Search Results (20)

Background and Objectives: Proximal tibiofibular joint detachment (PTFJD) is a fibular untethering procedure during lateral closing-wedge high tibial osteotomy (LCWHTO) for varus knee osteoarthritis. However, the PTFJD procedure is technically demanding, and confirmation of clear joint separation is not straightforward. The aim of this study was to compare the degree of completion and safety of PTFJD versus tibial-sided osteotomy (TSO); this latter procedure is our novel technique for fibular untethering during LCWHTO. Materials and Methods: Sixteen fresh frozen cadaver knees from eight cadavers were included in the study. Among the eight pairs of knees, one knee was randomly assigned to undergo PTFJD and the other knee to undergo TSO, which separates the fibula by osteotomizing the lateral cortex of the proximal tibia at the medial side of the proximal tibiofibular joint for fibular untethering during LCWHTO. After each procedure with LCWHTO, the posterior compartment of each knee was dissected to compare the degree of procedural completion and the distance from the posterior detachment or osteotomy site to posterior neurovascular structures between PTFJD and TSO groups. The pass-through test crossing the separation site from anterior to posterior using an osteotome was also performed to evaluate the protective effect of the muscular structures of the posterior compartment. Results: In the PTFJD group, four of eight cases (50%) showed fibular head fractures rather than division of the proximal tibiofibular joint. In contrast, in all TSO cases, the lateral cortex of the proximal tibia was clearly osteotomized from the medial side of the posterior proximal tibiofibular joint. Distances from the posterior detachment or osteotomy site to the common peroneal nerve, popliteal artery, and anterior tibial artery in the PTFJD and TSO groups were 20.8 ± 3.3 mm and 22.9 ± 3.6 mm (p = 0.382), 11.0 ± 2.4 mm and 9.8 ± 2.8 mm (p = 0.382), and 14.8 ± 1.9 mm and 14.9 ± 2.5 mm (p = 0.721), respectively. In the pass-through test, an osteotome was able to pass anteriorly to posteriorly in all eight PTFJD group cases. However, the osteotome was blocked posteriorly by the popliteus muscle in the TSO group cases, indicating protection of posterior neurovascular structures during the TSO procedure. Conclusions: TSO, a novel fibular untethering procedure for LCWHTO, resulted in clear separation of the fibula from the lateral tibial cortex, and protection of posterior neurovascular structures by the popliteus muscle during the procedure. We anticipate that our novel surgical technique will provide more clear-cut and safer fibular untethering for LCWHTO. Full article

Background and Objectives: Despite its advantages, lateral close-wedge high tibial osteotomy (LCWHTO) requires proximal tibiofibular joint detachment (PTFJD) or fibular shaft osteotomy for gap closing. These fibula untethering procedures are technically demanding and not free from the risk of neurovascular injuries. Our novel fibula untethering technique, tibial-sided osteotomy (TSO) near the proximal tibiofibular joint (PTFJ), aims to reduce technical demands and the risk of injury to the peroneal nerve and popliteal neurovascular structures. The purposes of this study were to introduce the TSO technique and compare the complexity and safety of TSO with those of radiographic virtual PTFJD, which is defined based on radiographic landmarks representing the traditional PTFJD technique. Materials and Methods: Between March and December 2023, 13 patients who underwent LCWHTO with TSO for fibula untethering were enrolled. All patients underwent MRI preoperatively and CT scanning postoperatively. The location of the TSO site on the postoperative CT scans was matched to preoperative MRI to measure the shortest distance to the peroneal nerve and popliteal artery. These values were compared with estimates of the distance between the PTFJ and neurovascular structures in the radiographic virtual PTFJD group. The protective effect of the popliteus muscle was evaluated by extending the osteotomy direction toward the posterior compartment of the knee. Results: The TSO procedure was straightforward and reproducible without producing incomplete gap closure during LCWHTO. On axial images, the distances between the surgical plane and the peroneal nerve or popliteal artery were significantly longer in the TSO group than in the radiographic virtual PTFJD group (both p = 0.001). On coronal and axial MRI, the popliteus muscle covered the posterior osteotomy plane in all patients undergoing TSO but did not cover the PTFJD plane in the radiographic virtual PTFJD group. Conclusions: Our novel TSO technique for fibula untethering during LCWHTO is reproducible and reduces the risk of neurovascular injury by placing the separation site more medially than in the PTFJD procedure. Full article

Background: Hamstring muscle injuries are common in basketball and result in long periods of inactivity. To reduce their incidence, preventive protocols, including proprioceptive neuromuscular facilitation (PNF) stretches, have been proposed. The aim of this study is to compare the short-term effects of PNF and PNF + neuromuscular electrical stimulation (NMES) on hamstring extensibility and, secondarily, on vertical jump capacity in young basketball players. Materials and Methods: The study was a randomized controlled trial. One group performed a PNF stretching protocol and the other PNF + NMES. Hamstring extensibility was measured using the Sit and Reach test and the popliteal angle and jump capacity were measured using the Counter Movement Jump, both before and immediately after the intervention. Results: Forty-five young male players participated. Both groups showed significant intra-group improvements (p < 0.001) in hamstring flexibility after the intervention. However, there were no significant intra-group differences (p > 0.05) in jump capacity. Additionally, no significant differences (p > 0.05) were observed between the two groups for any of the measured variables. Conclusions: Both programs are effective in increasing hamstring flexibility in the short term without impairing vertical jump capacity in young basketball players. Full article

Background/Objectives: Hamstring shortening is a significant musculoskeletal condition affecting the posture and mobility of the spine and lower extremities. This study examined the impact of incorporating neurodynamic slump stretch and suboccipital muscle inhibition into passive static stretching on hamstring flexibility in individuals with short hamstrings. Methods: 117 female participants were classified into three groups: the control group, which received passive static stretch of the hamstring muscle; the neurodynamic slump group, which received neurodynamic slump stretch with passive static stretch; and the suboccipital muscle inhibition group, which received suboccipital muscle inhibition with passive static stretch, for three sessions a week, 10 min each, for four weeks. The outcome measures were the popliteal angle test (PAT), straight leg raising (SLR) test, and forward bending test (FBT) at baseline, immediately following the first session and after four weeks. Results: Statistically significant differences were found within groups (p < 0.001) for all outcome measures. Between the groups, there was a more significant improvement in the PAT and the SLR tests, favoring the neurodynamic slump and suboccipital muscle inhibition groups in comparison with the passive static stretch group (p < 0.001) with no significant difference between the two groups after the first session and at four weeks of treatment. However, the FBT showed no significant differences immediately following the first session or at four weeks of treatment (p > 0.05). Conclusions: This study found that incorporating neurodynamic slump stretch and suboccipital muscle inhibition into passive static stretch techniques effectively treats short hamstrings in healthy individuals. Full article

Objective: The purpose of this cadaveric investigation was to provide a detailed morphologic description of the proximal gastrocnemius within the popliteal region of the knee and test the hypothesis that the gastrocnemius is anatomically positioned to function as an antagonist to the anterior cruciate ligament (ACL) of the knee. Methods: Twenty-two lower limbs from 11 embalmed cadavers underwent detailed dissection and anatomical analysis. Results: The results indicate that 63.3 ± 5.8% of the popliteal region is comprised of the hamstrings and the gastrocnemius, whereas 36.8 ± 5.7% is occupied by free space (fossa). Within the popliteal region, the gastrocnemius had a length crossing above the knee joint line of 5.4 ± 1.2 cm, which would likely result in a posterior pull on the femur during muscular contraction. Data provide an in-depth description of length and width morphology of the gastrocnemius and provide a detailed comparison between the medial and lateral heads of the muscle. Our results agree with earlier reports in the literature which suggest that the medial head is significantly longer and wider than the lateral head of the gastrocnemius. The medial head length was 23 ± 3.4 cm, compared to a lateral head length of 20.5 ± 2.9 cm. The medial head maximum width was 5.5 ± 1.6 cm, compared to a lateral head maximum width of 4.2 ± 1.1 cm. Conclusion: This research expands on past descriptions of the femoral origin of the gastrocnemius muscle’s medial head and confirms past descriptions of the lateral head origin on the femur. Our data clearly illustrate that the femoral attachment of the medial head of the gastrocnemius was much different (or more complex) than previously described and that it wraps around the posterior side of the medial femoral condyle and attaches more anteriorly. Further research should be directed at exploring the functional significance (if any) of these differences and examining the effect they may have on ACL function and knee joint kinematics. Full article

We aimed to investigate the effect of stretching exercises applied to the hamstring, one of the posterior muscle chains, on musculoskeletal flexibility, chest mobility, and respiratory function. Proprioceptive neuromuscular facilitation and static stretching exercises were applied to 30 healthcare personnel caring for children with developmental delays using a crossover randomized study design. Posterior muscle chain mobility was assessed using the popliteal angle test (PAT) for the hamstring muscle, the mobility of the lumbar muscles was assessed using the Schober test (ST), and the mobility of the posterior chain muscles as a whole was assessed using the finger-to-floor distance test. Chest mobility was measured using chest circumference measurements and lung volumes were measured using the pulmonary function test (PFT). The results showed that stretching exercises applied to the hamstrings led to significant improvements in PAT, ST, and chest mobility in the direction of maximal expiration (p < 0.05), without being superior to each other. Ten males (33.3%) and twenty females (66.7%) who met the inclusion criteria were analyzed. The mean age of the participants was 26.6 ± 5.9 years, the mean height was 169.53 ± 8.67 cm, the mean weight was 65.26 ± 12.03 kg, and the mean body mass index was 22.58 ± 3 kg/m². Chest inspiratory mechanics also showed a low positive correlation with posterior muscle mobility (r = 0.381; p = 0.038). There was no significant change in PAT. Within the framework of the myofascial theory, stretching exercises that can contribute positively to the musculoskeletal and respiratory system structures of healthcare professionals can be recommended and encouraged to healthcare professionals. Full article

Background: One of the main challenges of orthopedic surgery is adequate pain management after total knee arthroplasty. This work aimed to determine the anatomical safety area for infiltration through the posterior capsule of the knee in prosthetic surgery using Magnetic Resonance Imaging (MRI). Methods: A descriptive, observational, cross-sectional study was performed on 126 knee MRIs. The variables studied were age, sex, and distance between different neurovascular structures of the popliteal fossa (tibial nerve, common peroneal nerve, and vascular bundle). Data were analyzed for normality (Kolmogorov–Smirnov) and variance homogeneity (Levène). A value of p < 0.05 and a confidence interval of 9% were considered statistically significant for all comparisons. Student’s t-test was used to compare the means between independent samples. Results: We observed statistically significant differences between the sexes regarding EP–EPS (external plateau–external popliteal sciatic nerve (common peroneal)), EP–IPS (external plateau–internal popliteal sciatic nerve (tibial)), and IP–PA (internal plateau–popliteal artery) measurements. The average distance between both nerves, EPS–IPS (external popliteal sciatic nerve and internal popliteal sciatic nerve), was 25.96 mm in females, while the value obtained in males was 29.93 mm, but this difference was not statistically significant. Conclusions: The average distance from the posterior capsule to the EPS and IPS nerves is greater in males than in females, despite no statistical differences. The presence of a lateralized arteriovenous bundle reduces the infiltration area of the external compartment. Regarding the safety area, infiltration of the internal compartment is safe since the volume diffuses into the muscle mass of the internal gastrocnemius upon injection. To infiltrate the external compartment, the needle must move at least 2 cm from the midline toward the external side (to exceed the maximum displacement of the neurovascular bundle established at 1.82 cm), and not advance beyond 0.76 cm (minimum distance at which we located the common peroneal nerve in the external compartment). Full article

Popliteal artery aneurysm (PAA) is the most frequent peripheral aneurysm, primarily seen in male smokers with a prevalence below 1%. This exploratory study aims to shed light on cellular mechanisms involved in PAA progression. Sixteen human PAA and eight non-aneurysmatic popliteal artery samples, partially from the same patients, were analyzed by immunohistochemistry, fluorescence imaging, Affymetrix mRNA expression profiling, qPCR and OLink proteomics, and compared to atherosclerotic (n = 6) and abdominal aortic aneurysm (AAA) tissue (n = 19). Additionally, primary cell culture of PAA-derived vascular smooth muscle cells (VSMC) was established for modulation and growth analysis. Compared to non-aneurysmatic popliteal arteries, VSMCs lose the contractile phenotype and the cell proliferation rate increases significantly in PAA. Array analysis identified APOE higher expressed in PAA samples, co-localizing with VSMCs. APOE stimulation of primary human PAA VSMCs significantly reduced cell proliferation. Accordingly, contractile VSMC markers were significantly upregulated. A single case of osseous mechanically induced PAA with a non-diseased VSMC profile emphasizes these findings. Carefully concluded, PAA pathogenesis shows similar features to AAA, yet the mechanisms involved might differ. APOE is specifically higher expressed in PAA tissue and could be involved in VSMC phenotype rescue. Full article

There is a broad scope of literature investigating whole-body vibration (WBV) effects on blood flow (BF). However, it is unclear how therapeutic localized vibrations alter BF. Low-frequency massage guns are advertised to enhance muscle recovery, which may be through BF changes; however, studies using these devices are lacking. Thus, the purpose of this study was to determine if popliteal artery BF increases from localized vibration to the calf. Twenty-six healthy, recreationally active university students (fourteen males, twelve females, mean age 22.3 years) participated. Each subject received eight therapeutic conditions randomized on different days with ultrasound blood flow measurements. The eight conditions combined either control, 30 Hz, 38 Hz, or 47 Hz for a duration of 5 or 10 min. BF measurements of mean blood velocity, arterial diameter, volume flow, and heart rate were measured. Using a cell means mixed model, we found that both control conditions resulted in decreased BF and that both 38 Hz and 47 Hz resulted in significant increases in volume flow and mean blood velocity, which remained elevated longer than the BF induced by 30 Hz. This study demonstrates localized vibrations at 38 Hz and 47 Hz significantly increase BF without affecting the heart rate and may support muscle recovery. Full article

Background: The sciatic nerve (SN) is the widest nerve of the human body that exits the pelvis through the greater sciatic foramen, usually below the piriformis muscle (PM), and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The aim of this paper is to examine and identify the SN variations in relation to the PM, its prevalence, pattern, and course. Methods: A prospective-descriptive cross-sectional study was carried out to determine the frequency of anatomical variations in the exit of the SN in relation with the PM in 20 anatomical bodies (corpses) of both genders, in equal numbers. Results: The dissection of 40 SNs in corpses of both sexes in equal numbers showed that the SN exited inferior to the PM in 37 lower limbs (92.5%); between the fascicles of the PM and inferior to the PM in two lower limbs (5%); and in one thigh, between the fascicles of the PM and superior to the PM (2.5%). Our study reported that the SN divides in its terminal branches more commonly in the proximal part of the popliteal fossa in 55% of cases, in the gluteal region in 35% of cases, and in the middle third of the thigh in 10% of cases. Conclusions: Anatomical variations of the SN in relation to the PM are challenging for the diagnostic and therapeutic procedure in many clinical and surgical cases. Rapid recognition of the SN changes makes surgical approaches more accurate and effective. Our study confirmed that the SN exits the pelvis most commonly below the PM, although some anatomical variations may occur. Full article

Dry needling is a widely used technique for the treatment of painful syndromes in the musculature, however, its usefulness is of greater relevance in deep structures, such as the popliteus muscle, as it is more difficult to access. This muscle is heavily involved in knee pathology, being a source of pain and functional impairment, especially secondary to underlying pathologies. The method selected for the observation and study of the soft tissues, by means of imaging tests that do not use ionising radiation, is ultrasound. A cross-sectional observational study is proposed. It will be carried out in a healthy population, during the years 2021 and 2022, observing, by ultrasound, the results of the popliteal puncture technique, recorded by Mayoral del Moral et al. A popliteus muscle needle reach of 92% was achieved with this technique, in 48 of 50 patients. The results of the present cross-sectional observational study in living subjects, support that the popliteal puncture, described by Mayoral et al. is a reliable and safe approach, when performed with a 0.30 × 50 mm needle, and no adverse reactions or punctures of the vascular-nerve structures have been reported during the interventions. Full article

This study directly compared blood flow and oxygenation during six treatment parameters used with vertical and side alternating whole body vibration (WBV). Twenty-seven healthy adults were randomized into the vertical or side-alternating (vibration type) WBV group. Participants completed three WBV sessions a week apart, 5 sets of 1 min on/off, at 3 conditions (Vertical: 30 Hz and 4 mm, 40 Hz and 2 mm, 45 Hz and 4 mm; Side-alternating: 10 Hz and 4 mm, 18 Hz and 3 mm and 26 Hz and 2 mm). Blood flow velocity and popliteal artery diameter, muscle oxygenation, skin temperature, heart rate and blood pressure were assessed. Muscle oxygenation was significantly increased for all vibration frequencies and types following two minutes of WBV (14.78%, p = 0.02) and continued until immediately after the cessation of WBV (24.7%, p < 0.001). WBV also increased heart rate (23.9%, p < 0.001) and systolic blood pressure (8.9%, p < 0.001) regardless of frequency and vibration type. Side-alternating and vertical WBV increased muscle oxygenation and heart rate in healthy participants completing an isometric squat. Muscle oxygenation was not increased until the second vibration set indicating the amount of time spent on the platform may have a significant effect on increases in blood flow. Full article

As the spread of canine leishmaniasis (CanL) is increasing throughout the world, the need for effective agents to prevent its transmission has intensified. In this case report, an intact 1.5-year-old male French bulldog was presented for treatment of severe, sudden, and constant lameness on his right hindlimb, which had started approximately four months previously and was unresponsive to routine nonsteroidal anti-inflammatory drugs. A Neem oil-based product was sprayed three times a week on the dog’s coat for about fourteen months as the only prophylactic measure against CanL. The orthopedic examination revealed grade 3–4 lameness and marked atrophy of the thigh muscles with swollen and painful right stifle joint. The radiological investigation showed polyostotic periosteal proliferation at both hindlimbs. The diagnosis of CanL was established by examination of fine-needle aspiration of lymph nodes (left prescapular, right and left popliteal) and immunofluorescence antibody testing. A leishmanicidal therapeutic protocol was prescribed. Within ten days of starting the therapy, the dog was significantly less lame, and eight months later radiographic examination revealed complete regression of the bone lesions. Some owners resort to a naturalistic approach for CanL prevention, also using products that have not been clinically evaluated. Neem oil is thought to prevent sandfly bites in dogs. Some laboratory and field studies have identified Neem oil as a possible alternative herbal drug that is repellent to sandflies. However, the clinical, laboratory, and radiographic findings clearly show that the Neem oil spray formulation used in this case report was not an effective means of CanL prevention. There is no clinical evidence in support of Neem oil-based products for the protection of dogs against CanL transmission. As Neem oil has previously been shown to be somewhat volatile, this case report suggests that even though it is a very effective repellent against sandflies, in practice, its effect on the dogs’ coat was only short-lived. Full article

Primary soft-tissue lymphoma (PSTL) is a rare extranodal non-Hodgkin lymphoma, characterized by a mass growing within soft-tissue, which is connective tissue, adipose tissue, and skeletal muscle. Here, we describe a case of biphenotypic lymphoblastic lymphoma arising from soft tissue of the popliteal fossa in an 11-year-old boy. A pediatric review about PSTL revealed that anaplastic large cell lymphoma is the most common histological type and a biphenotypic lymphoblastic lymphoma has not yet been reported in childhood. Lymphoma should always be considered in patients presenting with a soft-tissue mass, and a comprehensive immunohistochemical evaluation, including B-cell, T-cell, and myeloid markers, is needed to make a correct diagnosis and establish the most suitable treatment. Full article

The popliteal tendon and muscle are major stabilizers of the human and dog knee, more specifically the postero-lateral corner. Injury to this complex causes posterior knee pain, and it is generally associated with other injured structures such as the lateral collateral ligament, lateral meniscus, and/or the cranial cruciate ligament. The popliteal complex is poorly reported in the horse, and its specific function has not been determined. Nevertheless, it is likely that it is similar to that of other species, and that injury to it could have similar clinical repercussions. Lameness due to stifle pathology is a serious clinical entity in sport horses. One of the cardinal diagnostic tools in lameness exams is ultrasonography; however, a comprehensive technique to examine the popliteal complex (tendon and muscle) in the horse has not been reported. The objective of the study was to develop a systematic ultrasound technique of the equine popliteal complex that allows identification of the insertion and variations of the popliteal tendon (PopT), as well as examination of the popliteal muscle (PopM). Comparison between anatomical variants among horses was studied in order to identify possible significant differences. For this, 10 university teaching horses were used, hence 20 stifles were examined, several times. With the ultrasound technique presented here, the PopT and PopM are consistently examined. The developed technique allows reliable examination of the popliteal complex in the horse, and it could be included during standard ultrasound examination of equine stifle. Full article