T2-mapping at 3 T after microfracture in the treatment of osteochondral defects of the talus at an average follow-up of 8 years.

PURPOSE: To compare repaired cartilage with native cartilage, and inter-observer reliability, using T2 mapping at 3 T for assessing cartilage repair in osteochondral defects of the talus after the microfracture technique. METHODS: We enrolled eight females and seven males undergoing arthroscopic microfracture for osteochondral defects of the talus at an average follow-up of 7.9 ± 2.2 years (range 5-13 years). Cartilage tissue was assessed using a 3-T magnetic resonance imaging unit with an 8-channel phased array foot and ankle coil (gradient strength, 50 mT/m; slew rate, 200 T/m/s). T2 maps were then calculated. Three independent boarded specialists evaluated the images, and magnetic resonance observation of cartilage repair tissue scores was used to assess the cartilage and joint status. Clinical results were assessed using the Hannover Scoring System (HSS) for the ankle and the American Orthopaedic Foot and Ankle Society (AOFAS) hind-foot score. RESULTS: No significant mean differences were found between the T2 properties of the repair tissue and those of the native reference cartilage (T2 = 38.6 ± 5.3 ms, range 30.2-55.8 ms vs. 40.3 ± 8.5 ms, range 31.4-59.8 ms, respectively; intra-class correlation coefficient = 0.94; confidence interval 0.84-0.99, P ≤ 0.001). Despite ≥50 % defect filling in all patients, subchondral bone changes were considerable. The HSS at the follow-up revealed a mean score of 87 ± 12 (range 51-97), and the AOFAS-Score was 90 ± 13 (range 59-100). CONCLUSIONS: 3 T T2 maps were similar in repaired and native cartilage with good inter-observer reliability. LEVEL OF EVIDENCE: IV.

The HOPE partnership: a public school district superintendent's policy and leadership perspective.

The author, superintendent of a midsized urban school district, describes his role in a partnership with a local university's undergraduate and health professions schools, and with various community entities. The author believes that the partnership owes its success to collective vision, knowledge, dedication, and commitment of all of its partners. The superintendent stresses that the partnership would not be possible without the support, assistance, and funding from outside sources. Also, the author believes that it is critical to involve key leaders and policymakers in the formation of these partnerships, especially those who are able to be effective in a shared-leadership environment. Establishing a partnership that has a clearly defined focus, is supported by policy and guiding principles, and is embedded in a systemic plan has proven to be an effective approach able to withstand leadership and other personnel changes and the continuous barrage on public school districts of new mandates and initiatives from local, state, and federal agencies.