Radiographic and clinical outcome of tibial plateau fractures treated with bone allograft.

BACKGROUND: To determine the clinical outcome of patients who had been treated with bone allografts during open reduction and internal fixation (ORIF) of tibial head fractures. METHODS: Patients who suffered a medial, lateral, or bicondylar fracture of the tibial plateau and underwent surgical treatment by open reduction and internal fixation (ORIF) using human femoral head bone allografts were included. Patients were invited to provide information for the following: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol Five Dimension score (EQ-5D), Lower Extremity Functional Scale (LEFS) and Parker Mobility Score. Bone mineral density (BMD) of the allograft area and the healthy human bone tissue were measured by quantitative computed tomography. RESULTS: A total of 22 patients with a mean follow-up time of 2.88 ± 2.46 years were included in our study. The most common fractures observed in this study were classified as Schatzker II (11 patients, 50.0%) or AO/OTA 41.B3 (12 patients, 54.5%) fractures. Postoperative WOMAC total was 13.0 (IQR = 16.3, range 0-33). Median quality of life (EQ-5D) score was 0.887 ± 0.121 (range 0.361-1.000). Median Lower Extremity Functional Scale (LEFS) score was 57.5 ± 19.0 (range 33-79). Mean Parker Mobility Score was 9 (range 6-9). Median bone mineral density (BMD) for the whole group was 300.04 ± 226.02 mg/cm3 (range - 88.68 to 555.06 mg/cm3) for region of interest (ROI 5) (central), 214.80 ± 167.45 mg/cm3 (range - 7.16 to 597.21 mg/cm3) for ROI 1-4 (marginal zones: medial, lateral, ventral, dorsal) and 168.14 ± 65.54 mg/cm3 (range 17.47-208.97 mg/cm3) for healthy bone tissue (femur and tibia). CONCLUSION: Based on WOMAC scores, LEFS, ambulatory status, and quality of life findings, it can be concluded that following tibial head ORIF with allograft bone patients has promising results.

Subsidence of a metaphyseal-anchored press-fit stem after 4-year follow-up: an EBRA-FCA analysis.

PURPOSE: Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analyse) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless metaphyseal-anchored press-fit stem after 4-year follow-up. METHODS: Applying a retrospective study design, we reviewed all consecutive patients who between 2012 and 2017 received a cementless Accolade II press-fit stem at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. EBRA-FCA measurements and statistical investigations were performed by two independent investigators. RESULTS: A total of 102 stems in 91 patients (female 60; male 31) fulfilled our inclusion criteria. Mean age at surgery was 66.2 (range 24.3-92.6) years. EBRA migration analysis showed a mean subsidence of 1.4 mm (range 0.0-12.0) at final follow-up. The angle between stem and femur axis was 0.5° (range 0.0°-2.8°) after 48 months. No correlations between gender or Dorr types and subsidence were found (p > 0.05). A body mass index > 30 kg/m2 showed a significant increase in stem subsidence within the first 6 (p = 0.0258) and 12 months (p = 0.0466) postoperative. CONCLUSIONS: Migration pattern of the metaphyseal-anchored stem and a low subsidence rate at final follow-up may predict a good long-term clinical result. TRIAL REGISTRATION: Number: 20181024-1875.

Migration characteristics of the Corail hydroxyapatite-coated femoral stem-a retrospective clinical evaluation and migration measurement with EBRA.

PURPOSE: Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analysis) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless press-fit stem after two years follow-up. Stem type and postoperative gap between collar and femur were evaluated as a risk factor. METHODS: Applying a retrospective study design, we reviewed all consecutive patients who between 2013 and 2017 received a cementless press-fit Corail stem (DePuy Orthopaedics Inc., Warsaw, IN, USA) at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. RESULTS: A total of 109 stems in 105 patients (female: 60; male: 45) fulfilled our inclusion criteria. Mean age at surgery was 67.8 (range, 21.6-90.5) years. EBRA migration analysis showed a mean subsidence of 1.8 mm (range, 0.0-12.1) at final follow-up. At 18 months mean subsidence of collared stems was significantly lower than in the collarless group [1.3 mm (range, 0.0-7.6) vs. 3.2 mm (range, 0.5-10.7), p = 0.0104]. Collared stems resting on the femoral cut presented a tendency to less subsidence than did collared stems showing a postoperative gap between collar and femur (1.3 vs. 2.0 mm) without finding statistical significance (p > 0.05). CONCLUSIONS: Low subsidence and the migration pattern of the cementless press-fit stem may predict a good long-term result. Collared stems investigated in our study provide good stability and are able to prevent significant subsidence. Trial registration number and date of registration: Number: 20181024-1875; Date: 2018-10-24.

Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in anterior cruciate ligamant deficient knees using magnetic resonance imaging.

PURPOSE: To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees. METHODS: Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen's Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures. RESULTS: The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91-0.95) and intra-observer (0.93-0.95) reproducibility was high. CONCLUSION: In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation. LEVEL OF EVIDENCE: II.

A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents-Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves.

BACKGROUND: The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents. METHODS: An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy (n=24) were compared to a residents group (n=16). Analyzed parameters were "time to complete a task," assessment of the movement of tools and values scoring damage to the surrounding tissues. RESULTS: After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level. CONCLUSION: The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand-eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.

Impact of the Covid-19 Pandemic on Orthopaedic and Trauma Surgery - A Systematic Review of the Current Literature.

BACKGROUND/AIM: The Coronavirus disease 2019 (COVID-19) has led to significant disruptions in various medical specialties. We herein aimed to provide a systematic review of the published literature on the impact by the Covid-19 pandemic on orthopaedic and traumatological care by focusing on the number of clinical visits, surgeries and reasons for consultation. MATERIALS AND METHODS: The published literature was reviewed using PubMed. Of 349 studies published between December 1, 2019 and October 1, 2020, 36 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. October 1, 2020 was used as the concluding date of publication. RESULTS: The number of elective visits declined by 50.0% to 74.0%. The number of emergency and trauma visits showed a decrease of 37.7% to 74.2%. Trauma surgery decreased by 21.2% to 66.7% and elective surgeries by 33.3% to 100%. CONCLUSION: Orthopaedic and trauma surgery is clearly influenced by the pandemic. It will be important to maintain treatment and surgical care of patients in order to avoid negative effects on treatment progress.

Good mid-term results with the trident peripheral self-locking cup: a clinical evaluation and migration measurement with EBRA.

INTRODUCTION: The most common cause of failure in total hip arthroplasty (THA) is aseptic loosening. Uncemented cup migration analysis by means of Einzel-Bild-Roentgen-Analyse (EBRA) has shown to be a good predictive indicator for early implant failure if the cup migrates more than 2 mm within 4 years after surgery. In this study, we performed a migration analysis of an uncemented peripheral self-locking (PSL) press-fit cup after 4 years follow-up. MATERIALS AND METHODS: We retrospectively reviewed all patients who received a trident PSL press-fit cup at our department between 2004 and 2017. A total of 636 patients were identified. As inclusion criteria for radiological analysis, a minimum follow-up of 2 years was defined. We reviewed medical histories and performed radiological analysis using EBRA software. EBRA measurements and statistical investigations were performed by two independent investigators. RESULTS: A total of 149 cups in 146 patients (female 82; male 64) met our inclusion criteria. Mean age at surgery was 65 years (33-89). We found a significant improvement in the WOMAC score pre- to postoperative (p < 0.0001). EBRA migration analysis showed a mean total migration of 0.6 mm (0.0-8.2) over our follow-up period of 4 years. Of the investigated cups, 69.8% showed a migration rate smaller than 2 mm in the investigated follow-up. CONCLUSION: The acetabular cup used in our study provides low migration at final follow-up. Therefore, a good long-term outcome can be expected for the PSL cup. TRIAL REGISTRATION: Trial registration number is 20181024-1875 and date of registration is 2018-10-24.

The reversed dynamic patellar apprehension test mimics anatomical complexity in lateral patellar instability.

PURPOSE: To develop a dynamic physical examination test that functionally simulates actual patellar instability events and that mimics the range of patellar stabilizer insufficiency in an individual patient. METHODS: Seventy-eight consecutive patients (male/female 35/43; mean age 22 ± 7 years) with recurrent lateral patellar instability and 35 controls (male/female 16/19; mean age 31 ± 14 years) were prospectively evaluated using the reversed dynamic patellar apprehension test (ReDPAT). Anatomical predisposition was assessed according to Dejour's classification of trochlear dysplasia, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, patellar height, and varus/valgus malalignment. RESULTS: The study group had an average of 3.4 ± 1.0 (1-6) anatomical risk factors for lateral patellar dislocation. Severe trochlear dysplasia (84%) and patella alta (49%) were the most common. Test sensitivity and specificity was 93.7% (95% CI 0.8584-0.9791) and 88.2% (95% CI 0.7255-0.9670), respectively. The positive predictive value reached 94.9% (95% CI 0.8739-0.9859) and the negative predictive value was 85.7% (95% CI 0.6974-0.9519). The ReDPAT results became positive at a mean knee flexion angle of 58° ± 17° (20°-90°). Knee flexion angle correlated significantly with the severity of trochlear dysplasia (p = 0.018), valgus deformity (p = 0.011), and the total number of anatomical risk factors (p = 0.02). CONCLUSION: This study introduced the reversed dynamic patellar apprehension test as a reliable clinical examination tool in the assessment of lateral patellar instability. The results of this study indicate that the degree of knee joint flexion at which the provocative sense of apprehension becomes positive correlates with severity of trochlear dysplasia, valgus deformity and the total number of anatomical risk factors for patellar instability. This test indicates the patient-specific end of stable patellar tracking and the beginning of patellar stabilizer insufficiency. Therefore, this test might be helpful in deciding for or against a bony procedure in the treatment of patellar dislocation. LEVEL OF EVIDENCE: II.

Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy.

PURPOSE: To investigate whether temporary postoperative compartment-unloading therapy after arthroscopic partial meniscectomy (APM)-with either knee braces or wedge insoles-leads to superior clinical outcome as compared to controls. This difference in clinical outcome was tested in the form of two knee scores, physical activity and general health outcome over the first postoperative year. METHODS: Sixty-three patients who underwent arthroscopic partial meniscectomy (APM) were randomized to one of the following three groups: 12 weeks postoperative knee compartment-unloading therapy with either a knee brace (brace group) or wedge insoles (insole group) or no specific postoperative therapy (control group). Patient-reported outcome was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC Score), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the MARX score (physical activity) and the SF-12 (general health). RESULTS: Sixty-three patients were available for analysis. Except for the SF-12 mental score, all other scores showed significant improvement over time. With regard to the hypotheses proposed, no significant group * time interactions were observed for any of the outcome parameters. This means that the group (i.e. the type of postoperative treatment) was not related to the degree of improvement of any of the scores. CONCLUSIONS: It was concluded that 12 weeks of compartment-unloading therapy-with either a knee brace or wedge insoles-is ineffective with regard to clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year following APM. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

Two-year gait analysis controls of the minimally invasive total hip arthroplasty by the direct anterior approach.

BACKGROUND: The purpose of the study was to determine the long-term functional outcome of two hip approaches by gait analysis. Patients were selected by prospective randomization, and operated on either by the anterolateral approach or by a minimally invasive direct anterior approach. METHODS: 33 patients (17 anterolateral approach; 16 direct anterior approach) were analyzed using a Vicon 870 system. Gait analysis was performed two years after total hip arthroplasty. Temporo-spatial and kinematic variables were obtained. FINDINGS: On chest and pelvic kinematics, no patient group demonstrated significant differences. The time-distance parameters showed significant differences with the anterior approach in cadence and stride time. INTERPRETATION: The study indicates that the direct anterior approach exerts positive effects compared with the anterolateral approach two years after surgery. The muscle-sparing concept of direct anterior approach results in significant differences in gait compared to the anterolateral approach 2 years after surgery.

Maximum lifetime body mass index is the appropriate predictor of knee and hip osteoarthritis.

INTRODUCTION: In light of inconsistencies in the literature, this study aimed to investigate the relationship between obesity (current and historic) and osteoarthritis (OA) of the knee or hip. MATERIALS AND METHODS: We examined 99 people (knee OA, hip OA and controls), age > 50 years, in a case-control study. The current weight, height and waist circumference were measured on site, and detailed weight changes over their lifetime were based on questionnaires and standardized interviews. We used binomial logistic regression to determine the predictive value for an osteoarthritis group membership of each derived indicator. RESULTS: An increase in 'maximum-BMI' increased the odds ratio for both knee OA (OR 1.2; CI 1.1-1.4; p = 0.005; R 2 = 0.36) and hip OA (OR 1.2; CI 1.0-1.3; p = 0.027; R 2 = 0.16). Current BMI was significantly associated with knee OA but not with hip OA. A high "minimum-BMI" (over the age of 18 years) had the highest odds ratio of all calculated indicators for both osteoarthritis groups. CONCLUSIONS: Based on our findings, it is concluded that the maximum BMI over one's lifespan is a better predictor of OA of the hip or the knee than the current BMI. The knee joint seems to be more sensitive to obesity as current BMI was associated only with knee OA but not with hip OA.

Guidelines for Treatment of Lateral Patella Dislocations in Skeletally Mature Patients.

The incidence of lateral patella dislocations is high, particularly in young females. Beside traumatic cases, many patients present with specific anatomical factors that predispose to lateral patella dislocations (torsional abnormalities of the femur or the tibia, trochlea dysplasia, patella alta, etc). It is of utmost importance to correct those pathologic factors during concomitant procedures as isolated reconstructions of the medial patellofemoral ligament would fail in the presence of severe anatomic risk factors. This article provides a comprehensive instruction on how to analyze the risk factors for lateral patella dislocation (anatomy, physical examination, imaging) and reports the authors' favorite surgical techniques. Moreover, treatment algorithms are provided for primary and recurrent cases of lateral patella dislocation.

Effect of hip braces on brake response time: Repeated measures designed study.

BACKGROUND: The question whether or not a patient with a hip brace should drive a car is of obvious importance because the advice given to patients to resume driving is often anecdotal as few scientific data are available on this specific subject. OBJECTIVES: To assess driving ability (brake response time) with commonly used hip braces. STUDY DESIGN: Repeated measures design. METHODS: Brake response time was assessed under six conditions: (1) without a brace (control), (2) with a typical postoperative hip brace with adjustable range of motion and the settings: unrestricted, (3) flexion limited to 70°, (4) extension blocked at 20° hip flexion, (5) both flexion and extension limited (20°/70°) and (6) an elastic hip bandage. Brake response time was assessed using a custom-made driving simulator as used in previous studies. The participants were a convenience sample of able-bodied participants. RESULTS: A total of 70 participants (35 women and 35 men) participated in our study. Mean age was 31.1 (standard deviation: 10.6; range: 21.7-66.4) years. A significant within-subject effect for brake response time was found ( p = 0.009), but subsequent post hoc analyses revealed no significant differences between control and the other settings. CONCLUSION: Based on our findings, it does not seem mandatory to recommend driving abstinence for patients wearing a hip orthosis. We suggest that our results be interpreted with caution, because (1) an underlying pathological hip condition needs to be considered, (2) the ability to drive a car safely is multifactorial and brake response time is only one component thereof and (3) brake response time measurements were performed only with healthy participants. Clinical relevance Hip braces are used in the context of joint-preserving and prosthetic surgery of the hip. Therefore, clinicians are confronted with the question whether to allow driving a car with the respective hip brace or not. Our data suggest that hip braces do not impair brake response time.

Driving abstinence is necessary after lumbar spinal fusion: a prospective cohort study.

PURPOSE: Studies on driving safety after lumbar spinal procedures are rare. Previous studies solely reported on a) driving reaction time (DRT) after lumbar nerve root blocks, b) DRT after discectomy and c) preliminary DRT findings after lumbar fusion. METHODS: DRT was assessed with a driving simulator as described before. Measurements were done one day before surgery (preop DRT), one week after surgery (postop1 DRT), three months (postop2 DRT) and one year postoperatively (postop3 DRT). Back pain was determined with visual analogue scales (VAS) on all four occasions. Additionally, we monitored each patient's pre-operative driving frequency and intake of analgesics. For statistical analysis we used an ANOVA for repeated measurements. RESULTS: Thirt eight of 51 patients completed all measurements (17 monosegmental fusion, 14 polysegmental fusion, seven other lumbar fusion procedures). The longitudinal changes in DRT showed overall significance (p = 0.013). Post-hoc tests determined p = 0.035 for the DRT-increase from pre- to postoperative. We did not determine a significant statistical effect for the type of surgery (p = 0.581) or patient age (p = 0.134). A tendency towards statistical significance was ascertained for the influence of patients' driving frequency on DRT (p = 0.051). CONCLUSIONS: We found increased DRT at the time of discharge after lumbar spinal fusion and therefore recommend driving abstinence for the time thereafter. Based on our findings it appears safe to return to driving at 3 months postoperative.

Changes in the Chemical Quality of Bone Grafts During Clinical Preparation Detected by Raman Spectroscopy.

METHODOLOGY: We determined the content of amide I, amide III, PO4, CO3, and CH2 in samples of fresh bone, bone frozen at -80°C thawed once, bone after two freeze-thaw cycles, and chemically cleaned bone chips. A total of 750 Raman spectra were collected per sample group and the derived quantitative values compared statistically by one-way ANOVA. RESULTS: We found statistically significant differences between the investigated sample groups differing in their treatment already after one freeze-thaw cycle and as well after multiple freeze-thaw cycles, and/or chemical cleaning. Chemical cleaning decreased the content of all measured components compared to the fresh sample as detected by Raman spectroscopy. We further used the derived data to calculate the mineral to matrix ratios for each sample group. DISCUSSION: Our data indicate that significant changes of the chemical quality and mineral to matrix ratio occur during freeze-thawing and chemical cleaning. At the same time, this study highlights the importance of sampling and testing at multiple locations for reliable predictions of the chemical composition. We think that it is very desirable to test the quality of bone graft material before transfer to a recipient; this might ultimately help define parameters to choose the best graft for the patient. It is also important to highlight that this is a preliminary study, which shows the importance of detecting changes in the chemical quality of bone grafts before transfer to the patient.

Knee Extensor Strength and Gait Characteristics After Minimally Invasive Unicondylar Knee Arthroplasty vs Minimally Invasive Total Knee Arthroplasty: A Nonrandomized Controlled Trial.

BACKGROUND: In light of the existing lack of evidence, it was the aim of this study to compare gait characteristics and knee extensor strength after medial unicondylar knee arthroplasty (MUKA) with those after total knee arthroplasty (TKA), given the same standardized minimally invasive surgery (MIS) approach in both groups. METHODS: Patients scheduled for MIS-MUKA or MIS-TKA as part of clinical routine were invited to participate. A posterior cruciate ligament-retaining total knee design was used for all MIS-TKA. A 3-dimensional gait analysis was performed preoperatively with a VICON system and at 8 weeks postoperative to determine temporospatial parameters, ground reaction forces, joint angles, and joint moments. At the same 2 times, isokinetic tests were performed to obtain peak values of knee extensor torque. A multivariate analysis of variance was conducted and included the main effects time (before and after surgery) and surgical group and the group-by-time interaction effect. RESULTS: Fifteen MIS-MUKA patients and 17 MIS-TKA patients were eligible for the final analysis. The groups showed no differences regarding age, body mass index, sex, side treated, or stage of osteoarthritis. We determined neither intergroup differences nor time × group interactions for peak knee extensor torque or any gait parameters (temporospatial, ground reaction forces, joint angles, and joint moments). CONCLUSION: It is concluded that MUKA is not superior to TKA with regard to knee extensor strength or 3-dimensional gait characteristics at 8 weeks after operation. As gait characteristics and knee extensor strength are only 2 of the various potential outcome parameters (knee scores, activity scores…) and quadriceps strength might take a longer time to recover, our findings should be interpreted with caution.

Effect of surgical shoes on brake response time after first metatarsal osteotomy--a prospective cohort study.

BACKGROUND: The aim of this study is to assess patients' driving ability when wearing surgical shoes following right-sided first metatarsal osteotomy. METHODS: From August 2013 to August 2015, 42 consecutive patients (mean age 54.5 years) with right-sided hallux valgus deformity underwent first metatarsal osteotomy. Patients were tested for brake response time (BRT) 1 day preoperatively (control run) and at 2 and 6 weeks postoperatively. Two different types of foot orthosis were investigated. BRT was assessed using a custom-made driving simulator. RESULTS: Preoperative BRT was 712 msec (standard deviation (SD), 221 msec). BRT was significantly slower at all tested postoperative times than preoperatively (p < 0.001). The patients showed significant impaired brake response time when wearing surgical shoes. Mean global American Orthopaedic Foot and Ankle Society (AOFAS) outcome score and AOFAS pain and alignment subscores increased postoperatively (p < 0.001). CONCLUSIONS: From our findings, we recommend driving abstinence for a minimum of 6 weeks postoperatively when using a surgical shoe after bunionectomy. However, patients should have sufficient recovery, exercise, and training before resuming driving a car, because safety is always a priority. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02354066.

Driving ability after right-sided ankle arthroscopy--A prospective Study.

INTRODUCTION: Due to the current lack of evidence the aim of this study was to investigate the driving ability after right-sided ankle arthroscopy. MATERIALS AND METHODS: Nineteen patients underwent right-sided ankle arthroscopy. Brake response time (BRT) was assessed preoperatively, 2 days, 2 weeks, 6 weeks, and 12 weeks postoperative. We also determined patients' clinical outcome (AOFAS and AOS questionnaires) and their driving frequency. RESULTS: BRT was 606ms preoperatively and changed to 821ms 2 days postoperative (p<0.001). The further postoperative BRT course was 606ms (2 weeks), 596ms (6 weeks) and 603ms (12 weeks) (p=n.s.). In addition, a significant influence of the AOS and AOFAS scores on BRT was found, namely poorer clinical outcome also leads to a prolonged BRT (p<0.01 for both). BRT was significantly prolonged in patients with little driving frequency (p=0.001). Furthermore, the 'time-by-driving interaction' was significant (p=0.018), which means the BRT-peak on the second day was much lower in low-frequency drivers. CONCLUSIONS: From the findings made in the current study we conclude that a driving abstinence of two weeks is necessary following right-sided ankle arthroscopy. Greater driving frequency and good clinical outcome seem to be associated with better driving ability. However, for the time being no exceptions should be made from the above-mentioned recommendation on driving abstinence.

The effect of ankle brace type on braking response time-A randomised study.

INTRODUCTION: The question whether or not a patient with an ankle brace should drive a car is of obvious importance because brake response time (BRT) is considered one of the most important factors for driving safety. MATERIALS AND METHODS: Applying a crossover study design, 70 healthy participants (35 women, 35 men) participated in our study. BRT was assessed using a custom-made driving simulator. We assessed BRT under six conditions: without a brace (control) (1), with a typical postoperative ankle brace with adjustable ROM and the settings: unrestricted (2), fixed at 15° (3) plantar flexion, restricted with 15°/50° (4) (dorsal/plantar flexion), a brace for ligament instabilities (5) and an elastic ankle bandage (6). Participants were instructed to apply the brake pedal exclusively with the right foot as quickly as possible on receipt of a visual stimulus. RESULTS: The 70 participants showed significantly impaired BRT with the ankle brace for ROM restriction in the settings: unrestricted (p<0.001), fixed at 15° plantar flexion (p<0.001) and 15°/50° dorsal/plantar flexion (p<0.001) as compared to the control group. BRT was not impaired with the brace for ankle instabilities or the elastic ankle bandage. CONCLUSIONS: In conclusion, right-sided ROM restricting ankle braces involve significant impairment of BRT in healthy participants. No such prolonged BRT was found for an elastic ankle bandage or the ligament brace.