Arguments for an increasing differentiation towards fibrocartilaginous components in midportion Achilles tendinopathy.

PURPOSE: The objective of this study was to investigate the fibrocartilaginous differentiation occurring in midportion Achilles tendinopathy. METHODS: Tendon samples were retrospectively collected from 23 patients, who had undergone surgery for midportion Achilles tendinopathy resistant to conservative treatment. Based on histological scores, the biopts were subdivided into three categories: a light, moderate and severe histopathological stage. Throughout these stages, immunohistochemical staining was performed against biglycan, aggrecan and collagen type II, components characteristic for fibrocartilage. Staining of these components was evaluated using a semi-quantitative scoring method. RESULTS: The immunohistochemical scores of biglycan and aggrecan were statistically significant between the histopathological stages (P < 0.001). The immunohistochemical scores were positively correlated with the increasing histopathological stages [Spearman's correlation coefficient = 0.93 for biglycan and 0.78 for aggrecan (P < 0.001)]. Staining for collagen type II remained negative throughout these stages. CONCLUSION: Immunohistochemical staining of the fibrocartilaginous components biglycan and aggrecan showed a progressive increase, correlated with a further evolved histopathological stage. This observation gave arguments for an increased differentiation towards fibrocartilaginous components at protein level in midportion Achilles tendinopathy.

Surgical treatment of tibial pseudarthrosis using the Ilizarov apparatus. A critical analysis.

Since November 1985 the authors have added the Ilizarov procedure to their armamentarium for the treatment of tibial pseudarthrosis. The results of a first clinical study of 10 patients are reported. The mean duration of follow-up is 17 months. The consolidation rate is higher with a transverse than with an oblique pseudarthrosis. The Ilizarov procedure combined with a corticotomy offers new perspectives in the management of massive bone defects. In the presence of severe malalignment, a gradual reduction can be carried out. The main complications are pin tract infections and algodystrophy.

The fibula pro tibia procedure in the treatment of nonunion of the tibia.

We reserve the fibula pro tibia procedure for infected nonunions or for cases that already have been subjected to one or more other methods of treatment. The fibula pro tibia procedure is a technically simple one-stage procedure. The site of the pseudarthrosis is not exposed; hence there is less risk of recurrent infection. Consolidation was achieved in 75% of our cases. The objective findings are positive: consolidation after an average of one year. Knee mobility is normal in most cases, and ankle mobility is only slightly decreased. In most cases the angular deformities are clinically acceptable. All infections have cleared.

Bolt fixation for syndesmotic injuries.

We performed a retrospective study of 28 patients who underwent bolt fixation for a syndesmotic injury to the ankle. The mean follow-up period was 66 months (range: 24-139 months). The results of surgery were assessed clinically and radiographically. Overall, this fixation device was found to adequately stabilise the syndesmosis during healing. Radiologically accurate syndesmosis reduction was achieved in 26 patients. The mean AOFAS score was 86 (range: 33-100). The majority of patients were very satisfied with the overall result. It is a simple and quick operative procedure providing reliable syndesmotic reduction. The material should not be removed prior to walking. The only drawback is the greater need for removal in the event of local symptoms.