7%) patients in Group1 and 10(15.9%) in Group2 had admitting diagnosis as non-pneumonia (p=0.07), some of them occurred mild pneumonia during hospital stay. White blood cell (2.2%, 9.5%) and neutrophil (9.5%) count above normal were more common on in Group 2 (p=0.04, p=0.04). Patients in Group 2 had higher concentration of aspartate aminotransferase (P=0.04) than Group 1. Most of patients had multiple lesions (75.6%, 69.8%) with bilateral distribution (73.3%, 58.7%) in both groups. Mixed ground-glass opacity (GGO) and consolidation appearance were seen in most patients. GGO components > consolidation appearance were more common in Group 1(31.1%) than in Group 2(8.0%) with a significant difference between groups (P<0.01). Patients had cough at onset disease (OR, 0.47; 95%CI, 0.23 to 0.96, p=0.04) and CT represented as GGO components more than consolidation (OR, 4.84; 95%CI, 1.80 to 13.04, p<0.01) were associated with hospitalization days. Conclusions COVID-19 non-pneumonia patients with longer hospitalization days might have the persistent symptoms or pneumonia occurrence after admission. Chest CT could help prompt diagnosis and monitor disease progression, GGO/consolidation >1 in mixed lesions was associated with shorter hospitalization days. Special attention should be paid to the role of radiological features in monitoring disease prognosis.

Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 199-204 ◽  
Author(s):  
Xia ◽  
Yang ◽  
Qu ◽  
Cheng ◽  
Wang
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Endothelin 1 ◽  
Significant Difference ◽  
Group 2 ◽  
One Year ◽  
Von Willebrand ◽  
The Impact ◽  
Group 1

Background: This study was designed to investigate the impact of carotid artery stenting (CAS) on plasma levels of P-selectin, von Willebrand (vWF) and endothelin-1. Patients and methods: Sixty-seven patients who received CAS were divided into group 1 (one stent for a simple lesion, n = 38) and group 2 (two stents for complex lesions, n = 29). The levels of P-selectin, vWF and endothelin-1 were measured before CAS, 1 h, 6h, 24 h and 2 weeks after the stenting. Results: Sixty-one patients completed one-year follow up. Restenosis was noted in 14 (23 %) patients, among these three (4.8 %) had a restenosis of > 50 % of the vascular lumen. In all patients, the levels of P-selectin, vWF and endothelin-1 increased immediately after CAS (P < 0.05 or < 0.01). The levels of vWF and endothelin-1 in group 2 were higher than in group 1 (P < 0.05 or 0.01). There was no significant difference in P-selectin and endothelin-1 between the restenosis and non-restenosis group (P > 0.05). The 24 h vWF in patients with restenosis were higher than in non-restenosis group (P < 0.05). Conclusions: CAS results in a significant increase in plasma P-selectin, vWF and endothelin-1. The post-CAS levels of P-selectin, vWF and endothelin-1 are related to the extent of endothelial injury. Whether they are associated with restenosis 12 months after the treatment requires further investigation.

scholarly journals Impact of Renal Function on Long-Term Clinical Outcomes in Patients With Coronary Chronic Total Occlusions: Results From an Observational Single-Center Cohort Study During the Last 12 Years

2020 ◽  
Vol 7 ◽  
Author(s):  
Lei Guo ◽  
Huaiyu Ding ◽  
Haichen Lv ◽  
Xiaoyan Zhang ◽  
Lei Zhong ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Clinical Outcomes ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The number of coronary chronic total occlusion (CTO) patients with renal insufficiency is huge, and limited data are available on the impact of renal insufficiency on long-term clinical outcomes in CTO patients. We aimed to investigate clinical outcomes of CTO percutaneous coronary intervention (PCI) vs. medical therapy (MT) in CTO patients according to baseline renal function.Methods: In the study population of 2,497, 1,220 patients underwent CTO PCI and 1,277 patients received MT. Patients were divided into four groups based on renal function: group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2], group 2 (60 ≤ eGFR &lt;90 ml/min/1.73 m2), group 3 (30 ≤ eGFR &lt;60 ml/min/1.73 m2), and group 4 (eGFR &lt;30 ml/min/1.73 m2). Major adverse cardiac event (MACE) was the primary end point.Results: Median follow-up was 2.6 years. With the decline in renal function, MACE (p &lt; 0.001) and cardiac death (p &lt; 0.001) were increased. In group 1 and group 2, MACE occurred less frequently in patients with CTO PCI, as compared to patients in the MT group (15.6% vs. 22.8%, p &lt; 0.001; 15.6% vs. 26.5%, p &lt; 0.001; respectively). However, there was no significant difference in terms of MACE between CTO PCI and MT in group 3 (21.1% vs. 28.7%, p = 0.211) and group 4 (28.6% vs. 50.0%, p = 0.289). MACE was significantly reduced for patients who received successful CTO PCI compared to patients with MT (16.7% vs. 22.8%, p = 0.006; 16.3% vs. 26.5%, p = 0.003, respectively) in group 1 and group 2. eGFR &lt; 30 ml/min/1.73 m2, age, male gender, diabetes mellitus, heart failure, multivessel disease, and MT were identified as independent predictors for MACE in patients with CTOs.Conclusions: Renal impairment is associated with MACE in patients with CTOs. For treatment of CTO, compared with MT alone, CTO PCI may reduce the risk of MACE in patients without chronic kidney disease (CKD). However, reduced MACE from CTO PCI among patients with CKD was not observed. Similar beneficial effects were observed in patients without CKD who underwent successful CTO procedures.

scholarly journals The impact of Covid-19 pandemic over the dental patients

2021 ◽  
Vol 10 (11) ◽  
pp. e252101119502
Author(s):  
Lara Steffany de Carvalho ◽  
Caroline Trefiglio Rocha ◽  
Rafael de Aguiar Vilela Júnior ◽  
Ivan Balducci ◽  
Amjad Abu Hasna
Keyword(s):  
Dental Care ◽  
Dental Treatment ◽  
Cross Contamination ◽  
Dental Patients ◽  
Significant Difference ◽  
Dental Offices ◽  
Group 2 ◽  
Respiratory Droplets ◽  
The Impact ◽  
Group 1

Objective: Covid-19 is a highly infectious disease; it is transmitted by patients’ secretions and respiratory droplets SARS-CoV-2 was detected in patients saliva making dental care professionals more susceptible for contamination and the patient less safe while seeking the dental treatment. Methodology: This quantitative study was elaborated through a questionnaire for patients who frequently seek dental care in private and publica dental care units. A total of 205 over-18 patients were included, those who left one or more questions without answer were excluded. Participants were able to refuse to answer any question or to participate in the questionnaire at all. The questionnaire was composed of five questions. Participants were divided into two groups: Group 1: private dental offices patients (n=98); Group 2: public dental clinic patients (n=107). Results: there was a significant difference between groups 1 and 2, in which 50% of group 1 feel safe while seeking dental care during the Covid-19 pandemic in comparison with 72.89% of group 2. There was no significant difference between groups 1 and 2, in which 93.87 and 94.39% of groups 1 and 2 respectively feel safe with the professionals' PPE and consider it sufficient. About 59.81% of the participants of group 2 do not feel insecure with the cross contamination caused by SARS-CoV-2 in collective health care units. Finally, there was a significant difference between groups 1 and 2, in which 74.48% of group 1 prefer to be attended by vaccinated professionals, instead of only 56.07% of group 2. Conclusion: it was concluded that not all dental patients feel safe while seeking dental treatment during the Covid-19 pandemic, however, they consider the professional PPE sufficient. Patients feel safe to be attended by vaccinated professionals.

Introduction of Combined Chemotherapies Plus Rituximab (R) Has Improved Outcome of Previously Untreated and Relapsed Follicular Lymphoma (FL) Patients (pts).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4703-4703
Author(s):  
Stefano Sacchi ◽  
Samantha Pozzi ◽  
Luigi Marcheselli ◽  
Alessia Bari ◽  
Stefano Luminari ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Clinical Stage ◽  
Cox Regression Analysis ◽  
Prognostic Features ◽  
Significant Difference ◽  
The Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Some data suggest that there are been no improvement in survival of FL Pts in the last three decades of the 20th century. However that review ended in 1992, before the introduction of R treatment. Most recently reported data, show that evolving chemotherapies, including the incorporation of R has led to outcome improvement. Between 1994 and 2004, 344 Pts with FL were enrolled in different GISL Trials. For the purpose of this study we considered 270 Pts with similar characteristics enrolled in trials including or not R. The first group accounts for 176 naive Pts treated with Antracycline plus Fludarabine containing regimens (Cohort #1: 125 Pts) or plus R (Cohort #2: 51Pts). The second group accounts for 99 relapsed Pts treated with Antracycline plus Fludarabine containing regimens (Cohort #3: 40 Pts) or plus R (Cohort #4: 59 Pts). To evaluate the impact of the incorporation of R in front line and salvage therapies we assessed the patients OS, FFS, TTF, SAR in these different Cohorts of Pts. Descriptive analysis of prognostic features showed differences in the distribution among groups. To compensate for these variations we also performed Cox regression analysis. Previously Untreated patients. Regarding group #1 and #2 that enrolled Pts with clinical stage IIB, III and IV, FFS and OS according to treatment did not show any statistical differences. The univariate analysis of baseline clinical features showed an impact on OS and FFS for clinical stage, LDH level, involvement of more than 4 nodal sites and presence of extranodal involvement. The prevalence of this characteristics were higher in group #2 than group #1. Thus the FFS from group #2 vs. group #1 was adjusted for variation in prognostic features by Cox regression analysis, that shows a failure Hazard Radio reduction (HR) of 40 % in Pts who received R. Because of difference in follow up (FU) (49 months in Cohort #1 vs 21 months in Cohort #2), to evaluate differences in OS we utilized exact Log Rank test for unequal FU. So far, a trend exists for better OS in R treated patients, although the difference is not statistically significant. Relapsed Patients. Clinical characteristics were similar in the two Cohorts of pts. TTF was better in R treated Pts and the difference was statistically significant (66% vs. 53% at 3 yrs, p=0.023) The analysis of SAR demonstrated a better result for R Cohort with a statistically significant difference (88% vs. 68% at 3 yrs, p=0.022). OS according to treatment protocol, showed advantage for patients in R Cohort and the difference was statistically significant (92% vs. 70% at 5 yrs, p=0.004). Conclusion. In naïve patients our retrospective analysis showed a reduction of HR for FFS and a trend toward better OS in R treated Pts. In relapsed Pts all outcome parameters as OS, TTF and SAR had significant improvement in the Cohort treated with R. Although any conclusions between nonrandomized groups maybe subject to differences in observed and unobserved prognostic features, we believe that improvement have occurred in the management of FL Pts with the introduction of combined chemotherapy with R.

Abstract 278: Phenomapping of Worsening Renal Function During Hospitalization for Acute Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ryuichiro Yagi ◽  
Shun Kosaka ◽  
Makoto Takei ◽  
Ayaka Endo ◽  
Naoki Hirata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Clustering Analysis ◽  
Distinct Population ◽  
Worsening Renal Function ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: Worsening renal function (WRF) during the hospitalization has been recognized as a predictor for worse outcomes in patients with acute heart failure (AHF). However, in recent years, elevation of serum creatinine during the acute phase of the treatment is accepted as a sign of efficient decongestion. Herein, we aimed to evaluate the phenotypic difference in this heterogeneous phenomenon by using clustering analysis. Methods: A total of 4000 patient data from the West-Tokyo Heart Failure Registry, a multicenter, prospective registry for consecutive AHF hospitalization were analyzed. Within 632 patients identified to have WRF (17%; defined as elevation of eGFR over 20 percent during the hospitalization), we applied two-step clustering analysis of phenotypic data (37 variables) to define and characterize phenotypically distinct population. After identification of phenotypically distinct subgroups, survival analysis with Cox proportional hazard was conducted to elucidate the impact of the classification on composite outcomes of heart failure re-hospitalization and all cause death. Results: The analysis identified four distinct populations (group 1-4) that distinctly differed in terms of clinical characteristics: Group1 composed of patients with reduced ejection fraction (EF), while group 2 to 4 were composed of patients with mid-range and preserved EF. Group 1 patients also had lowest eGFR and blood pressure at the time of admission. Group 1 and 2 patients were younger, but had higher plasma BNP compared to 3 and 4. Among these subgroups, group 1 had the worst, and group 2 had the most favorable prognosis. The difference in prognosis between these two groups was significant after adjustments with known prognostic factors (hazard ratio, 0.58; 95 percent confidence interval, 0.35-0.97). Conclusion: WRF represents heterogeneous condition; our clustering analysis revealed four phenotypically distinct population with significant difference in their prognosis. Further investigation is needed to assess its therapeutic implication.

Do pancreas cancer stem cells play crucial role in survival outcome?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15721-e15721
Author(s):  
Gokce Askan ◽  
Ibrahim Halil Sahin ◽  
Marinela Capanu ◽  
Mesruh Turkekul ◽  
Kenneth H. Yu ◽  
...  
Keyword(s):  
Stem Cells ◽  
Cancer Stem Cells ◽  
Lung Metastasis ◽  
Specific Antigen ◽  
Survival Outcome ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

e15721 Background: Recent studies indicate that pancreatic cancer stem cells (CSC) may predict disease behavior and survival outcomes of pancreatic ductal adenocarcinomas (PDACs) patients (pts). Several CSC markers have been reported in PDAC (Fitzgerald, TL, 2014). We herein evaluated the impact of CSC markers including CD44 and Epithelial Specific Antigen (ESA) on survival outcome of PDAC pts who had liver or lung metastasis after initial surgical resection (IR). Methods: Clinicopathologic features and survival of 59 PDACs were analyzed. Pts with IRB approval, and whom had available primary tumor tissue, were included. All neoplasms were immuno labeled with CD44 and ESA. Staining intensity was scored as weak (1), moderate (2), strong (3), while the staining pattern was scored as: few (1), patchy (2), and diffuse (3). The expression for CD44 and ESA was accepted positive if total score ≥4. Time from relapse to death (TRD) was estimated using the Kaplan-Meier method censoring patients that were alive at the last follow up. Survival curves were compared using the log-rank test Results: Of 59 pts, 42 (71 %) had liver, 10 (17%) had lung and 7 (12%) had both liver and lung metastasis. M/F = 34/25; mean age = 64.2 (range, 34-90). Patients were subcategorized as follows; thirteen cases were CD44 (+)/ESA (-) (group1) and 13 were CD44 (-)/ESA (+) (group 2). Eight (61.5%) of group 1 tumors and 2 (15.3%) of group 2 were poorly differentiated. At last follow-up, except one with 63 months survival, all pts died of disease with 23.3 months (range, 3-67) median OS. No significant difference in TRD was observed between group 1 (6.9 months) and 2 (13.8 months) (p = 0.62). However, we observed group 1 tumors had worse OS (12 months) compared to group 2 (36 months). Conclusions:A worse outcome trend was observed for pts with CD44 (+)/ESA (-), albeit not statistically significant and likely limited by small numbers. Further studies are warranted to evaluate the robustness of this observation.

scholarly journals AN INVESTIGATION OF THE SURGICAL ANATOMY OF THE PEDIATRIC ILIOTIBIAL BAND

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0010
Author(s):  
Philip L. Wilson ◽  
Henry B. Ellis ◽  
Connor G. Richmond ◽  
Meagan J. Sabatino ◽  
Charles W. Wyatt ◽  
...  
Keyword(s):  
Surface Area ◽  
Age Groups ◽  
Surgical Anatomy ◽  
Iliotibial Band ◽  
Anatomical Landmarks ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Gerdy’S Tubercle ◽  
Group 1

Background: Previous work on adult specimens have demonstrated some differential thickness of the iliotibial band (ITB) tissue in different areas. The purpose of this study was twofold: 1) to quantitatively and qualitatively describe the relevant surgical anatomy of the ITB, at the level of the knee, in pediatric cadaveric specimens in which either an iliotibial band tenodesis or extraphyseal reconstruction would be considered, and 2) to provide recommendations that allow the surgeon to obtain the ideal graft in terms of tissue width and location on the larger ITB structure. Methods: Pediatric cadaveric specimens (n=24) were dissected by a group of fellowship trained pediatric orthopaedic surgeons. Digital photography of each specimen was obtained prior to collecting quantitative data of the ITB and its three main divisions using digital calipers and a coordinated measurement device (Hexagon Romer Absolute V3 CMM). Measurements included thickness, surface area, length, and width of each branch; surface area and length of each insertion; and distance of insertion in relation to other pertinent anatomical landmarks. Specimens were grouped into four age groups (Group 1: 2 year olds, Group 2: 3 and 4 year olds, Group 3: 5-7 year olds, and Group 4: 9-11 year olds). The four age groups were compared utilizing ANOVA and nonparametric Kruskal-Wallis tests with post-hoc analysis using the Tukey method. In order to correlate measurements and age, a Spearman’s correlation was used. Results: All specimens (mean age 4.7 years; range 2-11) contained a visible ITB with a direct primary arm to Gerdy’s tubercle. Sixteen specimens (66.6%) had a visible trifurcation point, in which the aggregate of ITB fibers diverge into three distinct branches: a direct arm, the iliopatellar branch, and the iliotendinous branch (Figure 1). Fibers from the central third of the iliotibial band, as described as the primary site for harvest, do not terminate on Gerdy’s tubercle, but diverge to the patella, patellar tendon and a portion of Gerdy’s tubercle. The length from the trifurcation point to the insertion of the direct arm at Gerdy’s tubercle increased with each age group (21.3 mm, 29.9 mm, 31.5 mm, and 41.8 mm, respectively) with a significant difference seen between Group 1 and 4 (p<0.01) and Group 2 and 4 (p=0.03), indicating migration of this point with longitudinal growth. The mean thicknesses of the direct arm (0.55 mm), the iliopatellar branch (0.74 mm), and iliotendinous branch (0.42 mm) were not statistically different between age groups. Length, width, and surface area were also not statistically different between age groups. Conclusion: The ITB is a consistent, well-defined structure in pediatric specimens. While some longitudinal changes in the ITB and its insertions were seen with increasing age, the thickness and width of the direct arm of the ITB, typically harvested for extra-physeal ACL reconstruction, does not appear to differ between age groups and does not represent the thickest distal branch of the ITB. The location of ITB harvest may influence the impact that the extra-articular “capsular tightening” has on joint mechanics, including altering the compression across the joint, and/or the impact on the Pivot-Shift/rational laxity of the knee undergoing ITB reconstructions. Further study of the graft location/harvest and its impact on knee biomechanics is warranted. [Figure: see text]

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