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Azzopardi C, Almeer G, Kho J, Beale D, James S, Botchu R. Hamstring origin-anatomy, angle of origin and its possible clinical implications. J Clin Orthop Trauma 2020; 13:50-52. [PMID: 33717874 PMCID: PMC7920124 DOI: 10.1016/j.jcot.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The posterior compartment of the thigh is composed of three major muscles collectively known as the hamstring muscles. These consist of the biceps femoris short and long head, semimembranosus and semitendinosus. Excluding the short head of biceps femoris, the hamstrings contribute to the movement of the hip and the knee joints as they span across both joints. Our hypothesis is that the nature of the conjoint tendon -ischial angle predisposes to an increased risk of tearing in this hamstring component. We therefore aim to look at the anatomy of the hamstring origin at the ischial tuberosity and spatial relationship between the long head of biceps, semitendinosus and semimembranosus in the form of vector angles. MATERIAL AND METHODS 100 consecutive pelvic MRIs in patients under the age of 40 years were reviewed by musculoskeletal radiology fellow and a consultant musculoskeletal radiologist with more than 10 years' experience in musculoskeletal radiology and measured the angle of origin of conjoined tendon and semimembranosus at its ischial origin. P value using a paired t-test was less than 0.0001 confirming that the difference in the vector angle of the different hamstring components was statistically significant. RESULTS The median angle of origin of conjoined tendon was 12° and for semimembranosus was 6°. Applying the concept of Newton's second law to the angles calculated we demonstrated that an increase of 9% force applied to the conjoint tendon origin when compared to the semimembranosus tendon. CONCLUSION We hypothesis that the difference in the angle of origin of the components of hamstrings might be one of the reasons for the difference in the incidence and patterns of the injuries of the various muscles of the hamstrings.
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Affiliation(s)
- C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - G. Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - D. Beale
- Department of Radiology, Heath Lodge Clinic, Knowle, UK
| | - S.L. James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
- Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Abstract
INTRODUCTION There has been considerable interest in the direct anterior (DA) approach to total hip arthroplasty (THA) recently. To facilitate exposure of the proximal femur it is sometimes necessary to release the conjoint tendon. AIM To prospectively investigate whether release of the conjoint tendon has an impact on gait in the early postoperative period. METHODS We measured gait velocity, stride length, single-limb support and single-limb support symmetry preoperatively, at discharge from the hospital, and 2, 6 and 12 weeks and postoperatively. Participants also completed the Timed Up and Go and a series of questionnaires (WOMAC, SF-12, Harris Hip Score, and pain VAS) at each visit. RESULTS 36 participants undergoing a DA THA with a single surgeon were enrolled in this study. 22 participants had a release of the conjoint tendon during their surgery. We found no differences between the groups for any gait, patient-reported or surgical outcomes (p < 0.05). There was a total of 3 complications reported in the release group, and 1 complication in the group that did not have a release. CONCLUSION Although the conjoint tendon has an important role in the biomechanics of the hip, we found release of the conjoint tendon during the DA approach for THA to have no impact on gait or patient reported outcomes within 12 weeks post-surgery. Therefore, if the exposure of the proximal femur is limited, a low threshold for release of the conjoint tendon is recommended to improve visualisation.
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Affiliation(s)
- Bryn O Zomar
- London Health Sciences Centre, London, ON, Canada.,Western University, London, ON, Canada
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Pastor MF, Ferle M, Hagenah J, Ellwein A, Wellmann M, Smith T. The stabilization effect of the conjoint tendon in reverse total shoulder arthroplasty. Clin Biomech (Bristol, Avon) 2019; 63:179-184. [PMID: 30904752 DOI: 10.1016/j.clinbiomech.2019.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous factors determine stability of reverse total shoulder arthroplasty. The effect of the conjoint tendon in relation to stability remains unknown. In this biomechanical study, we evaluated the influence of the conjoint tendon on the anterior stability of reverse total shoulder arthroplasty with a hemispherical glenosphere and a glenosphere with 9 mm lateralisation. METHODS A reverse total shoulder arthroplasty was implanted in 6 human cadaveric shoulders. The anterior stability was evaluated using a shoulder simulator. Two conditions, intact and dissected conjoint tendon, and 2 component configurations, a hemispherical glenosphere and a glenosphere with 9 mm lateralisation, were tested in each specimen. Testing of anterior stability was performed in 30° and 60° of abduction, with 0° and 30° of external rotation in the glenohumeral joint. FINDINGS The conjoint tendon showed a significant influence on the anterior stability with a hemispherical glenosphere in 30° and 60° with neutral rotation (p = 0.028) as well as 30° abduction with 30° (p = 0.028) external rotation. The 9 mm lateralised glenosphere stabilized significantly reverse total shoulder arthroplasty with resected conjoint tendon compared to the hemispherical glenosphere with resected conjoint tendon (p = 0.028). INTERPRETATION In a biomechanical setting the conjoint tendon has a stabilizing influence on the anterior stability of the reverse total shoulder arthroplasty with a hemispherical glenosphere in an abducted arm position, but this stabilizing effect was not seen with the lateralised glenosphere. The single influence of the lateralisation of the glenosphere on anterior stability was shown in cases of resected conjoint tendon.
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Affiliation(s)
- M-F Pastor
- Department of Orthopaedic Surgery, Medical School Hannover, Hannover, Germany
| | - M Ferle
- Laboratory of Biomechanics and Biomaterials, Medical School Hannover, Germany
| | - J Hagenah
- Medical School Hannover, Hannover, Germany
| | - A Ellwein
- Department of Orthopaedic Surgery, Medical School Hannover, Hannover, Germany
| | - M Wellmann
- Department of Orthopaedic Surgery, Medical School Hannover, Hannover, Germany
| | - T Smith
- Department of Orthopaedic Surgery, Medical School Hannover, Hannover, Germany.
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Zhao G, Zhu R, Jiang S, Xu C, Xu N, Wang Y. Soft tissue restrictors of femoral elevation in direct anterior approach-an anatomic study. J Orthop Surg Res 2018; 13:308. [PMID: 30514330 PMCID: PMC6280390 DOI: 10.1186/s13018-018-1012-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background With the patient in a constant supine position, elevation of the femur in THA (DAA) provides a more intuitive and conducive location of the acetabulum for the correct placement of the acetabular prosthesis, but elevation of the femur for broaching becomes more challenging. The purpose of this study is to analyze the restriction of the ischiofemoral ligament and short external rotation muscles, and its effect on the elevation of the proximal femur in the DAA. Methods The study subjects comprised 5 freshly frozen cadavers with 10 normal hips. All of the anatomic dissections of all of the hips were performed through the DAA. The ischiofemoral ligament, piriformis, conjoint tendon, and external obturator were successively resected. All of the proximal femurs of the specimens were levered by a point tip curved retractor that was connected with a dynamometer. Through preliminary measurements, an applied force of 80 N was adopted and maintained on the curved retractor. The experiment was repeated to measure the displacement of the proximal femur being raised after the posterior structures of the hip joint had been resected in a stepwise fashion. The displacement of the retractor was recorded, and the data were then analyzed. Results The distance significantly increased after the ischiofemoral ligament was severed (P < 0.001). A prominent increase was demonstrated after the conjoint tendons were severed (P < 0.001). The distance insignificantly increased after the piriformis was severed (P > 0.05). After the obturator externus was cut off, the distance increased by an insignificant amount (P > 0.05). Conclusion In DAA, the ischiofemoral ligament contributed stability when the femur was being raised. The main contribution of restriction was provided by the conjoint tendon. The tendons of the obturator externus muscle and piriformis muscle did not provide any significant restriction when the femur was being raised.
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Affiliation(s)
- Gongyin Zhao
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Ruixia Zhu
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Shijie Jiang
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Chao Xu
- Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 210039, People's Republic of China
| | - Nanwei Xu
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China
| | - Yuji Wang
- Department of Orthopedics, Changzhou No.2 People's Hospital, the Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou City, 213003, Jiangsu Province, People's Republic of China. .,Departments of Orthopedic Surgery and Biochemistry and Molecular Biology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Nourissat G, Delaroche C, Bouillet B, Doursounian L, Aim F. Optimization of bone-block positioning in the Bristow-Latarjet procedure: a biomechanical study. Orthop Traumatol Surg Res 2014; 100:509-13. [PMID: 25065295 DOI: 10.1016/j.otsr.2014.03.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 03/03/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the Bristow-Latarjet procedure, optimal positioning of the coracoid bone-block on the anterior aspect of the glenoid (standing or lying on the glenoid rim) remains debated. A biomechanical study assessed the effect of the position of the bone-block with its attached conjoint tendon on anterior and inferior stabilization of the humeral head. MATERIALS AND METHODS The Bristow-Latarjet procedure was performed on 8 fresh cadaveric shoulders. The bone-block size was systematically at 2.5×1×1 cm. Anterior translation of the humeral head was stress induced under 30-N traction, in maximum external rotation at 0° and at 90° abduction: respectively, adduction and external rotation (ADER), and abduction and external rotation (ABER). Under radiological control, displacement of the center of the humeral head was compared with the glenoid surface at the 3, 4 and 5 o'clock (medial, antero-inferior and inferior) positions for the 2 bone-block positionings. RESULTS The lying position at 4 o'clock substantially decreased anterior and inferior displacement of the humeral head respectively in ADER and ABER; and in ABER it also tended to decrease anterior translation, but not significantly. The standing bone-block position did not affect translation. CONCLUSIONS Positioning the bone-block so that it lies on the anterior aspect of the glenoid in the middle of the antero-inferior quarter of the rim at 4 o'clock can decrease anterior displacement of the humeral head and inferior glenohumeral translation, especially in ADER for anterior displacement and in ABER for inferior displacement. STUDY DESIGN Laboratory study.
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Affiliation(s)
- G Nourissat
- Groupe Maussins, Clinical Orthopaedy and traumatology des Maussins, 67, rue de Romainville, 75019 Paris, France.
| | - C Delaroche
- Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - B Bouillet
- Centre hospitalier universitaire de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - L Doursounian
- Service de chirurgie orthopédique, hôpital Saint-Antoine, université Pierre-et-Marie-Curie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - F Aim
- Hôpital Saint-Antoine, université Pierre-et-Marie-Curie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Alagaratnam S, Nathaniel C, Cuckow P, Duffy P, Mushtaq I, Cherian A, Desai D, Kiely E, Pierro A, Drake D, De Coppi P, Cross K, Curry J, Smeulders N. Testicular outcome following laparoscopic second stage Fowler-Stephens orchidopexy. J Pediatr Urol 2014; 10:186-92. [PMID: 24045121 DOI: 10.1016/j.jpurol.2013.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 08/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess outcome after laparoscopic second-stage Fowler-Stephens orchidopexy (L2(nd)FSO). PATIENTS AND METHODS Retrospective review of 94 children (aged 0.75-16 years, median 2.75 years), who underwent L2(nd)FSO for 113 intra-abdominal testes between January 2000 and May 2009: 75 unilateral, 19 bilateral (11 synchronous; 8 metachronous). Follow-up (range 3 months-10.9 years, median 2.1 years) was available for 88 children (102 testes: 71 unilateral, 31 bilateral). RESULTS Testicular atrophy occurred in 9 out of 102 (8.8%), including 8 out of 71 (11.3%) unilateral and 1 out of 31 (3.2%) bilateral intra-abdominal testes (multivariate analysis: p = 0.59). Testicular ascent ensued in 9 out of 102 (8.8%), comprising four (5.6%) unilateral and five (16.1%) bilateral testicles (multivariate analysis: p = 0.11). Of the 18 bilateral testes brought to the scrotum synchronously none atrophied and four (22.2%) ascended, compared to one (7.7%) atrophy and one (7.7%) ascent among the 13 testes brought to the scrotum on separate occasions (Fisher exact test: p = 0.42 and p = 0.37, respectively). Mobilization of the testis through the conjoint tendon tended towards less ascent (multivariate analysis p = 0.08) but similar atrophy (p = 0.56) compared to mobilization through the deep-ring/inguinal canal. Logistical regression analysis identified no other patient or surgical factors influencing outcome. CONCLUSIONS This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.
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Affiliation(s)
- Swethan Alagaratnam
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Calvin Nathaniel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Peter Cuckow
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Patrick Duffy
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Abraham Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Divyesh Desai
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Edward Kiely
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Agostino Pierro
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - David Drake
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Kate Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
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