Joint Congruity Research Articles

Covariance in human limb joint articular morphology.

Limb synovial joints exhibit complex shapes that must accommodate often-antagonistic demands of function, mobility, and stability. These demands presumably dictate coordination among joint articular shapes, but the structure of morphological covariance within and among joints is unknown. This study analyzes the human shoulder, elbow, hip, and knee to determine how articular covariance is structured in relation to joint structure, accessory cartilage, and function. Surface models were created from the CT scans of 200 modern skeletons from the University of Tennessee Donated Skeletal Collection. Three-dimensional landmarks were collected on the shoulder, elbow, hip, and knee joints. Two-block partial least squares were conducted to determine associations between surfaces of conarticular shapes, functionally analogous articulations, and articulations belonging to the same bone. Except for the components of the shoulder, all conarticular pairs exhibit covariance, though the strength of these relationships appears unrelated to the amount of accessory cartilage in the joint. Only the analogous articulations of the humerus and femur exhibit significant covariance, but it is unlikely that this pattern is due to function alone. Stronger covariance within the lower limb than the upper limb is consistent broader primate patterns of within-limb integration. With the exception of the elbow, complementary joint function does not appear to promote strong covariance between articulations. Analogous humeral and femoral surfaces are also serially homologous, which may result in the articular associations observed between these bones. Broadly, these patterns highlight the indirect relationship between joint congruence and covariance.

Magnetic Resonance Imaging Manifestations of Annular Ligament Injuries in Children With Monteggia Fractures.

Magnetic resonance imaging (MRI) is commonly performed in children with elbow injuries to visualize soft tissues such as the annular ligament. Herein, we investigated the MRI manifestations of annular ligament injuries in children with Monteggia fractures following attempted closed reduction. The clinical and imaging data of 88 children with acute Monteggia fractures treated at our hospital between 2015 and 2019 were analyzed. Clinically and radiographically, 67 patients achieved radiologic reduction of the radial head at the time of MRI, whereas 21 patients had a failed closed reduction. Annular ligament injury and superior radioulnar joint congruency were analyzed qualitatively, and the maximum superior radioulnar joint gap distance was measured. MRI manifestations of annular ligament injury were primarily characterized as varying degrees of annular ligament displacement, as follows: I degree (10 patients), the annular ligament encircled the radial head without displacement; II degree (5 patients), the annular ligament was partially displaced but visibly encircled the radial head at the level of the radial notch; and III degree (73 patients), the annular ligament was completely displaced. In 15 patients with I and II degrees annular ligament injuries, the annular ligament encircled the radial head (maximum superior radioulnar joint gap distance, 1.2±0.3mm), showing good congruency of the superior radioulnar joint. In 73 patients with III degree annular ligament injury, the annular ligament was displaced and did not encircle the radial head (maximum superior radioulnar joint gap distance, 3.3±2.7mm; P <0.05), showing good congruency of the superior radioulnar joint in 25 of 73 patients, and significantly poor congruency in 48 of 73 patients ( P <0.05). Annular ligament injuries in children with Monteggia fractures exhibit different degrees of displacement of the annular ligament. In I and II degree annular ligament injuries, the annular ligament still encircles the radial head. In III degree annular ligament injuries, the annular ligament is displaced away and is no longer around the radial head. Without the annular ligament restraining the radial head, the superior radioulnar joint is more likely to exhibit poor congruency and increased gap distance. Level II.

Comparison of different intraoperative reduction monitoring methods in a cadaveric intraarticular calcaneal fracture model: 3D scan vs arthroscopy vs nanoscopy.

Visualization of the subtalar joint surface in surgical management of calcaneal factures remains a big challenge and anatomic reduction of the articular surface is essential for a good clinical outcome. We hypothesize that video-assistance can provide superior fracture reduction compared to fluoroscopy and that nanoscopy (NSC) achieves more extensive visualization compared to fracturoscopy (FSC). Ten human cadaveric feet with artificially pre-fractured intraarticular calcaneal fractures with involvement of the posterior facet were treated via a minimal invasive subtalar approach. After initial control of reduction by 2D fluoroscopy, the reduction was further analyzed intraoperatively by FSC and NSC. 3D Scan served as gold standard control of reduction. Need of revision of reduction after the different visualization techniques was recorded and the extent of visualization of the subtalar joint surface in the medio-lateral dimension was compared for FSC and NSC. To quantify access and visualization of the medial and posterior facet, a depth gauge was used to measure from laterally at the clinically widest portion of the calcaneus targeted to the sustentaculum tali. The distance in millimetres was referred to the complete medio-lateral distance seen on paracoronal CT at the widest portion of the calcaneus. Fracture analysis in preoperative CT-scans according to Sanders classification revealed four type IC, two IIA, three IIC and one IIIAC fractures. Mean visualization of the medial and posterior facet was significantly improved with NSC (30.4 ± 3.78mm) compared to FSC (23.6 ± 6.17mm) (p = 0.008). An imperfect reduction requiring revision was more often required with NSC compared to FSC. Insufficient reduction using video-assistance was found in two cases. In order to optimize subtalar joint reduction and congruency, video-assisted techniques, especially NSC, provide superior visualization and thus can improve reduction in the surgical treatment of intraarticular calcaneal fractures.

Considerations on recurrent patella dislocation in the adolescent athlete

Recurrent patellar dislocation is described as loss of joint congruence between the femoral trochlea and the articular facet of the patella after a second episode. The etiology is multifactorial, including local, rotational and dynamic anatomical factors, and there is no clarity about its real influence, despite its high incidence and clinical importance. A search of Pubmed, Elsevier, Scielo, and Uptodate was conducted to identify recent articles on patellofemoral instability and recurrent patella dislocation. The pathogenic origin of recurrent patellar dislocation involves structural abnormalities, or muscle imbalances, its management is difficult, and multiple surgical techniques can be used. We recommend studying the possible causes and being consistent with them to carry out definitive treatment.

Arthroscopically assisted internal fixation for treatment of acute ankle fracture: A systematic review and meta-analysis of comparative studies.

Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult intra-articular lesions, and treatment of traumatic intra-articular pathologies. The aim of this systematic review and meta-analysis was to provide evidence on whether ARIF is an alternative treatment protocol for ankle fractures. The PubMed, Embase, and Cochrane Library databases were searched independently by two investigators from the inception dates to October 9, 2022, for comparative studies. The risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials and the methodological index for non-randomized studies (MINORS) were used for assessing the methodological quality. Outcomes were evaluated in terms of the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, post-operative complications, arthroscopic findings, Visual Analogue Scale (VAS) score, and operation time. Cochrane Review Manager Software 5.4 was used to perform the statistical analysis. A total of 10 trials involving 755 patients were included in this meta-analysis. The results revealed that ARIF for ankle fractures was superior regarding functional outcomes and VAS scores when compared with open reduction and internal fixation (ORIF). No significant difference was noted in the post-operative complication rate and the operation time between the ARIF and ORIF groups. A high incidence of chondral or osteochondral lesions (OCLs), ligamentous injuries, and loose bodies with ankle fractures was found by ankle arthroscopy. ARIF for ankle fractures might be beneficial to offer superior functional outcomes and VAS score than ORIF. Orthopedic surgeons should take a high incidence of OCLs and ligamentous injuries into consideration for the treatment of acute ankle fractures. We believe that with the increase in surgical experience, the occurrence of post-operative complications and the extension of operation time will no longer be a potential concern for surgeons.

A current insight into Human Knee Menisci

Menisci of the knee are semilunar-shaped structures located between the condyles of the femur and tibia, together with articular surfaces of the tibial condyles form the acetabulum of the knee joint. They have multiple functions, affecting the proper joint biomechanics, even though in the past they were perceived as embryonic remnants. Menisci are involved in such vital functions as: load bearing, joint stability, joint congruity, increasing joint contact area, decreasing joint contact stresses, protection of articular cartilage, shock absorption, lubrication, limitation of extreme movement and proprioception.Menisci arise from a condensation of the intermediate layer of mesenchymal tissue. At later stages of development, it is observed a gradual decrease in the cellularity of the structure and increase of the collagen fibers, where collagen type I is a major fibrillar component. The meniscus is composed of an extracellular matrix mainly filled with water (72%) and collagen (22%), with a minority of proteoglycans, glycoproteins, peptides, and local cells - fibrochondrocytes.When it comes to vascularization, two main areas are present in the structure of meniscus: red-red zone - vascular, white-white zone – rather avascular, and in between the red-white zone. Major vascularization is ensured by the popliteal artery branches: medial, lateral and middle geniculate arteries. It was shown that meniscus can be vascularized in each zone, what is linked with the hypovascular zone regenerative potential. The vascularization pattern and nutritional status of a torn meniscus and the morphological pattern of the tear are crucial factors determining the success of a meniscus surgery. The healing potential of a torn meniscus is directly dependent on its blood supply.At present, it is known that proper performance of the knee joint is directly proportional to the amount of meniscus tissue. Their involvement in the multiple important functions leads to modern solutions focused on saving meniscus tissue.

Non-operative management of terrible triad injuries of the elbow; not so terrible?

Terrible triad injuries (TTIs) of the elbow have traditionally been reported to have poor outcomes, hence requiring surgical stabilisation. We identified and reviewed patients with TTIs treated non-operatively within our department. We retrospectively reviewed patients with TTI treated non-operatively with standardised elbow-instability rehabilitation from 2010 to 2020. We used Mason and Morrey classifications for radial head and coronoid fractures, respectively. Non-operative indications included a congruent joint on CT, significant co-morbidities pre-disposing to high-risk surgery and/or patient preference. Outcomes included Oxford Elbow Score (OES), ROM and complications. Nineteen patients were included (mean age 49; 37% female). At an average of 6 years (range 2-11 years) post-treatment, mean OES was 46 ± 7. At last clinic review, mean 6 months (2-15), average ROM was 131 ± 11° flexion, 8 ± 10° extension, 85 ± 12° supination and 85 ± 13° pronation. One patient required arthrolysis and another had an incongruent ulnohumeral joint which developed clicking with a functional ROM. Our report suggests non-operatively managed and appropriately rehabilitated TTI injuries can achieve good function and ROM. We recommend conservative management as a viable option in cases with joint congruency and no mechanical block in patients with significant co-morbidities or those refusing surgery but patients must be assessed on a case-by-case basis.

GANZ HEAD REDUCTION OSTEOTOMY FOR THE TREATMENT OF FEMORAL HEAD DEFORMITIES: RADIOLOGICAL AND FUNCTIONAL OUTCOMES

Ganz's studies made it possible to address joint deformities on both femoral and acetabular side brought by the Legg-Calvè-Perthes disease (LCPD). Femoral head reduction osteotomy (FHRO) was developed to improve joint congruency along with periacetabular osteotomy (PAO). The purpose of this study is to show the clinical and morphologic outcomes of the technique, and an implemented planning approach.From 2015 to 2023, 13 FHROs were performed on 11 patients for LCPD, in two centers. 11 of 13 hips had an associated PAO. A specific CT and MRI-based protocol for virtual simulation of the corrections was developed. Outcomes were assessed with radiographic parameters (sphericity index, extrusion index, integrity of the Shenton's line, LCE angle, Tonnis angle, CCD angle) and clinical parameters (ROM, VAS, Merle d'Aubigné-Postel score, modified-HHS, EQ5D-5L). Early and late complications were reported.The mean follow-up was 40 months. The mean age at surgery was 11,4 years. No major complications were recorded. One patient required a total hip arthroplasty. Femoral Head Sphericity increased from 45% to 70% (p &lt; 0,001); LCE angle from 18° to 42,8° (p &lt; 0,001); extrusion Index from 36,6 to 8 (p &lt; 0,001); Tonnis Angle from 14,4° to 6,2° (p = 0.1); CCD Angle from 131,7 to 136,5° (p &lt; 0,023). The VAS score improved from 3,25 to 0,75,(p = 0.06); Merle d'Aubigné-Postel score from 14.75 to 16 (p = 0,1); Modified-HHS from 65,6 to 89,05 (p = 0,02). The EQ 5D 5L showed significant improvements. ROM increased especially in abduction and extra-rotation.FHRO associated with periacetabular procedures is a safe technique that showed improved functional, clinical and morphologic outcomes in LCPD. The newly introduced simulation and planning algorithm may help to further refine the technique.

THIRTY-YEAR FOLLOW-UP STUDY OF ROTATIONAL ACETABULAR OSTEOTOMY

Satisfactory intermediate and long-term results of rotational acetabular osteotomy (RAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study is to examine the 30-year results of RAO.Between 1987 and 1994, we treated 49 patients (55 hips) with RAO for diagnosis of pre- OA or early-stage OA. Of those patients, 35 patients (43 hips) were available at a minimum of 28 years. The follow-up rate was 78.2% and the mean follow-up was 30.5 years. The mean age at the time of surgery was 34 years. Clinical evaluation was performed with the Merle d'Aubigne and Postel rating scale, and radiographic analyses included measurements of the center-edge angle, acetabular roof angle, and head lateralization index on preoperative, postoperative AP radiographs of the pelvis. Postoperative joint congruency was classified into four grades. The radiographic evidence of progression of OA was defined as the minimum joint space less than 2.5mm.The mean preoperative clinical score was 14.0, which improved to a mean of 15.3 at the time of the latest follow-up. The mean center-edge angle improved from 0.6° preoperatively to 34° postoperatively, the mean acetabular roof angle improved from 28.4°preoperatively to 1.0°postoperatively, the mean head lateralization index improved from 0.642 preoperatively to 0.59 postoperatively. Postoperative joint congruency was excellent in 11 hips, good in 29 hips, and fair in 3 hips. Nineteen patients (20 hips) had radiographic OA progression, and 10 patients (11 hips) were converted to THA. Kaplan-Meier survivorship analysis, with radiographic OA progression as the end point, predicted survival of 75.6% at 20 years and 48.8% at 30 years, and with THA conversion as the end point, 90.2% at 20 years and 71.2% at 30 years.The RAO is an effective surgical procedure for symptomatic dysplastic hips of pre- and early-stage OA and could change the natural history of the dysplastic hip.

Monteggia-like injuries : Pitfalls of surgical treatment

The term Monteggia-like lesions or Monteggia equivalent injuries includes fractures of the proximal ulna with dislocation and dislocation fractures of the radial head from the proximal radio-ulnar joint. The complexity of the injury requires adedicated understanding of the anatomical structures and their biomechanical properties. Particularly due to the rarity, the complication and revision rates are high. A conservative treatment is not usually effective. Three-dimensional imaging by computed tomography is part of the surgical preparation. The goal of surgical treatment is osteosynthetic reconstruction of the fractures and restoration of joint congruency. In cases of nonreconstructable radial head fractures, radial head arthroplasty may be necessary. In addition to reconstruction of the bony stabilizers, refixation of the ligamentous structures is essential for treatment success. The combination of complex fracture patterns and possible dislocation positions in the ulnohumeral, radiohumeral and proximal radio-ulnar joints poses agreat challenge to the surgeon. The most frequent complications are peri-implant infections, implant failure, loss of reduction, stiffness or instability. Especially the anatomical configuration of the proximal ulna is complex and requires accurate reconstruction. Therefore, reconstruction of the proximal ulna in length and rotation, including the coronoid process, is considered to be a key factor in the surgical treatment of Monteggia-like injuries.

A Modified Cannulated Cancellous Bone Impactor Is a Helpful Tool During Acetabular Fractures ORIF, a Technical Note

A Modified Cannulated Cancellous Bone Impactor Is a Helpful Tool During Acetabular Fractures ORIF, a Technical Note

Assessment of surgical management for locked fracture-dislocations of the proximal humerus in patients of different ages

BackgroundLocked fracture-dislocation of the proximal humerus (LFDPH) is a very severe complex injury; neither arthroplasty nor internal plating are fully satisfactory. This study aimed to evaluate different surgical treatments for LFDPH to determine the optimal option for patients of different ages. MethodsFrom October 2012 to August 2020, patients who underwent open reduction and internal fixation (ORIF) or shoulder hemiarthroplasty (HSA) for LFDPH were retrospectively reviewed. At follow-up, radiologic evaluation was performed to evaluate bony union, joint congruence, screw cut-out, avascular necrosis of the humeral head, implant failure, impingement, heterotopic ossification, and tubercular displacement or resorption. Clinical evaluation comprised the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant–Murley and visual analog scale (VAS) scores. Additionally, intraoperative and postoperative complications were assessed. ResultsSeventy patients (47 women and 23 men) with final evaluation results qualified for inclusion. Patients were divided into three groups: group A: patients aged under 60 years who underwent ORIF; group B: patients aged ≥60 years who underwent ORIF; and group C: patients who underwent HSA. At a mean follow-up of 42.6 ± 26.2 months, function indicators, namely shoulder flexion, and Constant–Murley and DASH scores, in group A were significantly better than those in groups B and C. Function indicators in group B were slightly but not significantly better compared with group C. Regarding operative time and VAS scores, there were no significant differences between the three groups. Complications occurred in 25%, 30.6%, and 10% of the patients in groups A, B, and C, respectively. ConclusionsORIF and HSA for LFDPH provided acceptable but not excellent results. For patients aged <60 years, ORIF might be optimal, whereas, for patients aged ≥60 years, both ORIF and HSA provided similar results. However, ORIF was associated with a higher rate of complications.

Facteurs influençant la reprise du sport après ostéotomie acétabulaire rotationnelle excentrique

BackgroundAlthough eccentric acetabular rotation osteotomy (ERAO) is an effective treatment for developmental dysplasia of the hip (DDH), there is little information about return to sports after ERAO. This study aimed to investigate 1) the patient factors that influence the return to sports after ERAO, 2) whether postoperative sports participation will affect future osteoarthritis progression. HypothesisSome factors affect the return to sports after ERAO. Patients and methodsOf 503 patients who underwent ERAO from 1990 to 2010, 124 who had been continuously participating in sports preoperatively (average 13.2 years after surgery) were included. Patient demographics of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative Kellgren-Lawrence (KL) grade, center edge angle, joint congruency, Harris hip score, complications and the survival rate were compared between the S group (patients who participated in the same sports preoperatively) and N group (patients who could not participate in sports postoperatively). ResultsSeventy-two (58%) and 52 patients (42%) in the S and N groups, respectively, had an overall return to sports rate of 64% (79 patients). The most common sports that patients participated in were swimming (30 patients [24%]), jogging (12 [10%]), and golf (10 [8%]) preoperatively, and swimming (14 patients [11%]), golf (8 [6%]), and jogging (8 [6%]) postoperatively. There were no significant differences between both groups in terms of sex, age, body mass index, unilateral to bilateral case ratio, history of treatment for childhood DDH, preoperative KL grade, and joint congruency. There was a significant difference in patient factors between the S (11 joints [14%]) and N (20 joints [38%]) groups only when the preoperative center edge angle was <0°. There was no significant difference in the preoperative Harris hip score and the final survey between the S (73.2±4.6 and 93.4±7.2) and N (72.5±4.8 and 92.1±7.4) groups. Complications showed no significant differences between the five patients (7%) in the S group and six patients (13%) in the N group. The KL grade progressed in 10 cases (grade II to III in 2 cases and grade III to IV in 8) in the S group and 8 cases (grade II to III in 1 case and grade III to IV in 7 cases) in the N group. The 10-year and 20-year joint survival rates with THA conversion as the endpoint were 98.1% (95% CI: 87.4%–99.7%) and 83.7% (95% CI: 62.6%–93.4%) in the S group and 100% (95% CI: 70.7%–99.3%) and 95.2% (95% CI: 12.6%–92.6%) in the N group, respectively. In the evaluation of factors affecting sports return by logistic regression analysis, only one significant factor (odds ratio 3.42, 95% confidence interval: 1.58–7.42, p<0.01) was the preoperative center edge angle <0°. DiscussionThe chief factor affecting the return to sports after surgery was a preoperative center edge angle <0°; moreover, the continuation of sports did not affect the subsequent progression of osteoarthritis or THA conversion. Level of evidenceLevel III, cohort study.

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue.

Terrible triad injuries

The complex injury pattern of aposterior elbow dislocation with concomitant radial head and coronoid fractures is usually referred to as a terrible triad injury. Due to the concomitant compromise of several osteoligamentous structures of the elbow joint relevant for stability, these injuries pose aparticularly major challenge to the treating trauma surgeons. For this reason, acareful preoperative analysis of all relevant injury components is mandatory in order to make an adequate treatment decision. In most cases, surgical treatment addressing all elements relevant for stability is necessary to achieve astable and congruent elbow joint. Only this enables early functional follow-up treatment and minimizes the complication rate. Delayed or even insufficient treatment with persistent (sub)dislocation must be avoided at all costs, otherwise there is ahigh risk of serious posttraumatic functional disorders of the elbow with rapid progression of osteoarthritis.

Patient-Reported Outcomes and Factors Impacting Success of the Periacetabular Osteotomy.

Hip dysplasia is a condition affecting both infants and adults, characterized by a shallow acetabulum that does not sufficiently cover the head of the femur. This leads to instability of the hip and elevated levels of mechanical stress around the acetabular rim. A popular procedure for the correction of hip dysplasia is the periacetabular osteotomy (PAO), in which fluoroscopically guided osteotomies around the pelvis are made to allow for repositioning of the acetabulum to fit properly on the femoral head. This systematic review aims to analyze patient factors that impact outcomes, as well as patient-reported outcomes such as the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients in this review did not undergo any prior intervention for acetabular hip dysplasia, allowing for an unbiased reporting of outcomes from all included studies. Of studies reporting HHS, the mean preoperative HHS was 68.92 and the mean postoperative HHS was 89.1. Of the study that reported mHHS, the mean preoperative mHHS was 70, and the mean postoperative mHHS was 91. Of the studies reporting WOMAC, the mean preoperative WOMAC was 66, and the mean postoperative WOMAC was 63. Key findings of this review are that of the seven included studies, six achieved a minimally important clinical difference (MCID) based on patient-reported outcomes, and factors impacting outcome are preoperative Tönnis osteoarthritis (OA) grade, pre and postoperative lateral-center edge angle (LCEA), preoperative hip joint congruency, postoperative Tönnis angle, and age. In patients with no prior intervention for hip dysplasia, the PAO is a successful procedure with significant improvement in postoperative patient-reported outcomes. Despite the reported success of the PAO, proper patient selection is vital to avoid early conversions to total hip arthroplasty (THA) and prolonged pain. However, further investigation is prompted regarding the long-term survivorship of the PAO in patients with no prior intervention for hip dysplasia.

Hip dysplasia: What influence do age, arthrosis and concomitant diseases have on the treatment result?

Pelvic osteotomies are an established treatment for symptomatic adult hip dysplasia with apromising long-term outcome. Results depend not only on the achieved acetabular reorientation but also on patient-factors like preoperative joint condition (degree of osteoarthritis and joint congruency) and age. Additionally, the diagnosis and appropriate therapy of impingement-associated hip deformities is essential in order to achieve good mid- and long-term outcomes. The influence of chondrolabral pathology on the outcome of pelvic osteotomies is not yet defined. Symptomatic patients with residual dysplasia after previous pelvic or acetabular osteotomies can benefit from an additional osteotomy, although results can be worse in comparison to prior unoperated joints. Obesity can make surgery more demanding and increases the complication profile of PAO, although it has no influence on the postoperative outcome. Regarding the overall prognosis after an osteotomy, the consideration of combined risk factors is superior to the concentration on individual factors alone.

Patient-reported Outcomes of Revision Ankle Open Reduction Internal Fixation

Ankle fractures may require revision surgery for malunion or suboptimal joint congruence results after initial surgical or nonsurgical treatment. There is limited literature on the outcomes of patients undergoing such revision surgery for ankle fracture malunion. In this retrospective case series, we determined clinical and functional outcomes of revision ankle open reduction internal fixation (ORIF) for 7 patients with ankle fracture malunion through patient-reported and radiographic outcomes. Patient-reported Outcomes Measurement Information System physical function and pain interference scores prerevision and postrevision procedure were obtained from 7 patients treated from January 2017 to October 2020. Postoperative complications including persistent pain, infection, hardware removal, hardware failure, and conversion to ankle arthrodesis were analyzed. Seven patients who underwent revision ORIF surgery for ankle fracture malunion between January 2017 and October 2020 were included. The average age was 46.3 12.2 years old; 85.7% of the patients were female; 14.3% were male. The average amount of time between revision ORIF procedure and collection of postoperative Patient-Reported Outcomes Measurement Information System scores was 19.3±5.9 months. Each of the 7 patients showed an increase in physical function after revision surgery (average preoperative physical function score: 30.7; average postoperative physical function score: 48.9). All patients showed a decrease in pain after revision surgery (average preoperative pain interference score: 64.8; average postoperative pain interference score: 55.7). Of the 7 participants who underwent revision ORIF, a majority did not experience any complications at least 1 year postprocedure, including infection, reoperation, or hardware removal. One participant underwent hardware removal for persistent pain and developed overlying cellulitis. For patients with ankle fracture malunion without significant post-traumatic degenerative changes of the ankle joint, revision ankle ORIF can be an effective method for improving physical function, decreasing pain, and preserving ankle joint motion. Level of Evidence: Level IV—case series.

Evaluation of congruency of condyle convexity and fossa concavity and interrelationship bony components in temporomandibular joint anterior dislocation.

This study aimed to compare the congruency of surface geometry of the articulating bones and morphologic differences in temporomandibular joint (TMJ) structure, between patients with TMJ anterior dislocation and healthy controls. The study included 15 patients with TMJ anterior dislocation and 15 controls who underwent cone-beam computed tomography. The surface angle of the articular fossa (fossa-concavity) and condyle (condyle-convexity) and joint spaces were measured from both sagittal and coronal views. The articular eminence morphology and horizontal condyle position were also evaluated. Coronal fossa angles were significantly lower in controls than in patients (p < 0.05). There was a positive correlation between coronal condyle and fossa angle values in controls and in patients' joints (p < 0.05), however, the fossa-condylar congruence was higher in controls than in patients. Superior joint space was significantly higher in controls than in patients (p < 0.05). There were no significant differences in articular eminence measurements, mean condyle angle variables and condyle position between the patients and controls (p > 0.05). The findings of this study which include lower joint congruency, higher fossa concavity and superior joint space distance in patients with anterior dislocation may be related to the inferior positioning of the condyle away from the fossa and potentially the elongation of the capsular ligament.

Is There a Relationship Between the Functional Level of Juvenile and Adolescent Patients With Down Syndrome and Hip Dysplasia?

The prevalence of hip dysplasia among patients with Down syndrome (DS) is higher than in the general population. We hypothesize that a relationship may exist between functional level and hip dysplasia in DS, but this has not been studied to date. The aim of this study is to evaluate whether there is a relationship between functional level and radiographic parameters of hip dysplasia or other measures. Retrospective cross-sectional comparative study of 652 patients with DS from a pediatric referral center database. Patients over 8 years of age with an anteroposterior pelvis radiograph and with no exclusion criteria were selected, totaling 132 patients (264 hips; 54.55% females; mean age 12.96 ± 2.87 y). Several radiographic parameters of the acetabulum [Sharp angle (SA), Tönnis angle (TA), Wiberg center-edge angle (W-CEA), extrusion index (EI), and acetabular retroversion signs], the proximal femur [neck shaft angle (NSA)], and joint congruence [Shenton line (SL)] were assessed. Patients were classified into 2 levels based on functional skills. A multivariate association analysis was performed between radiographic parameters and functional level. Sixty-one patients were compatible with a functional level I and 71 with a level II. Forty-six hips were dysplastic and 60 were borderline according to the W-CEA. A statistically significant relationship was found between the categorical distribution of certain radiographic measurements of hip dysplasia (EI, SA, TA, W-CEA, SL, and classification by functional level ( P < 0.0005). A significant receiver operating characteristic curve was obtained for W-CEA with a cutt-off point at 26.4 degrees for level I (area under the curve = 0.763; P < 0.005; sensitivity = 0.800 and specificity = 0.644). There was a fairly high correlation between EI and TA (0.749; P < 0.0005), EI and W-CEA (-0.817; P < 0.0005), and TA and W-CEA (-0.748; P < 0.0005). Numerous hips showed signs of acetabular retroversion, with no significant differences found between functional levels or association with hip dysplasia measures. The present study reveals a relationship between an increased risk of hip dysplasia and reduced functional levels in DS children older than 8 years. These findings may guide individualized clinical follow-up of hip development in DS children considering their functional level. Level III, retrospective comparative study.