The subtalar and talonavicular joints: a way to access the long-term load intake using conventional CT-data

Purpose: The aim of this study was to investigate the distribution of density of the subchondral bone plate within the articular surfaces of the subtalar and talonavicular joint regarding to its mineralisation and to verify whether a correlation to the mechanical bone strength exists. Methods: A total of 21 cadaverous lower leg specimens were investigated. Computed tomography osteo-absorptiometry (CT-OAM) was used to display the mineralisation of the subchondral bone plate analysing its density. The mechanical strength was measured by means of indentation testing. The distribution pattern was analysed regarding their dissemination with the main focus on number and location of their maxima. The correlation of both parameters was evaluated by linear regression. Results: The mineralisation and the mechanical strength were not distributed homogenously throughout the articular surfaces but showed unique and reproducible patterns. The range of absolute values for density and strength varied in between the samples and joint surfaces, but the number and location of the maxima evaluated by both methods showed to be concurring. The coefficient of correlation of both datasets ranged from 0.76 to 0.95 (median 0.88) and showed a linear dependency. Conclusions: Density distribution and mechanical strength of the subchondral bone plate are significantly associated and can be seen as a mirror of the long-term load intake of a joint. It can be concluded that CT-OAM as a tool to visualize subchondral bone plate density distribution regarding to its mineralisation can be used to indirectly gain information about joint biomechanics in vivo by the use of conventional CT-data

Functional and Structural Details about the Fabella: What the Important Stabilizer Looks Like in the Central European Population

The posterolateral corner of the knee accommodating the fabella complex is of importance in orthopaedic surgery. Unfortunately, there is a lack of data in literature for clinical routine. Therefore, we investigated the fabella's characteristics, biomechanical nature, and present histologic details. Of special interest were the fabella's occurrence and position, calcium concentration as long-term load intake indicator, and the histology. Within our analysis, fabellae were found in 30.0% of all datasets, located on the upper part of the posterolateral femoral condyle. The region of fabella contact on this condyle showed a significantly lower calcium concentration than its surroundings. Histologically, the fabella showed no articular cartilage but a clearly distinguishable fabellofibular ligament that consisted of two bundles: one, as already described in literature inserted at the fibular tip, and another part newly described on the top of the lateral meniscus. In its role of stabilizing the soft tissue structures of the posterolateral knee, the fabella seems to serve as suspension for the ligaments evolving from its base. Even though a joint formation of any kind is unlikely, the presence of a fabella needs to be kept in mind during knee examination and any surgical procedures