Segond's fracture: a biomechanical cadaveric study using navigation

Background Segond’s fracture is a well-recognised radiological sign of an anterior cruciate ligament (ACL) tear. While previous studies evaluated the role of the anterolateral ligament (ALL) and complex injuries on rotational stability of the knee, there are no studies on the biomechanical effect of Segond’s fracture in an ACL deficient knee. The aim of this study was to evaluate the effect of a Segond’s fracture on knee rotation stability as evaluated by a navigation system in an ACL deficient knee. Materials and methods Three different conditions were tested on seven knee specimens: intact knee, ACL deficient knee and ACL deficient knee with Segond’s fracture. Static and dynamic measurements of anterior tibial translation (ATT) and axial tibial rotation (ATR) were recorded by the navigation system (2.2 OrthoPilot ACL navigation system B. Braun Aesculap, Tuttlingen, Germany). Results Static measurements at 30 showed that the mean ATT at 30 of knee flexion was 5.1 ± 2.7 mm in the ACL intact condition, 14.3 ± 3.1 mm after ACL cut (P = 0.005), and 15.2 ± 3.6 mm after Segond’s fracture (P = 0.08). The mean ATR at 30 of knee flexion was 20.7 ± 4.8 in the ACL intact condition, 26.9 ± 4.1 in the ACL deficient knee (P[0.05) and 30.9 ± 3.8 after Segond’s fracture (P = 0.005). Dynamic measurements during the pivot-shift showed that the mean ATT was 7.2 ± 2.7 mm in the intact knee, 9.1 ± 3.3 mm in the ACL deficient knee(P = 0.04) and 9.7 ± 4.3 mm in the ACL deficient knee with Segond’s fracture (P = 0.07). The mean ATR was 9.6 ± 1.8 in the intact knee, 12.3 ± 2.3 in the ACL deficient knee (P[0.05) and 19.1 ± 3.1 in the ACL deficient knee with Segond’s lesion (P = 0.016). Conclusion An isolated lesion of the ACL only affects ATT during static and dynamic measurements, while the addition of Segond’s fracture has a significant effect on ATR in both static and dynamic execution of the pivot-shift test, as evaluated with the aid of navigation

Anatomic and histological study of the anterolateral aspect of the knee: a SANTI Group investigation

Background: The structure and function of the anterolateral aspect of the knee have been significantly debated, with renewed interest in this topic since the description of the anterolateral ligament (ALL). Purpose: To define and describe the distinct structures of the lateral knee and to correlate the macroscopic and histologic anatomic features. Study Design: Descriptive laboratory study. Methods: Twelve fresh-frozen human cadavers were used for anatomic analysis. In the left knee, a layer-by-layer dissection and macroscopic analysis were performed. In the right knee, an en bloc specimen was obtained encompassing an area from the Gerdy tubercle to the posterior fibular head and extending proximally from the anterior aspect to the posterior aspect of the lateral femoral epicondyle. The en bloc resection was then frozen, sliced at the level of the joint line, and reviewed by a musculoskeletal pathologist. Results: Macroscopically, the lateral knee has 4 main layers overlying the capsule of the knee: the aponeurotic layer, the superficial layer including the iliotibial band (ITB), the deep fascial layer, and the ALL. Histologically, 8 of 12 specimens demonstrated 4 consistent, distinct structures: the ITB, the ALL, the lateral collateral ligament, and the meniscus. Conclusion: The lateral knee has a complex orientation of layers and fibers. The ALL is a distinct structure from the ITB and is synonymous to the previously described capsulo-osseous layer of the ITB. Clinical Relevance: Increasingly, lateral extra-articular procedures are performed at the time of anterior cruciate ligament reconstruction. Understanding the anatomic features of the anterolateral aspect of the knee is necessary to understand the biomechanics and function of the structures present and allows surgeons to attempt to replicate those anatomic characteristics when performing extra-articular reconstruction

Do Clinical Outcomes and Failure Rates Differ in Patients With Combined ACL and Grade 2 MCL Tears Versus Isolated ACL Tears?: A Prospective Study With 14-Year Follow-up

Background: A combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) is a common injury pattern encountered during clinical practice. Recent systematic reviews have found no consensus on the optimal method of managing this combined ligament injury pattern, and no long-term studies with modern techniques are available in the literature. Purpose: To compare 2 groups of patients who underwent isolated ACL reconstruction in terms of failures and clinical scores at long-term follow-up. In the first group were patients with isolated ACL tears (ACL group), while the second was composed of patients with combined ACL and MCL grade 2 tears (ACL + MCL group). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients (37 in the ACL group and 20 in the ACL + MCL group) underwent isolated ACL reconstruction with a double-bundle technique between January and December 2005. Patients were contacted for scores on the International Knee Documentation Committee subjective form, Western Ontario and McMaster Universities Osteoarthritis Index, and Tegner activity scale as well as data regarding ipsilateral or contralateral revision ACL surgery. A 2-way analysis of variance for repeated measures was used to statistically assess the differences between the groups. Results: Overall, 49 patients (86%) completed the survey and were therefore included in the study. The minimum follow-up was 14.6 years (range, 14.1-15.2 years). There was a significant reduction in both groups of all the outcome scores between the intermediate and final-follow-up. The number of failures was 3 of 31 (9.7%) in the ACL group and 1 of 18 (5.5%) in the ACL + MCL group; this difference was not significant. Moreover, there were no clinical differences between the groups in terms of graft failures, contralateral lesions, and clinical scores. Conclusion: At 14-year follow-up, no clinical difference or increased failure rate was observed between the study groups, suggesting that isolated ACL reconstruction could represent an appropriate treatment for a combined ACL and MCL grade 2 lesion

Increased Rotatory Laxity after Anterolateral Ligament Lesion in Anterior Cruciate Ligament- (ACL-) Deficient Knees: A Cadaveric Study with Noninvasive Inertial Sensors

The anterolateral ligament (ALL) has been suggested as an important secondary knee restrain on the dynamic laxity in anterior cruciate ligament- (ACL-) deficient knees. Nevertheless, its kinematical contribution to the pivot-shift (PS) phenomenon has not been clearly and objectively defined, and noninvasive sensor technology could give a crucial contribution in this direction. The aim of the present study was to quantify in vitro the PS phenomenon in order to investigate the differences between an ACL-deficient knee and an ACL+ALL-deficient knee. Ten fresh-frozen paired human cadaveric knees (n=20) were included in this controlled laboratory study. Intact, ACL-deficient, and ACL+ALL-deficient knees were subjected to a manual PS test quantified by a noninvasive triaxial accelerometer (KiRA, OrthoKey). Kinematic data (i.e., posterior acceleration of the tibial lateral compartment) were recorded and compared among the three statuses. Pairwise Student's t-test was used to compare the single groups (p<0.05). Intact knees, ACL-deficient knees, and ACL+ALL-deficient knees showed an acceleration of 5.3±2.1 m/s2, 6.3±2.3 m/s2, and 7.8±2.1 m/s2, respectively. Combined sectioning of ACL and ALL resulted in a statistically significant acceleration increase compared to both the intact state (p<0.01) and the ACL-deficient state (p<0.01). The acceleration increase determined by isolated ACL resection compared to the intact state was not statistically significant (p>0.05). The ALL sectioning increased the rotatory laxity during the PS after ACL sectioning as measured through a user-friendly, noninvasive triaxial accelerometer

Introduction

Introduction to the book "Street Music and Narrative Traditions

Narrazioni e narratori

Il testo illustra le forme narrative di tradizione orale in Sicilia, dalla fiaba al racconto cavalleresco, dedicando particolare attenzione alle loro modalit\ue0 performative e al valore socioantropologico

Etnografie del suono tra natura e cultura

Relationship between nature and culture has deeply changed within the years, from an almost expected opposition of the two terms to a total overthrow which implies their mutual entanglement. The aim of this contribution is to show how such a change has affected oral musical tradition studies, focusing on some topics belong-ing to different theoretical-methodological frames and different historical periods: from comparative musicology to ethnomusicology, from anthropology of music to biomusicology (in reference also to evolutive musicology and to zoomusicology), from anthropology of sound to acustemology. Among the themes dealt with: the “na-ture” of musical scales, the phylogeny of musical behaviour (even according to an interspecies perspective), the musical instruments as a reflex of specific environmen-tal contexts, the connection nature-culture in the development of musical and cho-reutic knowledge and skills, the cultural relativism of the notion of “music” and its overcoming in an anthropology of the sound and, lastly, in acustemology

Le tradizioni musicali

Il testo offre una panoramica delle ricerche e dei caratteri generali relativi alla musica di tradizione orale in Sicilia, con riferimento alle principali tipologie di canti, balli e musiche strumentali

The Orbi Tradition: Blind Street Singers in Sicily

In Sicily, the street music was primarily entrusted to a class of professional singers and players called orbi (“blind”). In 1661 orbi gathered in Palermo at the brotherhood of the Immaculate Conception under the protection of the Jesuits, marking their first official appearance in the historical record. The testimonies of the activity of orbi between the 18th and 19th centuries offers a detailed account of both their repertoire – composed mainly of sacred songs, but also of storii (“narrative songs”), canzuni (“songs”), ditties and dance music – and their performative contecxts. For instance, they were called to perform at religious celebrations, weddings and convivial events, serenades, and performances of the Sicilian puppet theatre (Opera dei pupi). The blind players usually performed as a duo: a violinist and a player of citarruni (small three-stringed bass or adapted cello, in the twentieth century gradually replaced by the guitar). These street musicians – not all necessarily blind – were particularly active in the widespread dissemination of devotional poems of ecclesiastical origin in the Sicilian dialect. This important musical tradition is widely documented for Palermo but was not as well studied in Messina and Catania, the main cities of Eastern Sicily. This article takes into account historic and contemporary evidence of orbi activities, with a special attention for devotional celebrations and puppet theatre performances

La pluralit\ue0 dei sistemi musicali e le origini della musica (parte II)

Il testo tratta la nascita degli interessi scientifici verso le tradizioni musicali extraoccidentali grazie alla nuova disciplina denominata "musicologia comparata" e agli studi etno-antropologici di orientamento evoluzionista e diffusionista. In questo contesto di studio viene dato particolare rilievo alle ipotesi riguardanti le origini della musica, che vengono sinteticamente ripercorse e valutate.The text deals with the birth of scientific interests towards extra-western musical traditions thanks to the new discipline called "comparative musicology" and to ethno-anthropological studies of evolutionist and diffusionist orientation. In this context of study, particular importance is given to the hypotheses concerning the origins of music, which are briefly retraced and evaluated