BackgroundThe Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orthosis (TLSO), devised in 1976 by Dr. Lorenzo Aulisa (Institute of Orthopedics at the Catholic University of the Sacred Heart, Rome, Italy). The PASB was designed to overcome the limits imposed by the trunk anatomy. Indeed, the particular geometry of the brace is able to generate internal forces that modify the elastic reaction of the spine. The PASB is indicated for the conservative treatment of lumbar and thoraco-lumbar scoliosis. The aim of this article is to explain the biomechanic principles of the PASB and the rationale underlying its design. Recently published studies reporting the results of PASB-based treatment of adolescent scoliotic patients are also discussed.Description and principlesOn the coronal plane, the upper margin of the PASB, at the side of the curve concavity, prevents the homolateral bending of the scoliotic curve. The opposite upper margin ends just beneath the apical vertebra. The principle underlying such configuration is that the deflection of the inferior tract of a curved elastic structure, fixed at the bottom end, causes straightening of its upper tract. Therefore, whenever the patient bends towards the convexity of the scoliotic curve, the spine is deflected. On the sagittal plane, the inferior margins of the PASB reach the pelvitrochanteric region, in order to stabilize the brace on the pelvis. The transverse section of the brace above the pelvic grip consists of asymmetrical ellipses. This allows the spine to rotate towards the concave side only, leading to the continuous generation of derotating moments. On the sagittal plane, the brace is contoured so as to reduce the lumbar lordosis. The PASB, by allowing only those movements counteracting the progression of the curve, is able to produce corrective forces that are not dissipated. Therefore, the brace is based on the principle that a constrained spine dynamics can achieve the correction of a curve by inverting the abnormal load distribution during skeletal growth.ResultsSince its introduction in 1976, several studies have been published supporting the validity of the biomechanical principles to which the brace is inspired. In this article, we present the outcome of a case series comprising 110 patients with lumbar and thoraco-lumbar curves treated with PASB brace. Antero-posterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-year minimum follow-up from t4 (t5). The average CM value was 29.3°Cobb at t1 and 13.0°Cobb at t5. TA was 15.8° Perdroille at t1 and 5.0° Perdriolle at t5. These results support the efficacy of the PASB in the management of scoliotic patients with lumbar and thoraco-lumbar curves.ConclusionThe results obtained in patients treated with the PASB confirm the validity of our original biomechanical approach...
The study assessed the spontaneous repair of large critical full-thickness defects (FTD) in not mature and still growing sheep model and compared repaired tissue after Pridie's technique to the same technique combined with type I collagen matrix. Thirty-six FTD were divided into group 1 (untreated), group 2 (treated according to Pridie's technique with 10.2 as value ratio of marrow stimulation), and group 3 (treated using Pridie's marrow stimulation technique, and covered by a type I collagen matrix). The histological exam at 12 months showed fibrous repair of the untreated defects. In group 2 the reparative tissue showed a prevalence of fibrocartilaginous tissue. The mean ICRS visual assessment scale score was 8.9. In group 3 the reparative tissue was similar to the normal surrounding cartilage. The mean ICRS visual assessment scale score was 14.7. Subchondral drilling with defined ratio between the stimulated marrow area and the lesion area could improve the quality of FTD repair in articular cartilage in not mature and still growing stifle sheep model if combined with type I collagen matrix.
BackgroundConservative treatment in the Scheuermann’s kyphosis obtain, during skeletal growth, remodelling of the deformed vertebras. In a previous paper on Scheuermann’s kyphosis, we have studied the geometry variations of all vertebrae included in the curve, before and after the treatment.The purpose of this study was to confirm the effectiveness of conservative treatment in Scheuermann’s kyphosis and was to evaluate and compare the variation of the vertebral geometry with the curve trend in Cobb degrees, before and after conservative treatment.MethodsFrom a consecutive series of patients, we selected 90 patients with thoracic Scheuermann’s kyphosis, treated using anti-gravity brace: 59 male, 31 female. The mean age at the beginning of the treatment was 14 years.Radiographical measurements were performed on radiographs from a lateral projection, at the beginning (t1) and at the end of the treatment (t5). Vertebral geometry modifications at t1 and t5 were analysed according to the following parameters and evaluated by three independent observers: Anterior wedging angle (ALFA) of the apex vertebra and Posterior wall inclination (APOS) of the limiting lower vertebra. The curve was measured in Cobb degrees.ResultsThe results from our study showed that of the 90 patients with a thoracic curve mean value of Cobb degrees was 57.8 ± 6.0 SD at t1 and 41.3 ± 5.6 SD at t5. The differences between t1(angle at baseline) and t5 (end of treatment) were calculated for Cobb, ALFA and APOS angle and were respectively −16.4 ± 4.5, −6.4 ± 1.4 and −2.7 ± 1.2; tested with paired t-test were significative (p < 0.01). The results of the regression analysis to test the relationship between the three measures for the kyphosis (Cobb degree, ALFA and APOS) showed that the best association was between Cobb t5 and ALFA t5 (p < 0.01) and Cobb t1 and APOS t1 (p < 0.01). No significative association was found between the difference between ALFA and APOS.ConclusionWe sustain that using new parameters to study vertebral remodelling allows us to reach a better comprehension of Scheuermann spine response to anti-gravity brace treatment. Furthermore, the evaluation of the ALFA angle of the apex vertebra confirms to be more reliable than Cobb’s angle because it cannot be affected by the radiological position.
Follow-up evaluation of surgical treatment for LS showed a mild impairment of physical aspects of HRQoL, as measured by patient-oriented evaluation. Clinical examination findings showed significant improvement. Conversely, neurophysiologic follow-up showed a discordant outcome. We think that, to better assess the surgical indication, further study should be performed focused on natural history and the association between neurophysiologic evolution and patient outcome, etc.
The authors report a case of acute knee injury in a 14-year-old teenager. The X-ray showed a so-called Segond's fracture: a small avulsed bone fragment, elliptical in shape, lying immediately below the external tibial plateau, a few millimeters from the lateral tibial cortex. The fracture site was in the portion of the tibial condyle which is linked to the middle third of the lateral capsule by meniscal tibial fibers. Clinical examination under anesthesia and subsequent arthroscopy revealed a total intrasubstance ACL (anterior cruciate ligament) tear close to the proximal insertion. The authors confirm Segond's report of a possible association of this avulsion fracture with ACL injuries, even in adolescence.
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