Session 6: Pediatrics/Foot and Ankle
Onsdag den 25. oktober
11:00-12:00
Lokale: Helsinki/Oslo
Chairmen: Bjarne Møller Madsen og Jeannette Penny
Ahmed Abdul-Hussein Abood, Bjarne Møller-Madsen, Juan Manuel Shiguetomi-Medina, Morten Lykke Olesen, Hans Stødkilde-Jørgensen, Casper Bindzus Foldager, Ole Rahbek
Children's Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; MR Center, Aarhus University Hospital; Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital
Background: The use of biological material is currently explored for prevention of bone bridge formation, however no novel treatment technique has been proposed. An improvement in current clinical practice can be of great value to the affected children.
Purpose / Aim of Study: To investigate the efficacy of allogenic cartilage combined with platelet-rich plasma (PRP) for physeal repair in a porcine experimental gap model.
Materials and Methods: The study was carried out in six immature pigs. Allogenic cartilage was harvested from low-weight-bearing parts of the femoral condyle in pigs from the same breed. The cartilage was frozen and stored. Preoperatively, autologous venous blood was drawn from the animal. It was centrifuged using a commercial PRP kit (GPS® III, Zimmer Biomet). Standardized cylindrical defects were created in both hind legs of all included animals mimicking a defect after resection of a physeal bone bridge. The right leg was randomized for filling with allogenic cartilage, PRP and Tiseel® (Group A) or PRP and Tiseel® (Group B). The left leg received the other treatment. The cartilage was thawed and rinsed with saline. Perioperatively, it was cut into small chips of approximately 1 mm. The cartilage was blended with the Tiseel® and enriched with 1 mL of PRP. The mixture was inserted into the empty defect upon randomization. The contralateral defect was filled with Tiseel® and enriched with 1 mL of PRP. All animals underwent MRI scanning at 14 weeks.
Findings / Results: Formation of a bone bridge occurred in one animal (17%) in Group B. No animals (0%) formed a bone bridge in Group A. Water- content MRI showed a mean of 16,7% higher water-content in Group A compared to B.
Conclusions: Allogenic cartilage chips can prevent the formation of bone bridges when combined PRP and Tiseel®. The use of allogenic cartilage can spare the joint cartilage.
Children's Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; MR Center, Aarhus University Hospital; Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital
Background: The use of biological material is currently explored for prevention of bone bridge formation, however no novel treatment technique has been proposed. An improvement in current clinical practice can be of great value to the affected children.
Purpose / Aim of Study: To investigate the efficacy of allogenic cartilage combined with platelet-rich plasma (PRP) for physeal repair in a porcine experimental gap model.
Materials and Methods: The study was carried out in six immature pigs. Allogenic cartilage was harvested from low-weight-bearing parts of the femoral condyle in pigs from the same breed. The cartilage was frozen and stored. Preoperatively, autologous venous blood was drawn from the animal. It was centrifuged using a commercial PRP kit (GPS® III, Zimmer Biomet). Standardized cylindrical defects were created in both hind legs of all included animals mimicking a defect after resection of a physeal bone bridge. The right leg was randomized for filling with allogenic cartilage, PRP and Tiseel® (Group A) or PRP and Tiseel® (Group B). The left leg received the other treatment. The cartilage was thawed and rinsed with saline. Perioperatively, it was cut into small chips of approximately 1 mm. The cartilage was blended with the Tiseel® and enriched with 1 mL of PRP. The mixture was inserted into the empty defect upon randomization. The contralateral defect was filled with Tiseel® and enriched with 1 mL of PRP. All animals underwent MRI scanning at 14 weeks.
Findings / Results: Formation of a bone bridge occurred in one animal (17%) in Group B. No animals (0%) formed a bone bridge in Group A. Water- content MRI showed a mean of 16,7% higher water-content in Group A compared to B.
Conclusions: Allogenic cartilage chips can prevent the formation of bone bridges when combined PRP and Tiseel®. The use of allogenic cartilage can spare the joint cartilage.
Michael Skovdal Rathleff, Thomas Graven-Nielsen, Per Hölmich, Lukasz Winiarski, Kasper Krommes, Kristian Thorborg
Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University; Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital
Background: Patellofemoral pain (PFP) affects 7% of adolescents, especially the highly sports active. Current exercise-focused treatments are only effective for 30%. Previous exercise-focused treatments have not modified and controlled sports activity. Thus, a different treatment strategy is warrented as many adolescents continue to engage in the same high level sports despite knee pain.
Purpose / Aim of Study: The purpose of this study was to investigate the effect of a novel treatment strategy focusing on load management among adolescents with PFP.
Materials and Methods: This pre-registered prospective cohort study included 151 adolescents from 10-14 years of age with PFP. The intervention lasted 12 weeks and included four visits with a physiotherapist. The intervention included activity modification (week 0-4) to reduce loading of the patellofemoral joint using an activity ladder paradigm including pain monitoring, progressive home-based strengthening exercises (week 4-12), and a progression model for return to sport (week 4-12). Primary outcome was self-reported recovery at 3 months on a 7-point Likert- scale ranging from “much improved” to “much worse”. Adolescents were considered recovered if they reported “much improved” or “improved”.
Findings / Results: The median age was 13 years and the median symptom duration was 18 months. 83% participated regularly in sports while 24% used analgesics for their knee pain at baseline. At 12 week follow-up, 87% completed the questionnaire, of which 86% reported they were recovered and 7% used analgesics. 90% were satisfied with the result of the treatment and 95% would recommend it to a friend.
Conclusions: Activity modification, progressive strengthening exercises, and return to sports following a progression model appears highly effective compared to previous exercise-focused trials among adolescents with PFP.
Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University; Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital
Background: Patellofemoral pain (PFP) affects 7% of adolescents, especially the highly sports active. Current exercise-focused treatments are only effective for 30%. Previous exercise-focused treatments have not modified and controlled sports activity. Thus, a different treatment strategy is warrented as many adolescents continue to engage in the same high level sports despite knee pain.
Purpose / Aim of Study: The purpose of this study was to investigate the effect of a novel treatment strategy focusing on load management among adolescents with PFP.
Materials and Methods: This pre-registered prospective cohort study included 151 adolescents from 10-14 years of age with PFP. The intervention lasted 12 weeks and included four visits with a physiotherapist. The intervention included activity modification (week 0-4) to reduce loading of the patellofemoral joint using an activity ladder paradigm including pain monitoring, progressive home-based strengthening exercises (week 4-12), and a progression model for return to sport (week 4-12). Primary outcome was self-reported recovery at 3 months on a 7-point Likert- scale ranging from “much improved” to “much worse”. Adolescents were considered recovered if they reported “much improved” or “improved”.
Findings / Results: The median age was 13 years and the median symptom duration was 18 months. 83% participated regularly in sports while 24% used analgesics for their knee pain at baseline. At 12 week follow-up, 87% completed the questionnaire, of which 86% reported they were recovered and 7% used analgesics. 90% were satisfied with the result of the treatment and 95% would recommend it to a friend.
Conclusions: Activity modification, progressive strengthening exercises, and return to sports following a progression model appears highly effective compared to previous exercise-focused trials among adolescents with PFP.
Ahmed Abdul-Hussein Abood, Bjarne Møller-Madsen, Juan Manuel Shiguetomi-Medina, Hans Stødkilde-Jørgensen, Casper Bindzus Foldager, Ole Rahbek
Children's Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; MR Center Skejby, Aarhus University Hospital; Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital
Background: Bone bridges can occur due to physeal injury. This can lead to partial growth arrest and bone deformities. The current treatment is ineffective.
Purpose / Aim of Study: Investigate efficacy of autologous cartilage for physeal repair in a porcine experimental gap model.
Materials and Methods: Five immature pigs were included in the study. At baseline the medial part of the distal femoral physis was injured in both legs using a 6 mm cannulated drill. The drill was inserted 1.5 cm into the bone creating a standardized gap mimicking a defect after resection of a physeal bone bridge. The defects were rinsed with sterile saline. Upon randomization, the right leg was selected for either filling of defect with cartilage chips and Tiseel® (Group A, n =5) or Tiseel only (Group B, n=5). Cartilage was harvested from low-weight-bearing parts of the femoral condyle of the leg randomized for cartilage treatment. A sharp incision through the skin, patellar ligament and Hoffa’s fat pad was made. The articular surface was exposed. Through two 6 mm punches sites were designated and harvested. The cartilage fragments were cut with a scalpel perioperatively into smallest possible sized chips. The chips were molted with the Tisseel® and inserted into the empty defect. Tiseel® was inserted into the contralateral empty defect. The animals were housed for 14 weeks. MRI was performed at 14 weeks.
Findings / Results: No bone bridges were found on MRI in Group A. In Group B one case of bone bridge formation was verified. The water- content measured on MRI, showed a greater mean value (9,5%) in Group B.
Conclusions: Bone bridges were prevented when autologous cartilage chips were added to the Tiseel®. This suggests that transplantation of autologous cartilage chips may play a role in preventing bone bridge formation.
Children's Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital; Orthopaedic Research Laboratory, Aarhus University Hospital; MR Center Skejby, Aarhus University Hospital; Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital
Background: Bone bridges can occur due to physeal injury. This can lead to partial growth arrest and bone deformities. The current treatment is ineffective.
Purpose / Aim of Study: Investigate efficacy of autologous cartilage for physeal repair in a porcine experimental gap model.
Materials and Methods: Five immature pigs were included in the study. At baseline the medial part of the distal femoral physis was injured in both legs using a 6 mm cannulated drill. The drill was inserted 1.5 cm into the bone creating a standardized gap mimicking a defect after resection of a physeal bone bridge. The defects were rinsed with sterile saline. Upon randomization, the right leg was selected for either filling of defect with cartilage chips and Tiseel® (Group A, n =5) or Tiseel only (Group B, n=5). Cartilage was harvested from low-weight-bearing parts of the femoral condyle of the leg randomized for cartilage treatment. A sharp incision through the skin, patellar ligament and Hoffa’s fat pad was made. The articular surface was exposed. Through two 6 mm punches sites were designated and harvested. The cartilage fragments were cut with a scalpel perioperatively into smallest possible sized chips. The chips were molted with the Tisseel® and inserted into the empty defect. Tiseel® was inserted into the contralateral empty defect. The animals were housed for 14 weeks. MRI was performed at 14 weeks.
Findings / Results: No bone bridges were found on MRI in Group A. In Group B one case of bone bridge formation was verified. The water- content measured on MRI, showed a greater mean value (9,5%) in Group B.
Conclusions: Bone bridges were prevented when autologous cartilage chips were added to the Tiseel®. This suggests that transplantation of autologous cartilage chips may play a role in preventing bone bridge formation.
Polina Martinkevich, Ole Rahbek, Maiken Stilling, Line Kjeldgaard Pedersen, Martin Gottliebsen , Kjeld Søballe, Bjarne Møller-Madsen
Children's Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital; Orthopedic Surgery, Aarhus University Hospital; Children's Orthopaedics, Aalborg University Hospital; Children's Orthopedics, Aarhus University Hospital; Orthopaedic Surgery, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital
Background: What if we could avoid donor site pain from harvest of iliac crest bone graft by using hydroxyapatitetricalciumphosphate (HATCP) as a structural bone graft for calcaneal lengthening osteotomies (CLO) in children?
Purpose / Aim of Study: To compare the structural durability of HATCP to autologous iliac crest bone graft in CLO for symptomatic flexible pes planovalgus (FPPV) by using radiostereometric analysis (RSA).
Materials and Methods: A randomised controlled two-group parallel non- inferiority design with equal randomisation ratio of 1:1 with one year follow-up. Patients symptomatic PPV aged between 5-16 years were included. The primary outcome measure was the stability of the osteotomy, assessed by RSA. Measurements were obtained on the 1st/2nd postoperative day, at 6 weeks, 8 weeks, 6 months and at one year follow-up. Secondary, the health related quality of life was assessed by the Oxford Ankle Foot Questionnaire, before surgery, at 6 months and one year follow-up. Other outcome measures were the postoperative pain, analgesics consumption and complications. Statistics: We would accept the HATCP group to loose no more than a mean of 2 mm lengthening of the osteotomy in comparison to the AUTO group at one-year follow-up.
Findings / Results: There were 7 patients in the HATCP group and 5 in the AUTO group. One patient was excluded after 8 weeks, due to revisional surgery The difference in graft compression between the two groups (HATCP graft compression minus AUTO graft compression) was 2.02 mm (two-sided 90% CI: 0.73; 3.29). Both groups showed similar improvement of the OxAFQ scores at final follow-up. Complications were more frequently observed in the HATCP group,
Conclusions: We find HATCP to be of limited value as a structural bone graft for calcaneal lengthening osteotomies in its current form.
Children's Orthopaedics, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital; Orthopedic Surgery, Aarhus University Hospital; Children's Orthopaedics, Aalborg University Hospital; Children's Orthopedics, Aarhus University Hospital; Orthopaedic Surgery, Aarhus University Hospital; Children's Orthopaedics, Aarhus University Hospital
Background: What if we could avoid donor site pain from harvest of iliac crest bone graft by using hydroxyapatitetricalciumphosphate (HATCP) as a structural bone graft for calcaneal lengthening osteotomies (CLO) in children?
Purpose / Aim of Study: To compare the structural durability of HATCP to autologous iliac crest bone graft in CLO for symptomatic flexible pes planovalgus (FPPV) by using radiostereometric analysis (RSA).
Materials and Methods: A randomised controlled two-group parallel non- inferiority design with equal randomisation ratio of 1:1 with one year follow-up. Patients symptomatic PPV aged between 5-16 years were included. The primary outcome measure was the stability of the osteotomy, assessed by RSA. Measurements were obtained on the 1st/2nd postoperative day, at 6 weeks, 8 weeks, 6 months and at one year follow-up. Secondary, the health related quality of life was assessed by the Oxford Ankle Foot Questionnaire, before surgery, at 6 months and one year follow-up. Other outcome measures were the postoperative pain, analgesics consumption and complications. Statistics: We would accept the HATCP group to loose no more than a mean of 2 mm lengthening of the osteotomy in comparison to the AUTO group at one-year follow-up.
Findings / Results: There were 7 patients in the HATCP group and 5 in the AUTO group. One patient was excluded after 8 weeks, due to revisional surgery The difference in graft compression between the two groups (HATCP graft compression minus AUTO graft compression) was 2.02 mm (two-sided 90% CI: 0.73; 3.29). Both groups showed similar improvement of the OxAFQ scores at final follow-up. Complications were more frequently observed in the HATCP group,
Conclusions: We find HATCP to be of limited value as a structural bone graft for calcaneal lengthening osteotomies in its current form.
Peter Buxbom, Stig Sonne-Holm, Christian Wong
Orthopedic Department, Hvidovre University Hospital; Orthopedic Department, Hvidovre University Hospital; Orthopedic Department, Hvidovre University Hospital
Background: The surgical treatment of symptomatic flexible flatfoot in children depends on the severity of the malalignment of the hind and middle foot. The extra-articular subtalar arthrodesis (EAA) ad modum Grice is considerably less invasive than the intra- articular triple arthrodesis (IAA), but is it just as stable?
Purpose / Aim of Study: To assess the radiostereometric analysis (RSA) stability of the subtalar fusion in EAA and IAA.
Materials and Methods: 4-8 markers were inserted in both talus and calcaneus, which afterwards were used to analyse the RSA. The children were cast immobilized for 10 weeks, but allowed weight-bearing the last 5 weeks within the cast. RSA follow-up were planned 0, 5, 10 weeks, 6 and 12 months after surgery. RSA data were valid if CN < 150 and ME < 0.350.
Findings / Results: Eight EAA and 10 IAA were included in the study. In the analysis of both the EAA and the IAA group, there were considerable migration before achieving RSA stability. One EAA and two IAA remained RSA unstable until cast removal, but did not show signs of migration after cast removal. In this small population we did not see considerable different healing patterns between the two groups.
Conclusions: In the included groups we did not see differences in RSA stability between EAA and IAA.
Orthopedic Department, Hvidovre University Hospital; Orthopedic Department, Hvidovre University Hospital; Orthopedic Department, Hvidovre University Hospital
Background: The surgical treatment of symptomatic flexible flatfoot in children depends on the severity of the malalignment of the hind and middle foot. The extra-articular subtalar arthrodesis (EAA) ad modum Grice is considerably less invasive than the intra- articular triple arthrodesis (IAA), but is it just as stable?
Purpose / Aim of Study: To assess the radiostereometric analysis (RSA) stability of the subtalar fusion in EAA and IAA.
Materials and Methods: 4-8 markers were inserted in both talus and calcaneus, which afterwards were used to analyse the RSA. The children were cast immobilized for 10 weeks, but allowed weight-bearing the last 5 weeks within the cast. RSA follow-up were planned 0, 5, 10 weeks, 6 and 12 months after surgery. RSA data were valid if CN < 150 and ME < 0.350.
Findings / Results: Eight EAA and 10 IAA were included in the study. In the analysis of both the EAA and the IAA group, there were considerable migration before achieving RSA stability. One EAA and two IAA remained RSA unstable until cast removal, but did not show signs of migration after cast removal. In this small population we did not see considerable different healing patterns between the two groups.
Conclusions: In the included groups we did not see differences in RSA stability between EAA and IAA.
Kristoffer W. Barfod, Anja Falk Riecke, Anders Boesen, Philip Hansen, Jens Friedrich Maier, Simon Doessing, Anders Troelsen
Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Orthopedics, Copenhagen University Hospital Køge, Denmark.; Institute of Sports Medicine, Copenhagen University Hospital Bispebjerg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Køge, Denmark; Department of Orthopedics, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Denmark
Background: Valid length measurements of the different segments of the Achilles tendon, that connect to the three muscle bellies of the triceps surae are needed in order to investigate if differential elongation of the Achilles tendon takes place after rupture.
Purpose / Aim of Study: The purpose of this paper is to present data concerning accuracy and reliability of an ultrasound measurement of the free part of the Achilles tendon.
Materials and Methods: Both legs of 19 non-injured subjects were examined by MRI and ultrasound. The length from the distal tip of the soleus muscle to the tendon insertion on calcaneus was measured by three independent ultrasound examiners. Repeated ultrasound measurements were performed and compared to MRI measurements. Intra-rater and inter-rater reliability and the agreement between MRI and ultrasound were determined. Data were evaluated using the Intraclass Correlation Coefficient (ICC), the Standard Error of the Measurement (SEM) and the Minimal Detectable Change (MDC).
Findings / Results: The measurement showed excellent intra-rater reliability (ICC 0.94 [0.91;0.96], SEM 5mm and MDC 13mm) and inter-rater reliability (ICC 0.96 [0.93;0.97], SEM 4mm and MDC 11mm). Ultrasound measurements on average exceeded the MRI measurements by 2mm (n.s.); resulting in a measurement error of 5%.
Conclusions: The ultrasound measurement of the free part of the Achilles tendon showed good reliability and accuracy. For comparison between groups of non-injured subjects differences of more than 5mm can be detected. For repeated assessment of individual subject differences ≥ 13mm can be detected. The US measurement is a promising clinical tool to be further assessed in the setting of acute Achilles tendon rupture.
Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Orthopedics, Copenhagen University Hospital Køge, Denmark.; Institute of Sports Medicine, Copenhagen University Hospital Bispebjerg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg & Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Køge, Denmark; Department of Orthopedics, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Denmark
Background: Valid length measurements of the different segments of the Achilles tendon, that connect to the three muscle bellies of the triceps surae are needed in order to investigate if differential elongation of the Achilles tendon takes place after rupture.
Purpose / Aim of Study: The purpose of this paper is to present data concerning accuracy and reliability of an ultrasound measurement of the free part of the Achilles tendon.
Materials and Methods: Both legs of 19 non-injured subjects were examined by MRI and ultrasound. The length from the distal tip of the soleus muscle to the tendon insertion on calcaneus was measured by three independent ultrasound examiners. Repeated ultrasound measurements were performed and compared to MRI measurements. Intra-rater and inter-rater reliability and the agreement between MRI and ultrasound were determined. Data were evaluated using the Intraclass Correlation Coefficient (ICC), the Standard Error of the Measurement (SEM) and the Minimal Detectable Change (MDC).
Findings / Results: The measurement showed excellent intra-rater reliability (ICC 0.94 [0.91;0.96], SEM 5mm and MDC 13mm) and inter-rater reliability (ICC 0.96 [0.93;0.97], SEM 4mm and MDC 11mm). Ultrasound measurements on average exceeded the MRI measurements by 2mm (n.s.); resulting in a measurement error of 5%.
Conclusions: The ultrasound measurement of the free part of the Achilles tendon showed good reliability and accuracy. For comparison between groups of non-injured subjects differences of more than 5mm can be detected. For repeated assessment of individual subject differences ≥ 13mm can be detected. The US measurement is a promising clinical tool to be further assessed in the setting of acute Achilles tendon rupture.
Pernille Henszelman Jørsboe, Michael Stage Pedersen, Mostafa Benyahia, Mads Holm Møller, Thomas Kallemose, Merete Brink Speedtsberg, Hanne Bloch Lauridsen, Jeannette Østergaard Penny
Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Dept. Of Orthopaedic Surgery, Aleris-Hamlet Hospitaler, Søborg, Denmark; Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital at Hvidovre, Denmark; Human Movement Analysis Lab, 247, Dept of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Human Movement Analysis Lab, 247, Dept of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark
Background: Hallux rigidus can be treated with a proximal hemiarthroplasty (HemiCAP) to preserve motion in the 1st metatarsophalangeal joint (MTPJ), but the effect is poorly documented.
Purpose / Aim of Study: We examined the plantar force variables (PFV) under the hallux the 1st, 2nd, and 3rd – 5 th metatarsal heads (MH) on patients with HemiCAP and compared to healthy controls and secondarily examined the correlations of the PFVs and the 1st MTPJ range of motion (ROM) and pain.
Materials and Methods: 41 were included, median OP date 2011(2007- 2014), age 63(47-78). ROM measured by both goniometer and x-ray. Pain by VAS 1-10. Emed (Novel) Foot Pressure Mapping System measured peak force (N) and force/time integral (N/s). Force variables between operated feet and controls were compared by independent two-sample t-test or Wilcoxon rank sum test. Force variables association to ROM and pain by linear regression models.
Findings / Results: HemiCAP/Controls: Peak force (N): Hallux: 12(1-26)/20(4-30), 1st MH: 17(8-41)/24(14- 42), 2nd MH 24(15-37)/28(24- 37), 3rd-5th MH: 27(18-36)/30(25- 35). Force/time integral (N/s): Hallux: 1(1- 4)/4(1-12), 1st MH: 5(2- 18)/7(3-11), 2nd MH 8(4-13)/10(7- 13), 3rd-5th MH: 9(6-15)/10(8- 14), (p<0.05 for all). Dorsal ROM of the operated feet was median 45 degrees (range 10-75) by goniometer and 41 (16-70) by x-ray. An increase in ROM reduced the PFVs under the hallux, but not under the MHs. Most patients reported no pain and no correlation to PFVs were found.
Conclusions: As expected increased dorsiflexion reduces the force/time integral, but a mid-term HemiCAP does not restore the joint motion to normal. Decreased PFVs under the hallux may reflect a patient reluctance to load the first ray although plantar forces were not linked to pain. Most report minimal pain, but the pain score is biased by missing numbers and exclusion of revisions.
Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Dept. Of Orthopaedic Surgery, Aleris-Hamlet Hospitaler, Søborg, Denmark; Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital at Hvidovre, Denmark; Human Movement Analysis Lab, 247, Dept of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Human Movement Analysis Lab, 247, Dept of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark; Dept. Of Orthopaedic Surgery, Copenhagen University Hospital at Hvidovre, Denmark
Background: Hallux rigidus can be treated with a proximal hemiarthroplasty (HemiCAP) to preserve motion in the 1st metatarsophalangeal joint (MTPJ), but the effect is poorly documented.
Purpose / Aim of Study: We examined the plantar force variables (PFV) under the hallux the 1st, 2nd, and 3rd – 5 th metatarsal heads (MH) on patients with HemiCAP and compared to healthy controls and secondarily examined the correlations of the PFVs and the 1st MTPJ range of motion (ROM) and pain.
Materials and Methods: 41 were included, median OP date 2011(2007- 2014), age 63(47-78). ROM measured by both goniometer and x-ray. Pain by VAS 1-10. Emed (Novel) Foot Pressure Mapping System measured peak force (N) and force/time integral (N/s). Force variables between operated feet and controls were compared by independent two-sample t-test or Wilcoxon rank sum test. Force variables association to ROM and pain by linear regression models.
Findings / Results: HemiCAP/Controls: Peak force (N): Hallux: 12(1-26)/20(4-30), 1st MH: 17(8-41)/24(14- 42), 2nd MH 24(15-37)/28(24- 37), 3rd-5th MH: 27(18-36)/30(25- 35). Force/time integral (N/s): Hallux: 1(1- 4)/4(1-12), 1st MH: 5(2- 18)/7(3-11), 2nd MH 8(4-13)/10(7- 13), 3rd-5th MH: 9(6-15)/10(8- 14), (p<0.05 for all). Dorsal ROM of the operated feet was median 45 degrees (range 10-75) by goniometer and 41 (16-70) by x-ray. An increase in ROM reduced the PFVs under the hallux, but not under the MHs. Most patients reported no pain and no correlation to PFVs were found.
Conclusions: As expected increased dorsiflexion reduces the force/time integral, but a mid-term HemiCAP does not restore the joint motion to normal. Decreased PFVs under the hallux may reflect a patient reluctance to load the first ray although plantar forces were not linked to pain. Most report minimal pain, but the pain score is biased by missing numbers and exclusion of revisions.