Comparison of Total Joint Replacement With Arthrodesis of the First Metatarsophalangeal Joint.

BACKGROUND: The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiologic, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). METHODS: All consecutive patients with arthrodesis and RG from January 23, 2011, until September 18, 2019, at the authors' institution were considered for inclusion in the study. Preoperatively and at follow-up (FU), radiographs, and/or weightbearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual analog scale foot and ankle (VASFA), European Foot and Ankle Society (EFAS) score, MTP1 range of motion for dorsiflexion/plantarflexion (DF/PF) were registered and compared preoperatively and at FU. RESULTS: Seventy RG and 72 arthrodesis patients were included. Preoperative VASFA and EFAS scores did not differ between the RG and arthrodesis groups (average scores: VASFA, 50.6 and 45.6; EFAS score, 10.7 and 10.6, respectively; each P > .05). Wound healing delays without further operative measures were registered in 4 patients (6%) for RG and 5 (7%) for arthrodesis (P = .67), and 5 revisions in 5 patients (7%) for RG and 12 in 8 (11%) for arthrodesis (P = .05). The longest available FU was higher in RG than in arthrodesis (47 vs 37 months on average, P < .001). Pedography showed higher first metatarsal head or sesamoids and lower great toe force percentage from force of entire foot in RG than in arthrodesis (P = .05) resulting in physiological pattern in RG only. VASFA and EFAS scores at FU was higher in RG than in arthrodesis (average scores: VASFA, 72.6 and 63.6; EFAS score, 16.1 and 14.1, respectively; each P < .05). DF/PF measurement was only possible in RG (average value: DF/PF, 36.1/14.0). CONCLUSION: We found marginally lower revision rates and higher patient-reported outcome measures, joint motion (DF/PF), and more physiologic force distribution at slightly longer FU for the RG group than the arthrodesis group. Longer follow-up and broader clinical reporting are needed to identify the potential deficits of RG. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach - 5-year follow-up.

BACKGROUND: The aim of the study was to assess 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach. METHODS: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at the ankle treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. RESULTS: One hundred and twenty-nine patients with 136 chondral lesions were included in the study. The chondral lesions were located as follows (n (%)), medial talar shoulder only, 62 (46); lateral talar shoulder only, 42 (31); medial and lateral talar shoulder, 7 (10); tibia, 18 (13). The average for lesion size was 1.8 cm2, for VAS FA 45.7 and for EFAS Score 9.8. 2FU/5FU was completed in 105 (81 %)/104(81 %) patients with 112/111 previous chondral lesions. VAS FA improved to 79.8/84.2 and EFAS Score to 20.3/21.5 (2FU/5FU). No parameter significantly differed 2FU and 5FU. CONCLUSIONS: AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores at 2FU/5FU. 2FU and 5FU did not differ.

Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint - 5-year follow-up.

BACKGROUND: The aim of the study was to assess the 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1). MATERIAL AND METHODS: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. RESULTS: One hundred and ninety-eight patients with 238 chondral defects were included. In 21 % of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm2 on average. The most common location was metatarsal dorsal (33 %), and in most patients one defect was registered (74 %). Corrective osteotomy of the first metatarsal was performed in 79 %. 176 (89 %)/164 (83 %) patients completed 2FU/5FU. VAS FA/EFAS Score were preoperatively 46.8/11.9 and improved to 74.1/17.1 at 2FU and 75.0/17.3 at 5FU on average. No parameter significantly differed between 2FU and 5FU. CONCLUSIONS: AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 2FU and 5FU. The results between 2FU and 5FU did not differ.

Semi-automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) in the foot provides different angles than measurement by hand.

BACKGROUND: The purpose of this study was to compare semi-automatic software-based angular measurement (SAM) with previously validated measurement by hand (MBH) regarding angle values and time spent for the investigator for Weight-Bearing CT (WBCT). METHODS: In this retrospective comparative study, five-hundred bilateral WBCT scans (PedCAT, Curvebeam, Warrington, PA, USA) were included in the study. Five angles (1st - 2nd intermetatarsal angle (IM), talo-metatarsal 1-angle (TMT) dorsoplantar and lateral projection, hindfoot angle, calcaneal pitch angle) were measured with MBH and SAM (Bonelogic Ortho Foot and Ankle, Version 1.0.0-R, Disior Ltd, Helsinki, Finland) on the right/left foot/ankle. The angles and time spent of MBH and SAM were compared (t-test, homoscesdatic). RESULTS: The angles differed between MBH and SAM (mean values MBH/SAM; IM, 9.1/13.0; TMT dorsoplantar, -3.4/8.2; TMT lateral. -6.4/-1.1; hindfoot angle, 4.6/21.6; calcaneal pitch angle, 20.5/20.1; each p < 0.001 except the calcaneal pitch angle, p = 0.35). The time spent for MBH / SAM was 44.5 ± 12 s / 12 ± 0 s on average per angle (p < 0.001). CONCLUSIONS: SAM provided different angles as MBH (except calcaneal pitch angle) and can currently not be considered as validated angle measurement method (except calcaneal pitch angle). The investigator time spent is 73% lower for SAM (12 s per angle) than for MBH (44.5 s per angle). SAM might be an important step forward for 3D-angle measurement of WBCT when valid angles are provided.

Automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) provides different angles than measurement by hand.

BACKGROUND: Purpose of this study was to compare automatic software-based angular measurement (AM, Autometrics, Curvebeam, Warrington, PA, USA) with previously validated measurement by hand (MBH) regarding angle values and time spent for the investigator for Weight-Bearing CT (WBCT). METHODS: Five-hundred bilateral WBCT scans (PedCAT, Curvebeam, Warrington, PA, USA) were included in the study. Five angles (1st - 2nd intermetatarsal angle, talo-metatarsal 1-angle (TMT) dorsoplantar and lateral projection, hindfoot angle, calcaneal pitch angle) were measured with MBH and AM on the foot/ankle (side with pathology). Angles and time spent of MBH and AM were compared (t-test, homoscedatic). RESULTS: The specific pathologies were ankle osteoarthritis/instability, n = 147 (29%); Haglund deformity/Achillodynia, n = 41 (8%); forefoot deformity, n = 108 (22%); Hallux rigidus, n = 37 (7%); flatfoot, n = 35 (7%); cavus foot, n = 10 (2%); osteoarthritis except ankle, n = 82 (16%). The angles differed between MBH and AM (each p < 0.001) except the calcaneal pitch angle (p = 0.05). The time spent for MBH / AM was 44.5 ± 12 s / 1 ± 0 s on average per angle (p < 0.0011). CONCLUSIONS: AM provided different angles as MBH and can currently not be considered as validated angle measurement method. The investigator time spent is 97% lower for AM (1 s per angle) than for MBH (44.5 s per angle). Cases with correct angles in combination with almost no time spent showed the real potential of AM. The AM system will have to become reliable (especially in diminishing positive and negative angle values as defined) and valid which has to be proven by planned studies in the future. LEVEL OF EVIDENCE: Level III.

Partisan self-interest is an important driver for people's support for the regulation of targeted political advertising.

The rapid emergence of online targeted political advertising has raised concerns over data privacy and what the government's response should be. This paper tested and confirmed the hypothesis that public attitudes toward stricter regulation of online targeted political advertising are partially motivated by partisan self-interest. We conducted an experiment using an online survey of 1549 Americans who identify as either Democrats or Republicans. Our findings show that Democrats and Republicans believe that online targeted political advertising benefits the opposing party. This belief is based on their conviction that their political opponents are more likely to be mobilized by online targeted political advertising than are supporters of their own party. We exogenously manipulated partisan self-interest considerations of a random subset of participants by truthfully informing them that, in the past, online targeted political advertising has benefited Republicans. Our findings show that Republicans informed about this had less favorable attitudes toward regulation than did their uninformed co-partisans. This suggests that Republicans' attitudes regarding stricter regulation are based not solely on concerns about privacy violations, but also, in part, are caused by beliefs about partisan advantage. The results imply that people are willing to accept violations of their privacy if their preferred party benefits from the use of online targeted political advertising.

Comparison Matrix-Associated Stem Cell Transplantation (MAST) with Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle-A clinical matched-patient analysis.

BACKGROUND: The aim of the study was to compare Matrix-Associated Stem Cell Transplantation (MAST) with Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle. METHODS: In a matched-patient clinical follow-up study, patients with chondral lesion at the ankle that were treated with MAST from April 1, 2009 to July 15, 2016, and patients that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included and compared. Size and location of the chondral lesions and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Bone Marrow Aspirate Concentrate (BMAC) was used for MAST and Peripheral Blood Concentrate (PBC) for AMIC+PBC to impregnate a collagen I/III matrix (Chondro-Gide, Wollhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. RESULTS: One hundred and twenty-nine patients with 136 chondral lesions were included in both groups. The chondral lesions were located as follows (MAST/AMIC+PBC, n (%)), medial talar shoulder only, 59 (43)/62 (46); lateral talar shoulder only, 44 (32)/42 (31); medial and lateral talar shoulder, 7 (10)/7 (10); tibia, 19 (14)/18 (13). The lesion size was 1.6/1.8cm2 on average and VAS FA was 46.9/45.7 (MAST/AMIC+PBC). For MAST/AMIC+PBC groups, 107 (83%)/105 (81%) with 112/110 previous chondral lesions completed the defined 2-year-follow-up after 24.4/23.8 months on average. VAS FA improved to 82.3/79.8 (MAST/AMIC+PBC). No parameter significantly differed between MAST and AMIC+PBC groups. CONCLUSIONS: MAST and AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores in 2-year-follow-up. MAST and AMIC+PBC showed similar results.

Combination of PedCAT Weightbearing CT With Pedography Assessment of the Relationship Between Anatomy-Based Foot Center and Force/Pressure-Based Center of Gravity.

BACKGROUND: A customized pedography sensor (Pliance; Novel, Munich, Germany) was inserted into a pedCAT (Curvebeam, Warrington, PA). The aim of this study was to analyze the relative position of the anatomical foot center (FC) and the pedographic center of gravity (COG). The hypothesis was that FC should be a good predictor of mediolateral position of COG but not longitudinal since hindfoot anatomy allows free anteroposterior movement but limited mediolateral movement. METHODS: In 90 patients (180 feet), a pedCAT scan with simultaneous pedography with full weightbearing in a standing position was performed. The morphology-based definition of the FC was performed with the pedCAT data following the Torque Ankle Lever Arm System (TALAS) algorithm. The force/pressure-based COG was defined with the pedography data using a software-based algorithm. The distance between FC and COG and the direction of a potential shift (distal-proximal, mediolateral) was measured and analyzed. COG motion during data acquisition was recorded and analyzed. Mean age of patients was 53.8 (range, 17-84) years, and 57 (63%) were female. RESULTS: The distance between FC and COG was 28.7 mm on average (range, 0-60). FC was distal to COG in 175 feet (97%; mean, 27.5 mm; range, -15 to 60) and lateral in 112 feet (62%; mean, 2.0 mm; range, -18 to 20). CONCLUSIONS: There was a constant and major distal longitudinal shift of COG relative to FC and an inconstant minor mediolateral shift. CLINICAL RELEVANCE: The data might be taken into consideration for planning and follow-up in foot and ankle surgery.

Matrix-associated stem cell transplantation (MAST) in chondral defects of the ankle is safe and effective - 2-year-followup in 130 patients.

BACKGROUND: The aim of the study was to assess the 2-year-follow-up of matrix-associated stem cell transplantation (MAST) in chondral defects of the ankle. METHODS: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from October 1, 2011 to July 31, 2013 were analyzed. Size and location of the chondral defects, method-associated problems and the Visual Analogue Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analyzed. Stem cell-rich blood was harvested from the ipsilateral pelvic bone marrow and centrifuged (10min, 1500rpm). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide). The matrix was fixed into the chondral defect with fibrin glue. RESULTS: One hundred and forty-four patients with 150 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12-68 years), 85 (59%) were male. The VAS FA before surgery was 48.5 on average (range, 16.5-78.8). The defects were located as follows, medial talar shoulder, n=62; lateral talar shoulder, n=66 (medial and lateral talar shoulder, n=6), tibia, n=22. The defect size was 1.6cm2 on average (range, .6-6cm2). 130 patients (90%) completed 2-year-follow-up. The VAS FA improved to an average of 87.5 (range, 62.1-100; t-test (comparison with preoperative scores), p=.01). CONCLUSIONS: MAST led to improved and high validated outcome scores. No method related complications were registered. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the ankle.

Matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st metatarsophalangeal joint is safe and effective-2-year-follow-up in 20 patients.

The aim of the study was to assess the 2-year-follow-up of matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st metatarsophalangeal joint (MTPJ). In a prospective consecutive non-controlled clinical follow-up study, 20 patients with 25 chondral defect at the 1st MTPJ that were treated with MAST from October 1st, 2011 to March, 30th, 2013 were analysed. The size and location of the chondral defects range of motion (ROM), and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were registered. Stem cell-rich blood was harvested from the ipsilateral pelvic bone marrow and centrifuged (10min, 1500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. The age of the patients was 42 years on average (range, 35-62 years). The VAS FA before surgery was 50.5 (range, 18.3-78.4). The defects were located as follows, dorsal metatarsal head, n=12, plantar metatarsal head, n=5, dorsal & plantar, n=8 (two defects, n=5). The defect size was 0.7cm2 (range, .5-2.5cm2). ROM was 10.3/0/18.8° (dorsal extension/plantar flexion). All patients completed 2-year-follow-up. VAS FA improved to 91.5 (range, 74.2-100; t-test, p<.01). ROM improved to 34.5/0/25.5 (p=.05). The surgical treatment including MAST led to improved clinical scores and ROM. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the 1st MTPJ.

The social status of the male Nile tilapia (Oreochromis niloticus) influences testis structure and gene expression.

Dominant and territorial behaviour are known social phenomena in cichlids and social stress influences reproduction and growth. The gonadotropic hormones trigger spermatogenesis and subordinate males have typically lower levels of gonadotropins than dominant males. In this study, we compared testis morphology and gene expression of dominant and subordinate Nile tilapia males (d- and s-males) in socially stable communities. The d-males had the highest gonadosomatic index but they were not the largest animals in the majority of studied cases. Long-term d-males showed large groups of Leydig cells and hyperplasia of the tunica albuginea due to numerous cytochrome-P450-11ß-hydroxylase (Cyp11b) expressing myoid cells. Increased Cyp11b expression in d-males was reflected by elevated 11-ketotestosterone plasma values. However, immunofluorescence microscopy and expression analysis of selected genes revealed that most s-males conserved their capability for spermatogenesis and are, therefore, ready for reproduction when the social environment changes. Moreover, in s-males gene expression analysis by quantitative RT-PCR showed increased transcript levels for germ line-specific genes (vasa, sox2 and dmc1) and Sertoli-specific genes (amh, amhrII and dmrt1) whereas gene expression of key factors for steroid production (sf1 and cyp11b) were reduced. The Nile tilapia is a promising model to study social cues and gonadotropic signals on testis development in vertebrates.

Effect of malpositioned anterior cruciate ligament replacement on knee joint structures: a biomechanical model.

Any sort of malpositioning of anterior cruciate ligament (ACL) replacement leads to an overload of single fibers of the ACL replacement. As long as this does not result in a tear of these fibers so that isometry of the ACL replacement is restored, the abnormal forces acting in and on the ACL replacement are transmitted from the ACL replacement to the remainder of the knee joint structures. We assumed that the posterior cruciate ligament (PCL) is notably affected. The present biomechanical model illustrates the relevant force vectors and reveals the extent of the effect of malpositioned ACL replacement on knee joint structures, particularly the PCL. Further investigations are needed to find out if the presumably occurring overload of a malpositioned ACL replacement can be calculated from its position on an individual basis. This may help deduce recommendations for ACL replacement procedures in the future.

Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique.

We present a new all-inside technique for the reduction and fixation of posterior cruciate ligament avulsion fractures. Two suture discs and a mersilene band are used to continuously exert even pressure on the avulsion fragment, thereby maintaining reduction during healing. The risk of a loss of reduction and further fragmentation is minimized.

Orthotic management of Charcot feet after external fixation surgery.

The authors use a total contact cast (TCC), Charcot restraint orthotic walker (CROW), or prefabricated diabetic walker (DW) for the treatment of neuroarthropathy, depending on the medical, social, and economic circumstances. There is not one single orthosis for the treatment of Charcot feet, but there are several models with advantages and disadvantages the physician should be aware of. In a retrospective study of 200 Charcot feet, the ankle foot orthosis (AFO) built in the authors' workshop turned out to be an efficient and comfortable appliance for orthotic treatment after reconstructive surgery. They prefer this type of orthosis because of its versatility and its safe application in a compliant patient.

The effects of combined gentamicin-hydroxyapatite coating for cementless joint prostheses on the reduction of infection rates in a rabbit infection prophylaxis model.

Infections remain a critical issue in total joint arthroplasty. Addition of antibiotics to bone cement was shown to significantly improve antimicrobial prophylaxis in cemented joint arthroplasty. In cementless joint arthroplasty a comparable prophylaxis by local antibiotics has not been possible yet. The aim of the current study was to investigate the antimicrobial effect of two different gentamicin-hydroxyapatite (HA) coatings for cementless prostheses in a rabbit infection model. Staphylococcus aureus with a dose of 10(7) CFUs was inoculated into the intramedullary canal of the tibia of 30 rabbits followed by the implantation of standard steel HA K-wires (n=10), steel K-wires coated with a gentamicin-HA combination (n=10), and steel K-wires coated with a gentamicin-RGD-HA combination (n=10), respectively. The animals were sacrificed after 28 days and clinical, histological and microbiological assessment on the bone and on the removed K-wire itself by agar plating and DNA-pulsed field gel electrophoresis were carried out to detect infection. There was a statistically significant reduction of infection rates by both gentamicin-coating types (0 infections in both groups) compared to standard HA coating (7 infections in 8 animals; 2 animals were lost due to acute diarrhea) (p<0.001). An excellent correlation between agar plating testing results of the K-wires and of the bone samples was found. Detailed histology showed cortical lysis, abscess and sequester formation in the infected animals. Both gentamicin-coating types showed significant improvement of infection prophylaxis compared to standard HA coating and, therefore, this coating technology could help to improve infection prophylaxis in cementless total joint arthroplasty. In further studies biocompatibility of the coatings has to be assessed.

Radiology-pathology conference: osteosarcoma in a cartilaginous exostosis of the femur.

Osteochondromas are common lesions in the metaphyseal segments of the long bones and are known to be able to degenerate into chondrosarcoma. We present the case of a 20-year-old patient with an osteosarcoma at the base of a cartilaginous exostosis and discuss the causal relationship between the two lesions on the basis of the radiologic and pathologic findings.

Establishment of mesodermal gene expression patterns in early Xenopus embryos: the role of repression.

In Xenopus, activin-like signals are able to induce and pattern mesoderm in a concentration-dependent manner. Previous experiments demonstrated that discrete gene expression patterns can be formed in animal cap explants as a response to graded activin signals. We analyzed the spatiotemporal appearance of goosecoid (gsc), chordin (chd), and Xbrachyury (Xbra) mRNAs in whole Xenopus embryos ectopically expressing activin or BVg1. To discriminate between direct transcriptional regulation and indirect, protein synthesis-dependent effects of ectopic signals, we combined overexpression studies and cycloheximide treatment. Our experiments revealed long-range signaling of activin/BVg1, but the expression patterns of gsc, chd, and Xbra in response to activin/BVg1 indicated that repressors are essential to establish the proper expression of these genes. Analysis of endogenous gsc, chd, and Xbra transcript distribution in embryos treated with cycloheximide supported this concept. We, therefore, conclude that inhibition is fundamental during early embryonic patterning.