Long-term clinical outcome of collagenase clostridium histolyticum treatment is independent of Dupuytren Diathesis Score.

Collagenase clostridium histolyticum (CCH) is a pharmaceutical, non-surgical treatment option for Dupuytren Disease. However, recurrence is common, and predictors of treatment outcome of CCH treatment are largely unknown. In this retrospective study, we analysed the possible correlation between Abe's Dupuytren Diathesis Score (DDS) and recurrence after treatment with CCH. In a total of 74 patients, with an average follow-up of 5 years, we found an overall recurrence rate of 67% after 5y but no correlation with DDS. Sub-scale analysis indicated that the presence of knuckle pads was associated with a reduced recurrence risk. Patient satisfaction after CCH was high. Deriving from our data, there is no correlation between DDS and recurrence following CCH treatment. Therefore, at this moment, we do not advocate the use of the DDS when informing patients about recurrence rates after CCH treatment. Level of evidence: IV: therapeutic cohort study.

Primary endoprosthetic replacement of the arthritic CMC-1 joint.

OBJECTIVE: Osteoarthritis of the carpometacarpal (CMC)-1 joint is a common condition that can cause significant pain and functional problems. When nonoperative management fails, surgery may be indicated. Resection of the trapezium, often combined with soft tissue stabilization, is still considered the gold standard. But recovery time is often prolonged and a significant number of patients remain unsatisfied in the long term. Knowing that total endoprosthetic joint replacement is one of the most successful achievements of orthopedic surgery, many attempts have been made to produce a replacement for the CMC­1 joint that provides a better outcome than trapeziectomy. INDICATIONS: Eaton-Glickel stage 2-3 CMC­1 osteoarthritis. CONTRAINDICATIONS: Symptomatic pan-trapezial osteoarthritis (Eaton-Glickel stage 4), infection, young manual worker, poor bone quality or insufficient trapezium size. SURGICAL TECHNIQUE: A dorsoradial approach to the CMC­1 joint is used. Minimal resection of the trapezial and metacarpal articular surfaces, including osteophytes and loose bodies. Reaming of the trapezium and broaching of the metacarpal stem with dedicated instruments. Implantation of the endoprosthetic components. Selection of the correct neck length to ensure a stable joint. Closure of the capsule and skin. POSTOPERATIVE MANAGEMENT: Immobilization of thumb for 2 weeks in a splint. Followed by a removable thumb CMC brace for 4 weeks, starting with gentle mobilization exercises. No forceful gripping or pinching the first 6 weeks. RESULTS: A specific design-the uncemented, ball in socket, metal on polyethylene total joint replacement-has stood the test of time and successful long-term clinical and radiographic outcome results have been published. Recent comparative trials have shown better pinch strength, better pain relief and faster functional recovery, when compared to trapeziectomy with ligament reconstruction and tendon interposition. The incidence of complications such as dislocation, polyethylene wear and cup loosening is acceptable.

Etiology of knee pain in elite cyclists: A 14-month consecutive case series.

Overuse injuries of the knee are a common cause of missed training and competition days in elite cyclists, however the underlying conditions causing this knee pain are not well defined. We conducted a diagnostic study, investigating a consecutive series of 53 high level cyclists with non-traumatic knee pain over a 14 month period. Demographic data on the participants' cycling specialty and training level was noted. Clinical information concerning knee pain intensity, location and occurrence were collected using a questionnaire. Our results show 7 different overuse injuries were identified. The prepatellar friction syndrome accounted for the majority of these overuse injuries (46%), while medial plica syndrome (15%), biceps femoris tendinopathy (7.5%), patellar tendinopathy (9.4%), infrapatellar plica friction syndrome (7.5%), infrapatellar fat pad impingement (5.7%) and iliotibial band syndrome (3.7%) were other causes of knee pain in these athletes. In contrast to current belief, our results show that instead of patellofemoral cartilage overload, friction related overuse injuries are the most frequent and underestimated cause of knee pain in high level cyclists.

A prospective comparative study between a cooling device and manual cooling after total knee arthroplasty.

Studies have shown that the use of cryotherapy after a total knee arthroplasty can have beneficial effect on blood loss, pain and medication usage. In this study, the effect of the applied cryotherapy procedure is investigated. 52 patients underwent a total knee arthroplasty. The test group received continuous cooling, whereas the control group received manual conventional cooling with ice dressing. The knee circumference and range of motion, medication use, satisfaction and pain were investigated. There is no statistical significant difference in pain and medication usage. A significant difference is observed in the swelling of the knee on the first postoperative day, the range of motion on the 7 th , 10 th , 11 th and 12 th postoperative day, and the satisfaction rate. This study shows that continuous cooling has a positive effect on the swelling and range of motion of the knee, and on the satisfaction of the treatment. Clinical trial registration number : Clinical trial number : EudraCT2015-000259-26.