Plate-related results of opening wedge high tibial osteotomy with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation: a retrospective case series of 346 knees.

BACKGROUND: While open wedge high tibial osteotomy (owHTO) is an established standard procedure to treat medial osteoarthritis of the knee in combination with varus deformity, it bears the risk of postoperative hardware failures and lateral cortical hinge fractures. This in turn can lead to an accelerated osteoarthritis, non-union, or a loss of correction accuracy. The purpose of the study was to evaluate the radiologic outcomes of owHTO with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation in patients with medial osteoarthritis and varus deformity. METHODS: Three hundred twenty-four consecutive patients (346 knees) who were treated with owHTO using the PEEKPower HTO plate were included in this retrospective study; 89.9% of the patients were overweight or obese. Patients were followed by conventional radiographs over a 12-month period. Typical plate-related results such as the time and quality of gap healing as well as the correction accuracy were analyzed. Furthermore, the number of lateral cortex fractures was determined. RESULTS: Bony consolidation was observed after a mean gap healing time of 4.0 ± 1.7 months independent on the patients' weight (p = 0.2302). With increasing gap sizes, bony healing was significantly prolonged (p < 0.001). Additionally, patients with greater gap sizes had a significantly increased risk for a lateral cortex fracture (p = 0.0041). However, none of the patients had a non-union 1 year postoperative. A hinge fracture occurred in 30% of patients. Hinge fractures with Takeuchi grades I and II increased the gap healing time compared to no fracture (p = 0.0069 and p = 0.0002, respectively), but only 1.2% of patients with hinge fracture had a clinical relevant loss of correction ≥ 3 mm. No implant failures were found. CONCLUSIONS: Open wedge HTO using the PEEKPower HTO plate for patients with medial osteoarthritis of the knee in combination with tibial varus deformity leads to excellent bony consolidation also in cases with a hinge fracture, a gap size > 12 mm as well as for severely obese patients.

A new symptomatic intra-articular cord-like structure associated with discoid meniscus.

We introduce a new, not yet described cord-like structure of the knee of children associated with discoid or enlarged menisci. This structure was responsible for knee pathology (loss of extension) in 3 cases. The patients (5 to 8 years of age) complained of knee pain without skeletal abnormality or trauma. Magnetic resonance imaging revealed enlarged or discoid lateral menisci. The patients showed increasing limp with limited range of motion. Lack of extension was between 10 degrees and 45 degrees and continued under anesthesia. During arthroscopy, the menisci and the anterior and posterior cruciate ligaments (ACL, PCL) showed no abnormality other than the variant of the lateral meniscus described above. A tight cord-like structure was imposed, running laterally along the ACL. This cord-like structure was attached to the lateral femoral intercondylar area and the posterior horn region of the lateral meniscus in a sail-like shape. Two knees showed abnormal mobility of the lateral meniscus, tending to luxate. The ligamentous structure was cut stepwise lateral to the ACL, leaving the entire lateral meniscus undisturbed. Finally, full extension was achieved. Examination 7 to 27 months after surgery showed asymptomatic knees. This ligamentous structure is an important differential diagnosis to symptoms usually referred to as meniscus pathology. The appropriate treatment involves dissection. A loss of meniscal tissue followed by development of osteoarthritis can be prevented.

Predicting recurrence after primary anterior shoulder dislocation.

We evaluated the factors influencing the recurrence rate after primary anterior traumatic shoulder dislocation, especially sports activity. A significant number of patients changed to athletic activities that produce less shoulder strain. The natural assumption would be that sports activity directly influences recurrence. However, age-adjusted logistic regression analysis revealed that the correlation between sports and recurrence rate was false. Our statistical findings also clearly showed that physical therapy and immobilization do not reduce the risk of recurrence. The only factor associated with recurrence was age between 21 and 30 years. Patients in this age group who participate in high-risk sports activities should undergo primary surgical stabilization because of the increased risk of recurrence.