Poor osteochondral repair by a biomimetic collagen scaffold: 1- to 3-year clinical and radiological follow-up.

INTRODUCTION: Treatment of osteochondral injuries is challenging, and no gold standard has been established. Layered cell-free scaffolds are a new treatment option for these defects. The aim of this study was to evaluate the osteochondral repair in patients treated with the MaioRegen(®) scaffold, a cell-free biomimetic scaffold consisting of type I collagen and hydroxyapatite. Treatment using this scaffold has previously shown promising clinical results. METHODS: Ten patients with osteochondral lesions in the knee (n = 6) or in the talus (n = 4) were enrolled. The patients underwent pre-operative MRI and CT scans and were assessed at 1- and 2.5-year timescales post-operatively. The cartilage and bone formations were evaluated semi-quantitatively using the MOCART score. Knee patients were clinically evaluated using KOOS, subjective IKDC and Tegner scores, whereas ankle patients were evaluated using AOFAS Hindfoot and Tegner scores. RESULTS: Two patients were re-operated and excluded from further follow-up due to treatment failure. None of the patients had complete regeneration of the subchondral bone evaluated using CT. At 2.5 years, 6/8 patients had no or very limited (<10 %) bone formation in the defects and 2/8 had 50-75 % bone formation in the treated defect. MRI showed no improvement in the MOCART score at any time point. The IKDC score improved from 41.3 to 80.7, and the KOOS pain subscale improved from 63.8 to 90.8 at 2.5-year follow-up. No improvement was found with the remaining KOOS subscales, the Tegner or AOFAS Ankle-Hindfoot score. CONCLUSION: Treatment of osteochondral defects in the ankle and knee joint with a biomimetic scaffold resulted in incomplete cartilage repair and poor subchondral bone repair at 1- and 2.5-year follow-up. Clinical significant improvements were observed. These results raise serious concerns about the biological repair potential of the MaioRegen(®) scaffold, and we advise to use the MaioRegen(®) scaffold with caution. LEVEL OF EVIDENCE: Prospective therapeutic study, Level IV.

Bone properties of the humeral head and resistance to screw cutout.

UNLABELLED: Surgical treatment of fractures involving the proximal humeral head is hampered by complications. Screw cutout is the major pitfall seen in connection with rigid plating. We have exploited a bony explanation for this phenomenon. MATERIALS AND METHODS: We examined the convex surface of the humeral head looking at the density and the topographical strength of the subchondral bone using mechanical testing of bone cylinders harvested from the humeral head. We also studied the osseous architecture of the subchondral bone and thickness of the boneplate of the humeral head using a 3-dimensional serial sectioning technique. RESULTS: The bone strength and bone density correlated well and revealed large regional variations across the humeral head. Bone strength and stiffness of the trabecular bone came to a maximum in the most medial anterior and central parts of the humeral head, where strong textural anisotropy was also found. We found in particular a lower bone strength and density in the posterior and inferior regions of the humeral head. A rapid decline in bone strength within a few mm below a relatively thin subchondral plate was also reported. CLINICAL RELEVANCE: We have in this paper explored some of the most important factors connected with screw stability at the cancellous bone level. We discovered large variations in bone density and bone strength across the joint surface rendering certain areas of the humeral head less suitable for screw placement. The use of rigid plate constructs with divergent screw directions will predictably place screws in areas of the humeral head comprising low density and low strength cancellous bone. New concepts of plates and plating techniques for the surgical treatment of complex fractures of the proximal humerus should take bone distribution, strength, and architecture into account.

[The effect of geriatric intervention on rehabilitation of elderly patients with hip fracture]. / Effekten af geriatrisk intervention på rehabilitering af aeldre patienter med hoftefraktur.

INTRODUCTION: Hip fracture is the most common cause of long hospitalisation among elderly and is increasing in the group of elderly aged 85+ years. Hip fractures are associated with a host of factors and mainly caused by falls and osteoporosis. MATERIAL AND METHODS: The Geriatric Team of the orthopaedic ward, geriatric rehabilitation and follow-home function (GO) is compared to traditional orthopaedic treatment (ORT) among elderly aged 65+ with respect to: haemoglobin difference before surgery and 3-6 months after fracture, osteoporosis treatment, length of stay, change in accommodation, readmission and mortality within six months after admission and incidence of new fracture within two years. RESULTS: Median length of stay was reduced from 15 till 13 days. Significantly more were treated with calcium/D-vitamin and bisphosphonate. The risk of a new fracture within two years was lower (incidence rate ratio = 0,72 (95% confidence interval (CI: 0,39-1,32)). Geriatric intervention did not reduce readmission (odds ratio (OR)= 1,09 (95% CI: 0,71-1,67)) and mortality (OR = 1,22 (95% CI: 0,71-2,11)). CONCLUSION: A combined geriatric orthopaedic effort in elderly with hip fracture seems to improve the quality as well as the efficiency of treatment. The concept would benefit from further development and combination with other initiatives aimed at accelerating the treatment pathway of the elderly.

The outcome of arthroscopic and open surgery ankle arthrodesis: a comparative retrospective study on 107 patients.

PURPOSE: To evaluate the results of arthroscopic guided ankle arthrodesis, and the results of open surgery arthrodesis in two comparable groups of patients. METHODS: A group of 58 arthroscopic guided ankle arthrodeses was compared to a group of 49 ankles arthrodeses operated by open technique. The patients and ankles in both groups fulfilled the same criteria of inclusion except that the ankles operated by open technique had a varus/valgus malalignment exceeding 5 degrees. The pre- and postoperative treatment protocols were identical. RESULTS: The patients in the arthroscopic group were discharged on average 2.27 days earlier than the patients operated by open technique (p<0.01). Ninety percent of the patients in the arthroscopic group and 57% in the open group showed bony union after 12 weeks (p<0.01). The rate of union after 1 year was 95% in the arthroscopic group and 84% in the open group (n.s.). CONCLUSION: Arthroscopic guided ankle arthrodesis represents a safe and cost saving procedure.

Stability of a cannulated screw versus a Kirschner wire for the proximal crescentic osteotomy of the first metatarsal: a biomechanical study.

The purpose of this study was to compare the stability of a Kirschner wire (K-wire) versus a single cannulated screw for fixation of the proximal crescentic first metatarsal osteotomy. Seven matched pairs of fresh-frozen human cadaver first metatarsal specimens were dissected out en bloc at the first metatarsal-medial cuneiform complex; right and left specimens were randomized as to fixation. In screw specimens, a cannulated screw was mounted from the proximal medial side of the metatarsal, traversing osteotomy and engaging the lateral diaphyseal cortical bone. In the corresponding specimen, a K-wire was placed from the distal medial metatarsal cortex oriented as close to the longitudinal metatarsal axis as possible. Using a materials testing machine, a continuous load was applied to the plantar aspect of the metatarsal head at a rate of 5 mm/min until a displacement of 10 mm was reached. The following parameters were measured: initial stiffness of the entire specimen, stiffness of the osteotomy, the force required to create a 1-mm displacement, the force required to create a 0.15-mm gap across the osteotomy, and the ultimate force to create the 10-mm displacement. Both specimen and osteotomy stiffness were found to be significantly higher for screw fixation versus the K-wire (P <.05). Although there was also a difference in the force-to-failure load in favor of screw fixation, this result was found not found to be statistically significant.

[Measuring of preoperative anxiety by three self-reporting scales: State Trait Anxiety Inventory, Symptoms CheckList 92 and visual analogue scale]. / Måling af praeoperativ angst med tre selvrapporteringsskalaer: State Trait Anxiety Inventory, Symptoms CheckList 92 og visuel analogskala.

INTRODUCTION: Preoperative anxiety is a common phenomenon. It is therefore necessary to investigate whether quantitative self-reporting anxiety scales can be helpful in the anaesthetic clinic and research. The aim of this study was to compare the state trait anxiety inventory (STAI), symptoms checklist 92 (SCL 92), the subscales anxiety and phobic anxiety, and a visual analogue scale for anxiety (VAS). MATERIAL AND METHODS: Thirty-eight women consecutively referred for elective breast surgery filled in the rating scales the day before the operation. RESULTS: A statistically significant correlation was found between STAI, SCL 92, anxiety, and VAS. The patients' STAI and SCL 92 anxiety scores were markedly higher than that of the background population. DISCUSSION: In this study the STAI scale, SCL 92 anxiety, and VAS measure all essential features of the phenomenon. SCL 92 anxiety is nevertheless considered to be the most appropriate rating scale, because it has been validated in a Danish population.