The aim of this study was to determine the within-day and between-days reliability of surface electromyographic (EMG) power spectral analysis in assessing fatigability of the vastus medialis (VM) muscle during knee an...The aim of this study was to determine the within-day and between-days reliability of surface electromyographic (EMG) power spectral analysis in assessing fatigability of the vastus medialis (VM) muscle during knee and hip flexion under constant load application. The subjects were 13 healthy adult men free of knee abnormalities. Surface EMG was recorded from vastus medialis obliquus (VMO) and vastus medialis longus (VML) during sustained isometric contractions at 60% of maximal voluntary contraction until exhaustion on the leg press machine (static leg press test). Linear regression analysis was applied to median frequency (MF) time series to calculate initial MF and MF slope. For VMO and VML, the initial MF showed moderate to high reliability, while the MF slope showed high reliability (Intraclass correlation coefficient (ICC) = initial MF: 0.63 - 0.92, MF slope: 0.70 - 0.86). The results demonstrated that spectral analysis of surface EMG recording during isometric VM muscle contraction has high within-day and between-days reliability in the assessment of fatigability of the VMO and VML.展开更多
This study examined electromyographic amplitude(EMGRMS)-force relationships during repeated submaximal knee extensor muscle actions among chronic aerobically-(AT),resistance-trained(RT),and sedentary(SED)individuals.F...This study examined electromyographic amplitude(EMGRMS)-force relationships during repeated submaximal knee extensor muscle actions among chronic aerobically-(AT),resistance-trained(RT),and sedentary(SED)individuals.Fifteen adults(5/group)attempted 20 isometric trapezoidal muscle actions at 50%of maximal strength.Surface electromyography(EMG)was recorded from vastus lateralis(VL)during the muscle actions.For the first and last successfully completed contractions,linear regression models were fit to the log-transformed EMGRMS-force relationships during the linearly increasing and decreasing segments,and the b terms(slope)and a terms(antilog of y-intercept)were calculated.EMGRMS was averaged during steady force.Only the AT completed all 20 muscle actions.During the first contraction,the b terms for RT(1.3010.197)were greater than AT(0.9100.123;p?0.008)and SED(0.9120.162;p?0.008)during the linearly increasing segment,and in comparison to the linearly decreasing segment(1.0180.139;p?0.014),respectively.For the last contraction,the b terms for RT were greater than AT during the linearly increasing(RT?1.3730.353;AT?0.8830.129;p?0.018)and decreasing(RT?1.5260.328;AT?0.9700.223;p?0.010)segments.In addition,the b terms for SED increased from the linearly increasing(0.9680.144)to decreasing segment(1.2680.126;p?0.015).There were no training,segment,or contraction differences for the a terms.EMGRMS during steady force increased from the first-([64.0851.68]μV)to last-contraction([86.7349.55]μV;p?0.001)collapsed across training statuses.The b terms differentiated the rate of change for EMGRMS with increments in force among training groups,indicating greater muscle excitation to the motoneuron pool was necessary for the RT than AT during the linearly increasing and decreasing segments of a repetitive task.展开更多
Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of thi...Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008： twenty eight cases with isolated MPFL reconstruction （group Ⅰ）, forty one cases with the combination of MPFL reconstruction with vastus medialis advancement （group C）. All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months （12-65 months） without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point （P 〈0.05）. The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C （P 〉0.05）. However, the subjective questionnaire revealed a significant difference （P 〈0.05）, including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.展开更多
Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. ...Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging （MRI） and diffusion tensor imaging （DTI） to evaluate vastus medialis oblique （VMO） fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function. Methods： This prospective study involved 30 patients （7 males and 23 females; average age, 21.4 ± 3.8 years） clinically diagnosed with recurrent patellar dislocation in Peking University Third Hospital and 30 healthy volunteers matched for age, sex, and body mass index in our medical school between January 2014 and October 2014. None of the patients had a recent history of traumatic patellar dislocation or transient patellar dislocation. All patients underwent conventional MRI and DTI of the knee. The cross-sectional area of the VMO on MRI and the fractional anisotropy （FA）, apparent diffusion coefficient （ADC）, and primary （λ1）, secondary （λ2）, and three-level characteristic （λ3） values on DTI were measured. The independent-samples t-test was used to compare these parameters between the two groups. Results： Compared with the control group, the patient group showed significantly higher FA values （0.39 ± 0.05 vs. 0.33 ± 0.03） and significantly lower ADC （1.51 ± 0.13 vs. 1.58± 0.07）, λ2 （4.96 ±0.13 vs. 5.04 ± 0.07）, and λ3 values （4.44 ± 0.14 vs. 4.58 ± 0.07; t = 5.99, t = -2.58, t = 3.02, and t = -4.88, respectively： all P 〈 0.05）. Cross-sectional VMO area and λ1 values did not differ between the two groups （t = 1.82 and t = 0.22, respectively; both P 〉 0.05）. Conclusions： The functional status of the VMO is closely associated with recurrent patellar dislocation. MRI, especially DTI （FA, ADC, λ2, and ,λ3）, can detect early changes in VMO function and might lhcilitate the noninvasive monitoring of the functional status of the VMO in patients with recurrent patellar dislocation.展开更多
Background:Residual force enhancement(rFE),defined as increased isometric force following active lengthening compared to a fixed-end isometric contraction at the same muscle length and level of activation,is present a...Background:Residual force enhancement(rFE),defined as increased isometric force following active lengthening compared to a fixed-end isometric contraction at the same muscle length and level of activation,is present across all scales of muscle.While rFE is always present at the cellular level,often rFE"non-re sponders"are observed during joint-level voluntary contractions.Methods:We compared rFE between the joint level and single fiber level(vastus lateralis biopsies)in 16 young males.In vivo voluntary kneeextensor rFE was measured by comparing steady-state isometric torque between a stretch-hold(maximal activation at 150°,stretch to 70°,hold)and a fixed-end isometric contraction,with ultrasonographic recording of vastus lateralis fascicle length(FL).Fixed-end contractions were performed at 67.5°,70.0°,72.5°,and 75.0°;the joint angle that most closely matched FL of the stretch-hold contraction's isometric steady-state was used to calculate rFE.The starting and ending FLs of the stretch-hold contraction were expressed as%optimal FL,determined via torqueangle relationship.Resu lts:In single fiber experiments,the starting and ending fiber lengths were matched relative to optimal length determined from in vivo testing,yielding an average sarcomere excursion of~2.2-3.4μm.There was a greater magnitude of rFE at the single fiber(~20%)than joint level(~5%)(p=0.004),with"non-re sponders"only observed at the joint level.Conclusion:By comparing rFE across scales within the same participants,we show the development of the rFE non-responder phenomenon is upstream of rFE's cellular mechanisms,with rFE only lost rather than gained when scaling from single fibers to the joint level.展开更多
Background: Until recently it has not been possible to isolate the mechanical behavior of individual muscles during passive stretching. Muscle shear modulus(an index of muscle stiffness) measured using ultrasound shea...Background: Until recently it has not been possible to isolate the mechanical behavior of individual muscles during passive stretching. Muscle shear modulus(an index of muscle stiffness) measured using ultrasound shear wave elastography can be used to estimate changes in stiffness of an individual muscle. The aims of the present study were(1) to determine the shear modulus—knee angle relationship and the slack angle of the vastus medialis oblique(VMO), rectus femoris(RF), and vastus lateralis(VL) muscles;(2) to determine whether this differs between the muscles.Methods: Nine male rowers took part in the study. The shear modulus of VMO, RF, and VL muscles was measured while the quadriceps was passively stretched at 3°/s. The relationship between the muscle shear modulus and knee angle was plotted as shear modulus—knee angle curve through which the slack angle of each muscle was determined.Results: The shear modulus of RF was higher than that of VMO and VL when the muscles were stretched over 54°(all p < 0.01). No significant difference was found between the VMO and VL(all p > 0.05). The slack angle was similar among the muscles: 41.3°± 10.6°, 44.3°± 9.1°, and 44.3°± 5.6° of knee flexion for VMO, RF, and VL, respectively(p = 0.626).Conclusion: This is the first study to experimentally determine the muscle mechanical behavior of individual heads of the quadriceps during passive stretching. Different pattern of passive tension was observed between mono-and bi-articular muscles. Further research is needed to determine whether changes in muscle stiffness are muscle-specific in pathological conditions or after interventions such as stretching protocols.展开更多
Our previous study revealed that early application of electrical field stimulation（EFS） with the anode at the lesion and the cathode distal to the lesion reduced injury potential, inhibited secondary injury and was ...Our previous study revealed that early application of electrical field stimulation（EFS） with the anode at the lesion and the cathode distal to the lesion reduced injury potential, inhibited secondary injury and was neuroprotective in the dorsal corticospinal tract after spinal cord injury（SCI）. The objective of this study was to further evaluate the effect of EFS on protection of anterior horn motoneurons and their target musculature after SCI and its mechanism. Rats were randomized into three equal groups. The EFS group received EFS for 30 minutes immediately after injury at T_（10）. SCI group rats were only subjected to SCI and sham group rats were only subjected to laminectomy. Luxol fast blue staining demonstrated that spinal cord tissue in the injury center was better protected; cross-sectional area and perimeter of injured tissue were significantly smaller in the EFS group than in the SCI group. Immunofluorescence and transmission electron microscopy showed that the number of spinal cord anterior horn motoneurons was greater and the number of abnormal neurons reduced in the EFS group compared with the SCI group. Wet weight and cross-sectional area of vastus lateralis muscles were smaller in the SCI group to in the sham group. However, EFS improved muscle atrophy and behavioral examination showed that EFS significantly increased the angle in the inclined plane test and Tarlov＇s motor grading score. The above results confirm that early EFS can effectively impede spinal cord anterior horn motoneuron loss, promote motor function recovery and reduce muscle atrophy in rats after SCI.展开更多
Posterolateral dislocations of the knee are rare injuries.Early recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a t...Posterolateral dislocations of the knee are rare injuries.Early recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom.Examination revealed the pathognomonic anteromedial "pucker" sign.Anklebrachial indices were greater than 1.0 and symmetrical.Radiographs showed a posterolateral dislocation of the right knee.He underwent emergency open reduction without an attempt at closed reduction.Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis.Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h.Instead,open reduction should be performed once vascular compromise is excluded.展开更多
Prostate cancer is the second most prevalent cancer in men.Robot-assisted radical prostatectomy(RARP)has altered the landscape of prostate cancer treatment.Despite the excellent oncological outcomes associated with RA...Prostate cancer is the second most prevalent cancer in men.Robot-assisted radical prostatectomy(RARP)has altered the landscape of prostate cancer treatment.Despite the excellent oncological outcomes associated with RARP,the rate of erectile dysfunction(ED)remains high.Primary repair of disrupted cavernous nerves with interpositional nerve grafts has been described;however,the outcomes have been inconsistent.We hypothesize that this is attributed to Schwann cell atrophy and axonal regeneration limitations caused by long nerve grafts.We proposed the use of nerve transfer to support axonal regrowth via an inter-positional graft with additional donor axons.A cadaveric study was performed to evaluate the anatomical feasibility of a vastus lateralis nerve(VLN)transfer to the distal recipient cavernous nerve stump.The VLN is long with multiple branching patterns that allow tension-free coaptation of the cavernous nerve.We postulate that a dual innervation method using VLN nerve transfer together with interpositional nerve graft repair of the transacted cavernous nerves may improve the outcomes of ED post-RARP.展开更多
文摘The aim of this study was to determine the within-day and between-days reliability of surface electromyographic (EMG) power spectral analysis in assessing fatigability of the vastus medialis (VM) muscle during knee and hip flexion under constant load application. The subjects were 13 healthy adult men free of knee abnormalities. Surface EMG was recorded from vastus medialis obliquus (VMO) and vastus medialis longus (VML) during sustained isometric contractions at 60% of maximal voluntary contraction until exhaustion on the leg press machine (static leg press test). Linear regression analysis was applied to median frequency (MF) time series to calculate initial MF and MF slope. For VMO and VML, the initial MF showed moderate to high reliability, while the MF slope showed high reliability (Intraclass correlation coefficient (ICC) = initial MF: 0.63 - 0.92, MF slope: 0.70 - 0.86). The results demonstrated that spectral analysis of surface EMG recording during isometric VM muscle contraction has high within-day and between-days reliability in the assessment of fatigability of the VMO and VML.
基金granted by the Ethics Committee of University of Kansas(10-30-2012/HSCL#20495).
文摘This study examined electromyographic amplitude(EMGRMS)-force relationships during repeated submaximal knee extensor muscle actions among chronic aerobically-(AT),resistance-trained(RT),and sedentary(SED)individuals.Fifteen adults(5/group)attempted 20 isometric trapezoidal muscle actions at 50%of maximal strength.Surface electromyography(EMG)was recorded from vastus lateralis(VL)during the muscle actions.For the first and last successfully completed contractions,linear regression models were fit to the log-transformed EMGRMS-force relationships during the linearly increasing and decreasing segments,and the b terms(slope)and a terms(antilog of y-intercept)were calculated.EMGRMS was averaged during steady force.Only the AT completed all 20 muscle actions.During the first contraction,the b terms for RT(1.3010.197)were greater than AT(0.9100.123;p?0.008)and SED(0.9120.162;p?0.008)during the linearly increasing segment,and in comparison to the linearly decreasing segment(1.0180.139;p?0.014),respectively.For the last contraction,the b terms for RT were greater than AT during the linearly increasing(RT?1.3730.353;AT?0.8830.129;p?0.018)and decreasing(RT?1.5260.328;AT?0.9700.223;p?0.010)segments.In addition,the b terms for SED increased from the linearly increasing(0.9680.144)to decreasing segment(1.2680.126;p?0.015).There were no training,segment,or contraction differences for the a terms.EMGRMS during steady force increased from the first-([64.0851.68]μV)to last-contraction([86.7349.55]μV;p?0.001)collapsed across training statuses.The b terms differentiated the rate of change for EMGRMS with increments in force among training groups,indicating greater muscle excitation to the motoneuron pool was necessary for the RT than AT during the linearly increasing and decreasing segments of a repetitive task.
文摘Background The medial patellofemoral ligament （MPFL） reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.Methods We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008： twenty eight cases with isolated MPFL reconstruction （group Ⅰ）, forty one cases with the combination of MPFL reconstruction with vastus medialis advancement （group C）. All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.Results Patients were followed up for a mean of 42 months （12-65 months） without a recurrent dislocation reported.Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group Ⅰ and three in group Chad patellar lateral shift exceeding 1.5 cm with a hard end point （P 〈0.05）. The Kujala score improved significantly from 51.3±4.5 to 79.9±6.2 in group Ⅰ and from 53.7±5.2 to 83.9±6.5 in group C （P 〉0.05）. However, the subjective questionnaire revealed a significant difference （P 〈0.05）, including 12 excellent, seven good and nine fair in group Ⅰ and 30 excellent, six good and five fair in group C.Conclusion The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.
文摘Background： Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging （MRI） and diffusion tensor imaging （DTI） to evaluate vastus medialis oblique （VMO） fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function. Methods： This prospective study involved 30 patients （7 males and 23 females; average age, 21.4 ± 3.8 years） clinically diagnosed with recurrent patellar dislocation in Peking University Third Hospital and 30 healthy volunteers matched for age, sex, and body mass index in our medical school between January 2014 and October 2014. None of the patients had a recent history of traumatic patellar dislocation or transient patellar dislocation. All patients underwent conventional MRI and DTI of the knee. The cross-sectional area of the VMO on MRI and the fractional anisotropy （FA）, apparent diffusion coefficient （ADC）, and primary （λ1）, secondary （λ2）, and three-level characteristic （λ3） values on DTI were measured. The independent-samples t-test was used to compare these parameters between the two groups. Results： Compared with the control group, the patient group showed significantly higher FA values （0.39 ± 0.05 vs. 0.33 ± 0.03） and significantly lower ADC （1.51 ± 0.13 vs. 1.58± 0.07）, λ2 （4.96 ±0.13 vs. 5.04 ± 0.07）, and λ3 values （4.44 ± 0.14 vs. 4.58 ± 0.07; t = 5.99, t = -2.58, t = 3.02, and t = -4.88, respectively： all P 〈 0.05）. Cross-sectional VMO area and λ1 values did not differ between the two groups （t = 1.82 and t = 0.22, respectively; both P 〉 0.05）. Conclusions： The functional status of the VMO is closely associated with recurrent patellar dislocation. MRI, especially DTI （FA, ADC, λ2, and ,λ3）, can detect early changes in VMO function and might lhcilitate the noninvasive monitoring of the functional status of the VMO in patients with recurrent patellar dislocation.
基金supported by the Natural Sciences and Engineering Research Council of Canada(NSERC,Grant No.RGPIN-2024-03782).
文摘Background:Residual force enhancement(rFE),defined as increased isometric force following active lengthening compared to a fixed-end isometric contraction at the same muscle length and level of activation,is present across all scales of muscle.While rFE is always present at the cellular level,often rFE"non-re sponders"are observed during joint-level voluntary contractions.Methods:We compared rFE between the joint level and single fiber level(vastus lateralis biopsies)in 16 young males.In vivo voluntary kneeextensor rFE was measured by comparing steady-state isometric torque between a stretch-hold(maximal activation at 150°,stretch to 70°,hold)and a fixed-end isometric contraction,with ultrasonographic recording of vastus lateralis fascicle length(FL).Fixed-end contractions were performed at 67.5°,70.0°,72.5°,and 75.0°;the joint angle that most closely matched FL of the stretch-hold contraction's isometric steady-state was used to calculate rFE.The starting and ending FLs of the stretch-hold contraction were expressed as%optimal FL,determined via torqueangle relationship.Resu lts:In single fiber experiments,the starting and ending fiber lengths were matched relative to optimal length determined from in vivo testing,yielding an average sarcomere excursion of~2.2-3.4μm.There was a greater magnitude of rFE at the single fiber(~20%)than joint level(~5%)(p=0.004),with"non-re sponders"only observed at the joint level.Conclusion:By comparing rFE across scales within the same participants,we show the development of the rFE non-responder phenomenon is upstream of rFE's cellular mechanisms,with rFE only lost rather than gained when scaling from single fibers to the joint level.
文摘Background: Until recently it has not been possible to isolate the mechanical behavior of individual muscles during passive stretching. Muscle shear modulus(an index of muscle stiffness) measured using ultrasound shear wave elastography can be used to estimate changes in stiffness of an individual muscle. The aims of the present study were(1) to determine the shear modulus—knee angle relationship and the slack angle of the vastus medialis oblique(VMO), rectus femoris(RF), and vastus lateralis(VL) muscles;(2) to determine whether this differs between the muscles.Methods: Nine male rowers took part in the study. The shear modulus of VMO, RF, and VL muscles was measured while the quadriceps was passively stretched at 3°/s. The relationship between the muscle shear modulus and knee angle was plotted as shear modulus—knee angle curve through which the slack angle of each muscle was determined.Results: The shear modulus of RF was higher than that of VMO and VL when the muscles were stretched over 54°(all p < 0.01). No significant difference was found between the VMO and VL(all p > 0.05). The slack angle was similar among the muscles: 41.3°± 10.6°, 44.3°± 9.1°, and 44.3°± 5.6° of knee flexion for VMO, RF, and VL, respectively(p = 0.626).Conclusion: This is the first study to experimentally determine the muscle mechanical behavior of individual heads of the quadriceps during passive stretching. Different pattern of passive tension was observed between mono-and bi-articular muscles. Further research is needed to determine whether changes in muscle stiffness are muscle-specific in pathological conditions or after interventions such as stretching protocols.
基金supported by the National Natural Science Foundation of China,No.31400717,51577183the Natural Science Foundation of Beijing of China,No.7164317the Youth Innovation Promotion Association CAS,No.2018172
文摘Our previous study revealed that early application of electrical field stimulation（EFS） with the anode at the lesion and the cathode distal to the lesion reduced injury potential, inhibited secondary injury and was neuroprotective in the dorsal corticospinal tract after spinal cord injury（SCI）. The objective of this study was to further evaluate the effect of EFS on protection of anterior horn motoneurons and their target musculature after SCI and its mechanism. Rats were randomized into three equal groups. The EFS group received EFS for 30 minutes immediately after injury at T_（10）. SCI group rats were only subjected to SCI and sham group rats were only subjected to laminectomy. Luxol fast blue staining demonstrated that spinal cord tissue in the injury center was better protected; cross-sectional area and perimeter of injured tissue were significantly smaller in the EFS group than in the SCI group. Immunofluorescence and transmission electron microscopy showed that the number of spinal cord anterior horn motoneurons was greater and the number of abnormal neurons reduced in the EFS group compared with the SCI group. Wet weight and cross-sectional area of vastus lateralis muscles were smaller in the SCI group to in the sham group. However, EFS improved muscle atrophy and behavioral examination showed that EFS significantly increased the angle in the inclined plane test and Tarlov＇s motor grading score. The above results confirm that early EFS can effectively impede spinal cord anterior horn motoneuron loss, promote motor function recovery and reduce muscle atrophy in rats after SCI.
文摘Posterolateral dislocations of the knee are rare injuries.Early recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom.Examination revealed the pathognomonic anteromedial "pucker" sign.Anklebrachial indices were greater than 1.0 and symmetrical.Radiographs showed a posterolateral dislocation of the right knee.He underwent emergency open reduction without an attempt at closed reduction.Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis.Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h.Instead,open reduction should be performed once vascular compromise is excluded.
基金The funding for this project was provided by SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Program Pitch for Fund Research Support Grant 2019.
文摘Prostate cancer is the second most prevalent cancer in men.Robot-assisted radical prostatectomy(RARP)has altered the landscape of prostate cancer treatment.Despite the excellent oncological outcomes associated with RARP,the rate of erectile dysfunction(ED)remains high.Primary repair of disrupted cavernous nerves with interpositional nerve grafts has been described;however,the outcomes have been inconsistent.We hypothesize that this is attributed to Schwann cell atrophy and axonal regeneration limitations caused by long nerve grafts.We proposed the use of nerve transfer to support axonal regrowth via an inter-positional graft with additional donor axons.A cadaveric study was performed to evaluate the anatomical feasibility of a vastus lateralis nerve(VLN)transfer to the distal recipient cavernous nerve stump.The VLN is long with multiple branching patterns that allow tension-free coaptation of the cavernous nerve.We postulate that a dual innervation method using VLN nerve transfer together with interpositional nerve graft repair of the transacted cavernous nerves may improve the outcomes of ED post-RARP.
