Osteochondral defects (OCDs) of the talus are treated initially by arthroscopic bone marrow stimulation. For both large and secondary defects, current alternative treatment methods have disadvantages such as donor site morbidity or two-stage surgery. Demineralized bone matrix (DBM) was published for the treatment of OCDs of rabbit knees. Autologous platelet-rich plasma (PRP) may improve the treatment effect of DBM. We previously developed a goat model to investigate new treatment methods for OCDs of the talus. The aim of the current study was to test whether DBM leads to more bone regeneration than control OCDs, and whether PRP improves the effectiveness of DBM. A standardized 6-mm OCD was created in 32 ankles of 16 adult Dutch milk goats. According to a randomized schedule, 8 goats were treated with commercially available DBM (Bonus DBM, Biomet BV, Dordrecht, the Netherlands) hydrated with normal saline, and 8 were treated with the same DBM but hydrated with autologous PRP (DBM+PRP). The contralateral ankles (left or right) were left untreated and served as a control. The goats were sacrificed after 24 weeks and the tali were excised. The articular talar surfaces were assessed macroscopically using the international cartilage repair society (ICRS) cartilage repair assessment, with a maximum score of 12. Histologic analysis was performed using 5-μm sections, and histomorphometric parameters (bone% and osteoid%) were quantified on representative areas of the surface, center, and peripheral areas of the OCDs. Furthermore, μCT-scans of the excised tali were obtained, quantifying the bone volume fraction, trabecular number, trabecular thickness, and trabecular spacing in both the complete OCDs and the central 3-mm cylinders.Introduction
Methods
Osteochondral talar defects (OCDs) are sometimes located so far posteriorly that they may not be accessible by anterior arthroscopy, even with the ankle joint in full plantar flexion, because the talar dome is covered by the tibial plafond. It was hypothesized that computed tomography (CT) of the ankle in full plantar flexion could be useful for preoperative planning. The dual purpose of this study was, firstly, to test whether CT of the ankle joint in full plantar flexion is a reliable tool for the preoperative planning of anterior ankle arthroscopy for OCDs, and, secondly, to determine the area of the talar dome that can be reached by anterior ankle arthroscopy. In this prospective study, CT-scans with sagittal reconstructions were made of 46 consecutive patients with their affected ankle in full plantar flexion. In the first 20, the distance between the anterior border of the OCD and the anterior tibial plafond was measured both on the scans and during anterior ankle arthroscopy as the gold standard. Intra- and interobserver reliability of CT as well as agreement between CT and arthroscopy were assessed by intraclass correlation coefficients (ICCs) and a Bland and Altman graph. Next, the anterior and posterior borders of the talar dome as well as the anterior tibial plafond were marked on all 46 scans. Using a specially written computer routine, the anterior proportion of the talar dome not covered by the tibial plafond was calculated, both lateral and medial, indicating the accessible area.PURPOSE
METHODS
It has been suggested that a supramalleolar osteotomy can return the load distribution in the ankle joint to normal. However, due to the lack of biomechanical data, this supposition remains empirical. The purpose of this biomechanical study was to determine the effect of simulated supramalleolar varus and valgus alignment on the tibiotalar joint pressure, in order to investigate its relationship to the development of osteoarthritis. We also wished to establish the rationale behind corrective osteotomy of the distal tibia. We studied 17 cadaveric lower legs and quantified the changes in pressure and force transfer across the tibiotalar joint for various degrees of varus and valgus deformity in the supramalleolar area. We assumed that a supramalleolar osteotomy which created a varus deformity of the ankle would result in medial overload of the tibiotalar joint. Similarly, we thought that creating a supramalleolar valgus deformity would cause a shift in contact towards the lateral side of the tibiotalar joint. The opposite was observed. The restricting role of the fibula was revealed by carrying out an osteotomy directly above the syndesmosis. In end-stage ankle osteoarthritis with either a valgus or varus deformity, the role of the fibula should be appreciated and its effect addressed where appropriate.
New concepts in plate fixation have led to an evolution in plate design for olecranon fractures. The purpose of this study was
to compare the stiffness and strength of a contoured Locking Compression Plate (LCP) with a conventional plating method (one-third tubular plate) in a cadaveric comminuted olecranon fracture model with standardized osteotomy, and to evaluate the LCP fixation method in a prospectively included group of patients with complex olecranon fractures using validated outcome scores. In the biomechanical study, five matched pairs of cadaveric elbows were randomly assigned for fixation by either LCP or a conventional plating method. Specimens were mounted to a custom-made testing bench and subjected to cyclic loading until failure occurred while measuring gapping at the osteotomy site. In the clinical study, twenty-one patients treated with LCP for complex olecranon fractures had a mean follow up of 20 months (3–39 months) and functional and patient rated outcome were evaluated. In the biomechanical study, there was no significant difference in fixation stiffness and strength between one third tubular plating and LCP (p >
0.05). In the clinical study, the mean time to union of the fracture was 6 months (2–28 months). According to the Mayo Elbow Performance Index (MEPI) most patients had a good or excellent outcome. No patients reported difficulty with activities of daily living. Physical capacity showed minimal loss of stability and strength. Six patients had their hardware removed. Technical ease of application and advantageous features of the LCP -such as unicortical screw fixation and improved holding power in osteopenic bone- make it a good alternative implant for comminuted olecranon fractures.
1) To describe the inter reviewer agreement of a previously designed scoring scheme to rate abstracts submitted for presentation at the Dutch Orthopedic Association. 2) To test if quality of reporting of submitted abstracts increased in the years after the introduction of the scoring scheme. 3) To examine if a review process with a larger workload had lower inter rater agreement.
1) younger age, particularly age between 36 and 45 years, 2) experience of less than 10 years, 3) having a PhD degree, and 4) working in an academic or teaching setting. The majority of the respondents (65%) were aware of the Journal’s evidence-based medicine section, and 20% used the Journal’s evidence-based medicine abstracts in clinical decision-making. This increased awareness in evidence-based medicine was also reflected in a frequent use of Cochrane reviews in clinical decision-making (27%). Surgeons who used the Journal’s evidence-based medicine abstracts and Cochrane reviews had significantly higher competence scores.
We have quantitatively documented the insertion geometry of the main stabilising structures of the posterolateral corner of the knee in 34 human cadavers. The lateral collateral ligament inserted posterior (4.6 mm, The ligaments had a consistent pattern of insertion and, despite the variation between specimens, the standard deviations were less than the typical size of drill hole used in reconstruction of the posterolateral corner. The data provided in this study can be used in the anatomical repair and reconstruction of this region of the knee.
