Background: Bone marrow stem cells with their plasticity can be used to replace and repair the other damaged organs and tissues, so they can also be used to obtain bone healing of nonunions. Objective: to evaluate the results of percutaneous autologous bone marrow grafting to treat the tibia diaphyseal nonunions. Subjects and methods: 12 patients with noninfected nonunion of the tibia were diagnosed and treated in Viet Duc Hospital. About 250mL of marrow was aspirated, then separated and concentrated by density gradient centrifugation. The final mononuclear cell mass containing stem cells and progenitors was washed in 30ml of 0.9% NaCL and then injected into the damaged sites. Patients were evaluated by clinical and X-rays examinations with at least 6 months follow-up. Results: None of the patients had post - op complications. Bone union was obtained in eleven of the twelve patients (91,7%) at an average of 15,3 weeks (range, 9 - 30 weeks), the bone marrow grafts used for these patients who had bone union contained a mean of 5,65 \xb1 3,74 x 106 (0,95 - 11,73 x 106) CD34(+) stem cells in total. Conclusions: Percutaneous autologous bone - marrow grafting is a minimally invasive alternative and a simple, effective, safe method for the treatment of the tibia diaphyseal nonunions with the comparative bone healing rate. \r\n', u'\r\n', u'
Tibia/ pathology ; Bone Marrow/ anatomy & ; histology ; surgery

OBJECTIVETo provide an appropriate angle and depth of needle insertion in acupuncture at Zusanli (ST 36) and avoid injuring the nerve and blood vessel and exert the most effect.

METHODSEighty adult lower-limb samples were used to dissect and observe the relative layered structures and adjoining important nerves and blood vessels in needling Zusanli (ST 36) according to the national standard.

RESULTSThe needling depth from the skin to the interosseous membrane and from the skin to posterior border of tibialis posterior is (2.22 +/- 0.31) cm and (4.42 +/- 0.53) cm, respectively. There are flabellate branches of anterior tibial arteries and deep peroneal nerves around the needle in the superficial layer of interosseous membrane. The vessel and nerve bundles containing tibial nerve and posterior tibial vessels can be touched when the needle body past through tibialis posterior.

CONCLUSIONIt is recommended that ideal average depth of acupuncture is 2.22 cm and the maximum depth is 4.42 cm for oblique needling Zusanli (ST 36). When it is injected, the needle should be perpendicularly inserted or deviated slightly to the direction of tibia and paralleled to medial surface of tibia. And the safe needling depth is generally less than 5 cm. The point of the body surface between tibialis anterior and extensor digitorum longus at 3 cun below Dubi (ST 35) is also an effectively stimulating point.

Acupuncture Points ; Female ; Humans ; Male ; Needles ; Tibia ; anatomy & histology

OBJECTIVESTo provide the data on the shape, sizes, and locations of the attachments of the anterolateral bundle (ALB) and posteromedial bundle (PMB) of the posterior cruciate ligament (PCL) to the tibia, and to determine the reference landmarks and the methods for tibial tunnel positioning in double-bundle PCL reconstruction using double-double tunnel.

METHODSThirty cadaveric knees were used as specimens. PCLs were separated into bundles according to the PCL tension pattern during knee flexion-extension, and the functional bundle in each bundle was determined. Data were obtained to describe the size, shape, position, and center of the attachments of PCL bundles. The reference landmarks and methods for tibial tunnels positioning in double-bundle PCL reconstruction using double-double tunnel were determined.

RESULTSThe PCL insertion site was situated in the posterior intercondylar fossa. The longitudinal axis of the tibial attachment of PCL proceeded from proximal medial to distal lateral, and the mean angle between them and the tibial shaft was (16.5 +/- 1.4) degrees . The tibial insertion site of ALB and PMB were arranged in the proximal and distal on the whole, the tibial attachment of ALB could generally be described as rhomb in shape, and the mean area of it was (90 +/- 20) mm(2); the tibial attachment of PMB was rectangle in shape, the mean area of it was (96 +/- 32) mm(2), there was no statistic difference between the area of them (P > 0.05). There were functional bundles in both ALB and PMB persistently, which attached to the distal-lateral portion of the tibial attachment of ALB and the distal-medial portion of the tibial attachment of PMB respectively, they were both oval in shape, the mean area of them were (35 +/- 12) mm(2) and (36 +/- 6) mm(2) respectively, the difference between them was no statistic significant (P > 0.05). The mean distance between the centres of the tibial attachments of the functional bundles of ALB and that of PMB was (12.7 +/- 1.9) mm. The medial tibial spine, lateral tibial spine and the bony ridge on the posterior-proximal tibia were the key anatomic landmarks that could be used to aid in placement of independent tibial tunnels for a 2-bundle PCL reconstruction.

CONCLUSIONSThe tibial attachment of the PCL is sufficiently large to allow for placement of 2 independent tunnels. There are functional bundles in both ALB and PMB persistently and the optimum position for the tibial tunnel in double-bundle PCL reconstruction using double-double tunnel should be located in the attachment sites of the functional bundles of ALB and PMB.

Aged ; Female ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; anatomy & histology ; surgery ; Tibia ; anatomy & histology ; surgery

OBJECTIVESTo investigate the relationships among rotational alignment reference axes of distal femur and tibial mechanical axis, and determine the safest rotational alignment reference axis.

METHODSDigital photos were taken of 30 cadaveric lower extremities with knee in extension and flexion at 90 degrees , angles were measured among tibial mechanical axis and a line perpendicular to clinical epicondylar axis, a line perpendicular to surgical epicondylar axis, Whiteside's line and femoral mechanical axis. Statistical analysis of relationships among those axes were performed.

RESULTSThe angles among the tibial mechanical axis and a line perpendicular to the clinical epicondylar axis, a line perpendicular to the surgical epicondylar axis, Whiteside's line and femoral mechanical axis were 0.6 degrees varus, 3.9 degrees varus, 0.2 degrees valgus and 3.0 degrees varus respectively. The angle between the femoral mechanical axis and the tibial mechanical axis was significantly larger than the angles among the tibial mechanical axis and a line perpendicular to the clinical epicondylar axis, the Whiteside's line (P < 0.05). There was no significant difference compared with the angle between a line perpendicular to the surgical epicondylar axis and the tibial mechanical axis. Angles of the clinical epicondylar axis, the surgical epicondylar axis and the Whiteside's line between knee extension and flexion were 2.3 degrees valgus, 0.9 degrees varus and 3.1 degrees valgus respectively.

CONCLUSIONThe surgical epicondylar axis rather than the clinical epicondylar axis or the Whiteside's line is the safest femoral rotational alignment reference axis intraoperatively.

Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Femur ; anatomy & histology ; surgery ; Humans ; Knee Prosthesis ; Rotation ; Tibia ; anatomy & histology ; surgery

This study was performed to identify the chronological changes of the knee angle or the tibiofemoral angles in normal healthy Korean children. Full-length anteroposterior view standing radiographs of 818 limbs of 452 Korean children were analyzed. The overall patterns of the chronological changes in the knee angle were similar to those described previously in western or Asian children, but the knee angle development was delayed, i.e., genu varum before 1 yr, neutral at 1.5 yr, increasing genu valgum with maximum a value of 7.8 degrees at 4 yr, followed by a gradual decrease to approximately 5-6 degrees of genu valgum of the adult level at 7 to 8 yr of age. These normative data on chronological changes of knee angles should be taken into consideration when evaluating lower limb alignment in children.
Adolescent ; Child ; Child Development ; Child, Preschool ; Female ; Femur/anatomy & histology ; Humans ; Infant ; Knee Joint/anatomy & histology/*growth & development ; Male ; Retrospective Studies ; Tibia/anatomy & histology

This study sought to quantify normal human tibio-femoral joint kinematics in vivo. An eligible volunteer (a man in good health) was recruited, and a technical method of 3D image registration and coordinate transformation was used. The 3D point cloud models of his knee-flexion were illustrated by computed tomography. By use of the technique for 3D image registration, different models of several positions of knee-flexion were aligned to the same coordinate system. As for each model of the knee, the object coordinates of femur and tibia were built on the same location and direction in comparison with individual femur and tibia. Consequently, the error of constructing the object coordinate system in various coordinate systems can be avoided. Meanwhile, improved orthogonal coordinates systems were built on femur, tibia and patella. After orthogonal coordinates were built on each part of the knee, the Euler angle coordinate transformation was applied to acquire the data of the knee relative kinematics. Additionally, the data was proved to be effective, compared with that of recent literatures. With this method, arbitrary reference coordinates, or any alternative reference mode could be used in reconstruction of knee 3D kinematics images on a computer, and be applied in the kinematical analysis of other human joints or bones.
Femur ; anatomy & histology ; Humans ; Imaging, Three-Dimensional ; methods ; Kinetics ; Knee Joint ; anatomy & histology ; physiology ; Male ; Range of Motion, Articular ; physiology ; Tibia ; anatomy & histology ; Tomography, X-Ray Computed

INTRODUCTIONThe end of medial opening oblique wedge high tibial osteotomy (HTO) points into a narrow area between the articular cartilage of the posterolateral proximal tibia and proximal tibiofibular joint (PTFJ) at the tibial site, which is an anatomical safe zone (ASZ) for osteotomy. We studied the ASZ and its relation to the fibular tip, including the level of posterior cruciate ligament (PCL) insertion, to avoid penetration into the knee and PTFJ, and PCL injury by osteotomy.

METHODSTen pairs of embalmed cadaveric legs were disarticulated at the knee joint and then examined. Soft tissues at the proximal tibia were removed. The posterior capsule of the PTFJ was incised to identify the articular cartilage of the PTFJ at the tibial site. The height of the fibular tip and the thickness of the ASZ were measured and calculated to determine the relationship between the ASZ and fibular tip. The level of PCL insertion was measured from the posterior articular surface of the proximal tibia to the distal attachment of the PCL.

RESULTSThe average height of the fibular tip and the thickness of the ASZ were 5.43 ± 1.53 mm and 4.12 ± 1.60 mm, respectively. On average, the fibular tip was 1.31 ± 1.28 mm higher than the ASZ, and the level of PCL insertion was 10.10 ± 1.88 mm.

CONCLUSIONTo ensure safety during medial opening oblique wedge HTO, the end of osteotomy should point accurately into the ASZ at a level just below the fibular tip as reference. Proximal osteotomy thickness should not be less than 10 mm at the level of PCL insertion.

Cadaver ; Cartilage, Articular ; surgery ; Fibula ; anatomy & histology ; Humans ; Knee ; anatomy & histology ; Knee Joint ; anatomy & histology ; Middle Aged ; Osteotomy ; instrumentation ; methods ; Posterior Cruciate Ligament ; anatomy & histology ; Tibia ; anatomy & histology ; surgery

To develop a standard growth curve of the lower extremity in Korean children from 3 to 16 yr of age, the lengths from a total of 2087 normal long bone segments (582 femurs and 645 tibias in boys, and 417 femurs and 443 tibias in girls) were measured. Children were grouped by years of bone age, which was determined by using the Korean specific bone age standard; TW2-20 method. The growth spurt occurred in girls from eight to eleven years by bone age, and in boys from eleven to thirteen years. The mean tibial length relative to the mean femoral length was 0.78 in boys and 0.79 in girls. The overall growth pattern was similar to that observed in American children in the 1960s. Korean children and adolescents appear to have a different tempo of skeletal maturation during pubertal growth from that of English and American children and adolescents. The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities. These normative growth standards can be used for leg-length equalization purposes in children with anisomelia.
Adolescent ; Age Determination by Skeleton ; Bone Development ; Child ; Child, Preschool ; Female ; Femur/*anatomy & histology ; Growth ; Human ; Korea ; Male ; Reference Values ; Tibia/*anatomy & histology

Cadaver ; Humans ; India ; Models, Anatomic ; Models, Neurological ; Peroneal Nerve ; anatomy & histology ; Piriformis Muscle Syndrome ; physiopathology ; Sciatic Nerve ; anatomy & histology ; physiopathology ; Sciatica ; pathology ; Tibia ; innervation ; pathology

Objective To explore the feasibility and clinical value of ultrasonography in evaluating the morphology and function of medial collateral ligaments (MCL) after total knee arthroplasty (TKA). Methods Totally 38 patients undergoing routine KTA (group A) and 22 patients undergoing constrained condylar knee arthroplasty KTA with MCL injury (group B) were included. Long axis views of MCL were taken and the MCL thickness was measured on femur side and tibial side 1 cm away from the joint line, respectively. The thicknesses were compared between the two groups. Subsequently, the gap between the metal part of the femoral prosthesis and the spacer after dynamic valgus stress was measured. The distribution and composition of the gap between the two groups were compared. Results High-frequency ultrasound clearly showed the prosthesis and MCL after TKA. MCL fiber structures of both groups were intact. The MCL thickness on the tibial side in group B was (0.25±0.06)cm, which was significantly thinner than group A [(0.32±0.14)cm] (t=2.12, P=0.040).For the femur side, there was no significant difference (t=1.65, P=0.110) between these two groups [(0.37±0.09) cm in group B versus (0.42±0.12)cm in group A]. Under the condition of valgus stress, the gaps between the metal part of the femoral prosthesis and the spacer could be found in 11 cases in group B but only in 1 case in group A. The proportion of gaps in group B was significantly higher than that in group A (Fisher's exact test, P=0.000). Conclusions High-frequency ultrasound can clearly show the prosthesis and MCL after TKA. The injured MCL can be well joined but the thickness is thinner. Under the condition of valgus stress of the knee, the stability of the TKA can be evaluated according to the gap between the prosthesis and the spacer.
Arthroplasty, Replacement, Knee ; Femur ; Humans ; Knee Joint ; Medial Collateral Ligament, Knee ; anatomy & histology ; diagnostic imaging ; physiology ; Tibia ; Ultrasonography