مجله جراحی استخوان و مفاصل ایران
سال نهم شماره 4 (پیاپی 37، پاییز 1390)

Anterior cruciate ligament (ACL) tear is a common injury in sports. Different technigues for reconstruction of this ligament have been suggested. This paper compares the knee kinematics between «single bundle» and «double bundle» ACL reconstruction with hamstring tendon in a computerized knee model. A computer-knee modle was constructed. Then «single bundle» and «double bundle» ACL reconstruction was performed. The knee stability and ligament tension were tested in 3 different settings: 1) At 30° knee flexion under isolated postero-anterior load، valgus and rotational torque was applied، 2) In weight-bearing flexion range (from extension to 70° of flexion) an anterior load of 134 Newton was applied، 3) Knee model was loaded by a non-contact pivot farce to produce ACL rupture. The results showed no significant difference between «single bundle» and «double bundle» under isolated loading. The second and third model، however، showed 4 times greater tension on the ligament in «single bundle». The «single bundle» in the second technique of testing (weight bearing) showed at most 7 mm more displacement compared with «double bundle». In the third testing technique «double bundle» was stronger than «single bundle» in valgus torque resistance. The internal rotation stability was also more in «double bundle». Functional stability of knee model of ACL reconstruction with a «double bundle» graft is superior to a «single bundle» graft.

Tibial torsion is a term used to describe the physiologic twist of the distal relative to the proximal articular axis of the tibial bone in the transverse plane around its longitudinal axis. This study focuses on a method of tibial torsion measurement with computerized tomography cuts. Sixty four volunteers aged over 16 years old had CT imaging of proximal and distal tibia in a teaching hospital in Tehran-Iran. The images were evaluated for leg rotation by four physicians using two different techniques in two different occasions، one month apart. In the first technique the middle of tibia and middle of fibula were used as reference points and in the second method the perpendicular axis to the line connecting the distal fibular notches on CT scans was used. The values were analyzed، and the intra and inter observer agreements for tibia torsions were assessed. The inter-observer agreement in tibial torsion was. 861 and. 863 in the first and second methods respectively. The intra-observer reliability in both measurements techniques were. 868. The two techniques also had excellent agreement in tibial torsion measurements. The second technique has high reliability and reproductivity in assessing tibial rotation in fibula deformity.

Fibrin glue can be used for nerve repair. This study is to evaluate the repair of severed sciatic nerve in rats done by fibrin glue، comparing with an untreated group. In an interventional case series study، 18 Sprague rats had their sciatic nerve cut in the intervertebral canal. Fourteen rats were repaired by graft-repairing of nerve using fibrin glue and single suture. Four rats were left untreated as controls. The recovery of motor function was assessed after 4 months. Lower extremity muscle atrophy and absence of motor function recovery was observed in the untreated rats. Full functional recovery in lower limbs was observed in the 12 treated rats، while 2 rats walked with limp. The cut sciatic nerve repair in rat''s spinal canal، using fibrin glue and a microsurgical suture would result in good function motor recovery of lower extremity.

Entrapment of flexor pollicis longus at the level of A1 pulley is the most common cause of snapping or painful thumb upon flexion and extension motion; the so called which is called «Trigger Thumb». The aim of this study is to assess the efficacy of sonographically-guided intra tendon sheath corticosteroid injection in the management of trigger thumb. In a prospective study 104 patients (7 males، 97 females، 112 trigger thumbs) with the mean age of 52. 11±7. 63 who had trigger thumb underwent intra flexor sheath corticosteroid injection under the guide of ultrasound in a 2 year period in Rasht-Iran. Improvement was measured using the «Quinnell» grading system before and in intervals after 3 and 6 weeks; 3، 6 and 12 months after injection. From the 112 thumbs، 15 (13. 4%) required reinjection and/or surgery. Twelve (80%) of these 15 thumbs were simply re-injected، 2 (13. 3%) underwent surgery without re-injection but because of no improvement، underwent surgery. Reduction in Quinnell grade after the first injection was significant (p<. 0001). One year after the first injection، 111 of 112 thumbs (99. 1%) were symptom-free. Sonographically guided intra flexor sheath corticosteroid injectionis an effective method in the management of trigger thumb and would reduce the need for surgical release.

''Suprascapular nerve block'' is a well known technique for treating chronic shoulder pain. Ultrasonography-guided nerve block is a new technique hoping to decrease the complications of inadvertent injection of drug into the vessels or nerve sheet by increasing the accuracy and efficacy of the injections. In a trial clinical study، 50 Patients suffering from chronic shoulder pain were divided randomly into two groups. In the first group، nerve block was applied under the ultrasonograpy guide; and in the second group using direct anatomic landmarks (Moore technique). Pain score was assessed using a visual analog scale (VAS) and shoulder function was evaluated by constant shoulder score (CSS) before the injection and after the block. The patients'' satisfaction rate and efficacy were also evaluated and compared between the two groups. There was no statistically significant difference between the two groups in pain or shoulder functional scores before the procedure (p≥. 05). One week after the nerve block، the first group revealed significantly improvement in pain score p=. 035). Although shoulder function improved in both groups، the difference was not significant. (p≥. 05). One month later، pain and shoulder functional scores showed better improvement in group one compared to group two (p=. 000). No complication occurred in either group. Ultrasonography-guided suprascapular nerve block has better outcome in pain score and shoulder function compared with ''blindly'' blocking the nerve.

Standing and bending radiographies are pre-operative studies performed in patients with scoliosis to determine flexibility and appropriate treatment planning. The purpose of this study is to find correlation between pre-operative supine bending radiography and final scoliosis correction after surgery to find out if pre-operative bending radiographies could predict post operative final scoliosis correction. In a cross-sectional study، 83 patients with idiopathic scoliosis were studied and grouped based on Lenke classification of idiopathic scoliosis. Scoliosis curve was measured in standing and bending radiographs by 2 spine surgeons separately and the measurements were compared with post-operative curves. The post-operative measurements were always different from pre-operative bending film values. We cannot predict final scoliosis precisely from pre-operative supine bending radiographs in patients with idiopathic scoliosis.

Primary hydatid cyst of the muscle is so rare that it would not usually be considered in the differential diagnosis of soft tissue tumor even in endemic regions. A 40 year old male presented with a swelling and increscent pain following a pressure mass in the right arm. Diagnosis is suspected according to clinical symptoms and pathognomic but rare imaging findings of hydatid disease including «water lily sign».

Tissue engineering is a science to generate biological substitutes for regeneration، preservation and better operation of damaged tissues. Main components of tissue engineering are scaffolds، cells and growth factors. Also، bioreactors seem to be one of the fundamental parts. Scaffold is a 3D structure as a framework to support cell growth and extra cellular matrix deposition. Cells penetrate to scaffolds and grow، differentiate، proliferate and migrate according to physical and chemical signals. If the environment is appropriate for cells، they deposit ECM and new tissue will be formed. Tissue engineering science is to fabricate scaffolds which are suitable for cellular homing، to create and retain appropriate environment for cell maintenance and to control all the parameters which is important to generate new tissues.