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Amsterdam Foot & Ankle Course
Amsterdam Foot & Ankle Platform Studygroup
J R Soc Interface. 2013 Dec
Tissue engineering and regenerative medicine (TERM) has caused a revolution in present and future trends of medicine and surgery. In different tissues, advanced TERM approaches bring new therapeutic possibilities in general population as well as in young patients and high-level athletes, improving restoration of biological functions and rehabilitation. The mainstream components required to obtain a functional regeneration of tissues may include biodegradable scaffolds, drugs or growth factors and different cell types (either autologous or heterologous) that can be cultured in bioreactor systems (in vitro) prior to implantation into the patient. Particularly in the ankle, which is subject to many different injuries (e.g. acute, chronic, traumatic and degenerative), there is still no definitive and feasible answer to 'conventional' methods. This review aims to provide current concepts of TERM applications to ankle injuries under preclinical and/or clinical research applied to skin, tendon, bone and cartilage problems. A particular attention has been given to biomaterial design and scaffold processing with potential use in osteochondral ankle lesions.
Br J Sports Med. 2013 Dec
OBJECTIVE: To assess and summarise the economic evidence regarding diagnostic tests, treatment and prevention for lateral ankle sprains.
METHODS: Potential studies were identified from electronic databases and trial registries and by scanning reference lists. Risk of bias and methodological quality were evaluated. Two independent reviewers screened, assessed studies and extracted data. Data were synthesised descriptively due to study heterogeneity.
RESULTS: A total of 230 records were identified; 10 studies were included. Five studies conducted a full economic evaluation and five studies involved cost analyses. Lack of blinding was the main risk of bias. The methodological quality of the full economic evaluations was fairly good. Valuation of costs, measurement of outcomes and sensitivity analysis were points for improvement. Single studies showed that the Ottawa ankle rules (OAR) was cost effective for diagnosing lateral ankle sprains in the emergency setting compared with existing hospital protocols; acute treatment with anti-inflammatory medication and the plaster cast for severe sprains appeared cost effective; and neuromuscular training was cost effective in preventing ankle re-injury.
CONCLUSIONS: Results of this current systematic review supplements the evidence provided by reviews of effectiveness. There is evidence to support the implementation of OAR in the emergency setting, the use of anti-inflammatory medication and the plaster cast in the acute phase, and the prescription of neuromuscular exercises to prevent re-injury. Although the evidence is limited due to the low number of studies, shortcomings in methodological quality and small sample sizes, the findings may be used to inform clinical practice and practice guidelines.
On December 13 2013, Arjan Bot obtained his PhD-degree at the University of Amsterdam under supervision of Professor C.N. van Dijk as promotor en Dr. D.C. Ring as his co-promotores.
This thesis studies the influence of psychological factors in illness behavior in different
hand and upper extremity conditions encountered in the practice of a hand surgeon. The
importance of the language used by the patient and the amount of shared decision making
in an orthopaedic practice is investigated. This thesis focuses also on questionnaires which
are administered to measure these psychological factors and to create and validate shorter
The overall aim is to raise awareness of 1) the importance of psychological factors as
part of illness behavior in both traumatic and nontraumatic conditions of the upper extremity;
2) the importance of informed shared decision making and increase the amount of informed
shared decision making in their practice; 3) word choice of the patients as an expression of
emotional distress; 4) which questionnaires to use and to interpret results based on the mode of
administration; 5) factors important in determining nonresponse to questionnaires or clinical
follow-up, and 6) psychology evaluation to achieve better care for the patients when patients
express psychological distress.
Eur J Pediatr. 2013 Dec
Incidence of calcaneal apophysitis in the general population
Calcaneal apophysitis, or Sever's disease, is a traction apophysitis. It is a frequent cause of heel pain in children. Knowledge about the exact incidence of calcaneal apophysitis in the general population, however, is lacking.
From 34 general practices, records of patients between 6 and 17 years old, visiting the general practitioner (GP), were analysed. Diagnoses of calcaneal apophysitis were counted using computerised registration networks of GPs in 2008, 2009 and 2010.
There were 16,383 SOAP files searched and a number of 61 children with calcaneal apophysitis were established over the years 2010, 2009 and 2008, showing an incidence of 3.7 in 1,000 registered patients.
This is the first report on incidence rates of calcaneal apophysitis in general practice. With an incidence of 3.7 in 1,000 registered patients, it is a common pathologic entity, which requires more research on pathophysiology and therapy. The actual incidence may even be higher due the strict inclusion criteria of this study
Bone Joint J. 2013 Dec
van Bergen CJ, van Eekeren IC, Reilingh ML, Sierevelt IN, van Dijk CN
We have evaluated the clinical effectiveness of a metal resurfacing inlay implant for osteochondral defects of the medial talar dome after failed previous surgical treatment. We prospectively studied 20 consecutive patients with a mean age of 38 years (20 to 60), for a mean of three years (2 to 5) post-surgery. There was statistically significant reduction of pain in each of four situations (i.e., rest, walking, stair climbing and running; p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 62 (interquartile range (IQR) 46 to 72) pre-operatively to 87 (IQR 75 to 95) at final follow-up (p < 0.001). The Foot and Ankle Outcome Score improved on all subscales (p ≤ 0.03). The mean Short-Form 36 physical component scale improved from 36 (23 to 50) pre-operatively to 45 (29 to 55) at final follow-up (p = 0.001); the mental component scale did not change significantly. On radiographs, progressive degenerative changes of the opposing tibial plafond were observed in two patients. One patient required additional surgery for the osteochondral defect. This study shows that a metal implant is a promising treatment for osteochondral defects of the medial talar dome after failed previous surgery.
On November 14 and 15 the 6th Congress of the Slovak Society of Arthroscopy and Sports Traumatology was held in Bratislava. At this congress prof. Niek van Dijk has been rewarded with an honorary membership of the Slovak Society of Arthroscopy and Sports Traumatology.
The 2-day congress was attended by over 300 participants. There were more than 50 lectures on arthroscopic and minimally invasive surgery on the ankle. Main lecturer was prof. Niek van Dijk.
Knee Surg Sports Traumatol Arthrosc. 2013 Sep 18
Reilingh ML, Kerkhoffs GM, Telkamp CJ, Struijs PA, van Dijk CN
Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children.
Thirty-six (97 %) of 37 eligible patients with a symptomatic primary osteochondral talar defect were evaluated after a median follow-up of 4 years (range 1-12 years). Clinical assessment included the Berndt and Harty outcome question, Ogilvie-Harris score, Visual Analog Scale pain score (at rest, during walking and during running), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the SF-36. Weight-bearing radiographs were compared with preoperative radiographs with the use of an ankle osteoarthritis classification system.
Ninety-two per cent of the initially conservatively treated children [mean age 13 years (SD 2)] were eventually scheduled to undergo surgery. After fixation of the fragment, seven cases (78 %) reported a good Berndt and Harty outcome, and two cases (22 %) a fair outcome; the median AOFAS score was 95.0 (range 77-100). After debridement and bone marrow stimulation, 13 cases (62 %) reported a good Berndt and Harty outcome, three cases (14 %) a fair outcome, and five cases (24 %) a poor outcome; the median AOFAS score was 95.0 (range 45-100). No signs of degenerative changes were seen in both groups at follow-up.
Fixation and debridement and bone marrow stimulation of an osteochondral talar defect are both good surgical options after failed conservative treatment.
J Bone Joint Surg Am. 2013 Sep 4;95(17)
Lambers KT, van den Bekerom MP, Doornberg JN, Stufkens SA, van Dijk CN, Kloen P
There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis.
Fifty patients with pronation-external rotation (predominantly Maisonneuve) fractures were treated with open reduction and internal fixation of the syndesmosis utilizing only one or two screws. The results were evaluated at a mean of twenty-one years after the fracture utilizing three standardized outcomes instruments: (1) the Foot and Ankle Ability Measure (FAAM), (2) the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and (3) the Center for Epidemiologic Studies-Depression (CES-D) Scale. Osteoarthritis was graded according to the van Dijk and revised Takakura radiographic scoring systems. Bivariate and multivariate analyses were performed to identify predictors of long-term outcome.
Forty-four (92%) of forty-eighty patients had good or excellent AOFAS scores, and forty-four (90%) of forty-nine had good or excellent FAAM scores. Arthrodesis for severe osteoarthritis was performed in two patients. Radiographic evidence of osteoarthritis was observed in twenty-four (49%) of forty-nine patients. Multivariate analysis identified pain as the most important independent predictor of long-term ankle function as indicated by the AOFAS and FAAM scores, explaining 91% and 53% of the variation in scores, respectively. Analysis of pain as the dependent variable in bivariate analyses revealed that depression, ankle range of motion, and a subsequent surgery were significantly correlated with higher pain scores. No firm conclusions could be drawn after multivariate analysis of predictors of pain.
Long-term functional outcomes at a mean of twenty-one years after pronation-external rotation ankle fractures treated with one or two syndesmotic screws were good to excellent in the great majority of patients despite substantial radiographic evidence of osteoarthritis in one-half of the patients. The most important predictor of long-term functional outcome was patient-reported pain rather than physician-reported function or posttraumatic osteoarthritis. There was no significant association between radiographic signs of posttraumatic osteoarthritis and perceived pain in the present series.