These findings suggest that CTS in diabetic patients does not only stem from external anatomic factors, but is also dependent on internal factors such as metabolic and vascular causes and that its treatment should include the correction of these factors.

No abstract

The outcomes of 18 patients (11 females, 7 males; age, 40.4+/-11 years) at 2 years after ACL reconstruction with cryopreserved tibialis anterior allografts using a double bundle technique are presented. Most subjects (72%) described themselves as being moderately active before surgery. After providing written informed consent, subjects completed the 2000 IKDC Knee Form, underwent arthrometric knee measurements, and performed one-leg hop and isokinetic quadriceps and hamstring torque tests (60 degrees /s). Ninety-four percent (17/18) of the subjects had normal or near-normal grades for manual knee ligament tests. Knee arthrometry measurements revealed a mean 1.1-mm involved side increase at 134 N (8.9+/-2 mm vs 7.8+/-3 mm) and a 2-mm involved side increase during manual maximum testing (11.3+/-2 mm vs 9.3+/-3 mm). Group means revealed active knee flexion (136+/-8 degrees vs 139+/-6 degrees ) and knee hyper-extension (3+/-2 degrees vs 5+/-2 degrees ), which were slightly reduced at the involved knee. One-leg hop testing revealed a 15% mean deficit at the involved side (0.81+/-0.3 m vs 0.95+/-0.3 m). Isokinetic testing revealed an 11% mean deficit at the involved side (143.4+/-60 Nm vs 161.8+/-54 Nm) for the quadriceps and 7% greater strength at the involved side (105.9+/-35 Nm vs 98.8+/-35 Nm) for the hamstrings. Side-to-side comparisons revealed that many patients displayed less than normal quadriceps femoris torque (72%, 13/18), hamstring torque (28%, 5/18) and hop test (28%, 5/18) performance. Moderate positive correlations existed between involved side quadriceps ( r=0.80) and hamstring ( r=0.83) torque/bodyweight and hop test performance. Scores were 77.6+/-21 (range 28.7-100) and 78.1+/-16 (range 41.7-100) for the 2000 IKDC Subjective Knee Evaluation and Health Assessment forms. Most subjects (83%, 15/18) rated their current function at >or=91% of pre-injury levels and all subjects continued to participate at their pre-injury perceived activity level. At 2 years after ACL reconstruction with tibialis anterior allografts, this subject group displayed satisfactory functional outcomes. Tibialis anterior allograft use provides an effective ACL reconstruction alternative, particularly for older individuals who want to continue recreational sports.

This in vitro biomechanical study with cyclic loading compared the pullout strength of vertical, horizontal, and oblique sutures used for meniscal lesion repair. Following repair of vertical longitudinal lesions created in bovine medial menisci, three groups of seven specimens (vertical, horizontal, and oblique sutures) underwent cyclic loading in a randomized test order (5 mm/min, cycling between 5 and 50 N at 1 Hz for 100 cycles) prior to load to failure testing (5 mm/min). Displacement did not differ between groups during cyclic or load to failure testing. Construct stiffness during cyclic testing was superior for the oblique suture (6.9 +/- 1.5 N/mm, P = 0.007) and the vertical suture (6.4 +/- 7 N/mm, P = 0.03) groups compared to the horizontal suture group (4.4 +/- 0.52 N/mm). The oblique suture (171.9 +/- 25.9 N, P < 0.0001) and the vertical suture (145.9 +/- 32.3 N, P = 0.001) groups displayed superior load at failure compared to the horizontal suture group (88.8 +/- 8.2 N). Construct stiffness during load to failure testing did not differ between groups. Suture rupture was the failure mode for all specimens of the oblique suture group. Suture rupture was the failure mode for 57% (4/7) of the vertical suture group with the remaining specimens (3/7, 43%) failing from intact suture pullout through meniscal tissue. All horizontal suture group specimens failed by intact suture pulling through meniscal tissue. With comparable stiffness during cyclic testing, comparable load at failure as vertical sutures, and less evidence of intact suture pullout through the meniscus, an oblique suture technique may combine the beneficial characteristics of vertical (superior biomechanical strength) and horizontal (ease of application, longer sutures with a tendency to cover a larger meniscal tissue area) suture-repair techniques.

A conflict exists on whether the ligamentum capitis femoris has the neuro-morphological structures required for nociception or proprioception of the hip joint. Therefore, we investigated the morphological features and the presence of mechanoreceptors in 24 ligamentum capitis femoris biopsies obtained at open reduction in patients with developmental dysplasia of the hip. Of these 24 hips, 16 were completely dislocated and eight were subluxated. The mean age was 33.8 months (range 13-52 months) at the time of surgery. En bloc ligamentum capitis femoris and pulvinar were taken for biopsy specimen. Ligamentum capitis femoris was dissected and the weight of each ligament was determined using a highly sensitive balance. Specimens were stained with hematoxylin and eosin and Masson trichrome for routine histolopathological evaluation and examined immunohistochemically using monoclonal antibody against S-100 protein. All specimens were graded on a four-grade system according to the amount of coarse-thick collagen bundles and hyalinization. The mean number and type of mechanoreceptors of each specimen were recorded. When the mean age, the patient's weight and the ligamentum capitis femoris weight of each group (completely dislocated vs. subluxated) were compared, there were no significant differences. In the ligamentum capitis femoris of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the subluxated hips, distributed and of varied thickness. The elastic fibers of the dislocated hips were thicker and more numerous than those in the subluxated hips. We found a significant difference between the two groups with regard to the grade of collagen and hyalinization of ligamentum capitis femoris (P<0.004). We found type IVa, free nerve endings in 16 of 24 samples of ligamentum capitis femoris. The 66.6% presence of free nerve endings in the ligamentum capitis femoris suggests a role in nociception/proprioception of the hip in developmental dysplasia of the hip. Interestingly, the percentage and the mean numbers of free nerve endings containing ligamentum capitis femoris were similar in completely dislocated hip group and the subluxated group (62.5 vs. 75%, 12.13+/-9.07 vs. 9.37+/-9.24, respectively). We conclude that the morphological features of ligamentum capitis femoris are influenced by the severity of developmental dysplasia of the hip, whereas the distribution of free nerve endings are not influenced.