Arthroscopically assisted stabilization of displaced lateral clavicle fractures with coracoclavicular instability.

BACKGROUND: Lateral clavicle fractures associated with partial or complete injury of the coracoclavicular ligaments have traditionally been treated using a variety of open surgical techniques. PURPOSE OF THE STUDY: The aim of this prospective study was the evaluation of the clinical and radiologic outcome of displaced lateral clavicular fractures with coracoclavicular instability treated in an arthroscopic single TightRope technique including an interfragmentary cerclage. METHODS: From 2008 to 2010, 23 patients [8 women and 15 men; mean age 38 (24-63) years] who sustained a displaced lateral clavicular fracture type II according to Neer were included in this study. The follow-up consisted of a complete physical examination of the shoulder including range of motion, the constant score (CS), and the subjective shoulder value (SSV). The radiological follow-up included an anteroposterior stress view with 10 kg of axial load and bilateral axillary views to evaluate the coracoclavicular distance, the clavicular implant position, and healing of the fracture. RESULTS: After a mean follow-up of 23.0 (13-38) months, 20 patients (7 women and 13 men; mean age 38.3 (24-53) years) were available for follow-up. On average, patients achieved 95.1 (60-100) % in the SSV, 88.7 (64-99; contralateral side 91.8 points; p > 0.05) points in the CS. Radiologically, 18 of 20 patients (90 %) displayed a bony healing of the fracture. The average coracoclavicular distance of 11.2 (6-14) mm did not differ significantly from the healthy side [9.9 (8-14) mm]. In six cases (30 %), coracoclavicular ossifications appeared. Two of 20 patients had concomitant glenohumeral lesions (10 %). Two patients had secondary surgery [implant removal (N = 1 local implant irritation); plate osteosynthesis (N = 1 early loss of reduction)]. CONCLUSION: The arthroscopic-assisted and image intensifier-controlled closed reduction and single TightRope fixation with interfragmentary cerclage of displaced lateral clavicular fractures with coracoclavicular instability yields excellent clinical results and is able to recreate stability of the clavicle.

Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears.

Anterior cruciate ligament (ACL) tears are known to be a risk factor for incident knee osteoarthritis (OA). At the present time, it is unknown whether an incidental ACL tear in those with established knee OA alters the pattern of synovial joint damage. Therefore, our aim was to assess whether ACL tears in persons with knee OA are associated with specific patterns of cartilage loss, meniscal degeneration, and bone marrow lesion (BML) location. We included 160 participants from the progression subcohort of the Osteoarthritis Initiative (OAI) Study, an ongoing 4-year, multicenter study, focusing on knee OA. Regional cartilage morphometry measures including cartilage volume (mm(3)), denuded area, normalized cartilage volume, bone surface area, as well as location of meniscal pathology and BMLs in index knees on the same side were compared between those with and without ACL tears. Of the 160 subjects (51% women, age 62.1 (±9.9), BMI 30.3 (±4.7) kg/m(2)), 14.4% had an ACL tear. After adjusting for age, BMI and gender participants with ACL tears had significantly greater cartilage volume in the posterior lateral femur (P = 0.04) and the central medial tibia (0.001) compared to those without ACL tears. Normalized cartilage volume was not different between those with and without ACL tears. In addition, individuals with ACL tears had significantly larger bone surface areas in the medial tibia (P = 0,006), the central medial tibia (P = 0.008), the posterior lateral femur (P = 0.004), and the posterior medial femur (P = 0.04). Furthermore, participants with ACL tears showed significantly more meniscal derangement in the lateral posterior horn (P = 0.019) and significantly more BMLs in the lateral femur (P = 0.0025). We found clear evidence of predominant lateral tibiofemoral involvement, with OA-associated findings on MRI, including increased denuded area and bone surface area, BMLs, and meniscal derangement in knees of individuals with ACL tears compared to those without.

Patterns of femorotibial cartilage loss in knees with neutral, varus, and valgus alignment.

OBJECTIVE: Malalignment is known to alter medial-to-lateral femorotibial load distribution and to affect osteoarthritis (OA) progression in the mechanically stressed compartment. We investigated the pattern of cartilage loss in neutral, varus, and valgus knees. METHODS: Alignment was measured from full-limb radiographs in 174 participants with symptomatic knee OA. Coronal magnetic resonance images were acquired at baseline and a mean +/- SD of 26.6 +/- 5.4 months later. The weight-bearing femorotibial cartilages were segmented from paired images. Cartilage volume, surface area, and thickness were determined in total cartilage plates and defined subregions using proprietary software. RESULTS: The medial-to-lateral ratio of femorotibial cartilage loss was 1.4:1 in neutral knees (n = 74), 3.7:1 in varus knees (n = 57), and 1:6.0 in valgus knees (n = 43). The relative contribution of cartilage thickness change tended to be greater in knees with mild cartilage loss, whereas the increase of denuded area was greater in knees with accelerated cartilage loss. In both varus and neutral knees, the greatest changes were observed in the same subregions of the medial femorotibial compartment (central and external medial tibia, and central medial femur). In valgus and neutral knees, the subregions with the greatest changes in the lateral femorotibial compartment were also similar (internal and central lateral tibia, external lateral femur). CONCLUSION: The medial-to-lateral rate of femorotibial cartilage loss strongly depended on alignment. Subregions of greater-than-average cartilage loss within the stressed compartment were, however, similar in neutral, varus, and valgus knees. This indicates that the medial-to-lateral loading pattern is different, but that the (sub)regional loading pattern may not differ substantially between neutral and malaligned knees.