Diagnosis and Treatment of Acute Acromioclavicular Joint Injuries

Context Acute acromioclavicular joint (ACJ) dislocations are very common in young and active adults. Despite the high incidence of this injury, there is still some controversy on its diagnosis and treatment. Evidence Acquisition This review was based on the knowledge of the current literature listed in PubMed. It summarizes the current strategies for acute AC joint injuries. Results Acute injuries of the AC joint are very common among active individuals. Most authors recommend panorama- (stress-) view radiographs and additional radiographs for the horizontal instability. Low-grade injuries (Rockwood I-II) should be treated conservatively whereas high-grade injuries (Rockwood IV-VI) are best treated surgically. The most appropriate treatment for Rockwood III injuries is still a matter of debate and should be recommended based on the individual needs of the patient. Conclusions Based on the current literature, there still is no gold standard for the diagnosis of acute AC joint injuries. As surgical techniques, the hook plate as well as the arthroscopic button techniques are commonly used leading to good and reproducible results. However, evidence of the superiority of these techniques over alternative methods is lacking

Giant Cell Tumors of the Axial Skeleton

Background. We report on 19 cases of giant cell tumor of bone (GCT) affecting the spine or sacrum and evaluate the outcome of different treatment modalities. Methods. Nineteen patients with GCT of the spine (n = 6) or sacrum (n = 13) have been included in this study. The mean followup was 51.6 months. Ten sacral GCT were treated by intralesional procedures of which 4 also received embolization, and 3 with irradiation only. All spinal GCT were surgically treated. Results. Two (15.4%) patients with sacral and 4 (66.7%) with spinal tumors had a local recurrence, two of the letter developed pulmonary metastases. One local recurrence of the spine was successfully treated by serial arterial embolization, a procedure previously described only for sacral tumors. At last followup, 9 patients had no evidence of disease, 8 had stable disease, 1 had progressive disease, 1 died due to disease. Six patients had neurological deficits. Conclusions. GCT of the axial skeleton have a high local recurrence rate. Neurological deficits are common. En-bloc spondylectomy combined with embolization is the treatment of choice. In case of inoperability, serial arterial embolization seems to be an alternative not only for sacral but also for spinal tumors

A short-term in vivo model for giant cell tumor of bone

<p>Abstract</p> <p>Background</p> <p>Because of the lack of suitable <it>in vivo </it>models of giant cell tumor of bone (GCT), little is known about its underlying fundamental pro-tumoral events, such as tumor growth, invasion, angiogenesis and metastasis. There is no existing cell line that contains all the cell and tissue tumor components of GCT and thus <it>in vitro </it>testing of anti-tumor agents on GCT is not possible. In this study we have characterized a new method of growing a GCT tumor on a chick chorio-allantoic membrane (CAM) for this purpose.</p> <p>Methods</p> <p>Fresh tumor tissue was obtained from 10 patients and homogenized. The suspension was grafted onto the CAM at day 10 of development. The growth process was monitored by daily observation and photo documentation using <it>in vivo </it>biomicroscopy. After 6 days, samples were fixed and further analyzed using standard histology (hematoxylin and eosin stains), Ki67 staining and fluorescence <it>in situ </it>hybridization (FISH).</p> <p>Results</p> <p>The suspension of all 10 patients formed solid tumors when grafted on the CAM. <it>In vivo </it>microscopy and standard histology revealed a rich vascularization of the tumors. The tumors were composed of the typical components of GCT, including (CD51+/CD68+) multinucleated giant cells whichwere generally less numerous and contained fewer nuclei than in the original tumors. Ki67 staining revealed a very low proliferation rate. The FISH demonstrated that the tumors were composed of human cells interspersed with chick-derived capillaries.</p> <p>Conclusions</p> <p>A reliable protocol for grafting of human GCT onto the chick chorio-allantoic membrane is established. This is the first <it>in vivo </it>model for giant cell tumors of bone which opens new perspectives to study this disease and to test new therapeutical agents.</p

Unilateral aplasia of both cruciate ligaments

Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL) footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral) tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments

Morphologic characterization of osteosarcoma growth on the chick chorioallantoic membrane

<p>Abstract</p> <p>Background</p> <p>The chick chorio-allantoic membrane (CAM) assay is a commonly used method for studying angiogenic or anti-angiogenic activities <it>in vivo</it>. The ease of access allows direct monitoring of tumour growth by biomicroscopy and the possibility to screen many samples in an inexpensive way. The CAM model provides a powerful tool to study effects of molecules, which interfere with physiological angiogenesis, or experimental tumours derived from cancer cell lines. We therefore screened eight osteosarcoma cell lines for their ability to form vascularized tumours on the CAM.</p> <p>Findings</p> <p>We implanted 3-5 million cells of human osteosarcoma lines (HOS, MG63, MNNG-HOS, OST, SAOS, SJSA1, U2OS, ZK58) on the CAM at day 10 of embryonic development. Tumour growth was monitored by <it>in vivo </it>biomicroscopy at different time points and tumours were fixed in paraformaldehyde seven days after cell grafting. The tissue was observed, photographed and selected cases were further analyzed using standard histology.</p> <p>From the eight cell lines the MNNG-HOS, U2OS and SAOS were able to form solid tumours when grafted on the CAM. The MNNG-HOS tumours showed the most reliable and consistent growth and were able to penetrate the chorionic epithelium, grow in the CAM stroma and induce a strong angiogenic response.</p> <p>Conclusions</p> <p>Our results show that the CAM assay is a useful tool for studying osteosarcoma growth. The model provides an excellent alternative to current rodent models and could serve as a preclinical screening assay for anticancer molecules. It might increase the speed and efficacy of the development of new drugs for the treatment of osteosarcoma.</p

Medial Patellofemoral Ligament Reconstruction: A New Technique for Graft Fixation at the Patella Without Implants

Patellofemoral instability is a complex disorder that is often accompanied by insufficiency or tearing of the medial patellofemoral ligament. Over the past few years, several techniques using free tendon grafts for medial patellofemoral ligament reconstruction have become popular because of their reproducible effect and good outcome. Whereas most surgeons prefer femoral fixation of the graft using an interference screw, the possibilities of patellar fixation are numerous. All of the different techniques have their own advantages and pitfalls. We describe a technique in which we drill 2 blind-ending tunnels (1 cm) at the medial aspect of the patella, where the doubled graft (not the free ends) is pulled in and fixed. By using a special technique for shuttling the sutures, there is no need for an additional skin incision and no need for implants, allowing very secure graft fixation without a relevant risk of fracture

Sports Injuries While Wingfoiling

International audiencePURPOSE: Wingfoiling is a new popular water sport. Data on the risk of injury or overuse injuries are not yet available. The aim of the study was to analyze the incidence, mechanisms and risk factors for wingfoiling related injuries and the acceptance of safety equipment. PATIENTS AND METHODS: Data for this retrospective study were collected through an online standardized questionnaire. It was accessible from January 2022 to June 2022. Information on demographics, injury history, overuse complaints, use of (safety)equipment and fitness routines over the past 12 months were asked. RESULTS: A total of 415 completed the questionnaire in full and could be included in the study. Fourteen percent (n = 59) were female, 86% (n = 356) were male. The average age was 43.5 years. Fourteen percent (n = 59) participated in competitions. Thirty-one percent (n = 129) of all participants suffered at least one injury in the past 12 months out of a total of 356 injuries. This corresponds to an injury incidence of 5.7/1000h. Typical mechanism of injury was contact with the own sports equipment. The most frequent cause was individual riding errors due to fatigue with 77.5% (n = 276). The most common acute injury types were contusions, strains, cuts and abrasions of the lower extremities. In the case of chronic complaints (n = 173), the shoulder and knee joint were mainly affected. Seventy-three percent (n = 304) of the participants regularly used a protective equipment, such as a helmet or impactvest. CONCLUSION: The injury rate of wingfoiling is comparable to windsurfing and kitesurfing. The majority of injuries are minor injuries to the lower extremities. In case of serious injuries, it is mainly the bony thorax that is affected. Most participants already use protective equipment. Overuse complaints mostly affect the large joints

ACL reconstruction with quadriceps tendon graft and press-fit fixation versus quadruple hamstring graft and interference screw fixation – a matched pair analysis after one year follow up

Abstract Background The objective of the study was to compare the results of a primary anterior cruciate ligament reconstruction (ACLR) using the press-fit fixation technique for a quadriceps tendon (QT) graft to a standard quadrupled hamstring (HT) graft with interference screw fixation. Methods A retrospective cohort study with a 12-month follow up provided data for 92 patients. Exclusion criteria were accompanying ligament injuries and contralateral ACL injury. Patients who suffered a graft failure, which was defined as a side-to-side difference of > 3 mm, or infection were rated ‘D’ according to the IKDC and excluded from further evaluation. Forty-six patients underwent primary ACLR using the press-fit fixation technique for autologous bone QT graft. These patients were matched in terms of age, gender, accompanying meniscus tear and cartilage injury to 46 patients who underwent standard HT graft with interference screw fixation. Patients were evaluated according to the Lachman test, Pivot-Shift test, IKDC score, Tegner score, Rolimeter measurements, one-leg hop test, thigh circumference and donor side morbidity. Results No significant differences in Tegner score (p = 0.9), subjective or objective IKDC score (p = 0.9;p = 0.6), knee stability (Lachman Test p = 0.6; Pivot-Shift Test p = 0.4; Side-to-Side Difference p = 0.4), functioning testing (One-Leg Hop Test p = 0.6; Thigh Circumference p = 0.4) or donor side morbidity (p = 0.4) were observed at the follow up. The Lachman test was negative for 85% of the QT group and 83% of the HT group. The Pivot Shift Test was negative for 80% of the QT group and 85% of the HT group. The mean side-to-side difference was 1.6 ± 0 .2mm in both groups. The one-leg hop test revealed a collateral-side jumping distance of 96.2 ± 8.5% for the QT group and 95.5 ± 8.5% for the HT group. The thigh circumference of the injured leg was 98.3 ± 3.0% on the uninjured side in the QT group and 99.7 ± 3.0% in the HT group. A knee walking test resulted in no discomfort for 90% of the QT group and 85% of the HT group. The graft failure rate was 7.3% in the QT group and 9.8% in the HT group. Conclusion QT grafts fixated using the press-fit technique are a reliable alternative for primary ACL surgery

Traumatic lesions in a stable knee : masterly neglect - meniscectomy - repair

Traumatic meniscal tears are common injuries of the knee joint. In order to choose the treatment modality that best suits the needs of the individual patient, a well-structured assessment and thorough clinical examination are mandatory. An MRI is helpful for planning the procedure and defining the exact tear location. Small asymptomatic tears can often be treated conservatively (“masterly neglect”). If surgical treatment is necessary, as much viable meniscus tissue as possible should be preserved. Tears of the vascular zone usually can be treated by refixation, whereas tears of the avascular zone are treated by partial resection. Due to its biomechanical properties and chondroprotective function, preserving the meniscus is of high importance to avoid early degenerative changes of the knee joint