Last update: June 30, 2015

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June 2015


 Knee Surg Sports Traumatol Arthrosc. 2015 Jun 5.

Randomized comparison of tape versus semi-rigid and versus lace-up ankle support in the treatment of acute lateral ankle ligament injury.

van den Bekerom MP, van Kimmenade R, Sierevelt IN, Eggink K, Kerkhoffs GM, van Dijk CN, Raven EE.


Functional treatment is the optimal non-surgical treatment for acute lateral ankle ligament injury (ALALI) in favour of immobilization treatment. There is no single most effective functional treatment (tape, semi-rigid brace or lace-up brace) based on currently available randomized trials.
This study is designed as a randomized controlled trial to evaluate the difference in functional outcome after treatment with tape versus semi-rigid versus lace-up ankle support (brace) for grades II and III ALALIs. The Karlsson score and the FAOS were evaluated at 6-month follow-up.
One hundred and ninety-three patients (52 % males) were randomized, 66 patients were treated with tape, 58 patients with a semi-rigid brace and 62 patients with a lace-up brace. There were no significant differences in any baseline characteristics between the three groups. Mean age of the patients was 37.3 years (35.1-39.5; SD 15.3). Ninety-five males (49 %) were included. One hundred and sixty-one (59 + 50 + 52) patients completed the study through final follow-up; 32 % lost at follow-up. In two patients treated with tape support, the treatment was changed to a semi-rigid brace because of dermatomal blisters. Except for the difference in Foot and Ankle Outcome Score sport between the lace-up and the semi-rigid brace, there are no differences in any of the outcomes after 6-month follow-up.
The most important finding of current study was that there is no difference in outcome 6 months after treatment with tape, semi-rigid brace and a lace-up brace.

May 2015

J Pediatr Orthop. 2015 May 6.

Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy: A Pragmatic Therapeutic Randomized Clinical Trial.

Wiegerinck JI, Zwiers R, Sierevelt IN, van Weert HC, van Dijk CN, Struijs PA.


Calcaneal apophysitis is a frequent cause of heel pain in children and is known to have a significant negative effect on the quality of life in affected children. The most effective treatment is currently unknown. The purpose of this study is to evaluate 3 frequently used conventional treatment modalities for calcaneal apophysitis.
Three treatment modalities were evaluated and compared in a prospective randomized single-blind setting: a pragmatic wait and see protocol versus a heel raise inlay (ViscoHeel; Bauerfeind) versus an eccentric exercise regime under physiotherapeutic supervision. Treatment duration was 10 weeks.
age between 8 and 15 years old, at least 4 weeks of heel pain complaints due to calcaneal apophysitis based, with a minimal Faces Pain Scale-Revised of 3 points. Primary exclusion criteria included other causes of heel pain and previous similar treatment. Primary outcome was Faces Pain Scale-Revised at 3 months. Secondary outcomes included patient satisfaction and Oxford Ankle and Foot Questionnaire (OAFQ). Points of measure were at baseline, 6 weeks, and 3 months. Analysis was performed according to the intention-to-treat principles.
A total of 101 subjects were included. Three subjects were lost to follow-up. At 6 weeks, the heel raise subjects were more satisfied compared with both other groups (P<0.01); the heel raise group improved significantly compared with the wait and see group for OAFQ Children (P<0.01); the physical therapy group showed significant improvement compared with the wait and see group for OAFQ Parents (P<0.01). Each treatment modality showed significant improvement of all outcome measures during follow-up (P<0.005). No clinical relevant differences were found between the respective treatment modalities at final follow-up.
Treatment with wait and see, a heel raise inlay, or physical therapy each resulted in a clinical relevant and statistical significant reduction of heel pain due to calcaneal apophysitis. No significant difference in heel pain reduction was found between individual treatment regimes. Calcaneal apophysitis is effectively treated by the evaluated regimes. Physicians should deliberate with patients and parents regarding the preferred treatment.


Our department has recently received recognition of the International Olympic Committee (IOC) as IOC Research Center for Prevention of Injury and Protection of Athlete Health. Only nine centers worldwide have received this recognition. We received this recognition together with the VU
Over the next four years, all nine centers will be tasked with researching, developing and implementing effective preventive treatment methods for sports-related injuries and illnesses.

April 2015

During the combined AEA-SEROD meeting in Madrid, Prof C.Niek van Dijk was appointed as Honorary member of the Spanish Arhroscopy Association (AEA)
It is for the first time in the existence of the AEA that they decided to appoint an honorary member . This makes him the first honorary member of their Society.
With a certificate he also received the gold pin which is reserved for the pastpresidents of the AEA.
On the picture also John Bergfeld (pastpresident of ISAKOS) who was appoited honorary member of SEROD. 

A new chapter, Arthroscopic assisted Retrograde Drilling for large talar Cystic lesions, 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.

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.

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