Lüder C. Busch

Comparable Biomechanical Results for a Modified Single-Row Rotator Cuff Reconstruction Using Triple-Loaded Suture Anchors Versus a Suture-Bridging Double-Row Repair

PURPOSE To compare the biomechanical properties and footprint coverage of a single-row (SR) repair using a modified suture configuration versus a double-row (DR) suture-bridge repair in small to medium and medium to large rotator cuff tears. METHODS We created 25- and 35-mm artificial defects in the rotator cuff of 24 human cadaveric shoulders. The reconstructions were performed as either an SR repair with triple-loaded suture anchors (2 to 3 anchors) and a modified suture configuration or a modified suture-bridge DR repair (4 to 6 anchors). Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100, 180, and 250 N. Cyclic displacement and load to failure were determined. Furthermore, footprint widths were quantified. RESULTS In the 25-mm rupture, ultimate load to failure was 533 ± 107 N for the SR repair and 681 ± 250 N for the DR technique (P ≥ .21). In the 35-mm tear, ultimate load to failure was 792 ± 122 N for the SR reconstruction and 891 ± 174 N for the DR reconstruction (P ≥ .28). There were no statistically significant differences for both tested rupture sizes. Cyclic displacement showed no significant differences between the tested configurations at 60 N (P = .563), 100 N (P = .171), 180 N (P = .211), and 250 N (P = .478) for the 25-mm tear. For the 35-mm tear, cyclic displacement showed significantly lower gap formation for the SR reconstruction at 180 N (P = .037) and 250 N (P = .020). No significant differences were found at 60 N (P = .296) and 100 N (P = .077). A significantly greater footprint width (P = .028) was seen for the DR repair (16.2 mm) compared with the SR repair (13.8 mm). However, both reconstructions were able to achieve complete footprint coverage compared with the initial footprint. CONCLUSIONS The tested SR repair using a modified suture configuration was similar in load to failure and cyclic displacement to the DR suture-bridge technique independent of the tested initial sizes of the rupture. The tested DR repair consistently restored a larger footprint than the SR method. However, both constructs achieved complete footprint coverage. CLINICAL RELEVANCE SR repairs with modified suture configurations might combine the biomechanical advantages and increased footprint coverage that are described for DR repairs without increasing the overall costs of the reconstruction.

Influence of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament on External and Internal Tibiofemoral Rotation

Background The influence of the anteromedial and posterolateral bundles of the anterior cruciate ligament on tibiofemoral rotation might be of great value to detect anterior cruciate ligament injuries and investigate the postoperative restoration of rotational stability. Hypothesis The anterior cruciate ligament and especially the posterolateral bundle will have a significant influence on isolated tibiofemoral rotation. Study Design Controlled laboratory study. Methods Tibiofemoral rotation was measured in 20 human cadaveric knees using a noninvasive external measurement device (Rotameter) and a knee navigation system. The measurements of the knees with the intact anterior cruciate ligament were compared with the measurements after isolated resection of the posterolateral bundle and after a complete resection of the anterior cruciate ligament at an applied torque of 5,10, and 15 N·m. Statistical analysis was made using analysis of variance and the post hoc Scheffé test. The Pearson coefficient was used to compare both measurement techniques. Results In comparison with knees with an intact anterior cruciate ligament, the knees after isolated resection of the posterolateral bundle showed significant increase of tibiofemoral rotation at almost all applied torques (P < .05). Total resection of the anterior cruciate ligament also produced significant increases compared with the intact anterior cruciate ligament at torques of 5, 10, and 15 N·m as measured by the Rotameter (P < .05). Total resection of the anterior cruciate ligament yielded increases in rotation compared with posterolateral bundle resection alone, but these differences were not significant. The results of the knee navigation system confirmed the measured results of the Rotameter. Comparison of the 2 measurement methods revealed a high correlation at all applied torques, with Pearson correlation coefficients ranging from .85 to .95. Conclusion The anterior cruciate ligament and especially the posterolateral bundle of the anterior cruciate ligament have a significant effect on isolated tibiofemoral rotation. Therefore, the developed noninvasive device might be of great importance to investigate the status and the postoperative reconstruction of the anterior cruciate ligament in the clinical setting. Clinical Relevance Noninvasive measurement of tibiofemoral rotation might be useful to detect anterior cruciate ligament tears and to evaluate the restoration of rotational stability after anterior cruciate ligament surgery.

Anatomy of the superior glenohumeral ligament.

BACKGROUND The aim of the present study was to give a detailed, anatomical description of the superior glenohumeral ligament and its relationship with the neighbouring structures in the rotator interval. METHOD Twenty-seven cadaveric shoulder specimens were dissected in fine detail to describe superior glenohumeral ligament and additional histologic examination was performed. RESULTS The superior glenohumeral ligament is a constant, gross anatomic structure that was present in all of twenty-seven investigated specimens. The fibers of the superior glenohumeral ligament could be divided into two groups - the oblique and direct fibers. The direct fibers of the superior glenohumeral ligament arise from the glenoid labrum, run parallel with the tendon of the long head of the biceps brachii towards the lesser tubercle, which they also partly insert onto. The rest of the direct fibers course into the bottom of the bicipital groove and bridge over it, forming the superior part of the transverse humeral ligament. The oblique fibers arise from the supraglenoid tubercle, run over the intraarticular part of the tendon of the long head of the biceps brachii and insert below the coracohumeral ligament into the humeral semicircular ligament. CONCLUSION Due to its anatomic composition and tight connection with the neighboring articular structures, the superior glenohumeral ligament is involved in the stabilizing mechanisms of the intraarticular part of the tendon of the long head of the biceps brachii and plays an important role in the variety of clinical disorders that occur within the rotator interval.

Magnetic resonance imaging and correlative gross anatomy of the ligamentum semicirculare humeri (rotator cable).

The purpose of this study has been to demonstrate macroscopic and MRI anatomy of the so‐called rotator cable, otherwise known as the ligamentum semicirculare humeri (LSCH) of the superior shoulder joint capsule. Twelve shoulder joints from eight cadavers were dissected; seven of which, from four of the cadavers, were studied using MR arthrography (1.5‐Tesla device Somatom Symphony®, Siemens, Erlangen, Germany) prior to dissection. The MRI protocol included T1WI, PDWI, and DESS 3D WI standard sequences. The results of MRI were compared with gross anatomic dissection findings. The macroscopically recognizable capsular bundle of LSCH fibers was identified by anatomic dissection in all specimens. On MRI, the entire ligament or parts of it could be identified in six of seven cases. It was best visualized on axial images. In the evaluation of magnetic resonance images of superior shoulder joint structures, additional knowledge on the anatomy of the LSCH can be used by the radiologist to facilitate detailed interpretation of the shoulder MRI. Clin. Anat. 21:420–426, 2008.

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band—the spiral GHL—was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images.

Three-Dimensional Evaluation of Cyclic Displacement in Single-Row and Double-Row Rotator Cuff Reconstructions Under Static External Rotation

Background: The double-row suture bridge repair was recently introduced and has demonstrated superior biomechanical results and higher yield load compared with the traditional double-row technique. It therefore seemed reasonable to compare this second generation of double-row constructs to the modified single-row double mattress reconstruction. Hypothesis: The repair technique, initial tear size, and tendon subregion will have a significant effect on 3-dimensional (3D) cyclic displacement under additional static external rotation of a modified single-row compared with a double-row rotator cuff repair. Study Design: Controlled laboratory study. Methods: Rotator cuff tears (small to medium: 25 mm; medium to large: 35 mm) were created in 24 human cadaveric shoulders. Rotator cuff repairs were performed as modified single-row or double-row repairs, and cyclic loading (10-60 N, 10-100 N) was applied under 20° of external rotation. Radiostereometric analysis was used to calculate cyclic displacement in the anteroposterior (x), craniocaudal (y), and mediolateral (z) planes with a focus on the repair constructs and the initial tear size. Moreover, differences in cyclic displacement of the anterior compared with the posterior tendon subregions were calculated. Results: Significantly lower cyclic displacement was seen in small to medium tears for the single-row compared with double-row repair at 60 and 100 N in the x plane (P = .001) and y plane (P = .001). The results were similar in medium to large tears at 100 N in the x plane (P = .004). Comparison of 25-mm versus 35-mm tears did not show any statistically significant differences for the single-row repairs. In the double-row repairs, lower gap formation was found for the 35-mm tears (P ≤ .05). Comparison of the anterior versus posterior tendon subregions revealed a trend toward higher anterior gap formation, although this was statistically not significant. Conclusion: The tested single-row reconstruction achieved superior results in 3D cyclic displacement to the tested double-row repair. Extension of the initial rupture size did not have a negative effect on the biomechanical results of the tested constructs. Clinical Relevance: Single-row repairs with modified suture configurations provide comparable biomechanical strength to double-row repairs. Furthermore, as increased gap formation in the early postoperative period might lead to failure of the construct, a strong anterior fixation and restricted external rotation protocol might be considered in rotator cuff repairs to avoid this problem.

Germ cell migration and early development of the gonads in the trisomy 16 mouse — an animal model for Down's syndrome

The aneuploid condition of patients with Downs syndrome (trisomy 21) frequently leads to a sub- or infertility of these individuals. Gonads from adults and fetuses with trisomy 21 demonstrated histologically a remarkable reduction in germ cells. Disorders in the germ cell migration, the early development of the gonads as well as meiotic defects are thought to contribute to this pathomorphology. To gain information about premeiotic defects, investigations on the trisomy 16 mouse, an animal model for Downs syndrome, were carried out. By means of morphometric studies a delay in migration and a reduction in primordial germ cells was evaluated in trisomic mice of embryonic day 11 (E11). At day E13 a generalized growth retardation of the developing gonads was obvious in trisomic animals. Additionally performed electron microscopic examinations revealed signs of germ cell demise in trisomy 16 mice. Thus, the mechanisms of a diminished proliferation capacity, impaired migration and premature death of germ cells represent premeiotic disorders that presumably contribute to the pathomorphology observed in the gonads of individuals with Downs syndrome.

The Spiral Glenohumeral Ligament: An Open and Arthroscopic Anatomy Study

PURPOSE The purpose of this study was to visualize arthroscopically and to describe the micro- and macroscopic anatomy of the poorly known ligament of the anterior capsule of the glenohumeral joint: the so-called ligamentum glenohumerale spirale (spiral GHL). METHODS Twenty-two fresh shoulder joints were dissected, and the anatomy of the anterior capsular structures (the spiral GHL, the middle glenohumeral ligament [MGHL], and the anterior band as well as the axillary part of the inferior glenohumeral ligament [AIGHL and AxIGHL, respectively]) was investigated. For arthroscopic visualization, 30 prospective arthroscopic clinical cases and 19 retrospective video clips of the patients who had an arthroscopic shoulder procedure with a normal subscapularis tendon, labrum, and anterior joint capsule were evaluated. RESULTS The spiral GHL and the AxIGHL were present in all 22 shoulder specimens. The AIGHL was not recognizable on the extra-articular side of the joint capsule. The MGHL was absent in 3 shoulder specimens (13.6%). Arthroscopically, the spiral GHL was found in 22 (44.9%), the MGHL in 43 (87.8%), and the AIGHL in 46 (93.9%) of the cases. The spiral GHL arose from the infraglenoid tubercle and the triceps tendon and inserted together with subscapularis tendon onto the lesser tubercle of the humerus. CONCLUSIONS Our results suggest that extra-articular structure of the spiral GHL is consistently recognizable, the upper part of which can be arthroscopically identified. CLINICAL RELEVANCE Advanced anatomic knowledge of the spiral GHL helps the clinician better understand the normal anatomy of the shoulder joint and also helps to differentiate it from pathologic findings of the patient. The biomechanical importance of the spiral GHL and its connection with shoulder pathology remains to be determined in further studies.

The embryonic development of sensory organs and the skull in the trisomy 16 mouse, an animal model for Down's syndrome

The trisomy 16 mouse is a widely accepted animal model for the study of the embryonic development of human trisomy 21. While the development of the brain and heart has been thoroughly studied, there are hardly any data on the development of sensory organs like the eye, nose and ear. By studying scanning electron microscopic pictures and semithin sections from the tenth to the 15th day of development, we found delayed development of the nose, and, in particular, of the vomer. Sensory structures of the otic vesicle also showed a marked developmental delay. Pigmentation of the outer layer of the otic cup starts later in trisomic animals. Cleared specimens on day 16 showed retarded development of ossification centres in all areas of the skull. These findings correspond with the abnormal facial morphology found in Downs syndrome and may also provide new insights into the hearing impairment commonly found. The observations in the eye and skull bones indicate that neural crest tissue maldevelopment is not the sole cause of malformations.

Regeneration of the uterine epithelium in later stages of pseudopregnancy in the rabbit

SummaryMorphological changes of the uterine epithelium in later stages of pseudopregnancy in the rabbit have been studied using different morphological methods.The highly proliferated mucosa with numerous symplasms of a pseudopregnant animal returns to the morphology of a nonpregnant animal by apoptosis, moderate necrosis and lytic transformation of symplasms back to typical endometrial cells without desquamation of cells.The first signs of lytic transformation are observed on Day 8 of pseudopregnancy. Enhanced regeneration with apoptosis and lysis of the symplasmic nuclei is observed between Day 14 and Day 16. Full restoration of the epithelium with reppearance of ciliated cells, typical columnar and partly mucified epithelial cells is not completed earlier than Day 24 p. hCG. This epithelium, however, differs clearly from the epithelium of a virgin rabbit due to several residues of epithelial transformation. Thus, from a morphological point of view, pseudopregnancy in the rabbit lasts up to or even longer than Day 28 p. hCG with persisting ultrastructural remnants of the preceeding cycle.