The patellar ligament: A comprehensive review

The patellar ligament (PL) is an epiphyseal ligament and is part of the extensor complex of the knee. The ligament has gained attention due to its clinical relevance to autograft and tendinopathy. A variety of anatomical variations of the PL such as aplasia, numerical variations, and vascularity are being reported recently by clinicians and anatomists. The aim of this literature was to review the available literature to provide a consensus regarding anatomic variations of the PL, neurovasculature surrounding the PL, histology of the PL, and various aspects of PL measurements with relevance to the surgical considerations and sex and age-related differences. A narrative review of the patellar ligament was performed by conducting a detailed literature search and review of relevant articles. A total of 90 articles on the patellar ligament were included and were categorized into studies based on anatomical variations, neurovasculature, morphometrics, microanatomy, sex and age-related difference, and ACL reconstruction. The anatomical variations and morphometrics of the PL were found to correlate with the frequency of strain injuries, tendinopathy, and efficacy of the PL autograft in anterior cruciate ligament reconstruction. The sex differences in PL measurements and the effect of estrogen on collagen synthesis explained a higher incidence of patellar tendinopathy in women. An awareness of its variations enables careful selection of surgical incisions, thereby avoiding complications related to nerve injury. Accurate knowledge of the PL microanatomy assists in understanding the mechanism of ligament degeneration, rupture, autograft harvesting, and ligamentization results.     

Evaluation of filling materials in membrane‐protected bone defects. A comparative histomorphometric study in the mandible of miniature pigs.

In recent years, bone grafts and bone substitutes have been increasingly utilized underneath barrier membranes to optimize the treatment outcome of bone reconstructive therapy for defects in the alveolar process. In the present study, 4 different filling materials were evaluated in bone defects of similar dimensions in the mandible of miniature pigs. Blood clots and autografts were used as controls. The defects were covered with barrier membranes and allowed to heal for 4, 12 or 24 weeks. Histologic examination demonstrated that bone repair progressed through a programmed sequence of maturation steps closely resembling the pattern of bone development and growth regardless of whether bone grafts or substitutes were present or not. Histomorphometric analysis showed that autologous bone grafts (autografts) had the best osteoconductive properties during the initial healing period, with 39% of newly formed bone inside the membrane-covered defects at 4 weeks of healing. In addition, 87% of the graft surfaces were already covered by bone at this time. Both values were significantly higher for autografts than for the 4 alternative bone fillers (P < or = 0.05). At 12 weeks, these differences were no longer apparent, with all 5 filling materials showing similar values. Among the tested bone substitutes, tricalcium phosphate (TCP) showed a significantly higher percentage of bone fill at 24 weeks of healing. It can be concluded that sites filled with autografts clearly demonstrated the best results underneath barrier membranes in the early phase of healing. As far as degradation and substitution are concerned, TCP showed the most promising results. This filler, however, needs to be tested further in a more demanding animal model. Less favorable results were obtained for coral-derived hydroxyapatite granules and for demineralized freeze-dried bone allografts.     

Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.     

自体骨移植在腰椎后路椎间融合中的临床疗效分析

目的探讨腰椎后路手术中应用自体椎板、棘突骨颗粒为植骨材料行椎间融合治疗特殊的腰椎间盘突出症、腰椎管狭窄症及腰椎滑脱症等腰椎退变性疾病的临床效果。方法特殊腰椎间盘突出症、腰椎管狭窄症及腰椎滑脱症并行后路腰椎融合术(PLIF和TLIF)患者184例,按椎间融合材料分为3组,A组61例,单纯自体骨组;B组64例,PEEK椎间融合器组;C组59例,异体骨垫组。平均随访18个月(12~60个月)。统计3组患者术前一般资料、手术时间、术中出血量、术后下床时间、住院天数、术后融合率以及术后椎间高度及融合节段角度的变化情况,按JOA评分标准评价功能恢复情况。结果 3组患者术前一般资料、术中出血量、手术时间、术后下床时间、住院时间、JOA评分、术后1年椎间隙高度及融合节段角度比较,差异均无统计学意义(P0.05);3组患者术后3个月.JOA评分较术前均显著提高(P0.05)。A组术后1年的融合效果高于C组(P0.05);B组术后融合器移位的并发症发生率较高。结论在后路椎间融合中纯自体棘突、椎板骨移植能起到和PEEK融合器和异体骨融合器一样的维持椎间隙高度的作用,不延长术后卧床时间,且具有经济效益。     

L’ingénierie cutanée pour le traitement des brûlures graves

Severe burned patients need definitive and efficient wound coverage. Outcome of massive burns has been improved by using cultured epithelial autografts (CEA). Despite fragility, percentages of success take, cost of treatment and long-term tendency to contracture, this surgical technique has been developed in few burn centres. First improvements were to combine CEA and dermis-like substitute. Cultured skin substitutes provide earlier skin closure and satisfying functional result. These methods have been used successfully in massive burns. Second improvement was to allow skin regeneration by using epidermal stem cells. Stem cells have capacity to differentiate into keratinocytes, to promote wound repair and to regenerate skin appendages. Human mesenchymal stem cells contribute to wound healing and were evaluated in cutaneous radiation syndrome. Skin regeneration and tissue engineering methods remain a complex challenge and offer the possibility of new treatment for injured and burned patients.     

Double papilla repositioned flap for the treatment of isolated recession – A case report

Root coverage is achieved by many procedures like free gingival autografts, connective tissue grafts and pedicle grafts. Several studies state that root coverage using connective tissue grafts have high success rates but have disadvantages like creation of second surgical site and post-operative color harmony is less. Although Cohen and Ross reported more than 85% success in covering denuded roots, the degree of success varies among other clinicians. The double papilla pedicle graft has limited usefulness. The double papillae pedicle graft is most appropriate in those cases where esthetics demand a close tissue color match and where the papillae are large and have shallow gingival grooves.     

Initial experience with cultured epithelial autografts in massively burnt patients

Background: Prognosis in patients with severe burns is improved by early debridement and coverage with skin. The limiting factor in these patients is the lack of unburnt skin for harvesting. Cultured epithelial autograft (CEA) sheets provide an alternative means of covering debrided skin. This is a report on an initial experience with using CEA sheets. Methods: The two patients in this study had their medical records examined retrospectively. Results: The effective take of the CEA sheets was zero in both patients. One of the patients died approximately 6 weeks after admission. Conclusions: Because of the poor graft take seen in the patients in the present study, the use of CEA sheets only as a form of temporary biological dressing is recommended.     

新鲜羊膜联合自体角膜缘移植术治疗眼表疾病的疗效观察

【目的】观察新鲜羊膜联合自体角膜缘移植术治疗眼表疾病的疗效。【方法】对33例(39只眼)不同类型眼表疾病患行新鲜羊膜联合自体角膜缘移植，随访3～18m。【结果】术后移植片全部存活，角膜上皮愈合。术后视力均有不同程度提高。随访期问，眼表稳定，无新生血管形成及复发等。【结论】新鲜羊膜移植联合自体角膜缘移植术能有效治疗眼表疾病。