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Aseptic loosening from implant-associated osteolysis in reverse shoulder arthroplasty (RSA) may contribute to premature implant failure. Although articular side polyethylene (PE) damage has been well documented in the literature, no studies to date have investigated backside wear in RSA. The aims of this investigation were to (1) document and compare the damage between the backside and articular surface in explanted RSA components, (2) assess whether certain quadrants have a greater propensity for damage, and (3) report the most common mode(s) of backside PE damage.Twenty-one RSA humeral liners retrieved during revision procedures between 2005 and 2014 were included for analysis. The mean time between implantation and extraction was 16 months (10 days-88 months). Diagnoses at the time of revision included dislocation (10), infection (4), mechanical failure (3), loosening (2), and unknown (2). Liners were examined under light microscopy (×10-30 magnification) and damage on the articular and backside of the liner surface was graded using the modified Hood score. The location and damage modality were compared between the articular side and backside of the implant.Damage was noted on the articular surfaces of all 21 liners and on the backside surface of 20 liners. The total damage in all the quadrants was higher on the articular surface than on the backside of the component, with a mean difference in total quadrant damage scores of 11.74 ± 3.53 (P.001). There was no difference in damage among the quadrants on the backside (P = .44) or the articular surface (P = .08). The articular side exhibited greater scratching, abrasion, and surface deformation than the backside (P.001).This short-term retrieval study demonstrated that backside PE damage occurs on the humeral component of RSA implants. There was greater damage to the articular side of the liner but wear to the backside was present in almost all liners. The clinical importance of backside wear in RSA and its overall contribution to PE particulate disease and osteolysis needs further investigation.

The aim of this study was to compare the closed reduction interfragmentary pinning method (IPM) with the extension block technique (EBT) for bony mallet finger. Patients who underwent mallet finger operations were screened retrospectively for the following inclusion criteria: Doyle type 4c, age between 18 and 75 years, less than 4 weeks to surgery, and more than 1 year of follow-up time. Group I underwent a closed reduction IPM, and group II underwent the EBT. Lateral radiographs taken during the preoperative and final examination were used to evaluate the size and amount of displacement from the distal interphalangeal (DIP) joint and the dorsal fragment as well as the articular surface. Operation times were compiled from patient records. During the final examination, pain and DIP joint range of motion (ROM) were assessed and complications were recorded. The Crawford criteria were used for functional results. Fifteen patients in group I (8 men, 7 women) and 17 patients in group II (10 men, 7 women) were evaluated. Age, gender, time to surgery and follow-up time showed no statistically significant differences between the two groups. The differences in fragment size, preoperative and postoperative joint displacement, amount of dorsal displacement and DIP joint ROM were not statistically significant between the two groups. However, the operation time was significantly shorter time in group I than in group II (p=0.000). The average time to fracture union was significantly longer in group I (7.3 weeks) than in group II (6 weeks) (p=0.013). The EBT has faster time to union and is a safer method with lesser risk of arthritis and fragmentation. The IPM can be an alternative with shorter operation time, less pin bed infection and nail bed damage, especially in Doyle type 4c cases with large fragments.

We report a case of posttraumatic ulnar translocation of the carpus, which resulted after a fall from a six-foot ladder. This patient presented with multiple injuries to the skull bones, face, and limbs. A diagnosis of ulnar translocation of the carpus was missed on initial radiographs. Ulnar translocations require a high clinical index of suspicion and should be considered in the context of any high-impact injury to the wrist. A volar fleck just distal to the radial articular surface represents evidence of ligamentous disruption and should alert physicians that a more severe injury may be present. Nonsurgical and surgical treatment options are reviewed.

Polyvinyl alcohol hydrogel synthetic cartilage implants are increasingly used to treat advanced Freiberg disease. We report a case with recurrence of symptoms within 6 weeks and required revision for fracture of the implant. We describe a revision technique with modified osteochondral bone graft to deal with the variables of revision surgery namely: the bone loss, collateral ligament insufficiency, and changes to the proximal phalanx articular surface. We describe a postoperative plan, recovery and a good outcome achieved in 12 month follow-up.

Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14–20) and a mean follow-up of 34 ± 12 months (range: 17–57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16–28) to a post-operative median of 29 (range: 26–30) (P = 0.005). This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.

Background Extended curettage has increasingly become the preferred treatment for giant cell tumour of bone (GCTB), but the high recurrence rate after curettage poses a major challenge for orthopaedic surgeons. Computed tomography (CT) is valuable in the evaluation of GCTB. Our aim was to identify specific features of GCTB around the knee in pre-operative CT images that might have prognostic value for local recurrence. Methods We retrospectively analyzed data from 124 patients with primary GCTB around the knee who underwent extended curettage from 2010 through 2019. We collected demographic, clinical, and therapeutic data along with several CT-derived tumour characteristics. CT-derived tumor characteristics included tumour size, the distance between the tumour edge and articular surface (DTA), and destruction of posterior cortical bone (DPC). Akaike information criterion (AIC) was used to select which variables to enter into multivariate logistic regression models and to determine significant factors affecting recurrence. Results The total recurrence rate was 21.0% (26/124), and the average follow-up time was 69.5 ± 31.2 months (24–127 months). Age, DTA ( Conclusion Identifying certain features of GCTB around the knee on CT has prognostic value for patients treated with extended curettage. A three-factor model predicts tumour recurrence well after extended curettage.

Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane’s angle and Bohler’s angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type I and Type IV are significantly severer than Type II (P ). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P ). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II (7.65 ± 1.38 cm2) and IV (7.81 ± 1.74 cm2) (P ). Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P ). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P ). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence Level III, retrospective comparative study.

The purpose of this cadaveric study is to assess the talar articular surface visible through a modified posterior medial approach to the ankle joint for talar osteochondral defects. Ten fresh frozen cadaveric specimens were included. The talar surface area was outlined utilizing a marker. The talus was removed to measure the medial to lateral length and posterior to anterior length using a flexible ruler. A skin incision was made posterior to the medial malleolus. The incision was deepened through the flexor retinaculum. Dissection was carried between the posterior tibial and flexor digitorum longus tendons through the posterior tibial tendon sheath in order to access the posteromedial ankle joint. The posterior tibiofibular ligament should remain intact. A Hintermann distractor was then inserted to distract the ankle joint. The average articular cartilage visible from medial to lateral was 1.90 (68.6%) centimeters, while from posterior to anterior was 2.00 (43.6%) centimeters. Medial malleolar osteotomy is often required to visualize posteromedial talar osteochondral defects that are difficult to visualize with standard anterior ankle arthroscopy. Our study suggests that the modified posteromedial approach between the posterior tibial and flexor digitorum longus tendons and utilizing a Hintermann distractor allows for visualization of common posterior and central-medial lesions. When considering the anatomic 9-zone grid scheme proposed by Raikin et al, zone 4, 7, and 8 lesions can be assessed with this approach. A clinical study should be undertaken to evaluate the morbidity of this approach.

Latarjet procedure is a common standard in the treatment of anterior and anterior-inferior shoulder instability with a significant glenoid defect. However, like any other surgical technique, it has a list of certain intra- and postoperative complications, including mistakes in the positioning of the bone block. A necessary guarantee of prevention and reduction of the frequency of possible complications associated with graft positioning is a well-performedpreoperative planning with an understanding of the biomechanical functioning of the shoulder joint with the translated bone block. Objective. According to the mathematical modelling we studied the changes that occur in the stress-strain state of the shoulder joint model depending on the options for graft fixation and may occur during the Latarjet procedure. Methods. To solve this problem, a finite element model of the shoulder was created. The simulationswere performed using the SolidWorks computer-aided design system. The following situations were simulated: variants of fixing screws relative to the plane of the articular surface of the glenoid (parallel to the plane, at an angle of 10° and 20°) and variants of graft fixation height at the anterior edge of the glenoid (at the lower edge of the glenoid, 10 mm and 20 mm upper edge). Calculations of the stress-strain state of the models were performed with the CosmosM software package. Results and conclusions. The presence of a bone graft fixed with metal screws at the area of the defect at the anterior edge of the glenoid, leads to an increase in stress levels in the bone elements of the model. Changes in the stress-strain state of the shoulder model also occur, depending on the angle of the screws that secure the graft. The highest stress level was determined when providing the fixing screws at an angle of 10°, the lowest — when providing the screws parallel to the articular surface of the glenoid. The stresses on the locking screws increased slightly with increasing angle of the screws. When studying the height of graft fixation, the most favorable option, in terms of stress distribution on the articular surface of the glenoid and fixing screws, is its location in the lower part of the anterior edge of the glenoid.

The menisci of the knee are accurately evaluated by MRI. Knowledge of normal anatomy, imaging parameters, imaging appearance of the normal and torn meniscus, and common anatomic variants and pitfalls are essential in obtaining the correct imaging diagnosis. There are multiple imaging signs of meniscal tear, including linear signal intensity extending to an articular surface on at least 2 images, altered meniscal shape, displaced meniscal flap, ghost meniscus, meniscal extrusion, and parameniscal cyst. After surgery, granulation tissue may mimic tear. Diagnosis is improved by comparison to preoperative images, operative note, and intra-articular contrast administration.

Introduction: Knee joint is a major weight bearing synovial joint. In frontal radiograph we can see asymmetrical joint spaces between femoral and tibial components due to asymmetric wear and tear. Articular surfaces of tibial and femoral condyles are also asymmetrical. In frontal radiograph, the tibial condylar articular surface can be seen projected outside laterally or medially with respect to lateral or medial femoral condyle. Objectives: To measure tibial and femoral articular surface asymmetry. Measurement of tibial and femoral joint space. Materials and Methods: This epidemiological study was conducted in Orthopaedic outpatient department (OPD) of Ramakrishna Mission Seva Pratishthan Kolkata. Total 350 patients were selected. Frontal standing radiograph of both knees with 100% magnification were obtained. Tibial condylar asymmetry and joint spaces were measured with calliper. Height and weight measurements were also done. Statistical analysis was done. Results: In right knee 96% patients lateral tibial condyle was projected outside with respect to femoral condyle. In 9.3% patients’ medial tibial condyle was outside. In left knee 92.6% patients lateral tibial condyle was outside and 15.7% patients’ medial tibial condyle was outside. In right knee lateral joint space was mean + sd= 4.45 + 1.06, medial joint space mean + sd= 1.70 + 94. In left knee lateral joint space was mean + sd= 4.59 + 1.00, medial joint space was mean + sd= 1.76 + 1.00. Conclusion: In this study, in most of the patients we found tibial and femoral articular surface asymmetry mainly in lateral side. In joint space measurement, we found that medial joint space was less than lateral joint space in both knees.

We performed a retrospective review of standard anteroposterior and lateral radiographs of the thumb in 80 patients, to compare two radiographic landmarks, in terms of mediolateral bone support, for centering the trapezial component in total joint arthroplasty. On anteroposterior view, we identified the distal articular surface of the trapezium and trapezium width, and defined the two midpoints as radiographic landmarks for positioning a 9-mm trapezial cup. Mean trapezium width was significantly greater than the distal articular surface of the trapezium, and the midpoints did not match. Thus, after positioning simulated 9-mm prosthetic cups centered on each landmark, the residual radial bone distance was significantly greater using the landmark based on trapezium width. The mean value was 33% greater with this landmark, and the minimum value was 2.1 mm, compared to 0.2 mm using the landmark based on the distal articular surface. Our study thus suggested that the midpoint of the trapezium width is the more relevant radiographic landmark for centering the trapezial prosthetic cup in total joint arthroplasty, by preserving better bone stock on the radial side without depleting the ulnar side. On an intraoperative anteroposterior fluoroscopic view, this landmark could be used to check cup positioning. Nous avons effectué une revue rétrospective de radiographies standards de face et de profil du pouce chez 80 patients, afin de comparer deux repères radiographiques et d'identifier la solution la plus cohérente, d'un point de vue du support osseux médio-latéral, pour le centrage la cupule trapézienne dans l'arthroplastie totale trapézo-métacarpienne. Sur les radiographies de face, nous avons identifié la surface articulaire distale du trapèze et la largeur du trapèze. Ensuite, nous avons défini deux repères radiographiques au milieu de ces longueurs pour le positionnement d'une cupule trapézienne de 9 mm. La largeur du trapèze avait une valeur moyenne significativement plus élevée que la surface articulaire distale du trapèze, et leurs milieux ne correspondaient pas. Ainsi, après positionnement des cupules prothétiques simulées avec un diamètre de 9 mm centré sur chaque repère, la distance osseuse résiduelle radiale était significativement plus élevée en utilisant le repère basé sur la largeur du trapèze. La valeur moyenne était 33% plus élevée avec ce repère radiographique et sa valeur minimale était de 2.1 mm alors qu'elle était de 0.2 mm en utilisant le repère basé sur la surface articulaire distale. Notre étude suggère que le milieu de la largeur du trapèze est le repère radiographique le plus cohérent pour centrer la cupule prothétique trapézienne dans l'arthroplastie totale trapézo-métacarpienne, en préservant un meilleur stock osseux du côté radial sans épuiser le côté ulnaire. En effectuant une vue peropératoire de face avec la fluoroscopie, ce repère pourrait être utilisé pour vérifier le bon positionnement de la cupule.

Introduction An increasing number of ankle injuries with osteochondral lesions (OCL) also include lesions of the distal tibia. Therefore, the German Cartilage Society database is used to describe and examine the characteristics of these lesions and, early on, the results of different surgical therapies on the clinical outcome. Materials and methods Forty-seven patients out of 844 registered in the German Cartilage Society database met the inclusion criteria showing an OCL of the distal tibia (OLDT). Sixteen of them also presented a 1-year follow-up regarding the Foot and Ankle Ability Measure (FAAM). Further evaluations were included in the follow-up, such as the Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale for pain (VAS). Results The patients' mean age was 35 ± 11 with a mean BMI in the range of overweight (26/27 ± 5 kg/m2). The lesions were equally distributed on the articular surface of the distal tibia. Most patients were operated using anterior ankle arthroscopy [nT 34 (72%); nS 13 (81%)], while some (nT 9; nS 4) converted to open procedures. Almost 90% staged III and IV in the ICRS classification. Debridement, bone marrow stimulation, solid scaffolds, and liquid filler were the treatment choices among the subgroup. All therapies led to a clinical improvement between pre-op and 1-year follow-up but not to a significant level. Conclusion This study presents baseline data of OLDT based on data from a large database. BMS and scaffolds were the treatment of choice but did not present significant improvement after a 1-year follow-up.

The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ± 5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ± 7.08; activities of daily living score 89.57 ± 8.88; quality-of-life score 89.20 ± 7.44; sports score 75.00 ± 15.49; and other symptoms score 84.74 ± 7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ± 6.39. The VAS score was 0.72 ± 0.65. Ankle motion included dorsiflexion (13.18° ± 9.02°) and plantar flexion (32.27° ± 12.34°). Subtalar joint motion included eversion (10.91° ± 7.01°) and inversion (11.36° ± 7.45°). All scores of the healthy side were higher than those of the affected side (p .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.

Posterior malleolar fractures are often part of complex ankle fracture patterns. Radiographs and computed tomography are often obtained in the preoperative setting. In this study, we compared measurements from lateral ankle radiographs with measurements on axial computed tomography. We hypothesize that there is an association between measurements taken on lateral XR and certain fracture morphology such as medial extension and that measurements taken on lateral XR can be used to predict likelihood of medial extension type fractures. A multi-center retrospective analysis was performed involving patients with trimalleolar ankle fractures treated at two large urban healthcare systems ranging from January 1, 2010 to November 1, 2019. A total of 279 patients met criteria including 186 females and 93 males aged 18 to 90 with an average age 55. Four reviewers measured continuous variables on lateral radiograph and axial computed tomography: posterior malleolus fracture height, articular surface length, medial-lateral width, and anterior-posterior depth and then agreement was assessed via intraclass correlation coefficient. Pearson correlations were calculated for all pairwise combinations of measurements. Two fracture classification systems were then evaluated for association with the continuous variables. Lateral height was divided into quartiles and analyzed for the degree of association. Positive correlation was found between lateral height and axial depth/axial width. Taller lateral height values were statistically associated with medial extension type fractures. Lateral height 24.5mm-29.5mm is 3.1x higher, and lateral height29.5mm is 8.6x more likely to have medial extension when compared to shorter lateral heights(20.5mm). Based on these findings we suggest increased usage of pre-operative CT and evaluation for the use of posteromedial approaches in the setting of taller lateral height fracture patterns(24.5mm) as seen on lateral XR.

OBJECTIVES To identify the incidence of distal articular fractures in a series of distal third tibia shaft fractures and to report the utility of both computed tomography (CT) scans and Radiographic Investigation of the Distal Extension of Fractures into the Articular Surface of the Tibia (RIDEFAST) ratios for identification of articular involvement. DESIGN Retrospective cohort. SETTING Level 1 trauma center. PATIENTS Four hundred seventeen patients with distal third tibia shaft fractures were included in the study. INTERVENTION Intramedullary nail or plate fixation. MAIN OUTCOME MEASURES Type of articular fracture, time of diagnosis, and RIDEFAST ratios. RESULTS One hundred one of the 417 distal third fractures (24%) had a fracture of the distal tibia articular surface. Of these 101 fractures, 41 (41%) represented an extension of the primary fracture line and 60 (59%) were separate malleolar fractures. Of the 101 articular fractures, 95 (94%) were identified preoperatively and 6 (6%) were identified intraoperatively. Of the 95 fractures identified preoperatively, 87 (92%) were identified on plain radiographs and 8 (8%) by CT scan. Thirty-five preoperative CT scans were performed on distal third tibia shaft fractures in search of an intra-articular fracture. In 27 patients (77%), no articular fracture was present, representing an overall yield of 23% among CT scans performed to rule out an articular fracture in distal third tibia shaft fractures. RIDEFAST ratios for all 101 distal tibia shaft fractures with articular involvement and 100 fractures with no articular involvement were not significantly different (P > 0.05) using both coronal and sagittal plane measurements. CONCLUSIONS CT scans performed on distal third tibia shaft fractures in search of articular fractures had a low yield (23%). Widespread use of CT scan to diagnose fractures of the distal tibia articular surface in the setting of distal tibia shaft fractures does not seem warranted. No statistically significant differences in RIDEFAST ratios were found between fractures with and without articular involvement, indicating that more work is necessary before RIDEFAST can be used to reliably rule out articular involvement in this setting. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background This study examined a cohort of retrieved rotating hinge (RH) total knee arthroplasty implants of four different designs with emphasis on the surface damage observed on the polyethylene components. Our purpose was to determine if differences in polyethylene damage existed among the designs, and if those differences could be explained by differences in design characteristics. Materials and Methods Seventy-two RH implants from four manufacturers (DePuy LPS/SROM, Zimmer NexGen, Stryker Howmedica MRH, and Biomet Finn-OSS) removed at the time of revision performed between 2002 and 2017 were identified in our institutional retrieval registry. Damage to the surfaces of the polyethylene was assessed using a subjective grading system and evaluated in multiple zones. Design characteristics that were evaluated included the following: location of the dwell point on the polyethylene component, posterior position of the axle, and amount of hyperextension and rotation allowed by the implant. Results There were no differences in total damage scores between the four implant groups (P = .45). The Stryker Howmedica MRH group showed the least backside wear of all implants but significantly more articular-sided wear compared with two of the other three groups. All implants except NexGen showed increased total damage scores in implants revised for mechanical (vs nonmechanical) reasons and in implants with a longer duration of implantation. Conclusion No single implant design emerged as superior in terms of minimizing polyethylene wear damage. Polyethylene damage existed in various locations but was not different in severity across designs, suggesting that there is no clear superior RH design that minimizes overall articular surface wear compared with other designs.

Purpose Development and validation of an animal model of labral healing would facilitate translation of novel surgical and biological strategies to improve glenolabral healing. The purpose of this study was to characterize the anatomic and histological properties of the shoulder labrum in rat, rabbit, dog, pig, goat, and humans. Given the demonstrated similarities in size and structural morphology in other joints, it was hypothesized that the goat glenoid with surrounding capsulolabral complex would most closely resemble that of humans in terms of dimensions and structure, as observed grossly and histologically. Methods Cadaveric glenohumeral joints from rats (n = 8), New Zealand white rabbits (n = 13), Mongrel dogs (n = 9), Spanish goats (n = 10), Yorkshire pigs (n = 10), and humans (n = 9) were freshly harvested. Photographs were taken of the glenoid with its surrounding capsulolabral complex. Linear dimensions of the glenoid articular surface were measured. It was determined where the capsulolabral complex was continuous with, or recessed from, the articular glenoid surface. The glenoid was divided into 6 equal segments radiating out toward 12, 2, 4, 6, 8, and 10 o’clock positions. Samples were sectioned and stained with Safranin O/Fast green and Mallory Trichrome. Insertion of the capsulolabral tissue onto the glenoid was qualitatively assessed and compared with gross morphology. Results Dimensions of the goat glenoid most closely paralleled dimensions of the human glenoid. A capsulolabral complex was continuous with the glenoid surface from ~ 9 to 12 o’clock in the rats, 7 to 12 o’clock in rabbits, 5 to 12 o’clock in the dogs, and 9 to 12 o’clock in goats, 6 to 12 o’clock in pigs, and 2 to 8 o’clock in humans. In contrast to humans, no other species demonstrated an organized fibrocartilaginous labrum either macroscopically or histologically. Conclusion The animals in the present study did not possess a discrete fibrocartilaginous labrum by gross or histological evaluation, as directly compared to humans. While models using these animals may be acceptable for examining other shoulder pathologies, they are not adequate to evaluate labral pathology. Level of evidence Basic Science Study; Anatomy and Histology; Cadaveric Animal Model.

Introduction: Numerous classifications have been developed to assess tibial plateau fractures (TPF). Of these, the Schatzker system is the most widely reported in the literature yet this system is limited in its characterisation of morphological fracture features underlying the fracture location. The purpose of this study was to compare 3D morphological features of TPFs across different Schatzker types. Methods: This study retrospectively analysed preoperative TPF imaging data to reconstruct 3D models of the fractures. Ninety-one fractures (29 female, 62 male) were analysed and classified using Schatzker. Fracture location across Schatzker types was compared based on division of the articular surface into six ‘zones’. Additionally, morphological characteristics of the fractures were compared based on fracture type, including; the number, volume and shape of the fragments. Results: Schatzker II, IV and VI fractures were most common, making up 41%, 16% and 20%, respectively. Type II fractures commonly involved both the lateral and central aspect of the tibial plateau, similarly, type IV fractures incorporated the lateral condyle in most cases. Considering the morphological metrics, statistically significant differences were observed between Schatzker types for the number of; total, articular, cortical and volumetrically significant (all P < 0.001) fragments along with the volume of both primary (P < 0.001) and secondary (P = 0.02) fragments. Discussion: Assessment of underlying fracture characteristics in addition to fracture location can serve to provide greater detail relating to fracture morphology, which has the potential to assist with both surgical decision making and assessment of postoperative outcomes. Incorporating this information as part of a hierarchical or multifactorial framework for classifying fractures may help distinguish subtle differences between fracture types that are classifiable using the most current systems. Refereed/Peer-reviewed

Distal radius fractures are among the most common injuries to the upper extremity and have a bimodal distribution in younger male patients and older women. Young men suffer from high-energy injuries and older women from fragility fractures. Approximately 50% of these are intra-articular. Timely and appropriate treatment usually will lead to an acceptable outcome, but loss of congruity of the articular surface remains a difficult problem to manage. We report here on the case of a 16-year-old boy with malunion of the radial articular surface with lack of motion and pain. He was managed by replacing the displaced and damaged segment of the radial articular surface with a vascularized osteochondral graft from the proximal phalanx of the great toe. This matched the shape of this portion of the radius quite well, and he has had improvements in motion and pain in the 10 months since that time. The donor site has not caused him any difficulty to date.

Background Osteochondritis dissecans (OCD) is an idiopathic disorder of subchondral bone that causes focal articular cartilage disruption with the potential long-term consequence of premature osteoarthritis. Glenoid OCD is exceedingly rare. This case series aims to identify the grades of glenoid OCD and report its grade-specific treatment with clinical, radiological, and functional outcomes. Methods Prospectively collected data of consecutive patients diagnosed with a symptomatic glenoid OCD, who had a minimum 2-year follow-up, following nonoperative or surgical treatment, was retrospectively analyzed. Osteochondral defects secondary to acute trauma, instability, and primary osteoarthritis were excluded. Pretreatment and posttreatment clinical, radiological, and sports participation data were collected. This included pretreatment MRI for grading of glenoid OCD according to the International Cartilage Research Society (ICRS) OCD staging system, and postoperative MRI for grading of articular cartilage repair using the MOCART (MRI observation of cartilage repair tissue) scoring system. Results The study identified 7 competitive overhead athletes with symptomatic unilateral glenoid OCD, with a post-treatment minimum 2-year follow-up. Of 4 patients with ICRS OCD I, 3 healed with nonoperative treatment, whereas 1 progressed to ICRS OCD II. This patient along with another 3 patients with unstable glenoid OCD underwent arthroscopic OCD excision with bone marrow stimulation cartilage repair. All patients improved following treatment and had full passive and active range of shoulder movements, with normal strength and stability at the 2- year follow-up. The mean MOCART score on MRI at 2 years for the 4 patients who underwent surgery was 82.5 (range, 75-90). MRI documented healing in all 3 patients with ICRS OCD I who underwent nonoperative treatment. All patients returned to the same or higher level of sport following treatment, with mean time to return to sports being 8.0 months (range, 6-11 months) for nonoperative treatment, and 6.8 months (range, 5-10 months) for operative treatment. This difference was not statistically significant (P value .55). No patient had recurrence of symptoms till latest follow-up. Conclusion Despite the glenoid being a concave non–weight-bearing articular surface, OCD at this site has pathological grades similar to other convex weight-bearing articular surfaces. Notwithstanding the limited number of cases, it would appear that ICRS OCD I can often be successfully treated with nonoperative treatment, whereas ICRS OCD II, III, IV, warrant operative treatment. Bone marrow stimulation is a safe and predictable option for glenoid OCD cartilage repair and allows athletes a quick and successful return to sports.

Bony alignment is the primary goal in foot and ankle reconstruction of the cavovarus foot. This condition presents as a malalignment causing a medial overload of the ankle articular surface and lateral overload of the hindfoot, midfoot, and forefoot. A painful gait associated with articular degeneration of the numerous joints can lead to a chronic and rigid arthrosis of joints, warranting arthrodesis of the affected joints accordingly.

Many repair techniques have been used for quadriceps tendon rupture. Transosseous sutures are the golden standard since they can offer the safest and most stable tendon reattachment. Drilling in parallel to the patella’s longitudinal axis while avoiding the articular surface can be particularly challenging. In addition, drilling the patella has been shown to increase the possibility of an intraoperative fracture, especially if large diameter drills are being used. The present technical note demonstrates a simple, safe, cost-effective, and reproducible technique for quadriceps tendon repair. This technique is based on the use of a cruciate ligament reconstruction tibial tip aimer and guide wires with eyelet. After the accurate patella, entry and exit points for transosseous suturing are defined, the eyelet guide wires enable the passing of the sutures through the patella. Finally, the free ends of each suture are pulled and secured distally. This technique allows efficient and proper tendon fixation while minimizing potential complications.

Glenoid loosening is a common failure mechanism of anatomic total shoulder arthroplasty (TSA). New hybrid fixation glenoids allow bony ingrowth and decrease the rates of glenoid loosening. The purpose of this study is to describe a new failure mode of polyethylene dissociation from the ingrowth cage in a single implant design. A retrospective review was performed using an institutional shoulder arthroplasty database of a single hybrid cage glenoid (Exactech, Gainesville, FL). Implants demonstrating this failure mechanism were investigated. Five out of 206 (2.4%) primary TSAs with cage glenoids performed at our institution and 2 referred for revision suffered glenoid articular face failure. Mean age was 57 (range 38–67 years). Two of 7 failures (29%) occurred secondary to trauma. Failure occurred at mean 14 months after index arthroplasty (range 0–30 months). Revision occurred at mean 24 months after index arthroplasty (range 6–39 months). Six of the 7 patients (86%) had posteriorly augmented glenoids. All 6 patients who had available pre-failure radiographs demonstrated off-axis deviation between the peripheral pegs and central cage (mean 4.8°, range 3°–6°), which may predispose the implant to failure by pre-stressing the material interface. Failure between the glenoid articular face and the central ingrowth cage is a unique failure mechanism to modular hybrid ingrowth glenoids. We hypothesize that this is predisposed by off-axis drilling leading to pre-stressing of the material interface. Surgeons should be aware of the existence of this failure mechanism, particularly when seeing patients with acute pain after an otherwise unproblematic TSA.

Background The coronoid process plays a vital role in preserving elbow stability. In cases of acute or chronic deficiency of the coronoid process, reconstruction is warranted to restore stability and to avoid early joint degeneration. The distal clavicle might be a useful osteochondral autograft for coronoid reconstruction with low donor-site morbidity. This study evaluated the fitting accuracy of the distal clavicle as an autograft for coronoid process reconstruction. Methods One hundred upper-extremity computed tomography scans of 85 body donors were available for this study (mean age, 69 ± 17 years; 46 male and 39 female donors; 15 bilateral specimens). Standardized 40% transverse defects of the coronoid process were digitally created; the distal clavicles were digitally harvested and placed onto the defects by a best-fit technique in 2 different orientations using commercially available software: (1) with the superior aspect of the articular surface of the graft oriented toward the coronoid tip and (2) with the inferior aspect of the articular surface of the graft oriented toward the coronoid tip. The fitting accuracy of the grafts to the native coronoid process was evaluated from lateral to medial using custom code. Results Regardless of the orientation of the graft, the distal clavicle provided a good fit in the central portion of the coronoid process. In the lateral and medial aspects of the defect, however, the fitting accuracy of the graft declined significantly (P ≤ .044). No significant differences were observed between ipsilateral and contralateral grafts (P ≥ .199). The intrarater reliability was excellent. Conclusion The results of this study suggest that a distal clavicle autograft may be suitable to replace a transverse defect of the coronoid process; however, it may not fully reconstruct the anteromedial and anterolateral aspects of the coronoid.

Up to the present time practically not studied the peculiarities of formation of cartilage in the various compartments of the shoulder joint in dogs, as well as zones of least resistance joints in General. Available studies mainly use visual diagnostic methods, without applying morphological and morphometric. There is no information about age-related cytomorphological transformations occurring in the joint in normal and pathological conditions. In this regard, the aim of our study was to determine the zone of risk of damage to the shoulder joint in dogs. Studies were conducted on dogs and cadaver material, selected from giant, large and mediumsized breeds. Arthroscopic studies of dogs were performed, as well as light microscopy of histological sections of freshly treated samples of joint tissues. As a result of trauma to the joint is transformed physiological synovial folds in sklerozirovanie a pathological form that occurs in German shepherd dogs over 5 years of age in 60% of cases. The process of mineralization of the matrix and the appearance of multiple foci of ossification occurs asynchronously in the cartilage of the head of the humerus and the articular cavity of the scapula. Osteoplastic processes in the area of articulation occur unevenly. Cartilage coating of the articular surface of the shoulder blade is characterized by a more uniform distribution than the articular rotation of the humerus head. The zones of risk of damage to the structures of the shoulder joint in dogs were determined. These include: cranial and medial compartments of the joint, the caudal area of the cartilaginous coating of the humerus, the caudal area of the articular surface of the scapula cavity. The data obtained make up for the information about the diagnosis and risk factors in the development of shoulder joint pathologies in dogs of large and giant breeds. They should be used in clinical diagnosis and surgery of the musculoskeletal system in animals.

Wrist arthroscopy in the setting of distal radius fractures allows for direct visualization of the articular surface and treatment of associated soft tissue injuries. Arthroscopic techniques may be used to fine tune reductions with residual articular step-off or gap after an initial reduction attempt and are critical for addressing free articular fragments and die-punch lesions. Surgeon training, experience, and comfort with wrist arthroscopy remains a barrier to widespread adoption of this technique. Level I studies are needed to investigate whether improved articular reduction leads to meaningful clinical differences.

Objectives The competing functional demands of diarthrodial joints, permitting mobility while retaining enough stability to transmit forces across the joint, have been linked with the shape and size of the joint's articular surfaces. A clear understanding of the relationship between joint morphology and joint movement potential is important for reconstructing locomotor behaviors in fossil taxa. Methods In a sample of matched tali and calcanei of lorisids (n = 28) and cheirogaleids (n = 38), we quantify the surface areas of the talar and calcaneal ectal (=posterior talocalcaneal) articular surfaces and model the principal curvatures of these surfaces with quadric formulas. These two taxonomic groups have similar body masses, but differ substantially in positional behavior, so that differences in joint surface morphology should reflect adaptive demands of their locomotor behavior. Results Compared with cheirogaleids, lorisids exhibit: (a) a significantly greater area difference between their paired joint surfaces; and (b) a more pronounced saddle shape for the talar ectal facet. Conclusion The increased subtalar joint mobility observed in lorisids may be achieved by increasing the amount of sliding and rolling that can occur at the subtalar joint. The subtalar joint morphology observed in two fossil euarchontans, the plesiadapiforms Purgatorius sp. and Plesiadapis cookei, compares favorably with the morphology observed among lorisids, potentially suggesting antipronograde postures within these extinct taxa.

STUDY DESIGN A retrospective comparative study with radiographic measurements. OBJECTIVE The aim of this study was to investigate incidences and risk factors of screw-related superior facet articular surface violation (FASV) and optimal pedicle screw angles (PSAs) to avoid FASV at L4 and L5 levels in transforaminal lumbar interbody fusion (TLIF) with either open surgery (OS) or minimal invasive (MIS) techniques with 3D C-arm navigation. SUMMARY OF BACKGROUND DATA L4 to S1 are common levels in TLIF. Adjacent segment diseases (ASD) following TLIF is not uncommon. Screw-related FASV at the superior level is one of the potential risk factors for ASD. METHODS In the OS and MIS groups, 111 and 110 screws were included at L4 level, and 114 and 110 screws at L5 level, respectively. Postoperative computed tomography examined screw-related FASV at L3-4 and L4-5 facet levels. The entry point was the location where pedicle screws placed into the facet joints. RESULTS The OS technique and insertion at the L5 level increased the likelihood of FASV 2.56 and 1.81 times, respec-tively. Multivariate logistic regressions analysis determined PSA was a significant factor associated with FASV. Pearson r between PSA and the distance between midline and entry point was 0.905 (P

Tarsal coalition is a rare condition; only two cases had been reported showing first tarsometatarsal joint coalition. We presented a case of a 22-year-old man who had a medial column left foot pain started 5 years prior to diagnosis. Patient was diagnosed with left first tarsometatarsal joint coalition. Following consultation, the patient decided to undergo surgery. Surgical management included debridement of the coalition and reconstruction of articular surface with Chondrotissue. Outcomes were assessed using the Manchester Oxford Foot Questionnaire (MOXFQ) and Foot and Ankle Ability Measure (both Activity of daily living subscale [FAAM ADL] and Sport subscale [FAAM Sport]). Postoperative follow-up continued for 6 months. The overall MOXFQ score had improved from 84 to 43.75%. FAAM ADL scores improved from 39.3 to 91.66%. FAAM sport scores had improved from 0% preoperatively to 33.37% at 6 months postoperatively. Patient had a significant improvement in all aspect of activities of daily living, sport, pain and social interaction (as measured by MOXFQ, FAAM ADL/Sports).

Background:The effect of high tibial osteotomy (HTO) on the stress distribution across the knee joint is not completely understood. Subchondral bone density is considered to reflect the pattern of stress distribution across a joint surface.Purpose:To assess the distribution of subchondral bone density across the proximal tibia in nonarthritic knees and in the knees of patients with osteoarthritis (OA) before and after HTO.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively collected radiological and computed tomography data from 16 patients without OA (control group) and 17 patients with OA. Data from the OA group were collected before and 1.5 years after HTO. Subchondral bone density of the proximal tibia was assessed with computed tomography–osteoabsorptiometry. The locations and percentages represented by high-density areas (HDAs) on the articular surface were quantitatively analyzed.Results:The ratio of the HDA of the medial compartment to the total HDA (medial ratio) was significantly higher in the preoperative OA group (mean, 80.1%) than in the control group (61.3%) ( P < .001). After HTO, the medial ratio decreased significantly to 75.1% ( P = .035 in comparison with preoperative values) and was significantly correlated with the hip-knee-ankle angle in both groups: control ( r = −0.551; P = .033) and OA ( r = −0.528; P = .043). The change in medial ratio after HTO was significantly correlated with the change in hip-knee-ankle angle ( r = 0.587; P = .035). In the medial compartment, the HDA in the most lateral region of 4 subregions increased after HTO, but that in 3 medial subregions decreased.Conclusion:In this exploratory study, HTO shifted the HDA of the medial compartment of the proximal tibial articular surface toward the lateral compartment. In contrast, the HDA of the most lateral region of the medial compartment increased after HTO. This change in subchondral bone density may result from the change in stress distribution.

Purpose (1) to improve the comprehension of the topographical position of the talar dome beneath the inferior articular surface of the tibia and, (2) to illustrate the changes of possible access to the articular surface of the talar dome during arthroscopic treatment of talar osteochondral defects in an anatomical model. Methods Twenty matched pairs (n = 40) of anatomical ankle specimen were used. All specimens were mounted in a standardized fashion, 3-dimensional radiography was performed in 4 defined positions (maximum dorsiflexion, neutral position, noninvasive distraction, and maximum plantarflexion). All radiographs were analyzed and statistically compared. Results Anterior accessibility was highest in maximum plantarflexion (medial: 49.20 ± 9.86%, lateral: 48.19 ± 8.85%), followed by non-invasive distraction (medial: 33.60 ± 7.96%, lateral: 31.98 ± 8.30%). Neutral position (medial: 19.34 ± 6.90%, lateral: 17.54 ± 6.63%) and dorsiflexion (medial: 15.36 ± 5.03%, lateral: 13.88 ± 4.33%) were not able to significantly increase accessibility. Posterior accessibility was greatest in maximum dorsiflexion (medial: 56.69 ± 9.65%, lateral: 46.82 ± 8.36%), followed by neutral position of the ankle joint (medial: 40.95 ± 8.28%, lateral: 31.06 ± 6.92%). Noninvasive distraction (medial: 31.41 ± 8.18%, lateral: 22.99 ± 7.63%) was still significantly better than plantarflexion (medial: 14.54 ± 5.10%, lateral: 13.89 ± 3.14%) and slightly increased accessibility to the talar dome. Medially, a central area of 5.89 ± 9.76% was accessible by maximum plantarflexion and maximum dorsiflexion from anterior and posterior, respectively, laterally a central blind spot of 4.99 ± 8.61% was detected. Conclusions From an anatomical point of view, maximum joint positions of the ankle (i.e., plantarflexion and dorsiflexion) allow for better access to the talar dome in anterior and posterior ankle arthroscopy. Noninvasive distraction may increase accessibility in anterior approaches, but has no benefit from posterior. Clinical Relevance This study provides insight into the morphology of the ankle joint in a standardized laboratory setup and illustrates the influence of different surgically relevant ankle joint positions. The presented data allow for better preoperative planning for the arthroscopic treatment of talar osteochondral defects.

Background & Objectives: Preservation of the articular congruity is the principle prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixation as a method of treatment for distal end of radius fracture has more than 60 yrs of documented clinical experience. The main aim of this study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation.Methods: In a prospective controlled study, 30 cases of intra-articular fractures of distal end radius in adult patients were treated with uniplanar bridging type of external fixation using the principle of ligamentotaxis and augmentation by K wires. Mean age of the patients was 37.3years, External fixator was applied for a mean duration of 6 weeks and cases were followed up for an average of 37.0 weeks post operatively.Results: Assessed as per De merit point system of Gartland and Werley (modified by Sarmiento 1975) for functional results at the end of 6 months of follow up. Excellent to good functional result was noted in 83.3%.Conclusion: External fixation and ligamentotaxis provides better functional and anatomical results in intra-articular fractures of distal end radius. The success not only depends on the anatomical restoration of the articular surface. It also depends on the associated soft tissue injuries and articular damage.

AIM: To assess the clinical and functional outcome of surgically treated proximal tibial fractures with dual plating at AIMS, B.G. Nagara during August 2018 to December 2020.Objectives1.To assess the articular surface anatomical reduction of PROXIMAL tibia perfectly by operative treatment with internal fixation.2.To assess the union of fractures radiologically after internal fixation with dual plates3.To assess the clinical outcome associated with this treatment modalitya.Range of movements of knee jointb.Relief of pain for the patientc.Return to routine daily activities and workMaterials and Methods: Total number of cases studied were 20.•Inclusion criteria: All patients who are skeletally mature with proximal tibia fracture Schatzker type V and VI (>18 years), AO Muller type 41-C1, 41-C2, 41-C3, Gustilo-Anderson type I and II compound proximal tibial fracture.•Exclusion Criteria: Patients with Gustilo-Anderson Type 3 compound tibial plateau fractures, Children with proximal tibial fractures with intact growth plate, patients with pathological proximal tibial fractures apart from osteoporosis.Observation and Results: Our study used Honkonen Jarvinen Criteria for radiological, functional, clinical outcome which showed excellent to good result. Our study reported Honkonen Jarvinen Clinical outcome to be 85% excellent, 12% good and 2% fair. The functional outcome was 80% excellent, 14% good, 4% fair and 2% poor. The Radiological outcome showed 79% excellent, 15% good, 0.70% fair results.Conclusion: From this study we conclude that, proximal tibial fractures (Schatzker type V and type VI) managed surgically with dual plating gives excellent anatomic reduction, accurate axial and articular alignment with rigid internal fixation by dual locking plate, achieving a stable and better functional knee joint.

Background: The sacroiliac joint has a structure in which the direction of the load relative to the articular surface is irrational, as the joint surface is not perpendicular to the trunk load axis; it is likely to incur more degenerative changes than other weight-bearing joints. Materials and methods: This retrospective study consisted of a total of 145 cases — 104 (71.7%) men and 41 (28.3%) women — who were referred to Gaziantep University Medical Faculty Radiology Department Polyclinic for pelvic computed tomography (CT) from 2013 to 2018. The mean age was 33.5 years (range: 18–60 years). Pelvis CT images were performed according to the exclusion criteria specified by the experienced orthopaedic surgeon. Patients were excluded from the study if they were younger than the age of 18, had a condition involving the sacroiliac joint, had an endocrine disorder, or had a history of a trauma affecting the pelvis CT examination. Results: In this current study, six types of anatomic variations were detected. Iliosacral complex variation has been determined as the most common type of variation. The incidence of variations of sacroiliac joint in all cases was 28.9%. Degenerative changes were seen in 5.5% of patients fewer than 30 years of age. When it comes to the patients whose age range is 30–60, the percentage of the degenerative changes is 12.4%. In patients who were 30 years and older, the prevalence of degenerative changes increased progressively with increasing age. Conclusions: In this study, it is thought that the knowledge of variations in normal population and degenerative changes will contribute to the better understanding of normal morphological structure of sacroiliac joint and to the anatomical literature. It’s seen that there is not a statistically significant relationship between degenerative changes and anatomical variations.

Background: Patellar tendon rupture is a relatively infrequent injury, resulting in severe morbidity if neglected or treated improperly. The treatment aims to preserve the extensor mechanism. Quite a few reconstruction techniques have been proposed. Still, most result in complications including contractures, adhesions & atrophy of the quadriceps tendon, fracture of the patella, damage to the patellar articular surface and patella Alta or Baja. We use a modified technique to reconstruct a ruptured patellar tendon using ipsilateral semitendinosus and gracilis autograft without making a trans-osseous patellar tunnel. Surgical technique: The patellar tendon is sutured using an end to end technique. The procedure involves harvesting and suturing semitendinosus, and gracilis tendons end to end. A horizontal tunnel of 4.5-mm diameter is drilled at a point one centimetre posterior to the tibial tuberosity. One free end of the graft is passed through this tunnel in a medial to the lateral direction and then placed in front of the patella in a figure-of-eight fashion. Each end is then introduced transversely through the distal end of the quadriceps tendon along the proximal margin of the patella. The two ends are pulled distally and placed in a figure-of-eight fashion again. Finally, the ends were sutured in between where they overlapped after adjusting the tension and the position of the patella. Conclusion: This modified technique reduces patella associated complications like fracture and patellofemoral cartilage damage. The figure of eight patterns allows the adjustment of graft tension as deemed required for keeping the patella in the ideal position. The load from the patella is directly transmitted to the tibial tubercle so that the repaired patellar tendon remains tension-free and can heal properly. Moreover, when the knee flexes, the patella is pulled downward and is prevented from anterior translation to stabilise the patella and maintain appropriate tracking. Most importantly, this technique avoids postoperative splinting and thereby facilitates early mobilisation and hence a better outcome.

The problem of repair of full-layer defects in the articular surface remains highly relevant. New methods of chondroplasty should be tested in preclinical studies on animals. Full quality control of the newly formed regenerate is often possible only when an animal is euthanized. However, the design of some experiments implies animal observation for a long time. Therefore, lifetime assessment of the quality of the formed tissue regenerate after chondroplasty would be very convenient. We have developed a new method for assessing the quality of regenerate using computed tomography in preclinical studies on rabbits. This method can be used to measure completeness of defect filling, density of the newly formed regenerate, and also to evaluate similar parameters of the newly formed tissue in the area of the subchondral bone, intermediate zone, and cartilage. The new method makes it possible to assess the dynamics of formation and restructuring of newly formed tissue after chondroplasty without euthanizing the animal.

The aim of this study was to investigate the reliability of distal interphalangeal joint (DIPJ) subluxation and articular surface involvement measurements during the assessment of bony mallet finger. Two observers measured articular involvement, subluxation ratio and rated joint congruency on 30 lateral radiographs of patients with bony mallet finger on two separate occasions. All measurements and ratings were done on magnified digital radiographs on a workstation. The intraclass correlation coefficient (ICC) and kappa statistics were used to establish relative agreement between observers. The intra-observer reliability for articular involvement and subluxation ratio were good for Observer A (ICCs 0.888 and 0.775) and excellent for Observer B (ICCs 0.958 and 0.910) on both occasions. However, the subluxation rating was moderate for both observers (kappa 0.772 and 0.780, respectively). Inter-observer reliability for articular involvement (ICC 0.884) and the subluxation ratio (ICC 0.818) was good on the first measurement. Although the subluxation rating was perfect for the first measurement (kappa 0.927), it was moderate for the second (kappa, 0.619). The reliability of articular involvement (%) and subluxation ratio (%) measurement was good and excellent. However, the decision on whether the DIPJ is congruent or incongruent was only moderately reproducible. These findings show us that surgeons should be cautious when assessing subluxation, which is the most important criterion for choosing the appropriate treatment.

Foundation: Posterior cruciate tendon (PCL) is one of two cruciate tendons that settle the knee joint. The PCL attatches to back intercondylar territory and passes antero superiorly to embed into the horizontal surface of the average femoral condyle. The point of the current examination was to build up the distinction in useful, clinical and radiological result among holding and expulsion of PCL in TKR. What's more, attempt to build up a connection between specific signs to one of the two procedures. Subjects and techniques: This audit was finished utilizing standard philosophy laid out in the Cochrane Handbook and announced the discoveries as per the Preferred Reporting Items for Systematic Reviews and Meta-investigations (PRISMA) proclamation rules. Our included examinations (Randomized preliminaries, Prospective correlation studies and Retrospective examination contemplates). Results: The writing search and cross-referring to brought about an aggregate of 142 articles Fig (1); 23 copies had been identified and eliminated, leaving 119 articles. Complete 111 articles were screened, of which 64 were dismissed due to off-subject modified works (22 articles), inability to fulfill the consideration models (14 articles), or both (28 articles). In the wake of perusing the excess 47 full-text articles, another 26 articles were rejected on account of insufficient subtleties and dubious analysis and result measures. At last, 21 articles on the treatment of patients with essential OA were incorporated. End: It was recommended that the advantages of PCL maintenance would be generally evident in the youthful and dynamic patients It give a more prominent possible scope of movement with successful femoral move back and a moderately level tibial articular surface. It goes about as a restriction to temporary dislodging of the knee. People with PCL holding prostheses have more balanced step, particularly during moving, than do people with either PCL forfeiting or PCL – subbing plans.

The review article is about clinical experience in the use of modern tomographic methods (magnetic resonance imaging (MRI) and X-ray computed tomography (CT)) in the diagnosis and assessment of the progression of malignant bone neoplasms, summarizing the results of the largest studies demonstrating the comparative characteristics of the methods. Numerous data demonstrate high sensitivity of MRI and form the following diagnostic tasks that can be solved by this method: the involvement degree of soft tissues in the pathological process, damage to the neurovascular bundle, the articular surface, assessment of the extent of tumor in the bone marrow canal. At the same time, CT shows a higher sensitivity in assessing cortical destruction and the degree of matrix mineralization. The article discusses the variety of program sequences and modes of MRI scanning, the prospects of the method in assessing the prevalence, staging, and differential diagnosis of bone tumors.

Patellar fracture morphology varies based on the mechanism of injury. Most fractures are either a result of direct impact or through an indirect eccentric extensor contraction injury. Each fracture pattern requires appropriate preoperative planning and individualization of the fixation method. Displaced fractures affect the extension apparatus, and often require surgical fixation. Surgical treatment is recommended in fractures with any of the following features: articular step-off > 2 mm, > 3 mm of fracture displacement, open fractures, and displaced fractures affecting the extensor mechanism. Meticulous handling of the soft-tissue envelope is of the utmost importance, given the patella's tenuous blood supply and limited soft-tissue envelope. Incongruent articular surface can result in detrimental long-term effects; therefore, surgical treatment is directed toward anatomic reduction and fixation. The evolution of patellar fracture fixation continues to maximize options to balance rigid fixation with low-profile fixation constructs. Improving functional outcomes, minimizing soft-tissue irritation, and limiting postoperative complications are possible by using the therapeutic principles of rigid anatomical fixation and meticulous soft-tissue handling.

Introduction: Preferred sites of osteochondritis dissecans (OCD) are the distal femur and humerus, and the dome of the talus. We report a rare case of a professional soccer player with bilateral OCD of the talar posterior calcaneal articular surface. Case Report: The left talus showed a loose but not displaced fragment, and pain was relieved with 3 months of conservative treatment. The right had two loose fragments that were displaced from their beds in the talar posterior calcaneal articular surface. The loose bodies were surgically excised. The player remains symptom free 4 years after the operation and participates in professional games. Thus, although OCD of the talar posterior calcaneal articular surface remains a relatively uncommon injury, we suggest that treatment methods tailored to the OCD stage as per Berndt and Harty classification may be successful. The exact causes and establishment of a treatment protocol in these cases will depend on the investigation of future cases. Conclusion: Since this case of OCD of the talar posterior calcaneal articular surface was bilateral, we hypothesized that it may have been caused by microtrauma in the sense of repetitive, excessive compression of the subchondral bone, or by a vascular etiology. Keywords: Case report, lateral hindfoot pain, osteochondral lesion, subtalar articular facet, subtalar joint.

Background: The number of total knee arthroplasty (TKA) surgeries performed each year is increasing worldwide and mechanical alignment (MA) is currently seen as the gold standard procedure. However, taking neutral alignment as the universal goal may be mistaken. In our hospital, we currently conduct kinematically aligned TKA (KA-TKA). Three different types of implants are used: the cruciate-retaining (CR) type, cruciate-sacrificing (CS) type, or bi-cruciate-retained (BCR) type. We aimed to compare the coronal alignment observed following KA-TKA and MA-TKA and in normal knees, as well as that achieved with different types of implants. Methods: The study comprised 206 knees of Japanese patients who underwent KA-TKA using varying implants in our Hospital between May 2019 and April 2020. Measurements of pre- and postoperative coronal alignment were determined from weight-bearing full-leg standing radiographs. The postoperative results were compared to measurements taken from patients who underwent MA-TKA (N = 96) and normal knees (N = 60). Results: No significant differences between the KA-TKA group and normal knees were found for the medial proximal tibial angle (MPTA) (–4.2° ± 2.6° vs –3.8° ± 2.5°) or joint line orientation angle (JLOA) (0.2° ± 1.9° vs 0.3° ± 1.4°). However, when MA-TKA was compared to KA-TKA and normal knees, there were significant differences in both the MPTA and JLOA (p Conclusions: Here, we demonstrated that following KA-TKA, the articular surface of the tibia exhibited a similar varus alignment as that of normal knees, meaning that the technique reproduces the native knee. Furthermore, KA is patient-specific, and does not have the same failures as MA-TKA. Therefore, we anticipate a paradigm shift from mechanical to kinematic alignment, which may help reduce the dissatisfaction rate of TKA patients.

Background. The modern principles of reconstruction of the anterior cruciate ligament (ACL) and well-known surgical techniques do not take into account the peculiarities of the anatomical structure of the female knee. This happens due to insufficient substantiation that these peculiarities could influence the results of the treatment. The purpose of this study was to obtain new data on the structure of the areas of the ACL attachment, taking into consideration patient’s gender and the surgical anatomy. Material and Methods. 40 unpaired “fresh” anatomical preparations of the human female and male knees were studied. After preparation of the knee joints, the morphometry of the distal femoral epiphysis and the proximal tibial epiphysis was carried out by a digital sliding caliper according to 16 parameters. The shape, size, area, and the distance of the ACL attachment center from individual bone structures were assessed. The obtained data were correlated with the gender type of the knee structure. Results. The distal femoral epiphysis of the “female” type knee joint compared with the “male” type revealed the significant differences (p0.05) in the following parameters: the width of the condyles at the level of the transepicondylar line, the width of the intercondylar fossa, the length and height of the lateral condyle, and the ratio of the condyles width at the level of the transepicondylar line to the height of the lateral condyle. The tibial proximal epiphysis showed the gender differences in the articular surface frontal and sagittal dimensions, the width of the intercondylar eminence and the posterior slope of the tibial epiphysis articular surface. These features determined the different proportions of the female knee structure. The area of the anterior cruciate ligament femoral attachment and its center in the “female” type of structure were located 3 mm distal and 1.5 mm posteriorly (anteriorly and downwardly in arthroscopic imaging). The area of the tibial attachment of the same ligament and its center were localized 2 mm anteriorly in comparison with the “male” type structure. Conclusion. The discovered anatomical differences made it possible to distinguish the “female” and “male” types of the knee structure. The topography of the anterior cruciate ligament attachment areas is gender specific. This should be taken into account in the anatomical reconstruction of the ligament.

Background Transtrochanteric posterior rotational osteotomy (PRO) is one of the joint-preserving surgeries for osteonecrosis of the femoral head. In general, postoperative femoral neck-shaft varus realignment is planned to obtain a sufficient intact articular surface of the femoral head in the weight-bearing portion. Unlike anterior rotational osteotomy, PRO allows for more than 90° rotation of the femoral head, resulting in more complicated morphology. However, little is known about the potential risk of postoperative femoral retroversion after PRO. This simulation study aims: 1) to assess whether postoperative femoral neck-shaft varus realignment can coexist with preserved femoral anteversion after PRO, 2) and whether postoperative proximal femoral morphology could be predicted with approximation equations. Hypothesis High degree (> 90°) PRO is favourable for femoral neck-shaft varus realignment, but unfavourable for maintaining postoperative femoral anteversion. Materials and methods PRO was simulated by using CT data from 10 hips in 10 healthy volunteers. During simulation, the intertrochanteric osteotomy plane was determined three-dimensionally based on anteroposterior-view line (the osteotomy line on anteroposterior view) and lateral-view line (the osteotomy line on lateral view). By changing either the angle of anteroposterior-view line or lateral-view line, we simulated 90°, 110°, 130° and 150° PRO. To clarify the effects of various posterior rotation angles on postoperative proximal femoral morphology, we made simplified PRO models through changing only the posterior rotation angle. Results In the 90°, 110°, 130° and 150° PRO models, the vertically inclined angle of anteroposterior-view line showed a significant positive correlation with femoral neck-shaft varus realignment (90° PRO, r = 0.90; 110° PRO, r = 0.95; 130° PRO, r = 0.97; 150° PRO, r = 0.99), while a significant negative correlation with postoperative femoral anteversion angle (90° PRO, r = −0.97; 110° PRO, r = −0.95; 130° PRO, r = −0.92; 150° PRO, r = −0.7). Likewise, the posteriorly tilted angle of lateral-view line showed a significant negative correlation with both femoral neck-shaft varus realignment (90° PRO, r = −0.81; 110° PRO, r = −0.81; 130° PRO, r = −0.79; 150° PRO, r = −0.72) and postoperative femoral anteversion angle (90° PRO, r = −0.90; 110° PRO, r = −0.89; 130° PRO, r = −0.92; 150° PRO, r = −0.88). In the simplified PRO models, the posterior rotation angle showed a significant positive correlation with femoral neck-shaft varus realignment (r = 0.33), while a significant negative correlation with postoperative femoral anteversion angle (r = −0.76). The approximation equations for predicting the proximal femoral morphology after PRO were validated. Discussions It was confirmed that high-degree PRO (> 90°) is favourable for femoral neck-shaft varus realignment, but works against preserving femoral anteversion. With the approximation equations developed in the current study, surgeons could examine the feasibility of PRO based on postoperative femoral anteversion. In terms of hip joint function and subsequent total hip arthroplasty, excessive deformities including femoral retroversion and severe varus deformity could be avoided. Level of evidence IV; case series without control group.

The tibial pilon fracture is a complex lesion, which requires experienced clinical judgment and adequate planning to achieve good results. Treatment concepts enunciated by Ruedi and Allgower remain valid but have undergone modifications. The reconstitution of the fibular length is not always the first step to be performed. In the reconstruction of the articular surface, the prognosis is already sealed by the initial cartilage damage, and it is better to achieve stability and alignment. The stabilization of the medial column is essential, but it must be associated with the stabilization of at least one other column in complex fractures.

BACKGROUND Previous studies analyzing the acetabuli in patients with slipped capital femoral epiphysis (SCFE) have not definitively addressed the relationship between SCFE and acetabular shape. Femoral head overcoverage and acetabular version are thought to contribute to SCFE. The purpose of this study was to determine the acetabular morphology and orientation in hips with SCFE and compare them with normally developing children. METHODS Pelvic computed tomography (CT) images of patients with SCFE were compared with pelvic CTs of patients without orthopedic abnormalities (normal controls). Three-dimensional (3-D) reconstructions were created from each CT examination. Custom software uniformly aligned the pelvis then determined acetabular measures from the reconstructions including acetabular version, acetabular tilt, articular surface area, and acetabular coverage angle measured in a radial manner dividing the acetabulum into octants. RESULTS Two-hundred forty-four hips were included (53 SCFE, 31 unaffected contralateral hips in patients with SCFE, and 160 controls). The acetabular version was similar among SCFE hips, unaffected contralateral hips, and normal controls (P=0.48). Control hips had higher acetabular tilt than SCFE-affected hips (P=0.01) and unaffected contralateral hips (P=0.04). The acetabular surface area was higher in SCFE-affected hips compared with controls (P

Background An important surgical landmark in the distal radius is the watershed line. The watershed line is a landmark for the positioning of volar locking plates (VLP) in the distal radius. Inconsistencies remain in the literature as to the presence and dimensions of landmarks in this compact area. We studied the detailed anatomy and dimensions of the distal radius with reference to bony anatomy around the watershed line, with special attention to the area between the pronator quadratus (PQ) and radial styloid. Materials and Methods The distal radius regions of 31 cadavers (23 right sided and 8 left sided) were dissected and studied. The heights at the junction of the scaphoid and lunate fossa, at the radial styloid, at the midpoint in between, and the widths of the PQ line, scaphoid, and lunate fossa were measured. The angle subtended by the pronator fossa and the radial styloid was also recorded. Results The mean heights at the junction of the scaphoid and lunate fossa, radial styloid, and midpoint in between were 5.1, 15.7, and 8.2 mm, respectively. The widths of the PQ line, scaphoid, and lunate fossa were 27, 19.4, and 10.6 mm, respectively. The mean angulation between the pronator fossa and the radial styloid was 128.9 degrees. Conclusion The area between the PQ and watershed line comprises a narrow area of bone which tapers to a point at its medial extent largely below the lunate fossa, thus it can hardly contain any implant proximal to the lunate fossa. The anterior orientation of this area and the concave anatomy of the articular surface mean careful screw direction is imperative to avoid inadvertent joint penetration. An angulation exists between the pronator fossa and the radial styloid, below the scaphoid fossa.

An interesting international debate has been developed over the past 10 years (the last decade) surrounding the surgical procedure for recurrent anteroinferior instability and a definitive consensus is lacking on the factors which favor one technique over another, especially when bone loss is present (soft tissue vs. bone block). Glenoid bone loss is commonly observed in the shoulder with anterior instability, and it is difficult to evaluate the shape of the glenoid using plain radiograph, therefore, computed tomography or intraoperative observation is recommended for accurate assessment of glenoid bone loss and Hill-Sachs lesion. When we consider the bony defect of the glenoid as a risk factor for surgical failure, it is crucial to take into consideration the features of a concomitant Hill-Sachs lesion. However, all the previous reports focusing on the size of the Hill-Sachs lesion or on the glenoid bone loss in isolation, overlook the interaction of the 2 lesions through the arc of range of motion and how this may influence instability. The glenoid track is the first model to determine, in a dynamic way, how bone loss on both sides of the joint can lead to instability. The glenoid track is a zone of contact created by the glenoid on the humeral articular surface when the arm is moved along the end-range of motion (abduction and external rotation). The use of the glenoid track concept can potentially help guide surgical decision-making.