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Featured Application: Osseous landmarks are of great importance in the anatomical placement of the graft in ACL reconstruction. Differentiating which of them are more reliable than others thus improves surgical procedures. During knee arthroscopy, easy orientation is important, and possible landmarks include the lateral intercondylar ridge (LIR) and the lateral bifurcate ridge (LBR). The objective was to show the feasibility of the LIR and the LBR as landmarks of the femoral attachment of the anterior cruciate ligament (ACL) among subjects with different levels of training. Thirty-six formalin-phenol-fixed lower extremities were acquired for this prospective macroscopic anatomical study. All soft tissue apart from the ligaments was removed. The two bundles of the ACL and their origins were identified, marked and photographed. Photographs were taken in an arthroscopic setting. An orthopedic surgeon, an anatomist and a medical student identified the ridges. The LIR existed in 80.6% of samples, while the LBR existed in 13.8% of samples. A significant difference existed between the raters in correctly identifying the LIR (p < 0.01). Due to its high frequency, the LIR seems more reliable than the LBR, especially as the LBR has the potential for false positive identification. Nevertheless, as these ridges are not easily discernible, the surgeon has to know the anatomy of the intercondylar notch perfectly to stand even a small chance of correctly placing drill holes in ACL reconstruction. New guidelines for more easily recognizing LIR and LBR arthroscopically are proposed. [ABSTRACT FROM AUTHOR]

Purpose: The decision regarding the timepoint of a return to sports after anterior cruciate ligament (ACL) reconstruction is complex and depends on many factors, including objectively tested physical and psychological readiness as well as biological healing. The aim of this study was to investigate the influence of repetitive extracorporeal shockwave therapy (ESWT) on return-to-sports duration, clinical results and MRI results after ACL reconstruction with hamstring tendons (HT). Material and Methods: In this prospective controlled study, all patients with acute ACL ruptures were treated by ACL reconstruction with HT. Patients were randomized into two groups (Group A: ESWT group; Group B: control group). Patients in the ESWT group received focused shockwave therapy 4, 5 and 6 weeks after ACL surgery. Follow-up investigations including IKDC score, Lysholm score, VAS and evaluation regarding return-to-sports timepoints that were conducted 3-, 6-, 9- and 12-months post-operation. An MRI investigation was performed 12-months post-operation and graft maturation (signal intensity ratio (SIR)) as well as femoral and tibial tunnel characteristics (bone marrow oedema, tunnel fluid effusion) were assessed. Results: In total, 65 patients (27.65 ± 7.07 years; 35 male/30 female) were included in this study. The mean timepoint for "return-to-pivoting-sports" was 27.92 weeks (±2.99) in the ESWT group as well as 42.64 weeks (±5.18) in the control group (p < 0.001). In the ESWT group 31 patients (vs. control group: n = 6) attained the "pre-injury activity level", whereas 6 patients (vs. control group: n = 22) did not reach this level within 12 months post-operation. The IKDC score, Lysholm score, and VAS showed significant improvement in the ESWT group compared with the control group for all time-points (p < 0.001). The mean SIR in the ESWT group revealed 1.81 (±0.88), whereas the control group showed a mean SIR of 2.68 (±1.04) (p < 0.01). Discussion: In conclusion, this is the first study investigating the effect of repetitive ESWT on ACL reconstruction with clinical outcome measurements, including the duration of return-to-sports activity and an MRI follow-up examination. Return-to-sports parameters, clinical scores and graft maturation were significantly improved in the ESWT group. This study may support an earlier return-to-sports timepoint by ESWT and is of high clinical relevance as ESWT is a cost-effective treatment option with no relevant side effects. [ABSTRACT FROM AUTHOR]

Abstract Background Distal radius fractures (DRF) are one of the most common fractures and often need surgical treatment, which has been validated through biomechanical tests. Currently a number of different fracture models are used, none of which resemble the in vivo fracture location. The aim of the study was to develop a new standardized fracture model for DRF (AO-23.A3) and compare its biomechanical behavior to the current gold standard. Methods Variable angle locking volar plates (ADAPTIVE, Medartis) were mounted on 10 pairs of fresh-frozen radii. The osteotomy location was alternated within each pair (New: 10 mm wedge 8 mm / 12 mm proximal to the dorsal / volar apex of the articular surface; Gold standard: 10 mm wedge 20 mm proximal to the articular surface). Each specimen was tested in cyclic axial compression (increasing load by 100 N per cycle) until failure or −3 mm displacement. Parameters assessed were stiffness, displacement and dissipated work calculated for each cycle and ultimate load. Significance was tested using a linear mixed model and Wald test as well as t-tests. Results 7 female and 3 male pairs of radii aged 74 ± 9 years were tested. In most cases (7/10), the two groups showed similar mechanical behavior at low loads with increasing differences at increasing loads. Overall the novel fracture model showed a significant different biomechanical behavior than the gold standard model (p < 0,001). The average final loads resisted were significantly lower in the novel model (860 N ± 232 N vs. 1250 N ± 341 N; p = 0.001). Conclusion The novel biomechanical fracture model for DRF more closely mimics the in vivo fracture site and shows a significantly different biomechanical behavior with increasing loads when compared to the current gold standard.