Reconstruction of the extremely atrophied mandible with iliac crest onlay grafts followed by two endosteal implants: a retrospective study with long-term follow-up

Treatment outcomes of implant-retained lower dentures on two endosseous implants placed in severely atrophied mandibles after reconstruction with iliac crest onlay grafts were assessed in a retrospective observational study. All consecutive patients treated between 2000 and 2007 were recalled in 2012 (n = 40). Survival of the implants, the condition of hard and soft peri-implant tissues, and patient satisfaction were scored. One implant was lost after 5.5 years. The mean mandibular symphysis height was 8.9 ± 2.2, 16.4 ± 2.7, 15.7 ± 2.7, and 15.4 ± 2.5 mm at intake, after augmentation, after implantation, and at the last recall visit, respectively. Mean radiographic peri-implant bone loss was 0.6 ± 0.7 mm. Mean clinical index scores were very low. Patient satisfaction was high. Surgical complications related to the donor site were seroma (n = 1), haematoma (n = 2), and sensory disturbance of the lateral femoral cutaneous nerve (n = 1); all had resolved before placement of the implants. Eleven patients reported postsurgical sensory disturbances of the mental nerve, of whom five still experienced some sensory disturbance at the last recall visit. Augmentation of the extremely resorbed mandible with an iliac crest onlay graft followed by placement of two implants 4 months later provides a solid basis for a bar-retained overdenture with favourable clinical and radiographic results.     

Musculotendinous architecture of pathological supraspinatus: A pilot in vivo ultrasonography study

Architectural changes associated with tendon tears of the supraspinatus muscle (SP) have not been thoroughly investigated in vivo with the muscle in relaxed and contracted states. The purpose of this study was to quantify the geometric properties within the distinct regions of SP in subjects with full‐thickness tendon tears using an ultrasound protocol previously developed in our laboratory, and to compare findings with age/gender matched normal controls. Twelve SP from eight participants (6 male/2 female), mean age 57 ± 6.0 years, were investigated. Muscle geometric properties of the anterior region (middle and deep parts) and posterior region (deep part) were measured using image analysis software. Along with whole muscle thickness, fiber bundle length (FBL) and pennation angle (PA) were computed for architecturally distinct regions and/or parts. Pathologic SP was categorized according to the extent of the tear in the tendon (with or without retraction). In the anterior region, mean FBL of the pathologic SP was similar with normal controls; however, mean PA was significantly smaller in pathologic SP with retraction compared with normal controls, in the contracted state (P < 0.05). Mean FBL in the posterior region in both relaxed and contracted states was significantly shorter in the pathologic SP with retraction compared with normal controls (P < 0.05). Findings suggest FBL changes associated with tendon pathology vary between the distinct regions, and PA changes are related to whether there is retraction of the tendon. The ultrasound protocol may provide important information on architectural changes that may assist in decision making and surgical planning. Clin. Anat., 2013. © 2012 Wiley Periodicals, Inc.     

Approach and treatment of the adult acquired flatfoot deformity

Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.     

The Physiologic Basis of Surgery

Four methods of allograft tendon-to-muscle anastomosis were tested in single cycle distraction to failure using 10 anastomosed ovine calcaneal tendon-biceps brachii units. The tendon-muscle units were compared to intact ovine biceps brachii muscle units. Methods of tendon-to-muscle anastomosis were derived from modifications of existing muscle tendon repair and tenorrhaphy techniques. Load to failure (N), stiffness (N/cm), distraction (cm), and modes of failure were recorded. Of the four methods tested, the side-to-side technique demonstrated the highest load to failure (152.1 N), the greatest stiffness (17.6 N/cm), the least distraction (2.99 cm) before failure, and the least amount of muscle tissue trauma at failure. Results indicate that, of the methods tested, the side-to-side technique offers the greatest initial stability and should therefore allow adequate revascularization and healing of the anastomosis site.