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Jeuken R, Vles G, Jansen E, Loeffen D, Emans P. The Modified Hedgehog Technique to Repair Pure Chondral Shear-off Lesions in the Pediatric Knee. Cartilage 2021; 13:271S-279S. [PMID: 31215793 PMCID: PMC8808865 DOI: 10.1177/1947603519855762] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The paediatric knee is prone to pure chondral shear-off lesions due to the developing osteochondral unit. Refixation of the chondral fragment is commonly done using metalwork or absorbable biomaterials. Both fixation methods come with biomaterial-related drawbacks. Earlier work on chondral allografts for cartilage repair in adults has shown successful osteochondral integration when the chondral allograft is treated with multiple incisions and then glued to the subchondral bone using fibrin glue. This is commonly referred to as the "hedgehog technique." This study investigates the feasibility of a modification of the hedgehog technique in autologous cartilage to repair shear-off lesions in children. DESIGN Three consecutive patients (aged 11, 12, and 14 years) with shear-off chondral fragments of 2, 5, and 8 cm2 were treated using this modified hedgehog technique. The calcified side of the chondral fragments were multiply incised and trimmed obliquely for an interlocking fit in the defect site. Fibrin glue and, if indicated sutures, were applied to fix the fragment to the defect. In 1 patient, an anterior cruciate ligament (ACL) repair was also performed. Patients were evaluated clinically and by magnetic resonance imaging (MRI) up to 12 months postoperatively. RESULTS Twelve months after surgery, all patients reported no pain and showed complete return to sport and full range of motion. MRI showed no signs of fragment loosening. CONCLUSIONS The modified hedgehog technique is a feasible treatment option to repair pure chondral shear-off lesions in the paediatric knee. This was the first time this technique was used in autografting.
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Affiliation(s)
- R.M. Jeuken
- Department of Orthopaedic Surgery and
Laboratory for Experimental Orthopedics, Maastricht University Medical Center,
Maastricht, The Netherlands,R.M. Jeuken, Department of Orthopaedic
Surgery and Laboratory for Experimental Orthopedics, Maastricht University
Medical Center, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.
| | - G.F. Vles
- Department of Trauma and Orthopaedics,
University College Hospital London, Fitzrovia, London, UK
| | - E.J.P. Jansen
- Department of Orthopaedic Surgery,
Zuyderland Medical Center, Sittard, Geleen, The Netherlands
| | - D. Loeffen
- Department of Radiology, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - P.J. Emans
- Department of Orthopaedic Surgery and
Laboratory for Experimental Orthopedics, Maastricht University Medical Center,
Maastricht, The Netherlands
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Hopp SJ, Pizanis A, Briem J, Hahner J, Mettelsiefen L, Herath SC, Histing T, Pohlemann T, Fritz T. A novel press-fit minimally-invasive symphysiodesis technique. J Exp Orthop 2020; 7:67. [PMID: 32940814 PMCID: PMC7498525 DOI: 10.1186/s40634-020-00284-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
Objective Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery. Methods We developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments. Results Using this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure. Conclusion Thus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis.
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Affiliation(s)
- Sascha J Hopp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany.,Groin Pain and Core Injury Center, Lutrina Clinic, Karl-Marx-Straße 33, 67655, Kaiserslautern, Germany
| | - Antonius Pizanis
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Jeremy Briem
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Jill Hahner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Laura Mettelsiefen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany
| | - Tobias Fritz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Saarland, Kirrbergerstr 1, 66421, Homburg/Saar, Germany.
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Rollmann MF, Herath SC, Histing T, Braun BJ, Schmalenbach J, Draenert Y, Draenert K, Pohlemann T. Long-term results of reconstructing the joints' articular surface in the knee and ankle with the surgical diamond instrumentation (SDI). Eur J Trauma Emerg Surg 2020; 47:1627-1634. [PMID: 32086544 DOI: 10.1007/s00068-020-01318-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The surgical diamond instrumentation (SDI), a precise wet-grinding technology, promised contact healing of press-fit inserted bone and even hyaline cartilage, lacks medium- and long-term results. This retrospective study was conducted to identify risk factors associated with the failure of the technique and the subjective patient outcome. METHODS All patients treated for cartilage defects of the knee or ankle joint using the SDI technology between 2000 and 2012 with a follow-up > 1 year were included. Patients with general joint diseases or joint-related procedures, except for corrective osteotomies, were excluded. A standardized questionnaire (EQ-5D) and a questionnaire-based patient-reported outcome survey were used. Descriptive statistics were applied. A multivariate analysis examining risk factors for joint failure was performed. A p value < 0.05 was considered to indicate significant differences. RESULTS 87 patients with autologous osteochondral transplantation (68 knee, 19 ankle) were included. The median age was 53 years (IQR 37.5-63.0 years) for knee and 36 years (IQR 27.5-54.0 years) for ankle joints. 57.9% of knee and 55.6% of ankle patients were female. Nine patients (8 knee, 1 ankle) had received arthroplasty. 93.3% of knee and 83.3% of ankle patients had an excellent function or minor disabilities. 73.3% of knee and 64.7% of ankle patients did not require pain medication. The mean EQ-5D score was 0.84 for knee and 0.77 for ankle. Patients with higher age were more likely to receive arthroplasty (p = 0.022). CONCLUSIONS The SDI technique provides promising results with excellent joint survival rates and satisfying patient-reported outcomes. Failure of the technique might be associated with higher age.
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Affiliation(s)
- Mika Frieda Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg, Saar, Germany.
| | - Steven Christian Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Tina Histing
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Benedikt Johannes Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Julia Schmalenbach
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg, Saar, Germany
| | - Yvette Draenert
- Center of Orthopaedic Research, Gabriel-Max-Str. 3, 81545, München, Germany
| | - Klaus Draenert
- Center of Orthopaedic Research, Gabriel-Max-Str. 3, 81545, München, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, 66421, Homburg, Saar, Germany
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Herath SC, Braun BJ, Rollmann MF, Mörsdorf P, Holstein JH, Pohlemann T. Autologous Transplantation of Press-fit Bone Cylinders in the Treatment of Pelvic Nonunion. Orthop Surg 2019; 11:516-523. [PMID: 31050213 PMCID: PMC6595114 DOI: 10.1111/os.12463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/27/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022] Open
Abstract
The present study describes method for autologous bone transplantation to an area of nonunion at the pelvic ring in a way that ensures the best possible bone‐to‐bone interface (“press‐fit”) and provides optimal preconditions for the ingrowth of the bone graft. We modified a technique that has been used to transplant press‐fit bone‐baseplate‐cartilage cylinders for the repair of joint cartilage defects. The technique allows for precise harvesting of bone cylinders with a diamond‐coated and fluid‐cooled instrument. At the site where the graft shall be inserted, a cylindrical hole is created with a corresponding hollow diamond‐coated trephine. This ensures an optimal press‐fit implantation of the graft. The new surgical technique has been applied in four patients with nonunion of the pelvic ring. No intraoperative or postoperative complications occurred. In three patients, the procedure led to a reduction of pain and a higher level of mobility as well as a timely radiographic union (imaging not available for another patient). Our technique offers a valuable new treatment option for pelvic nonunion. The current article serves as a proof of concept. Future comparative studies will have to determine its value in detail.
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Affiliation(s)
- Steven C Herath
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Mika F Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Philipp Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Jörg H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
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Draenert KD. CORR Insights(®): Reamed Intramedullary Nailing has an Adverse Effect on Bone Regeneration During the Distraction Phase in Tibial Lengthening. Clin Orthop Relat Res 2016; 474:825-6. [PMID: 26758441 PMCID: PMC4746181 DOI: 10.1007/s11999-016-4696-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/04/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Klaus Dieter Draenert
- Center for Orthopaedic Sciences, Gabriel-Max-Strasse 3, Munich, Bavaria 81545 Germany
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