Posterior Tibial Slope is Increased in Patients With Tibial Tubercle Fractures and Osgood-Schlatter Disease.

BACKGROUND: Osgood-Schlatter disease (OSD) and tibial tubercle fractures are pathologies that affect the tibial tubercle apophysis in preadolescents and adolescents. Anatomic alignment of the proximal tibia may explain why some children develop OSD or sustain tibial tubercle fractures and some do not. Recent data has shown an association between posterior tibial slope angle (PTSA) and both OSD and proximal tibia physeal fractures. In this study, we compare radiographic parameters between patients with non-OSD knee pain, knees with OSD, and knees with tibial tubercle fracture to elucidate a difference between these groups. METHODS: Patients treated for OSD, tibial tubercle fractures, and knee pain, from 2012 to 2018, were retrospectively reviewed. Radiographic parameters for each study group included PTSA, anatomic lateral distal femoral angle, anatomic medial proximal tibial angle, patellar articular height, and the distance from the inferior aspect of the patellar articular surface. Caton-Deschamps index was then calculated. Demographic data was collected including age, sex, and body mass index. Demographic and radiographic data was compared using analysis of variance tests, χ2 tests, 2-sample t tests, and multiple linear regression. RESULTS: Two hundred fifty-one knees in 229 patients met inclusion criteria for the study. In all, 76% were male and the average age of the overall cohort was 14 years old. In patients with tibial tubercle fractures, the majority of fractures were Ogden type 3b (65%). After controlling for demographic variability, average PTSA in the fracture cohort was significantly greater than that in the control cohort (ß=3.49, P<0.001). The OSD cohort had a significantly greater posterior slope (ß=3.14) than the control cohort (P<0.001). There was no statistically significant difference between the fracture and OSD cohorts. There was also no difference in Caton-Deschamps index between the 2 study groups when compared with the control group. CONCLUSION: This study demonstrates that patients with tibial tubercle fractures and patients with OSD have an increased PTSA when compared with the control group. This information adds to the body of evidence that increased tibial slope places the proximal tibial physis under abnormal stress which may contribute to the development of pathologic conditions of proximal tibia such as OSD and tibial tubercle fractures. LEVEL OF EVIDENCE: Level III; retrospective comparative study.

Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient.

BACKGROUND: Donor site morbidity and limited volume remain primary drawbacks of using bone graft from the iliac crest and an impetus for finding other sources of autologous bone-graft material. The Synthes Reamer/Irrigator/Aspirator (RIA) has been found to have value as an autologous bone-graft harvesting device. The purpose of this study was to compare the cellular and biochemical characteristics of bone grafts obtained with use of the RIA and from the iliac crest of the same patient. METHODS: A prospective study was performed on a consecutive series of ten skeletally mature patients presenting for repair of nonunited tibial or femoral fractures. Graft material was harvested from both the iliac crest (in the standard fashion) and the medullary canal of the femur or tibia (with use of the RIA) of each patient. Portions of each autologous graft sample were assessed histologically and by genomewide transcriptional profiling for biochemical markers known to be expressed during fracture-healing. RESULTS: Principal-component analysis comparing the messenger RNA expression profiles in the RIA and iliac crest samples showed that the expression profile at each harvest site was unique and independent of patient, age, sex, or any identified comorbidity. Transcriptional analysis showed that the RIA samples had greater levels of expression of genes associated with vascular, skeletal, and hematopoietic tissues. Additionally, stem cell markers and growth factors that act early in the osteogenic cascade were more abundant in the RIA samples compared with the iliac crest samples. CONCLUSIONS: This is the first study to directly compare the histological and molecular profiles of bone grafts from reaming debris and the iliac crest of the same patient. The debris generated during intramedullary reaming, harvested with use of the RIA technique, and the bone graft harvested from the iliac crest possessed a similar transcriptional profile for genes known to act in the early stages of bone repair and formation. This suggests that reaming debris may be a viable alternative to iliac crest bone graft when autologous cancellous graft is needed.

Evidence for using bisphosphonate to treat Legg-Calvé-Perthes disease.

BACKGROUND: The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity. QUESTIONS/PURPOSES: In this systematic review, we answered the following questions: (1) Does bisphosphonate (BP) therapy decrease femoral head deformity and improve pain and function in LCPD or other juvenile osteonecrotic conditions? And (2) does BP therapy decrease femoral head deformity in experimental studies of juvenile femoral head osteonecrosis? METHODS: We searched the literature from 1966 to 2011 for clinical and experimental studies on BP therapy for juvenile femoral head osteonecrosis. Studies specifically addressing clinical and/or radiographic/histologic outcomes pertaining to pain and function and femoral head morphology were analyzed. RESULTS: Three Level IV clinical studies met our inclusion criteria. Only one study initiated BP therapy during the precollapsed stage of osteonecrosis and reported prevention of femoral head deformity in nine of 17 patients. All studies noted subjective improvements of pain and gait in patients treated with intravenous BPs. Of the eight experimental studies reviewed, seven reported reduced femoral head deformity and six found better preservation of trabecular framework in animals treated with BPs. CONCLUSIONS: Clinical evidence lacks consistent patient groups and drug protocols to draw definitive conclusions that BP therapy can decrease femoral head deformity in juvenile osteonecrotic conditions. Experimental studies suggest BP therapy protects the infarcted femoral head from deformity, but it lacks bone anabolic effect. Further basic and clinical research are required to determine the potential role of BPs as a medical treatment for LCPD.

Accuracy, reliability, and validity of a 3-dimensional scanner for assessing torso shape in idiopathic scoliosis.

STUDY DESIGN: Prospective cohort with concurrent controls. OBJECTIVE: To establish accuracy, reliability, and validity of the Vitronic 3D Body Scanner for the evaluation of torso asymmetry in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Improved appearance is an important expectation of treatment for patients with scoliosis and their parents. Despite being the "gold standard" for quantifying outcomes, Cobb angles do not explain perception of appearance or quality of life. Surface topography is an attractive noninvasive alternative to radiography but has not been studied in the context of patient-centered outcomes. METHODS: Thirty-six adolescents with idiopathic scoliosis undergoing surgical correction had pre- and postoperative radiographs and evaluation of standing posture, torso surface shape, and responses to the Scoliosis Research Society-22 and Spinal Appearance Questionnaire. Twenty-one adolescents without scoliosis were evaluated for comparison. Scanner accuracy was assessed by scanning an object of known dimensions. Within-session reliability of body shape measures constructed from scan data was assessed. Discriminant validity was assessed by examining pre- to postoperative differences. Concurrent validity was examined through correlations of scan measures with radiographs, optoelectronic measures of posture, and self-report responses to the Scoliosis Research Society-22 and Spinal Appearance Questionnaire. RESULTS: Scan system measurement error was 1.74 ± 1.56 mm. Within-session reliability was excellent for the control (intraclass correlation coefficient = 0.83) and scoliosis (intraclass correlation coefficient = 0.94) groups. Medial/lateral torso shift, rotation, and right/left asymmetry differed significantly among the preoperative, postoperative, and control groups (analysis of variance, P < 0.05). Torso asymmetry measures correlated with radiographical measures (r = 0.43-0.51), optoelectronical measures of posture and symmetry (r = 0.33-0.75), and appearance and quality-of-life domains of the Scoliosis Research Society-22 (r = 0.35-0.64) and the Spinal Appearance Questionnaire (r = 0.48-0.67). CONCLUSION: The Vitronic 3D Body Scanner has sufficient accuracy, reliability, and validity to monitor torso asymmetry due to scoliosis. Scan-based measures differentiate between normal and pathological and between preoperative and postoperative body shape and show good correlation with measures of appearance and quality of life.