For the treatment of isolated full-thickness chondral lesion of the knee, m-AMI can be used effectively and may potentially accelerate recovery. A larger patient cohort and follow-up supported by histological analyses are necessary to determine long-term outcomes.
Several controversies exist regarding the surgical difficulties and the results of total knee arthroplasty performed after failed valgus high tibial osteotomy (HTO), and the main subject is the change in patellar height that results as patella baja or infera. The purpose of this retrospective study was to evaluate patellar height after valgus HTO and the measurement methods that were actually used. Eighty-five knees that were subjected to valgus HTO were evaluated both preoperatively and postoperatively according to the Insall-Salvati Index (ISI), Blackburne-Peel Index (BPI), and Caton Index (CI) to assess any alteration of patellar tendon height that was present. All cases underwent closing wedge osteotomy with three staples or plate internal fixation and were allowed early range of motion. Significant decrease in mean patellar height ratios was detected according to all three indexes at 85 months of mean follow-up. The percentages of the decrease were 8.26% in ISI, 9.08% in BPI, and 6.34% in CI. Two knees showed patella infera according to ISI, one according to BPI and three according to CI. There were no significant correlations between the indexes and clinical status of the patients. Elevation of patella relative to the femur in closing wedge valgus HTO procedure due to the shortening of the segment between tibial tuberosity and joint line is normally expected. A significant decrease in patellar height according to ISI suggests that there should be patellar tendon shortening as patellar height cannot be changed. BPI and CI for determining patellar height in valgus HTO do not accurately measure the alteration of patella because they may affect the tibial inclination and antero-posterior translation of the proximal fragment. Another measuring system based on femoral reference points should be proposed to determine the exact change of patellar height in the valgus HTO procedure.
Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot.
Endoscopic calcaneoplasty with the patient in the prone or supine position appears to be a safe and effective surgical procedure for the treatment of retrocalcaneal bursitis and Haglund's disease.
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