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Background: Defining the optimal cutting plane for derotational osteotomy at the distal femur for correction of torsion in cases of patellofemoral instability is still challenging. This preliminary study investigates changes of frontal alignment by a simplified trigonometrical model and demonstrates a surgical guidance technique with the use of femur cadavers. The hypothesis was that regardless of midshaft bowing, a cutting plane perpendicular to the virtual anatomic shaft axis avoids unintended valgus malalignment due to derotation., Methods: A novel mathematical model, called the Pillar-Crane-Model, was developed to forecast changes on frontal alignment of the femur when a perpendicular cutting plane to the virtual anatomical shaft was chosen. As proof of concept, eight different torsion angles were assessed on two human cadaver femora (left and right). A single cut distal femoral osteotomy perpendicular to the virtual anatomical shaft was performed. Frontal plane alignment (mLDFA, aLDFA, AMA) was radiographically analyzed before and after rotation by 0°, 10°, 20°, and 30°. Measurements were compared to the model., Results: The trigonometrical equation from the Pillar-Crane-Model provides mathematical proof that slight changes into varus occur, seen by an increase in AMA and mLDFA, when the cutting plane is perpendicular to the virtual anatomical shaft axis. A table with standardized values is provided. Exemplarily, the specimens showed a mean increase of AMA from 4.8° to 6.3° and mLDFA from 85.2° to 86.7 after derotation by 30°. Throughout the derotation procedure, aLDFA remained at 80.4° ± 0.4°SD., Conclusions: With the use of this model for surgical guidance and anatomic reference, unintended valgus changes on frontal malalignment can be avoided. When the cutting plane is considered to be perpendicular to the virtual anatomical shaft from a frontal and lateral view, a slight increase of mLDFA results when a derotational osteotomy of the distal femur is performed.

Background: Medial tibial stress syndrome is one of the most common causes of exertional leg pain in runners whereas musculoskeletal tumors and tumor-like lesions are rare encounters in orthopedic sports medicine practice. Unicameral (simple) bone cyst is a well-known tumor-like lesions of the bone typically affecting children and adolescents. Bilateral occurrence is very rare though and has never been reported before in both tibiae. Failing to accurately diagnose a tumorous lesion can entail far-reaching consequences for both patients and physicians., Case Presentation: We report the case of large bilateral unicameral bone cysts of the diaphyseal tibiae mimicking medial tibial stress syndrome in a 17-year old professional athlete. This is the first report of symmetric tibial unicameral bone cysts in the literature. The patient complained about persisting shin splint-like symptoms over 5 months despite comprehensive conservative treatment before MRI revealed extensive osteolytic bone lesions in both diaphyseal tibiae. The patient-tailored, less-invasive surgical procedure, allowing the patient to return to his competitive sports level symptom-free 3 months after surgery and to eventually qualify for this years Biathlon Junior World Championships, is outlined briefly. Pathogenesis and various treatment options for this entity will be discussed., Conclusion: This report will help to raise awareness for musculoskeletal tumors as differential diagnosis for therapy-refractory symptoms in young athletes and encourage medical staff involved in sports medicine and athlete support to perform early high quality imaging and initiate sufficient surgical treatment in similar cases. Moreover, our less-invasive surgical procedure aiming for a fast return to sports might be an optimal compromise between traditional open curettage with low risk of recurrence and a soft tissue-saving and bone-sparing minimal-invasive technique.

Dexamethasone (DEX) is known to induce diabetes and dyslipidemia. We have compared fasting triacylglycerol and cholesterol concentrations across 20 lipoprotein fractions and glucose tolerance in control (standard diet) and DEX-treated 7-month-old males of two rat strains, Brown Norway (BN) and congenic BN.SHR-(Il6-Cd36)/Cub (BN.SHR4). These two inbred strains differ in a defined segment of chromosome 4, originally transferred from the spontaneously hypertensive rat (SHR) including the mutant Cd36 gene, a known target of DEX. Compared to BN, the standard-diet-fed BN.SHR4 showed higher cholesterol and triacylglycerol concentrations across many lipoprotein fractions, particularly in small VLDL and LDL particles. Total cholesterol was decreased by DEX by more than 21% in BN.SHR4 contrasting with the tendency to increase in BN (strain*DEX interaction p = 0.0017). Similar pattern was observed for triacylglycerol concentrations in LDL. The LDL particle size was significantly reduced by DEX in both strains. Also, while control BN and BN.SHR4 displayed comparable glycaemic profiles during oral glucose tolerance test, we observed a markedly blunted DEX induction of glucose intolerance in BN.SHR4 compared to BN. In summary, we report a pharmacogenetic interaction between limited genomic segment with mutated Cd36 gene and dexamethasone-induced glucose intolerance and triacylglycerol and cholesterol redistribution into lipoprotein fractions.