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Cavus foot is a complex podiatric deformity that requires precise and in-depth work-up through an objective, physical, and radiographic examination. The goal of surgical treatment is to eliminate pain while establishing a plantigrade foot structure. Triple arthrodesis has proven to be an effective surgical procedure for treatment of moderate to severe rearfoot deformity with or without the presence of rearfoot arthritic changes. The foot and ankle surgeon must always be aware that no two cavus deformity cases are alike, therefore one may require additional surgical procedures including soft tissue balancing, joint-sparing osteotomies, and/or supplementary arthrodesing procedures.

Isolated patellar resurfacing served as an early treatment for patellofemoral arthritis but was abandoned because of erosion of the native femoral trochlear groove over time. We present the case of a large native tibial osteolytic lesion 20 years after isolated patellar resurfacing with a cemented polyethylene component. The patient had severe tricompartmental arthritic changes. The patellar component was very worn, and the resultant particle debris produced a large cavitary lesion in the proximal tibia. Osteolysis is a rare complication in patellofemoral arthroplasty, and, to our knowledge, this is the first reported case of native tibial osteolysis after isolated patellar resurfacing. The patient was treated with initial curettage and bone grafting of the lesion followed by total knee arthroplasty with a tibial cone and stemmed tibial fixation.

PURPOSE OF REVIEW: Numerous surgical techniques are available to treat osteochondral defects of the knee. The aim of this review is to analyse these procedures, including their methodology, outcomes and limitations, to create a treatment algorithm for optimal management. RECENT FINDINGS: Osteochondral defects of the knee significantly alter the biomechanics of the joint. This can cause symptomatic and functional impairment as well as considerable risk of progressive joint degeneration. Surgical interventions aim to restore a congruent, durable joint surface providing symptomatic relief and reducing the risk of early arthritic changes. These methods include fixation, chondroplasty, microfracture, autologous matrix-induced chondrogenesis, autograft transplants, allograft transplants and autologous chondrocyte implantation. There is currently much debate as to which of these methods provides optimal treatment of osteochondral defects. SUMMARY: The overall evidence supports the use of each technique depending on the individual characteristics of the lesion. New technologies provide exciting prospects; however, long-term outcomes for these are not yet available.

This study aimed to describe the involvement of the lesser sigmoid notch in fractures to the coronoid process. We hypothesized that injuries to the lateral aspect of the coronoid process regularly involve the annular ligament insertion at the anterior lesser sigmoid notch.Patients treated for a coronoid process fracture at our institution between 06/2011 and 07/2018 were included. We excluded patients 18 years, patients with arthritic changes or previous operative treatment to the elbow, and patients with concomitant injuries to the proximal ulna. In patients with involvement of the lesser sigmoid notch, the coronoid height and fragment size (anteroposterior, mediolateral, and craniocaudal) were measured.Seventy-two patients (mean age: 47 years ± 17.6) could be included in the study. Twenty-one patients (29.2%) had a fracture involving the lateral sigmoid notch. The mean anteroposterior fragment length was 7 ± 1.6 mm. The fragment affected a mean of 43 ± 10.8% of the coronoid height. The mean mediolateral size of the fragment was 10 ± 5.0 mm, and the mean cranio-caudal size was 7 ± 2.7 mm.Coronoid fractures regularly include the lesser sigmoid notch. These injuries possibly affect the anterior annular ligament insertion which is important for the stability of the proximal radioulnar joint and varus stability of the elbow.ZIEL: Ziel dieser Untersuchung war es, die Beteiligung der Incisura radialis ulnae bei Frakturen des Proc. coronoideus ulnae zu untersuchen. Hypothese der Studie war es, dass bei Verletzungen des lateralen Proc. coronoideus ulnae regelmäßig die Bandinsertion des Lig. anulare der Incisura radialis ulnae beteiligt ist.Patienten, die mit einer Fraktur des Proc. coronoideus ulnae zwischen 06/2011 und 07/2018 in unserer Institution behandelt wurden, wurden in diese Untersuchung eingeschlossen. Ausgeschlossen wurden alle Patienten 18 Jahren, mit arthrotischen Veränderungen oder vorangegangenen Operationen am Ellenbogen sowie bei begleitenden Verletzungen der proximalen Ulna. Bei Beteiligung der Incisura radialis ulnae wurden die Frakturfragmente (anterio–posterior, medio-lateral und kraniokaudal) sowie die Koronoidhöhe standardisiert in der CT vermessen.Insgesamt konnten 72 Patienten mit einem Alter von 47 ± 17,6 Jahren eingeschlossen werden. Hiervon zeigten 21 Patienten (29,2%) eine Beteiligung der Incisura radialis ulnae. Die mittlere anterio–posteriore Fragmentgröße war 7 ± 1,6 mm, im Mittel waren 43 ± 10,8% der Koronoidhöhe beteiligt. Die mittlere medio-laterale Fragmentgröße war 10 ± 5,0 mm, die kraniokaudalen Ausmaße 7 ± 2,7 mm.Frakturen des Proc. coronoideus ulnae involvieren regelmäßig die Incisura radialis ulnae. Diese Verletzungen können die Insertion des Lig. anulare umfassen, welches für die Stabilität des proximalen Radioulnargelenks sowie für eine Varusstabilität des Ellenbogens entscheidend ist.

Background Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. Methods The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. Results In low-grade overlengthening (type I) conservative treatment can be an option. In Types II–IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. Discussion The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.

INTRODUCTION: A total ankle replacement in a jet pilot after an open, high-energy foot and ankle fracture and dislocation with talar extrusion in a plane crash was carefully evaluated before considering fitness to fly.CASE REPORT: A 33-yr-old male test pilot of the Italian Air Force was involved in a plane crash and reported an open high-energy fracture/dislocation of the right ankle, with the expulsion of the right talus due to the impact, and other fractures. A titanium replica was inserted inside the ankle. However, the patient suffered from intolerable pain and developed arthritic changes in the cartilage of the tibial plafond. For these reasons, a decision was made to perform a custom-made total ankle replacement.DISCUSSION: The 2-yr follow-up after the last operation and the evaluation of the pilot’s fitness to fly are reported in this case study. The pilot was assessed fit to fly, including high performance military aircrafts.Verde P, Guardigli S, Morgagni F, Roberts S, Monopoli D, Scala A. Total ankle replacement in a military jet pilot. Aerosp Med Hum Perform. 2020; 91(7):597–603.

Ulnar collateral ligament (UCL) injuries of the thumb are among the most common injuries of the hand. Whether the injury is acute or chronic, a complete rupture of the ligament is usually managed with operative repair to restore thumb stability with pinch and grip, as well as to avoid arthritic changes. Here we present a patient who underwent UCL repair. We will discuss the natural history, preoperative care, intraoperative technique, and postoperative considerations.

Arthritis of the hip is a degenerative disease characterised by pain and inflammation. It is common and most often affects middle-aged to older adults, with the definitive management being total hip replacement. Advances in the surgical techniques has brought about the popularity of hip preservation surgery in patients with pre-arthritic hip abnormalities, with a goal to prevent progression to early arthritis and subsequently prolong the need for arthroplasty. There is a large body of evidence correlating femoroacetabular impingement (FAI) and the progression of osteoarthritis. Hip arthroscopy is a successful technique in the management of FAI and labral damage. There is, however, less evidence behind its use in those patients with established arthritic changes. After review of such evidence, we believe hip arthroscopy, and other hip preservation procedures, have a key role, and should be considered in the management of early hip arthritis. However, there is no role for such procedures in end-stage arthritis.

Osteonecrosis of the femoral head (ONFH) affects mainly young patients and causes secondary hip osteoarthritis if remains untreated. Several operative treatments have been introduced with successful outcomes in the early stages. However, in late stages of ONFH treatment may be challenging due to the progressive nature of disease and many surgeons prefer arthroplasty option after collapse. Considering the size, age and etiology an effort should be made to preserve hip joint selected patients with early collapse or minimal arthritic changes. The purpose of the current review is to discuss the results of joint preserving procedures for late stages of ONFH.

Background The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints. Methods We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes. Results The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P Conclusions Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis. Level of evidence: III, observational study.

This is a technique guide for open anterior capsule reconstruction in unstable native hips due to Ehlers–Danlos syndrome. Ehlers–Danlos syndrome is a connective tissue disease that predisposes an individual to hypermobility of their soft tissues and recurrent subluxations and dislocations of their joints. This may lead to constant instability, guarding of the hip, and subsequent arthritic changes and poor quality of life. We demonstrate anterior capsule reconstruction of the hip using an Achilles tendon allograft performed through a direct anterior approach to the hip (Heuter's approach). This technique guide outlines in detail the surgical steps required to accomplish this reconstructive procedure. Furthermore, a narrated surgical video is provided that clearly depicts the anticipated result of the increased constrained provided to the hip from the anterior capsule reconstruction using an Achilles tendon allograft.

Double radial tears of the lateral meniscus are rare injuries that typically occur in the setting of an acute anterior cruciate ligament rupture. Full-thickness radial tears of the meniscus body and root render the meniscus nonfunctional from a loss of hoop stress resistance. Repair of these tears can normalize contact pressures in the lateral compartment and delay arthritic changes. We describe our technique for repairing a lateral meniscus body radial tear and concomitant posterior root tear, via inside-out suture repair and transtibial suture repair, respectively. This investigation was performed at Mayo Clinic.

BACKGROUND Medial discoid meniscus (MDM) is an exceedingly rare anatomic abnormality that presents similarly to other meniscal pathologies. Symptomatic MDM is typically managed arthroscopically with mixed short-term and long-term outcomes, although the existing knowledge about MDM is limited. The purpose of this study was to describe the presentation and surgical treatment of MDM in pediatric and adolescent patients. METHODS Medical records of 12 knees with MDM in 8 pediatric and adolescent patients treated between 1991 and 2016 were reviewed retrospectively for patient characteristics, clinical manifestations, radiographic findings, operative techniques, and surgical outcomes. RESULTS Of the 446 knees diagnosed arthroscopically with discoid menisci, lateral discoid meniscus was noted in 434 knees (97.3%) and MDM was present in 12 knees (2.7%). The MDM series included 8 patients of mean age 13.8 years (range: 7.8 to 19.8), of which 5 were males (63%), and 4 (50%) had bilateral involvement. Of the 11 knees with available clinical records, all cases presented symptomatically (pain, mechanical symptoms); 10 (91%) had concurrent physical exam findings. On intraoperative examination, discoid morphologies were described as complete in 4/8 knees (50%) or incomplete in 4/8 (50%), with associated instability in 6/12 (50%). Meniscal tears were reported in 9 cases (75%)-primarily, horizontal cleavage tears. Saucerization was performed in 11 knees (92%), with medial meniscal repair in 7 (58%), when indicated. Retear of the medial meniscus occurred in 4/11 knees (36%) at a mean of 25.8 months postoperation; 2 knees required revisions. One knee developed arthrofibrosis and underwent arthroscopic lysis of adhesions. CONCLUSIONS MDM is a rare diagnosis, representing 3% of all discoid menisci, with a nonspecific clinical manifestation. Operative management of symptomatic MDM typically involves saucerization and meniscal repair, when indicated, for concurrent tears. Symptom resolution is common short-term, but long-term outcomes include recurrent meniscal tears. Subsequent observational studies are important to evaluate long-term outcomes, such as arthritic changes, with the advancement of arthroscopic techniques for meniscal preservation. LEVEL OF EVIDENCE Level IV-retrospective case series.

BACKGROUND: Posterolateral corner (PLC) injuries of the knee are often overlooked for its complex anatomy, and frequent association with cruciate ligament injuries. Overlooked injuries lead to reconstruction failure of cruciate ligaments, chronic knee pain and early arthritic changes. Many reconstruction methods are described, but the best treatment still remains elusive. In this study, we have treated grade-III PLC injuries by the ‘anatomic LaPrade’ technique and the ‘fibula-based Modified Larson’ technique, and evaluated their outcomes. Our hypothesis was that both the groups will have similar improvements after surgery. METHODS: An open-label prospective comparative study was done with a total of 28 patients from August 2013 to July 2019. Patients were treated alternatively by LaPrade or Modified Larson technique using hamstring autografts. Follow-up visits were done at sixth week and subsequently at 3, 6, 12, 18 and 24 months postoperatively. Outcomes were measured by Dial Test, side-to-side difference in lateral opening on varus stress radiographs, Lysholm score and IKDC subjective score. RESULTS: During analysis, we considered 25 patients only as three patients were lost to follow-up. Both the groups had comparable improvements in rotational stability, lateral opening on varus stress, Lysholm score and IKDC subjective score. CONCLUSION: Both LaPrade and Modified Larson technique showed good clinical results in restoring varus and rotational stability of knee in grade-III posterolateral corner injury of the knee. LEVEL OF EVIDENCE: II (prospective, comparative study)

Background Thumb carpometacarpal joint (CMCJ) osteoarthritis is common and can lead to significant morbidity making it a condition frequently treated by hand surgeons when initial conservative measures fail. The surrounding ligamentous structures are complex and important to maintain thumb CMCJ stability. Objectives The aim of this study was to review the normal and arthritic anatomy of the thumb CMCJ, focusing on morphology and position of osteophytes and the gap between metacarpal bases, and the effect of these on intermetacarpal ligament integrity. This may be the sole ligament suspending the first metacarpal following trapeziectomy and could determine the need for further stabilization during surgery, avoiding potential future failures. Methods Computed tomography (CT) scans of a normal cohort and those with arthritic changes who had undergone trapeziectomy following the scan were identified. The three-dimensional reconstructions were examined for osteophyte position on the saddle and the intermetacarpal distance. Results A total of 55 patients, 30 normal and 25 arthritic, were identified and studied. The most common anatomic position for osteophytes was the intermetacarpal ulnar aspect of the trapezium. The intermetacarpal distance increased by an average of 2.1 mm in the presence of the arthritic process. Conclusions The findings point to an increase in the intermetacarpal distance, and hence lengthening of the ligament with potential damage, possibly secondary to osteophyte formation and wear. Further prospective research is required to determine whether using preoperative CT scanning to define osteophyte position and measure the intermetacarpal distance would predict probable damage to the ligament, hence providing an indication for stabilization and reconstruction in trapeziectomy surgery. Level of Evidence This is a Level III, retrospective cohort study.

Irreparable rotator cuff tears (IRCTs) in young and considerably active patients are difficult to treat because it is mostly associated with poor outcome which may lead to a painful and dysfunctional shoulder. Most of the IRCTs are encountered in massive size rotator cuff tears which associated with high failure rate following surgical repair. Thus, the IRCTs was considered challenging for its poor healing rate following repair which may induce the arthritic changes. Since the advent of arthroscopic superior capsular reconstruction (ASCR) of the shoulder in 2013, it has gained its popularity. The procedure has become the most popular option for joint-preserving shoulder surgery for patients with IRCTs. It works by providing a static restraint to the superior humeral head migration to optimize the rotator cuff force couples, hence improving joint kinematics. The acceptance of superior capsular reconstruction has made it rapidly evolving in terms of a wider variety of procedures and broader surgical indications. Despite the enthusiasm and widely acceptance towards the procedure, there are still many queries that exist regarding the best indications, surgical technique particularly graft of choice, the long-term outcome, and the complication and risk of the superior capsular reconstruction (SCR). This narrative review provide the current evidence of SCR in an attempt to provide a state-of-the-art knowledge.

OBJECTIVE. Imaging plays a critical role in the assessment of patients with femoroacetabular impingement (FAI). With better understanding of the underlying pathomechanics and advances in joint-preserving surgery, there is an increasing need to define the most appropriate imaging workup. The purpose of this article is to provide guidance on best practices for imaging of patients with FAI in light of recent advances in corrective FAI surgery. CONCLUSION. Pelvic radiography with dedicated hip projections is the basis of the diagnostic workup of patients with suspected FAI to assess arthritic changes and acetabular coverage and to screen for cam deformities. Chondrolabral lesions should be evaluated with unenhanced MRI or MR arthrography. The protocol should include a large-FOV fluid-sensitive sequence to exclude conditions that can mimic or coexist with FAI, radial imaging to accurately determine the presence of a cam deformity, and imaging of the distal femoral condyles for measurement of femoral torsion. CT remains a valuable tool for planning of complex surgical corrections. Advanced imaging, such as 3D simulation, biochemical MRI, and MR arthrography with application of leg traction, has great potential to improve surgical decision-making. Further research is needed to assess the added clinical value of these techniques.

Case A 62-year-old woman with a medical history of nail-patella syndrome (NPS) presented with chronic right shoulder pain. Physical examination revealed that her right shoulder had a restricted range of motion. Radiograph of the shoulder revealed arthritic changes with glenohumeral joint space narrowing, inferior humeral head osteophytes, and posterior glenoid wear. The patient was successfully treated with total shoulder arthroplasty (TSA). The patient had an uneventful postoperative course and was satisfied with her quality of life at the 30-month follow-up. Conclusion TSA may be successfully performed with careful reaming of the hypoplastic glenoid fossa in patients with NPS.

Treatment of irreparable rotator cuff tears can be one of the most difficult problems for orthopedic surgeons to address. While the decision-making process is sometimes straightforward, as in the elderly patient with an irreparable rotator cuff tear, this problem presents a significant challenge in the young patient without significant arthritic changes. Superior capsular reconstruction (SCR) has emerged as a viable treatment option for treating irreparable rotator cuff tears in patients with pain and loss of function who do not have a significant amount of arthritis. While there are many options for graft choice when performing a SCR, dermal allograft has been shown to provide good clinical and radiographic results without the morbidity of an autograft harvest. Continued work is needed to understand the long-term outcomes from SCR with dermal allograft.

Study Design: Cross-sectional survey. Objectives: Degenerative cervical myelopathy (DCM) is a common syndrome of acquired spinal cord impairment caused by canal stenosis secondary to arthritic changes of the spine. International guidelines consider physiotherapy an option for mild, stable DCM; however, few studies have been conducted on nonoperative management. The objective was to determine current usage and perceptions of nonoperative physiotherapy for DCM. Methods: Persons with DCM were recruited to a web-based survey. Participants with complete responses that had not received surgery were included (n = 167). Variables included symptom duration, treatment history, current disability, and demographic characteristics. Results: Disease and demographic characteristics were equivalent between those who did and did not receive physiotherapy. In all, 19.5% of physiotherapy recipients reported subjective benefit from physiotherapy. Those perceiving benefit had significantly higher mJOA (modified Japanese Orthopaedic Association) scores, lower neck pain scores, and shorter symptom duration. In multivariate logistic regression analysis, those with mild DCM were more likely to perceive benefit than those with severe DCM, as were those with moderate DCM (to a lesser extent). Individuals whose diagnosis was delayed 1 to 2 years were less likely to perceive benefit than those that waited 0 to 6 months. Conclusions: The provision of nonoperative physiotherapy in the management of DCM is inconsistent and appears to differ from international guidelines. Few patients perceived benefit from physiotherapy; however, this was more likely in those with mild DCM and in those with shorter symptom durations. Further work is needed to establish the appropriate role of physiotherapy for this population.

The purpose of this study was to investigate the clinical and radiographic outcomes of arthroscopic iliac bone grafting with capsulolabral reconstruction for severe glenoid bone loss with a minimum of 5 years' follow-up.The inclusion criterion was shoulders that underwent arthroscopic iliac bone grafting for20%-25% glenoid defect between January 2007 and April 2014, and the exclusion criterion was5 years' follow-up. Iliac crest bone grafts of approximately 2.0 cm length and 0.8 cm height were arthroscopically fixed to the anterior glenoid using 2 cannulated screws followed by capsulolabral repair. Rowe score, Western Ontario Shoulder Instability Index (WOSI), and passive range of motion were evaluated. Radiographic findings including the Kellgren and Lawrence osteoarthritis grade and graft integration on 3-dimensional computed tomography at the final follow-up were also evaluated.Forty-eight shoulders met the inclusion criteria, and 24 shoulders with ≥5 years' follow-up were included (1 died; 23 were lost follow-up): 22 males, 2 females; a mean age at surgery, 30 years (range, 18-52 years); a mean follow-up of 8 years (range, 5-11 years). The mean preoperative glenoid bone defect was 22% (range, 20%-28%). All shoulders had a Hill-Sachs lesion including 4 on-track lesions. One shoulder experienced traumatic redislocation at 5 years after surgery. The scores significantly improved: Rowe score, 19 ± 8 to 94 ± 8 (P.001); WOSI, 1547 ± 241 to 439 ± 318 (P.001). Postoperative flexion showed significant improvement from 158 ± 18 to 169 ± 11 (P = .008), whereas internal rotation deteriorated from T8 ± 3 to T10 ± 3 (P = .005). Graft integration showed remodeling in 54% and excessive absorption in 13%. Osteoarthritis grades progressed significantly (P.001), but only grade 1 osteoarthritic changes were seen, except for 4 shoulders with grade 2 osteoarthritis.Arthroscopic iliac bone grafting for traumatic anterior shoulder instability with severe glenoid bone loss yielded satisfactory outcomes with mid-term follow-up. Arthritic changes progressed in half of the shoulders; however, most shoulders only demonstrated grade 1 osteoarthritis.Level IV, therapeutic case series.

Purpose: To report mid- to long-term clinical and radiological outcomes after microfracturing for symptomatic chondral defects of the glenohumeral joint Methods: All patients who underwent glenohumeral arthroscopic microfracturing between 2002 and 2012 at a single center were considered for inclusion in this retrospective study. Clinical outcome was evaluated using the Constant Score, Oxford Shoulder Score, and Subjective Shoulder Value. Progression of joint space narrowing, sclerosis, marginal osteophytes, and presence of cysts over time were assessed using 4 different radiological grading systems Results: A total of 16 patients (n = 9 female, n = 7 male) with a mean age of 51.8 ± 12.6 years at the time of surgery and a mean follow-up of 122 ± 51.2 months (range, 61-204 months) were included in this retrospective study. Nine patients (56.3%) showed an isolated chondral defect, while 7 patients (43.8%) had concomitant pathologies. Constant Score (60.3 ± 12.7 vs. 85.9 ± 9.3; P < .001), Oxford Shoulder Score (29.0 ± 5.8 vs. 42.4 ± 4.5; P < .001), and Subjective Shoulder Value (23.9 ± 7.4 vs. 84.3 ± 10.9; P < .001) changed significantly from pre- to postoperative. The majority of patients (88%) were able to return to their preoperative level of activity. Three patients (19.8%) developed radiological signs of progressive glenohumeral degeneration during the study period. However, only 1 patient (6.25%) showed a progression of arthritic changes of more than 1 grade according to radiographic classifications. Two patients (12.5%) underwent revision surgery to a hemi shoulder arthroplasty during the study period at 12 and 36 months after the initial procedure Conclusions: Glenohumeral microfracturing is commonly performed together with other procedures, but seems to be a feasible treatment option for contained cartilage lesions in active patients reproducibly yielding good mid- to long-term outcome. Level of Evidence: Level IV, therapeutic case series.

Introduction. Cubonavicular coalitions represent a relatively rare condition with less than forty cases described in the literature, the majority of which are fibrocartilaginous. To our knowledge, cubonavicular osseous coalition associated with osteoarthritis of the midfoot has never been described.Case Presentation. We present the case of a 26-year-old man with bilateral Achilles tendinosis, in whom radiological studies show an incidental finding of a complete osseous cubonavicular coalition, as well as a partial osseous cubo-third cuneiform coalition and a fibrous band between the first and second cuneiforms of the right foot, associated with arthritic changes of the tarsometatarsal joint. A nonosseous calcaneocubonavicular coalition was found on the left foot. These multiples coalitions were asymptomatic in this case.Discussion. Cubonavicular coalition, even asymptomatic, can cause midfoot osteoarthritis in young patients. We may therefore suspect that the immobility of the cubonavicular joint causes additional stress on the midfoot.

Previous studies have attempted to characterize patellar morphology and its relation to patellofemoral osteoarthritis but have utilized relatively small samples. We designed a large-scale cadaveric analysis to elucidate any potential relationship. Patellar morphology in 1,032 patellae was characterized using patellar facet concavity patterns initially developed by Wiberg and using the ratio of the lateral and medial facet lengths. Patellofemoral arthritis grading for specimens was previously completed based primarily on osteophytic burden. The average age at time of death was 56 ± 10 years. Wiberg's grading returned kappa values of 0.43 for intrarelator reliability and 0.27 for interrelator reliability. Using multiple regression analysis, Wiberg's type II was found to be correlated with patellofemoral arthritis (p = 0.003). Lateral to medial facet ratio measurements returned intraclass coefficients of 0.91 for intrarelator reliability and 0.85 for interrelator reliability. There was no association between lateral to medial facet ratio and osteoarthritis. Regression analysis between Wiberg's typing and lateral-to-medial ratio (L:M) resulted in a coefficient of determination of 0.14. To our knowledge, this is the largest study evaluating the relationship between patellar morphology and arthritis. Although there was a relationship between Wiberg's type II and patellofemoral arthritis, the Wiberg systems was not easily reproducible in our study and returned a correlation with arthritis different then anatomically expected. A more reproducible system of lateral to medial facet ratio was investigated but did not find an association with arthritic changes. Given these findings, we did not find a patella morphology grading system which is both reliable and valid in regard to association with patellofemoral arthritis.

This review investigated the potential value of computed tomography (CT) scans for the evaluation and management of knee arthritis and arthroplasty. Specifically, we evaluated the following: (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. To compare if CT or X-ray imaging is more accurate and clinically relevant, a search was performed using Boolean search operators and terms: “CT,” “radiograph,” “joint alignment,” “knee,” and “arthroplasty,” which yielded 661 results. Studies were evaluated based on (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. Correlative and comparative analyses of imaging modalities to pre-, intra-, and postoperative clinical and patient-related factors were performed for the 63 included studies. CT scans were found to better detect medial and lateral arthritic changes, bony deformities, subchondral cysts, and cartilage losses. CT scans were shown to 99% accurately predict prosthetic sizes preoperatively. CT scans can also help better visualize surrounding anatomy, such as the posterior cruciate ligament, and have therefore been linked to better soft tissue protection during total knee arthroplasty. Although radiation is a potential concern, newer imaging protocols have comparable exposure to plain radiographs. Compared with plain radiographs, CT scans were found to be more accurate and provide more clinically relevant data. Therefore, the authors recommend the use of CT for the evaluation of certain patients with arthritis and for preoperative planning for knee arthroplasty.

Background: There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic ankle instability. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively ( P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points ( P < .001), 8 patients (36.4%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression of arthritis stage. Conclusions: Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability. Level of Evidence: Level IV, retrospective case series.

Flatfoot is the most common foot disease, the prevalence of which is 30-70% according to many authors. Planovalgus foot deformity asymptomatically existing for a long time can further lead to pain syndrome and limping, sensitivity disorders, trophic disorders, limitation of foot joints mobility, development of arthritic changes with corresponding progression of the function impairment. Timely initiation of treatment, complex pathogenetic and symptomatic therapy as well as strict adherence to the doctor's recommendations help to achieve maximum effect. The aims of treatment of patients with flatfoot are posture stabilization and support of overloaded zones of the plantar surface, improvement of supply of the foot and musculoskeletal apparatus, as well as foot joints, and reduction of pain syndrome. Despite the prevalence of pathology, as well as a wide range of methods of treatment and rehabilitation, conservative treatment does not always lead to a positive result and the problem remains unresolved. This literature review describes the main directions of conservative therapy of patients with flatfoot from the view of evidence-based medicine. The data on the use of special ortheses and orthopedic shoes for correcting the foot deformities are discussed with a description of possible complications. The main forms of exercise therapy used to stabilize the foot muscles tonus, are analyzed. The application of physiotherapeutic factors aimed at improving trophic and blood supply of tissues, as well as strengthening of the musculoskeletal apparatus of the lower legs and feet, is described. Data on the use of complex conservative treatment of patients with flatfoot are presented. The article also focuses on the use of drug therapy as part of the complex treatment.

The lateral meniscus is vital in dissipating the force in the lateral compartment of the knee. A complete radial tear of the meniscus can lead to extrusion, rendering it nonfunctional and resulting in deleterious arthritic changes to the lateral compartment. Arthroscopic repair of a complete radial tear of the lateral meniscus poses a challenge to orthopaedic surgeons. Although some would advocate for meniscectomy, we present a technique for an outside-in repair using 3 sutures and standard arthroscopic portals. Overall, this provides for an excellent reduction of the meniscus.

Purpose The purpose of this study was to establish consensus statements via a modified Delphi process on the Latarjet procedure, remplissage, and glenoid-bone grafting for anterior shoulder instability. Methods A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. Results The technical approaches identified in the statements on the Latarjet procedure and glenoid bone-graft were that a subscapularis split approach should be utilized, and that it is unclear whether a capsular repair is routinely required. Furthermore, despite similar indications, glenoid bone-grafting may be preferred over the Latarjet in patients with bone-loss greater than can be treated with a coracoid graft, and in cases of surgeon preference, failed prior Latarjet or glenoid bone-grafting procedure, and epilepsy. In contrast, the primary indications for a remplissage procedure was either an off-track or engaging Hill-Sachs lesion without severe glenoid bone loss. Additionally, in contrast to the bone-block procedure, complications following remplissage are rare, and loss of shoulder external rotation can be minimized by performing the tenodesis via the safe-zone and not over medializing the fixation. Conclusion Overall, 89% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the prognostic factors that are important to consider in those undergoing a glenoid bone-grafting procedure including age, activity level, Hill-Sachs Lesion, extent of glenoid bone-loss, hyperlaxity, prior surgeries, and arthritic changes. Furthermore, there was unanimous agreement that it is unclear whether a capsular repair is routinely required with a glenoid bone graft, but it may be beneficial in some cases. There was no unanimous agreement on any aspect related to the Latarjet procedure or Remplissage. Level of Evidence Level V: expert opinion.

Background Acetabular labral tears in the hip have become an increasingly common finding in active duty members due to improved diagnostic capabilities. This has led to a dramatic increase in operative management despite a lack of evidence to support clear long-term benefits. Literature review demonstrated overwhelmingly positive short-term outcomes for labral repairs; however, scattered case reports exist demonstrating debilitating outcomes in young patients, ultimately resulting in total hip arthroplasty. Case report A 27-yr-old pilot originally presented with groin pain. Initial X-ray demonstrated a CAM lesion of the right hip and subsequent MRA showed an acetabular labral tear. The patient underwent open arthrotomy with labral repair and femoroplasty with minimal improvement in symptoms. Repeat imaging over 2 yr showed early onset osteoarthritis with rapid progression and a recurrent labral tear. Due to the significant progression of osteoarthritis, the patient was given the choice between a repeat labral repair and total hip arthroplasty. The patient elected for hip arthrotomy with labral repair and extensive synovectomy, which yielded minimal improvement in symptoms. Discussion Acetabular labral tears have become a hot topic in the field of orthopedics as a result of a surge in diagnoses likely due to improvements in imaging, most notably MRAs. This has led to considerable debate regarding how to best manage this condition. The literature overwhelmingly shows positive short-term outcomes for surgical management; however, long-term follow-up studies are lacking. The literature has demonstrated multiple case reports resulting in significant complications as a result of these operations, including chondrolysis and eventual need for total hip arthroplasty. Therefore, patient selection is critical as the population tends to be young and active, and the potential complications can be catastrophic. In any case, it is clear that further research is required.Sardon CJ, Resnick ML. Severe arthritic changes following acetabular labral repair and femoroplasty in an air force pilot. Aerosp Med Hum Perform. 2018; 89(2):147-150.

Background: Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method. Purpose: To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables. Results: A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort. Conclusion: The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.

Treatment of scaphoid fractures has been focused mainly on achieving union, with less attention to restoring normal scaphoid shape and orientation. Malalignment of one carpal bone will disrupt the kinetics of the entire wrist. The dorsal intercalated segment instability deformity associated with scaphoid waist nonunion is a nondissociative form of carpal instability. It has to be reduced in the treatment of scaphoid waist nonunions to avoid kinetic problems that will lead to arthritic changes. Computerized tomography scanning has become indispensable to visualize the humpback deformity clearly. Different techniques may be used to restore the normal anatomy of scaphoid, from non-vascularized graft to arthroscopic bone grafting, and also the option of vascularized bone grafting.

Aim. To evaluate the features of formation of posttraumatic heterotopic ossification of the elbow; to develop their classification allowing to differentially resolve the issues of tactics and treatment and outcome predicting. Methods. 292 patients were observed with elbow fractures and fracture-dislocations (group B and C according to AO/ASIF classification). 40 (14%) of them were diagnosed with posttraumatic heterotopic ossification. Results. This complication more frequently occurred in fracture-dislocations (23 patients, 57.5%) than in T-U-shaped fractures (13 patients, 32.5%). Thus, the factor of soft tissue trauma plays one of the key roles in the occurrence of this complication. Timelines of ossification occurrence also have some patterns causing a direct relationship with the severity of the damage. Indeed, in fracture-dislocations ossification within 5 weeks after the trauma was identified in 70% of cases, while in T-U-shaped fractures and other damage - only in 40%. Herewith, some correlation is identified for patient’s age and gender: ossification occurs in the early stages more often in men under the age of 30 years. We developed a classification of posttraumatic heterotopic ossification of the elbow allowing to effectively determine the tactics, treatment and prognosis of the outcomes of ossification. In case of mild and moderate severity of ossification management is conservative and functional and occupational prognoses are favorable. In case of severe ossification surgical treatment is recommended. Primary and secondary arthritic changes should be considered. Both functional and professional prognoses are unfavorable. Results of the treatment are: good - 70%, satisfactory - 25% and unsatisfactory - 5%. Conclusion. Dependence of occurence of posttraumatic heterotopic ossification from a number of factors was determined (magnitude of anatomical damage of the soft tissues surrounding the joint, gender and age, treatment tactics, rehabilitation methods), suggested classification allows to differentially resolve the issues of treatment and outcome prediction.

Uvod: Liječenje zapuštenih slučajeva posttraumatskog pes equinovarusa u odrasloj dobi veoma je zahtjevno. Radi se o rigidnim deformacijama stražnjeg dijela stopala koje su popraćene uznapredovalim osteoartrotskim promjenama. U korekciji deformiteta potrebna je primjena kombinacije koštanih i mekotkivnih zahvata. Prikaz slučaja: U ovom radu prikazano je liječenje posttraumatskog deformiteta stopala s varusom gležnja od 40, Introduction: Neglected pes equinovarus deformity at the adulthood is difficult to correct. It is usually a rigid deformity associated with arthritic changes of the hindfoot joint. Combined bone and soft tissue procedure is necessary to correct the deformity. Case report: We present a case of acquired severe rigid pes equinovarus in adulthood with varus ankle of 40

Stickler syndrome or hereditary progressive arthro-ophthalmopathy is an autosomal dominant condition characterized by ocular manifestations, arthritic changes, orofacial features, and deafness, in variable degrees. This is a case report of a 48-day-old infant who presented with severe feeding difficulty. It also details the clinical, diagnostic features, and management of an infant with Stickler syndrome.

Many treatment options have been proposed for treatment of irreparable posterosuperior rotator cuff tears. Among these options, latissimus dorsi tendon transfer can be considered a good alternative, especially in young patients before development of glenohumeral arthritic changes, aiming at rebalancing the shoulder with a functioning subscapularis muscle and restoring both active external rotation and elevation with the aid of a properly functioning deltoid muscle. The technique was recently adapted from open to arthroscopically assisted with numerous advantages. We propose a combined fully arthroscopic technique for transfer of latissimus dorsi and teres major in which the tendons are fixed in a flat manner at the junction of supraspinatus and infraspinatus to decrease failure rate.

This study sought to develop a noninvasive, reliable, clinically relevant, and easy-to-implement mouse model that can be used for investigation of the pathophysiology of PTOA and for preclinical testing of new therapies of PTOA. Accordingly, we have established a closed intraarticular tibial plateau compression loading-induced injury model of PTOA in C57BL/6J mice. In this model, a single application of a defined loading force was applied with an indenter to the tibial plateau of the right knee to create injuries to the synovium, menisci, ligaments, and articular cartilage. The limiting loading force was set at 55 N with the loading speed of 60 N/s. This loading regimen limits the distance that the indenter would travel into the joint, but still yields substantial compression loading energy to cause significant injuries to the synovium, meniscus, and articular cartilage. The joint injury induced by this loading protocol consistently yielded evidence for key histological hallmarks of PTOA at 5–11 weeks post-injury, including loss of articular cartilage, disorganization of chondrocytes, meniscal hyperplasia and mineralization, osteophyte formation, and degenerative remodeling of subchondral bone. These arthritic changes were highly reproducible and of a progressive nature. Because 50% of patients with meniscal and/or ligament injuries without intraarticular fractures developed PTOA over time, this intraarticular tibial plateau compression loading-induced injury model is clinically relevant. In summary, we have developed a noninvasive intraarticular tibial plateau compression loading-induced injury model in the mouse that can be used to investigate the pathophysiology of PTOA and for preclinical testing for new therapies.

Purpose To deduce the contributing factors to idiopathic condylar resorption in young female patients, we hypothesized that 17β-estradiol (E2) deficiency would cause arthritic changes in the mandibular condyle under mechanical overloading in a rat model. We also hypothesized that osseous changes in the microstructure by the combination of E2 deficiency and mechanical overloading would be different depending on the region of the condyle. Materials and Methods The mandibular condyles of female Sprague-Dawley rats were mechanically overloaded (50g) 8 weeks after an ovariectomy (OVX). Changes in the condyles were analyzed with micro–computed tomography and histochemical and immunohistochemical staining. Results The size of the mandibular condyle decreased significantly with OVX or mechanical loading. The incidence of arthritic changes, including osteophyte formation, bone erosion, and flattening, was significantly different between the sham and OVX groups. The posterior parts of the condyles showed poor bone quality before OVX, and their condition significantly worsened with reduced bone mineral density and bone volume/tissue volume, as well as a sparse trabecular pattern. Conclusions E2 deficiency and mechanical overloading of the temporomandibular joint cause morphologic changes in the mandibular condyle and changes in the osseous microstructure, which are more apparent in areas of poor bone quality.

Background Medial meniscus posterior root tear can result in medial meniscus extrusion. However, the severity of medial meniscus extrusion is different in each root tear patient. The purpose of this study was to identify the factors that contribute to the severity of medial meniscus extrusion with medial meniscus posterior root tear, such as duration of disease, the degree of arthritis—chondral wear, subchondral edema, osteophyte size, and Kellgren–Lawrence (K/L) grade—and mechanical alignment for appropriate treatment method. Methods From January 2009 to August 2014, we retrospectively analyzed magnetic resonance imaging (MRI) and simple x-ray of 99 patients with medial meniscus posterior root tear. The duration of the disease was identified through retrospective chart review. The severity of medial meniscus extrusion, the presence of subchondral edema, the degree of chondral wear, and the size of the osteophyte were measured on MRI. K/L grade was confirmed on simple x-ray, and the mechanical axis was measured on whole extremity radiographs. Statistical analysis was performed by using bivariate correlation analysis and one-way analysis of variance. Results The mean medial meniscus extrusion was 4.61 mm, and the mean duration of the disease was 15.52 months. The mean degree of chondral wear was 25.8%, and 63 out of 99 cases showed subchondral edema. The average alignment was 4.30 degrees, and the average size of the osteophyte was 1.48 mm. There were 40 cases (40.4%) with K/L grade I, 48 cases (48.5%) with grade II, 11 cases (11.1%) with grade III, and no cases with grade IV. In the group mean analysis between the K/L grade and the severity of medial meniscus extrusion, the average medial meniscus extrusions were 3.97 mm in grade I, 4.93 mm in grade II, and 5.59 mm in grade III. There was a statistical significance between the size of the osteophyte and the severity of medial meniscus extrusion (P = 0.000), K/L grade, and the severity of medial meniscus extrusion (P = 0.001). Conclusions The severity of medial meniscus extrusion with medial meniscus posterior horn root tear is associated with the size of the osteophyte and K/L grade.

© 2020 American Society for Surgery of the Hand Purpose: To evaluate the radiographic and clinical outcomes of patients with scaphoid malunion after acute fracture at a mean of 7 years after injury. Methods: Patients with scaphoid malunion were identified from a departmental database of acute scaphoid fractures. Patients with a scaphoid height-to-length ratio greater than 0.6 on final follow-up computed tomography (CT) scan were considered malunited. These patients were contacted to return for CT imaging and clinical assessment. A total of 22 patients were included (4 females and 18 males). Average age of the group was 41 years (range, 16–64 years) and average length of follow-up was 7.4 years (range, 4.4–11.8 years) after injury. Results: Ten patients who underwent CT imaging demonstrated arthritic changes at the radial styloid, scaphoid fossa, or scaphotrapeziotrapezoid joint(s). Despite this, patients had good clinical function that was not significantly different compared with the uninjured side. Patients reported minimal pain and disability based on patient-reported outcome measures, and there was a moderate correlation between passive range of motion and height-to-length ratio. Conclusions: Nearly half of all patients with malunited acute scaphoid fractures demonstrated radiographic findings of early arthritis on CT imaging but overall good clinical results on midterm follow-up. Type of study/level of evidence: Prognostic IV.

To determine the relationship between preoperative subluxation of the original menisci and postoperative graft subluxation after lateral meniscal allograft transplantation (MAT). Forty patients who underwent isolated lateral MATs in meniscus-deficient knees with a low-grade chondral lesion (≤ICRS grade 2) were assessed. Lateral subluxation of the native meniscus before meniscectomy and those of remaining meniscal tissue before MAT were measured on mid-coronal MRI scans taken at each time point. Postoperative meniscal subluxation was assessed using MRI at 6 months postoperatively, when the full rehabilitation protocols were completed. Correlation analyses were conducted to determine the associations between each of two preoperative lateral displacements and the postoperative graft subluxation. The mean lateral subluxations before primary meniscectomy and before MAT were 0.3 ± 1.0 mm and 0.2 ± 0.8 mm, respectively. At 6 months postoperatively, it was 2.3 ± 1.9 mm. There were no significant correlations between the preoperative subluxation at the two preoperative time points and the postoperative extrusion (Spearman rho 2-sided test: ρ = − 0.058, (n.s.) for the native meniscus; Pearson r 2-sided test, r = 0.309, (n.s.) for the remaining meniscal rim). Between the postoperative nonextruded and extruded groups, there were no significant differences for the preoperative subluxations. There are no associations between preoperative lateral subluxation of the native menisci and postoperative subluxation of meniscal transplants in patients who undergo MAT on the lateral compartment with low-grade arthritic changes. The extrusion phenomenon may be a distinct feature of transplanted menisci rather than an individual characteristic of meniscal displacement. Surgeons need to keep in mind that graft extrusion in nonarthritic knees might occur during transplantation. IV.

In athletes, scapholunate injuries may be misdiagnosed as wrist sprains which over time almost invariably lead to scapholunate advanced collapse (SLAC) of the wrist. In this setting, arthritic changes progress from the radioscaphoid joint to the lunocapitate interval, usually preserving the radiolunate articulation. Treatment options for SLAC range from nonoperative alternatives to wrist denervation, limited intercarpal fusions, proximal row carpectomy, and total wrist fusion. This article describes four-corner fusion and proximal row carpectomy as 2 widely used and successful options for the management of SLAC.

Loss of knee range of motion after anterior cruciate ligament (ACL) reconstruction is a very disabling problem. Loss of motion can not only lead to the development of anterior knee pain, inability to return to sports, and persistent weakness but also be a significant cause of the early arthritic changes that are often seen with ACL injuries. Unfortunately, motion loss is often overlooked or not fully appreciated as a cause to postoperative knee pain, limited function, or subsequent arthritic changes. Loss of motion after an ACL reconstruction can have devastating outcomes that often persist despite treatment. Given the overall poor results after surgical treatment of motion loss, it is best to prevent motion issues from arising in the first place.

Introduction: Hip arthroscopy for treatment of femoroacetabular impingement (FAI) has shown significant pain and functional improvement. However, the differential outcome of each of the FAI morphological types in contrast to one another remains largely unknown. This study was conducted to detect a possible difference in outcome among different FAI types treated using hip arthroscopy.Methods: In this prospective non randomized comparative study, after exclusion of non-FAI cases and cases with advanced arthritic changes, 90 hips in 85 patients that had hip arthroscopy for the treatment of FAI between 2011 and 2015 in our center were analyzed. The collected patient reported outcome measures (PROMs) included visual analog scale (VAS) of pain, the modified Harris hip score (mHHS), and the non arthritic hip score (NAHS) both preoperatively and at final follow-up. Patient satisfaction was collected at final follow-up. Postoperative PROMs were subjected to three main comparisons based on each of FAI type, labral procedure, and extent of cartilage damage. Repeat comparison based on FAI type after matching of exact chondrolabral condition was also attempted.Results: Mean follow-up was 32.8 months (five patients lost from follow-up). There was a significant improvement in the overall PROMs. This improvement was significantly higher in the cam group in contrast to the mixed group. After matching for chondrolabral condition, this difference was consistent and more evident.Discussion: The outcome of arthroscopic treatment of pure cam FAI is significantly better than that of mixed FAI. Matching of the same chondrolabral condition and repeating the comparison yields similar results.

Many pathological deformities affect the midfoot joints including pes planovalgus, pes cavus, and Charcot neuroarthropathy. These joints are susceptible to primary and post-traumatic arthritic changes secondary to chronic instability or traumatic degeneration. The naviculocuneiform joint plays a unique role in midfoot articulations and maintenance of the medial longitudinal arch. The navicular itself can be prone to stress fractures and subsequent avascular process that contributes to damage of the articulating cuneiform surfaces. A common treatment for degenerative arthritis of the naviculocuneiform joint is arthrodesis. This chapter highlights the morphology recognition and fusion techniques that can be utilized for a successful arthrodesis of the naviculocuneiform joint.