The medial side of the knee is comprised of ligaments, myotendinous and meniscal structures that work as a unit to stabilize the joint. The superficial medial collateral ligament is its core ...structure. Still, all elements of the medial side have load-sharing relationships, leading to a cascade of events in the scenario of insufficiency of any of them. Understanding the medial soft tissue structures as part of a unit is of utmost importance because the most common ligaments damaged in knee injuries belong to it. Surprisingly, there is a lack of high-level evidence published around the issue, and most studies focus on the superficial medial collateral ligament, overlooking the complexity of these injuries. Acknowledging the consequences for joint biomechanics and treatment outcomes, interest in this area is growing between researchers. Emerging evidence may become a game-changer in the future management of these injuries.
Based on a thorough research of published literature, this review provides a current biomechanical concepts and clinical guidance to treat these injuries.
Instability after total knee arthroplasty is a common but poorly understood complication.
Data from a large national registry was used to study patient and prosthesis characteristics of 2605 total ...knee arthroplasty revisions for instability. The cumulative percent revision was calculated using Kaplan-Meier estimates, and Cox proportional models used to compare revision rates. The rate of further revision was analyzed with regard to prostheses used in the first revision.
Instability increased from 6% of all first revision procedures in 2003 to 13% in 2019. The revision risk was lower for minimally stabilized prostheses, males, and patients aged ≥65 years. Polyethylene insert exchange was used for 55% of revision procedures, using a thicker insert in 93% and a change in insert conformity in 24% of cruciate-retaining knees. The increase in either thickness or conformity had no effect on the rate of further revision. After a revision for instability, 24% had a second revision by 14 years. Recurrent instability accounted for 32% of further revisions. A lower second revision rate was seen after revision of both femoral and tibial components, and where constrained components were used.
Revision for instability is increasing. Revising both femoral and tibial components led to a lower rate of second revision compared to a change in insert alone. Recurrent instability was common.
Background:
Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and ...predictors of outcome.
Methods:
Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed.
Results:
90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found (n = 5 IR, n = 8 THA+repair), including 9 re-operations (n = 4 IR, n = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores (p = 0.0175), and there was trend (p > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA).
Conclusions:
Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.
Objectivos:A transplantação renal é a forma de tratamento de eleição da doença renal crónica terminal. Este tratamento cirúrgico tem vindo a sofrer alterações ao longo dos anos, com vista a melhorar ...os resultados do mesmo, e diminuir as co-morbilidades associadas, sendo a técnica do procedimento o alvo deste estudo de revisão.Materiais e Métodos:Realizou-se uma revisão da literatura nesta área, recorrendo-se a livros e artigos publicados, bem como, à observação de procedimentos no Serviço de Urologia e Transplantação Renal dos Hospitais da Universidade de Coimbra, com início em Maio de 2010 e término em Março de 2011.Resultados:Da análise realizada, são apresentados dois grandes procedimentos: a nefrectomia do dador (vivo ou cadáver) e a implantação no receptor, composta pela incisão, colocação do enxerto, anastomose vascular e anastomose urinária.Cada um possui opções técnicas que são empregues por diferentes centros, e serão alvo de análise.Conclusões:Dentro destes passos, existem diferentes técnicas, todas elas possuindo vantagens e desvantagens, que não trazem um total consenso sobre o procedimento de eleição, pelo que, a escolha deve ser adequada ao doente e à experiência do centro.
Periodontal disease (PD) refers to a group of inflammatory diseases caused by bacterial plaque in the periodontium and ranges from an early stage (gingivitis) to an advanced stage (periodontitis). It ...is a multifactorial disease that results from the interaction of the host defence mechanisms with the plaque microorganisms. Early detection, diagnosis and treatment are essential in the control of this disease. PD has an enormous impact on human and veterinary medicine due to its high prevalence.
The most common animal PD models use dogs and non-human primates, although other animals (rats, mice, hamsters, rabbits, miniature pigs, ferrets, and sheep) have also been employed. Dog models have contributed significantly to the current understanding of periodontology. The most important clinical aspects of canine PD are considered in this review and the various animal models are examined with an emphasis on the role of the dog as the most useful approach for understanding human PD and in the development of new therapeutic and preventive measures.
Periodontal disease (PD) refers to a group of inflammatory diseases that affect the periodontium, the organ which surrounds and supports the teeth. PD is a highly prevalent disease with a ...multifactorial etiology and, in humans the individual susceptibility is known to be strongly determined by genetic factors. Several candidate genes have been studied, namely genes related with molecules involved in the inflammatory response. Interleukin-10 (IL-10) is a cytokine with important anti-inflammatory and immunomodulatory roles, and several studies indicate an association between IL10 polymorphisms and PD. In dogs, an important animal model in periodontology, PD is also a highly prevalent naturally occurring disease, and only now are emerging the first studies evaluating the genetic predisposition. In this case–control study, a population of 90 dogs (40 dogs with PD and 50 healthy dogs) was used to study the IL10 gene, and seven new genetic variations in this gene were identified. No statistically significant differences were detected in genotype and allele frequencies of these variations between the PD cases and control groups. Nevertheless, one of the variations (IL10/2_g.285G>A) leads to an amino acid change (glycine to arginine) in the putative signal peptide, being predicted a potential influence on IL-10 protein functionality. Further investigations are important to clarify the biological importance of these new findings. The knowledge of these genetic determinants can help to understand properly the complex causal pathways of PD, with important clinical implications.
•A pioneer study of the canine IL10 gene and periodontal disease was developed.•We detected seven new genetic variations in the canine IL10 gene.•No statistically significant differences were detected between groups.•The IL10/2_g.285G>A variation leads to an amino acid change (glycine to arginine).•Further studies are important to clarify the biological importance of our findings.
•This research employed a multidisciplinary approach to study ancient dogs.•We aimed to understand humans’ interest in the maintenance and breeding of dogs.•Iberian Chalcolithic dogs already ...exhibited signs of body size variation.•Dental analyses revealed that dogs died young without signs of periodontitis.•We detected mitogenomic variability through the presence of clades A and C.•Molecular sex inference allowed the identification of one female and two males.
Domesticated dogs have been present in the Iberian Peninsula long before other domesticated species, back to the late Palaeolithic period. Their origin is still uncertain, but dogs were already well established during the Chalcolithic period (ca. 5000–4000 BP). This study employed a multidisciplinary approach comprising osteometric, radiographic and palaeogenomic analyses to characterize Chalcolithic Iberian Canis remains. Two Chalcolithic archaeological sites – Leceia, Oeiras, in Portugal, and El Casetón de la Era, Villalba de los Alcores, Valladolid, in Spain – were the main focus of this study. Osteometric and odontometric data from eleven other sites in Iberia were also included. Osteometric results show signs of phenotypic variability, likely the result of human-driven selective pressure. Dental radiographic and dental wear analyses allowed age at death estimation for four individuals (two juvenile and two adults). Three Chalcolithic Iberian dogs had their mitogenomes resequenced and the mitochondrial DNA analysis allowed to assign each individual to two of the major known haplogroups – A and C. Molecular sex infered by the chromosomeX/chromosome1 coverage ratio allowed to identify one female and two males. This study unveils some aspects of the Iberian Chalcolithic dogs: these dogs already exhibited various morphotypes whose profiles might be associated to the performance of certain tasks, as well as mitogenomes of two distinct lineages that help tracking the evolutionary paths of Iberian dogs.
Periodontal disease (PD) is the most common inflammatory disease of the oral cavity of domestic carnivores. In Human Medicine molecular genetics research showed that several genes play a role in the ...predisposition and progression of this complex disease, primarily through the regulation of inflammatory mediators, but the exactly mechanisms are poorly understood. This study aims to contribute to the characterization of the genetic basis of PD in the dog, a classically accepted model in Periodontology. We searched for genetic variations in the interleukin-6 (
IL6) gene, in order to verify its association with PD in a case–control study including 25 dogs in the PD case group and 45 dogs in the control group. We indentified and characterized three new genetic variations in
IL6 gene. No statistically significant differences were detected between the control and PD cases groups. Our results do not support an evidence for a major role contribution of these variants in the susceptibility to PD in the analyzed population. Nevertheless, the sequence variant I/5_g.105
G
>
A leads to an amino acid change (arginine to glutamine) and was predicted to be possibly damaging to the IL6 protein. A larger cohort and functional studies would be of extreme importance in a near future to understand the possible role of IL6 variants in this disease.
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