BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this...BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this injury.Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses.Up to 40%of patients who suffer from an ankle sprain develop chronic ankle instability.Chronic instability can lead to prolonged periods of pain,immobility and injury recurrence.Identification of factors that influence return to work(RTW)and return to sports(RTS)after a lateral ankle sprain(LAS)may help seriously reduce healthcare costs.AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023.Inclusion criteria were as follows:(1)Injury including LAS or chronic ankle instability;(2)Described any form of treatment;(3)Assessment of RTW or RTS;(4)Studies published in English;and(5)Study designs including randomized controlled clinical trials,clinical trials or cohort studies.Exclusion criteria were:(1)Studies involving children(age<16 year);or(2)Patients with concomitant ankle injury besides lateral ankle ligament damage.A quality assessment was performed for each of the included studies using established risk of bias tools.Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis.A best evidence synthesis was performed in cases of qualitative outcome analysis.For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.RESULTS A total of 8904 patients were included in 21 studies,10 randomized controlled trials,7 retrospective cohort studies and 4 prospective cohort studies.Fifteen studies were eligible for meta-analysis.The overall RTS rate ranged were 80%and 83%in the all treatments pool and surgical treatments pool,respectively.The pooled mean days to RTS ranged from 23-93 d.The overall RTW rate was 89%.The pooled mean time to RTW ranged from 5.8-8.1 d.For patients with chronic ankle instability,higher preoperative motivation was the sole factor significantly and independently(P=0.001)associated with the rate of and time to RTS following ligament repair or reconstruction.Higher body mass index was identified as a significant factor(P=0.04)linked to not resuming sports or returning at a lower level(median 24,range 20-37),compared to those who resumed at the same or higher level(median 23,range 17-38).Patients with a history of psychological illness or brain injury,experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains.The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits.We also observed that 10%of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.CONCLUSION All treatments yielded comparable results,with each treatment potentially offering unique advantages or benefits.Preoperative motivation may influence rehabilitation after LAS.Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.展开更多
This current concepts review outlines the role of diffe-rent imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articul...This current concepts review outlines the role of diffe-rent imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone(usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography(CT) and magnetic resonance imaging(MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available.展开更多
BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive endstage surgeries.Currently,there are no clinical studies on the Ankle Spacer.AIM To describe the operative technique and the clini...BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive endstage surgeries.Currently,there are no clinical studies on the Ankle Spacer.AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple,cystic osteochondral lesions of the talus in patients with failed prior operative treatment.METHODS This is a prospective study during which patients were assessed preoperatively,at 2-and 6 wk,and at 3,6,12 and 24 mo postoperatively.Patients with multiple,cystic or large(≥15 mm)osteochondral lesions of the talus after failed prior surgery were included.The primary outcome measure was the numeric rating scale(NRS)for pain during walking at 2 years postoperatively.Secondary outcome measures included the NRS in rest and during stair climbing,the American Orthopaedic Foot and Ankle Society Hindfoot Score,the Foot and Ankle Outcome Score,the Short-Form 36 physical and mental component scale,and the Range of Motion(ROM).Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence.Revision rates and complications were also assessed.RESULTS Two patients underwent an Ankle Spacer implantation on the talus.The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years,in patient 1 and 2,respectively.The other patient-reported outcome measures also improved substantially.There were no re-operations nor complications.Radiological imaging showed no loosening of the implant and no change of implant position.CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking,improvement in clinical outcomes as assessed with PROMs,and no complications or re-operations.This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.展开更多
BACKGROUND Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy.Regarding patient reported outcome measures there seems to be no difference between capsular repair o...BACKGROUND Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy.Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.AIM To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging(MRI)scan after capsular repair or unrepaired capsulotomy.METHODS A case series study was performed;a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan.The presence of a capsular defect and gap size were independently evaluated on MRI.RESULTS A total of 28 patients(29 hips)were included.Patient demographics were comparable between treatment groups.There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group(P=0.13).In the group of patients with a defect,median gap sizes at the acetabular side were 5.9 mm(range:2.7-9.0)in the repaired and 8.0 mm(range:4.5-18.0)in the unrepaired group(P=0.462).At the muscular side gap sizes were 6.6 mm(range:4.1-9.0)in the repaired group and 11.5 mm(range:3.0-18.0)in the unrepaired group(P=0.857).The calculated Odds ratio(OR)for having a capsular defect with an increasing lateral center-edge(CE)angle was 1.12(P=0.06).The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1(P=0.05).CONCLUSION There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy.Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.展开更多
BACKGROUND Polyethylene(PE)particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty(THA).As highly cross-linked polyeth...BACKGROUND Polyethylene(PE)particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty(THA).As highly cross-linked polyethylene(HXLPE)is presumed to give lower wear rates,in vivo studies are needed to confirm this.AIM To compare the wear of REXPOL,a HXPLE,with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis(RSA).METHODS Patients were randomised to receive either a HXLPE(REXPOL)or a conventional PE insert during primary THA.RSA images were obtained directly postoperative and after 6 wk,12 wk,6 mo,12 mo,24 mo and five years.Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery.RESULTS The HXLPE(REXPOL)showed less wear in the latero-medial direction.Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume,whereas the REXPOL did not show these outcomes over time.Improvement from baseline in functional outcome did not significantly differ.CONCLUSION Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years.This study confirms,for the first,that the REXPOL HXLPE inlay is preferred to standard PE.展开更多
BACKGROUND Kitesurfing is an increasingly popular and potentially dangerous extreme water sport.We hypothesized that kitesurfing has a higher injury rate than other(contact)sports and that the minority of injuries are...BACKGROUND Kitesurfing is an increasingly popular and potentially dangerous extreme water sport.We hypothesized that kitesurfing has a higher injury rate than other(contact)sports and that the minority of injuries are severe.AIM To investigate the incidence and epidemiology of kitesurfing injuries in a Dutch cohort during a complete kitesurfing season.METHODS Injury data of 194 kitesurfers of various skill levels,riding styles and age were surveyed prospectively during a full kitesurf season.The participants were recruited through the Dutch national kitesurf association,social media,local websites and kitesurf schools.Participants completed digital questionnaires monthly.The amount of time kitesurfing was registered along with all sustained injuries.If an injury was reported,an additional questionnaire explored the type of injury,injury location,severity and the circumstances under which the injury occurred.RESULTS The mean age of participants was 31 years(range,13-59)and the majority of the study population was male(74.2%).A total of 177 injuries were sustained during 16816 kitesurf hours.The calculated injury rate was 10.5 injuries per 1000 h of kitesurfing.The most common injuries were cuts and abrasions(25.4%),followed by contusions(19.8%),joint sprains(17.5%)and muscle sprains(10.2%).The foot and ankle were the most common site of injury(31.8%),followed by the knee(14.1%)and hand and wrist(10.2%).Most injuries were reported to occur during a trick or jump.Although the majority of injuries were mild,severe injuries like an anterior cruciate ligament tear,a lumbar spine fracture,a bimalleolar ankle fracture and an eardrum rupture were reported.CONCLUSION The injury rate of kitesurfing is in the range of other popular(contact)sports.Most injuries are relatively mild,although kitesurfing has the potential to cause serious injuries.展开更多
文摘BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this injury.Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses.Up to 40%of patients who suffer from an ankle sprain develop chronic ankle instability.Chronic instability can lead to prolonged periods of pain,immobility and injury recurrence.Identification of factors that influence return to work(RTW)and return to sports(RTS)after a lateral ankle sprain(LAS)may help seriously reduce healthcare costs.AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023.Inclusion criteria were as follows:(1)Injury including LAS or chronic ankle instability;(2)Described any form of treatment;(3)Assessment of RTW or RTS;(4)Studies published in English;and(5)Study designs including randomized controlled clinical trials,clinical trials or cohort studies.Exclusion criteria were:(1)Studies involving children(age<16 year);or(2)Patients with concomitant ankle injury besides lateral ankle ligament damage.A quality assessment was performed for each of the included studies using established risk of bias tools.Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis.A best evidence synthesis was performed in cases of qualitative outcome analysis.For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.RESULTS A total of 8904 patients were included in 21 studies,10 randomized controlled trials,7 retrospective cohort studies and 4 prospective cohort studies.Fifteen studies were eligible for meta-analysis.The overall RTS rate ranged were 80%and 83%in the all treatments pool and surgical treatments pool,respectively.The pooled mean days to RTS ranged from 23-93 d.The overall RTW rate was 89%.The pooled mean time to RTW ranged from 5.8-8.1 d.For patients with chronic ankle instability,higher preoperative motivation was the sole factor significantly and independently(P=0.001)associated with the rate of and time to RTS following ligament repair or reconstruction.Higher body mass index was identified as a significant factor(P=0.04)linked to not resuming sports or returning at a lower level(median 24,range 20-37),compared to those who resumed at the same or higher level(median 23,range 17-38).Patients with a history of psychological illness or brain injury,experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains.The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits.We also observed that 10%of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.CONCLUSION All treatments yielded comparable results,with each treatment potentially offering unique advantages or benefits.Preoperative motivation may influence rehabilitation after LAS.Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.
文摘This current concepts review outlines the role of diffe-rent imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone(usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography(CT) and magnetic resonance imaging(MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available.
文摘BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive endstage surgeries.Currently,there are no clinical studies on the Ankle Spacer.AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple,cystic osteochondral lesions of the talus in patients with failed prior operative treatment.METHODS This is a prospective study during which patients were assessed preoperatively,at 2-and 6 wk,and at 3,6,12 and 24 mo postoperatively.Patients with multiple,cystic or large(≥15 mm)osteochondral lesions of the talus after failed prior surgery were included.The primary outcome measure was the numeric rating scale(NRS)for pain during walking at 2 years postoperatively.Secondary outcome measures included the NRS in rest and during stair climbing,the American Orthopaedic Foot and Ankle Society Hindfoot Score,the Foot and Ankle Outcome Score,the Short-Form 36 physical and mental component scale,and the Range of Motion(ROM).Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence.Revision rates and complications were also assessed.RESULTS Two patients underwent an Ankle Spacer implantation on the talus.The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years,in patient 1 and 2,respectively.The other patient-reported outcome measures also improved substantially.There were no re-operations nor complications.Radiological imaging showed no loosening of the implant and no change of implant position.CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking,improvement in clinical outcomes as assessed with PROMs,and no complications or re-operations.This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.
文摘BACKGROUND Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy.Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.AIM To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging(MRI)scan after capsular repair or unrepaired capsulotomy.METHODS A case series study was performed;a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan.The presence of a capsular defect and gap size were independently evaluated on MRI.RESULTS A total of 28 patients(29 hips)were included.Patient demographics were comparable between treatment groups.There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group(P=0.13).In the group of patients with a defect,median gap sizes at the acetabular side were 5.9 mm(range:2.7-9.0)in the repaired and 8.0 mm(range:4.5-18.0)in the unrepaired group(P=0.462).At the muscular side gap sizes were 6.6 mm(range:4.1-9.0)in the repaired group and 11.5 mm(range:3.0-18.0)in the unrepaired group(P=0.857).The calculated Odds ratio(OR)for having a capsular defect with an increasing lateral center-edge(CE)angle was 1.12(P=0.06).The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1(P=0.05).CONCLUSION There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy.Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.
文摘BACKGROUND Polyethylene(PE)particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty(THA).As highly cross-linked polyethylene(HXLPE)is presumed to give lower wear rates,in vivo studies are needed to confirm this.AIM To compare the wear of REXPOL,a HXPLE,with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis(RSA).METHODS Patients were randomised to receive either a HXLPE(REXPOL)or a conventional PE insert during primary THA.RSA images were obtained directly postoperative and after 6 wk,12 wk,6 mo,12 mo,24 mo and five years.Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery.RESULTS The HXLPE(REXPOL)showed less wear in the latero-medial direction.Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume,whereas the REXPOL did not show these outcomes over time.Improvement from baseline in functional outcome did not significantly differ.CONCLUSION Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years.This study confirms,for the first,that the REXPOL HXLPE inlay is preferred to standard PE.
文摘BACKGROUND Kitesurfing is an increasingly popular and potentially dangerous extreme water sport.We hypothesized that kitesurfing has a higher injury rate than other(contact)sports and that the minority of injuries are severe.AIM To investigate the incidence and epidemiology of kitesurfing injuries in a Dutch cohort during a complete kitesurfing season.METHODS Injury data of 194 kitesurfers of various skill levels,riding styles and age were surveyed prospectively during a full kitesurf season.The participants were recruited through the Dutch national kitesurf association,social media,local websites and kitesurf schools.Participants completed digital questionnaires monthly.The amount of time kitesurfing was registered along with all sustained injuries.If an injury was reported,an additional questionnaire explored the type of injury,injury location,severity and the circumstances under which the injury occurred.RESULTS The mean age of participants was 31 years(range,13-59)and the majority of the study population was male(74.2%).A total of 177 injuries were sustained during 16816 kitesurf hours.The calculated injury rate was 10.5 injuries per 1000 h of kitesurfing.The most common injuries were cuts and abrasions(25.4%),followed by contusions(19.8%),joint sprains(17.5%)and muscle sprains(10.2%).The foot and ankle were the most common site of injury(31.8%),followed by the knee(14.1%)and hand and wrist(10.2%).Most injuries were reported to occur during a trick or jump.Although the majority of injuries were mild,severe injuries like an anterior cruciate ligament tear,a lumbar spine fracture,a bimalleolar ankle fracture and an eardrum rupture were reported.CONCLUSION The injury rate of kitesurfing is in the range of other popular(contact)sports.Most injuries are relatively mild,although kitesurfing has the potential to cause serious injuries.
