Radiographic findings and anatomical variations of the caudal cervical area in horses with neck pain and ataxia: case–control study on 116 horses

BackgroundAbnormalities of the ventral lamina of the sixth cervical vertebra (AVL-C6) are thought to exert abnormal stress on the articular process joints (APJs) of the cervicothoracic junction. The aim of the study was to investigate the association between AVL-C6 and radiographic findings in the caudal cervical area and between clinical signs of neck pain and ataxia and radiographic findings.MethodsMedical records of horses subjected to cervical radiography were reviewed. Horses were classified into those with neck pain (group C), those with ataxia (group A) and healthy horses (group H). Presence of AVL-C6 and increased size, dysplasia, remodelling, fragmentation and osteochondral fragment at the APJs (C5–T1) were recorded. Univariable logistic regression analysis was performed to identify the associations between explanatory and dependent variables. Variables with P<0.2 were included in the multivariable analysis.ResultsOne hundred and sixteen horses were included (44 in group C, 29 in group A, 66 in group H); 24 of 116 horses had radiographic AVL-C6. Age, AVL-C6 and overall/C6–C7 increase in size remained in the final models.ConclusionsThe presence of AVL-C6 and moderate/severe increase in size of the caudal cervical APJs increase the odds of showing neck pain and, if severe, ataxia.

Retrospective evaluation of outcomes of bone peg fixation for osteochondral lesion of the talus

Aims The hypothesis of this study was that bone peg fixation in the treatment of osteochondral lesions of the talus would show satisfactory clinical and radiological results, without complications. Methods Between September 2014 and July 2017, 25 patients with symptomatic osteochondritis of the talus and an osteochondral fragment, who were treated using bone peg fixation, were analyzed retrospectively. All were available for complete follow-up at a mean 22 of months (12 to 35). There were 15 males and ten females with a mean age of 19.6 years (11 to 34). The clinical results were evaluated using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at the final follow-up. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion. Results The mean VAS and AOFAS score improved significantly from 6.3 (4 to 8) and 70.6 (44 to 78) preoperatively to 1.6 (0 to 5) and 91.1 (77 to 100) at the final follow-up, respectively (p < 0.001). The classification on MRI was stage 2a in nine patients, stage 3 in 14, and stage 4 in two. The lesion was located on the posteromedial aspect of the dome of the talus in 19 patients, the anterolateral aspect in five, and the centrolateral aspect in one. The mean size of the fragment was 11.2 mm (5 to 20) horizontally, 10.4 mm (7 to 18) vertically, and 5.2 mm (3 to 10) deep, respectively. The postoperative healing state was good in 19 patients and fair in six. Conclusion Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Cite this article: Bone Joint J 2020;102-B(10):1349–1353.

Posteromedial Approach for Osteochondral Lesions of the Talus

Background: Medial malleolar osteotomy is an established procedure for accessing the medial localized osteochondral lesions of the talus. The purpose of this study was to describe a single approach, which allows perpendicular access to the lesion without a malleolar osteotomy. Methods: Six patients were treated surgically for medial localized talar osteochondral lesions. Four patients had stage III and 2 patients had stage IV lesions. A single posteromedial approach was used for accessing the medial talar dome. Results: The method of treatment was mosaicplasty in 4 patients and osteochondral fragment fixation in 2 patients. One patient who was treated with a fragment fixation procedure showed screw loosening. Incorporation of the osteochondral grafts was proved by magnetic resonance imaging in all mosaicplasty cases. Conclusion: A single posteromedial approach was sufficient in the posteromedial localized osteochondral lesion of the talus. As the lesion was approached by soft tissue exposure only, a malleolar osteotomy was not required. Thus, osteotomy-related complications were avoided. Level of Evidence: Level IV, retrospective case series.

Osteochondritis Dissecans of Lateral Process of Talus Involving the Subtalar Joint: An Unusual Case

Osteochondral dissecans (OCD)of talus is an uncommon injury is often missed initially. We reported a rare case of OCD of the lateral process of talus involving the subtalar joint in a 34-year-old male. Magnetic resonance imaging exhibited degenerative changes at the subtalar joint, with a 12 × 10 × 15-mm subchondral cystic lesion within the lateral part of talus in the posterior subtalar joint and two osseous loose bodies in the lateral compartment, which were removed through the sinus tarsi approach. A 1.2 × 1.5-cm osteochondral fragment distal to the lateral process of talus was noted intraoperatively. The subchondral cyst was excised and the fragment fixed with a 4-mm partially-threaded cannulated cancellous screw. The foot and ankle disability score improved from 26.0 preoperatively to 92.3 at the 1-year follow-up. Thus, talus OCD is an unusual condition that mandates a thorough clinical and radiological work-up and prompt management.

Retrograde Drilling for Osteochondral Lesion of the Talus in Juvenile Patients

Background: Retrograde drilling (RD) is generally used for treating osteochondral lesion of the talus (OLT) with a stable osteochondral fragment and nearly normal articular cartilage surface. Previous studies that included participants of various ages have reported good clinical results. This study aimed to clarify the clinical outcomes of RD for OLT in juvenile patients whose bone-forming ability and physical activity might affect the healing process. Methods: This retrospective study included 8 juvenile patients who underwent RD for OLT (5 boys and 3 girls, mean age 14.9 years, mean follow-up 2 years, 7 medial and 1 central lesion). American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and ankle activity score were evaluated, and arthroscopic findings were graded according to the International Cartilage Research Society (ICRS) classification system. The condition of the underlying bone was assessed on preoperative computed tomographic images. The stability, incorporation, and subsidence of the osteochondral fragment, articular surface congruity, and the area of the bone marrow lesion (BML) were evaluated using magnetic resonance imaging (MRI). Results: AOFAS ankle-hindfoot score and ankle activity score significantly improved postoperatively. Arthroscopically, the lesions were classified as ICRS grade 0 or 1. Bone sclerosis or multiple small cysts of the underlying bone were observed in all patients. MRI demonstrated no signs of osteochondral fragment instability or subsidence, good or fair fragment incorporation, good articular surface congruity, or slight irregularity. The postoperative BML was reduced; however, these BMLs were still detectable at 1 year after surgery. Conclusion: Our data suggested that RD is an option for treating juvenile patients with OLT refractory to nonoperative treatment at short-term follow-up. Although bone sclerosis or multiple small cysts were identified in the underlying bone preoperatively and the BML under the osteochondral fragment remained postoperatively, clinical status such as pain and physical activity level were improved by RD. Level of Evidence: Level IV, retrospective case series.

Patellar instability

Lateral patellar dislocation (PD) has multifactorial origin. Its treatment will depend on the physical demands of the patient, triggering event and injury mechanism of PD, number of dislocation episodes, patellofemoral joint morphology, and concomitant injuries. After primary PD, despite the risk of recurrence being 33-77%, first treatment option is mostly conservative, except if an osteochondral fragment needs to be refixed or removed. This practice has been questioned lately by the Patella Instability Severity Score that determines the risk for recurrent PD in function of age, bilaterality, and anatomical risk factors. Risk behavior in relation to sports activity seems to be an additional risk factor. The treatment of recurrent PD is surgical with only low recurrent rate (2-4%). Medial patellofemoral ligament (MPFL) reconstruction is the most widely used technique. The ideal candidates are subjects with painless intervals between PD and without major trochlear dysplasia (TD) or patella alta. However, postoperative pain and loss of flexion might be observed if the graft is overtensioned or its fixation point malpositioned. Trochleoplasty is the only technique that aims at improving containment with the risk to increase peak forces due to incongruence. Due to the demanding technique its superiority over isolated MPFL reconstruction has been described only in grotesque TD and PD in higher knee flexion (>60°). Tibial tubercle osteotomy can be distalized in case of patella alta or medialized in case of lateralized tibial tubercle. Indication should be considered carefully, since patellar tracking will be influenced almost throughout the full range of motion and might therefore induce discomfort or pain.

Ring-shaped lateral meniscus combined with an accessory meniscus: A rare anatomical variant

A ring-shaped meniscus is a very rare anatomical variant among all meniscal abnormalities. Additionally, an accessory meniscus is extremely rare, and only a few cases have been reported. We herein report a case involving the combination of these two features in a single lateral meniscus. These abnormalities were found during arthroscopic surgery for removal of an osteochondral fragment that had detached from the patellar bone and plication of the medial patellofemoral ligament in a patient with acute patellar dislocation. To our knowledge, each variant is extremely rare and the combination of the two variants has not been reported.

Fixation Technique Using PLLA Pins Gives Good Clinical Results Regardless of Bone Condition in Osteochondral Lesion of Talar Dome

Category: Ankle Introduction/Purpose: Osteochondral lesion of the talus (OLT) has various treatment options which are chosen depending on the stage, size and cartilage condition. The fixation technique can restore the natural congruency with the hyaline cartilage. However, it is not clear whether a bone condition such as the disruption of the subchondral bone plate will affect the clinical results after the fixation of the osteochondral fragment. We hypothesized that even if the subchondral bone plate were disrupted, if the articular cartilage condition in the osteochondral fragment were good, then the clinical results of the fixation technique would be good. The aim of this study was to explore whether the fragment’s bone condition affects clinical outcomes including second look arthroscopy. Methods: Eighteen ankles in 17 patients, which had undergone the fixation technique using poly-L-lactide (PLLA) pins, were included. The mean follow-up period was 18.8±8.9 months. They consisted of 10 males and 7 females, with a mean age of 20.1±10.1 years. Based on the fragment’s bone condition on preoperative CT, ankles were divided into 3 groups; normal, segmentation, and absorption groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score were evaluated both pre and post surgery. On MRI, the BME area was measured, and stability, incorporation, subsidence, and the surface of the articular cartilage of the fragment were evaluated. Second look arthroscopic findings were evaluated in 13 ankles. The repair of OLT was assessed according to the criteria of the ICRS which are allocated for the degree of filling defect by repair tissue, integration, and surface appearance of the repair site. Results: The AOFAS score before surgery significantly improved from 72.1±2.8 points to 98.6±3.3 points at the final follow-up in all ankles. In each group, the AOFAS score improved and there were no significant differences in AOFAS score among the 3 groups at final follow-up. MRI at 1 year showed good incorporation and cartilage surface in all groups, but the bone marrow lesion in the absorption group was significantly larger than that in the other groups. In the second look arthroscopic findings, the ICRS scale for the normal, segmentation, and absorption groups produced 10.6±1.7 points, 9.8±1.9 points, and 10.7±1.2 points, respectively. Conclusion: Good clinical results including those of second look arthroscopy for osteochondral fragment fixation using PLLA pins in OLT were obtained, even in the case of disruption of the subchondral bone plate. Since the fixation procedure can restore the native contour of the articular cartilage surface, this surgical procedure is a viable option for large OLT lesions regardless of bone condition in the osteochondral fragment.