The enthesis, the specialized junction between tendon and bone, is a common site of injury. Although notoriously difficult to repair, advances in interfacial tissue engineering techniques are being ...developed for restorative function. Most notably are 3D in vitro co-culture models, built to recreate the complex heterogeneity of the native enthesis. While cell and matrix properties are often considered, there has been little attention given to native enthesis anatomical morphometrics and replicating these to enhance clinical relevance. This study focuses on the flexor digitorum profundus (FDP) tendon enthesis and, by combining anatomical morphometrics with computer-aided design, demonstrates the design and construction of an accurate and scalable model of the FDP enthesis. Bespoke 3D-printed mould inserts were fabricated based on the size, shape and insertion angle of the FDP enthesis. Then, silicone culture moulds were created, enabling the production of bespoke anatomical culture zones for an in vitro FDP enthesis model. The validity of the model has been confirmed using brushite cement scaffolds seeded with osteoblasts (bone) and fibrin hydrogel scaffolds seeded with fibroblasts (tendon) in individual studies with cells from either human or rat origin. This novel approach allows a bespoke anatomical design for enthesis repair and should be applied to future studies in this area.
Fractures of the thumb metacarpal base Brown, Matthew T.; Rust, Philippa A.
Injury,
November 2020, 2020-11-00, 20201101, Letnik:
51, Številka:
11
Journal Article
Abstract
Introduction
This systematic review aims to compare the rate and time to return to sport or work following surgical interventions for isolated scapholunate ligament (SLL) injury.
Sources of ...data
A PRISMA-compliant systematic search of Medline, EMBASE, Cochrane, AMED, CINAHL Plus and SPORTDiscus was performed using keywords ‘scapholunate’, ‘scapholunate ligament’, ‘scaphoid lunate’, ‘sport’, ‘sport injury’, ‘athlete’, ‘athletic performance’, ‘elite’, ‘return to sport’, ‘training’, ‘work’, ‘activity’, ‘return to activity’. Adult patients with isolated SLL injury, without osteoarthritis, were included.
Areas of agreement
Fourteen papers, including six different surgical interventions, met the criteria for the final analysis. All surgical techniques demonstrated acceptable rates of return to work or sport (>80%).
Areas of controversy
The optimal surgical intervention for isolated SLL injury remains undetermined due to heterogeneity and limited sample sizes of published studies.
Growing points
This systematic review has provided clarification on the available literature on treatment modalities for isolated SLL injuries in the absence of osteoarthritis.
Areas timely for developing research
Prospective, randomized, primary studies are needed to establish optimal treatment for acute isolated SLL injuries.
The enthesis possesses morphological adaptations across the soft-hard tissue junction which are not fully restored during surgical avulsion repairs. This loss of anatomical structure, highly related ...to function, contributes to poor clinical outcomes. Investigating the native macro- and micro-structure of a specific enthesis can provide functional and biomechanical insights to develop specialised, novel tissue-engineered therapeutic options and potentially improve current surgical treatments for avulsion injuries.
This study examines the anatomy and histomorphology of the flexor digitorum profundus (FDP) enthesis in 96 fresh-frozen human cadaveric fingers, quantitatively and qualitatively analyzing the shape, size, angle of tendon fibres and histological architecture, and explores differences in sex, finger and distance along the enthesis using linear mixed effects models.
Macroscopically, results showed a consistent trapezoidal insertion shape of 29.29 ± 2.35 mm
mean surface area, but with significant morphometric size differences influenced primarily by the smaller dimensions of the little finger. Microscopically, a fibrocartilaginous enthesis was apparent with a 30.05 ± 0.72
mean angle of inserting tendon fibres, although regional variation in fibrocartilage and the angle change of tendon fibres before insertion existed.
The implication of these findings on native and specific FDP enthesis function is discussed whilst providing recommendations for optimal FDP enthesis recreation for interfacial tissue engineers and hand surgeons. The study emphasizes the importance of region-specific knowledge whilst also describing methods applicable to assessing any soft tissue insertion.
This study aimed to identify the effects of basal thumb surgery on the range of dart thrower’s motion. Thirteen fresh-frozen cadaveric specimens were placed in a customized jig. Simulated ...scaphotrapeziotrapezoid joint fusion was carried out on all specimens. Half the specimens then underwent trapeziectomy and the rest had excision of the distal pole of the scaphoid. Simulated scaphotrapeziotrapezoid fusion reduced the range of dart thrower’s motion to 89% of the range in the intact wrists, from a mean of 117° to 104°. Although this reduction is not large, it was statistically significant. Simulated trapeziectomy caused a very small increase in dart thrower’s motion range compared with the range in the intact wrists. Simulated distal pole of scaphoid excision did not change the range of dart thrower’s motion. These results may inform preoperative decisions for surgical management of basal osteoarthritis of the thumb.
Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to ...minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.
This review aims to provide information on return rates and times to return to sport following surgical management of triangular fibrocartilage (TFC) tears.
A systematic search of CINAHAL, Cochrane, ...EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords 'triangular', 'fibro-cartilage', 'complex', 'tear', 'distal radio-ulnar joint', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'.
In all of the 10 studies included, conservative management for 6 weeks to 6 months was the first-line treatment. If symptoms persisted following this period, surgical management was advised. Arthroscopic debridement was recommended for central tears, and arthroscopic repair was recommended for peripheral tears.
The optimal treatment modalities for TFC tears remain to be defined.
Traumatic central tears can be treated with arthroscopic debridement alone. Arthroscopic repair with an all-inside repair can improve return rates to sport over an outside-in technique for ulna-sided tears.
Future prospective studies should aim to establish the optimal treatment modalities for TFC tears.
Dart-thrower’s motion (DTM) is a functional wrist movement from maximum radial extension to maximum ulnar flexion. This study defines a reference range of DTM in a healthy population.
Goniometric ...measurements were collected from both wrists of 200 healthy volunteers. Mean age was 21.1 years (range, 18–25 years), 126 volunteers (63%) were female, and 177 (89%) were right-handed. Volunteers also reported perceived difficulty of performing DTM.
For male subjects, the mean arc of motion was 126° (range, 83°–166°) for dominant and 114° (range, 62°–148°) for nondominant wrists. For female subjects, the mean values were 129° (range, 79°–170°) and 126° (range, 70°–167°), respectively. On multiple regression analysis, female subjects had a significantly increased range of dominant and nondominant arc of motion compared with males. Older subjects had significantly increased dominant but reduced nondominant arc of motion. High inter- and intrarater reliability was observed for goniometric measurement of DTM (intraclass correlation coefficients, 0.93–0.98).
This study quantified a reference range of DTM in normal individuals.
This study provides a reference range for DTM in a young adult population, which may aid clinical comparison of measurements of wrist movement and evaluation of conditions and treatments that impact DTM.
This study aimed to audit large quantities of mini C-arm data used in hand and wrist surgery and to analyse what effect the type and anatomical location of procedures had on screening time and dose ...area product. Of a total of 2032 procedures, the median screening time was 11 seconds and median dose area product was 0.75 cGycm2. The third quartile value for screening time was 23 seconds and dose area product was 1.62 cGycm2. The median screening time for closed procedures was 7 seconds and the dose area product was 0.57 cGycm2. The median screening time for open surgery was 23 seconds with a median dose area product of 1.45 cGycm2. The data for steroid injection procedures were similar to those of the closed procedures, with a median screening time of 7 seconds and dose area product of 0.45 cGycm2. We found no significant differences in the screening time or dose area product between procedures on the wrist and forearm compared with the hand and digits.
Level of evidence: III
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