Dynamic MR imaging analysis of instability in the injured Lisfranc joint with an MRI-compatible foot stressor device.

PURPOSE: To evaluate the applicability of an MRI-compatible foot stressor device in patients with image-proven or clinically suspected Lisfranc joint injuries. METHOD: This prospective study evaluated Lisfranc joint injury by utilizing a joint-specific, stress device that was engineered to replicate weightbearing and physical examination maneuvers. Sixteen patients with either clinically suspected or image-proven Lisfranc joint injuries were recruited from September 2018 to November 2019 (9 men, 7 women; mean age, 39.3 years; age range, 14-68 years). Resting and stressed MR sequences of the injured and non-injured feet were obtained. Measured values for Lisfranc interval widths, dorsal tarsometatarsal subluxations, and lambda-angles were subtracted between the stressed and resting images to calculate net stress-induced changes. A graded injury schema was used to measure significance. RESULTS: The foot stressor device reliably generated stress-induced changes in the Lisfranc joint during dynamic MRI examination. All morphologically abnormal ligaments on resting images demonstrated stress-induced changes, whereas all morphologically normal ligaments lacked evidence of instability. More severely injured Lisfranc ligaments allowed greater Lisfranc joint widening (IOL, p < 0.001; PCL, p < 0.001; DCL, p < 0.001). More highly graded DCL injuries allowed greater dorsal TMT subluxation when present (p < 0.001). Angular gain in the midfoot (lambda-angle) correlated with the graded IOL score (p < 0.001). Acute-to-subacute injuries demonstrated greater inducible changes than chronic injuries (p = 0.047). Seven patients underwent surgery and nine patients received physical therapy. CONCLUSIONS: Stress-induced changes in the midfoot provided information on the degree of ligament pathology and associated joint instability in Lisfranc joint injuries.

The painful total ankle arthroplasty: a diagnostic and treatment algorithm.

The last decade has seen a considerable increase in the use of in total ankle arthroplasty (TAA) to treat patients with end-stage arthritis of the knee. However, the longevity of the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment algorithm for the painful TAA to be used when considering revision surgery. Cite this article: Bone Joint J 2017;99-B:5-11.

Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle.

The foot and ankle outcome score (FAOS) has been evaluated for many conditions of the foot and ankle. We evaluated its construct validity in 136 patients with osteoarthritis of the ankle, its content validity in 37 patients and its responsiveness in 39. Data were collected prospectively from the registry of patients at our institution. All FAOS subscales were rated relevant by patients. The Pain, Activities of Daily Living, and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2. All subscales except Symptoms were responsive to change after surgery. We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle. However, some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments.

Anatomic reinsertion of the distal biceps tendon rupture through a single anterior approach: extensile or mini-invasive approach? A retrospective study at mean 45-month follow-up.

PURPOSE: To evaluate and compare clinical results and complication rate of a standard and mini-invasive reconstruction technique for distal biceps tendon rupture. METHODS: Twenty-eight cases of biceps tendon rupture were evaluated at mean 45-month follow-up. A standard anterior approach was used in 19 cases, and a less invasive anterior approach was used in nine cases. Suture anchors were used for tendon reconstruction in all cases. Elbow range of motion (ROM), subjective strength recovery, time to return to work and sports activities, and complications were recorded. Disability of the Arm, Shoulder and Hand Score (DASH) the Oxford Elbow Score (OES), and the Mayo Elbow Performance Score (MEPS) were obtained for all patients. RESULTS: Mean ROM recovery was almost complete. Mean subjective strength recovery allowed full return to sports and work in 93 % of cases, within mean 3-month postoperative. Mean DASH, OES, and MEPS scores were good. The clinically relevant complications rate was 17.8 %, all associated with the standard extensile approach group (Group A). Asymptomatic heterotopic ossifications were detected in four cases (14.3 %), not affecting functional recovery. CONCLUSIONS: Clinical results and complications rate of anatomical reconstruction of the distal biceps tendon rupture were comparable to the literature. Comparison between Group A and B showed no significant differences in terms of ROM, and OES and MEPS scores. Strength recovery, time to return to sports and work, and DASH score showed a positive trend in Group B. The clinically relevant complications rate was 0 % in Group B and 26 % in Group A.

Bone marrow aspirate and bone allograft to treat acetabular bone defects in revision total hip arthroplasty: preliminary report.

OBJECTIVES: The safety and effectiveness of autologous mesenchymal cells for treating bone defects in humans is still uncertain. The present study presents a new technique consisting of allogeneic bone grafting enriched with bone marrow concentrate to treat acetabular bone defects resulting from aseptic loosening of the acetabular cup after total hip replacement. PATIENTS AND METHODS: Five adult patients were included in the study. Prior to surgery, patients were tested for antibodies to common pathogens. Treatment consisted of bone allogeneic scaffold seeded with bone marrow mesenchymal cells harvested from the iliac crest and concentrated using an FDA-cleared device. Clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months after surgery. To assess viability, morphology, and the immunophenotype, bone marrow nucleated cells were cultured in vitro, then tested for sterility and evaluated for the possible replication of adventitious viruses. RESULTS: In 4 of 5 patients, both clinical and radiographic healing of the bone defect together with bone graft integration was observed at the mean time of 3.5 months. Mean follow-up was 2 years. One patient failed to respond. No post-operative complications were observed. Bone marrow nucleated cells were enriched 3.8-fold by a single concentration step. Enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. No viral reactivation was observed. CONCLUSIONS: Allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest, may represent a good alternative to treat acetabular bone defects observed in revision hip arthroplasty.

Urinary complications from breast cancer metastasis: case report and review of the literature.

Breast cancer is the most prevalent malignant disease among women, with the exception of non-melanoma skin cancers. Malignant breast tumours metastasise to lungs, bone, liver, lymph nodes and skin, but the literature also reports few cases of unusual metastases such as to the bladder. We present the case of a 57-year-old woman affected by lobular invasive breast cancer and complaining of high urinary frequency with nicturia. To date this is the seventh reported case of isolated metastatis of breast carcinoma to the bladder.