1. The study examined the effect of meniscus removal on anterior cruciate ligament (ACL)-deficient knee laxity using a navigation system.
2. It found that patients who underwent partial or total removal of the medial meniscus had significantly greater anterior tibial translation during Lachman and drawer tests, compared to patients with an isolated ACL injury.
3. Under pivot shift testing, all groups showed similar results except for anterior displacement, which was significantly greater in patients who underwent a meniscectomy.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Arthroscopic Anterior Cruciate Ligament Reconstruction Using Four-Strand Hams...Apollo Hospitals
In this study, we analyzed the clinical outcomes at two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.
Medcrave - Long term follow up of regnauld’s procedureMedCrave
We performed a retrospective study to assess the long-term outcome of regnauld’s procedure, as originally described by Regnauld [1], for the treatment of hallux valgus. This procedure includes the treatment of hallux limitus, hallux rigidus and hallux valgus with associated degenerative joint disease.
Quantitative Analysis of Patellar Tendon Abnormality in Asymptomatic Professi...Medical_Lab
Abnormalities in B-mode ultrasound images of the patellar tendon often take place in asymptomatic athletes but it is still not clear if these modifications forego or can predict the development of tendinopathy. Subclinical tendinopathy can be arbitrarily defined as either the presence of light structural changes in B-mode ultrasound images in association with mild
neovascularization (determined with Power Doppler images) or the presence of moderate/severe structural changes with or without neovascularization. Up to now, the structural changes and neovascularization of the tendon are evaluated qualitatively by visual inspection of ultrasound images. The aim of this study is to investigate the capability of a quantitative texture-based approach to determine tendon abnormality of “pallapugno” players. B-mode ultrasound images of the patellar tendon were acquired in 14 players and quantitative texture parameters were calculated within a Region of Interest (ROI) of both the non-dominant and the dominant tendon. A total of 90 features were calculated for each ROI, including 6 first-order descriptors, 24 Haralick features, and 60 higher-order spectra and entropy features. These features on the dominant and non-dominant side were used to perform a multivariate linear regression analysis (MANOVA) and our results show that the descriptors can be effectively used to determine tendon abnormality and, more importantly, the occurrence of subclinical tendinopathy.
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot T...CrimsonPublishersOPROJ
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot Treatment by Mario Lampropulos* in Crimson Publishers: Orthopedic Research and Reviews Journal
Corrigendum to “Special surgical technique for knee arthroplasty”Apollo Hospitals
We typically operate more than 1200-1800 cases a year, out of which we have included 300 cases randomly for the study. All these selected cases were local residents and easy to follow-up.
Presentation at American Academy of Orthopaedic Surgeons, New Orleans 2018. This study demonstrates that re-operation rates after this procedure are broadly comparable to those seen after isolated ACLR. The high rates of stiffness and complications seen with non-anatomical ITB based procedures was not observed in this series
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
Arthroscopic Anterior Cruciate Ligament Reconstruction Using Four-Strand Hams...Apollo Hospitals
In this study, we analyzed the clinical outcomes at two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.
Medcrave - Long term follow up of regnauld’s procedureMedCrave
We performed a retrospective study to assess the long-term outcome of regnauld’s procedure, as originally described by Regnauld [1], for the treatment of hallux valgus. This procedure includes the treatment of hallux limitus, hallux rigidus and hallux valgus with associated degenerative joint disease.
Quantitative Analysis of Patellar Tendon Abnormality in Asymptomatic Professi...Medical_Lab
Abnormalities in B-mode ultrasound images of the patellar tendon often take place in asymptomatic athletes but it is still not clear if these modifications forego or can predict the development of tendinopathy. Subclinical tendinopathy can be arbitrarily defined as either the presence of light structural changes in B-mode ultrasound images in association with mild
neovascularization (determined with Power Doppler images) or the presence of moderate/severe structural changes with or without neovascularization. Up to now, the structural changes and neovascularization of the tendon are evaluated qualitatively by visual inspection of ultrasound images. The aim of this study is to investigate the capability of a quantitative texture-based approach to determine tendon abnormality of “pallapugno” players. B-mode ultrasound images of the patellar tendon were acquired in 14 players and quantitative texture parameters were calculated within a Region of Interest (ROI) of both the non-dominant and the dominant tendon. A total of 90 features were calculated for each ROI, including 6 first-order descriptors, 24 Haralick features, and 60 higher-order spectra and entropy features. These features on the dominant and non-dominant side were used to perform a multivariate linear regression analysis (MANOVA) and our results show that the descriptors can be effectively used to determine tendon abnormality and, more importantly, the occurrence of subclinical tendinopathy.
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot T...CrimsonPublishersOPROJ
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot Treatment by Mario Lampropulos* in Crimson Publishers: Orthopedic Research and Reviews Journal
Corrigendum to “Special surgical technique for knee arthroplasty”Apollo Hospitals
We typically operate more than 1200-1800 cases a year, out of which we have included 300 cases randomly for the study. All these selected cases were local residents and easy to follow-up.
Presentation at American Academy of Orthopaedic Surgeons, New Orleans 2018. This study demonstrates that re-operation rates after this procedure are broadly comparable to those seen after isolated ACLR. The high rates of stiffness and complications seen with non-anatomical ITB based procedures was not observed in this series
Presentation delivered at 2020 AAOS annual meeting by Dr Adnan Saithna, Professor of Orthopedic Surgery, Overland Park, Kansas. This randomised controlled study demonstrates that combined ACL and anterolateral ligament reconstruction is not associated with an increased risk of adverse events when compared to isolated ACL reconstruction
The Principe of high tibial osteotomy is to reduce the stresses of the internal compartment of the knee by valgizing the tibia.The
total knee arthroplasty on this tibia with a “malunion” presents technical difficulties related to the initial approach, the presence of osteosynthesis material, the presence of malunion and the change of bone density. The objectives of this study are to determine the clinical and radiographic results of patients undergoing Total Knee Arthroplasty (TKA) after High Tibial Osteotomy (HTO). This is a retrospective descriptive study including patients undergoing Total Knee Arthroplasty (TKA) after an High Tibial Osteotomy (HTO) at the Hospital of Mont de Marsan (France) from 2008 to 2017 with a minimum follow-up of 12 months. Thirty knees (27 patients) were recruited. The sex ratio was 1.72. The average age was 70.33 years (54years-88years). The average time between High Tibial Osteotomy (HTO) and Total Knee Arthroplasty (TKA) was 10.83 years (1 year-26 years). The medial opening was 63.33% and lateral closure for the rest. Clinical improvement was observed, with an average gain of 24.97 points for pain, 1 point for stability, 1 point for knee mobility and 5 points for walking distance. The clinical result was perfect in 13.33%, excellent in 42% and medium in 36.67% of cases. The alignment was obtained in 76.67% of cases (p = 0.0039). The posterior tibial slope, epiphyseal varus, patellar height were corrected in 80% of cases respectivly (p = 0.000011, p = 0.44, p = 0.15). Residual pain was observed in 26.66%, joint stiff ness in 16.66%, skin healing disorder in
16% and infection in 6.66% of cases. Total knee arthroplasty made it possible to recover the failure of an high tibial osteotomy.
Functional outcome of Arthroscopic reconstruction of single bundle anterior c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. 3600 Knee Surg Sports Traumatol Arthrosc (2016) 24:3599–3604
1 3
12] proved that suturing a meniscal tear significantly
reduces the ATT to levels comparable to the uninjured
state. Although meniscal preservation in ACL reconstruc-
tion in the knees with combined ACL and medial meniscus
injuries have the theoretical advantage of being protective
to the articular cartilage, meniscectomy remains necessary
for irreparable meniscal tears. In previous clinical studies,
meniscectomy combined with ACL reconstruction has been
reported to result in significant pain relief and functional
improvement [16, 18].
However, the effect of meniscectomy on the knee stabil-
ity and rotational kinematics during ACL reconstruction
is still controversial, as no sound agreement is present in
the literature due to the scarceness of clinical quantitative
data. Indeed, to the authors’ knowledge, there are no previ-
ous in vivo studies that assessed intraoperatively the effect
of meniscal status in an ACL-deficient knee. The purpose
of this study was to determine, in vivo, the effect of differ-
ent levels of meniscectomy on an ACL-deficient knee. The
hypothesis was that medial meniscectomy would have sig-
nificantly affected the kinematics, increasing the static and
dynamic laxity.
Materials and methods
Fifty-six consecutive patients (45 men and 11 women)
were enrolled in the study. The inclusion criteria were acute
or chronic ACL deficiency with or without an irreparable
medial meniscal tear. The exclusion criteria were lateral
meniscal tear, reparable medial meniscal tears, additional
ligament tears or history of ACL reconstruction in the
injured knee.
All the patients were operated by the same surgeon
(XX). At the time of surgery, the patients were divided
into three groups depending on the status of the medial
meniscus. Group BH, 8 patients with bucket-handle tear of
medial meniscus who have undergone a subtotal meniscec-
tomy; Group PHB, 19 patients with posterior horn body of
medial meniscus tear who have undergone a partial menis-
cectomy; and Group CG with isolated ACL rupture, as a
control group, with 29 patients.
The mean (SD) age at surgery was 33 (10) years. The
mean (SD) time from the first knee injury to the surgical
procedure was 25 (39) months.
In order to evaluate preoperative joint laxity, a surgi-
cal navigation system was adopted (BLU-IGS, Orthokey,
Lewes, Delaware, DE, USA), equipped with software spe-
cifically dedicated to intraoperative kinematics acquisitions
(KLEE, Orthokey, Lewes, Delaware, DE, USA).
Testing protocol
The examination protocol was performed after meniscec-
tomy and before ACL reconstruction utilizing the method
developed by Martelli et al. [12].
The surgeon manually performed the clinical kinematic
tests at maximum force.
The following were analysed:
• Anterior/posterior displacement at 30° of flexion
(AP30)
• Anterior/posterior displacement at 90° of flexion
(AP90)
• Internal/external rotation at 30° (IE30)
• Internal/external rotation at 90° (IE90)
• Varus/valgus test at 0° (VVO)
• Varus/valgus test at 30° (VV30)
• Pivot-shift (PS) test was used to assess the dynamic lax-
ity. It was strictly executed following the clinical grad-
ing defined by Jacob et al. [5].
In order to quantify the pivot-shift test, according to the
literature [6, 12], three different parameters were evalu-
ated: the area included by the lateral tibial compartment
translation with respect to flexion/extension angle (named
AREA); the POSTERIOR ACC, that corresponds to the
posterior acceleration of the lateral tibial compartment dur-
ing tibial reduction; and finally, the maximal anterior dis-
placement of the lateral tibial compartment (named ANTE-
RIOR DISPLACEMENT) [10].
The reliability of all laxity tests performed at maximum
force was evaluated by the research group in previous stud-
ies [9, 13]. During the whole set of tests and reconstruc-
tions, the examiner was the same and was blind for test
quantitative results in order to avoid bias in the acquisitions.
All the enrolled patients signed informed consent forms
to participate in the research study approved by the Institu-
tional Review Board (IRB approval: Prot 40/CE/US/ml) of
Istituto Ortopedico Rizzoli (Bologna, Italy).
Statistical analysis
The presence of outliers data in the kinematic test results was
evaluated using the Modified Thompson Tau method before
applying inference analysis. In order to obtain a small sample
size in each group, a non-parametric statistical approach was
required: Mann–Whitney test was applied to compare the dif-
ferent groups to CG. An alpha value of 0.05 was set as signifi-
cant. All statistical analysis was performed using Analyse-it/
Excel (Microsoft, Redmond, Washington State, USA).
3. 3601Knee Surg Sports Traumatol Arthrosc (2016) 24:3599–3604
1 3
Results
Anterior/posterior displacement
Concerning AP30, a significant (P < 0.01) higher lax-
ity for both BH and PHB group compared to the CG has
been found. In particular, the CG showed a median value
of 10.1 mm (range 8.9–11.4 mm), the BH group a median
value of 14.5 mm (range 13–15.6 mm), and the PHB group
a median value of 13.5 mm (range 12.6–14.7 mm). No
significant difference (n.s) was observed between the two
groups with meniscal tear.
Analogously, AP90 was significantly higher (p < 0.01)
in the two groups with a meniscal tear. The median value
of this laxity parameter was 7.0 mm (range 6.5–8.4 mm)
in the CG group, 12.2 mm (range 11.1–13.6 mm) in the
BH group and 10.3 mm (range 8.4–11.7 mm) in the PHB
group. The difference between BH and PHB group was sig-
nificant as well (P = 0.03) (Fig. 1).
Varus/valgus and internal/external rotation
Concerning the static rotational laxity at 0°, 30° and 90°
degree of knee flexion (IE30, IE90, VV0, VV30), there
was no statistical differences (n.s) between the three study
groups (Figs. 2, 3).
Pivot‑shift test
AREA and POSTERIOR ACC
No significant differences in terms of AREA and POSTE-
RIOR ACC were found among the three groups (n.s).
Concerning the ANTERIOR DISPLACEMENT of the
pivot-shift, a statistically significant difference among the
three tested groups was found.
In particular, in the CG, the median value resulted was
20.3 mm (range 12.4–23.9 mm); in the BH group, the result
was 28.0 mm (range 20.4–32.7 mm); and lastly in the PHB
Fig. 1 Graphical representation
of anterior tibial displacement
(mm) at 30° and 90° (AP30–
AP90) for the three study
groups: CG (control group),
BH (bucket-handle) and PHB
(posterior horn body)
Fig. 2 Graphical representation
of internal/external rotational
laxity [°] at both 30° and 90°
degree of knee flexion (IE30,
IE90) for the three study
groups: CG (control group),
BH (bucket-handle) and PHB
(posterior horn body)
Fig. 3 Graphical representation
of varus/valgus rotational laxity
[°] at both 0° and 30° degree
of knee flexion (VV0, VV30)
for the three study groups: CG
(control group), BH (bucket-
handle) and PHB (posterior
horn body)
4. 3602 Knee Surg Sports Traumatol Arthrosc (2016) 24:3599–3604
1 3
group, resulting median value was 34.5 mm (range 28.0–
35.7 mm). The comparison between CG and BH group was
statistically significant (P = 0.04) as was the difference
between CG and PHB (P = 0.01). The results have been
graphically reported (Fig. 4).
Discussion
The most important finding of the present in vivo study
is that subtotal medial meniscectomy in ACL-deficient
knees increases anterior tibial translation at 30° and 90° of
knee flexion. Further, at deeper angles of flexion, menis-
cal defects due to a bucket-handle tear have significantly
increased this laxity parameter compared to a meniscal
defect limited to the posterior horn body. With the com-
bined rotatory and axial loads of a pivoting manoeuvre,
both meniscal defects produced a significant increase in
anterior displacement compared to the control group. On
the other hand, no significant change in terms of rotational
laxity was observed.
The importance of the medial meniscus as a second-
ary stabilizer in the ACL-deficient knee is well studied in
in vitro conditions. Some authors showed that meniscec-
tomy in an ACL-deficient knee increased instability. Seon
et al. [17], in an in vitro study, detected that subtotal medial
meniscectomy increased anterior tibial translation at all
flexion angles under anterior tibial load. This is consistent
with the present work and previous studies in the litera-
ture [2, 8, 11, 19], as well. However, some authors did not
observe an increase in knee laxity after meniscectomy [15].
The data of the present work slightly differ from the
in vitro paper by Musahl et al. [14]. They investigated knee
laxity parameter by means of Lachman test under 68 N load
and mechanized pivot-shift test on ten fresh-frozen hip-to-
toe lower extremities. Similarly, to the current paper, laxity
evaluation was performed with a navigation system. Both
laxity testing was performed, first in ACL-deficient knees,
and after medial and lateral meniscectomies. They showed
that medial meniscus is a significant secondary restraint to
anterior tibial translation, but did not significantly affect
the anterior translation of the lateral compartment during
the simulated pivot shift in ACL-deficient knees. A reason
for this disagreement might lay in the differing set-up; the
young population of the current study is likely to have bet-
ter tissue quality than fresh-frozen specimens. Therefore,
it is expected that laxity’s changes are easier to detect in
an in vivo set-up. Lorbach et al. [11], testing cadaveric
specimens, found that partial or total meniscectomy of the
medial meniscus determine a significant impact on knee
kinematics in the ACL-deficient knee evaluated by Lach-
man and pivot-shift test, whereas the repair of the menis-
cus was able to reduce it, similar to the ACL-deficient knee
with intact meniscus.
Papageorgiou et al. [15], in an in vitro study, measured
the kinematics of the knee and the in situ force in the ACL-
reconstructed knee after medial meniscectomy. They meas-
ured the anterior tibial translation under a combined 134 N
anterior and 200 N axial compressive tibial load for several
testing conditions using a robotic/universal force-moment
sensor testing system. They did not find any difference
in terms of tibial translation, but they reported that after
medial meniscectomy, the force in the ACL graft increases
between 30 and 50 %. In consequence, they suggested that
the ACL replacement grafts may be subjected to higher
risks of failure.
Wu et al. [22] performed an in vivo evaluation on a series
of patients undergoing different degrees of meniscectomy
combined with an ACL reconstruction. They did not find
any difference in terms of anteroposterior laxity. However,
the instrumental laxity assessment was performed with the
arthrometer KT2000 which has lower precision compared
to a navigation system. Moreover, the patients that under-
went meniscal resection achieved a worse clinical result in
terms of subjective scores and activity level compared to
the group that underwent isolated ACL reconstruction.
Chen et al. [3], in an in vitro porcine study, analysed
three different conditions using a robotic system (CASPAR
Fig. 4 Graphical representation
of pivot-shift test laxity parame-
ters: AREA, POSTERIOR ACC,
ANTERIOR DISPLACEMENT.
Results have been reported for
three study groups: CG (control
group), BH (bucket-handle) and
PHB (posterior horn body)
5. 3603Knee Surg Sports Traumatol Arthrosc (2016) 24:3599–3604
1 3
Staubli RX90, Orto MAQUET, Germany): intact medial
meniscus, posterior or anterior horn of medial meniscus
resection, and total medial meniscectomy.
They concluded that medial meniscectomy had no effect
in anterior tibial translation, but the posterior horn medial
meniscectomy increased the internal rotation, while the
anterior horn medial meniscectomy increased the external
rotation.
Results could be affected by the fact that porcine knee
joints never reach full extension arresting their range of
motion at about 30° of flexion.
Also evaluating ACL-intact knees, Spang et al. [21]
showed that the removal of the meniscus led to a signifi-
cant increase in anterior tibial translation at all knee flexion
angles. This is in contrast to the in vitro study of the effect
of meniscectomy on the biomechanics of the normal knee,
by Levy et al. [8], in which no increase in the tibial dis-
placement after complete medial meniscectomy was found.
The lower value of lateral tibial displacement in the BH
group compared to the PHB once during PS test is in the
authors’ opinion generated by an alteration of the centre of
rotation due to the greater amount of the meniscal tissue
removed. Such tissue removal can move the centre of rota-
tion forward, reducing the amount of anterior displacement
detected during the test.
In the setting of primary ACL reconstruction, these find-
ings could help the clinician to be aware of the highest pre-
operative laxity of the meniscus deficient, in order to even-
tually consider customized surgical solutions to address
this unfavourable condition.
There are some limitations to the present study. The first
is the difference in meniscus tear patterns and extension
among the studied subjects. While in in vitro study, it is
possible to control the precise size of the lesions.
Another limitation is that the laxity tests were performed
by a navigation system, and not under force and displace-
ment control modes. Anyway, the repeatability of the per-
formed test has been already tested in previous studies
showing encouraging results [9, 13, 23].
Despite the previously reported limitations, to the best
of the authors’ knowledge, this is the first in vivo study per-
formed with an objective tool such as navigation system
that investigated the effect of different types of meniscal
defects on an ACL-deficient knee.
Conclusion
The present work proved that meniscal defects significantly
affect the kinematics of an ACL-deficient knee in terms of
anterior tibial translation under static and dynamic testing.
These results point out the importance of menisci in joint
behaviour. Future clinical studies are needed to detect the
long-term effect of these zero-time kinematic differences.
The authors advocate the development of high precision
objectives and non-invasive tools for laxity’s evaluation in
clinical settings.
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