The anterior inferior tibiofibular ligament (AiTFL) is the primary lateral ligamentous stabilizer of the ankle syndesmosis. Current syndesmosis repair techniques traverse the tibia and fibula, but do not anatomically reconstruct the AiTFL. We compared a novel AiTFL anatomic repair technique (ART) to rigid syndesmosis screw fixation (SCREW). Twelve cadaveric below knee specimens were compared radiographically and using a biomechanical testing protocol. All specimens underwent a CT scan of the ankle joint prior to testing. Next, the AiTFL, interosseous membrane and deltoid ligament were sectioned, and the posterior malleolus osteotomized, to recreate a trimalleolar-equivalent ankle fracture. The posterior malleolus was repaired with the posterior ligamentous insertions intact and functional (PMALL). Ankles were examined under fluoroscopy with an external rotation stress exam and the medial clear space (MCS) measured. Specimens were then randomized to receive either a conventional syndesmosis screw (SCREW), or the novel anatomic repair technique (ART). External rotation stress fluoroscopy was repeated. A second CT was completed and the fibular position compared to the pre-injury CT. Each specimen was then loaded in external rotation until failure using a custom biomechanical jig.Purpose
Method
We report the difficulties encountered during surgery, and the long term results of patients who had Crowe 3 or 4 DDH and a technically difficult primary hip arthroplasty using the modular S-ROM stem.
4 patients had a technical complication during surgery. The average pre-op Harris Hip Score was 37, at 5 years it was 83, and at 10 years 81. The SF12 measure of physical and mental wellbeing was 43.90 physical/54.48 mental at 5 years, and 41.64 physical/54.03 mental at 10 years. The WOMAC average score (the lower the score the better the outcome) was 27 at 5 years and 23 at 10 years. None of the S-ROM stems had been revised, 2 hips had undergone acetabular revision and one hip had a liner exchange. None of the S-ROM stems were loose at latest follow-up. Four hips had osteolysis in Gruen zone 1, one hip had osteolysis in zone 7, and one hip had osteolysis in zone 1 and 7. There was no evidence of osteolysis around or distal to the sleeve.
S-ROM stem/sleeve modularity allows femoral component anteversion independent of the position of best fit in the proximal femur, and helps overcome the technical difficulty in these patients.
