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The aim of this study was to quantify the effect of torsion deformity on the lower limb kinetics during the loading response phase of gait. A total of 24 subjects: 6 end-staged medial knee OA with torsion deformity (TKO), 8 without torsion deformity (KOA), and 10 controls (CON) were imaged using computed tomography (CT). Internal moment of support and sagittal hip, knee and ankle joint moments were assessed using gait analysis. TKO showed greater external rotations of the proximal tibia and the distal femur compared to subjects with medial knee OA without torsion deformity and controls. TKO showed greater moment of support and a greater knee extensor moment when compared to controls when supporting the weight of the body during gait. The TKO intorsion deformity occurred as a result of a proximal malrotation of the tibia. In the presence of torsion deformity, the kinetic synergy of the lower limb showed increased total moment of support for subjects with medial knee OA. The greater extensor output from TKO may be the result of an increased muscular response to overcome an interrupted inter-segmental exchange of accelerations during the loading response phase of gait.
Background: Staple line reinforcement material has been
demonstrated to raise the burst pressure threshold after linear intestinal
stapling. Numerous bioprosthetic materials have been utilized in surgical
practice. Porcine urinary bladder matrix (ACell, Inc.) is an extracellular
matrix material derived from porcine bladder used to reinforce surgically
repaired soft tissue, and facilitate the body’s regenerative capacity.
Objective: This study represents the first evaluation of urinary bladder matrix
in gastrointestinal staple line reinforcement. Methods: Pathogen-free pigs
underwent midline laparotomy under general anesthesia. Small intestinal
division was performed with an endoscopic linear stapler. Nineteen intestinal divisions
were performed with urinary bladder matrix staple line reinforcement, and
twenty divisions were unreinforced. Staple lines were then subjected to burst
pressure analysis by intraluminal infusion of dyed Krebs solution at an
infusion rate of 20 ml·min-1 under manometric monitoring.
Upon visible staple line extravasation, intraluminal pressure was recorded.
Results: Intestinal staple lines reinforced with urinary bladder matrix
exhibited significantly higher burst pressure threshold (p < 0.05).
Reinforced staple lines had an average burst pressure of 99 ± 33 mmHg, compared
to 61 ± 37 mmHg for unreinforced staple lines. Conclusion: Staple line
reinforcement using urinary bladder matrix acutely improves burst pressures of
intestinal staple lines when compared with unreinforced staple lines. Its
regenerative properties may confer a long-term advantage to staple line
reinforcement. These findings, along with previous findings of constructive
remodeling in the presence of urinary bladder matrix in treatment of the
gastrointestinal system, suggest that UBM may serve a role in gastrointestinal
staple line reinforcement.