Biomechanical Assessment of Hip Capsular Repair and Reconstruction Procedures Using a 6 Degrees of Freedom Robotic System.

Background: Although acetabular labral repair has been biomechanically validated to improve stability, capsular management of the hip remains a topic of growing interest and controversy.

Purpose: To biomechanically evaluate the effects of several arthroscopically relevant conditions of the capsule through a robotic, sequential sectioning study.

Study Design: Controlled laboratory study.

An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 2: Anterolateral Ligament Reconstruction Combined With Anterior Cruciate Ligament Reconstruction.

Background: Recent biomechanical studies have demonstrated that an extra-articular lateral knee structure, most recently referred to as the anterolateral ligament (ALL), contributes to overall rotational stability of the knee. However, the effect of anatomic ALL reconstruction (ALLR) in the setting of anterior cruciate ligament (ACL) reconstruction (ACLR) has not been biomechanically investigated or validated.

Purpose/hypothesis: The purpose of this study was to investigate the biomechanical function of anatomic ALLR in the setting of a combined ACL and ALL injury.

An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 1: Secondary Role of the Anterolateral Ligament in the Setting of an Anterior Cruciate Ligament Injury.

Background: Recent investigations have described the structural and functional behavior of the anterolateral ligament (ALL) of the knee through pull-apart and isolated sectioning studies. However, the secondary stabilizing role of the ALL in the setting of a complete anterior cruciate ligament (ACL) tear has not been fully defined for common simulated clinical examinations, such as the pivot-shift, anterior drawer, and internal rotation tests.

Hypothesis: Combined sectioning of the ALL and ACL would lead to increased internal rotation and increased axial plane translation during a pivot-shift test when compared with isolated sectioning of the ACL.

Validation of a six degree-of-freedom robotic system for hip in vitro biomechanical testing.

Currently, there exists a need for a more thorough understanding of native hip joint kinematics to improve the understanding of pathological conditions, injury mechanisms, and surgical interventions. A biomechanical testing system able to accomplish multiple degree-of-freedom (DOF) movements is required to study the complex articulation of the hip joint. Therefore, the purpose of this study was to assess the repeatability and comparative accuracy of a 6 DOF robotic system as a testing platform for range of motion in vitro hip biomechanical analysis.

The Anterolateral Ligament: An Anatomic, Radiographic, and Biomechanical Analysis.

Background: Recent publications have described significant variability in the femoral attachment and overall anatomy of the anterolateral ligament (ALL). Additionally, there is a paucity of data describing its structural properties.

Purpose: Quantitative data characterizing the anatomic and radiographic locations and the structural properties of the ALL may be used to guide graft selection and placement and to facilitate the future development of an evidence-based approach to ALL reconstructions.

Ankle syndesmosis: a qualitative and quantitative anatomic analysis.

Background: Syndesmosis sprains can contribute to chronic pain and instability, which are often indications for surgical intervention. The literature lacks sufficient objective data detailing the complex anatomy and localized osseous landmarks essential for current surgical techniques.

Purpose: To qualitatively and quantitatively analyze the anatomy of the 3 syndesmotic ligaments with respect to surgically identifiable bony landmarks.

An anatomical study of the acetabulum with clinical applications to hip arthroscopy.

Background: The clock face has been employed to define the position of labral pathology in relation to identifiable arthroscopically relevant acetabular landmarks. The purpose of this study was to qualitatively and quantitatively describe arthroscopically relevant anatomy of the acetabulum. We aimed to present a surgical landmark that is located in close proximity to the usual location of labral pathology as an alternative to the midpoint of the transverse acetabular ligament as a reference point.

Characterization of robotic system passive path repeatability during specimen removal and reinstallation for in vitro knee joint testing.

Robotic testing systems are commonly utilized for the study of orthopaedic biomechanics. Quantification of system error is essential for reliable use of robotic systems. Therefore, the purpose of this study was to quantify a 6-DOF robotic system's repeatability during knee biomechanical testing and characterize the error induced in passive path repeatability by removing and reinstalling the knee.

Posterior cruciate ligament graft fixation angles, part 1: biomechanical evaluation for anatomic single-bundle reconstruction.

Background: Currently, no consensus exists for the optimal graft fixation angle for anatomic single-bundle (SB) posterior cruciate ligament reconstructions (PCLRs). Additionally, direct graft forces have not been measured. Alternative graft fixation angles and the resultant graft forces should be investigated to optimize the stability of SB PCLRs without overconstraining the knee.

Posterior cruciate ligament graft fixation angles, part 2: biomechanical evaluation for anatomic double-bundle reconstruction.

Background: Prior studies have suggested that anatomic double-bundle (DB) posterior cruciate ligament reconstruction (PCLR) reduces residual laxity compared with the intact state better than single-bundle PCLR. Although the anterolateral bundle (ALB) and posteromedial bundle (PMB) reportedly act codominantly, few studies have compared commonly used graft fixation angles and the influence that graft fixation angles have on overall graft forces and knee laxity.

Hypothesis: Graft fixation angle combinations of 0°/75° (PMB/ALB), 0°/90°, 0°/105°, 15°/75°, 15°/90°, and 15°/105° would significantly reduce knee laxity from the sectioned PCL state while preventing in vitro graft forces from being overloaded between any of the graft fixation angles.

Qualitative and Quantitative Anatomic Investigation of the Lateral Ankle Ligaments for Surgical Reconstruction Procedures.

Background: Lateral ankle sprains are common sports injuries that may require surgery for chronic lateral ankle instability. Anatomic repair or reconstruction is desired, yet there is a scarcity of quantitative information regarding the origins and insertions of the lateral ligaments related to surgically pertinent osseous landmarks.

Methods: Fourteen ankle specimens were dissected to isolate the anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament, and cervical ligament.

Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur.

Background: Hip endoscopy facilitates the treatment of extra-articular disorders of the proximal femur. Unfortunately, current knowledge of proximal femur anatomy is limited to qualitative descriptions and lacks surgically relevant landmarks.

Purpose: To provide a quantitative and qualitative analysis of proximal femur anatomy in reference to surgically relevant bony landmarks.

A qualitative and quantitative analysis of the attachment sites of the proximal hamstrings.

Purpose: Proximal hamstring tears represent a challenge. Surgical repair of such tears has been reported utilizing both open and endoscopic techniques. It was hypothesized that the proximal attachments of the hamstring muscle group could be reproducibly and consistently measured from pertinent bony anatomical reference landmarks.

A quantitative analysis of hip capsular thickness.

Purpose: The purpose of this study was to provide a comprehensive quantitative analysis of capsular thickness adjacent to the acetabular rim in clinically relevant locations.

Methods: Dissections were performed and hip capsular measurements were recorded on 13 non-paired, fresh-frozen cadaveric hemi-pelvises using a coordinate measuring device. Measurements were taken for each clock-face position at 0, 5, 10 and 15 mm distances from the labral edge.

The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study.

Background: The deltoid ligament has both superficial and deep layers and consists of up to six ligamentous bands. The prevalence of the individual bands is variable, and no consensus as to which bands are constant or variable exists. Although other studies have looked at the variance in the deltoid anatomy, none have quantified the distance to relevant osseous landmarks.

Kinematic analysis of the posterior cruciate ligament, part 2: a comparison of anatomic single- versus double-bundle reconstruction.

Background: A more thorough understanding of the posterior cruciate ligament (PCL) has led to an increase in awareness and treatment of complex PCL injuries. Controversy exists about whether PCL reconstruction (PCLR) using an anatomic single-bundle (aSB) or anatomic double-bundle (aDB) technique is the most effective.

Hypothesis: An aDB PCLR provides significantly better anterior-posterior and rotatory knee stability compared with an aSB PCLR and more closely recreates normal knee kinematics.

Kinematic analysis of the posterior cruciate ligament, part 1: the individual and collective function of the anterolateral and posteromedial bundles.

Background: The posterior cruciate ligament (PCL) is composed of 2 functional bundles and has an essential role in knee function and stability. There is, however, a limited understanding of the role of each individual bundle through the full range of knee flexion.

Hypothesis: Both bundles provide restraint to posterior tibial translation across a full range of knee flexion.

Superficial medial collateral ligament anatomic augmented repair versus anatomic reconstruction: an in vitro biomechanical analysis.

Background: When surgical intervention is required for a grade 3 superficial medial collateral ligament (sMCL) tear, there is no consensus on the optimal surgical treatment. Anatomic augmented repairs and anatomic reconstructions for treatment of grade 3 sMCL tears have not been biomechanically validated or compared.

Hypothesis: Anatomic sMCL augmented repairs and anatomic sMCL reconstruction techniques will reproduce equivalent knee kinematics when compared with the intact state, while creating significant improvements in translational and rotational laxity compared with the sMCL sectioned state.

Biomechanical comparison of anatomic single- and double-bundle anterior cruciate ligament reconstructions: an in vitro study.

Background: Arthroscopic identification of the anteromedial (AM) and posterolateral (PL) bundle locations of the anterior cruciate ligament (ACL) has facilitated an improved quantitative description of ACL anatomy. Few studies have directly compared the biomechanical laxity of anatomic single-bundle (SB) versus anatomic double-bundle (DB) ACL reconstruction techniques based on precise anatomic descriptions.

Hypothesis: Anatomic tunnel positioning for SB and DB reconstructions would produce comparable anterior-posterior and rotatory knee laxity.

Simulation as a learning strategy: supporting undergraduate nursing students with disabilities.

Aims And Objectives: To promote simulation as a learning strategy to support undergraduate nursing students with disabilities.

Background: Supporting undergraduate nursing students with disabilities has gained further momentum because of amendments to the Disability Discrimination Act in 2009. Providers of higher education must now ensure proactive steps to prevent discrimination against students with a disability are implemented to assist in course progression.

Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci.

Background: The clinical importance of the meniscal posterior root attachments has been recently reported by both biomechanical and clinical studies. Although several studies have been performed to evaluate surgical techniques, there have been few studies on the quantitative arthroscopically pertinent anatomy of the posterior meniscal root attachments.

Hypothesis: The posterior root attachments of the medial and lateral menisci are consistent among specimens, and repeatable quantitative measurements using arthroscopically pertinent landmarks are achievable.

Assessment of lower extremity motor adaptation via an extension of the force field adaptation paradigm.

Lower extremity rehabilitation has seen recent increased interest. New tools are available to improve gait retraining in both adults and children. However, it remains difficult to determine optimal ways to plan interventions due to difficulties in continuously monitoring outcomes in patients undergoing rehabilitation.

Peer learning partnership: an innovative strategy to enhance skill acquisition in nursing students.

The development of clinical skills for nursing students is a critical component of any undergraduate nursing program. Providing sufficient quality experience for students to develop competence has been recognised as a problem in skill acquisition. At the same time, peer learning has been identified as a valuable strategy for teaching and learning.