Anatomic anterior cruciate ligament reconstruction: a changing paradigm

Carola van Eck onderzocht de anatomische reconstructie van de voorste kruisband en verwerkte haar bevindingen in een richtlijn. Deze leidt een chirurg door alle stappen van de behandeling, vanaf het onderzoeken van de patiënt en het uitvoeren van de operatie tot het beoordelen van het postoperatief herstel. De richtlijn heeft de vorm van een stroomdiagram dat gevolgd kan worden tijdens de gehele procedure. Het voorschrift is toepasbaar op zowel enkele als dubbele-bundelreconstructies en kan op basis van onderzoek of wetenschappelijke literatuur worden aangepast. Herstel van de anatomie van de voorste kruisband moet de kans op knieslijtage reduceren

Assessment of correlation between knee notch width index and the three-dimensional notch volume

This study was done to determine whether there is a correlation between the notch volume and the notch width index (NWI) as measured on the three most frequently used radiographic views: the Holmblad 45A degrees, Holmblad 70A degrees, and Rosenberg view. The notch volume of 20 cadaveric knees was measured using Computed Tomography (CT). The Holmblad 45A degrees, Holmblad 70A degrees, and Rosenberg notch view radiographs were digitally re-created from the CT scans for each specimen, and the NWI was measured by two observers. The Pearson correlation coefficient between the NWI and notch volume was calculated, as well as between the three views. An independent t test was performed to determine the difference in NWI and notch volume between male and female specimens. The reliability for each view was also determined. There was no correlation between the NWI as measured on the Holmblad 45A degrees, Holmblad 70A degrees, or Rosenberg view and the notch volume. All three radiographic views proved reliable, but showed only a moderate correlation with each other. Men had larger notch volumes than women, but there was no difference in NWI. A knee with a small intercondylar notch is often considered an increased risk for ACL rupture. The NWI is a frequently used two-dimensional method to determine notch size. However, in the present study, this index was not positively correlated with the overall volume of the notch. Based on the results of the current study, the authors would advice to use caution when using notch view radiographs in a clinical setting to predict risk of ACL ruptur

Complexity assessed by the INTERMED in patients with somatic symptom disorder visiting a specialized outpatient mental health care setting:: A cross-sectional study

Background Somatic symptom disorders (SSD), a new classification in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition is associated with problematic diagnostic procedures and treatment that lead to complex care. In somatic health care, the INTERMED has been used to assess levels of complexity; however, in SSD this instrument has not yet been applied. Objective This study aims to explore complexity in patients with SSD using the INTERMED, hereby contributing to an increased comprehension of this new patient group. Method In this cross-sectional study, the INTERMED was used to assess complexity in outpatients with SSD at the Clinical Centre of Excellence for Body, Mind, and Health (The Netherlands), along biologic, psychologic, social, and health care domains. This was done retrospectively with patient files from consecutive patients from 2011 until 2015.ResultsIn the total SSD sample (N = 187), 63% was female, the mean age (standard deviation) was 42 (±12.4) years, with an average educational level. The mean INTERMED score was 23.5 indicating high overall complexity in this population. A high proportion of our sample (69%) scored as highly complex (>20). High complexity was associated with higher depression and anxiety scores, but not with a higher number of physical symptoms. Conclusions This study demonstrates that patients with SSD form a high-complex group, with higher scores compared with literature about multiple sclerosis, rheumatoid arthritis, or patient waiting for a liver transplant. INTERMED outcomes indicate a need for extensive diagnostic procedures and integrated multidisciplinary care for patients with SSD. Attention should especially be paid to mental disorders (depression and anxiety), given their association with high complexity