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Our aim was to assess the use of intra-operative fluoroscopy
in the assessment of the position of the tibial tunnel during reconstruction
of the anterior cruciate ligament (ACL). Between January and June 2009 a total of 31 arthroscopic hamstring
ACL reconstructions were performed. Intra-operative fluoroscopy
was introduced (when available) to verify the position of the guidewire
before tunnel reaming. It was only available for use in 20 cases,
due to other demands on the radiology department. The tourniquet
times were compared between the two groups and all cases where radiological
images lead to re-positioning of the guide wire were recorded. The
secondary outcome involved assessing the tibial interference screw
position measured on post-operative radiographs and comparing with
the known tunnel position as shown on intra-operative fluoroscopic
images.Objectives
Methods
This study aimed to investigate time-dependent gene expression
of injured human anterior cruciate ligament (ACL), and to evaluate
the histological changes of the ACL remnant in terms of cellular
characterisation. Injured human ACL tissues were harvested from 105 patients undergoing
primary ACL reconstruction and divided into four phases based on
the period from injury to surgery. Phase I was <
three weeks,
phase II was three to eight weeks, phase III was eight to 20 weeks,
and phase IV was ≥ 21 weeks. Gene expressions of these tissues were
analysed in each phase by quantitative real-time polymerase chain
reaction using selected markers (collagen types 1 and 3, biglycan,
decorin, α-smooth muscle actin, IL-6, TGF-β1, MMP-1, MMP-2 and TIMP-1).
Immunohistochemical staining was also performed using primary antibodies
against CD68, CD55, Stat3 and phosphorylated-Stat3 (P-Stat3). Objectives
Methods
Femoroacetabular impingement (FAI) causes pain
and chondrolabral damage via mechanical overload during movement
of the hip. It is caused by many different types of pathoanatomy,
including the cam ‘bump’, decreased head–neck offset, acetabular
retroversion, global acetabular overcoverage, prominent anterior–inferior
iliac spine, slipped capital femoral epiphysis, and the sequelae
of childhood Perthes’ disease. Both evolutionary and developmental factors may cause FAI. Prevalence
studies show that anatomic variations that cause FAI are common
in the asymptomatic population. Young athletes may be predisposed
to FAI because of the stress on the physis during development. Other
factors, including the soft tissues, may also influence symptoms and
chondrolabral damage. FAI and the resultant chondrolabral pathology are often treated
arthroscopically. Although the results are favourable, morphologies
can be complex, patient expectations are high and the surgery is
challenging. The long-term outcomes of hip arthroscopy are still
forthcoming and it is unknown if treatment of FAI will prevent arthrosis.
The Kaplan-Meier estimation is widely used in orthopedics to
calculate the probability of revision surgery. Using data from a
long-term follow-up study, we aimed to assess the amount of bias
introduced by the Kaplan-Meier estimator in a competing risk setting. We describe both the Kaplan-Meier estimator and the competing
risk model, and explain why the competing risk model is a more appropriate
approach to estimate the probability of revision surgery when patients
die in a hip revision surgery cohort. In our study, a total of 62 acetabular
revisions were performed. After a mean of 25 years, no patients
were lost to follow-up, 13 patients had undergone revision surgery
and 33 patients died of causes unrelated to their hip.Objectives
Methods
Numerous complications following total knee replacement (TKR)
relate to the patellofemoral (PF) joint, including pain and patellar
maltracking, yet the options for A total of three knees with end-stage osteoarthritis and three
knees that had undergone TKR at more than one year’s follow-up were
investigated. In each knee, sequential biplane radiological images
were acquired from the sagittal direction (i.e. horizontal X-ray
source and 10° below horizontal) for a sequence of eight flexion
angles. Three-dimensional implant or bone models were matched to
the biplane images to compute the six degrees of freedom of PF tracking
and TF kinematics, and other clinical measures.Objectives
Methods
Pathological fractures in children can occur
as a result of a variety of conditions, ranging from metabolic diseases and
infection to tumours. Fractures through benign and malignant bone
tumours should be recognised and managed appropriately by the treating
orthopaedic surgeon. The most common benign bone tumours that cause pathological
fractures in children are unicameral bone cysts, aneurysmal bone
cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological
fractures through a primary bone malignancy are rare, these should
be recognised quickly in order to achieve better outcomes. A thorough
history, physical examination and review of plain radiographs are
crucial to determine the cause and guide treatment. In most benign
cases the fracture will heal and the lesion can be addressed at
the time of the fracture, or after the fracture is healed. A step-wise
and multidisciplinary approach is necessary in caring for paediatric
patients with malignancies. Pathological fractures do not have to
be treated by amputation; these fractures can heal and limb salvage
can be performed when indicated.
