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The shapes and relative movements of the femur and tibia at the knee.

Unlike the situation at the hip, controversy continues as to the shape of the bones in the knee (for example, are the femoral condyles helical in sagittal section?) and as to the way in which the femur moves on the tibia (for example, does the femur roll-back during flexion?). Although the replaced knee is unlikely to achieve normal kinematics, it seems desirable to understand how far it departs from normal. A knowledge of the normal is also important in the management of ligament injuries. Thus it is desirable to resolve these controversies. We have studied the shape of the bones and the way in which they move in the normal cadaveric knee using MRI as a first step to developing an MRI protocol for establishing the kinematic behaviour of the knee in the clinical setting. Our results have been confirmed in normal volunteers using Open Access and Interventional MRI. The latter enables the knee to be imaged whilst the subject is weight-bearing.

Adult↗

[Bilateral atraumatic epiphysiolysis of the head of the tibia].

We report above a 14-year old boy, who suffered from a bilateral epiphyseal fracture type Salter/Harris II of the proximal tibia within four weeks without having an adequate trauma. Accompanying injuries were not found. On the left side we performed a osteosynthesis by K-wires due to an dorsal flexion of the epiphyseal fragment, the other side was treated conservatively with an plaster tutor. On both sides we achieved a correct axis and length in a uncomplicated healing with free joint movement. On the base of the result of our treatment we show a literature review of this rare form of epiphysiolysis.

Adolescent↗

Interactive effects of tunnel dilation on the mechanical properties of hamstring grafts fixed in the tibia with interference screws.

The effect of dilation of the tibial tunnel on the strength of hamstring graft fixation using interference screws was evaluated. In all, 28 RCI screws were tested in male human tibia-hamstring constructs with tibial tunnels reamed or dilated to the respective size of the graft diameter. Dilation of the tibial tunnel failed to significantly enhance hamstring fixation. Grafts secured in dilated tunnels displayed an 11% greater resistance to the initiation of graft slippage (174+/-112 N) compared to their undilated controls (156+/-77 N, P=0.63). Dilation of the tibial tunnel increased the failure load by an average of 4%, independent of screw diameter (dilated specimens: 360+/-120 N, controls: 345+/-88 N, P=0.74). Biomechanical research on the effect of tibial tunnel dilation in hamstring fixation has not provided satisfactory evidence as to the benefits of this additional surgical step during anterior cruciate ligament (ACL) reconstruction.

Anterior Cruciate Ligament↗

Effects of risedronate on trabecular microstructure and biomechanical properties in ovariectomized rat tibia.

We determined the effect of risedronate on the trabecular microstructure of ovariectomized rat tibiae, using micro-computed tomography, in order to investigate how changes in microstructure contribute to biomechanical properties. Fifty 18-week-old rats underwent sham operation (n=10) or ovariectomy (OVX) (n=40). The OVX rats were further divided into four groups (n=10 for each group) and treated with risedronate at doses of 0, 0.1, 0.5 or 2.5 mg/kg for 9 months. OVX caused deterioration of three-dimensional trabecular microstructure, notably structure model index (SMI) and connectivity density, while treatment of OVX rats with risedronate at 0.5 and 2.5 mg/kg improved those deleterious microstructural changes. Biomechanical property, as assessed by finite element analysis (FEA), correlated significantly with trabecular bone volume fraction (BV/TV), and the correlation further increased substantially when microstructural parameters were added, especially SMI and connectivity density, with risedronate therapy. Thus, it is suggested that, in addition to increasing bone mass, risedronate improves biomechanical property by maintaining a plate-like structure as well as connectivity of trabeculae.

Animals↗

Unanticipated changes in steady-state mRNA levels for glyceraldehyde-3-phosphate dehydrogenase in rat tibiae.

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA levels are commonly used as an internal control to normalize gene expression data based on the belief that this gene is constitutively expressed. However, GAPDH mRNA levels increased by more than 2.5-fold in tibiae of hindlimb unloaded female rats compared to L32 mRNA levels. Similarly, GAPDH mRNA levels increased compared to 18S ribosomal RNA. Treatment with growth hormone and alcohol show no disparity in GAPDH mRNA levels whereas in some experiments, parathyroid hormone and 17beta-estradiol increased GAPDH mRNA levels. Taken together, these findings indicate that it is essential to demonstrate that GAPDH expression is not altered prior to using the gene as an internal control.

Animals↗

Effects of estrogen and progesterone on tibia histomorphometry in growing rats.

The present study was performed to evaluate possible interactions between estrogen and progesterone on peak cancellous bone mass. Ovariectomized (OVX) growing rats were treated with 17beta-estradiol (4.8 microg/day), progesterone (4.8 mg/day), a combination of the two sex steroids, or with vehicle for 14 days beginning 7 days after OVX. The tibiae were removed for histomorphometric analysis of the proximal metaphysis. OVX and growth each resulted in net resorption of cancellous bone at a sampling site adjusted for longitudinal bone growth. Estradiol and progesterone treatment each antagonized bone loss by inhibiting the decrease in trabecular number. Estradiol increased but progesterone had no effect on trabecular thickness. Progesterone did not influence either osteoclast number or the resorption of the pretreatment fluorochrome label. Estradiol reduced osteoclast number and inhibited label resorption, the latter change being accentuated by combination treatment. Estradiol reduced and progesterone enhanced the mineral apposition and bone formation rates. The results indicate that estradiol and progesterone have independent activities on cancellous bone turnover during growth. Whereas estradiol reduced bone turnover, progesterone had a stimulatory effect on bone formation. These findings suggest that progesterone has a role in establishing and maintaining peak cancellous bone volume during growth.

Animals↗

Short-term effects of high dose estrogen on tibiae of growing male rats.

The short-term effects of estrogen at a single high dose (4 mg/kg body weight/day for 14 days) were determined on tibiae in the normal (noncastrate) growing male rat. In cortical periosteal bone, at a middiaphyseal site devoid of resorbing activity, estrogen suppressed periosteal bone formation and apposition rates, resulting in a smaller cross-sectional area. In middiaphyseal endocortical bone, estrogen had no effect on apposition and formation rates and, because medullary area was unchanged, probably had no effect on endocortical bone resorption. In the proximal tibial metaphysis, estrogen greatly suppressed longitudinal growth rate. In a site within the metaphysis adjusted for the effects of growth, cancellous mineral apposition was greatly reduced by the hormone. Estrogen-treated rats retained more of a fluorochrome label deposited in cancellous bone at the beginning of the study than vehicle-treated animals, indicating a reduced net bone loss. As a result of the lowered resorption induced by estrogen, cancellous bone mass (area and perimeter) were both significantly higher in estrogen-treated rats. No evidence was found for an anabolic action of the hormone in the male rat; indeed, estrogen reduced indices of bone formation.

Aging↗

Centrifugal isolation of bone marrow from bone: an improved method for the recovery and quantitation of bone marrow osteoprogenitor cells from rat tibiae and femurae.

SUMMARY. The high variation often observed in the ex vivo fibroblastic-colony forming unit (CFU-f) assay is likely to be due to both biological and experimental variation. To determine whether we could improve experimental methods we developed an alternative method of bone marrow cell (BMC) isolation employing a centrifugation step. The osteogenic capacity of centrifugally isolated BMC was compared to that of BMC that were isolated using the standard "flushing" technique using the CFU-f assay. The centrifugation method was found to be both quick and simple to perform and allowed simultaneous preparation of all samples. Centrifugally isolated BMC gave rise to approximately 100% more cfu-ap and cfu-f in cultures from both tibiae and femurae. The proportion of alkaline phosphatase positive colonies remained the same and colony morphologies were similar for both isolation methods. Histological comparison of the flushed and spun bones showed that after the flushing procedure many cells remained in the marrow cavity especially in the trabecular area. In contrast, centrifugation completely emptied the marrow space of all cells except bone lining cells and osteoblasts. Thus the osteogenic capacity of the bone marrow can be expressed as the number of CFU-f per bone instead of the frequency as is the norm. Using these methods to isolate BMC for ex vivo investigations should lead to a reduction in CFU-f number variation due to the isolation method. http://link.springer-ny. com/link/service/journals/00223/bibs/65n5p411.html</++ +hea

Animals↗

Intracortical epidermoid cyst of the tibia.

Epidermoid cyst in a long bone is an extremely rare condition. The authors describe such a tumor located in the cortex of the tibia in a 21-year-old woman. She was successfully treated with curettage and autogenous bone grafting.

Adult↗

Harris lines of the tibia across centuries: a comparison of two populations, medieval and contemporary in Central Europe.

OBJECTIVE: To determine the incidence of Harris lines in two medieval populations which inhabited the Canton of Berne, in Central Switzerland, and to compare the results with those of a contemporary population living in the same geographical area. A simplified method is described for measuring the age of the individual at the time of formation of Harris lines, with possible future applications. DESIGN AND PATIENTS: Radiographs of 112 well-preserved tibiae of skeletons of two medieval populations from the eighth to fifteenth centuries were reviewed for the incidence of Harris lines. The results were compared with those of 138 current patients living in the same geographic location in Central Switzerland. Age and gender of the medieval individual were determined using known anthropological methods. Age of bone at the time of formation of Harris lines was estimated according to the method of Maat. RESULTS: Harris lines were found in 88 of 112 (80%) of the examined medieval skeletons and in 28 of 138 (20%) of the living individuals. Higher incidences of Harris lines were found at the age of 2 years and at ages between 8 and 12 years in both populations. No gender difference was found regarding the incidence of Harris lines. In both populations the occurrence of Harris lines was associated with certain diseases such as degenerative bone disease, trauma, osteoporosis, rheumatoid arthritis, peripheral vascular diseases, rickets and bony deformities. CONCLUSION: A high incidence of Harris lines was found in the medieval population, perhaps reflecting difficult living and hygienic conditions, but also the poor care and neglect of the children population. Measuring the age of the individual at the time of formation of Harris lines is simple and may have future clinical applications in the paediatric population for medico-legal purposes. The application of Harris lines as a marker in follow-up of osteoporosis may need further evaluation.

Adolescent↗

Symptomatic giant (10-cm) bone island of the tibia.

A bone island represents a focus of mature compact bone within the cancellous bone, and it can be diagnosed based on characteristic clinical and radiologic features. The lesion is typically asymptomatic with a preference for the pelvis, femur, and other long bones. On radiographs, the lesion appears as an ovoid, round or oblong homogeneously dense and sclerotic focus in the cancellous bone. The characteristic features of this lesion are radiating bony streaks, known as thorny radiations or pseudopodia. Most bone islands are small, and the majority of these lesions measure from 0.1 to 2.0 cm. A giant bone island, defined as having a diameter greater than 2 cm, has been rarely reported in the English-language literature. We report here on a case of a giant bone island that measured 10 x 1.7 x 1 cm in the diaphysis of the right tibia in a 31-year-old man who complained of right lower leg pain for 3 weeks.

Adult↗

Primary hemangiopericytoma of the tibia: MR and angiographic correlation.

The Magnetic Resonance Imaging (MRI) appearances of primary osseous hemangiopericytoma (HPC) have been rarely described. We report on a 46-year-old Chinese man with primary osseous HPC of the right tibia. The characteristic vascular distribution of this tumor, presenting with a "spoke-wheel" appearance on MR images and with angiographic correlation, is described. Although not pathognomonic, this MR appearance may be an important finding in suggesting the diagnosis of osseous HPC.

Amputation, Surgical↗

Primary hemangiopericytoma of bone located in the tibia.

Primary hemangiopericytoma of the bone is a rare tumor. We describe a patient with primary hemangiopericytoma of the tibia treated by surgery. The clinical and radiological features of this tumor are described. The radiological and histopathological different diagnosis of hemangiopericytoma is discussed.

Adult↗

Congenital longitudinal deficiency of the tibia.

We performed a clinical and radiographic review of 15 patients (19 limbs) with longitudinal deficiency of the tibia treated between 1981 and 2001. Ten limbs with Kalamchi type I deficiencies were managed by through-knee amputation. Five type II deficiencies were treated by foot ablation and tibiofibular synostosis, either at the same time or staged, but prosthetic problems may arise from varus alignment and prominence of the proximal fibula. Patients with type III deficiencies (four cases) were treated by foot ablation. Prosthetic problems relating to proximal or distal tibiofibular instability may necessitate additional surgical intervention.

Abnormalities, Multiple↗

Treatment of primary malignant bone tumours of the distal tibia.

We treated 15 patients with primary malignant bone tumours of the distal tibia of which 14 were treated by limb salvage surgery. Reconstructions were done by allografts with or without microvascular fibula transfer, by bone transport, by fibula transfer alone or by endoprosthetic replacement. The most successful methods were bone transport and endoprosthetic replacement. However, serious complications with deep infections leading to secondary amputation occurred in four patients and in all reconstruction groups. After a mean follow up of 7 years, no local recurrence occurred, and all patients were alive and free of disease. After radical resection, bone transport in defects less than 15 cm is a viable option. In larger defects in children, allograft with vascularised fibula is an acceptable alternative, but amputation still has a role in this group. In adults, endoprosthetic replacement with proper soft tissue coverage is a viable option in cases with large bony defects.

Adolescent↗

Sarcomatous change in the Pagetoid tibiae.

We reviewed 13 cases of tibial Paget's sarcoma constituting 14% of all registered Paget's sarcoma cases of the Scottish Bone Tumour Registry between January 1947 and June 2004. Eleven patients were male, and in ten patients the tumour involved the upper half of the tibia. In all cases, the main presenting feature was progressively worsening pain followed by a mass in six, a pathological fracture in five and tibial bowing in four. In nine patients, a lytic lesion was seen radiologically. Histologically, there were three osteosarcomas and ten malignant fibrous histiocytomas. Limb ablation was carried out in 11 patients, of whom nine had trans-femoral amputation. Six patients received adjuvant radiotherapy and/or chemotherapy. Post-operative complications included stump revision in two cases, non-union of a pathological fracture of the tibial tuberosity and a stress fracture. The median survival was 17 months.

Aged↗

Congenital pseudarthrosis of the tibia.

The present concepts of the aetiology, prevention and treatment of congenital pseudarthrosis of the tibia are discussed. The satisfactory results of Ilizarov's method and vascularised fibular grafting make these methods optimal choices for treatment. When they are not available, a bone graft with intramedullary fixation is a valuable alternative.

Amputation, Surgical↗