Standardized multi-planar reformation improves the reliability of the assessment of the anterolateral ligament in ACL-deficient knees.

PURPOSE: The anterolateral ligament (ALL) is an important structure for controlling anterolateral rotatory stability of the knee. Its assessment, however, is difficult using standardized MRI images. The goal of this study was to assess the reliability of judging the integrity of the ALL on multi-planar reformatted (MPR) MRI images and on standard coronal reformatted (SCR) MRI images in knees with an anterior cruciate ligament (ACL) rupture. METHODS: Forty-eight patients (14 females, 34 males, 30 ± 6 years (mean age ± standard deviation)) with acute ACL ruptures (< 2 weeks) and no additional knee injuries (except segond fractures) were included. Images were assessed by two independent raters twice with at least a 2-week interval in between. The assessment was first performed on SCR images and thereafter on MPR images. Images were judged for assessability of the ALL and then the integrity of the ALL was rated. RESULTS: Depending on rater and read, the ALL was judged as "torn" in between 5 (10.4%) and 11 (22.9%) patients out of 48 patients on SCR images. On MRP images, the ALL was judged as "torn" in between 5 (10.4%) and 6 (12.5%) patients out of 48 patients, depending on rater and read. Inter- and intra-rater reliability for the assessment of the ALL using MPR images was "substantial" to "almost perfect". Inter- and intra-rater reliability for the assessment using SCR was "fair" to "substantial". CONCLUSION: MPR images should be used when assessing the integrity of the ALL. Assessment quality is independent of patient positioning during MRI acquisition and the ALL can be displayed in full length on one image. LEVEL OF EVIDENCE: Level III.

Survival, functional outcome and satisfaction of first revision total knee arthroplasty at a mean eleven-year follow-up.

PURPOSE: Providing long-term outcome data after rTKA and compare one- versus two-stage and septic versus aseptic revisions. METHODS: This study represents a single-center retrospective study of first rTKAs performed for any reason with a final follow-up of a minimum of five years. Outcome parameters included stability assessment ROM, radiologic assessment, HSS score, KSS score, OKS score, EQ-5D-3L and VAS. 44 patients were included in the study. Subgroups analysis of one- versus two-stage revision and septic versus aseptic revision was performed. RESULTS: The leading causes of rTKA in this mean 11 year follow-up study were aseptic loosening (36%) and periprosthetic joint infection (27%). At the final follow-up, there was a 89% survivorship of the implants. Patients showed a ROM of 114 ± 13°, HSS score of 78 ± 12, KKS objective score of 77 ± 16, KSS expectation and satisfaction score of 32 ± 11, KSS functional activity score of 50 ± 20, OKS of 30 ± 9, VAS of 53 ± 25 and EQ-5D index of 0.649. Functional outcome scores were not significantly altered in the analyzed subgroups. CONCLUSIONS: In our 11 years follow-up, we obtained 89% implant survivorship. Measurements regarding functional outcome and pain showed results in the medium range of the respective scores, while patient satisfaction lay in the upper third. No significant differences in outcome scores between one- and two-stage revisions and septic versus aseptic revisions were observed. Level of Evidence Level III, retrospective cohort study.

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases.

PURPOSE: The purpose of this study is to report and compare outcome data of both primary and revision cases using a rotating hinge knee (RHK) implant. METHODS: This study retrospectively analyzed 63 cases (19 primary, 44 revisions) at a mean follow-up of 34 ± 8 months after RHK implantation. Outcome parameters were stability, range of motion (ROM), loosening, Hospital of Special Surgery Score (HSS), Knee Society Score (KSS), Oxford Knee Score (OKS), EQ-5D-3L, and Visual Analog Scale (VAS) for overall function. Revision rates and implant survival are reported. RESULTS: Eleven percent showed medio-lateral instability < 5 mm, a mean ROM of 115° ± 17° and radiologic loosening occurred in 8% (2% symptomatic). PROMS showed the following results: HSS 79 ± 18, KSS 78 ± 27, OKS 26 ± 10, EQ-5D index 0.741 ± 0.233 and VAS 70 ± 20. Primary cases revealed better outcomes in HHS (p = .035) and OKS (p = 0.047). KSS, EQ-5D index and VAS did not differ between primary and revision cases (p = 0.070; p = 0.377; p = 0.117). Revision rate was 6.3% with an implant survival of 96.8%. CONCLUSIONS: RHK arthroplasty can be performed with good clinical outcome and low revision rate in revision and complex primary cases. RHK is an option in cases where standard arthroplasty and even implants with a higher degree of constraint have reached their limits. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Seventy percent long-term survival of the repaired ACL after dynamic intraligamentary stabilization.

PURPOSE: Primary repair of the anterior cruciate ligament (ACL) is regaining popularity. Long-term results are lacking. The purpose of the current study was to determine the survival of the primarily repaired ACL after dynamic intraligamentary stabilization. METHODS: Between 2011 and 2013, 57 patients with acute proximal ACL ruptures underwent DIS repair within 3 weeks from injury and were available for final follow-up at least 5 years postoperatively. Failure as an end point was defined as conversion to ACL reconstruction, failure to restore stability with persisting laxity side-to-side laxity of > 5 mm or a late-traumatic re-rupture or loss of stability. Kaplan-Meier survival analysis was performed. RESULTS: Kaplan-Meier survival analysis demonstrated an overall survival of 70.0% (standard error SE 6.6%) at 74 months follow-up. Patients performing competitive sports prior to injury demonstrated an inferior long-term ACL survival of 56.4% (SE 11.6%). Patients performing recreational sport activities demonstrated a survival rate of 79.2% (SE 7.7%). The one factor demonstrating a direct influence on failure after adjustment was a high-pre-injury level of physical (odds ratio 4.0 confidence interval 1.0-15.8, p = 0.04). CONCLUSION: The minimum 5 years survival rate after primary ACL repair using this technique was 70%. This value dropped to 56% in highly active patients performing competitive sports. Patients not suffering failure of repair demonstrated adequate restoration of knee laxity and high satisfaction. This study not only underlines the potential of ACL repair, but also highlights the danger of the procedure if strict patient selection is not appreciated. LEVEL OF EVIDENCE: Level IV.

The Ganz acetabular reinforcement ring shows excellent long-term results when used as a primary implant: a retrospective analysis of two hundred and forty primary total hip arthroplasties with a minimum follow-up of twenty years.

PURPOSE: The acetabular reinforcement ring with a hook (ARRH) has been designed for acetabular total hip arthroplasty (THA) revision. Additionally, the ARRH offers several advantages when used as a primary implant especially in cases with altered acetabular morphology. The implant facilitates anatomic positioning by placing the hook around the teardrop and provides a homogenous base for cementing the polyethylene cup. Therefore, the implant has been widely used in primary total hip arthroplasty at our institution. The present study reports the long-term outcome of the ARRH after a minimum follow-up of 20 years. METHODS: Two hundred and ten patients with 240 primary THAs performed between April 1987 and December 1991 using the ARRH were retrospectively reviewed after a minimum follow-up of 20 years. Twenty-three of 240 hips were lost to follow-up, 110 patients with 124 THAs had deceased without having a revision surgery performed. This left 93 hips for final evaluation. Of those, 75 hips were assessed clinically and radiographically after a mean follow-up of 23.1 years (range 21.1-26.1 years). In 18 cases, clinical and radiographic assessment was omitted because implant revision had been performed prior to the follow-up investigation. The primary endpoint was defined as revision for aseptic loosening. RESULTS: Out of the 93 hips available for final evaluation, 14 hips were revised for aseptic loosening; another four were revised for other reasons (deep infection n = 2, recurrent dislocation n = 2). The survival probability of the cup was 0.96 (95% confidence interval 0.93-0.99) after 20 years with aseptic loosening as endpoint. Radiographic analysis of the surviving 75 hips showed at least one sign of radiographic loosening in 24 hips. The mean Merle d'Aubigne score increased from 8 points pre-operatively to 15 points at final follow-up (7.5 ± 1.8 vs 15.0 ± 2.3, p < 0.001). The mean HHS was 85 ± 14 at final follow-up. Radiographic loosening did not correlate with the clinical outcome. CONCLUSIONS: The long-term results of the ARRH in primary THA are comparable to results with standard cemented cups and modern cementless cups. We believe that the ARRH is a versatile implant for primary THA, especially in cases with limited acetabular coverage and altered acetabular bone stock where the ARRH provides sufficient structural support for a cemented cup.

Correction to: Reconstruction of AAOS type III and IV acetabular defects with the Ganz reinforcement ring: high failure in pelvic discontinuity.

The author would like to correct the errors in the publication of the original article. The corrected details are given below for your reading.

Reconstruction of AAOS type III and IV acetabular defects with the Ganz reinforcement ring: high failure in pelvic discontinuity.

BACKGROUND: Large acetabular defects and pelvic discontinuity represent complex problems in revision total hip arthroplasty. This study aimed to investigate whether reconstruction with the Ganz reinforcement ring would provide durable function in large acetabular defects. PATIENTS AND METHODS: 46 hips (45 patients, 19 male, 26 female, mean age 68 years) with AAOS type III and IV defects undergoing acetabular revision with the Ganz reinforcement ring were evaluated at a mean follow-up of 74 months (24-161 months). Fourteen patients died during follow-up. All surviving patients were available for clinical assessment and radiographic studies. Radiographs were evaluated for bone healing and component loosening. A Cox-regression model was performed to identify factors influencing survival of the Ganz-ring. RESULTS: In the group of AAOS III defects, 3 of 26 acetabular reconstructions failed, all due to aseptic loosening. In pelvic discontinuity (AAOS IV), 9 of 20 hips failed due to aseptic loosening (n = 4), deep infection (n = 3), and non-union of the pelvic ring (n = 2). With acetabular revision for any reason as an endpoint, the estimated Kaplan-Meier 5-year survival was 86% in type III defects and 57% in type IV defects, respectively. The presence of pelvic discontinuity was identified as the only independent predictive factor for failure of the Ganz ring acetabular reconstruction (AAOS III vs. IV, Hazard ratio: 0.217, 95%, Confidence interval: 0.054-0.880, p = 0.032). CONCLUSION: The Ganz reinforcement ring remains a favorable implant for combined segmental and cavitary defects. However, defects with pelvic discontinuity demonstrate high failure rates. The indications should therefore be narrowed to acetabular defects not associated with pelvic discontinuity.

Validation of a standardized mapping system of the hip joint for radial MRA sequencing.

OBJECTIVE: Intraarticular gadolinium-enhanced magnetic resonance arthrography (MRA) is commonly applied to characterize morphological disorders of the hip. However, the reproducibility of retrieving anatomic landmarks on MRA scans and their correlation with intraarticular pathologies is unknown. A precise mapping system for the exact localization of hip pathomorphologies with radial MRA sequences is lacking. Therefore, the purpose of the study was the establishment and validation of a reproducible mapping system for radial sequences of hip MRA. MATERIALS AND METHODS: Sixty-nine consecutive intraarticular gadolinium-enhanced hip MRAs were evaluated. Radial sequencing consisted of 14 cuts orientated along the axis of the femoral neck. Three orthopedic surgeons read the radial sequences independently. Each MRI was read twice with a minimum interval of 7 days from the first reading. The intra- and inter-observer reliability of the mapping procedure was determined. RESULTS: A clockwise system for hip MRA was established. The teardrop figure served to determine the 6 o'clock position of the acetabulum; the center of the greater trochanter served to determine the 12 o'clock position of the femoral head-neck junction. The intra- and inter-observer ICCs to retrieve the correct 6/12 o'clock positions were 0.906-0.996 and 0.978-0.988, respectively. CONCLUSIONS: The established mapping system for radial sequences of hip joint MRA is reproducible and easy to perform.

Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis.

Background: Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Results: Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Conclusion: Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level of Evidence: Level 3 (meta-analysis including Level 3 studies).

SHIP1 deficiency causes inflammation-dependent retardation in skeletal growth.

Inflammation and skeletal homeostasis are closely intertwined. Inflammatory diseases are associated with local and systemic bone loss, and post-menopausal osteoporosis is linked to low-level chronic inflammation. Phosphoinositide-3-kinase signalling is a pivotal pathway modulating immune responses and controlling skeletal health. Mice deficient in Src homology 2-containing inositol phosphatase 1 (SHIP1), a negative regulator of the phosphoinositide-3-kinase pathway, develop systemic inflammation associated with low body weight, reduced bone mass, and changes in bone microarchitecture. To elucidate the specific role of the immune system in skeletal development, a genetic approach was used to characterise the contribution of SHIP1-controlled systemic inflammation to SHIP1-dependent osteoclastogenesis. Lymphocyte deletion entirely rescued the skeletal phenotype in Rag2 -/- /Il2rg -/- /SHIP1 -/- mice. Rag2 -/- /Il2rg -/- /SHIP1 -/- osteoclasts, however, displayed an intermediate transcriptomic signature between control and Rag2 +/+ /Il2rg +/+ /SHIP1 -/- osteoclasts while exhibiting aberrant in vitro development and functions similar to Rag2 +/+ /Il2rg +/+ /SHIP1 -/- osteoclasts. These data establish a cell-intrinsic role for SHIP1 in osteoclasts, with inflammation as the key driver of the skeletal phenotype in SHIP1-deficient mice. Our findings demonstrate the central role of the immune system in steering physiological skeletal development.

Exploring the Potential of Electronic Patient-Reported Outcome Measures to Inform and Assess Care in Sarcoma Centers: A Longitudinal Multicenter Pilot Study.

BACKGROUND: Electronic patient-reported outcome measures (ePROMs) are useful tools to assess care needs of patients diagnosed with cancer and to monitor their symptoms along the illness trajectory. Studies regarding the application of ePROMs by advanced practice nurses (APNs) specialized in sarcoma care and the use of such electronic measures for care planning and assessing quality of care are lacking. OBJECTIVE: To explore the potential of ePROMs in clinical practice for assessing the patient's quality of life, physical functionality, needs, and fear of progression, as well as distress and the quality of care in sarcoma centers. METHODS: A multicenter longitudinal pilot study design was chosen. Three sarcoma centers with and without APN service located in Switzerland were included. The instruments EQ-5D-5L, Pearman Mayo Survey of Needs, the National Comprehensive Cancer Network Distress Thermometer, PA-F12, and Toronto Extremity Salvage Score were used as ePROMs. Data were analyzed descriptively. RESULTS: Overall, 55 patients participated in the pilot study; 33 (60%) received an intervention by an APN, and 22 (40%) did not. Patients in sarcoma centers with APN service reported overall higher scores in quality of life and functional outcome. The number of needs and distress level were lower in sarcoma centers with APN service. No differences were found with respect to patients' fear of progression. CONCLUSIONS: Most of the ePROMs proved to be reasonable in clinical practice. PA-F12 has shown low clinical relevance. IMPLICATIONS FOR PRACTICE: Using ePROMs appears to be reasonable to obtain clinically relevant patient information and to evaluate the quality of care in sarcoma centers.

Flap Reconstruction Outcome Following Surgical Resection of Soft Tissue and Bone Sarcoma in the Setting of (Neo)adjuvant Therapy: A Sarcoma Center Experience.

BACKGROUND: Soft tissue and bone sarcomas are heterogeneous groups of malignant tumors. The shift in their management, with an emphasis on limb salvage, has deemed the involvement of reconstructive surgeons an integral part of their multidisciplinary treatment. We present our experience with free and pedicled flaps in the reconstruction of sarcomas at a tertiary referral university hospital and major sarcoma center. MATERIALS AND METHODS: All patients undergoing flap reconstruction after sarcoma resection over a 5-year period have been included in the study. Patient-related data and postoperative complications were collected retrospectively, ensuring a minimum follow-up of 3 years. RESULTS: A total of 90 patients underwent treatment with 26 free flaps and 64 pedicled flaps. Postoperative complications occurred in 37.7% of patients, and the flap failure rate was 4.4%. Diabetes, alcohol consumption and male gender were associated with increased early necrosis of the flap. Preoperative chemotherapy significantly increased the occurrence of early infection and late dehiscence, while preoperative radiotherapy was associated with a higher incidence of lymphedema. Intraoperative radiotherapy was associated with late seromas and lymphedema. CONCLUSIONS: Reconstructive surgery with either pedicled or free flaps is reliable, but it can be demanding in the setting of sarcoma surgery. A higher complication rate is to be expected with neoadjuvant therapy and with certain comorbidities.

Pathomorphology and treatment of femoroacetabular impingement.

Femoroacetabular impingement is recognized as a major cause of hip pain and early hip joint osteoarthritis in young adults. The dynamic conflict between the femoral neck and the acetabular rim has been shown to result in labral tears, cartilage lesions, and early osteoarthritis. To be successful, the treatment strategy should address the underlying pathomorphology at the femoral neck, the acetabulum, or both. An overview of the various pathomorphologies leading to femoroacetabular impingement and a treatment algorithm intended to preserve the native hip joint should be helpful to the orthopaedic surgeon treating patients with this condition.

3D printed fracture reduction guides planned and printed at the point of care show high accuracy - a porcine feasibility study.

PURPOSE: After surgical treatment of comminuted diaphyseal femoral and tibial fractures, relevant malalignment, especially rotational errors occur in up to 40-50%. This either results in a poor clinical outcome or requires revision surgery. This study aims to evaluate the accuracy of reduction if surgery is supported by 3D guides planned and printed at the point of care. METHODS: Ten porcine legs underwent computed tomography (CT) and 3D models of femur and tibia were built. Reduction guides were virtually constructed and fitted to the proximal and distal metaphysis. The guides were 3D printed using medically approved resin. Femoral and tibial comminuted diaphyseal fractures were simulated and subsequently reduced using the 3D guides. Postoperative 3D bone models were reconstructed to compare the accuracy to the preoperative planning. RESULTS: Femoral reduction showed a mean deviation ± SD from the plan of 1.0 mm ± 0.9 mm for length, 0.9° ± 0.7° for varus/valgus, 1.2° ± 0.9° for procurvatum/recurvatum and 2.0° ± 1.7° for rotation. Analysis of the tibial reduction revealed a mean deviation ± SD of 2.4 mm ± 1.6 mm for length, 1.0° ± 0.6° for varus/valgus, 1.3° ± 1.4° for procurvatum/recurvatum and 2.9° ± 2.2° for rotation. CONCLUSIONS: This study shows high accuracy of reduction with 3D guides planned and printed at the point of care. Applied to a clinical setting, this technique has the potential to avoid malreduction and consecutive revision surgery in comminuted diaphyseal fractures. LEVEL OF EVIDENCE: Basic Science.

Staged treatment of a comminuted femoral fracture with Masquelet technique and 3D printed reposition guides.

Background: Comminuted femoral fractures pose a challenge to the trauma surgeon due to the absence of bony references during surgery. Therefore, malalignment of length and axis can occur and necessitate revision surgery. During the last decade, 3D-planning has evolved as a surgical aid in difficult cases. Case report: An 18-year-old male patient suffered a polytrauma following a motorcycle accident. This report is about the treatment of a 3rd degree open and comminuted fracture of the left distal femur. The fracture was treated with Masquelet's two-staged technique. With the intent of avoiding malalignment, the second stage surgery was performed with the aid of 3D-planned reduction guides. Despite complex fracture pattern, complete fracture union was achieved with acceptable final alignment (side-to-side comparison of length, axis and femoral torsion). Conclusion: In this case, performing Masquelet's two-staged surgery with the aid of 3D-printed reposition guides yielded favorable results in regards to rotational malalignment. The malrotation of the femur was reduced after the second operation to a clinically acceptable side-to-side difference (10°). This technique remains technically challenging due to soft tissue tension and limited possibility of soft tissue release.

Collagen wrapping and local platelet-rich fibrin do not improve the survival rates of ACL repair with dynamic intraligamentary stabilization: a retrospective case series after ≥5 years postoperatively.

PURPOSE: Anterior cruciate ligament (ACL) repair has been recommended as a treatment principle for ACL tears. Several authors have advocated a potential role for primary repair techniques in the ACL decision tree. However, long-term results have been controversial. This study aims to determine the survival of the primarily repaired ACL after dynamic intraligamentary stabilization (DIS) with and without augmentation. METHODS: Between 2014 and 2019, 102 patients with isolated proximal ACL ruptures underwent DIS repair within 21 days from injury and were available for follow-up either clinically or telephonically after ≥5 years postoperatively. In 45 cases, DIS repair was augmented with collagen fleece wrapping, platelet-rich fibrin (PRF) or both. Failure was defined as traumatic re-rupture or conversion to ACL reconstruction. The patients being available for physical examination underwent a.-p. stability measurement with a KT-1000 device. Functional outcome was measured with the IKDC, Tegner and Lysholm scores. Kaplan-Meier survival analysis, Log-Rank Test and Binominal logistic regression were performed. RESULTS: After a minimum 5-year follow-up, 71/102 (69.6%) DIS repairs were not re-reptured and clinically and/or subjectively stable. Augmentation did not improve survival rates (p = 0.812). The identified factors influencing failure were a younger age and a pre-injury Tegner activity level of ≥7. 95.7% of those patients with an intact ACL repair had normal or near normal knee function based on the IKDC scoring system. CONCLUSIONS: The 5-year overall survival rate of DIS was 69.6%. Collagen fleece wrapping and local PRF application did not improve survival. Patients not suffering failure of repair demonstrated high satisfaction. Nevertheless, the results are inferior to those of established ACL reconstruction procedures. LEVEL OF EVIDENCE: Case series, Level IV.

Quantitative determination of the femoral offset templating error in total hip arthroplasty using a new geometric model.

AIMS: Traditionally, total hip arthroplasty (THA) templating has been performed on anteroposterior (AP) pelvis radiographs. Recently, additional AP hip radiographs have been recommended for accurate measurement of the femoral offset (FO). To verify this claim, this study aimed to establish quantitative data of the measurement error of the FO in relation to leg position and X-ray source position using a newly developed geometric model and clinical data. METHODS: We analyzed the FOs measured on AP hip and pelvis radiographs in a prospective consecutive series of 55 patients undergoing unilateral primary THA for hip osteoarthritis. To determine sample size, a power analysis was performed. Patients' position and X-ray beam setting followed a standardized protocol to achieve reproducible projections. All images were calibrated with the KingMark calibration system. In addition, a geometric model was created to evaluate both the effects of leg position (rotation and abduction/adduction) and the effects of X-ray source position on FO measurement. RESULTS: The mean FOs measured on AP hip and pelvis radiographs were 38.0 mm (SD 6.4) and 36.6 mm (SD 6.3) (p < 0.001), respectively. Radiological view had a smaller effect on FO measurement than inaccurate leg positioning. The model showed a non-linear relationship between projected FO and femoral neck orientation; at 30° external neck rotation (with reference to the detector plane), a true FO of 40 mm was underestimated by up to 20% (7.8 mm). With a neutral to mild external neck rotation (≤ 15°), the underestimation was less than 7% (2.7 mm). The effect of abduction and adduction was negligible. CONCLUSION: For routine THA templating, an AP pelvis radiograph remains the gold standard. Only patients with femoral neck malrotation > 15° on the AP pelvis view, e.g. due to external rotation contracture, should receive further imaging. Options include an additional AP hip view with elevation of the entire affected hip to align the femoral neck more parallel to the detector, or a CT scan in more severe cases.Cite this article: Bone Jt Open 2022;3(10):795-803.

Treatment of Knee Dislocation With Primary Repair and Suture Augmentation: A Viable Solution.

Background: Different surgical techniques have been described for the treatment of knee dislocation (KD). Nonoperative approaches are frequently combined with surgical reconstruction using auto- or allograft. Purpose: To evaluate the midterm results of primary surgical repair and suture augmentation to treat KD. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD were evaluated at a mean of 49 ± 16 months after surgical treatment that included primary repair and suture augmentation. Magnetic resonance imaging, stress radiographs, and outcome scores were obtained at the follow-up. Clinical examination including hop tests and force measurements for flexion and extension was performed. Results: The mean difference in pre- to postinjury Tegner scores was -2 ± 1. The outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15 (International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate Ligament-Return to Sport after Injury scale). Compared with the uninjured knee, the range of motion of the injured knee was reduced by 21° ± 12°. Twelve patients felt fit enough to perform hop tests and showed a mean deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs revealed an 11 ± 7-mm higher anteroposterior translation on the injured side. Four patients had secondary ligament reconstructions due to persistent instability and 7 underwent arthroscopic arthrolysis due to stiffness. A significant increase of osteoarthritis was found for the medial, lateral, and patellofemoral compartments (P = .007, .004, and .006, respectively). Conclusion: Primary repair and suture augmentation of KD led to satisfactory clinical midterm results despite persistent radiological instability and a significant increase in osteoarthritis. This technique allows the return to activities of daily living without subjective instability in most nonathletic patients. Secondary ligament reconstructions should be performed if relevant instability persists to decrease the risk of secondary meniscal and cartilage damage.

Incidence, predictive factors, and prognosis of chondrosarcoma in patients with Ollier disease and Maffucci syndrome: an international multicenter study of 161 patients.

BACKGROUND: Enchondromatosis is characterized by the presence of multiple benign cartilage lesions in bone. While Ollier disease is typified by multiple enchondromas, in Maffucci syndrome these are associated with hemangiomas. Studies evaluating the predictive value of clinical symptoms for development of secondary chondrosarcoma and prognosis are lacking. This multi-institute study evaluates the clinical characteristics of patients, to get better insight on behavior and prognosis of these diseases. METHOD: A retrospective study was conducted using clinical data of 144 Ollier and 17 Maffucci patients from 13 European centers and one national databank supplied by members of the European Musculoskeletal Oncology Society. RESULTS: Patients had multiple enchondromas in the hands and feet only (group I, 18%), in long bones including scapula and pelvis only (group II, 39%), and in both small and long/flat bones (group III, 43%), respectively. The overall incidence of chondrosarcoma thus far is 40%. In group I, only 4 patients (15%) developed chondrosarcoma, in contrast to 27 patients (43%) in group II and 26 patients (46%) in group III, respectively. The risk of developing chondrosarcoma is increased when enchondromas are located in the pelvis (odds ratio, 3.8; p = 0.00l). CONCLUSIONS: Overall incidence of development of chondrosarcoma is 40%, but may, due to age-dependency, increase when considered as a lifelong risk. Patients with enchondromas located in long bones or axial skeleton, especially the pelvis, have a seriously increased risk of developing chondrosarcoma, and are identified as the population that needs regular screening on early detection of malignant transformation.

Celecoxib enhances radiation response of secondary bone tumors of a human non-small cell lung cancer via antiangiogenesis in vivo.

PURPOSE: Cyclooxygenase-2 (COX-2) inhibitors mediate a systemic antitumor activity via antiangiogenesis and seem to enhance the response of primary tumors to radiation. Radiosensitizing effects of COX-2 inhibition have not been reported for bone metastases. Therefore, the aim of this study was the investigation of the radiosensitizing effects of the selective COX-2 inhibitor celecoxib in secondary bone tumors of a non-small cell lung carcinoma in vivo. MATERIALS AND METHODS: Human A549 lung carcinomas were implanted into a cranial window preparation in male SCID mice (n = 24). Animals were treated with either celecoxib or radiation (7 Gy single photon dose) alone or a combination of celecoxib and radiation, respectively. Untreated animals served as controls. The impact of radiation and COX-2 inhibition on angiogenesis, microcirculation, and tumor growth was analyzed over 28 days by means of intravital microscopy and histological methods. RESULTS: Monotherapies with radiation as well as celecoxib had significant antitumor effects compared to untreated controls. Both therapies reduced tumor growth and vascularization to a similar extent. The simultaneous administration of celecoxib and radiation further enhanced the antitumor and antiangiogenic effects of single-beam radiation. With the combined treatment approach, tumor vascularization and tumor size were decreased by 57% and 51%, respectively, as compared to monotherapy with radiation. CONCLUSION: The combined application of radiation therapy and COX-2 inhibition showed synergistic effects concerning the inhibition of tumor growth and tumor angiogenesis. Therefore, the combination of radiation with COX-2 inhibitor therapy represents a promising approach to improve the therapeutic efficacy of radiotherapy of bone metastases.