Tendinopathy is a debilitating musculoskeletal
condition which can cause significant pain and lead to complete rupture
of the tendon, which often requires surgical repair. Due in part
to the large spectrum of tendon pathologies, these disorders continue
to be a clinical challenge. Animal models are often used in this
field of research as they offer an attractive framework to examine
the cascade of processes that occur throughout both tendon pathology and
repair. This review discusses the structural, mechanical, and biological
changes that occur throughout tendon pathology in animal models,
as well as strategies for the improvement of tendon healing. Cite this article:
This study compared the quality of reduction
and complication rate when using a standard ilioinguinal approach and
the new pararectus approach when treating acetabular fractures surgically.
All acetabular fractures that underwent fixation using either approach
between February 2005 and September 2014 were retrospectively reviewed
and the demographics of the patients, the surgical details and complications
were recorded. A total of 100 patients (69 men, 31 women; mean age 57 years,
18 to 93) who were consecutively treated were included for analysis.
The quality of reduction was assessed using standardised measurement
of the gaps and steps in the articular surface on pre- and post-operative
CT-scans. There were no significant differences in the demographics of
the patients, the surgical details or the complications between
the two approaches. A significantly better reduction of the gap,
however, was achieved with the pararectus approach (axial: p = 0.025,
coronal: p = 0.013, sagittal: p = 0.001). These data suggest that the pararectus approach is at least equal
to, or in the case of reduction of the articular gap, superior to
the ilioinguinal approach. This approach allows direct buttressing of the dome of the acetabulum
and the quadrilateral plate, which is particularly favourable in
geriatric fracture patterns. Cite this article:
The interaction between the lumbosacral spine
and the pelvis is dynamically related to positional change, and
may be complicated by co-existing pathology. This review summarises
the current literature examining the effect of sagittal spinal deformity
on pelvic and acetabular orientation during total hip arthroplasty
(THA) and provides recommendations to aid in placement of the acetabular
component for patients with co-existing spinal pathology or long
spinal fusions. Pre-operatively, patients can be divided into four
categories based on the flexibility and sagittal balance of the
spine. Using this information as a guide, placement of the acetabular
component can be optimal based on the type and significance of co-existing
spinal deformity. Cite this article:
We report the clinical outcome and findings at
second-look arthroscopy of 216 patients (mean age 25 years (11 to 58))
who underwent anterior cruciate ligament (ACL) reconstruction or
augmentation. There were 73 single-bundle ACL augmentations (44
female, 29 male), 82 double-bundle ACL reconstructions (35 female,
47 male), and 61 single-bundle ACL reconstructions (34 female, 27
male). In 94 of the 216 patients, proprioceptive function of the knee
was evaluated before and 12 months after surgery using the threshold
to detect passive motion test. Second-look arthroscopy showed significantly better synovial
coverage of the graft in the augmentation group (good: 60 (82%),
fair: 10 (14%), poor: 3 (4%)) than in the other groups (p = 0.039).
The mean side-to-side difference measured with a KT-2000 arthrometer
was 0.4 mm (-3.3 to 2.9) in the augmentation group, 0.9 mm (-3.2
to 3.5) in the double-bundle group, and 1.3 mm (-2.7 to 3.9) in
the single-bundle group: the result differed significantly between
the augmentation and single-bundle groups (p = 0 .013). No significant
difference in the Lysholm score or pivot-shift test was seen between
the three groups (p = 0.09 and 0.65, respectively). In patients
with good synovial coverage, three of the four measurements used
revealed significant improvement in proprioceptive function (p = 0.177,
0.020, 0.034, and 0.026). We conclude that ACL augmentation is a reasonable treatment option
for patients with favourable ACL remnants. Cite this article:
The aim of this study was to examine whether asymmetric loading
influences macrophage elastase (MMP12) expression in different parts
of a rat tail intervertebral disc and growth plate and if MMP12
expression is correlated with the severity of the deformity. A wedge deformity between the ninth and tenth tail vertebrae
was produced with an Ilizarov-type mini external fixator in 45 female
Wistar rats, matched for their age and weight. Three groups were
created according to the degree of deformity (10°, 30° and 50°).
A total of 30 discs and vertebrae were evaluated immunohistochemically
for immunolocalisation of MMP12 expression, and 15 discs were analysed
by western blot and zymography in order to detect pro- and active
MMP12.Objectives
Methods
This study compares the outcomes of two methods
of fixation of displaced fractures of the radial neck. The 58 patients
with a mean age of 38.5 years (18 to 56), were treated in a non
randomised study with screws (n = 29) or a plate and screws (n =
29) according to the surgeon’s preference. The patients were reviewed at one year. Radiographs and functional
evaluations were carried out up to one year post-operatively, using
the Broberg and Morrey functional evaluation score, range of movement,
and assessment of complications. The mean functional scores did not differ significantly between
groups (90 (55 to 100) Cite this article:
A total of 20 patients with a depressed fracture
of the lateral tibial plateau (Schatzker II or III) who would undergo open
reduction and internal fixation were randomised to have the metaphyseal
void in the bone filled with either porous titanium granules or
autograft bone. Radiographs were undertaken within one week, after
six weeks, three months, six months, and after 12 months. The primary outcome measure was recurrent depression of the joint
surface: a secondary outcome was the duration of surgery. The risk of recurrent depression of the joint surface was lower
(p <
0.001) and the operating time less (p <
0.002) when titanium
granules were used. The indication is that it is therefore beneficial to use porous
titanium granules than autograft bone to fill the void created by
reducing a depressed fracture of the lateral tibial plateau. There
is no donor site morbidity, the operating time is shorter and the
risk of recurrent depression of the articular surface is less. Cite this article:
The Gamma nail is frequently used in unstable
peri-trochanteric hip fractures. We hypothesised that mechanical failure
of the Gamma nail was associated with inadequate proximal three-point
fixation. We identified a consecutive series of 299 Gamma nails
implanted in 299 patients over a five-year period, 223 of whom fulfilled
our inclusion criteria for investigation. The series included 61
men and 162 women with a mean age of 81 years (20 to 101). Their fractures
were classified according to the Modified Evans’ classification
and the quality of fracture reduction was graded. The technical
adequacy of three points of proximal fixation was recorded from
intra-operative fluoroscopic images, and technical inadequacy for
each point was defined. All patients were followed to final follow-up
and mechanical failures were identified. A multivariate statistical
analysis was performed, adjusting for confounders. A total of 16
failures (7.2%) were identified. The position of the lag screw relative
to the lateral cortex was the most important point of proximal fixation,
and when inadequate the failure rate was 25.8% (eight of 31: odds
ratio 7.5 (95% confidence interval 2.5 to 22.7), p <
0.001). Mechanical failure of the Gamma nail in peri-trochanteric femoral
fractures is rare (<
1%) when three-point proximal fixation is
achieved. However, when proximal fixation is inadequate, failure
rates increase. The strongest predictor of failure is positioning
the lateral end of the lag screw short of the lateral cortex. Adherence
to simple technical points minimises the risk of fixation failure
in this vulnerable patient group. Cite this article:
The August 2013 Foot &
Ankle Roundup360 looks at: mobility, ankles and fractures; hindfoot nailing: not such a bad option after all?; little treatment benefit for blood injection in tendonitis; fixed bearing ankles successful in the short term; hindfoot motion following STAR ankle replacement; minimally invasive calcaneal fracture fixation?; pes planus in adolescents; and subluxing peroneals and groove deepening
We describe the technique and results of medial
submuscular plating of the femur in paediatric patients and discuss its
indications and limitations. Specifically, the technique is used
as part of a plate-after-lengthening strategy, where the period
of external fixation is reduced and the plate introduced by avoiding
direct contact with the lateral entry wounds of the external fixator
pins. The technique emphasises that vastus medialis is interposed
between the plate and the vascular structures. A total of 16 patients (11 male and five female, mean age 9.6
years (5 to 17)), had medial submuscular plating of the femur. All
underwent distraction osteogenesis of the femur with a mean lengthening
of 4.99 cm (3.2 to 12) prior to plating. All patients achieved consolidation
of the regenerate without deformity. The mean follow-up was 10.5 months
(7 to 15) after plating for those with plates still Placing the plate on the medial side is advantageous when the
external fixator is present on the lateral side, and is biomechanically
optimal in the presence of a femoral defect. We conclude that medial
femoral submuscular plating is a useful technique for specific indications
and can be performed safely with a prior understanding of the regional
anatomy. Cite this article:
The April 2015 Research Roundup360 looks at: MCID in grip strength and distal radial fracture; Experiencing rehab in a trial setting; Electrical stimulation and nerve recovery; Molecular diagnosis of TB?; Acetabular orientation: component and arthritis; Analgesia after knee arthroplasty; Bisphosphonate-associated femoral fractures
The June 2014 Wrist &
Hand Roundup360 looks at: aart throwing not quite as we thought; two-gear, four-bar linkage in the wrist?; assessing outcomes in distal radial fractures; gold standard Swanson’s?; multistrand repairs of unclear benefit in flexor tendon release; for goodness’ sake, leave the thumb alone in scaphoid fractures; horizons in carpal tunnel surgery; treading the Essex-Lopresti tightrope; wrist replacement in trauma? and radial shortening reliable in the long term for Kienbock’s disease
The aim of this study was to evaluate the ten-year
clinical and functional outcome of hip resurfacing and to compare it
with that of cementless hip arthroplasty in patients under the age
of 55 years. Between 1999 and 2002, 80 patients were enrolled into the study:
24 were randomised (11 to hip resurfacing, 13 to total hip arthroplasty),
18 refused hip resurfacing and chose cementless total hip arthroplasty
with a 32 mm bearing, and 38 insisted on resurfacing. The mean follow-up
for all patients was 12.1 years (10 to 14). Patients were assessed clinically and radiologically at one year,
five years and ten years. Outcome measures included EuroQol EQ5D,
Oxford, Harris hip, University of California Los Angeles and University
College Hospital functional scores. No differences were seen between the two groups in the Oxford
or Harris hip scores or in the quality of life scores. Despite a
similar aspiration to activity pre-operatively, a higher proportion
of patients with a hip resurfacing were running and involved in
sport and heavy manual labour after ten years. We found significantly higher function scores in patients who
had undergone hip resurfacing than in those with a cementless hip
arthroplasty at ten years. This suggests a functional advantage
for hip resurfacing. There were no other attendant problems. Cite this article:
The restoration of knee alignment is an important
goal during total knee arthroplasty (TKA). In the past surgeons aimed
to restore neutral limb alignment during surgery. However, previous
studies have demonstrated alignment to be dynamic, varying depending
on the position of the limb and the degree of weight-bearing, and
between patients. We used a validated computer navigation system
to measure the femorotibial mechanical angle (FTMA) in 264 knees in
77 male and 55 female healthy volunteers aged 18 to 35 years (mean
26.2). We found the mean supine alignment to be a varus angle of
1.2° (standard deviation ( Knee alignment is different in different individuals and is dynamic
in nature, changing with different postures. This may have implications
for the assessment of alignment in TKA, which is achieved in non-weight-bearing conditions
and which may not represent the situation observed during weight-bearing. Cite this article:
The April 2014 Hip & Pelvis Roundup360 looks at: Recent arthroplasty and flight; whether that squeak could be a fracture; diagnosing early infected hip replacement; impaction grafting at a decade; whether squeaking is more common than previously thought; femoral offset associated with post THR outcomes; and periprosthetic fracture stabilisation.
We measured the tension in the interosseous membrane
in six cadaveric forearms using an Cite this article:
Unlinked, linked and convertible total elbow
arthroplasties (TEAs) are currently available. This study is the
first to report the clinical results of the convertible Latitude
TEA. This was a retrospective study of a consecutive cohort of 63
patients (69 primary TEAs) with a mean age of 60 years (23 to 87).
Between 2006 and 2008 a total of 19 men and 50 women underwent surgery.
The mean follow-up was 43 months (8 to 84). The range of movement,
function and pain all improved six months post-operatively and either
continued to improve slightly or reached a plateau thereafter. The
complication rate is similar to that reported for other TEA systems.
No loosening was seen. Remarkable is the disengagement of the radial
head component in 13 TEAs (31%) with a radial head component implanted. Implantation of both the linked and the unlinked versions of
the Latitude TEA results in improvement of function and decreased
pain, and shows high patient satisfaction at mid-term follow-up. Cite this article:
The long-term survival of the cementless Spotorno
CLS femoral component in patients aged >
50 years at the time of
arthroplasty was investigated. Survivorship analysis of a consecutive
series of 85 patients (100 hips; under 50 years of age at a mean
follow-up of 18.4 years (16.3 to 20.8)) was performed. The clinical
and radiographic outcomes were satisfactory. The overall rate of
survival of the femoral component was 93.5% (95% confidence interval
(CI), 90.9 to 96.1) after 19 years. Survival with revision for aseptic
loosening as the end point was 95.7% (95% CI 93.6 to 97.8%) at 19
years. This study demonstrates an excellent long-term survival of the
Spotorno CLS femoral component after 16 to 20 years in young patients
undergoing total hip arthroplasty. Cite this article:
The February 2015 Spine Roundup360 looks at: Paracetamol use for lower back pain; En-bloc resection of vertebra reported for the first time; Spinopelvic disassociation under the spotlight; Hope for back pain; Disc replacement and ACDF equivalent in randomised study; Interspinous process devices ineffective
Damage to the cartilage of the distal radioulnar
joint frequently leads to pain and limitation of movement, therefore repair
of this joint cartilage would be highly desirable. The purpose of
this study was to investigate the fixation of scaffold in cartilage
defects of this joint as part of matrix-assisted regenerative autologous
cartilage techniques. Two techniques of fixation of collagen scaffolds,
one involving fibrin glue alone and one with fibrin glue and sutures, were
compared in artificially created cartilage defects of the distal
radioulnar joint in a human cadaver. After being subjected to continuous
passive rotation, the methods of fixation were evaluated for cover
of the defect and pull out force. No statistically significant differences were found between the
two techniques for either cover of the defect or integrity of the
scaffold. However, a significantly increased mean pull out force
was found for the combined procedure, 0.665 N (0.150 to 1.160) This suggests that although successful fixation of a collagen
type I/III scaffold in a distal radioulnar joint cartilage defect
is feasible with both forms of fixation, fixation with glue and
sutures is preferable. Cite this article: