Investigating the Etiology and Diagnosis of Sacroiliac Joint Pain

The sacroiliac (SI) joint is often characterized as a large, auricular-shaped, and diarthrodial synovial joint. The SI ligamentous structure is more extensive in the dorsal part due to the absence of the posterior capsule, which functions as a connecting band between the sacrum and ilium. In addition, a network of muscles supports the SI joint that helps deliver regional muscular forces to the pelvic bones. The third and fourth decades of life promote senescent changes manifested by surface irregularities, crevice formation, fibrillation, and clumping of chondrocytes.

Robotic Tensegrity Structure with a Mechanism Mimicking Human Shoulder Motion

This paper proposes a three degrees-of-freedom tensegrity structure with a mechanism inspired by the ligamentous structure of the shoulder. The proposed mechanism simulates the wide motion ranges of the human shoulder joint and is composed of three rigid bodies and sixteen steel wires with three mutually perpendicular rotating axes. Since it belongs to the class 1 tensegrity structure that the rigid bodies do not make any contact with each other, the joint has a certain amount of flexibility, which not only can help protect its mechanism from external impacts but also can prevent human injury that might happen when the mechanism and humans interact each other. Moreover, the proposed mechanism can be manufactured by using fewer materials than a fully rigid mechanism, and thus, it can be made in a lightweight fashion and reduce the inertial effects as well. Finally, to actuate the robotic shoulder, the cables connected to each motor are able to drive the rotating shafts of the joint mechanism.

Functional anatomy of the pelvis and gluteal region

A thorough understanding and knowledge of the regional anatomy of the pelvis and gluteal regions is essential for the understanding of the pathology and the flaps required for the reconstruction of various defects. The bony and ligamentous structure of the pelvis and the muscular and vascular anatomy of the gluteal region are described.

The Use of the Comma Sign and Tissue for Recognition, Reduction, and Stability During Arthroscopic Repair of Combined Anterosuperior Cuff Tears

Background: The comma sign is a useful marker for combined retracted supraspinatus and subscapularis tears. It was first described by the group of Burkhart as a “composite ligamentous structure” of the rotator interval attached to the retracted subscapularis. However, Neyton and coworkers suggested that the ruptured superior part of subscapularis is pulled upward by supraspinatus retraction. This video illustrates the value of “comma” recognition for reduction and repair stability. We feel that the comma tissue can be a composition of rotator interval ligaments with or without superior subscapularis contribution depending on an associated cleavage tear. Indications: Patients with retracted anterosuperior tears, unless muscle quality is poor (Goutallier classification ≥3). Understanding of the comma tissue is difficult but of crucial importance to assess complex anterosuperior cuff tears for reduction and repair with stability by maintaining and integrating this comma link into the repair construct. Technique Description: Arthroscopic setup includes beach chair position, armholder, cerebral saturation monitoring (target mean arterial blood pressure of about 70 mm Hg). Previously described circumferential portals were used for a repair with a double row construct (4 medial anchors: 2.5 for subscapularis; 1.5 for supraspinatus) and 2 lateral anchors. The superior boarder of subscapularis as well as the retracted capsular layer of supraspinatus was reduced and fixed using a lasso loop technique. Key stages are (1) tendon manipulation with 2 traction sutures; (2) tendon release; (3) comma reduction; (4) footprint preparation (burr, microfracture); (5) retrograde suture passing; (6) knot tying, knotless lateral row; and (7) a close surgeon to physiotherapist rehabilitation link (6 weeks passive to 90°, no resistance training for 3-6 months). Results: Senior author’s (S.B.) series: 32 anterosuperior tears over 4 years (mean age: 62 years, 48-73 years), minimum follow-up 1 year showed good results (mean SSV: 85% [preop. 35%], range: 40%-95%; mean Constant: 82 [preop. 30], range: 40-90). One major complication (cutibacterium infection; brick layer; workers compensation; invalidity demand; Constant/Subjective Shoulder Value both 40) and minor temporary stiffness at 3 months (8 patients; 22%). Conclusion: Adequate reduction and comma integration into a solid repair construct, as well as responsible rehabilitation surveillance, deliver successful results after technically intricate anterosuperior repairs.

Methods of Tibiofibular Syndesmosis Fixation

The tibiofibular syndesmosis is a ligamentous structure connecting the distal ends of the tibia and fibula. This article presents and compares the available methods of treatment of syndesmosis injuries. Current publications from the online database PubMed and relevant available books are analysed and compared with AO Surgery guidelines. Metal and bioabsorbable syndesmotic screws and the suture button technique, including all possible modifications of these approaches, are compared. The focus is on the technical aspects of the procedures, functional outcomes and complications of these procedures. According to the literature, the best long-term functional outcomes are obtained with the dynamic fixation method involving the suture button. This fixation technique is closest to a physiological connection, there is no need to subsequently remove the implant and return to work is faster. Given all this, the popularity of this fixation technique can be expected to increase dynamically.

Homoeopathy—A Plausible Alternative Treatment of De Quervain's Tenosynovitis: Case Reports

Background De Quervain's tenosynovitis (DQT) is a disorder characterised by pain on the radial side of the wrist, impairment of thumb function and thickening of the ligamentous structure covering the tendons in the first dorsal compartment in the wrist. Methods Two patients—a 50-year-old housewife and a 43-year-old computer operator were treated with a homoeopathic medicine ‘Rhus toxicodendron’ prescribed in 1M potency. The assessment was done using a visual analogue scale (VAS) for pain, quality of life (QoL) and range of motion (ROM) at baseline and end of the treatment. Assessment of causal attribution of treatment effect was done with the Modified Naranjo Criteria. Result Both the cases showed a marked reduction in VAS (from +8 to 0 for both cases) and increase in QoL (from +5 to +10 & from +7 to +9) and ROM. The Modified Naranjo Criteria total score for each case was +7/13. Conclusion Homoeopathy can be an effective approach in the management of DQT. Randomised controlled trials are thus indicated.

Microstructural and Mechanical Properties of the Anterolateral Ligament of the Knee

Background: The variable anatomy and controversy of the anterolateral ligament (ALL) reflect the complex relationship among the anterolateral knee structures. Purpose/Hypothesis: The purpose was to quantify the microstructural and mechanical properties of the ALL as compared with the anterolateral capsule (ALC) and lateral collateral ligament (LCL). The primary hypotheses were that (1) there is no difference in these properties between the ALL and ALC and (2) the LCL has significantly different properties from the ALL and ALC. Study Design: Descriptive laboratory study. Methods: The LCL, ALL, and ALC were harvested from 25 cadaveric knees. Mechanical testing and microstructural analyses were performed using quantitative polarized light imaging. The average degree of linear polarization (AVG DoLP; mean strength of collagen alignment) and standard deviation of the angle of polarization (STD AoP; degree of variation in collagen angle orientation) were calculated. Results: Linear region moduli were not different between the ALC and ALL (3.75 vs 3.66 MPa, respectively; P > .99). AVG DoLP values were not different between the ALC and ALL in the linear region (0.10 vs 0.10; P > .99). Similarly, STD AoP values were not different between the ALC and ALL (24.2 vs 21.7; P > .99). The LCL had larger modulus, larger AVG DoLP, and smaller STD AoP values than the ALL and ALC. Of 25 knee specimens, 3 were observed to have a distinct ALL, which exhibited larger modulus, larger AVG DoLP, and smaller STD AoP values as compared with nondistinct ALL samples. Conclusion: There were no differences in the mechanical and microstructural properties between the ALL and ALC. The ALC and ALL exhibited comparably weak and disperse collagen alignment. However, when a distinct ALL was present, the properties were suggestive of a ligamentous structure. Clinical Relevance: The properties of the ALL are similar to those of a ligament only when a distinct ALL is present, but otherwise, for the majority of specimens, ALL properties are closer to those of the capsule. Variability in the ligamentous structure of the ALL suggests that it may be more important in some patients than others and reconstruction may be considered in selective patients. Further study is needed to better understand its selective role and optimal indications for reconstruction.

The Anterior Oblique Ligament description in the knee anteromedial compartment

Purpose: To describe a ligamentous structure in the anteromedial region of the knee identified in a series of anatomical dissections of cadaveric specimens.Methods: Sixteen cadaveric knees were dissected to study the medial compartment. Exclusion criteria were signs of trauma, previous surgery, signs of osteoarthritis and poor preservation state. The main structures of this region were identified during medial dissection. After releasing the superficial medial collateral ligament (sMCL) of the tibia, the Anterior Oblique Ligament (AOL), was isolated. The morphology of the structure and its relationship with known anatomical parameters were determined. For the statistical analysis, the means and standard deviations were calculated for continuous variables. A 95% confidence intervals was defined as significant. Student's t-tests were used for continuous variables.Results: After dissection a distinct ligamentous structure (AOL) was found in the medial region of the knee. This structure was found in 100% of the cases, was located extracapsularly and originated in the anterior aspect of the medial epicondyle, running obliquely toward the tibia. When crossing the joint, the ligament presented a fan-shaped opening, exhibiting a larger area at the tibial insertion. The AOL had a mean thickness of 6.83±1.34 mm at its femoral origin and 13.06±1.91 at its tibial insertion. It had a significantly (p = 0.0009) longer mean length with the knee at 90° of flexion (33.82±9.50 mm) than with the knee in total extension (26.56±9.48 mm), indicating that the ligament is tensioned in flexion.Conclusion: A structure was identified in the anteromedial compartment of the knee with a ligamentous appearance originating in the medial femoral epicondyle and with tibial insertion anterior to the sMCL. Clinical relevance: This study demonstrates the anatomy of a new medial structure of the knee. As a result, there will be a better understanding of the stability of the knee.