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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.

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.

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.

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.

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.

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).

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: 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.

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.

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 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.

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.

Background The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. Methods We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients’ basic data and postoperative data were collected and compared. Results A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). Conclusion This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.

Objectives To assess the outcome of the sinus tarsi approach and C-Nail fixation of displaced intra-articular calcaneal fractures (DIACFs). Design Prospective study. Setting University Trauma Department. Patients Sixty-four patients (mean age 44.3 years, 48 men and 16 women) with 75 DIACFs were treated between October 1, 2016 and December 31, 2018. Intervention In all cases, the posterior facet was reduced through the sinus tarsi approach and fixed with one or 2 screws. After reducing all fragments to the articular block, the final fixation was performed percutaneously with C-Nail, locked with 6 screws. Main outcome measurements Patients were assessed for restoration of the Bohler angle, complications, and overall fracture reduction. To assess the functional outcome, we used the Mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and Maryland Foot Score after 12 months. Results The Bohler angle improved from -0.5 degrees preoperatively to 28.6 degrees postoperatively. The articular step-off was reduced from 5.4 mm preoperatively to 0.6 mm postoperatively. The postoperative radiologic calcaneal score was 2.9, on average. Superficial wound edge necrosis was seen in 3 patients (4%) and superficial infection was observed in one (1.3%). After a 1-year follow-up, we recorded a mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. Conclusions After obtaining an anatomic reduction of the articular surface of the posterior facet with lag screws, the C-Nail represented a viable alternative to plate stabilization in the treatment of DIACFs, combining primary stability with low soft tissue complications. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Weightbearing computed tomography (WBCT) enables visualization of the foot and ankle as patients stand under load. Clinical measurements of WBCT images are generally limited to two-dimensions, which reduces the ability to quantify complex morphology of individual osseous structures as well as the alignment between two or more bones. The shape and orientation of the healthy/normal subtalar joint, in particular, is not well-understood, which makes it very difficult to diagnose subtalar pathoanatomy. Herein, we employed statistical shape modeling to evaluate three-dimensional (3D) shape variation, coverage, space, and congruency of the subtalar joint using WBCT data of 27 asymptomatic healthy individuals. The four most relevant findings were: (A) talar and calcaneal anatomical differences were found regarding the presence of (a) the talar posterior process, (b) calcaneal pitch, and (c) curvature of the calcaneal posterior facet; (B) the talar posterior facet articular surface area was significantly greater than the calcaneal posterior facet articular surface area; (C) the posterior facet varied in joint space distance, whereas the anteromedial facet was even; and (D) the posterior and anteromedial facet of the subtalar joint was consistently congruent. Despite considerable shape variation across the population, the posterior and anteromedial articular facets of the subtalar joint were consistently congruent. Results provide a detailed 3D analysis of the subtalar joint under a weightbearing condition in a healthy population which can be used for comparisons to pathological patient populations. The described SSM approach also shows promise for clinical evaluation of the subtalar joint from 3D surface reconstructions of WBCT images.

Bone marrow lesions (BML) are painful changes in subchondral bone which can be reliably identified on magnetic resonance imaging and have been identified in patients suffering from hip osteoarthritis (OA) and related conditions. Created via repetitive microdamage at the articular surface and dysregulated subchondral healing, BML have been linked to traumatic, inflammatory, degenerative, metabolic and neoplastic processes. While BML are known to be a common pathology throughout the body, BML at the hip have not been extensively studied in comparison to those at the knee. Due to the hip’s unique biomechanical architecture, function and loading, and independent risk factors leading to hip OA, hip BMLs must be independently understood. The identification of BML in the setting of a pre-osteoarthritic condition may provide a target for treatment and prevention of joint degeneration. By continuing to define and refine the relationships between BML, subchondral bone cysts and OA, prevention, diagnosis and treatment of OA could shift, leading to an improved quality of life and increased longevity of individuals’ native hips.

Latarjet procedure is one of the relevant techniques for the anterior and antero-inferior type of recurrent instability at the shoulder joint with a defect of the articular surface of the glenoid. A deeper study requires arthroscopic modification of this operation to assess its clinical effectiveness. Objective: to conduct a comparative analysis of open and arthroscopic Latarjet procedure, to evaluate intraoperative and postoperative complications and side effects of this surgical technique. Methods: a prospective randomized study was conducted, which included 30 patients: after open Latarjet procedure — 16 (53.3 %), arthroscopic — 14 (46.7 %). The results were evaluated at 3 and 6 weeks, 3–4 and 6–9 months after the operation using x-ray methods, computed tomography, Walch-Duplay and Rowe scales, and intraoperative and postoperative complications were also analyzed. In the case of arthroscopic technique, an increase in the volume of external rotation during the adduction and abduction of the shoulder, an open technique — a decrease (p = 0.01). A decrease of the volume during internal rotation (spinous process) was revealed with the use of both techniques, but with better results after arthroscopic (p = 0.02). Conclusions: when using arthroscopic and open methods of Latarjet procedure, a statistically confirmed equal improvement in results is observed with recurrent instability of the shoulder joint. The results indicate the clinically significant advantages of restoring the function of the shoulder joint, especially external rotation when using the arthroscopic technique of Latarjet procedure in comparison with the open technique.

Despite profound advancements in arthroscopic rotator cuff repair (RCR) techniques, radiologic failure rates may be in excess of 60% with repairs of large and massive tears in the elderly population. One of the strategies to improve these healing rates has been “patch” augmentation of the cuff repair. At the same time, superior capsular reconstruction (SCR) has gained significant popularity as an option for irreparable rotator cuff (RC) tears. Some have also advocated performing SCR in addition to arthroscopic RCR to reinforce the repair and improve healing rates. Techniques involving the use of fascia lata, ECM patches, and long head of the biceps (LHB) for SCR to reinforce the cuff repair have all been elegantly described. In this article, we propose a technique that enables a combination of the aforementioned procedures and involves performing RCR with patch augmentation, as well as SCR using LHB. In doing so, the repaired RC is bordered by the patch over its bursal surface and the LHB on the articular surface (functioning as the superior capsule), thus giving us the name “Hamburger technique” (a 3-layered construct).

Purpose To evaluate the magnetic resonance imaging (MRI) characteristics of Segond fractures, including the structures attached to the avulsed fragment, the integrity of anterolateral ligament (ALL) and iliotibial band (ITB), and fragment size and location. Methods This was a retrospective, cross-sectional study with MRI scans from 2016 to 2019 with the term “Segond” in the reports, signs of acute trauma, and a bony anterolateral tibial avulsion (Segond) fracture. Two experienced observers accessed images to evaluate fragment dimensions (anteroposterior, mediolateral, and craniocaudal) and distances from anatomic landmarks (Gerdy’s tubercle, articular surface, and posterolateral tibial corner). ALLs and ITBs also were evaluated, both for integrity and for attachment to the avulsed bony fragment. Data were statistically evaluated for significant correlations. Results Forty-eight knee MRIs of patients suffering from a combined anterior cruciate ligament and Segond injury were evaluated. The ALL presented with edema in 28 cases (58.3%) and was torn in 3 cases (6.3%). The ALL was attached to the bone fragment in all cases and the ITB also was attached in 25 cases (52.1%). Receiver operating characteristic curves also demonstrated that the larger each of the dimensions and the volume of the fragment, the greater the probability of ITB fibers being inserted. Also, the narrower the distance from the fragment to the center of Gerdy’s tubercle, the greater the probability of iliotibial band fibers being attached. Interobserver correlation varied from 0.87 to 0.97 for all measurements. Conclusions In all combined ACL injuries and Segond fracture MRI cases, the complete ALL inserted on the avulsed bony fragment, whereas the posterior part of the ITB was only attached in 52.1% of the cases. Segond fracture fragment size was predictive for the structures attached to it. The ALL was abnormal in 64.5% of cases and presented a clear discontinuity in 6.3%. Level of Evidence Case Series, Level IV.

The goal was to examine gender differences of patient characteristics and outcome after cartilage repair based on a collective of nearly 5,000 patients. Patient characteristics, accompanying therapies, and outcome (Knee Injury and Osteoarthritis Outcome Score [KOOS], reoperations, patient satisfaction) of 4,986 patients of the German cartilage register DGOU were assessed by t test for possible gender differences. P values

Summary Osteochondritis dissecans (OCD) commonly develops in the elbow, knee, and other joints of teenage patients who are engaged in sporting activities. However, OCD of the glenoid (OCD-Gl) is rarely found in teenage patients, especially those in their early teens. To our best knowledge, there have been no English reports of OCD-Gl in the early teens. A 13-year-old, right-handed amateur baseball infielder felt sharp pain in his right shoulder and noted articular repitus after making a long throw. An anteroposterior radiograph of the right shoulder showed an apparent linear fracture of the glenoid. On the bilateral shoulder view, separation of the epiphysis of the proximal right humerus (epiphysiolysis) was evident. Axial computed tomography (CT) showed a linear crack in the articular surface. Three-dimensional CT (3D-CT) revealed a bulge on the posterior side of the glenoid. The final diagnosis was OCD-Gl associated with Little Leaguer's shoulder. After four months, the linear crack in the glenoid was no longer detected on Xray films. Since the crack and bulging of the glenoid were also no longer seen on CT scans, so he was permitted to play baseball again. On review at 22 months, he had continued playing baseball without pain or crepitations and a radiograph showed no recurrence. Because diagnosis of OCD-Gl is difficult, it may not be recognized until the clinical stage gradually advances in the late teens or twenties. But, early detection and treatment at a younger age remains the best management for OCD-Gl. Considering the present case, there is a possibility that OCD-Gl may ccur in the early teens.

Objective To describe the spontaneous evolution of age-related changes affecting knee joint articular cartilage, walking speed and a serum biomarker of cartilage remodeling in C57BL/6-JRj wild-type male mice. Design Histological changes were assessed by the Osteoarthritis Research Society International (OARSI) score (0=normal, 6=vertical clefts/erosion to the calcified cartilage extending >75% of the articular surface) in newborn, 1-week- and 1-, 3-, 6-, 9- and 12-month-old C57BL/6-JRj wild-type male mice, walking speed by the Locotronic system, and serum C-terminal telopeptide of type II collagen (CTX-II) content by ELISA in 1-, 3-, 6-, and 9-month-old C57BL/6-JRj wild-type male mice. Results Mean (SD) OARSI score significantly increased from 0.2 (0.3) to 1.3 (0.6) ( p=0.03) between 1 and 3 months of age and from 1.3 (0.6) to 3.3 (0.6) ( p=0.04) between 3 and 6 months of age. Mean walking speed was stable between 1 and 6 months of age but significantly decreased from 11.4 (1.8) to 3.2 (0.8) cm.s-1 ( p=0.03) between 6 and 9 months of age. Serum CTX-II content was maximal at 1 month of age, then decreased from 12.2 (8.5) to 2.4 (8.4) pg/ml ( p=0.02) between 1 and 3 months of age, remaining low and stable thereafter. Conclusions C57BL/6-JRj wild-type male mice showed continuously increasing osteoarthritic changes but delayed decreasing walking speed with age. These variations were maximal between 3 and 9 months of age. Maximal serum CTX-II content preceded these changes.

This study aimed to compare the contact areas of Bankart repair with suture anchors placed on the articular surface of the glenoid versus at the rim of the glenoid because it is unclear which technique most effectively restores the footprint after Bankart repair. Ten fresh frozen cadaveric shoulders (mean age 70.7 years) were dissected. The attachment site of the capsulolabral complex from the 1 o’ clock position to the 6 o’clock position was marked with ink, and the contact area of the anterior-inferior capsulolabral complex on the glenoid neck was measured using imageJ. Bankart lesions were created, and two types of Bankart repair were performed on each specimen. The suture anchors were inserted at the glenoid rim (Rim group) and onto the glenoid articular surface 2 mm from the rim (Surface group). Using pressure-sensitive films, we examined the interface contact area. The Rim group recreated 64.9% of the native surface area, while the Surface group recreated 47.3% of the area. The Rim group recreated significantly greater contact area compared to the Surface group (P = 0.0008). The anchor placement to the glenoid rim recreates the footprint of the capsulolabral complex on the anterior inferior glenoid better than the anchor placement onto the articular surface.

PURPOSE: Articular cartilage is known to be mechanically anisotropic. In this paper, the acoustic anisotropy of bovine articular cartilage and the effects of freeze-thaw cycling on acoustic anisotropy were investigated. METHODS: We developed apparatus and methods that use a magnetic L-shaped sample holder, which allowed minimal handling of a tissue, reduced the number of measurements compared to previous studies, and produced highly reproducible results. RESULTS: SOS was greater in the direction perpendicular to the articular surface compared to the direction parallel to the articular surface (N=17, P = 0.00001). Average SOS was 1,758 ± 107 m/s perpendicular to the surface, and 1,617 ± 55 m/s parallel to it. The average percentage difference in SOS between the perpendicular and parallel directions was 8.2% (95% CI: 5.4% to 11%). Freeze-thaw cycling did not have a significant effect on SOS (P>0.4). CONCLUSION: Acoustic measurement of tissue properties is particularly attractive for work in our laboratory since it has the potential for nondestructive characterization of the properties of developing engineered cartilage. Our approach allowed us to observe acoustic anisotropy of articular cartilage rapidly and reproducibly. This property was not significantly affected by freeze-thawing of the tissue samples, making cryopreservation practical for these assays.

Distal femur fractures are complex and relatively rare. Conservative treatment has now been abandoned. The purpose of surgical treatment is to obtain an anatomical reduction of the articular surface, restoring the coronal and sagittal axis of the skeletal segment with a stable osteosynthesis, thus avoiding post-operative immobilization and allowing for early physical therapy. The literature reports similar results with different kinds of osteosynthesis: anterograde or retrograde nailing, dynamic compression screw plate, locking compression plates, and blade plates. Not only the type of fracture, but also the experience of the single surgeon should be taken into account when choosing the type of osteosynthesis.

Purpose Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.

Introduction: Estimation of stature plays an important role in the process of anthropolog y. This mirrors the culture, built of a person and many factors. Hence the anthropometric technique is exclusively used by medical scientists and anatomists to estimate the body size since many years. The present study was conducted to estimate the left humer al length from the measurements of proximal and distal segments of humerus in region of North Karnataka population using regression equation. This helps in estimating the stature of individual using standard regression formulae and tocompare these data with the study conducted in other countries for the use in forensic and archeologicalstudies. The current study was therefore focussed on proximal and distal segments of left humerus and using these, the length of the left humerus was estimated. Materials and Methods: The different measurements of proximal and the distal segments of 47 left humeri and the mean values of the maximum length of the left humerus (MHL) were noted and used in our study to derive the regression equation. . Maximum length of humerus, vertical and transverse diameter of proximal segment, transverse diameter and biepicondylar width of distal segment were measured using anthropometric techniques. Results: With the fragment measurements obtained, regression equations for left humeri was derived to estimate the maximum length of the humerus in North Karnataka region population. On applying the regression analysis, among 47left humeri, it was found that, the vertical diameter of superior articular surface had significant role in estimating the maximum humeral length with maximum correlation coefficient of 0.87 (p Conclusion: The result of this study concludes that the length of the left humerus can be estimated from the measures of proximal and distal segments of left humerus. Keywords: Regression equation, Left humerus, Estimation of length.

Introduction: Many professionals including anthropologists, medical scientists and anatomists had been using the anthropometric technique to estimate the body size since decades or even centuries. The study which we have conducted in North Karnataka of South Indian was to estimate the length of the right humerus from the dimension of proximal and distal segments of humerus using a regression equation. This is absolutely essential for archeologists, anthropologists and forensic investigators, even when a fragment of bone is available. The current study was therefore focused on the measurement of proximal and distal segments of humerus from which the length of the humerus was estimated. Materials and Methods: The maximum lengths of the right humeri (MHL) were measured and the mean values were calculated. The different measurements of proximal and the distal segments of 53 right humeri were noted and used in our study. Maximum length of humerus, vertical and transverse diameter of proximal segment, transverse diameter and biepicondylar width of distal segment were measured using anthropometric techniques. A regression equation was formulated to calculated the length of the entire humerus provided we can access the measurements of different fragments available. Results: With the measurements obtained analysis was done using descriptive statistics. Regression equation for right humeri was derived to estimate the length of the right humerus. On applying the regression analysis, among 53 right humeri, it was proved that, the vertical diameter of superior articular surface had significant role in estimating the maximum humeral length with maximum correlation coefficient of 0.94(p Conclusion: Thus we can conclude that the length of the right humerus can be estimated from the measures of proximal and distal segments of right humerus. Keywords: Regression equation, Right humerus, Estimation of length, North Karnataka.

Boering’s arthrosis is a rare disorder of the temporomandibular joints that usually occurs in the second decade and seldom after age 20. It was first described by G. Boering in 1966. It is more common in females and can be unilateral or bilateral. The disease results in resorption of the condyle with elongation of the articular surface resulting in the characteristics toadstool appearance observed on panoramic images. Condylar changes are often accompanied by anterior displacement of the disc and remodeling of the glenoid fossa. Facial asymmetry is almost always present. We present a case of a 9-year-old female with Boering’s arthrosis. She presented with facial asymmetry and bite abnormality but did not report symptoms typically associated with temporomandibular disorders.

Avascular necrosis is an ischemic or cytotoxic necrosis of epiphyseal bone, responsible for joint pain, altered life quality and frequently affecting young patients. Avascular necrosis can be unifocal or multifocal, underlining the possibility of a systemic origin. Avascular necrosis involves the femoral head in more than 75% of cases. Although avascular necrosis is irreversible, many risk factors must be sought, including corticosteroid treatment, hypercholesterolemia, sickle cell disease or alcohol abuse. MRI imaging is the main exploration for the diagnostic and staging of the disease, and should be performed in unexplained hip pain in young patients with normal X-rays. In the earlier stages of the disease (stage I and II of the Arlet and Ficat classification), joint surface is preserved, and conservative treatment is recommended. In the more advanced stages (III and IV of the Arlet and Ficat classification), the articular surface collapses and joint arthroplasty is the main treatment. However, there are some recent therapeutic advances, based on mesenchymal stem cells, which may contribute, in the future, to improve the bad functional prognosis of the disease.