ABSTRACT
The case presented is that of a 23-year-old man suffering from osteochonditis dissecans (OCD) of the medial femoral condyle, in whom a free piece of cartilage had separated off and there was a large osteochondral defect despite numerous operations. After refixation of the fragment failed, an autologous chondrocyte transplantation (ACT) was performed using the sandwich technique. Three years after the operation the patient is very satisfied with the result. The radiological findings show stable repair of the bony and cartilaginous defect area. This case report shows that ACT is a valid method for the treatment of large osteochondral defects even after several previous failed operations. The low donor site morbidity is an important advantage over other methods, such as transplantation of osteochondral plugs.
Subject(s)
Chondrocytes/transplantation , Femur/surgery , Joint Loose Bodies/surgery , Knee Joint/surgery , Osteochondritis Dissecans/surgery , Salvage Therapy , Adult , Arthroscopy , Femur/pathology , Follow-Up Studies , Humans , Joint Loose Bodies/diagnosis , Knee Joint/pathology , Magnetic Resonance Imaging , Male , Osteochondritis Dissecans/diagnosis , Postoperative Complications/diagnosis , Postoperative Complications/surgery , ReoperationABSTRACT
The subacromial impingement syndrome describes the pathological contact between the rotatory cuff and the acromion. It is only a symptom and not a generic term for the different pathological diseases of the subacromial region. It is the diagnostical aim to verify the pathogenesis of the impingement syndromes and it is essential to differentiate structural versus functional causes. The diagnosis "impingement syndrome" should not have an acromioplastic procedure as general consequence. Because the expression "impingement syndrome" does not show causal approach it should no longer be used as a diagnosis. The term subacromial syndrome, in conjunction with the underlying pathological cause, acquires more therapeutic and prognostic clarity.
Subject(s)
Shoulder Impingement Syndrome/diagnosis , Shoulder Impingement Syndrome/therapy , Shoulder Pain/diagnosis , Shoulder Pain/therapy , Diagnosis, Differential , Humans , Practice Guidelines as Topic , Practice Patterns, Physicians'ABSTRACT
Flatfoot deformity is characterized by a multiplanar hindfoot malalignment. Although the etiology remains unclear, the deformity is mainly attributed to ligamentous laxity and dysfunction of the posterior tibial tendon. Obesity is thought to be a risk factor that additionally impairs hindfoot stability. Performing a retrospective clinical and radiological study, we compared two groups, each with 75 patients. One group included patients with a flatfoot deformity stage 2, while the other group showed no hindfoot malalignment. Reviewing the weight and calculating the body mass index revealed significantly increased values for those patients with flatfoot deformity (P=0.034 and P>0.001, respectively). This correlation should be considered during the decision-making process on surgical strategies. In obese patients with flatfoot deformity, stage 2 soft tissue reconstruction and hindfoot osteotomies should be combined with hindfoot arthrodeses, i.e. subtalar fusion, to maintain sufficient and durable stability.
