Relationship between human femorotibial joint configuration and the morphometry of the anterior cruciate ligament.

INTRODUCTION: Individual variations in the anatomy of the knee joint have been suggested to affect the ability to functionally compensate for ACL insufficiency or to put an individual at an increased risk of ACL injury. These variations include the posterior tibial slope, the concavity of the medial tibial plateau, the convexity of the lateral tibial plateau, and the configuration of the femoral condyles. METHOD: This anatomical study investigates if there is a correlation between the individual surface geometry of the femorotibial joint and the morphometry of the ACL. These data were assumed to provide evidence whether or not the functional stability of an ACL-insufficient knee may be derived from its radiographic surface geometry. Standardised measurement techniques were used to analyse the surface geometry of 68 human cadaver knees. Data were correlated with the cross-sectional area, the area of insertion and position of the footprint of the ACL and its functional bundles. RESULTS: Analysis revealed that there was a significant, but weak correlation between the femoral and tibial area of ACL insertion and the depth of the medial and lateral femoral condyle. No correlation was found between the surface geometry of the femorotibial joint and the cross-sectional area of the ACL. The results of this anatomical study suggest that the relationship between the joint surfaces and the morphometry of the ACL primarily is a function of size of the knee joint. CONCLUSIONS: Based on our results, there is no evidence that the stability of the knee can be derived from its radiographic surface geometry.

Morphometric and biomechanical comparison of tendons used for interposition arthroplasty in carpometacarpal arthritis of the thumb.

PURPOSE: To identify the wrist tendon most effectively maintaining the trapezial space in interpositional arthroplasty in osteoarthritis of the carpometacarpal joint of the thumb. METHODS: The morphometrics of the os trapezium and the tendons of the flexor carpi radialis, extensor carpi radialis longus, and abductor pollicis longus were determined. The stiffness and compressive loading characteristics of the rolled-up tendons were compared to the os trapezium. RESULTS: No significant morphometric differences between the three tendons were found. The mass and volume of the trapezium was significantly larger when compared to the tendon balls. No significant differences in the compressive loading resistance were found between the tendons, but the mean stiffness was 85% lower when compared to the os trapezium. CONCLUSIONS: Neither tendon material approached the volume nor the stiffness provided by the os trapezium. Any tendon is considered to insufficiently maintain the trapezial space following trapeziectomy.

Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty.

This study investigates differences in the anatomy of male and female knee joints to contribute to the current debate on sex-specific total knee implants. Morphometric data were obtained from 60 human cadaver knees, and sex differences were calculated. All data were corrected for height, and male and female specimens presenting with an identical length of the femur were analyzed as matched pairs. Male linear knee joint dimensions were significantly larger when compared with females. When corrected for differences in height, medial-lateral dimensions of male knees were significantly larger than female; however, matched paired analysis did not prove these differences to be consistent. Although implant design should focus interindividual variations in knee joint anatomy, our data do not support the concept of a female-specific implant design.

The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee.

BACKGROUND: Osteoarthritis is the most common joint disease of adults worldwide. Its incidence rises with age. Both intrinsic and extrinsic risk factors promote its development. In men aged 60 to 64, the right knee is more commonly affected; in women, the right and left knees are affected with nearly equal frequency. METHODS: The PubMed, Medline, Embase and Cochrane Library databases were selectively searched for current studies (up to September 2009; case reports excluded) on the epidemiology, etiology, diagnosis, staging, and treatment of osteoarthritis of the knee. The search terms were "gonarthrosis," "prevention," "conservative treatment," "joint preservation," "physical activity," "arthroscopy," "osteotomy," "braces," "orthoses," and "osteoarthritis knee joint." RESULTS AND CONCLUSION: Osteoarthritis is not yet a curable disease, and its pathogenesis remains unclear. The best treatment for osteoarthritis of the knee is prevention. The goal of therapy is to alleviate clinical manifestations. The therapeutic spectrum ranges from physiotherapy and orthopedic aids to pharmacotherapy and surgery.

Treatment delay of bone tumours, compilation of a sociodemographic risk profile: a retrospective study.

BACKGROUND: Bone tumours are comparatively rare tumours and delays in diagnosis and treatment are common. The purpose of this study was to analyse sociodemographic risk factors for bone tumour patients in order to identify those at risk of prolonged patients delay (time span from first symptoms to consultation), professional delay (from consultation to treatment) or symptom interval (from first symptoms to treatment). Understanding these relationships might enable us to shorten time to diagnosis and therapy. METHODS: We carried out a retrospective analysis of 265 patients with bone tumours documenting sociodemographic factors, patient delay, professional delay and symptom interval. A multivariate explorative Cox model was performed for each delay. RESULTS: Female gender was associated with a prolonged patient delay. Age under 30 years and rural living predisposes to a prolonged professional delay and symptom interval. CONCLUSION: Early diagnosis and prompt treatment are required for successful management of most bone tumour patients. We succeeded in identifying the histology independent risk factors of age under 30 years and rural habitation for treatment delay in bone tumour patients. Knowing about the existence of these risk groups age under 30 years and female gender could help the physician to diagnose bone tumours earlier. The causes for the treatment delays of patients living in a rural area have to be investigated further. If the delay initiates in the lower education of rural general physicians, further training about bone tumours might advance early detection. Hence the outcome of patients with bone tumours could be improved.

Stabilization of the femoral head with a gliding screw in slipped capital femoral epiphysis.

OBJECTIVE: In situ fixation of the proximal femoral epiphysis to prevent further dislocation while maintaining the potential for longitudinal growth by insertion of a central gliding screw. Prevention of secondary coxarthrosis. INDICATIONS: Incipient and imminent slipped capital femoral epiphysis in children with a displacement angle of < 30 degrees in the axial view (ET' < 30 degrees ) and prophylactic treatment of the contralateral side. CONTRAINDICATIONS: Allergies to implant materials. SURGICAL TECHNIQUE: A Kirschner wire is inserted through a lateral proximal approach in the femur into the center of the displaced epiphysis at a right angle to its base. Overdrilling of the wire, thread tapping in the cancellous bone, insertion of the cannulated gliding screw with washer. The screw threads lie only in the epiphysis. The unthreaded part of the screw bridges the growth plate. The screw is allowed to protrude by about 2.5 cm to prevent an epiphyseodesis effect. POSTOPERATIVE MANAGEMENT: Partial weight bearing of the affected extremity up to 10 kg body weight for 6 weeks. Thrombosis prophylaxis during convalescence only for adolescents with signs of puberty (menarche/pubarche). Restriction on sports activities for 3 months. Follow-ups: clinical and radiologic examinations at 3 months postoperatively, then clinical examination every 6 months and radiologic assessment annually (possibly earlier, if there is a growth spurt). The gliding screw is removed when growth is completed. RESULTS: 63 hips (34 prophylactically and 29 therapeutically) were stabilized with the gliding screw. Clinically, the prophylactically stabilized hips showed excellent outcomes; of the therapeutically stabilized hips, the results were 19 excellent, seven good, two satisfactory, and one poor. Differences in leg length were seen in five cases, whereby the average value was 0.3 cm (0-1 cm). Chondrolysis or femoral head necrosis was not observed. Screw revision was necessary in 22 cases because contact between the screw head and the cortex would have prevented continued longitudinal growth (unintentional epiphyseodesis).