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Mirzayan R, Ragheb JM, Jeshion-Nelson K, DeWitt DO, Cruz CA. Fresh Osteochondral Allograft Transplantation of the Capitellum for the Treatment of Osteochondritis Dissecans. Am J Sports Med 2024; 52:2620-2627. [PMID: 39140729 DOI: 10.1177/03635465241262769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern. PURPOSE To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period. STUDY DESIGN Case series; Level of evidence, 4. METHODS After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments. RESULTS A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications. CONCLUSION FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - Jonathan M Ragheb
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Kian Jeshion-Nelson
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - David O DeWitt
- Department of Orthopaedic Surgery, Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - Christian A Cruz
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
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Leal J, Hones KM, Hao KA, Slaton PT, Roach RP. Arthroscopy and Microfracture for Osteochondritis Dissecans of the Capitellum in Adolescent Athletes Shows Favorable Return to Sport: A Systematic Review. Arthroscopy 2024; 40:1325-1339. [PMID: 37714441 DOI: 10.1016/j.arthro.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX) with or without debridement as well as associated indications, clinical outcomes, radiographic outcomes, and complications. METHODS A literature search of all published literature in the English language from PubMed, EMBASE, Scopus, and Cochrane from database inception to April 4, 2022, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies presented demographics and outcomes for adolescent (<21 years old) patients diagnosed with capitellar OCD who underwent arthroscopic MFX (or drilling/subchondral drilling) or MFX (or drilling/subchondral drilling) with debridement (or loose body removal/chondroplasty). Studies containing multiple surgical techniques that did not distinguish characteristics and outcomes of individual patients by surgical technique were excluded. Additionally, if there was overlap in patient populations between 2 studies, the study with less outcome data was excluded. Extracted data included study properties, patient demographics, lesion characteristics, surgery details, and patient outcomes, including range of motion, outcome scores, and RTS rates. Bias was assessed via the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Nine studies of 136 patients and 138 elbows met criteria. Included articles were published between 2005 and 2020 with MINORS scores of 8 to 14 (50% to 88%). The age ranged from 12.7 to 15.7 years with most patients being involved in baseball or gymnastics and a rate of dominant elbow involvement of 55% to 100%. Patient follow-up ranged from 16 to 138 months. All 9 studies reported RTS, ranging from 65% to 100%. Six of these studies categorized the level to which the patient returned, with patients RTS at the same level of competition ranging from 60% to 100%. Six studies reported complications, with a range rate of 0% to 43%; there were a total of 10 complications, 7 of which required reoperations. CONCLUSIONS Arthroscopic MFX with or without arthroscopic debridement is a safe and effective treatment for OCD lesions of the capitellum in young, athletic patients. Included studies reported improved clinical, radiographic, and patient-reported outcomes. Aside from 1 study reporting an RTS of 65%, the rate of RTS ranged from 86% to 100%. The percentage of patients returning to sport at the same level of competition ranged from 60% to 100% with a time to RTS ranging from 4.1 to 5 months. A single study reported a complication rate of 43%, while remaining studies reported complication rates between 0% and 19%, with loose bodies being the most common complication requiring reoperation. Follow-up ranged from 16 to 138 months. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Justin Leal
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A..
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | | | - Ryan P Roach
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
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De Nordenflycht D, Matus G, Aravena JP, Toloza H. Osteochondritis dissecans of the temporomandibular joint: a scoping review. Oral Maxillofac Surg 2024; 28:29-38. [PMID: 36631710 DOI: 10.1007/s10006-022-01134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). METHODS An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons. CONCLUSION OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.
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Affiliation(s)
- Diego De Nordenflycht
- Universidad Andres Bello, Faculty of Dentistry, Quillota # 980 Torre E, Viña del Mar, Chile.
| | | | | | - Héctor Toloza
- Universidad Andres Bello, Faculty of Dentistry, Quillota # 980 Torre E, Viña del Mar, Chile
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Malik SS, Rasidovic D, Saeed A, Jordan RW, Maclean S, I Bain G. Management of osteochondritis dissecans (OCD) of the elbow trochlea in the adolescent population: A systematic review. Shoulder Elbow 2022; 14:415-425. [PMID: 35846402 PMCID: PMC9284302 DOI: 10.1177/17585732221079585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Background Elbow trochlea osteochondritis dissecans (OCD) is rare with limited information on it. The aim of this systematic review is to assess the published evidence on trochlea OCD in terms of presenting symptoms, location of OCD and outcome of management in adolescent patients. Patient & Methods A review of the online databases MEDLINE and Embase was conducted according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting on any aspect of trochlea OCD management were eligible for inclusion and appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results 16 studies were eligible for inclusion with a total of 75 elbow. Mean age was 14 years (8-19) of which 46 were males. The main presenting symptoms were pain (95%). Non-operative care was reported in 86% of elbows with resolution of symptoms in 76%. Surgical management was described in 14%. There were equal number of arthroscopic and open procedures. 94% had successfully resolution of symptoms post-operatively. Conclusion Elbow trochlea OCD is a rare pathology and one that can be managed non-operatively in the majority of cases with good resolution of symptoms. However, if this fails, operative options are available with excellent results reported. Level of evidence Level IV, Systematic review.
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Affiliation(s)
| | | | - Abu Saeed
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. Int J Surg 2022; 101:106616. [PMID: 35427798 DOI: 10.1016/j.ijsu.2022.106616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess the safety of minimally invasive surgery (MIS) for orthopedic spinal, upper limb and lower limb procedures, this systematic review of systematic reviews compared their complications with open procedures. MATERIALS AND METHODS A literature search was conducted electronically (PubMed, Cochrane library and Web of Science; May 8, 2021) without language restriction in the past five years. Reviews that consulted at least two databases, compared MIS with open orthopedic surgery, and reported the following: intraoperative, post-operative or total complications, function, ambulation, pain, hospital stay, reoperation rate and operation time were included. Article selection, quality assessment using AMSTAR-2, and data extraction were conducted in duplicate on predesigned forms. In each review, a subset analysis focusing on prospective cohort and randomized studies was additionally performed. PROSPERO CRD42020178171. RESULTS The search yielded 531 articles from which 76 reviews consisting of 1104 primary studies were included. All reviews were assessed as being low quality. Compared to open surgery, MIS had fewer total, postoperative and intraoperative complications in 2/10, 2/11 and 2/5 reviews of spinal procedures respectively, 1/3, 1/4 and 1/2 reviews of upper limb procedures respectively, and 4/6, 2/7 and 0/2 reviews of lower limb procedures respectively. CONCLUSIONS MIS had greater overall safety compared to open surgery in spinal procedures. In upper limb and lower limb procedures, MIS was not outright superior to open procedures in terms of safety hence a general preference of MIS is not justified on the premise of a better safety profile compared to open procedures.
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Obey MR, Hillen TJ, Broughton JS, Smith MV, Goldfarb CA. Magnetic Resonance Imaging Assessment of Cartilage Appearance Following Marrow Stimulation of Osteochondritis Dissecans of the Humeral Capitellum. J Hand Surg Am 2022; 48:409.e1-409.e11. [PMID: 34996634 DOI: 10.1016/j.jhsa.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteochondritis dissecans (OCD) of the capitellum is often treated by marrow stimulation techniques with good long-term outcomes. Magnetic resonance imaging (MRI) can be used to characterize the healing of cartilage repair tissue. However, no formal system exists for assessment of cartilage healing after marrow stimulation in capitellar OCD. The aims of this study were to describe the postoperative MRI appearance of capitellar repair cartilage after debridement and marrow stimulation for capitellar OCD and assess differences between symptomatic and asymptomatic patients. METHODS This was a retrospective study of patients with capitellar OCD who underwent arthroscopic debridement and marrow stimulation and had a postoperative MRI to assess healing. The classification system developed by Marlovits and colleagues (Magnetic Resonance Observation of Cartilage Repair Tissue) was used to quantitatively profile the cartilage repair tissue in comparison to adjacent "normal" cartilage. Study participants completed an online survey to correlate outcomes with cartilage appearance. RESULTS Eleven patients who underwent MRI for routine evaluation (asymptomatic), and 18 who underwent MRI for symptoms were identified. Overall, 59% of defects were completely filled, and in 83%, the cartilage surface had ulcerations or fibrillations. The cartilage variables were similar between symptomatic and asymptomatic patients. Capitellar subchondral bone edema was observed on the MRI of every patient who underwent a reoperation and was present in only 62% of those who did not. Clinical scores did not correlate with MRI cartilage findings, but the small sample size limited conclusions regarding clinical outcomes related to postoperative cartilage features seen on MRI. CONCLUSIONS This detailed assessment of cartilage appearance by MRI after marrow stimulation for capitellar OCD demonstrated that incomplete cartilage fill was common in both symptomatic and asymptomatic patients. Those requiring a second surgery were more likely to demonstrate subchondral bone edema. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
| | - Travis J Hillen
- Department of Radiology, Washington University in St. Louis, St. Louis, MO
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A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:4041-4066. [PMID: 33620512 DOI: 10.1007/s00167-021-06489-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. METHODS The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. RESULTS Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10-18.5) and a median follow-up of 39 months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic-assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8-99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70-87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3-94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5-95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3-99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7-99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients). CONCLUSION Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures. LEVEL OF EVIDENCE Level IV.
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Obey MR, Goldfarb CA, Broughton JS, Gebhart SS, Smith MV. Early Improvement in Patient-Reported Outcome Scores After Operative Treatment of Osteochondritis Dissecans of the Humeral Capitellum. J Hand Surg Am 2021; 46:1120.e1-1120.e7. [PMID: 33931273 DOI: 10.1016/j.jhsa.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/14/2020] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Outcome measures that lack sensitivity for the detection of clinical changes early after surgery for capitellar osteochondritis dissecans (OCD) make it difficult to determine the optimal treatment for these defects. We sought to evaluate the early responsiveness of patient-reported outcomes measurement information system (PROMIS) scores in a cohort of patients operatively treated for capitellar OCD. METHODS Four PROMIS questionnaires (mobility, upper extremity [UE], pain interference, and peer relations) were electronically administered to patients treated for capitellar OCD at a single tertiary academic medical center between January 1, 2015, and July 1, 2018. The questionnaires were administered at the initial preoperative outpatient clinic visit as well as at the 2-week, 6-week, and final return-to-play (RTP) visits. RESULTS Twenty-nine patients (31 elbows, mean age 12.9 years) with available preoperative and postoperative PROMIS data were included. The mean final follow-up period was 26 weeks. Compared with that before surgery, there was a significant improvement in the mobility, pain interference, and UE scores at 6 weeks following surgery. The scores improved most significantly by 6 weeks, reached a relative plateau, and remained significantly improved through the RTP visit thereafter. Patients with preoperative, intra-articular loose bodies scored significantly better than those without them during the 6-week and RTP visits. Patients with lesions >1 cm2, compared with those with lesions ≤1 cm2, demonstrated greater improvement in the UE scores during the RTP visit. CONCLUSIONS In patients undergoing operative treatment for capitellar OCD, a significant improvement in the PROMIS domains of mobility, pain interference, and UE can be expected early in the postoperative period, with majority of patients reaching their greatest improvement in scores by 6 weeks following surgery. CLINICAL RELEVANCE This is important information for preoperative counseling. In addition, this information is helpful in confirming that PROMIS scores are responsive in the detection of changes in outcomes during the early postoperative period in this population.
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Affiliation(s)
- Mitchel R Obey
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | | | - J Sam Broughton
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Sandra S Gebhart
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Matthew V Smith
- Department of Orthopedic Surgery, Washington University, St. Louis, MO.
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Abstract
This review presents the current understanding of the etiology, pathogenesis, and how to diagnose and treat osteochondritis dissecans (OCD) at the elbow joint followed by an analysis of particular characteristics and outcomes of the treatment. OCD is seen in patients with open growth plates (juvenile OCD [JOCD] and in adults [AOCD] with closed growth plates [adult OCD). The etiology at smaller joints remains as unclear as for the knee. Mechanical factors (throwing activities [capitulum] seem to play an important role. Clinical symptoms are unspecific. Thus, imaging techniques are most important for the diagnosis. In low-grade and stable lesions, treatment involves rest and different degrees of immobilization until healing. When surgery is necessary, the procedure depends on the OCD stage and on the state of the cartilage. With intact cartilage, retrograde procedures are favorable while with damaged cartilage, several techniques are used. Techniques such as drilling and microfracturing produce a reparative cartilage while other techniques reconstruct the defect with osteochondral grafts or cell-based procedures such as chondrocyte implantation. There is a tendency toward better results when reconstructive procedures for both the bone and cartilage are used. In addition, comorbidities at the joint have to be treated. Severe grades of osteoarthritis are rare.
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Affiliation(s)
- Juergen Bruns
- Wilhelmsburger Krankenhaus Groß-Sand, Hamburg, Germany,Juergen Bruns, Wilhelmsburger Krankenhaus Gross-Sand, Groß Sand 3, Hamburg, 21107, Germany.
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Kircher J. Editorial Commentary: Elbow Arthroscopy in the Pediatric Patient-Small Lesions in a Small Joint but With a Big Impact. Arthroscopy 2021; 37:1971-1972. [PMID: 34090576 DOI: 10.1016/j.arthro.2021.02.030] [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: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023]
Abstract
Elbow arthroscopy has evolved to be a powerful tool for the treatment of a broad spectrum of pathologies over the past almost 40 years. The small joint with a complex arthroscopic anatomy demands special training and exceptional skills from the orthopaedic surgeon. On the basis of this fact and in light of the close proximity of the neurovascular structures, complication rates are somewhat higher compared with other large joints such as the knee and the shoulder. Nevertheless, elbow arthroscopy has also found its way into the treatment of joint pathologies in pediatric patients. The spectrum of pathologies differs from that in the adult population, with fewer degenerative changes and many growth-related issues such as osteochondral lesions (osteochondritis dissecans) of the capitellum. Generally speaking, clinical outcomes, return to sports, and patient satisfaction are excellent and complication rates are low. The latter remains a target for further improvement in light of the many years those pediatric elbow joints have ahead.
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Both Debridement and Microfracture Produce Excellent Results for Osteochondritis Dissecans Lesions of the Capitellum: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e593-e603. [PMID: 34027472 PMCID: PMC8128994 DOI: 10.1016/j.asmr.2020.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/16/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the available literature pertaining to the indications, outcomes, and complications of both microfracture (MFX) and simple debridement for capitellar osteochondritis dissecans (OCD). Methods A comprehensive literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Studies were included if they evaluated OCD of the capitellum that underwent either arthroscopic debridement (AD) or MFX. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) scale. Patient demographic characteristics, imaging findings, return-to-sport rates, patient-reported outcomes, range of motion (ROM), complications, failures, and reoperations were recorded. Results Eleven studies with 327 patients (332 elbows) met the inclusion criteria. Methodological Index for Non-randomized Studies (MINORS) scores ranged from 63% to 75% and showed considerable heterogeneity. Both AD and MFX showed improvement in patient outcome scores, ROM, and return to play, although the data precluded relative conclusions. Improvement in motion after MFX ranged from 4.9° to 5° of flexion, 5° to 22.6° of extension, 1° to 2° of pronation, and 0.5° to 2° of supination, whereas after AD, it ranged from –4° to 6° of flexion and –0.4° to 14° of extension, with prono-supination noted in only 1 study. The rate of return to play at a similar level of preinjury athletic competition ranged from 55% to 75% after MFX and from 40% to 100% after AD. Lesion location was discussed in only 1 study. Postoperative imaging trended toward early degenerative changes, most commonly of the radial head. Complications were only reported in 1 MFX study; in all cases, the complication was transient ulnar nerve neurapraxia. Reoperation rates ranged from 0% to 10%, and reoperation was most commonly performed to address radial head enlargement. Five studies reported no reoperations. Conclusions Both AD and MFX for capitellar OCD appear to yield excellent improvements in pain, ROM, patient outcome scores, and return to sport. Given that comparable mid-term outcomes can be achieved with debridement alone, without the use of MFX, similarly to recent prospective studies in the knee, AD alone may be a reasonable approach to relatively small OCD defects. Level of Evidence Level IV, systematic review of studies, all Level IV evidence.
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HY C, D E, B T. Elbow arthroscopy - Indications and technique. J Clin Orthop Trauma 2021; 19:147-153. [PMID: 34099974 PMCID: PMC8167286 DOI: 10.1016/j.jcot.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022] Open
Abstract
Throughout the years, elbow arthroscopy has advanced tremendously due to improvements in technology and surgical techniques. It is now considered a safe and effective treatment for a variety of elbow disorders. Due to the small working space and nearby neurovascular structures, it is a technically challenging procedure. It can be used to successfully treat complaints caused by loose bodies, osteoarthritis, arthrofibrosis, OCD, lateral epicondylitis, VEOS and fractures. The most devastating complication of elbow arthroscopy is (permanent) nerve injury. Therefore, distortion of the anatomy of the elbow joint and transposition of the ulnar nerve can be a contra-indication for elbow arthroscopy due to the higher risk of postoperative complications. The results of the arthroscopy depend on the experience, knowledge, technique and expertise of the performing surgeon.
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Affiliation(s)
- Chow HY
- Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4818, CK Breda, the Netherlands,Corresponding author.
| | - Eygendaal D
- Department of Orthopaedics, Amsterdam University Medical Centres, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - The B
- Department of Orthopaedics, Amphia Hospital, Molengracht 21, 4818, CK Breda, the Netherlands
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Looney AM, Rigor PD, Bodendorfer BM. Evaluation and management of elbow injuries in the adolescent overhead athlete. SAGE Open Med 2021; 9:20503121211003362. [PMID: 33996078 PMCID: PMC8072106 DOI: 10.1177/20503121211003362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022] Open
Abstract
With an increased interest in youth sports, the burden of overhead throwing elbow injuries accompanying early single-sport focus has steadily risen. During the overhead throwing motion, valgus torque can reach and surpass Newton meters (N m) during the late cocking and early acceleration phases, which exceeds the tensile strength (22.7–33 N m) of the ulnar collateral ligament. While the ulnar collateral ligament serves as the primary valgus stabilizer between and degrees of elbow flexion, other structures about the elbow must contribute to stability during throwing. Depending on an athlete’s stage of skeletal maturity, certain patterns of injury are observed with mechanical failures resulting from increased medial laxity, lateral-sided compression, and posterior extension shearing forces. Together, these injury patterns represent a wide range of conditions that arise from valgus extension overload. The purpose of this article is to review common pathologies observed in the adolescent overhead throwing athlete in the context of functional anatomy, osseous development, and throwing mechanics. Operative and non-operative management and their associated outcomes will be discussed for these injuries.
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Affiliation(s)
- Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Paolo D Rigor
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Blake M Bodendorfer
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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14
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Patel SP, Conyer RT, Shybut TB. Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects. Arthrosc Tech 2020; 9:e1727-e1730. [PMID: 33294333 PMCID: PMC7695613 DOI: 10.1016/j.eats.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023] Open
Abstract
Chondral and osteochondral lesions of the humeral capitellum, most notably osteochondritis dissecans, most commonly present in adolescent baseball players and gymnasts. A variety of surgical techniques can be used to address these lesions. Osteochondral autograft transfer has recently shown superior rates of return to sport. We describe osteochondral autograft transfer from the contralateral knee to treat a large full-thickness chondral lesion of the humeral capitellum. Osteochondral allograft backfill of the donor site is shown as well. This surgical procedure is technically demanding but very reproducible and maximizes return to play in patients while minimizing donor-site morbidity.
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Affiliation(s)
- Shiv P. Patel
- Baylor College of Medicine–Burkhart Research Institute for Orthopaedics, San Antonio, Texas, U.S.A.,Address correspondence to Shiv P. Patel, M.D., M.S., 1207 Agora Springs Dr, San Antonio, TX 78258, U.S.A.
| | - Ryan T. Conyer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Theodore B. Shybut
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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15
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Logli AL, Leland DP, Bernard CD, Sanchez-Sotelo J, Morrey ME, O'Driscoll SW, Krych AJ, Wang Z, Camp CL. Capitellar Osteochondritis Dissecans Lesions of the Elbow: A Systematic Review of Osteochondral Graft Reconstruction Options. Arthroscopy 2020; 36:1747-1764. [PMID: 32035172 DOI: 10.1016/j.arthro.2020.01.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically evaluate the outcomes and complications of osteochondral autograft transfer (OAT) and osteochondral allograft transplantation (OCA) for the surgical treatment of capitellar osteochondritis dissecans (OCD). METHODS A literature search was conducted across 3 databases (PubMed, Cochrane, and CINAHL [Cumulative Index to Nursing and Allied Health Literature]) from database inception through December 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Individual study quality was assessed using the Methodological Index for Non-randomized Studies scale. Studies were published between 2005 and 2019. RESULTS Eighteen studies consisting of 446 elbow OCD lesions treated with OAT surgery were included. There was a single OCA study eligible for inclusion. Patient ages ranged from 10 to 45 years. Of the OAT studies, 4 used autologous costal grafts whereas the remainder used autografts from the knee. Outcome measures were heterogeneously reported. A significant improvement in Timmerman-Andrews scores from preoperatively to postoperatively was reported in 9 of 10 studies. Return-to-play rates to the preinjury level of competitive play ranged from 62% to 100% across 16 studies. Significant improvement in motion, most often extension, was noted in most studies. Reported complication, reoperation, and failure rates ranged from 0% to 11%, 0% to 26%, and 0% to 20%, respectively. When used, knee autografts resulted in low donor-site morbidity (Lysholm scores, 70-100). CONCLUSIONS OAT surgery for large, unstable OCD lesions of the capitellum reliably produced good outcomes, few complications, and a high rate of return to competitive play. Complications are relatively uncommon, and donor-site morbidity is low. Less is known about the performance of OCA given the paucity of available literature. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Anthony L Logli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Devin P Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Zhen Wang
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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16
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Gowd AK, Beck EC, Nabor D, Waterman BR. A Staged Arthroscopic Approach to Fixation of Unstable Osteochondritis Dissecans in the Medial Femoral Condyle of the Knee Using Nonabsorbable Fixation Screws. Arthrosc Tech 2020; 9:e477-e481. [PMID: 32368467 PMCID: PMC7189124 DOI: 10.1016/j.eats.2019.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans is a focal lesion of articular cartilage that can result in fragment instability with progression of early osteoarthritis. Regarding the knee joint, salvage of an unstable lesion can be achieved using arthroscopic-assisted reduction and fixation via a 2-stage process. The first involves arthroscopic fixation of the fragment using nonbioabsorbable screws, whereas the second stage performed 12 weeks later involves removal of the screws and confirmation of successful healing of the lesion. Previous studies have demonstrated excellent outcomes in patients undergoing fixation for unstable chondral lesions not amenable to conservative treatment. A critical component of successful treatment is understanding the importance of hardware placement and technique. The purpose of the Technical Note is to describe a method performing this 2-stage arthroscopic repair of an unstable chondral lesion located on the medial femoral condyle of the knee.
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Affiliation(s)
| | - Edward C. Beck
- Address correspondence to Edward C. Beck, M.D., M.P.H., Department of Orthopedic Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd., Winston-Salem, NC 27101.
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17
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Pederzini LA, Bartoli M, Cheli A, Nicoletta F, Severini G. Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD). Knee Surg Sports Traumatol Arthrosc 2019; 27:3291-3296. [PMID: 31236634 DOI: 10.1007/s00167-019-05568-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The primary outcomes are the evaluation and quantification of pain relief and improvement in range of motion after OAT in OCD. The secondary outcomes are: resuming of sport activities, evaluation of the ADL recovery rate and subjective evaluation of the quality of life improvement. METHODS Nine patients, affected by an unstable and non-acute OCD lesion of the capitulum humeri, have been treated by the same surgeon. The patient mean age was 22.4 (16-45 years). All subjects were treated with the same surgical technique (arthroscopic OAT from the same side knee, a single cylinder of 6.5-9 mm in diameter) and underwent the same rehabilitation. The mean follow-up was 48 months (30-52 months). The authors documented the clinical assessment of each patient and carried out a questionnaire which included the VAS scale, MEPS Score and Quick DASH score. Patients were asked for MRI and radiographs pre- and post-operatively at follow-up. RESULTS The mean range of motion improvement was 17.9° in extension (range 13°-27°) and 10.6° in flexion (range 0°-20°) The VAS mean improvement was 7.1 (range 6-8) and the mean post-op value 0.6 (range 0-3). The MEPS score mean post-operative value was 98.3 (range 85-100). The Quick-DASH mean post-operative value was 2.5 (range 0-9.1) with a mean improvement of 41.4 points (range 36.4-47.7 points). All patients resumed sports in 6 months post-operatively. CONCLUSIONS The autologous transplant of an osteochondral plug is a safe and promising procedure. Despite being more demanding, the arthroscopic approach is a valuable tool if the surgeon aims to reduce the invasiveness of the procedure, with all the consequent advantages. LEVEL OF EVIDENCE IV Retrospective case series, therapeutic study.
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Affiliation(s)
- Luigi Adriano Pederzini
- Orthopeadics and Traumatology Unit, Nuovo Ospedale Civile di Sassuolo, Via Francesco Ruini 2, 41049, Sassuolo, MO, Italy
| | - Matteo Bartoli
- Orthopeadics and Traumatology Unit, Nuovo Ospedale Civile di Sassuolo, Via Francesco Ruini 2, 41049, Sassuolo, MO, Italy.
| | - Andrea Cheli
- Orthopeadics and Traumatology Unit, Nuovo Ospedale Civile di Sassuolo, Via Francesco Ruini 2, 41049, Sassuolo, MO, Italy
| | - Fabio Nicoletta
- Orthopeadics and Traumatology Unit, Nuovo Ospedale Civile di Sassuolo, Via Francesco Ruini 2, 41049, Sassuolo, MO, Italy
| | - Gabriele Severini
- Università Cattolica del Sacro Cuore-Fondazione Policlinico Gemelli, Largo Agostino Gemelli 8, 00168, Rome, RM, Italy
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18
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Osteochondrale Läsionen am Ellbogen. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-0288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Logli AL, Bernard CD, O'Driscoll SW, Sanchez-Sotelo J, Morrey ME, Krych AJ, Camp CL. Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. Curr Rev Musculoskelet Med 2019; 12:1-12. [PMID: 30645727 PMCID: PMC6388572 DOI: 10.1007/s12178-019-09528-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF THE REVIEW To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on current best evidence and surgeon experience. RECENT FINDINGS Recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews and meta-analyses. These studies have focused on understanding how lesion characteristics such as size, location, and appearance on advanced imaging can predict treatment success. Current literature continues to support nonoperative management for stable lesions. Operative intervention is generally required for unstable lesions and treatment strategies are largely dictated by lesion size and location: debridement or reparative techniques for small lesions while larger lesions or those in high-stress locations are better served by bone and/or cartilage restoration procedures. There has been a rising interest in the use of allograft materials and cell-based therapies. Overhead athletes are uniquely predisposed to capitellar OCD due to the nature of forces applied to the radiocapitellar joint during repeated activity in the overhead position. Despite improvements in operative techniques, successful use of alternative graft materials, and a better understanding of how lesion characteristics influence results, there is still much to learn about this challenging disorder. Future research should focus on comparing operative techniques, refining their indications, and further developing a reliable treatment algorithm that best serves the overhead athlete.
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Affiliation(s)
- Anthony L Logli
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Christopher D Bernard
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Shawn W O'Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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20
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van den Bekerom MPJ, van Riet R. Is there any difference between open and arthroscopic treatment for osteochondritis dissecans of the humeral capitellum? INTERNATIONAL ORTHOPAEDICS 2018; 42:1201. [PMID: 29546608 DOI: 10.1007/s00264-018-3882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Michel P J van den Bekerom
- Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
- Orthopaedic Department, AZ Monica Hospital, Deurne, Belgium.
| | - Roger van Riet
- Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Orthopaedic Department, AZ Monica Hospital, Deurne, Belgium
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21
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Chen W, Zhang Y. Prominent and fruitful development of orthopaedic research in China. INTERNATIONAL ORTHOPAEDICS 2018; 42:455-459. [PMID: 29478208 DOI: 10.1007/s00264-018-3840-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,Hebei Institute of Orthopaedics and Traumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Hebei Institute of Orthopaedics and Traumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
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