Combined autologous chondrocyte implantation (ACI) with supra-condylar femoral varus osteotomy, following lateral growth-plate damage in an adolescent knee: 8-year follow-up

We report the 8-year clinical and radiographic outcome of an adolescent patient with a large osteochondral defect of the lateral femoral condyle, and ipsilateral genu valgum secondary to an epiphyseal injury, managed with autologous chondrocyte implantation (ACI) and supracondylar re-alignment femoral osteotomy. Long-term clinical success was achieved using this method, illustrating the effective use of re-alignment osteotomy in correcting mal-alignment of the knee, protecting the ACI graft site and providing the optimum environment for cartilage repair and regeneration. This is the first report of the combined use of ACI and femoral osteotomy for such a case

Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?

PURPOSE - Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS - Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS - Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS - The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE: II

Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability?

PURPOSE - Tibial tuberosity-trochlear groove distance (TT-TG) has been regarded as a useful tool for establishing therapeutic choices for patellar instability. Recently, it has been shown that TT-TG negatively correlated with the quadriceps angle, suggesting that if used individually, neither provide a valid measure of instability. This study aimed to compare TT-TG distance between both knees in patients with unilateral instability to assess whether this measurement is a decisive element in the management decisions for patellar instability. METHODS - Sixty-two patients (18 male and 44 female), reporting to a specialist patella clinic for recurrent unilateral patellar instability, were included in the study. Patients underwent bilateral long leg computed tomography scan to determine TT-TG distance in both knees. Tibial TT-TG in symptomatic and asymptomatic knees in the same individual was compared statistically. RESULTS - Mean TT-TG distance in the symptomatic knee was 16.9 (±4.9) mm, compared to 15.6 (±5.6) mm in the asymptomatic knee. Tibial TT-TG was not significantly different between stable and unstable knees (n.s.). CONCLUSIONS - The lack of difference in TT-TG distance between stable and unstable knees suggests that TT-TG distance alone may not be a decisive element in establishing therapeutic choices for patellar instability. It should, therefore, be interpreted with caution during clinical evaluations. LEVEL OF EVIDENCE: II

Reliability of patellotrochlear index in patellar height assessment on MRI-correction for variation due to change in knee flexion.

OBJECTIVES To assess the reliability of patellotrochlear Index (PTI) in patellar height assessment on successive MRI scans in asymptomatic patients. MATERIALS AND METHODS Sixty-four patients with two successive MRI scans (128 studies) of the same knee for non-patellofemoral joint symptoms were identified retrospectively. PTI and knee flexion angle were assessed independently by three observers to assess interobserver reliability. The effect of knee flexion on PTI was assessed by comparing the change in values of PTI in each patient correlated with change in knee flexion. RESULTS Sixty-four MRIs of patients (M:F) aged between 18 and 35 years (mean 24.6) years were assessed. The mean PTI for initial scan group was 0.33% (95% CI: 0.29-0.37; SD: 0.15) and consecutive scan group was 0.30% (CI: 0.27-0.33; SD: 0.3). The difference was not significant (p = 0.097 using a paired t test) with high inter-observer correlation (0.9) in both sets. Spearman's rho for knee flexion angle and PTI was found to be positive and statistically significant (0.41; p = 0.001). A linear regression model was derived using a scatter chart of change in PTI with change in knee flexion for each patient. The gradient of the linear regression line was used to estimate a cPTI (corrected PTI) value (corrected to 0 degrees of knee flexion), defined as cPTI = PTI - 1.3a (a = knee flexion angle). CONCLUSIONS This study demonstrates high inter-observer correlation of PTI on MRI and high test-retest reliability indicating unconscious quadriceps contraction does not change the index sufficiently. Knee flexion significantly alters PTI, increased patellotrochlear engagement with flexion increases the index. We propose use of the formula cPTI = PTI -1.3a to correct the index to 0 degree knee flexion in clinical practice

Plan of Action for Pillar Two of the Global Soil Partnership: Encourage investment, technical cooperation, policy, education, awareness and extension in soil

Pillar Two of the GSP underpins many of the actions under the other Pillars by addressing the general lack of societal awareness of the importance of soil in people’s lives and the well - being of the planet. In many cases, deficiency in education is the specific underlying cause of unsustainable land management practices, of the general lack of investment (both in education and physical measures to protect soil) and, as importantly, of the widespread political reluctance to adopt short - and long - term measures to preserve and enhance soil conditions. The Plan of Action (PoA) for Pillar 2 consists of six interlinked and interdependent components: policy, investment, education, extension, public awareness and technical cooperation. The development of the PoA was initiated at the European Network Soil Awareness (ENSA) workshop in Aberdeen in September 2013. This was followed by discussions at the 2013 Global Soil Week in Berlin which lead to the establishment of a Working Group to produce a draft plan of action , which was eventually endorsed by t he ITPS in April 2014. The PoA was presented, reviewed and adopted by the Plenary Assembly of the GSP in July 2014. Seven key recommendations are presented. Robust policy frameworks are one means of ensuring the sustainable management and protection of soils. Therefore, governments must be in vited to create or reinforce policies on soil and its protection. Whereas soil protection and management is a long - term aim, most political decisions are governed by short - term ambitions that reflect the lifetime of governments or politicians. Today’s highly urbanised society means that the population is largely detached from food and fibre production issues and lack s a fundamental understanding of the role o f soil in enabling such life - critical services. It is disappointing to observe that society in many parts of the world attaches a greater value to developments in subjects such as particle physics and mobile communication than essential issues such as soil fertility. The PoA calls for a systematic awareness raising campaign in all countries on how soil relates to people’s everyday lives. This can be done through brief and vivid messages, not only as part of the World Soil Day celebrations and during the forthcoming International Year of Soils, but also as a sustained long - term outreach and engagement programme. The PoA recommends a significant increase in investments to support such actions. Education in soil sciences is important and needs to be taken into account by other disciplines. The current soil science community should strive to show synergies with other domains to demonstrate its relevance. Pressure should be brought at all levels to halt the decline in soil science teaching at tertiary level, while boosting professional technical qualifications and support to educationalists, so that soils and agriculture can be more appealing for the younger generations. Soil extension services should interpret and present relevant research - based information to a broader range of stakeholders in an understandable and usable form, including farmer - to - farmer schemes or through initiatives such as the Soils Doctors Programme. The technical approach underlying the extension services should reflect mutually beneficial cooperation rather than from mere transfers from one partner to another. Finally, investments must go hand in hand with awareness o f the importance of soil resources. These investments should develop an effective skills base and entrepreneurship among soil users. The GSP should make full use of such tools as the Healthy Soils Facility to generate and facilitate the collection of financial contributions to the PoA