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Purpose: Osteochondral lesions of the talus are often located posteromedially requiring open surgery to facilitate solid and complete osteochondral reconstruction. The aim of the study was to identify the optimal anatomical site for medial malleolar osteotomy based on the criteria of minimal cartilage damage (Study I) and to report on the morbidity in patients receiving osteotomy performed at the previously identified site (Study II).Methods: For Study I, cartilage coverage of the tibiofibular ankle joint facet was measured in 40 cadaveric ankles (20 cadaver specimens). In Study II, we assessed clinical (VAS pain score, AOFAS score, range of motion) and radiological outcome measures (SPECT-CT) in 17 patients (mean age, 36.8 ± 10.8 years) undergoing medial malleolar osteotomy.Results: The medial edge in the transition zone of the tibial plafond to the medial malleolus showed less than 75 % of cartilage coverage in 62.5 % of cadavers (Study I). Surgery resulted in lower pain levels (2.4 ± 2.6 compared with 6.3 ± 1.8 points; p < 0.001) and greater AOFAS scores (82.9 ± 14.1 compared with 43.5 ± 10.8 to points; p < 0.001) compared with baseline (Study II). No signs of intra-operative damage or mal- or non-union were found. Long-term morbidity was found in one patient. Implant removal was necessary in 12 of 17 patients (71 %).Conclusion: Anatomically, there is an optimal location for the medial malleolar osteotomy at the medial ankle edge involving minimal cartilage damage. Clinical results using this location showed no short- or mid-term morbidity and little long-term morbidity. However, many patients required re-intervention for implant removal.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

The aim of this case report is to describe a novel technique for treatment of large osteochondral lesions of the talus using autologous matrix-induced chondrogenesis with a collagen I/III membrane. [ABSTRACT FROM AUTHOR]

River network structures are known to be scale-invariant, characterized by Horton scalingratios, and power-law relations between geomorphological variables (e.g., Hack&#x2019;s law). Rivernetworks also manifest scaling character for their functions, such as hydraulic geometry, orin-stream nutrient uptake processes. Human-related variables (e.g., human settlements) alsoreveal globally consistent scale-invariance over stream orders within a river basin. Based onscaling properties of river networks, recent work demonstrated scaling of dissolvedorganic carbon removal at the basin-scale (exported from diffuse sources). Ourrecent study showed that point-source nutrient loads discharged from wastewatertreatment plants (WWTPs) exhibited scaling properties in three large river basins inGermany. In the current study, we link these scaling ideas to investigate how spatiallyheterogeneous nutrient loads discharged from multiple urban point sources (i.e.,WWTPs) scale across urbanized basins. Available data from three German riverbasins for size distribution and locations of WWTPs are used to determine scalingof nutrient loads based on stream order hierarchy and spatial patterns based onGeomorphologic Width Function approach. Nutrient loads from spatially heterogeneouspoint sources are super-imposed in diffuse nutrient loads to produce spatially heterogeneouspatterns of nutrient concentrations. We examine the joint contribution of hydrologicdilution and in-stream processes to the emergent scaling across the entire basin ofwater-quality impairments (nutrient concentrations exceeding specified thresholds). [ABSTRACT FROM AUTHOR]