Search Results (13)

Background: The isolated rectus femoris tendon (RT) is a less commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Graft selection is a critical part of ACL reconstruction, especially in revision surgery. Hypothesis: This study compares patient-reported outcome measurements (PROMs) between revision ACL reconstruction with an RT autograft and a hamstring tendon (HT) autograft. We hypothesized that the RT autograft will yield comparable functional results and high patient satisfaction. Study Design: This was a cohort study; the level of evidence is III. Methods: Fifty-five patients (RT n = 28; HT n = 27) who underwent revision ACL reconstruction were included in this study, with a mean follow-up time of 40.3 months (range, 16.4–64.8) for RT and 61.2 months (range, 34.6–86.3) for HT. Apart from the harvesting technique, the surgical technique was the same for both groups. Clinical and intraoperative data were collected for our postoperative registry. In addition, funcinal outcome was measured using the International Knee Documentation Committee score (IKDC), the Lysholm score, Tegner activity scale, and numeric rating scale (NRS). The type and frequency of postoperative complications were documented. Results: At the final follow-up, no significant differences were observed between the RT and HT groups in the IKDC (mean ± SD: 74.7 ± 10.9 vs. 74.9 ± 12.9), Lysholm score (90.9 ± 15.0 vs. 89.0 ± 14.6), or Tegner activity scale (median [IQR]: 5 [4–6] vs. 5 [4–6]). The mean femoral tunnel diameter was 9.0 mm (range, 7.5–10 mm) for the RT and 8.2 mm (range 7.0–9.5 mm) for the HT. The use of the RT reduced the need for a two-stage procedure by 50% compared to HT (n = 5 vs. n = 10), although this difference was not statistically significant (p = 0.11). Stability measured by the Lachman test improved significantly in both groups from the pre- to postoperative period. Retear of the ACL graft was observed in two patients in both groups (7.1% RT and 7.4% HT). Conclusions: The RT and HT autografts achieved similar outcomes in PROMs for revision ACL reconstruction. Good tendon quality with parallel fibers and adjustable thickness characterize the RT. A tendency for a reduced rate of two-stage surgery with RT was noticed. Clinical Relevance: The incidence of revision ACL reconstruction is rising. Surgeons should be aware of all the available graft options. The isolated RT expands the range of autografts available for ACL reconstruction. Full article

Osteoarthritis (OA) is a prevalent disease among the elderly population, necessitating effective treatment options. Total joint arthroplasty (TJA) is a reliable surgical procedure that has shown good long-term clinical outcomes for OA. However, certain challenges, such as implant failure caused by particle-induced aseptic loosening or hypersensitivity to metal ions, remain unresolved in TJA. High-performance ceramic implants have emerged as a promising solution to address these persistent implant-related issues. This review article provides an overview of the composition and characteristics of ceramics used in TJA, highlighting their potential advantages and associated risks. While ceramic implants have demonstrated excellent performance in vivo for hip and knee arthroplasty, their bioinert behaviour is still considered a crucial factor regarding cementless options. Therefore, novel methods are investigated that seem to be able to combine the benefits of ceramic materials with an excellent osseointegration behaviour, which makes ceramics as implant materials an even stronger option for future applications. Full article

Consideration of the individual carpal bone characteristics of the wrist plays a key role in well-functioning biomedical devices and successful surgical procedures. Although geometric differences and individual bone sizes have been analyzed in the literature, detailed morphologic descriptions and correlations covering the entire wrist reported in a clinical context are lacking. This study aimed to perform a comprehensive and automatic analysis of the wrist morphology using the freely available “Open Source Carpal Database” (OSCD). We quantified the size of each of the individual carpal bones and their combination. These sizes were extracted in n = 117 datasets of the wrist of the OSCD in anatomical directions and analyzed using descriptive statics and correlation analysis to investigate the morphological characteristics under sex-specific aspects and to provide regression plots and equations to predict individual carpal bone sizes from the proximal and distal row dimensions. The correlations in the proximal row were higher compared to the distal row. We established comprehensive size correlations and size rations and found that there exist statistical differences between sex, particularly of the scaphoid. The regression plots and equations we provided will assist surgeons in a more accurate preoperative morphological evaluation for therapy planning and may be used for future anatomically inspired orthopedic biomedical device designs. Full article

The wrist joint plays a vital role in activities of daily living. Clinical applications, e.g., therapeutic planning, prosthesis design, and wrist biomechanical analysis, require a detailed understanding of wrist maneuvers and motion. The lack of soft tissue information, motion analysis on limited carpal bones, etc., restrain the investigation of wrist kinematics. In this study, we established 3D models of carpal bones with their cartilages, and revealed the helical axes (HA) of all eight carpal bones for the first time. Both left and right hands at different positions of flexion-extension (FE) and radial-ulnar deviation (RUD) from five subjects were in-vivo imaged through a magnetic resonance imaging device. We segmented all of the bones, including cartilage information in the wrist joint, after which we explored the kinematics of all carpal bones with the HA method. The results showed that the HA of all carpal bones for FE bounded tightly and was mainly located slightly above the radius. During the RUD, carpal bones in the distal row rotated along with wrist movement while the scaphoid, lunate, and triquetrum primarily flexed and extended. Further results reported that the carpal bones translated greater in RUD than in FE. With the generation of more delicate wrist models and thorough investigations of carpal motion, a better understanding of wrist kinematics was obtained for further pathologic assessment and surgical treatment. Full article

The carpal bones are eight small bones with irregularities and high curvature on their surfaces. The 3D model of the carpal bone serves as the foundation of further clinical applications, e.g., wrist kinematic behavior. However, due to the limitation of the Magnetic Resonance Imaging (MRI) technique, reconstructed carpal bone models are discretely undersampled, which has dramatic stair-step effects and leads to abnormal meshes on edges or surfaces, etc. Our study focuses on determining the viability of various smoothing techniques for a carpal model reconstructed by in vivo gathered MR images. Five algorithms, namely the Laplacian smoothing algorithm, the Laplacian smoothing algorithm with pre-dilation, the scale-dependent Laplacian algorithm, the curvature flow algorithm, and the inverse distance algorithm, were chosen for evaluation. The assessment took into account the Relative Volume Difference and the Hausdorff Distance as well as the surface quality and the preservation of morphological and morphometric properties. For the five algorithms, we analyzed the Relative Volume Difference and the Hausdorff Distance for all eight carpal bones. Among all the algorithms, the scale-dependent Laplacian method processed the best result regarding surface quality and the preservation of morphological and morphometric properties. Based on our extensive examinations, the scale-dependent Laplacian algorithm is suitable for the undersampled carpal bone model with small volume and large curvature. Full article

In this study, three different musculoskeletal modeling approaches were compared to each other. The objective was to show the possibilities in the case of a simple mechanical model of the wrist, using a simple multi-body-simulation (MBS) model, and using a more complex and patient-specific adaptable wrist joint MBS model. Musculoskeletal modeling could be a useful alternative, which can be practiced as a non-invasive approach to investigate body motion and internal loads in a wide range of conditions. The goal of this study was the introduction of computer-based modelling of the physiological wrist with (MBS-) models focused on the muscle and joint forces acting on the wrist. Full article

The human wrist joint is an elegant mechanism. The wrist allows the positioning and orienting of the hand to the forearm. The computational modeling of the human hand, especially of the wrist joint, can reveal important information about biomechanical mechanisms and provide the basis for its dysfunction and pathologies. For instance, this could be used for therapy planning in total wrist arthroplasty (TWA). In this study, different optimization methods and sensitivity analyses of anatomical parameters for musculoskeletal modeling were presented. Optimization includes finding the best available value of an objective function, including a variety of different types of objective functions. In the simplest case, optimization consists of maximizing or minimizing a function by systematically choosing input values from within an allowed set and computing the value of the function. Optimization techniques are used in many facets, such as the model building of joints or joint systems such as the wrist. The purpose of this study is to show the variability and influence of the included information for modeling, investigating the biomechanical function and load situation of the joint in representative scenarios. These possibilities to take them into account by an optimization and seem essential for the application of computational modeling to joint pathologies. Full article

The Swanson silicone prosthesis was one of the first devices to realize total wrist arthroplasty (TWA). It has been used regularly since the early 1960s. This systematic review of the literature evaluated the status quos of TWA. The present study was conducted according to the PRISMA guidelines. A literature search was made in Medline, PubMed, Google Scholar, and the Cochrane Library databases. The focus of the present study was on implant survivorship and related functional outcomes. Data from 2286 TWA (53 studies) were collected. Fifteen studies were included for the analysis of implant survivorship. Fifteen studies were included for the analysis of pain. Twenty-eight studies were included for the analysis of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Grip strength was tracked in 16 studies. The range of motion (RoM) was evaluated in 46 studies. For supination and pronation, 18 articles were available. Despite some methodological heterogeneities, TWA may be effective and safe in pain reduction and improving function and motion. There is still a range for a future improvement of the procedure. Full article

Background: Distal first metatarsal osteotomies are commonly performed operative procedures for hallux valgus deformity, and usually involve fixation with a metal screw. However, various bioabsorbable osteosynthesis materials have been in use for a number of years. One recent innovation is the Shark Screw^®, a human cortical bone allograft. This study aimed to evaluate the efficacy and safety of this allogeneic screw in the stabilization of Reversed L-Shaped osteotomy, a modified Chevron osteotomy. Methods: In a prospective study, 15 patients underwent a Reversed L-Shaped osteotomy stabilized with the allogenic bone screw Radiological data on osteointegration of the screw and correction of the intermetatarsal angle were recorded. Furthermore, each follow-up examination included the collection of clinical data, the American Orthopedic Foot and Ankle Society (AOFAS) score, evaluation of pain level, and patient’s overall satisfaction. Results: Full osseous fusion of the osteotomy was seen in all patients. The bone screws were radiographically integrated after approximately 6.5 (±2.6) months. Neither nonunion nor failure occurred in any of our cases. Furthermore, we did not find any potential graft reaction. The AOFAS score improved significantly from 51.6 (±15.2) points to 90.9 (±10.3) (p < 0.001). The preoperative hallux valgus angle and intermetatarsal angle decreased significantly from 24.8 (±4.9) degrees to 7.2 (±4.4) degrees (p < 0.001) and 12.6 (±3.2) degrees to 4.8 (±1.3) degrees (p < 0.001), respectively. Conclusions: With this study, we demonstrated the efficiency of the allogenic bone screw (Shark Screw^®) in regard to clinical and radiological short-term outcomes. Full article

The wrist is by far the most differentiated section of the musculoskeletal system. The spectrum of wrist injuries ranges from minor injuries to complex traumas with simultaneous loss of functions, resulting in enormous economic costs. A proper understanding of the anatomy and biomechanics is essential for effective treatment, whether conservative or surgical; this applies to the wrist no less than to other parts of the human body. Here; information on the wrist anatomy; kinematics; and biomechanical behavior is presented, commencing with a brief explanation of the structure of its hard and soft tissues. Eight carpal bones in combination with two forearm bones (radius and ulna) construct the wrist joint. The motion of the wrist joint is initiated by the muscles of the forearm, and strong and short ligaments ensure the stability of the wrist. All of these components are essential to bringing functions to the wrist joint because these structures allow wrist mobility and sustainability. In addition, the kinematics of the wrist joint is presented and different biomechanical model approaches. The therapeutic (surgical) restoration of the balance between the load–bearing capacity and the actual stress on a joint is the prerequisite for a lifelong and trouble-free function of a joint. Regarding the complex clinical problems, however, a valid biomechanical wrist joint model would be necessary as assistance, to improve the success of systematized therapies based on computer–aided model–based planning and intervention. Full article

Introduction: Many procedures are available to manage cartilage defects of the talus, including microfracturing (MFx) and Autologous Matrix Induced Chondrogenesis (AMIC). Whether AMIC or MFx are equivalent for borderline sized defects of the talar shoulder is unclear. Thus, the present study compared the efficacy of primary isolated AMIC versus MFx for borderline sized focal unipolar chondral defects of the talar shoulder at midterm follow-up. Methods: Patients undergoing primary isolated AMIC or MFx for focal unipolar borderline sized chondral defects of the talar shoulder were recruited prospectively. For those patients who underwent AMIC, a type I/III collagen resorbable membrane was used. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, American Orthopedic Foot and Ankle Score (AOFAS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Data concerning complication rate and additional procedures were also collected. Results: The mean follow-up was 43.5 months. The mean age of the 70 patients at operation was 32.0 years, with a mean defect size of 2.7 cm². The mean length of hospitalization was shorter in the MFx cohort (p = 0.01). No difference was found between the two cohorts in terms of length of prior surgery symptoms and follow-up, mean age and BMI, sex and side, and defect size. At a mean follow-up of 43.5 months, the AOFAS (p = 0.03), VAS (p = 0.003), and Tegner (p = 0.01) scores were greater in the AMIC group. No difference was found in the MOCART score (p = 0.08). The AMIC group evidenced lower rates of reoperation (p = 0.008) and failure (p = 0.003). Conclusion: At midterm follow-up, AMIC provides better results compared to MFx. Full article

Introduction: The potential of autologous matrix-induced chondrogenesis (AMIC) to restore unipolar focal chondral defects of the knee is promising. However, the outcome compared to microfracturing (MFx) for certain defect sizes (2–3 cm²) is still uncertain. Therefore, the present study compared primary isolated AMIC versus MFx in a cohort of patients with borderline sized focal unipolar chondral defects of the knee at midterm follow-up. Methods: Patients with chondral defects of the knee who underwent AMIC or MFx were compared. An arthroscopic approach was used for MFx, and a minimally invasive parapatellar arthrotomy for AMIC. For those patients who underwent AMIC, a collagen membrane was used with fibrin glue. The patients answered independently: Visual Analogic Scale (VAS), Tegner Activity Scale, International Knee Documentation Committee (IKDC), and the Lysholm scores. Results: A total of 83 patients with a mean age of 30.2 and body mass index (BMI) of 26.9 kg/m² were recruited. Of them, 33.7% (28 of 83) were women, and 55.4% (46 of 83 patients) had defects in the right knee. The mean length of symptoms before surgery was 43.3 months. The mean size of the defect was 2.7 cm². The mean length of follow-up was 42.1 months. No difference was found in terms of symptoms and follow-up length, mean age and BMI, mean size of defect, sex, and side. The AMIC cohort reported greater IKCD (p > 0.0001), Lysholm (p = 0.002), VAS (p = 0.01), Tegner (p = 0.004) scores. The AMIC cohort reported lower rate of failure (p = 0.005) and revision surgery (p = 0.02). No difference was found in the rate of arthroplasty (p = 0.2). No delamination or hypertrophy were detected. Conclusion: AMIC demonstrated superiority over MFx for focal unipolar chondral defects of the knee. At approximately 40 months follow-up, the IKDC, Lysholm, and VAS scores were greater in the AMIC group. Patients treated with AMIC also demonstrated a higher level of sport activity, and lower rates of failure and revision surgeries. Full article

Introduction: Evidence on the management of chondral defects of the patella arises from studies in which the patellofemoral joint was treated together with the femorotibial joint and primary and revision settings. Furthermore, the superiority of Autologous Matrix Induced Chondrogenesis (AMIC) over microfractures (MFx) for patellar chondral defects is uncertain. Therefore, the present study compared primary isolated AMIC versus MFx for focal unipolar chondral defects of the patellar facet joints at midterm follow-up. Methods: Patients undergoing AMIC or isolated MFx surgery for borderline-sized focal unipolar chondral defects of the patellar facet joints were followed at our institution. All surgeries were performed in the same fashion by experienced surgeons. A parapatellar arthrotomy was adopted in all surgeries. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, International Knee Documentation Committee (IKDC), and the Lysholm scores. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Results: 38 patients were enrolled in the present study: 27 underwent AMIC, and 11 MFx. The mean follow-up was 45.1 months. The mean age of the patients at baseline was 34.5 years. The mean size of the defect was 2.6 cm². The MFx cohort experienced a shorter length of the hospitalization (P = 0.008). There was no difference in terms of follow-up and previous symptoms duration, mean age, sex, side, defect size, and BMI. At last follow-up, the AMIC cohort reported greater IKDC (P = 0.01), Lysholm (P = 0.009), and Tegner (P = 0.02), along with a low rate of failure (P = 0.02). VAS was lower in the AMIC group (P = 0.002). No difference was found in the MOCART score (P = 0.09), rates of revision (P = 0.06), and arthroplasty (P = 0.2). Conclusion: The AMIC procedure achieves greater IKDC and Lysholm score, and a significant reduction of the VAS score in the management of patellar chondral defects. The Tegner scale demonstrated greater activity after AMIC procedure. Finally, the AMIC group evidenced a lower rate of failure. Similarity was found on MOCART score, rates of revision, and arthroplasty between the two procedures. Full article