Last update: March 31, 2015

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March 2015


Arthroscopy. 2015 Mar 19.

Arthroscopic Treatment for Anterior Ankle Impingement: A Systematic Review of the Current Literature.

Zwiers R, Wiegerinck JI, Murawski CD, Fraser EJ, Kennedy JG, van Dijk CN.


To provide a comprehensive overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement.
A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was performed. Studies that met the following inclusion criteria were reviewed: studies reporting outcomes of arthroscopic treatment for anterior ankle impingement; studies reporting on more than 20 patients; a study population with a minimum age of 18 years; and studies in the English, Dutch, German, Italian, or Spanish language. Two reviewers independently performed data extraction. Extracted data consisted of population characteristics, in addition to both primary and secondary outcome measures. The Downs and Black scale was used to assess the methodologic quality of randomized and nonrandomized studies included in this review.
Twenty articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with anterior ankle impingement. In the studies that reported patient satisfaction rates, high percentages of good to excellent satisfaction were described (74% to 100%). The percentages of patients who would undergo the same procedure again under the same circumstances were also high (94.3% to 97.5%). Complication rates were low (4.6%), particularly with respect to major complications (1.1%). The high heterogeneity of the included studies made it impossible to compare the results of the studies, including between anterolateral impingement and anteromedial impingement.
Arthroscopic treatment for anterior ankle impingement appears to provide good outcomes with respect to patient satisfaction and low complication rates. However, on the basis of the findings of this study, no conclusion can be made in terms of the effect of the type of impingement or additional pathology on clinical outcome.



J Orthop Trauma. 2015 Mar 14.

Posterior Malleolar Fracture Patterns.

Mangnus L, Meijer D, Stufkens SA, Mellema JJ, Steller EP, Kerkhoffs GM, Doornberg JN.


To 1) characterize posterior malleolar fracture morphology using Cole fracture mapping; and 2) study reliability of Quantification of Three-Dimensional Computed Tomography (Q3DCT)-modelling for posterior malleolar fractures with respect to quantification of fragment size (mm) and true articular involvement (mm).
CT-scans of a consecutive series of 45 patients with an ankle fracture involving the posterior malleolus were reconstructed to calculate 1) fracture maps, 2) fragment volume; 3) articular surface of the posterior malleolar fragment; 4) articular surface of intact tibia and 5) articular surface of the medial malleolus by three independent observers. 3D-animation of this technique is shown on www.traumaplatform.org.
Fracture mapping revealed 1) a continuous spectrum of postero-lateral oriented fracture lines and 2) fragments with postero-lateral to postero-medial oriented fracture lines extending into the medial malleolus. Reliability of measurements of the volume and articular surface of posterior malleolar fracture fragments was defined as almost perfect according to the categorical system of Landis (inter-class coefficient (ICC), range 0.978 - 1.000).
Mapping of posterior malleolar fractures revealed a continuous spectrum of Haraguchi III to I fractures, and identified Haraguchi type II as a separate pattern. Q3DCT-modelling is reliable to assess fracture characteristics of posterior malleolar fracture fragments. Morphology might be more important than posterior malleolar fracture size alone for clinical decision making.

January 2015

A new chapter MTP-1 Arthroscopy has been added to the book on surgical techniques. Please go to the index to find out which chapters are online at the moment and to view the future chapters.

December 2014


Knee Surg Sports Traumatol Arthrosc. 2014 Dec 25.

Validity and reliability of a Dutch version of the Foot and Ankle Ability Measure.

Weel H, Zwiers R, Azim D, Sierevelt IN, Haverkamp D, van Dijk CN, Kerkhoffs GM.

The aim of the study was to develop a Dutch language version of the Foot and Ankle Ability Measure (FAAM) and evaluate its measurement properties according to the consensus-based standards for the selection of health measurement instruments (COSMIN) definitions.
A forward-backward translation procedure was performed and subsequently the Dutch version of the FAAM was evaluated for its reliability and validity in 369 patients with a variety of foot and ankle complaints. The reliability was assessed by calculating the intraclass correlation coefficients (ICC, test-retest reliability), Cronbach's alpha (internal consistency), the standard error of measurement and the minimal detectable change (MDC). Additionally, this was done for athletes. The construct validity was assessed by the use of Spearman's correlation coefficient between FAAM domains and similar and contradictory domains of the Foot and Ankle Outcome Score, Short Form 36 and the Numeric Rating Scale for pain.
The ICC of the subscales ranged from 0.62 to 0.86. Cronbach's alpha's minimum was 0.97. At individual level, the MDC ranged from 23.9 to 44.7 and at group level from 2.77 to 4.32. In the subgroup of athletes, the reliability was higher. The hypothesized correlations of the construct validity were supported by an 80 % confirmation rate.
The Dutch version of the FAAM met adequate measurement properties, although the reliability is not optimal. The FAAM-Sport subscale is more useful in athletes and the FAAM-Sport % seems not to contribute. In athletes with various foot and ankle symptoms, the FAAM can be used for functional assessment and follow-up at group level. For the general population, the FAAM is less appropriate.

Foot Ankle Surg. 2014 Dec;20(4):241-7. doi: 10.1016/j.fas.2014.05.008. Epub 2014 Jun 9.

The impact of ankle osteoarthritis. The difference of opinion between patient and orthopedic surgeon.

Witteveen AG, Hofstad CJ, Breslau MJ, Blankevoort L, Kerkhoffs GM.

Outcome measures for ankle osteoarthritis (OA) are created by physicians with little input of the target patient group. The aim of this study was to determine the difference in opinion between patients and orthopedic surgeons concerning the importance of specific symptoms of ankle OA and its impact on daily life and function.
A modified Delphi method was applied, consisting of structured interviews with patient focus groups and experts, followed by a poll using 32 statements. The difference in opinion between patients and orthopedic surgeons was evaluated.
Forty patients and forty orthopedic surgeons responded to the 32 statements. Statistically significant differences in opinion on symptoms, function and the impact of ankle OA on daily life were found.
This study demonstrates a significant difference in opinion between patients and orthopedic surgeons concerning specific symptoms of ankle OA. These results advocate incorporating the needs and demands of the individual patient for new outcome measures.

The first Teach the Teacher ankle arthroscopy course in Hong Kong! The course will take place in the Prince of Wales hospital from 3 till 5 December 2014.


November 2014


Knee Surg Sports Traumatol Arthrosc. 2014 Nov 1.

Treatment of midportion Achilles tendinopathy: an evidence based overview.

Zwiers R, Wiegerinck JI, van Dijk CN


In Achilles tendinopathy, differentiation should be made between paratendinopathy, insertional- and midportion Achilles tendinopathy. Midportion Achilles tendinopathy is clinically characterized by a combination of pain and swelling at the affected site, with impaired performance as an important consequence. The treatment of midportion Achilles tendinopathy contains both non-surgical and surgical options. Eccentric exercise has shown to be an effective treatment modality. Promising results are demonstrated for extracorporeal shockwave therapy. In terms of the surgical treatment of midportion Achilles tendinopathy, no definite recommendations can be made.


Acta Orthop. 2014 Oct 28:1-7.


Comparison of optical coherence tomography and histopathology in quantitative assessment of goat talus articular cartilage.

Cernohorsky P, Kok AC, Bruin DM, Brandt MJ, Faber DJ, Tuijthof GJ, Kerkhoffs GM, Strackee SD, van Leeuwen TG.


Background and purpose:
Optical coherence tomography (OCT) is a light-based imaging technique suitable for depiction of thin tissue layers such as articular cartilage. Quantification of results and direct comparison with a reference standard is needed to confirm the role of OCT in cartilage evaluation.

Materials and methods:
Goat talus articular cartilage repair was assessed quantitatively with OCT and compared with histopathology using semi-automated analysis software. Osteochondral defects were created centrally in goat tali with subsequent healing over 24 weeks. After sacrifice, the tali were analyzed using OCT and processed into histopathology slides. Cartilage thickness, repair tissue area, and surface roughness were measured. Also, light attenuation coefficient measurements were performed to assess differences in the properties of healthy tissue and repair tissue.

Intra-class correlation coefficients for resemblance between the 2 techniques were 0.95 (p < 0.001) for thickness, 0.73 (p = 0.002) for repair tissue area, and 0.63 (p = 0.015) for surface roughness. Light attenuation differed significantly between healthy cartilage (8.2 (SD 3.9) mm-1) and repair tissue (2.8 (SD 1.5) mm-1) (p < 0.001).

Compared to histopathology as the standard reference method, OCT is a reproducible technique in quantitative analysis of goat talus articular cartilage, especially when assessing cartilage thickness and to a lesser extent when measuring repair tissue area and surface roughness. Moreover, differences in local light attenuation suggest measurable variation in tissue structure, enhancing the clinical applicability of quantitative measurements from cartilage OCT images.

October 2014

The Australian Orthopaedic Association (AOA) organizes the 2014 Annual Scientific Meeting from 12-16 October in Melbourne, Australia. The theme of this meeting is ‘Orthopaedic Advances in the 21st Century - What's the Evidence?'

Prof. dr. C. Niek van Dijk will give three Instructional Course Lectures on Thursday the 16th of October:
- "Endoscopic treatment of the Achillies tendon" (8.00 - 8.30 a.m.)
- "Anterior and posterior ankle arthroscopy" (1.30 - 2.00 p.m.)
- "The rational for the diagnosis and treatment of talar OCD" (3.30-4.00 p.m.)

More information is available on the website.

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