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van Bergen CJA, Kerkhoffs GMMJ, Marsidi N, Korstjens CM, Everts V, van Ruijven LJ, van Dijk CN, Blankevoort L. Osteochondral defects of the talus: a novel animal model in the goat. Tissue Eng Part C Methods 2013; 19:449-57. [PMID: 23136872 DOI: 10.1089/ten.tec.2012.0401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Osteochondral defects of the talus pose a difficult therapeutic challenge. An experimental animal model of the ankle joint is not available. The aim of this study was to test a newly developed animal model for osteochondral defects of the ankle in vivo. Osteochondral defects were created in the talus of goat hind legs using a posterolateral surgical approach. The defects were filled with either autologous cancellous bone or donor demineralized bone matrix or left empty as control. After 12 weeks of healing, the specimens were analyzed with radiography, macroscopy, microcomputed tomography, histology, histomorphometry, and fluorescence microscopy. It was possible to create a standardized defect in each talus. The implanted material remained in place. The analyses showed that most bony tissue was generated in the defects filled with autologous bone and least in the control defects. Our findings show that a standard osteochondral defect can be created in the talus by a relatively simple procedure in a large animal that allows qualitative and quantitative evaluation. The model can be used in future experiments to investigate alternative treatment methods before they are introduced into clinical practice.
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Kerkhoffs GMMJ, van Es N, Wieldraaijer T, Sierevelt IN, Ekstrand J, van Dijk CN. Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surg Sports Traumatol Arthrosc 2013; 21:500-9. [PMID: 22622781 PMCID: PMC3549245 DOI: 10.1007/s00167-012-2055-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 05/10/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes. METHODS A literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes. RESULTS Medical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism. CONCLUSIONS Posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors. LEVEL OF EVIDENCE Literature review and expert opinion, Level V.
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Valkering KP, Golanó P, van Dijk CN, Kerkhoffs GMMJ. "Web impingement" of the ankle: a case report. Knee Surg Sports Traumatol Arthrosc 2013; 21:1289-92. [PMID: 22688500 PMCID: PMC3657074 DOI: 10.1007/s00167-012-2077-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/22/2012] [Indexed: 01/12/2023]
Abstract
This case report presents two patients with persisting anterior ankle impingement pain after an ankle distortion. A web-like intra-articular fibrous band was discovered and resected. The patients presented were, after a 1-year follow-up, pain free.
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van der Heiden R, Bruinsma WE, Kerkhoffs GMMJ, Goslings JC, Schep NWL. [Treatment of primary anterior shoulder dislocation; do not always treat conservatively]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2013; 157:A5526. [PMID: 24020620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
According to the current guidelines, primary anterior shoulder dislocations are treated conservatively after repositioning by short-term immobilisation of the shoulder. Shoulder stabilization surgery--either open or arthroscopically--reduces the risk of recurrence and improves the functional outcome over the long term. Active young adults are known to have up to a 90% increased risk of recurrent dislocation after the conservative treatment of a primary shoulder dislocation. Active young men particularly benefit from shoulder stabilization surgery. When comparing operative techniques, there is no difference between an open procedure and an arthroscopic procedure in terms of recurrence. The choice between open treatment and arthroscopic treatment depends on the preference of the patient and the experience of the surgeon.
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Kok AC, Dunnen SD, Tuijthof GJM, van Dijk CN, Kerkhoffs GMMJ. Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg 2012; 51:777-82. [PMID: 22999970 DOI: 10.1053/j.jfas.2012.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Indexed: 02/03/2023]
Abstract
Although results of bone marrow stimulation in osteochondral defects of the talus (OCLT) have been satisfactory, the technique performance has not yet been subjected to review as a prognostic factor. The aim of this systematic review is to determine whether variation within technique influences outcome of bone marrow stimulation for OCLT. Electronic databases were searched for articles on OCLT treated with bone marrow stimulation techniques, providing a technique description. Six articles on microfracture were included (198 patients). Lesion size averaged 0.9 cm (2) to 4.5 cm (2), and follow-up varied from 2 to 6 years. Key elements were removal of unstable cartilage, hole depth variation between 2 and 4 mm until bleeding or fat droplets occurred, and a distance between the created holes of 3 to 4 mm. The success rate (excellent/good results by any clinical outcome score) was 81%. There is a vast similarity in the technique with similar outcomes as in previous general reviews; therefore variation in technique as currently described in the literature does not seem to influence the outcome of bone marrow stimulation for OCLT. Whether the instruments used or the hole depth and geometry influence clinical outcome remains to be determined. Microfracture is safe and effective for OCLTs smaller than 15 mm. However, in this review, only 81% of patients obtained satisfactory results. Larger clinical trials are needed with clearly defined patient groups, technique descriptions, and reproducible outcome measures to provide insight in the specific indications and the preferred technique of bone marrow stimulation.
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Struijs PAA, Kerkhoffs GMMJ, Besselaar PP. Treatment of dysplasia epiphysealis hemimelica: a systematic review of published reports and a report of seven patients. J Foot Ankle Surg 2012; 51:620-6. [PMID: 22819617 DOI: 10.1053/j.jfas.2012.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 02/03/2023]
Abstract
Dysplasia epiphysealis hemimelica is a rare entity. It is characterized by cartilage overgrowth in the epiphyses and is considered to be an epiphyseal osteochondroma. It usually presents during childhood and can cause pain and functional limitations. The aim of the present study was to describe the entity through our cases and published data and to present the results of our suggested treatment. A systematic search was performed to retrieve and describe all studies on dysplasia epiphysealis hemimelica. Studies were included if sufficient information on the patient characteristics, lesion location, treatment, and outcomes were described. In addition, we report on 7 of our patients. In our review, 48 studies were found, of which 42 could be included. Owing to the large heterogeneity in the studies, no pooling of data was performed. The studies included 138 patients with 255 lesions. Approximately 27% were female patients. The age at presentation ranged from 3 months to 66 years; however, in most, the entity was discovered before 8 years of age. No apparent guidelines were presented concerning the treatment strategy; however, most investigators performed resection because of pain or limitations in the range of motion. Most lesions were located in the ankle or foot (139 of 255). In our own cases, 5 of 7 patients experienced pain, limited range of motion, or activity restriction. The mean follow-up period was 4 years. Dysplasia epiphysealis hemimelica is a rare entity, occurring predominantly in the lower extremity of in young male patients. Its aggressive growth warrants aggressive treatment in the case of pain or functional or range of motion limitations.
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van Bergen CJA, Tuijthof GJM, Blankevoort L, Maas M, Kerkhoffs GMMJ, van Dijk CN. Computed tomography of the ankle in full plantar flexion: a reliable method for preoperative planning of arthroscopic access to osteochondral defects of the talus. Arthroscopy 2012; 28:985-92. [PMID: 22342200 DOI: 10.1016/j.arthro.2011.11.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 11/22/2011] [Accepted: 11/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine whether preoperative computed tomography (CT) of the ankle joint in full plantar flexion is a reliable and accurate tool to determine the anterior arthroscopic accessibility of talar osteochondral defects (OCDs). METHODS Twenty consecutive patients were prospectively studied. All patients had an OCD of the talar dome and had a preoperative CT scan of the affected ankle in maximum plantar flexion. Accessibility of the OCD was defined by the distance between the anterior border of the OCD and the anterior distal tibial rim. This distance was measured on sagittal CT reconstructions by 2 investigators. The reference standard was the distance between the same landmarks measured during anterior ankle arthroscopy by an orthopaedic surgeon blinded to the CT scans. Intraobserver and interobserver reliability of CT, as well as the correlation and agreement between CT and arthroscopy, were calculated. RESULTS The measured distance between the anterior border of the OCD and the anterior distal tibial rim ranged from -3.1 to 9.1 mm on CT and from -3.0 to 8.5 mm on arthroscopy. The intraobserver and interobserver reliability of the measurements made on CT scans (intraclass correlation coefficients >0.99, P < .001), as well as the correlation between CT and arthroscopy, were excellent (r = 0.98, P < .001). CONCLUSIONS Measurements on CT scans of the ankle in full plantar flexion are a reliable and accurate preoperative method to determine the in situ arthroscopic location of talar OCDs.
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van den Bekerom MPJ, Struijs PAA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GMMJ. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train 2012; 47:435-43. [PMID: 22889660 PMCID: PMC3396304 DOI: 10.4085/1062-6050-47.4.14] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem. OBJECTIVE To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain. STUDY SELECTION Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults. DATA SOURCES MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually. DATA EXTRACTION We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models. DATA SYNTHESIS After deduction of the overlaps among the different databases, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full texts of these articles were retrieved and thoroughly assessed as described. This resulted in the inclusion of 11 trials involving 868 patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest. CONCLUSIONS Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.
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de Leeuw PAJ, Kerkhoffs GMMJ. Ankle arthroscopy in children. Ann R Coll Surg Engl 2012; 94:216; author reply 216-7. [PMID: 22507738 DOI: 10.1308/003588412x13171221500141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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van Sterkenburg MN, Kerkhoffs GMMJ, van Dijk CN. Good outcome after stripping the plantaris tendon in patients with chronic mid-portion Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 2011; 19:1362-6. [PMID: 21541711 DOI: 10.1007/s00167-011-1514-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 04/12/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE Achilles tendinopathy is a problem that is generally difficult to treat. The pain is frequently most prominent on the medial side of the mid-portion of the tendon, where the plantaris tendon is running parallel to the Achilles tendon. The purpose of this study was to assess whether excision of the plantaris tendon would relieve symptoms. METHODS Three patients with pain and stiffness at the mid-portion of the Achilles tendon were treated by excision of the plantaris tendon. Preoperatively, these patients experienced recognizable tenderness on palpation of the medial side of the mid-portion of the Achilles tendon with localized nodular thickening at 4-7 cm proximal to the insertion. MRI indicated Achilles tendinopathy with the involvement of the plantaris tendon. RESULTS The plantaris tendon was bluntly retrieved and excised with a tendon stripper through a 4-cm incision in the proximal calf. We report a good-to-excellent outcome of this novel procedure in three patients with chronic mid-portion Achilles tendinopathy CONCLUSION The medial pain might be based on the involvement of the plantaris tendon in the process. LEVEL OF EVIDENCE IV.
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Tuijthof GJM, Visser P, Sierevelt IN, Van Dijk CN, Kerkhoffs GMMJ. Does perception of usefulness of arthroscopic simulators differ with levels of experience? Clin Orthop Relat Res 2011; 469:1701-8. [PMID: 21290203 PMCID: PMC3094627 DOI: 10.1007/s11999-011-1797-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 12/13/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some commercial simulators are available for training basic arthroscopic skills. However, it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience. QUESTIONS/PURPOSES We addressed the following questions: (1) Do commercial simulators have construct (times to perform tasks) and face validity (realism), and (2) is the perception of usefulness (educational value and user-friendliness) related to level of experience? METHODS We evaluated two commercially available virtual reality simulators (Simulators A and B) and recruited 11 and nine novices (no arthroscopies), four and four intermediates (one to 59 arthroscopies), and seven and nine experts (> 60 arthroscopies) to test the devices. To assess construct validity, we recorded the median time per experience group for each of five repetitions of one identical navigation task. To assess face validity, we used a questionnaire to judge up to three simulator characteristic tasks; the questionnaire asked about the realism, perception of educational value, and perception of user-friendliness. RESULTS We observed partial construct validity for Simulators A and B and considered face validity satisfactory for both simulators for simulating the outer appearance and human joint, but barely satisfactory for the instruments. Simulators A and B had equal educational value according to the participants. User-friendliness was judged better for Simulator B although both were graded satisfactory. The perception of usefulness did not differ with level of experience. CONCLUSIONS Our observations suggest training on either simulator is reasonable preparation for real-life arthroscopy, although there is room for improvement for both simulators.
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van Sterkenburg MN, Kerkhoffs GMMJ, Kleipool RP, Niek van Dijk C. The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study. J Anat 2011; 218:336-41. [PMID: 21323916 PMCID: PMC3058219 DOI: 10.1111/j.1469-7580.2011.01335.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 12/28/2022] Open
Abstract
The source of pain and the background to the pain mechanisms associated with mid-portion Achilles tendinopathy have not yet been clarified. Intratendinous degenerative changes are most often addressed when present. However, it is questionable if degeneration of the tendon itself is the main cause of pain. Pain is often most prominent on the medial side, 2-7cm from the insertion onto the calcaneus. The medial location of the pain has been explained to be caused by enhanced stress on the calcaneal tendon due to hyperpronation. However, on this medial side the plantaris tendon is also located. It has been postulated that the plantaris tendon might play a role in these medially located symptoms. To our knowledge, the exact anatomy and relationship between the plantaris- and calcaneal tendon at the level of complaints have not been anatomically assessed. This was the purpose of our study. One-hundred and seven lower extremities were dissected. After opening the superficial fascia and paratendon, the plantaris tendon was bluntly released from the calcaneal tendon moving distally. The incidence of the plantaris tendon, its course, site of insertion and possible connections were documented. When with manual force the plantaris tendon could not be released, it was defined as a 'connection' with the calcaneal tendon. In all specimens a plantaris tendon was identified. Nine different sites of insertion were found, mostly medial and fan-shaped onto the calcaneus. In 11 specimens (10%) firm connections were found at the level of the calcaneal tendon mid-portion. Clinical and histological studies are needed to confirm the role of the plantaris tendon in mid-portion Achilles tendinopathy.
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Tuijthof GJM, Horeman T, Schafroth MU, Blankevoort L, Kerkhoffs GMMJ. Probing forces of menisci: what levels are safe for arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc 2011; 19:248-54. [PMID: 20814661 PMCID: PMC3023859 DOI: 10.1007/s00167-010-1251-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/09/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE to facilitate effective learning, feedback on performance during arthroscopic training is essential. Less attention has been paid to feedback on monitoring safe handling of delicate tissues such as meniscus. The goal is to measure in vitro probing forces of menisci and compare them with a theoretical maximum probing force (TMPF). METHOD menisci samples of ten cadavers were mounted on force platforms to measure probing forces up to 20 N in three directions. Nineteen subjects participated: six novices (experience <60 arthroscopies), ten intermediates (>60 arthroscopies), and three faculty (>250 a year). All had to perform three tasks on each meniscus sample with an arthroscopic probe: push three times on the superior meniscal surface, perform one continuous run on the superior meniscal surface, and push three times on the inferior meniscal surface. The absolute maximum probing force (AMPF) was determined for each condition. A multivariable linear regression analysis was performed to assess the influence of experience on the force magnitude (P < 0.05). AMPFs were compared to the TMPF (estimated to be 8.5 N). RESULTS the AMPF of the push task was on average 2.8 N (standard deviation (SD) of 0.8 N), of the continuous run task 2.5 N (SD 0.9 N), and of the pull task 3.9 N (SD 2.0 N). Significant difference was present between experts and novices (P < 0.05). The AMPFs are in the same order of magnitude as the TMPF. CONCLUSION the results indicate the necessity of using a safety level for tissue manipulation when training arthroscopy and a value for is magnitude.
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Witteveen AGH, Sierevelt IN, Blankevoort L, Kerkhoffs GMMJ, van Dijk CN. Intra-articular sodium hyaluronate injections in the osteoarthritic ankle joint: effects, safety and dose dependency. Foot Ankle Surg 2010; 16:159-63. [PMID: 21047602 DOI: 10.1016/j.fas.2009.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 09/22/2009] [Accepted: 10/08/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND To determine the efficacy, safety and dose dependency of intra-articular Orthovisc(®) hyaluronic acid injections in the ankle. METHODS A prospective single blinded study in patients with symptomatic ankle-osteoarthritis. Patients were randomly allocated to 1, 2, 3 ml, or 3 weekly injections of 1 ml (3 × 1 ml). Primary outcome was 'pain during walking' at 15 weeks measured on a 100mm VAS. RESULTS Twenty-six patients (ITT) participated. The 3 × 1 ml dose group showed statistically significant decreases at week 7 for 'pain during walking' and 'pain at rest' (p=0.046). At week 15 decreases were significant for 'pain at rest' (p=0.046). There was no significant decrease of VAS-scores in any of the single dose groups. Seven patients experienced temporary local swelling and increased pain in the injected ankle. CONCLUSIONS Orthovisc(®) viscosupplementation in the ankle joint is effective and well tolerated. The 3 × 1 ml dose regimen shows the best results.
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van Sterkenburg MN, van Bergen CJA, Kerkhoffs GMMJ. Juvenile wakeboarder locks ankle on shore. Knee Surg Sports Traumatol Arthrosc 2010; 18:1661-3. [PMID: 20407754 DOI: 10.1007/s00167-010-1140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/01/2010] [Indexed: 11/25/2022]
Abstract
This report presents an adolescent wakeboarder with persistent pain after conservative treatment of a Salter Harris type II distal fibular fracture. On physical examination the pain was localised over the anterior inferior tibiofibular ligament. Additional imaging revealed that this syndesmotic impingement was caused by a loose body caught in the syndesmotic area. The loose body was successfully removed from the anterior inferior tibiofibular ligament by anterior ankle arthroscopy. With functional aftertreatment, the patient had resumed full sports activities after 8 weeks. At 1-year follow-up there were no persistent symptoms.
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Tuijthof GJM, Beimers L, Kerkhoffs GMMJ, Dankelman J, Dijk CNV. Overview of subtalar arthrodesis techniques: options, pitfalls and solutions. Foot Ankle Surg 2010; 16:107-16. [PMID: 20655009 DOI: 10.1016/j.fas.2009.07.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 07/20/2009] [Accepted: 07/24/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtalar arthrodesis (SA) is the preferred treatment for painful isolated subtalar disease. Although results are generally favourable, analysis of current operative techniques will help optimizing this treatment. The aim was to give an overview of SA-techniques and their pitfalls. Possible solutions were identified. MATERIALS AND METHODS A literature search was performed for papers that presented SA operative techniques. The general technique was divided into phases: surgical approach, cartilage removal, bone graft selection, hindfoot deformity correction and fixation. RESULTS The published series were invariably retrospective reviews of small heterogenous groups of different hindfoot pathologies. The weighted outcome rate for SA was 85% (68-100%) performed in 766 feet and for SA requiring correction of malalignment 65% (36-96%) in 1001 feet. Non-union (weighted percentage 12%), malalignment (18%), and screw removal (17%) were the prevailing late complications. PITFALLS The following pitfalls were identified: 1) early complications related to the incisions made in open approaches, 2) insufficient cartilage removal, improper bone graft selection and fixation techniques, all possibly leading to non-union, 3) morbidity caused by bone graft harvesting and secondary screw removal, 4) under- or overcorrection of the hindfoot possibly due to improper intraoperative verification and 5) inadequate assessment of bony fusion. SOLUTIONS The review provides solutions to possibly overcome some pitfalls: 1) if applicable use an arthroscopic approach in combination with distraction devices and new burrs, 2) if possible use local bone graft or allografts, 3) use two screws for fixation to prevent rotational micromotion, and 4) improve assessment of operative outcome by application of appropriate assessment of bony fusion and alignment. CONCLUSION The review provides practical suggestions to optimize SA-techniques.
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de Vries JS, Kerkhoffs GMMJ, Blankevoort L, van Dijk CN. Clinical evaluation of a dynamic test for lateral ankle ligament laxity. Knee Surg Sports Traumatol Arthrosc 2010; 18:628-33. [PMID: 19924401 PMCID: PMC2855027 DOI: 10.1007/s00167-009-0978-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 10/19/2009] [Indexed: 02/07/2023]
Abstract
The dynamic anterior ankle tester (DAAT) has shown a good reliability in testing anterior talar translation in earlier studies. The goal of the present study was first to evaluate the reliability of the DAAT in a clinical setting and second to analyze its ability to detect increased ligament laxity. In 39 patients with unilateral chronic lateral ankle instability, the anterior talar translation of the affected and non-affected side was measured pre and postoperatively using the DAAT, Telos stress radiographs, and the manual anterior drawer test. In contrast to both other tests, the DAAT was not able to accurately detect increased ligament laxity preoperatively or decreased laxity of the affected ankle postoperatively. The DAAT showed a low sensitivity to change (the difference between the mean pre and postoperative value) and a low reliability compared to both other tests. There were no correlations between the three tests. In conclusion, the DAAT showed a low reliability in effectively testing lateral ankle ligament laxity in a clinical setting. This is in contrast to earlier evaluations.
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Tuijthof GJM, van Sterkenburg MN, Sierevelt IN, van Oldenrijk J, Van Dijk CN, Kerkhoffs GMMJ. First validation of the PASSPORT training environment for arthroscopic skills. Knee Surg Sports Traumatol Arthrosc 2010; 18:218-24. [PMID: 19629441 DOI: 10.1007/s00167-009-0872-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 06/29/2009] [Indexed: 11/27/2022]
Abstract
The demand for high quality care is in contrast to reduced training time for residents to develop arthroscopic skills. Thereto, simulators are introduced to train skills away from the operating room. In our clinic, a physical simulation environment to Practice Arthroscopic Surgical Skills for Perfect Operative Real-life Treatment (PASSPORT) is being developed. The PASSPORT concept consists of maintaining the normal arthroscopic equipment, replacing the human knee joint by a phantom, and integrating registration devices to provide performance feedback. The first prototype of the knee phantom allows inspection, treatment of menisci, irrigation, and limb stressing. PASSPORT was evaluated for face and construct validity. Construct validity was assessed by measuring the performance of two groups with different levels of arthroscopic experience (20 surgeons and 8 residents). Participants performed a navigation task five times on PASSPORT. Task times were recorded. Face validity was assessed by completion of a short questionnaire on the participants' impressions and comments for improvements. Construct validity was demonstrated as the surgeons (median task time 19.7 s [8.0-37.6]) were more efficient than the residents (55.2 s [27.9-96.6]) in task completion for each repetition (Mann-Whitney U test, P < 0.05). The prototype of the knee phantom sufficiently imitated limb outer appearance (79%), portal resistance (82%), and arthroscopic view (81%). Improvements are required for the stressing device and the material of cruciate ligaments. Our physical simulation environment (PASSPORT) demonstrates its potential to evolve as a training modality. In future, automated performance feedback is aimed for.
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Rukavina A, Kerkhoffs GMMJ, Schneider P, Kuster MS. Recurrent hemarthrosis after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18:898-900. [PMID: 20076944 PMCID: PMC2887507 DOI: 10.1007/s00167-009-1031-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 12/14/2009] [Indexed: 12/22/2022]
Abstract
This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization.
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Kerkhoffs GMMJ, Rademakers MV, Altena M, Marti RK. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique. J Bone Joint Surg Am 2009; 91 Suppl 2 Pt 1:101-15. [PMID: 19255203 DOI: 10.2106/jbjs.h.01500] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia. METHODS From 1977 through 1998, a combination of an intra-articular elevation and a lateral opening wedge varus osteotomy of the proximal part of the tibia was performed in twenty-three consecutive patients. The patients were assessed clinically and radiographically at a minimum of five years postoperatively. RESULTS A correction of the intra-articular depression and the valgus malalignment was achieved and the anatomic lower-extremity axis was restored in all patients. The clinical results were evaluated at a mean of thirteen years (range, two to twenty-six years) after the reconstructive osteotomy. Two patients had an early failure and were considered to have had a poor result. Two other patients had severe progression of osteoarthritis after the osteotomy, four had slight progression, and fifteen had no progression. There were no nonunions. There were two superficial wound infections, which were treated successfully without surgical intervention. According to the scale of Lysholm and Gillquist, the subjective result was excellent for seventeen patients (74%), good for three, fair for one, and poor for two. CONCLUSIONS A knee-joint-preserving osteotomy can provide satisfactory results in active patients with painful posttraumatic lateral depression and valgus malunion of the proximal part of the tibia.
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Kerkhoffs GMMJ, Rademakers MV, Altena M, Marti RK. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. J Bone Joint Surg Am 2008; 90:1252-7. [PMID: 18519318 DOI: 10.2106/jbjs.d.01816] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus malunions of the proximal part of the tibia. METHODS From 1977 through 1998, a combination of an intra-articular elevation and a lateral opening wedge varus osteotomy of the proximal part of the tibia was performed in twenty-three consecutive patients. The patients were assessed clinically and radiographically at a minimum of five years postoperatively. RESULTS A correction of the intra-articular depression and the valgus malalignment was achieved and the anatomic lower-extremity axis was restored in all patients. The clinical results were evaluated at a mean of thirteen years (range, two to twenty-six years) after the reconstructive osteotomy. Two patients had an early failure and were considered to have had a poor result. Two other patients had severe progression of osteoarthritis after the osteotomy, four had slight progression, and fifteen had no progression. There were no nonunions. There were two superficial wound infections, which were treated successfully without surgical intervention. According to the scale of Lysholm and Gillquist, the subjective result was excellent for seventeen patients (74%), good for three, fair for one, and poor for two. CONCLUSIONS A knee-joint-preserving osteotomy can provide satisfactory results in active patients with painful posttraumatic lateral depression and valgus malunion of the proximal part of the tibia.
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Kerkhoffs GMMJ, Struijs PAA, van Dijk CN. Acute treatment of inversion ankle sprains: immobilization versus functional treatment. Clin Orthop Relat Res 2007; 463:250-1; author reply 251. [PMID: 17912059 DOI: 10.1097/blo.0b013e318156fd3f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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298
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Kerkhoffs GMMJ, Handoll HHG, de Bie R, Rowe BH, Struijs PAA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev 2007:CD000380. [PMID: 17443501 DOI: 10.1002/14651858.cd000380.pub2] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ankle sprains are one of the most commonly treated musculoskeletal injuries. The three main treatment modalities for acute lateral ankle ligament injuries are immobilisation with plaster cast or splint, 'functional treatment' comprising early mobilisation and use of an external support (e.g. ankle brace), and surgical repair or reconstruction. OBJECTIVES We aimed to compare surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2006), the Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to December 2005), EMBASE, CINAHL and reference lists of articles, and contacted researchers in the field. This review is considered updated to January 2006. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing surgical with conservative interventions for treating ankle sprains in adults. DATA COLLECTION AND ANALYSIS At least two authors independently assessed methodological quality and extracted data. Where appropriate, results of comparable studies were pooled. We performed sensitivity analyses to explore the robustness of the findings. MAIN RESULTS Twenty trials were included. These involved a total of 2562 mostly young active adult males. All trials had methodological weaknesses. Specifically, concealment of allocation was confirmed in only one trial. Data for pooling individual outcomes were only available for a maximum of 12 trials and under 60% of participants. The findings of statistically significant differences in favour of the surgical treatment group for the four primary outcomes (non-return to pre-injury level of sports; ankle sprain recurrence; long-term pain; subjective or functional instability) when using the fixed-effect model were not robust when using the random-effects model, nor on the removal of one low quality (quasi-randomised) trial that had more extreme results. A corresponding drop in the I(2) statistics showed the remaining trials to be more homogeneous. The functional implications of the statistically significantly higher incidence of objective instability in conservatively treated trial participants are uncertain. There was some limited evidence for longer recovery times, and higher incidences of ankle stiffness, impaired ankle mobility and complications in the surgical treatment group. AUTHORS' CONCLUSIONS There is insufficient evidence available from randomised controlled trials to determine the relative effectiveness of surgical and conservative treatment for acute injuries of the lateral ligament complex of the ankle. High quality randomised controlled trials of primary surgical repair versus the best available conservative treatment for well-defined injuries are required.
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Marti RK, Kerkhoffs GMMJ, Rademakers MV. Korrekturosteotomie bei lateraler Tibiakopfimpression und Valgusfehlstellung. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2007; 19:101-13. [PMID: 17345029 DOI: 10.1007/s00064-007-1197-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Improvement of joint congruency in malunited lateral tibial plateau fractures, reduction of pain, prevention of osteoarthritis. INDICATIONS Valgus malalignment of the proximal tibia combined with intraarticular depression of the tibial plateau. CONTRAINDICATIONS Patients in poor general condition. Severe loss of knee function Elderly patients (> 65 years). Chronic infection. Soft-tissue problems, Inability to perform non-weight bearing after the operation SURGICAL TECHNIQUE Oblique osteotomy of the middle third of the fibula. Straight lateral or parapatellar approach to the lateral proximal tibia. Lateral arthrotomy of the knee joint. Proximal open wedge osteotomy of the tibia. Intraarticular correction of the depressed lateral tibial plateau through subchondral impaction of cancellous bone grafts. Evaluation of leg alignment. Interposition of bicorticocancellous bone grafts to maintain the open wedge osteotomy. Internal fixation, if necessary. POSTOPERATIVE MANAGEMENT Continuous passive motion to 90 degrees of flexion from the 1st postoperative day. After application of a stabilizing brace, patients are allowed toe-touch weight bearing for 8 weeks. After radiologic bony healing has occurred, patients are allowed to increase weight bearing stepwise. RESULTS Between 1977 and 1998, 23 patients were operated on. There were two failures resulting in one arthrodesis and one total knee arthroplasty. After an average of 14 years (5-26 years) 21 patients were followed up. Two patients suffered from severe progression of osteoarthritis after the osteotomy, four had some progression of cartilage degeneration, and 15 presented without changes in osteoarthritis. Mean difference in pre- and postoperative tibiofemoral angle was 8.6 degrees (range 13-4.4 degrees), mean difference in pre- and postoperative depression 6 mm (range 4-9 mm), and mean difference in pre- and postoperative range of motion 12 degrees (range 0-20 degrees). There were no nonunions.
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Been HD, Kerkhoffs GMMJ, Maas M. Suspected atlantoaxial rotatory fixation-subluxation: the value of multidetector computed tomography scanning under general anesthesia. Spine (Phila Pa 1976) 2007; 32:E163-7. [PMID: 17334278 DOI: 10.1097/01.brs.0000257342.69537.5f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical case reports and radiologic study. OBJECTIVES To emphasize the value of computed tomography (CT) scan under general anesthesia in order to prevent misdiagnosing atlantoaxial rotatory fixation-subluxation in children with acute torticollis. SUMMARY OF BACKGROUND DATA A "cock-robin" posture clinically characterizes painful rotatory fixation of the atlantoaxial joint in children. Classically, the observation of persistent displacement of the dens between the lateral mass of the atlas and asymmetry of the atlantoaxial joint on radiography confirmed the diagnosis. More recently, (dynamic) CT scanning or magnetic resonance imaging is used to confirm the diagnosis. However, when a CT scan is performed with the head of the patient in the "cock-robin" position, there is a serious chance of misinterpretation due to the abnormal anatomic position of the atlantoaxial joint. METHODS Four consecutive cases of children presenting with an acute torticollis were analyzed. All were neurologically intact. A conventional single-slice CT scan made with the head rotated in the "cock-robin" position confined rotatory dislocation of the atlantoaxial joint. Subsequently, the patients were referred to our hospital for further treatment. To confirm the diagnosis before potential treatment, a multidetector CT scan under general anesthesia was performed in all 4. RESULTS The multidetector CT scans under general anesthesia did not show any abnormalities. All patients were treated conservatively and recovered completely within 4 weeks of being referred to our hospital. CONCLUSIONS Multidetector CT scanning under general anesthesia is recommended in children when there is suspicion for a spontaneously developed atlantoaxial rotatory fixation-subluxation.
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