The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o'clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.
In humans, the gallbladder normally lies, at least partially, within the gallbladder fossa, a depression located on the visceral surface of the liver, between the right anatomical lobe of the liver and the quadrate liver lobe. During routine cadaveric dissections, we noted that livers from cadavers without gallbladders appeared to have less distinct gallbladder fossae than did livers where gallbladders were present. The purpose of the present study was to test the hypothesis that the volume of the gallbladder fossa is greater in livers when a gallbladder is present than in livers without gallbladders. To test this hypothesis, livers with their associated gallbladder were removed from cadavers and the visceral surface of each sample was observed to determine whether or not a gallbladder was present. After photographing all livers and removing gallbladders, if present, the volume of the irregularly‐shaped gallbladder fossa was determined from a mold of the fossa. To make this mold, an insulating foam sealant (Dow, Midland, MI, USA) was instilled into the area of the fossa. After foam expansion was complete, the material was trimmed flush with the surrounding liver parenchyma. This mold then was removed from the fossa and allowed to air‐dry. The volume of the gallbladder fossa was calculated by dividing the weight of the mold by the density of the foam material. Additionally, the dimensions of each fossa were estimated using an electronic digital caliper (VWR, Radnor, PA, USA) to measure the largest distance for the depth, length, and width of each mold. Statistical analyses were performed using R. Comparison of group means utilized Welch’s t‐test and the Pearson product‐moment correlation coefficient was used for correlation analyses. Livers were obtained from 34 cadavers (19 females, 15 males) with a mean age of 84.1 ± 10.8 yrs (range of 60–105 yrs). There were 8 cadavers without gallbladders (6 females, 2 males, mean age of 83.9 ± 6.6 yrs), and 26 cadavers with gallbladders (13 females, 13 males, mean age of 84.2 ± 11.9 yrs). The mean volume of gallbladder fossae from livers with gallbladders (31.01 ± 17.82 ml) was significantly greater than fossae in livers without gallbladders (8.75 ± 4.72 ml) (p=2.3 e‐06). All three measurements taken of the fossae molds (depth, length, and width) were significantly larger in the “with gallbladder livers” (p<0.05), with the largest percent difference being between the depth of the fossae – mean depth of the fossae mold from livers with a gallbladder was 20.69 ± 6.17 mm versus fossae without gallbladders having a mean depth of 7.60 ± 2.57 mm (p=1.77e‐09). When comparing the volume of fossae to the depth, length, and width of the molds, the correlation was strongest between the volume and the depth of the fossae (r=0.838, p=6.1e‐10). In conclusion, the mean volume of the gallbladder fossa was significantly greater for livers in which a gallbladder was present than in livers lacking gallbladders, with the greatest relative change in the fossae dimensions, after gallbladder remova...
Background: To investigate differences in the tibial tubercle-trochlear groove (TT-TG) and patellar tendon-posterior cruciate ligament (PT-PCL) distances in symptomatic patients with non-contact internal knee derangements (IKD) and symptomatic patients with internally intact knees (control). Methods: A retrospective review of MRI studies was completed by comparing 78 patients with meniscal and ligamentous derangements of the knee to 63 internally intact knees (age range, 13 to 50 years). MRI findings were reviewed independently by two board-certified radiologists to assess for agreement. TT-TG and PT-PCL distances were measured on proton density-weighted axial images by two independent observers blinded to the MRI and arthroscopic findings. Independent t tests were used to determine differences in TT-TG distance between the internal derangement and control groups. Chi-square tests were used to compare categorical variables for distributional equality between study groups. Results: The mean TT-TG distance averaged across the two raters in the IKD group was 11.5 mm (95% confidence interval [CI], 10.6-12.4), compared to 8.3 mm (95% CI, 7.6-9.0) in the control group (p < 0.001). The mean PT-PCL distance similarly averaged across both raters was 20.6 mm (95% CI, 19.7-21.5) for the IKD group compared to 18.2 mm (95% CI, 17.2-19.2) for the control group (p < 0.001). Among the IKD group, there were 51 meniscal tears, 12 cruciate ligament tears, and 15 tears with a combination of meniscal and cruciate findings. IKD was significantly correlated with greater TT-TG distance (p < 0.001) and greater PT-PCL distance (p < 0.003) when compared with control. Conclusions: Increased TT-TG distances and PT-PCL distances are associated with both cartilaginous and ligamentous internal knee injuries in the present study, with TT-TG distances greater than the 12 mm representing a new threshold for concern.
The primary objectives of this research were to pilot the use of a new pain and mobility outcome measure, the Pain and Mobility Index (PMI), and to assess its convergent validity with the Short Physical Performance Battery (SPPB). Twenty-eight subjects were divided into nonhospitalized and hospitalized groups. The number of subjects needed for future research using the PMI to assess for rehospitalization risk is at least 124. Discharge SPPB and PMI scores showed a good correlation, and there was a significant difference in bed mobility scores and SPPB scores between the nonhospitalized and hospitalized groups.
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