Aims. In the native hip, the hip capsular
Abstract. Objectives. The study aims to determine whether an arthroscopic
Aims. The Chopart joint complex is a joint between the midfoot and hindfoot. The static and dynamic support system of the joint is critical for maintaining the medial longitudinal arch of the foot. Any dysfunction leads to progressive collapsing flatfoot deformity (PCFD). Often, the tibialis posterior is the primary cause; however, contrary views have also been expressed. The present investigation intends to explore the comprehensive anatomy of the support system of the Chopart joint complex to gain insight into the cause of PCFD. Methods. The study was conducted on 40 adult embalmed cadaveric lower limbs. Chopart joint complexes were dissected, and the structures supporting the joint inferiorly were observed and noted. Results. The articulating bones exhibit features like a cuboid shelf and navicular beak, which appear to offer inferior support to the joint. The expanse of the spring
Aims. Triplane ankle fractures are complex injuries typically occurring in children aged between 12 and 15 years. Classic teaching that closure of the physis dictates the overall fracture pattern, based on studies in the 1960s, has not been challenged. The aim of this paper is to analyze whether these injuries correlate with the advancing closure of the physis with age. Methods. A fracture mapping study was performed in 83 paediatric patients with a triplane ankle fracture treated in three trauma centres between January 2010 and June 2020. Patients aged younger than 18 years who had CT scans available were included. An independent Paediatric Orthopaedic Trauma Surgeon assessed all CT scans and classified the injuries as n-part triplane fractures. Qualitative analysis of the fracture pattern was performed using the modified Cole fracture mapping technique. The maps were assessed for both patterns and correlation with the closing of the physis until consensus was reached by a panel of six surgeons. Results. Fracture map grouped by age demonstrates that, regardless of age (even at the extremes of the spectrum), the fracture lines consolidate in a characteristic Y-pattern, and no shift with closure of the physis was observed. A second fracture map with two years added to female age also did not show a shift. The fracture map, grouped by both age and sex, shows a Y-pattern in all different groups. The fracture lines appear to occur between the anterior and posterior inferior tibiofibular
Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar
Aims. The optimal procedure for the treatment of ossification of the posterior longitudinal
Aims. Surgical approaches that claim to be minimally invasive, such as the direct anterior approach (DAA), are reported to have a clinical advantage, but are technically challenging and may create more injury to the soft-tissues during joint exposure. Our aim was to quantify the effect of soft-tissue releases on the joint torque and femoral mobility during joint exposure for hip resurfacing performed via the DAA. Methods. Nine fresh-frozen hip joints from five pelvis to mid-tibia cadaveric specimens were approached using the DAA. A custom fixture consisting of a six-axis force/torque sensor and motion sensor was attached to tibial diaphysis to measure manually applied torques and joint angles by the surgeon. Following dislocation, the torques generated to visualize the acetabulum and proximal femur were assessed after sequential release of the joint capsule and short external rotators. Results. Following initial exposure, the ischiofemoral
Aims. Paediatric triplane fractures and adult trimalleolar ankle fractures both arise from a supination external rotation injury. By relating the experience of adult to paediatric fractures, clarification has been sought on the sequence of injury,
Introduction.
Aims. Mid-level constraint designs for total knee arthroplasty (TKA) are intended to reduce coronal plane laxity. Our aims were to compare kinematics and
Aims. The purpose of this study is to determine an individual’s age-specific prevalence of total knee arthroplasty (TKA) after cruciate
Abstract. Introduction. We present a case series of patients that underwent knee
Aims. Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing. Our aim was to report the results of a prospective study of arthroscopic suture of this
Modeling the kinetic effects of the soft tissue structures is a major challenge for dynamic simulation of knees and other joints. We describe a technique whereby a multi-fiber
Aims. This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology. Methods. Initial research questions were generated using an online survey sent to all 680 members of the British Association for Surgery of the Knee (BASK). Duplicates were removed and a longlist was generated from this scoping exercise by a panel of 13 experts from across the UK who provided oversight of the process. A modified Delphi process was used to refine the questions and determine a final list. To rank the final list of questions, each question was scored between one (low importance) and ten (high importance) in order to produce the final list. Results. This consensus exercise took place between December 2020 and April 2022. A total of 286 clinicians from the BASK membership provided input for the initial scoping exercise, which generated a list of 105 distinct research questions. Following review and prioritization, a longlist of 51 questions was sent out for two rounds of the Delphi process. A total of 42 clinicians responded to the first round and 24 responded to the second round. A final list of 24 research questions was then ranked by 36 clinicians. The topics included arthroplasty, infection, meniscus, osteotomy, patellofemoral, cartilage, and
Background. Supination-external rotation (SER) injuries make up 80% of all ankle fractures. SER stage 2 injuries (AITFL and Weber B) are considered stable. SER stage 3 injury includes disruption of the posterior malleolus (or PITFL). In SER stage 4 there is either medial malleolus fracture or deltoid injury too. SER 4 injuries have been considered unstable, requiring surgery. The deltoid
There is currently no commercially available and clinically successful treatment for scapholunate interosseous
Aims. Complete ruptures of the ulnar collateral
Purpose. We conducted a prospective study to investigate the role of the LARS
Objectives. Congenital cruciate
Poor availability of allografts in South Africa has led to an increased use of synthetic augmentation to stabilize knee joints in the treatment of knee dislocations. This study aims to evaluate multiligament knee injuries treated with a posterior cruciate
Introduction and Objective. The human body is designed to walk in an efficient way. As energy can be stored in elastic structures, it is no surprise that the strongest elastic structure of the human body, the iliofemoral
This study aims to create a novel computational workflow for frontal plane laxity evaluation which combines a rigid body knee joint model with a non-linear implicit finite-element model wherein collateral
We have assessed the clinical and radiological outcome of traumatic knee injuries resulting in open reconstruction of the posterior cruciate
This paper introduces a new biological material for the treatment and augmentation of
Aims. The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial
Being commonly missed in the clinical practice, Lisfranc injuries can lead to arthritis and long-term complications. There are controversial opinions about the contribution of the main stabilizers of the joint. Moreover, the role of the
Introduction. To determine if elite athletes can return to professional sport after MCL or posterolateral (PLC) reconstruction using LARS
The pattern of injury to the carpal
Acromioclavicular joint injuries are one of the most common injuries in the shoulder girdle complex. Surgical management is considered based on patient profile, level of activity, pain, and classification of injury. To date, a vast array of surgical techniques have been proposed and described in the literature, a possible reason being that the optimal solution is still uncertain. The aim of this study is to determine the efficacy of an alternative surgical technique. This study is a retrospective case series of 80 patients that have been operated by a single surgeon over a period of 6 years. A novel surgical technique, the ‘BiPOD method’, was applied where a synthetic artificial
Chronic lateral ankle instability (CLAI) is treated operatively, whereas acute ligament injury is usually treated nonoperatively. Such treatments have been widely validated. Apoptosis is known to cause
Aims. The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the
Abstract. Introduction. The aim of this study was to determine if elite athletes could return to professional sport after MCL or PLC reconstruction using LARS
Aims. To test the hypothesis that reseeded anterior cruciate ligament (ACL)-derived cells have a better ability to survive and integrate into tendon extracellular matrix (ECM) and accelerate the
Tendon and ligament injuries represent highly prevalent and unmet clinical challenge that may significantly benefit from tissue engineering therapeutic strategies, once optimal cell source and biomolecules regulating tendon homeostasis are properly defined. Herein, we aimed to evaluate the expression of tendon/
Introduction. The convincible wisdom is that the release of MCL in severe varus knee should be progressive. This release is usually carried on after resecting the osteophyte and gradually carried on until the MCL is well balanced. However, sometimes, extensive release and releasing the superficial MCL can lead to instability in flexion. On a personal communication with many Asian surgeons they have been doing a careful release of the posteromedial corner in the varus knee and in majority of cases such release is adequate. And even in severe cases of varus knee superficial MCL doesn't need to be released. 20 total knee replacements were performed by the same surgeon using ZimmerPS implant. In the varus deformity ranges from 15–35 degrees. The first bony section was made carefully. All osteophytes were removed and resected. The posterior bone osteophytes were also resected and the intercondylar notches were made along with the posterior release. After doing the bony cut in 18 of those cases the medial compartment was still tight and both flexion and extension. A careful release was carried in the postal medial corner-First using an osteotome around the posteromedial corner to release the soft tissue. After that the thick fibrous tissue that formed like pseudo meniscus was also resected until we were able to reach the posterior capsule. In some cases those scar tissues even extended to the capsule requiring the resecting of the postal medial capsule. We meticulously resected all those scar tissues and in many of those cases were able to visualize the MCL
Aims. The purpose was to evaluate early clinical, patient-reported, and radiological outcomes of the scapholunate
Objectives. Many in vitro studies have investigated the mechanism by which mechanical signals are transduced into biological signals that regulate bone homeostasis via periodontal
Poor soft tissue balance in total knee arthroplasty (TKA) is one of the most primary causes of dissatisfaction and reduced joint longevity, which are associated with postoperative instability and early implant failure. 1. Therefore, surgical techniques, including mechanical instruments and 3-D guided navigation systems, in TKA aim to achieve optimum soft tissue balancing in the knee to improve postoperative outcome. 2. Patella-in-Place balancing (PIPB) is a novel technique which aims to restore native collateral
Trapeziectomy with
Aims. Options for the treatment of intra-articular ligament injuries are limited, and insufficient
Aims. Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without posterior cruciate
Abstract. Objectives. The scapholunate interosseous
Aims. A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided
There is no consensus for the appropriate surgical management of chronic ulnar collateral
Ligaments and tendons are vital musculoskeletal soft tissues, which are commonly injured due to overuse and trauma. Their distinct functions are well known however their unique structure and biochemical composition and how they change with disease is poorly described. The most commonly injured
INTRODUCTION. Proper
Aims. The aim of this prospective study was to assess the long-term clinical, radiological, functional, and quality of life (QoL)-related outcome of patients treated with the synthetic
INTRODUCTION. Applying the proper amount of tension to knees collateral
Reconstruction of the anterior cruciate ligament (ACL) allows to restore stability of the knee, in order to facilitate the return to activity (RTA). Although it is understood that the tendon autograft undergoes a ligamentous transformation postoperatively, knowledge about longitudinal microstructural differences in tissue integrity between types of tendon autografts (ie, hamstring vs. patella) remains limited. Diffusion tensor imaging (DTI) has emerged as an objective biomarker to characterize the
We reviewed retrospectively 490 patellar
To compare posterior cruciate
Abstract. Cranial cruciate
Neer Type-IIB lateral clavicle fractures are inherently unstable fractures with associated disruption of the coracoclavicular (CC)
Background. Achieving good
Introduction. Chronic ankle instability is a common condition that can be effectively treated with arthroscopic lateral ankle
Objectives. The aim of this study was to investigate the biomechanical effect of the anterolateral
The extent of soft-tissue release and the exact structures that need to be released to correct deformity and balance the knee has been a controversial subject in primary total knee arthroplasty. Asian patients often present late and consequently may have profound deformities due to significant bone loss and contractures on the concave side, and stretching of the collateral
Background. The hip joint capsular
Alignment of total joint replacement in the valgus knee can be done readily with intramedullary alignment and hand-held instruments. Intramedullary alignment instruments usually are used for the femoral resection. The distal femoral surfaces are resected at a valgus angle of 5 degrees. A medialised entry point is advised because the distal femur curves toward valgus in the valgus knee, and the distal surface of the medial femoral condyle is used as reference for distal femoral resection. In the valgus knee, the anteroposterior axis is especially important as a reliable landmark for rotational alignment of the femoral surface cuts because the posterior femoral condyles are in valgus malalignment, and are unreliable for alignment. Rotational alignment of the distal femoral cutting guide is adjusted to resect the anterior and posterior surfaces perpendicular to the anteroposterior axis of the femur. In the valgus knee this almost always results in much greater resection from the medial than from the lateral condyle. Intramedullary alignment instruments are used to resect the proximal tibial surface perpendicular to its long axis. Like the femoral resection, resection of the proximal tibial surface is based on the height of the intact medial bone surface. After correction of the deformity,
Abstract. Optimal acetabular component position in Total Hip Arthroplasty is vital for avoiding complications such as dislocation and impingement, Transverse acetabular
Although multifunctional delivery systems can potentially improve safety and efficacy of therapeutic protein delivery in the biological treatment of injured tissues, ability to track and manipulate protein delivery systems in vivo to ensure localization at the treatment site is still a concern. We hypothesized that incorporating superparamagnetic iron oxide (SPIO) into calcium phosphate (CaP) coated β-tricalcium phosphate (β-TCP) microparticles would allow for Magnetic Resonance Imaging (MRI) based tracking in vivo and SPIO incorporation would not impact the biological activity of proteins delivered with these microparticles. To address the efficacy and limitations in therapeutic protein delivery, a CaP coated microparticle which incorporates superparamagnetic iron oxide (SPIO-CaP-MP) was created and used in a rat knee medial collateral
There have been differing descriptions of the
anterolateral structures of the knee, and not all have been named
or described clearly. The aim of this study was to provide a clear
anatomical interpretation of these structures. We dissected 40 fresh-frozen
cadaveric knees to view the relevant anatomy and identified a consistent
structure in 33 knees (83%); we termed this the anterolateral ligament
of the knee. This structure passes antero-distally from an attachment
proximal and posterior to the lateral femoral epicondyle to the
margin of the lateral tibial plateau, approximately midway between
Gerdy’s tubercle and the head of the fibula. The
Objectives. Unicompartmental knee arthroplasty (UKA) is one surgical option for treating symptomatic medial osteoarthritis. Clinical studies have shown the functional benefits of UKA; however, the optimal alignment of the tibial component is still debated. The purpose of this study was to evaluate the effects of tibial coronal and sagittal plane alignment in UKA on knee kinematics and cruciate
Aims. The aim of this study was to assess the effect of posterior cruciate
Despite of the high success of TKA, 20% of recipients remain dissatisfied with their surgery. There is an increasing discordance in the literature on what is an optimal goal for component alignment. Furthermore, the unique patient specific anatomical characteristics will also play a role. The dynamic characteristic of a TKR is a product of the complex interaction between a patient's individual anatomical characteristics and the specific alignment of the components in that patient knee joint. These interactions can be better understood with computational models. Our objective was to characterise
Introduction.
Ankle sprains have been shown to be the most common sports related injury. Ankle sprain may be classified into low ankle sprain or high ankle sprain. Low ankle sprain is a result of lateral
Purpose: At a time when total knee arthroplasty (TKA) with an ultra-congruent tibial plateau or a mobile plateau are advocated by many, the question is whether TKA with a fixed plateau preserving the posterior cruciate
Introduction. The knowledge of the right amount of tension of the collateral
Introduction. Cruciate retaining knee replacements are only implanted into patients with “healthy”
Aims. The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral
Most total knee prostheses are designed to have limited congruence between the femoral and tibial components to reduce constraint, based on the widely accepted principle that “constraint causes loosening”. Studies of the normal knee, however, indicate that stability under axial load occurs mostly by the geometric conformity of the surfaces. When moving in the plane of flexion-extension, the
In-situ assessment of collateral
Objectives. Ligaments which heal spontaneously have a healing process that
is similar to skin wound healing. Menopause impairs skin wound healing
and may likewise impair
Complete or partial disruption of the collateral
Introduction. Traditional treatment of idiopathic flatfoot in the adult population include calcaneal neck lengthening or fusions. These surgical methods result in abnormal function with significant complication rates. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring
Summary Statement. This study explores the therapeutic use of MSCs to enhance
Background. The anatomy of the human body has been studied for centuries. Despite this, recent articles have announced the presence of a new knee ligament- the anterolateral
Background. Return to sports after anterior cruciate ligament reconstruction (ACLR) is multifactorial and rotational stability is one of the main concerns. Anterolateral
Abstract. Introduction. Historic MCL reconstruction techniques focused on the superficial MCL to restore valgus stability while overlooking tibial external rotation and the deep MCL. This study assessed the ability of a contemporary medial collateral
Introduction. Joint mechanics and implant performance have been shown to be sensitive to
The meniscofemoral
The kinematic and kinetic characteristics of the knee after TKR are known to be strongly influenced by the alignment and positioning of the implanted components. In this paper we apply a virtual multi-fiber
We describe the clinical outcome of a technique of surgical augmentation of chronic massive tears of the rotator cuff using a polyester
Soft tissue balance is important for good clinical outcome and good stability after TKA.
Limited information is published regarding the activity level after gracilis autograft reconstruction, and usually a knee-injury based score is used rather than a specific ankle PROM. The purpose of this study was to investigate the activity level and functional results after lateral ankle gracilis autograft reconstruction in patients with severe lateral ankle instability. The hypothesis was that patients would regain their pre-injury Tegner activity level or one level below and secondary to compare a specific ankle activity score, instability and function score. Finally, donor site and graft complications, clinical stability and range of motion were measured. All 69 patients (50 women, 19 men) recorded at the hospital with severe instability who underwent reconstruction of the anterior talofibular and the calcaneofibular
Background. Despite the success of total knee arthroplasty (TKA) restoration of normal function is often not achieved. Soft-tissue balance is a major factor leading to poor outcomes including malalignment, instability, excessive wear, and subluxation. Mechanical
Purpose: The purpose of this work was to validate the most reliable technique for obtaining
Background. Despite the success of total knee arthroplasty (TKA) restoration of normal function is often not achieved. Soft tissue balance is a major factor for poor outcomes including malalignment, instability, excessive wear, and subluxation. Computer navigation and robotic-assisted systems have increased the accuracy of prosthetic component placement. On the other hand, soft tissue balancing remains an art, relying on a qualitative feel for the balance of the knee, and is developed over years of practice. Several instruments are available to assist surgeons in estimating soft tissue balance. However, mechanical devices only measure the joint space in full extension and at 90° flexion. Further, because of lack of comprehensive characterization of the
Correct alignment and
Introduction. Whether anterior referencing (AR) or posterior referencing (PR) are optimal to position and size the femoral component in Total Knee Arthroplasty (TKA) remains controversial. This controversy stems, in part, from a lack of understanding of whether one technique more consistently balances the medial/lateral collateral
Chronic
Prior implant designs have relied on a four-bar link theory and featured J-curve femoral components intended to recreate femoral rollback of the native knee, but this design could lead to anterior femoral sliding or paradoxical motion. Recent kinematic analyses of the native human knee have shown the medial compartment to be more stable to anteroposterior translation than the lateral, resulting in a “medial pivot” motion as the knee flexes. “Medial pivot” designs in total knee arthroplasty were introduced in the 1990s to attempt to re-create this motion. They consist of an asymmetric tibial insert with a highly congruent medial compartment and less conforming lateral compartment. The femoral component has a single radius of curvature and a high degree of conformity. In vivo fluoroscopic studies have shown medial pivot designs to be successful in achieving its intended motion, while other cruciate-retaining designs had a higher incidence of paradoxical anterior translation and lateral condylar lift-off. Furthermore, numerous investigations have shown medial pivot designs to have excellent outcomes and survivorship at up to 10 years post-operatively. However, the contention in this debate that medial pivot designs avoid the need for
Introduction. The trapezio-metacarpal joint (TMCJ) is subject to constant multiplanar forces and is stabilised by the bony anatomy and ligamentous structures.
The anterolateral
The consideration of the individual knee