Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

<p>Abstract</p> <p>Background</p> <p>The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively.</p> <p>Methods</p> <p>In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up.</p> <p>Results</p> <p>The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively.</p> <p>Conclusions</p> <p>To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.</p

Who is the African Farmer? The Importance of Actor Representations in the Debate About Biotechnology Crops in Africa

The discussion about the impact of agricultural biotechnology on Africa is deeply divided and contains widely diverging claims about the impact of biotechnology on African farmers. Building upon literature on the ‘good farmer’ that highlights that farmers identities are an important factor in explaining the success or failure of agri- cultural change, we argue that the identity of the farmer is an undervalued yet crucial aspect for understanding the debate about the impact of agricultural biotechnology on African farmers. In this article we therefore investigate what farmers’ identi- ties are implicated in the arguments about the impact of biotechnology on African farmers. We aim to identify the main fault lines in different accounts of the African biotechnology farmer by analysing the identities ascribed to them in two prominent cases of controversy: the debates at the 2002 World Summit on Sustainable Devel- opment in Johannesburg and the discussion about the impact of biotechnology on smallholder farmers in the Makhathini flats in KwaZulu Natal, South Africa. Our findings demonstrate that arguments about biotechnology are informed by diverging conceptions of who the African farmer is, what is important for the African farmer, and what role the African farmer has in relation to agricultural biotechnology. These findings remain relevant for current discussions on gene editing technologies like CRISPR-Cas. Openly discussing these different views on the identity of smallholder farmers is crucial for moving forward in the biotechnology controversy and can inform future attempts to elicit the farmer’s voice

Innovation and the commons:lessons from the governance of genetic resources in potato breeding

This article explores the relation between innovation and resources that are governed as commons by looking at the governance of potato genetic resources, especially in the context of the emergence ofhybrid diploid potato breedingthat will enable potato propagation through true seeds. As a new breeding tool, hybrid diploid potato breeding may not only revolutionize traditional potato breeding practices, it may also strongly affect current governance modes of potato genetic resources as a commons. Contrary to conventional accounts of the commons that treat technological innovation mainly as an exogenous factor, we argue that technological innovation can better be understood as an endogenous factor. In particular, we develop aco-production frameworkof innovation and the commons that draws attention to the different ways in which innovation, commons and its governance interact. Using this framework, we demonstrate that the constitution of potato genetic resources as a commons cannot be understood without considering the various ways in which technological innovation affects resources and mediate how these are governed. While reversely, technological innovations themselves are also enabled and constrained by users who govern potato genetic resources as a shared resource. We argue that changes in the governance of genetic resources can be understood as a change from one socio-technical constellation to another, whereby innovations, resources, and institutions are continuously co-produced

MR-plastination-arthrography: A new technique used to study the distal tibiofibular syndesmosis

Purpose: The purpose of this study was to describe a new technique called MR plastination arthrography to study both intra- and extra-articular anatomy. Materials and methods: In six human cadaveric lower legs MR arthrography was performed in either a one-step or two-step procedure. In the former a mixture of diluted Gadolinium and dyed polymer was injected. In the latter the dyed polymer was injected after arthrography wih diluted Gadolinium. Three-millimeter slices of these legs, obtained in a plane identical to that of the MR images, were plastinated according to the E12 technique of von Hagens. The plastination slices were subsequently compared with the MR images. Results: The one-step procedure resulted in an inhomogeneous arthrogram. The two-step procedure resulted in a good correlation between the high-resolution MR images and plastination slices, as expressed by a good comparison of anatomic detail of the small syndesmotic recess. Conclusions: Images of the distal tibiofibular syndesmosis obtained with plastination arthrography correlated well with images acquired by MR arthrography when performed in a two-step procedure

Chronic instability of the anterior syndesmosis of the ankle: Biomechanical, kinematical, radiological and clinical aspects

This thesis is concerned with chronic anterior instability of the tibiofibular syndesmosis of the ankle. The ankle plays a fundamental role in locomotion. It consists of the talocrural and distal tibiofibular joint. The latter is a syndesmosis, a fibrous joint with ample intervening fibrous connective tissue. The syndesmosis consists of the anterior inferior tibiofibular ligament (ATiFL, also known as the anterior syndesmosis), the interosseous ligament (IL), and the posterior inferior tibiofibular and transverse ligaments (PTiFL and TL), also known as the posterior syndesmosis). Some authors recognize the transverse ligament as a separate entity. Injuries of the tibiofibular syndesmosis can occur in isolation or in combination with osseous or ligamentous ankle injuries. This thesis focuses on syndesmotic injuries without ankle fractures. To stress that no ankle fracture is present they are called ‘isolated syndesmotic injuries’, even though concomitant ligamentous or soft tissue injuries and tibiofibular avulsion fractures may be present. In this thesis the emphasis will be put on chronic anterior syndesmotic instability, but other syndesmotic injuries will be mentioned too