Femoral head collapse due to avascular necrosis (AVN) is a relatively rare occurrence following intertrochanteric fractures; however, with over thirty-thousand intertrochanteric fractures per year in England and Wales alone, and an incidence of up to 1.16%, it is still significant. Often patients are treated with a hip fixation device, such as a sliding hip screw or X-Bolt. This study aimed to investigate the influence of three factors on the likelihood of head collapse: (1) implant type; (2) the size of the femoral head; and (3) the size of the AVN lesion. Finite element (FE) models of an intact femur, and femurs implanted with two common hip fixation designs, the Compression Hip Screw (Smith & Nephew) and the X-Bolt (X-Bolt Orthopaedics), were developed. Experimental validation of the FE models on 4. th. generation Sawbones composite femurs (n=5) found the peak failure loads predicted by the implanted model was accurate to within 14%. Following validation on Sawbones, the material modulus (E) was updated to represent cancellous (E=500MPa) and cortical (E=1GPa) bone, and the influence of implant design, head size, and AVN was examined. Four head sizes were compared: mean male (48.4 mm) and female (42.2 mm) head sizes ± two standard deviations. A conical representation of an AVN lesion with a lower modulus (1MPa) was created, and four different radii were studied. The risk of head collapse was assessed from (1) the critical buckling pressure and (2) the peak failure stress. The likelihood of head collapse was reduced by implantation of either fixation device. Smaller head sizes and greater AVN
There was no statistically significant difference in baseline lesion volume between decreasing lesions and unchanged lesions.
Introduction. The ankle cartilage has an important function in walking movements, mainly in sports; for active young people, between 20 and 30 years old, the incidence of osteochondral lesions is more frequent. They are also more frequent in men, affecting around 21,000 patients per year in USA with 6.5% of ankle injuries generating osteochondral lesions. The lesion is a result of ankle sprain and is most frequently found in the medial location, in 53% of cases. The main objective of this work was to develop an experimental and finite element models to study the effect of the ankle osteochondral lesion on the cartilage behavior. Materials and Methods. The right ankle joint was reconstructed from an axial CT scan presenting an osteochondral lesion in the medial position with 8mm diameter in size. An experimental model was developed, to analyze the strains and influence of
Mirels’ score predicts the likelihood of sustaining pathological fractures using pain,
Background. Masses are not uncommon in the foot and ankle. Most of these masses are benign, often leading clinicians to underestimate their potential for malignancy. Methods. We conducted a retrospective review of our clinical records, on patients with histologically confirmed musculoskeletal tumours of the foot and ankle, treated in a single nstitution between 2010 and 2019. The maximum diameter of each lesion was determined through MRI or Ultrasound analysis in centimeters. To develop a scoring system we compared the risk of malignancy with five criteria: site (proximal or distal to the first TMTJ), gender, age, composition and the diameter as observed. Results. Our study included 496 patients, of whom 39 (7.9%) were identified as having malignancies. The incidence of malignancy demonstrated an increased propensity among male patients, patients over 50 years of age and lesions located proximal to the TMTJ. A ROC Analysis determined that lesions measuring over 2.85 cm had an increased risk of malignancy, with a PPV of 31.1%, a NPV of 94.2%, a Sensitivity of 0.82, and a Specificity of 0.62. These identified patterns of risk were employed to formulate a scoring system, aimed at facilitating informed clinical judgment in the referral of patients to regional tumor services. Conclusion. The new OxFAT scoring system highlights the importance of
Autologous osteochondral transplantation (AOT) is an effective treatment for large Osteochondral Lesions of the Talus (OLT), however little is reported on an athletic population, who are likely to place higher demands on the reconstruction. The aim is to report the outcomes of large OLT (>150mm. 2. ) within an athletic population. The study population was limited to professional or amateur athletes (Tegner score >6) with an OLT of size 150mm. 2. or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included Return to Sport, VAS and FAOS Scores. In addition, graft incorporation was evaluated by MRI using MOCART scores at 12 months post-surgery. 38 athletes including 11 professional athletes were assessed. Mean follow-up was 46 months. Mean
Abstract. Introduction. The incidence of significant acute chondral injuries with patella dislocation is around 10–15%. It is accepted that chondral procedures should only be performed in the presence of joint stability. Methodology. Patients were identified from surgeon/hospital logs. Patient demographics,
Introduction. In osteonecrosis of the femoral head (ONFH), reduction in the size, or complete resolution of the necrotic lesion has been reported to occur spontaneously without any specific treatment. Recently, there was a report that the reduction was time-dependent. We evaluated the change in the size of necrotic lesions of ONFH using magnetic resonance imaging (MRI) more than 10 years after the initial diagnosis. Methods. Fifteen hips in 13 patients with atraumatic ONFH who had been followed-up for more than 10 years were enrolled in this study. They were categorized into two groups; A Simple Observation Group and a Multiple Drilling Group. The Simple Observation Group included 6 hips in 5 patients treated non-operatively. There were 3 men and 2 women who had an average age of 42 years at the time of their initial diagnosis. Initial Ficat and Arlet stages were I in 2 cases, IIA in 3 cases, and IIB in 1 case. The Multiple Drilling Group included 9 hips in 9 patients treated surgically with multiple drilling. They were all men who had an average age of 38 years at the time of operation. There were 2 cases of stage I and 7 cases of stage IIA. The necrotic
Introduction. Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include
Introduction: Acute neurological damage from spinal cord injuries is believed to be localised, however it initiates a cascade of secondary events which usually leads to extensive and permanent neurological deficit. The secondary damage begins with the disruption of the blood-spinal cord barrier which unleashes a protracted inflammatory response. This prolonged inflammatory response is the catalyst for the secondary neurodegeneration and limited repair response that occurs in the chronic phase of a spinal cord injury. In this study it was proposed that the acute delivery of the angiogenic growth factors vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) would mediate inflammation and restore the blood spinal cord barrier. This would minimise the formation of glial scar and reduce the extent of secondary degeneration caudal and cranial to the lesion site. Methods: Adult male Wistar rats (400g) were anesthetised. Complete laminectomies were performed at T10 and the animals were subjected to T10 hemisection. Animals were randomised to a treatment group (Lesion Control (LC), Gel Control (GC) and Angiogenic Gel (AG)) after the spinal cord was cut. Each treatment group had 6 animals sacrificed 3 months post injury. Sections were stained with antibodies to neurofilament 200, glial fibrillary acidic protein, smooth muscle actin (SMA), and fluorescent secondary antibodies and mounted with DAPI. The
INTRODUCTION. Avascular necrosis (AVN) of the femoral head (FH) initiates from biological disruptions in the bone and may progress to mechanical failure of the hip. Mechanical and structural properties of AVN bone have not been widely reported, however such understanding is important when designing therapies for AVN. Brown et al.[1] assessed mechanical properties of different regions of AVN FH bone and reported 52% reduction in yield strength and 72% reduction in elastic modulus of necrotic regions when compared to non-necrotic bone. This study aimed to characterise structural and mechanical properties of FH bone with AVN and understand the relationship between lesion volume and associated mechanical properties. METHODS. Twenty FH specimens from patients undergoing hip arthroplasty for AVN and six non-pathological cadaveric FH controls were collected. Samples were computed tomography scanned and images analysed for percentage lesion volume with respect to FH volume. Samples were further divided for structural and mechanical testing. The mechanical property group were further processed to remove 9mm cylindrical bone plugs from the load bearing and non-load-bearing regions of the FHs. FH and bone plug samples were tested in compression (1mm/min); elastic modulus and yield stress were calculated. RESULTS. Imaging. Individual
Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include
There is no optimal treatment for osteochondral defects of the talus after failed primary surgical treatment. To treat these patients, a 15-mm diameter metal implant was developed for the medial talar dome. The present study was undertaken to evaluate the clinical effectiveness of the metal implantation technique for osteochondral lesions of the medial talar dome. This is a prospective case series. The inclusion criteria were the combination of a large OCD (ϕ >12 mm) of the medial talar dome, persistent complaints >1 year after treatment, and clinically relevant pain levels. The exclusion criteria were: age <18 years, OCD size >20 mm, ankle osteoarthritis grade 2 or 3, concomitant ankle pathology, and diabetes. The primary outcome measure was the Numeric Rating Scale pain (NRS) rest, walking, running, and stair climbing. Secondary outcome measures were: Foot Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and clinical and radiographic complications. The Wilcoxon signed ranks test was used to calculate p-values. Between October 2007 and March 2009 10 patients were included. The median follow-up was 2 years (range, 2–3 years). On preoperative CT scanning, the median
Sensitive and accurate measures of osteolysis around TKR are needed to enhance clinical management and assist in planning revision surgery. Therefore, our aim was to examine, in a cadaver model of osteolysis around TKR, the sensitivity of detection and the accuracy of measuring osteolysis using Xray, CT and MRI. Fifty-four simulated osteolytic lesions were created around six cadaver knees implanted with either a cemented or cementless TKR. Twenty-four lesions were created in the femur and thirty in the tibia ranging in size from 0.7 cm3 to 14 cm3. Standard anteroposterior and lateral fluoroscopically guided radiographs, CT and MRI scans with metal reduction protocols were taken of the knees prior to the creation of lesions and at every stage as the
Introduction. Autologous chondrocyte implantation presents a viable alternative to microfracture in the repair of damaged articular cartilage of the knee; however, outcomes for patellar lesions have been less encouraging. ChondroCelect (CC) is an innovative, advanced cell therapy product consisting of autologous cartilage cells expanded ex vivo through a highly controlled and consistent manufacturing process. Purpose. To assess the effect of CC in the treatment of patellofemoral lesions, for which standard treatment options had failed and/or no other treatment options were considered feasible. Methods. CC was administered to 61 patients with patellar lesions (predominantly secured with a biological membrane; mean
Purpose. The presence of a Hill-Sachs lesion is a major contributor to failure of surgical intervention following anterior shoulder dislocation. The relationship between
Introduction: Alveolar soft part sarcoma (ASPS) is a soft tissue tumour found primarily in adolescents and young adults. It has an incidence of 0.5 – 1.0 % of all soft tissue sarcomas and a predilection for females. The lesion is inherently malignant and may occur throughout the body however, reports suggest they are predominantly detected in the anterior thigh. Symptoms include a painless slow-growing mass but ASPS can commonly present with brain or lung metastases due to the high vascularity of the lesion. Microscopically, cellular groups exist with centralised areas of necrosis, thus resulting in a pseudoalveolar appearance. Methods: We identified six cases of histologically proven ASPS. The mean age was 28.5 years (21–36). Four patients were male. All patients had a primary presentation of a mass, two of which were painful. All patients, except one, presented within 8 months of the onset of symptoms (mean 3.8 months) with the other seeking medical advice only after 72 months. The location of the mass included the thigh in three patients and the triceps, soleus and retroperitoneal space in the others. Four patients underwent pre-operative diagnostic biopsies. Surgical excision was performed in all patients. Results: The mean size of tumour was 9.4 x 9.4 x 6.3cm but there was no correlation between
Introduction: In the evaluation of various treatments that may have an effect on bone, there are certain inherent difficulties in selecting an appropriate outcome measure to determine whether a specific treatment is efficacious. This is particularly true for clinical studies. Methods: Using Pubmed, a service of the U.S. National Library of Medicine that searches MEDLINE and other life science journals for citations of biomedical articles, a review of the current instruments used for outcome measures relating to osteonecrosis and bone blood flow was conducted. Abstracts from previous ARCO meetings were also reviewed. Results: For the treatment of osteonecrosis, most outcome measures have focused on pain relief, surgery or need for surgery, disease progression (advancing stage), and change in
Background:. Full thickness cartilage defect of the knee frequently resulted in fibrous tissue formation, and larger lesions often lead to degenerative arthritis of the knee. Many techniques are designed to repair the cartilage defect including chondrocyte transplantation, microfracture and osteochondral graft. Each method has achieved some success but no universal results. Autologus osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness. Purpose:. The purpose of this retrospective study was to evaluate the medium-term results of autologous osteochondral graft for focal contained articular cartilage defects of the knee in 25 patients with 26 knees with 2- to 7-year follow-up. Patients and Methods:. The cohort consisted of 17 men and 8 women with an average age of 31.3 ± 11.8 (range 20 to 65) years. One patient had bilateral knees. The diagnosis included 9 osteonecrosis, 10 osteochondritis dessicans, and 7 traumatic defects. A 1.0 mm oversized 10 mm long ossteochondral plug was harvested from either from the sulcus terminalis or the intercondylar notch, and implanted into the recipient site The numbers of osteochondral plug ranged from 1 to 3. In larger lesions, osteochondral grafts were implanted in the weight bearing area, and microfracture in non-weight bearing area. Postoperative management included crutch walking with non-weight bearing for 6 weeks, then partial weight bearing for another 6 weeks before full weight bearing. Range of knee motion, quadriceps and hamstring strengthening exercises were encouraged. The evaluations included functional assessment, radiograph of the knee and second look arthroscopy. Results:. At follow-up of 52.9 ± 20.3 (range 25 to 84) months, the results were 50% excellent, 35% good, 11% fair and 4% poor. Overall satisfactory results were noted in 85%. The improvements in pain and function of the knee ranged from 8 to 16 weeks after surgery. There was no correlation of the clinical results with the diagnosis of the lesion. However, the