https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60353-5.pdf

Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales

Background The accuracy and maintenance of syndesmosis reduction are essential when treating ankle fractures with accompanying syndesmosis injuries. The primary aim of this study was to compare syndesmosis screw and TightRope fixation in terms of accuracy and maintenance of syndesmosis reduction using bilateral computed tomography (CT). Study design Single centre, prospective randomised controlled clinical trial; Level of evidence 1. Methods This study (ClinicalTrials.gov, NCT01742650) compared fixation with TightRope ® (Arthrex, Naples, FL, USA) or with one 3.5-mm tricortical trans-syndesmotic screw in terms of accuracy and maintenance of syndesmosis reduction in Lauge-Hansen pronation external rotation, Weber C-type ankle fractures with associated syndesmosis injury. Twenty-one patients were randomised to TightRope fixation and 22 to syndesmotic screw fixation. Syndesmosis reduction was assessed using bilateral CT intraoperatively or postoperatively, and also at least 2 years after surgery. Functional outcomes and quality of life were assessed using the Olerud–Molander score, a 100-mm Visual Analogue Scale, the Foot and Ankle Outcome Score, and the RAND 36-Item Health Survey. Grade of osteoarthritis was qualified with follow-up cone-beam CT. Results According to surgeons’ assessment from intraoperative CT, screw fixation resulted in syndesmosis malreduction in one case whereas seven syndesmosis were considered malreduced when TightRope was used. However, open exploration and postoperative CT of these seven cases revealed that syndesmosis was well reduced if the ankle was supported at 90˚. Retrospective analysis of the intra- and post-operative CT by a radiologist showed that one patient in each group had incongruent syndesmosis. Follow-up CT identified three patients with malreduced syndesmosis in the syndesmotic screw fixation group, whereas malreduction was seen in one patient in the TightRope group ( P  = 0.33). Functional scores and the incidence of osteoarthritis showed no significant difference between groups. Conclusion Syndesmotic screw and TightRope had similar postoperative malreduction rates. However, intraoperative CT scanning of ankles with TightRope fixation was misleading due to dynamic nature of the fixation. After at least 2 years of follow-up, malreduction rates may slightly increase when using trans-syndesmotic screw fixation, but reduction was well maintained when fixed with TightRope. Neither the incidence of ankle joint osteoarthritis nor functional outcome significantly differed between the fixation methods.

A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography.

Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.

Ankle osteoarthritis: etiology, diagnostics, and classification.

In multimodality imaging, the need to combine morphofunctional information can be approached by either acquiring images at different times (asynchronous), and fused them through digital image manipulation techniques or simultaneously acquiring images (synchronous) and merging them automatically. The asynchronous post-processing solution presents various constraints, mainly conditioned by the different positioning of the patient in the two scans acquired at different times in separated machines. The best solution to achieve consistency in time and space is obtained by the synchronous image acquisition. There are many multimodal technologies in molecular imaging. In this review we will focus on those multimodality image techniques more commonly used in the field of diagnostic imaging (SPECT-CT, PET-CT) and new developments (as PET-MR). The technological innovations and development of new tracers and smart probes are the main key points that will condition multimodality image and diagnostic imaging professionals' future. Although SPECT-CT and PET-CT are standard in most clinical scenarios, MR imaging has some advantages, providing excellent soft-tissue contrast and multidimensional functional, structural and morphological information. The next frontier is to develop efficient detectors and electronics systems capable of detecting two modality signals at the same time. Not only PET-MR but also MR-US or optic-PET will be introduced in clinical scenarios. Even more, MR diffusion-weighted, pharmacokinetic imaging, spectroscopy or functional BOLD imaging will merge with PET tracers to further increase molecular imaging as a relevant medical discipline. Multimodality imaging techniques will play a leading role in relevant clinical applications. The development of new diagnostic imaging research areas, mainly in the field of oncology, cardiology and neuropsychiatry, will impact the way medicine is performed today. Both clinical and experimental multimodality studies, in humans and animals, will have to demonstrate an efficient use of the imaging information provided by the modalities to affect the future of medical imaging.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/cmmi.393

Multimodality imaging techniques

Lateral ankle sprains have been shown to be one of the most common musculoskeletal injuries in both athletes and the recreationally active population. Moreover, it is estimated that approximately 30% of people who incur a lateral ankle sprain will sustain recurrent ankle sprains and experience symptoms of pain and instability that last > 1 year. Chronic ankle instability (CAI) is the term used to describe cases involving repetitive ankle sprains, multiple episodes of the ankle "giving way," persistent symptoms, and diminished self-reported function for > 1 year after the initial ankle sprain. The optimal conservative treatment for CAI is yet to be determined; however, comparison between patients with CAI and individuals showing no history of ankle sprain has revealed several characteristic features of CAI. These include diminished range of motion, decreased strength, impaired neuromuscular control, and altered functional movement patterns. We propose a new treatment paradigm for conservative management of CAI with the aim of assessing and treating specific deficits exhibited by individual patients with CAI.

A new paradigm for rehabilitation of patients with chronic ankle instability.

The precise localisation of osteoarthritic changes is crucial for selective surgical treatment. Single photon-emission CT-CT (SPECT-CT) combines both morphological and biological information. We hypothesised that SPECT-CT increased the intra- and interobserver reliability to localise increased uptake compared with traditional evaluation of CT and bone scanning together. We evaluated 20 consecutive patients with pain of uncertain origin in the foot and ankle by radiography and SPECT-CT, available as fused SPECT-CT, and by separate bone scanning and CT. Five observers assessed the presence or absence of arthritis. The images were blinded and randomly ordered. They were evaluated twice at an interval of six weeks. Kappa and multirater kappa values were calculated. The mean intraobserver reliability for SPECT-CT was excellent (kappa = 0.86; 95% CI 0.81 to 0.88) and significantly higher than that for CT and bone scanning together. SPECT-CT had significantly higher interobserver agreement, especially when evaluating the naviculocuneiform and tarsometatarsal joints. SPECT-CT is useful in localising active arthritis especially in areas where the number and configuration of joints are complex.

J. Müller-Brand

Papers

SPECT-CT imaging in degenerative joint disease of the foot and ankle