Diagnostic performance of a 3D double-echo steady-state sequence at 3 T using radial reformats for detecting and grading rotator cuff tears: a pilot diagnostic accuracy study with magnetic resonance imaging and arthroscopic correlation.

BACKGROUND: In diagnosing rotator cuff tears (RCTs), magnetic resonance imaging (MRI) is the imaging modality of choice, and its accuracy is improving constantly. PURPOSE: To evaluate the diagnostic performance of a high-resolution 3D double-echo steady-state (DESS) sequence with radial and paracoronal 3-T MRI regarding the grading of RCTs in correlation with conventional 2D MRI and arthroscopic findings. MATERIAL AND METHODS: We retrospectively compared arthroscopic findings of RCTs with preoperative MRI, including conventional 2D sequences and radial and paracoronal DESS images in 20 patients. Two observers evaluated supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSC) tendon tears using a grading system. For statistical analysis, arthroscopy was used as the reference standard. RESULTS: Inter-observer agreement for detecting and grading SSP, ISP, and SSC tendon tears on radial and paracoronal sliced 3D DESS MRI was excellent (intraclass-correlation [ICC] = 0.92-0.98; all P < 0.001). Regarding the detection of SSP lesions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 93.8%, 50%, 88.2%, and 66.7% for both radial and paracoronal DESS imaging. A sensitivity of 100%, specificity of 61.1%, PPV of 22.2%, and NPV of 100% were noted for detecting ISP tendon tears using radially reformatted DESS images. Regarding detecting SSC tendon tears using radially reformatted DESS images, sensitivity, specificity, PPV, and NPV were 100%, 81.3%, 50%, and 100%, respectively. The results with standard 2D MRI were similar. CONCLUSION: The DESS technique with radially reformatted images provided excellent sensitivity and high inter-observer agreement in detecting RCTs. It showed a moderate to high correlation between MRI and arthroscopy for diagnosing SSP and SSC tendon tears.

The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff.

PURPOSE: The acromiohumeral distance is in practice often evaluated on MRI by radiologists and a reduction diagnosed as subacromial impingement. However, the acromiohumeral distance as indicator for a decentered glenohumeral joint is defined on a true AP radiograph with the patient standing or sitting. The present study therefore evaluated the influence of the patient position by comparing the acromiohumeral distance in both modalities in shoulders with an intact rotator cuff. METHODS: On MRI images and true AP radiographs of patients > 20 and < 80 years with an intact rotator cuff the acromiohumeral distance was measured. The maximum cranio-caudal size of the glenoid was measured as a reference to allow a direct comparison of both modalities. RESULTS: Two-hundred and thirty-four shoulders (mean patients age 45.8 ± 14.3 years) were included. The mean acromiohumeral distance/glenoid size ratio of all shoulders was significantly larger (P < 0.0001) on the MRI with 4.6 ± 1.0 in comparison to 4.1 ± 0.9 in the radiographs indicating a smaller acromiohumeral distance on the MRI. In absolute values, a mean acromiohumeral distance of 9.2 mm ± 1.8 on MRI in comparison to 10.4 mm ± 2.4 on the radiographs was calculated. Herewith, the acromiohumeral distance in the MRI was in the average 1.2 mm ± 2.1 (13%) smaller than the in corresponding radiographs (P < 0.0001). CONCLUSION: The acromiohumeral distance is significantly smaller in the MRI in comparison to AP radiographs in shoulders with an intact rotator cuff and should not be used as a decision criterion on MRI to assess glenohumeral centering or subacromial space width. LEVEL OF EVIDENCE: IV.

Treatment of unstable hips with the Tübingen splint in early postnatal period: radiological mid-term results of 75 hips with mean follow-up of 5.5 years.

PURPOSE: For treatment of unstable hips, the Tübingen splint is a treatment option. After the initial treatment, regular radiological follow-up examinations are recommended but there is a lack of long-term outcome studies. Therefore, the further development of unstable hips treated with the Tübingen splint were evaluated. METHODS: From 2004 to 2015 116 patients with 161 unstable hips treated with the Tübingen splint were evaluated. Inclusion criteria were: 1) successfully treated unstable hip (type D, III and IV); 2) pelvic radiographs at the age of one to ≤ two, two to ≤ four and four to ≤ eight years. The acetabular index (ACI) of all and the centre-edge angle (CEA) of the third radiograph were measured and classified according to the Tönnis classification. RESULTS: A total of 53 patients with 75 unstable hips (type D 34 (45.3%), III 33 (44.0%), IV 8 (10.7%)) were included. In comparison of the first, second and third radiograph, an increase of normal findings was seen in 31 (41.3%) to 53 (70.7%) and 60 (80.0%) hips, respectively. However, a decrease of slightly dysplastic hips from 31 (41.3%) to 19 (25.3%) and 14 (18.7%) respectively and severely dysplastic hips from 13 (17.3%) to three (4.0%) and one (1.3%) hip respectively was detected. In comparison of first to second radiograph, 32 hips improved and five hips deteriorated and of second to third radiograph 16 hips improved and six hips deteriorated. The Tönnis classification of ACI compared with CEA showed no significant differences (p = 0.442). CONCLUSION: This study shows a good development of unstable hips treated with the Tübingen splint with mean follow-up 5.5 years. Nevertheless, unexpected deteriorations could be identified. The CEA is an alternative to the ACI. LEVEL OF EVIDENCE: IV.

Histologic examination of the shoulder capsule shows new layer of elastic fibres between synovial and fibrous membrane.

PURPOSE: In the present study, a systematic histological analysis of the glenohumeral joint capsule was conducted. MATERIALS AND METHODS: 12 cadaveric shoulders were examined. Inclusion criteria were: 1) intact joint capsule and 2) fixation in neutral position. The tissue samples were Elastica Hematoxylin-van-Gieson-(ElHvG) stained and diameter, quantity, and distribution patterns were analyzed. RESULTS: We detected a new layer (elastic boundary layer, EBL) between the synovial and fibrous membrane. The elastic fibres of the EBL differ considerably in diameter, quantity, and distribution pattern. CONCLUSIONS: A previously undescribed layer was noticed, which we named elastic boundary layer for now.

Lumbar lordosis as tool to assess the level of pain in patients with low back pain after lumbar disc herniation.

BACKGROUND: It is presently unknown if lumbar lordosis (LL) might be applied to monitor low back pain (LBP) in patients with lumbar disc herniation (LDH). There is presently only conflicting data that does not show a correlation of LL with LBP: Previous studies do either include chronic LBP or do not consider that each patient has an individual value of LL that cannot be compared to other patients. METHODS: Power analysis: At least 32 patients had to be enrolled in the study. Out of 84 consecutive patients with acute onset of pain (<6 weeks) that were treated operatively from 11/2015 to 04/2017 by microscopic laminotomy for LDH, 35 were enrolled in this retrospective within - subject analysis after exclusion of patients with chronic LBP or severe disc degeneration of the lumbar spine. We recorded self - reported assessment of pain (VAS) and LL before the operation, 1 week and 6 weeks after the operation. We performed a paired - samples t - test (within - subject) to compare means of LL at admission to our institution with LL 6 weeks after surgery. Pearson's correlation was determined for LL and VAS. Significance level was set at p < 0.05. RESULTS: VAS at admission to our institution was 7.1 (0.4), VAS 6 weeks after surgery was 1.0 (0.3).LL at admission to our institution was 40.0 (2.1), LL 6 weeks after surgery was 48.0 (1.8). The difference was significant (p < 0.0005) with a high statistical power (1-ß = 0.99).Correlation of LL and VAS was significant (p < 0.01, r = -0.32). CONCLUSIONS: The increase of lumbar lordosis following surgery is significantly correlated to the decrease in the level of perceived pain in patients with a LDH and may be used as an additional tool to monitor the success of treatment in the investigated group of patients.

Position of the acromioclavicular joint and relation to the critical shoulder angle in shoulders with rotator cuff tears.

OBJECTIVE: To evaluate the position of the acromioclavicular joint (ACJ) and relation to the critical shoulder angle (CSA) in shoulders with rotator cuff tears (RCT). METHODS: In a matched pair study including 75 shoulders with arthroscopically validated RCT and 75 controls (mean age 59.4 ± 7.9 years) the position of the ACJ in relation to the glenoid and the CSA were measured on true ap radiographs. RESULTS: The CSA is larger (p = 0.0018) and the position of the ACJ is more lateral (p = 0.0016) in shoulders with RCT in comparison to matched controls. CONCLUSION: The more lateral position of the ACJ in shoulders with a large CSA might be an additional component in the multifactorial pathogenesis of RCT.

Outcome after subtalar screw arthroereisis in children with flexible flatfoot depends on time of treatment: Midterm results of 95 cases.

OBJECTIVES: The subtalar screw arthroereisis (SSA) is a treatment option for painful pediatric flexible flatfeet (PFF). Hence, the optimal time point for a SSA is discussed controversially. Therefore the present study evaluates the influence of the patient's age at surgery on the radiological outcome to provide further evidence in this matter. METHODS: From 08/2007 to 12/2015 50 patients with 95 PFF were included. Inclusion criteria were: 1) Patients with PFF under or equal 15 years of age, 2) treatment with SSA and 3) presence of pre-op, post-op and follow up (FU) routine biplane radiographs. A subdivision was made into group A: 5-8 years, group B: 9-12 years and group C: 13-15 years. The radiographs were analyzed for: 1) calcaneal-pitch (CP), 2) lateral talocalcaneal angle (lat. TCA), 3) a.p. talocalcaneal angle (a.p. TCA, kite angle) and 4) navicular-cuboidal-index (NCI) and meary angle. RESULTS: Our study showed the best deformity correction when surgery was conducted between 9 and 12 years of age (group B), with significant improvement in all measured parameters without secondary deterioration during FU. In group A, the SSA show inferior results with poorer long-term success with only an improvement in the a.p. TCA. Group C showed mixed results. While CP and NCI improved, the lat. TCA deteriorated in FU. In conclusion, the ideal age for surgical intervention by SSA is between 9 and 12 years. Surgery before the age of 8 years did not show long-term success and delayed treatment at the age of 13-15 was only partially successful with deterioration during FU period. LEVEL OF EVIDENCE: IV.

Symptomatic medial synovial plica of the knee joint: an underestimated pathology in young patients.

INTRODUCTION: To prospectively evaluate the outcome of arthroscopic resection of a symptomatic medial plica in patients under 30 years with evaluating the influence of sports, knee trauma and plica type. METHODS: 35 consecutive patients (38 knees), mean age 16.2 ± 4.7 years (9-26 years), 28 females (73.7%) were prospectively included. Patients with any additional surgical procedures or cartilage lesions > ICRS grade I were excluded. The influence of trauma to the knee, level of sport and the morphologic plica type on the outcome was evaluated in addition to standard knee scores before and 20.1 ± 9.3 months (12-44 months) after surgery. RESULTS: The Knee Injury and Osteoarthritis Outcome Score improved significantly from 50.2 ± 19.1% (12.5-94.6) to 80.7 ± 15.3% (48.2-100; p < 0.001). The Tegner Activity Scale improved significantly from 2.2 ± 1.5 (0-6) to 4.9 ± 1.7 (3-10; p < 0.001) and the Kujala Anterior Knee Pain Scale improved significantly from 52.6 ± 16.6 (16-86) to 80.7 ± 16.5 (46-100; p < 0.001). The level of pain in the knee decreased from 7.9 ± 2.0 (1-10) to 3.1 ± 2.6 (0-9; p < 0.001) at follow-up on a numeric rating scale (0-10). Neither trauma to the knee, high impact sport, cartilage lesions to the medial femoral condyle nor the plica type or associated ICRS grade I cartilage lesion to the medial femoral condyle had a significant effect on the outcome parameters. CONCLUSION: Arthroscopic resection of a symptomatic medial plica provides excellent clinical results in young patients. Trauma, high impact sports, ICRS grade I cartilage lesions to the medial femoral condyle or the plica type are not associated with a poorer outcome. LEVEL OF EVIDENCE: Level IV, prospective case series with no control group.

The association between a low critical shoulder angle and SLAP lesions.

PURPOSE: To evaluate the critical shoulder angle (CSA), acromion index (AI) and further acromion parameters in patients with isolated SLAP lesions compared with patients without SLAP lesions. METHODS: Between 2012 and 2016, the CSA, AI, lateral acromion angle (LAA) and acromion slope (AS) were radiologically examined in consecutive patients > 18 years having had a shoulder arthroscopy with isolated SLAP lesion types II-IV. These were compared to controls without SLAP lesions and without (control group I) or with (control group II) complete supraspinatus tendon (SSP) tears. RESULTS: 75/103 patients with isolated SLAP lesion types II-IV with a mean age of 46.5 years (± 13.0, 18.1-76.3) were analyzed, 61% of them being male. For control, n = 211 consecutive patients (47% male) with an intact SSP and SLAP complex and a mean age of 52.3 years (± 15.0, 18.6-88.4) and n = 115 patients (60% male) with an intact SLAP complex but complete SSP tears, mean age 66.6 years (± 9.3, 44.7-87.9) were examined. The CSA in SLAP patients was 29.6° (± 3.5, 21.0-38.0), 33.8° (± 3.7, 25.1-46.9) in no SLAP and no SSP (p < 0.001) and 36.7° (± 3.6, 29.1-46.6) in no SLAP but SSP (p < 0.001). The area under the curve (AUC) for CSA was 0.83 for SLAP lesions resulting in a probability of 83% for patients with SLAP lesion to be associated with a specific CSA. CONCLUSIONS: Isolated SLAP lesion types II-IV are associated with a low CSA < 30°. The AI, the AS as well as the LAA showed no correlation with SLAP lesions. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Blood supply in the bicipital groove: A histological analysis.

The vascular anatomy in the closed bicipital groove with the long head of the biceps brachii muscle tendon (LHBT), its mesotenon and the transverse ligament intact has not been analyzed on a histological level yet. An anatomic dissection and histologic study was conducted by using 24 cadaveric formaldehyde fixated shoulders. The bicipital groove including the LHBT and its intact sheath was cut en-bloc, fixated, sliced in 7 µm sections, Azan stained and the vascular anatomy analyzed under light microscopy. Each sideward branch deriving from the main ascending branches of the anterior humeral circumflex artery (ACHA) in the mesotenon of the LHBT was identified and followed through multiple sections to identify its direction and area of supply. Per specimen, a mean of 2.71±1.85 branches could be identified running through the soft tissue of the mesotenon towards the osseous walls of the groove. Of the total 65 arterial branches in all specimens, 22 (33.8%) were running into the medial wall of the groove and 40 (61.5%) into the lateral wall (P<0.01). The results indicate that branches of the ACHA in the mesotenon of the LHBT provide blood supply not only to the tendon but to the osseous bicipital groove as well and here significantly more to the lateral than to the medial osseous wall. In addition, Pacini-like mechanoreceptors could be identified in the mesotenon in 9 (37.5%) of the specimens which has not been described up to now.

Biceps tenodesis versus tenotomy in isolated LHB lesions: a prospective randomized clinical trial.

INTRODUCTION: Currently there exists no clear evidence concerning the surgical treatment of LHB lesions with either tenotomy or tenodesis. The aim of the study is therefore to evaluate elbow flexion and forearm supination force as well as the biceps muscle distalization according to both techniques in isolated LHB lesions. METHODS: Consecutive patients aged 40-70 years with shoulder arthroscopies for isolated SLAP or biceps pulley lesions were prospectively randomized to arthroscopic suprapectoral intraosseous LHB tenodesis or tenotomy. Pre-, 6 and 12 months postoperatively, the SST, ASES, Constant-Murley and LHB scores were recorded. The elbow flexion force was measured in 10°/90° flexion, the supination force in neutral/pronation position. In addition, the maximum upper-arm circumference and its position relative to the radial epicondyle of the humerus were evaluated preoperatively and in follow-up. RESULTS: 20/22 patients (mean age 52.0 ± 8.5; range 36-63 years, 11 male) completed the follow-up. 9/20 were treated with LHB tenodesis (mean age 51.5 ± 9.5; range 37-63 years, 7 male) and 11/20 with tenotomy (mean age 52.8 ± 8.0; range 36-62 years, 4 male). The force measurements and scores showed no significant difference after 12 months. Tenodesis achieved a significant increase in force 6 months postoperatively compared to preoperatively. One tenodesis patient and three tenotomy patients showed a postoperative popeye-sign deformity. CONCLUSION: This prospective randomized study comparing LHB tenodesis and tenotomy in isolated LHB lesions has shown no significant difference in elbow flexion and forearm supination force and clinical scores after 12 months. After LHB tenotomy, there was a non-significant trend for a higher rate of popeye-sign deformities of the upper arm and biceps muscle cramps.

Osteochondritis dissecans shows a severe course and poor outcome in patients with juvenile idiopathic arthritis: a matched pair study of 22 cases.

Juvenile osteochondritis dissecans (JOCD) and juvenile idiopathic arthritis (JIA) are both common diseases which may affect joints and bony structures in pediatric patients. In some cases, JOCD and JIA occur at the same time. In this study, the course of JOCD in patients with JIA was therefore evaluated to provide possible recommendations for further treatment opportunities and control examinations. From 06/2012 to 03/2018 55 children with JOCD with or without JIA were examined. Inclusion criteria were: (1) age ≤ 16 years, (2) diagnosis of a JOCD with or without JIA and (3) two routine MRI controls. The JOCD evaluation based on the classification according to Bruns and the measurement of the largest extent via MRI. 18 of these 55 children met our criteria: 11 JOCD findings of 7 patients with JIA (group A) were matched according to age and localization of JOCD to 11 patients without JIA (group B). Mean age of disease onset of JIA was 8.2 years (oligo JIA) and of JOCD 11.6 years. The mean time follow-up was 17.7 months. At all observation time points more JOCD findings (with stage III° and IV°, respectively) along with a significant deterioration was seen in group A compared to group B. The comparison of the last MRI control between group A and group B shows a significant smaller defect size (decrease of 54.5%, p = 0.028) in group B (97.9 ± 48.9 mm2) as in group A (185.1 ± 102.9 mm2). In comparison of first (169.7 ± 84.2 mm2) and last MRI (97.9 ± 48.9 mm2) a significant decrease in lesion size of JOCD in group B was seen (decrease of 58.4%, p = 0.048). Patients with JIA show a more progressive and severe course of JOCD. Therefore, we recommend (1) the early use of MRI in patients with JIA and persistent joint pain to detect potential JOCD and (2) in presence of JIA and JOCD regular MRI follow-up controls to identify deteriorating JOCD findings and prevent early joint destruction in pediatric patients.

Prevalence of Propionibacterium acnes in the glenohumeral compared with the subacromial space in primary shoulder arthroscopies.

HYPOTHESIS: We hypothesized that the prevalence of Propionibacterium acnes in patients undergoing primary shoulder arthroscopy is equal in the glenohumeral space compared with the subacromial space. METHODS: Patients aged 18 years or older with shoulder arthroscopies were included. The exclusion criteria were prior shoulder operations, complete rotator cuff tears, systemic inflammatory diseases, tumors, shoulder injections within 6 months of surgery, and antibiotic therapy within 14 days preoperatively. After standardized skin disinfection with Kodan Tinktur Forte Gefärbt, a skin swab was taken at the posterior portal. Arthroscopy was performed without cannulas, prospectively randomized to start either in the glenohumeral space or in the subacromial space, with direct harvesting of a soft-tissue biopsy specimen. Sample cultivation was conducted according to standardized criteria for bone and joint aspirate samples and incubated for 14 days. Matrix-assisted laser desorption-ionization time-of-flight spectrometry was used for specimen identification in positive culture results. RESULTS: The study prospectively included 115 consecutive patients with normal C-reactive protein levels prior to surgery (54.8% men; mean age, 47.2 ± 14.6 years). P acnes was detected on the skin after disinfection in 36.5% of patients, in the glenohumeral space in 18.9%, and in the subacromial space in 3.5% (P = .016). CONCLUSION: The prevalence of P acnes is significantly higher in the glenohumeral space compared with the subacromial space in primary shoulder arthroscopies. The results do not confirm the contamination theory but also cannot clarify whether P acnes is a commensal or enters the joint hematologically or even lymphatically or via an unknown pathway. Despite standardized surgical skin disinfection, P acnes can be detected in skin swab samples in more than one-third of patients.

Long-term outcome of pigmented villonodular synovitis of the hip after joint preserving therapy.

INTRODUCTION: Pigmented villonodular synovitis (PVNS) is a rare, destructive synovial disease that affects the hip joint the second most common after the knee. However, in contrast, joint preserving surgery in the hip joint is considered to be significantly more difficult or even impossible due to earlier occurrence of osteochondral dissemination and surgical difficulties. Today, earlier diagnosis due to the generous use of MRI and modern surgical strategies raise hope for improved outcomes. METHODS: Since 2005, six patients with PVNS of the hip and a minimal follow-up of 2 years underwent joint preserving surgery in our institution (mean age 20.5 years, range 14-27). After PVNS was suspected in the MRI and confirmed by arthroscopic biopsy (four diffuse, two focal forms), synovectomy was carried out in 5 patients via surgical hip dislocation and in one focal case via arthroscopy. In diffuse forms, adjuvant radiosynoviorthesis (RSO) was conducted 6-8 week postoperatively. MRI and clinical examinations were performed during follow-up. RESULTS: After a mean follow-up of 8 years (range 35-141 months), five of six patients did not show recurrence or secondary osteoarthritis. Clinical outcome evaluation resulted in a mean modified Harris Hip Score of 91 points (range 67-100 points). A 21-year-old patient with a diffuse form and advanced osteochondral involvement at the time of diagnosis was eventually treated by total hip arthroplasty. CONCLUSION: In cases without osteochondral involvement, recurrence-free long-term results without progression of joint degeneration can be achieved by joint preserving therapy.

The influence of suprapectoral arthroscopic biceps tenodesis for isolated biceps lesions on elbow flexion force and clinical outcomes.

PURPOSE: To prospectively evaluate elbow flexion force, cosmetic and clinical outcome of all-arthroscopic suprapectoral biceps tenodesis for isolated biceps lesions. METHODS: Tenodesis was performed using a 6.25-mm absorbable interference screw for intraosseous fixation. Seventeen out of 24 patients (70.8 %, median age 49.0 ± 10.1 years; 10 = male) could be included for 24 months follow-up. Elbow flexion strength in 10° and 90° elbow flexion, the upward-directed force of the upper arm in the O'Brien position, objective evaluation of a Popeye-sign deformity and validated clinical scores (CMS, SST, ASES) were assessed preoperatively, 3, 6, 12 and 24 months postoperatively. RESULTS: Elbow flexion strength in 90° improved significantly from 12 months onwards (P = 0.001) without significant difference to the contralateral arm from 3 months postoperatively (n.s.). At 24 months, an average increase of 46.4 % (median 37.7 %) from preoperative could be seen. The dominant arm was affected in 70.6 %. All scores showed a significant improvement 3 months postoperatively: SST (P = 0.003), ASES (P = 0.006) and total CMS (P < 0.001). Three patients (17.6 %) developed a distalization of the maximum biceps circumference of more than 20 % compared to preoperative. CONCLUSIONS: All-arthroscopic proximal suprapectoral intraosseous single-limb biceps tenodesis for the treatment of isolated biceps lesions provides good-to-excellent clinical results with significant improvement of elbow flexion strength and clinical scores and no significant difference to the unaffected contralateral arm. LEVEL OF EVIDENCE: IV.

Arthroscopic Treatment for Primary Septic Arthritis of the Hip in Adults.

Purpose. Primary septic arthritis is a rare differential diagnosis of acute hip pain in adults. Inspired by the success of all-arthroscopic treatment in pediatric patients, we developed a diagnostic and surgical pathway for our adult patients. Methods. Seven patients, average age 44 ± 13.7 years with acute hip pain since 4.4 ± 2.9 days in the average, were included. Septic arthritis was confirmed by joint aspiration and dissemination was excluded by MRI and standard radiographs. Surgical treatment consisted of immediate arthroscopic lavage using 4 portals for debridement, high-volume irrigation, partial synovectomy, and drainage. Results. Patients were treated in hospital for 12.4 ± 3.1 days (range 7-16 days). WBC and CRP returned to physiological levels. During the mean follow-up of 26.4 ± 19.4 months (range 13-66 months) no patient showed recurrence of infection. The 5 patients with an unimpaired hip joint prior to the infection had a mean modified Harris Hip Score of 94 ± 5.6 points (range 91-100) at final follow-up. Conclusions. Arthroscopic therapy using a minimally invasive approach with low perioperative morbidity for the treatment of primary septic arthritis of the adult hip is able to restore normal hip function in acute cases without dissemination of the infection. Level of Evidence. IV.

Arthroscopic Autologous Chondrocyte Transplantation for Osteochondritis Dissecans of the Elbow.

Osteochondritis dissecans of the humeral capitellum is characterized by separation of a circumscript area of the articular surface and the subchondral bone in juvenile patients. In advanced lesions, arthroscopic fragment refixation or fragment removal with microfracturing or drilling can be successful. The purpose of this technical note is to describe an all-arthroscopic surgical technique for 3-dimensional purely autologous chondrocyte transplantation for osteochondral lesions of the humeral capitellum.

Injectable autologous chondrocyte transplantation for full thickness acetabular cartilage defects: early clinical results.

INTRODUCTION: Acetabular cartilage lesions are frequently seen in young patients with hip pain and have been identified as an important prognostic factor. New therapies have complemented abrasion and microfracture procedures. The aim of the study is to evaluate the early outcome of patients with arthroscopic injectable autologous chondrocyte transplantations (ACT) for full thickness acetabular cartilage defects. METHODS: A two-step procedure ACT was performed in patients with full thickness acetabular cartilage defects measuring ≥2 cm(2). The patients were closely followed with clinical examination, pre- and postoperative scores until the latest available follow-up of 3, 6, 12, and 24 months. RESULTS: 20 consecutive cases (4 female, 16 male, mean age 33 years) were included. No patients were lost at final follow-up. The average defect size was 5.05 (range 2-6) cm(2). The average follow-up was 12.05 (range 6-24) months. Three months postoperatively the preoperative scores improved significantly from a mean mHHS of 63-81 points (p = 0.009), iHOT33 of 44-66 % (p = 0.028) and subjective hip assessment (Subjective Hip Value, SHV) of 60-87 % (p = 0.007). After 12 months the results improved significantly to a mean mHHS of 93 points (p = 0.017), an iHOT33 of 79 % (p = 0.007) and an SHV of 82 % (p = 0.048) compared with the preoperative scores. DISCUSSION: The injectable matrix associated ACT is a reliable procedure, yielding promising early results with a significant increase of all scores evaluated in patients with full thickness acetabular cartilage defects.

Arthroscopic treatment of femoroacetabular impingement shows persistent clinical improvement in the mid-term.

INTRODUCTION: The concept of femoroacetabular impingement (FAI) and the indication for surgical intervention have been established in the last decade. Despite promising short-term results and emerging arthroscopic techniques, it remains unclear whether patients benefit from surgical correction in the mid- to long-term and whether progressive joint degeneration can be prevented. MATERIALS AND METHODS: A retrospective study of our first 50 consecutive patients who underwent arthroscopic correction for FAI was conducted. The modified Harris hip score (mHHS) was assessed preoperatively and at final follow-up. In addition, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and a subjective hip value (SHV) were added at final follow-up. Degenerative changes according to Kellgren and Lawrence scale and the α angle were analyzed preoperatively and on the most recent radiograph. RESULTS: Of a total of 50 patients, 44 (24 male, 20 female) with a mean age of 34.3 years (17-65) were available with complete follow-up. Of these 44 patients, 39 were treated with correction of the femoral offset for isolated cam deformity, 5 with additional focal pincer correction and partial labral resection. After a mean follow-up of 66.3 ± 14.5 months the mHHS had improved significantly from 67.2 ± 6.4 preoperatively to 86.4 ± 13.5 (p < 0.001). The WOMAC score (converted to 0 = best/100 = worst) resulted in mean indices for the subcategories pain, stiffness and function of 11.8 ± 16.5, 12.2 ± 17.8 and 9.1 ± 16.1. The SHV was reported with a mean of 77.7 ± 21.8 % at final follow-up. The α angle was reduced significantly from 57.2° ± 10.1° to 46.3° ± 7.4° (p < 0.001). The Kellgren and Lawrence score showed a non-significant trend from 2.0 ± 0.8 preoperatively to 2.2 ± 0.9 in the most recent radiograph (p = 0.46). 5 patients had been converted to a total hip arthroplasty a mean of 28 ± 7.1 months postoperatively. These patients were significantly (p < 0.01) older with a mean age of 49.8 ± 7.8 years and showed significantly higher present osteoarthritic changes with an average Kellgren and Lawrence score of 2.6 ± 2.5 before FAI correction (p < 0.01). CONCLUSIONS: Arthroscopic correction of femoroacetabular impingement results in a persistent clinical improvement without significant progression of degenerative changes in the majority of patients. The indication for surgery should be established cautiously when degenerative changes are present. LEVEL OF EVIDENCE: Level IV, Case series with no comparison group.