Peter Verdonk

Universitair Ziekenhuis Ghent, Gand, Flanders, Belgium

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Publications (128)360.73 Total impact

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    ABSTRACT: There are several surgical options for recurrent patella dislocations. As the reconstruction of the medial patellofemoral ligament (MPFL) has been proven to restore stability, it has become more accepted. Aim of this study was to investigate the clinical outcome after MPFL reconstruction as an isolated procedure or in association with a transposition of the tibial tubercle (in case of patella alta or an excessive TT-TG) in a large prospective cohort study. Additionally, the effect on patellar height was analysed radiographically using the Caton-Deschamps index. In a large prospective cohort study of 129 knees in 124 patients (81 females, 48 males, mean age 22.8 ± 7.7 years), 91 knees received primary MPFL reconstruction (group 1) and 38 were a combination with a transposition of the tibial tubercle (group 2). The clinical follow-up was evaluated using KOOS and Kujala scores preoperatively and 1 year postoperatively. Patient satisfaction, complications and revision surgery were recorded. Overall, Kujala improved significantly from 53.5 (SD 22.7) preoperatively to 74.7 (SD 20.5) postoperatively (p < 0.01). All KOOS subdomains improved significantly (p < 0.01). No significant difference for Kujala score between groups was noticed. Revision rate was (5/129) 3.9 %. Reconstruction was supplemented with a transfer of the tibial tuberosity in (38/129) 29.4 % of the cases and shows a comparable outcome. MPFL reconstruction is a viable treatment option for episodic patellar dislocation. A concomitant tuberositas transposition is useful in selected patients. I.
    Knee Surgery Sports Traumatology Arthroscopy 06/2015; DOI:10.1007/s00167-015-3654-0 · 2.84 Impact Factor
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    ABSTRACT: Trochlear dysplasia appears in different geometrical variations. The Dejour classification is widely used to grade the severity of trochlear dysplasia and to decide on treatment. To investigate the effect of trochlear dysplasia on patellofemoral biomechanics and to determine if different types of trochlear dysplasia have different effects on patellofemoral biomechanics. Controlled laboratory study. Trochlear dysplasia was simulated in 4 cadaveric knees by replacing the native cadaveric trochlea with different types of custom-made trochlear implants, manufactured with 3-dimensional printing. For each knee, 5 trochlear implants were designed: 1 implant simulated the native trochlea (control condition), and 4 implants simulated 4 types of trochlear dysplasia. The knees were subjected to 3 biomechanical tests: a squat simulation, an open chain extension simulation, and a patellar stability test. The patellofemoral kinematics, contact area, contact pressure, and stability were compared between the control condition (replica implants) and the trochlear dysplastic condition and among the subgroups of trochlear dysplasia. The patellofemoral joint in the trochlear dysplastic group showed increased internal rotation, lateral tilt, and lateral translation; increased contact pressures; decreased contact areas; and decreased stability when compared with the control group. Within the trochlear dysplastic group, the implants graded as Dejour type D showed the largest deviations for the kinematical parameters, and the implants graded as Dejour types B and D showed the largest deviations for the patellofemoral contact areas and pressures. Patellofemoral kinematics, contact area, contact pressure, and stability are significantly affected by trochlear dysplasia. Of all types of trochlear dysplasia, the models characterized with a pronounced trochlear bump showed the largest deviations in patellofemoral biomechanics. Investigating the relationship between the shape of the trochlea and patellofemoral biomechanics can provide insight into the short-term effects (maltracking, increased pressures, and instability) and long-term effects (osteoarthritis) of different types of trochlear dysplasia. Furthermore, this investigation provides an empirical explanation for better treatment outcomes of trochleoplasty for Dejour types B and D dysplasia. © 2015 The Author(s).
    The American Journal of Sports Medicine 03/2015; 43(6). DOI:10.1177/0363546515572143 · 4.70 Impact Factor
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    ABSTRACT: The treatment of osteochondral lesions is of great interest to orthopaedic surgeons because most lesions do not heal spontaneously. We present the short-term clinical outcome and MRI findings of a cell-free scaffold used for the treatment of these lesions in the knee. A total of 38 patients were prospectively evaluated clinically for two years following treatment with an osteochondral nanostructured biomimetic scaffold. There were 23 men and 15 women; the mean age of the patients was 30.5 years (15 to 64). Clinical outcome was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner activity scale and a Visual Analgue scale for pain. MRI data were analysed based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system at three, 12 and 24 months post-operatively. There was a continuous significant clinical improvement after surgery. In two patients, the scaffold treatment failed (5.3%) There was a statistically significant improvement in the MOCART precentage scores. The repair tissue filled most of the defect sufficiently. We found subchondral laminar changes in all patients. Intralesional osteophytes were found in two patients (5.3%). We conclude that this one-step scaffold-based technique can be used for osteochondral repair. The surgical technique is straightforward, and the clinical results are promising. The MRI aspects of the repair tissue continue to evolve during the first two years after surgery. However, the subchondral laminar and bone changes are a concern. Cite this article: Bone Joint J 2015; 97-B:318-23. ©2015 The British Editorial Society of Bone & Joint Surgery.
    03/2015; 97-B(3):318-23. DOI:10.1302/0301-620X.97B3.34555
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    ABSTRACT: The purpose of this review was to evaluate the role of biological augmentation and tissue engineering strategies in meniscus surgery. Although clinical (human), preclinical (animal), and in vitro tissue engineering studies are included here, we have placed additional focus on addressing preclinical and clinical studies reported during the 5-year period used in this review in a systematic fashion while also providing a summary review of some important in vitro tissue engineering findings in the field over the past decade. A search was performed on PubMed for original works published from 2009 to March 31, 2014 using the term "meniscus" with all the following terms: "scaffolds," "constructs," "cells," "growth factors," "implant," "tissue engineering," and "regenerative medicine." Inclusion criteria were the following: English-language articles and original clinical, preclinical (in vivo), and in vitro studies of tissue engineering and regenerative medicine application in knee meniscus lesions published from 2009 to March 31, 2014. Three clinical studies and 18 preclinical studies were identified along with 68 tissue engineering in vitro studies. These reports show the increasing promise of biological augmentation and tissue engineering strategies in meniscus surgery. The role of stem cell and growth factor therapy appears to be particularly useful. A review of in vitro tissue engineering studies found a large number of scaffold types to be of promise for meniscus replacement. Limitations include a relatively low number of clinical or preclinical in vivo studies, in addition to the fact there is as yet no report in the literature of a tissue-engineered meniscus construct used clinically. Neither does the literature provide clarity on the optimal meniscus scaffold type or biological augmentation with which meniscus repair or replacement would be best addressed in the future. There is increasing focus on the role of mechanobiology and biomechanical and biochemical cues in this process, however, and it is hoped that this may lead to improvements in this strategy. There appears to be significant potential for biological augmentation and tissue engineering strategies in meniscus surgery to enhance options for repair and replacement. However, there are still relatively few clinical studies being reported in this regard. There is a strong need for improved translational activities and infrastructure to link the large amounts of in vitro and preclinical biological and tissue engineering data to clinical application. Level IV, systematic review of Level I-IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2015; 31(5). DOI:10.1016/j.arthro.2014.11.044 · 3.19 Impact Factor
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    ABSTRACT: This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2015; 31(4). DOI:10.1016/j.arthro.2014.11.045 · 3.19 Impact Factor
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    ABSTRACT: Background : Post-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring it with a novel 3-D computed tomography based method. Methods : Thirty-five ACL-deficient subjects were included, underwent anatomic single-bundle ACL reconstruction and were evaluated at 1 year after surgery with the use of 3-D CT imaging. Three independent observers semi-automatically delineated femoral and tibial tunnel outlines, after which a best-fit cylinder was derived and the tunnel diameter was determined. Finally, intra- and inter-observer reliability of this novel measurement protocol was defined. Results : In femoral tunnels, the intra-observer ICC was 0.973 (95% CI: 0.922-0.991) and the inter-observer ICC was 0.992 (95% CI: 0.982-0.996). In tibial tunnels, the intra-observer ICC was 0.955 (95% CI: 0.875 – 0.985). The combined inter-observer ICC 0.970 (95% CI:). Tunnel widening was significantly higher in allografts compared to autografts, in the tibial tunnels (p = 0.013) as well as in the femoral tunnels (p = 0.007). Conclusions : To our knowledge, this novel, semi-automated 3D-computed tomography image processing method has shown to yield highly reproducible results for the measurement of bone tunnel diameter and area. This series showed a significantly higher amount of tunnel widening observed in the allograft group at 1-year follow-up. Level of Evidence: Level II, Prospective comparative study
    The Knee 10/2014; 21(5). DOI:10.1016/j.knee.2014.05.003 · 1.70 Impact Factor
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    ABSTRACT: To investigate the biomechanical effect of skeletal knee joint abnormalities, the authors propose to implant pathologically shaped rapid prototyped implants in cadaver knee specimens. This new method was validated by replacing the native trochlea by a replica implant on four cadaver knees with the aid of cadaver-specific guiding instruments. The accuracy of the guiding instruments was assessed by measuring the rotational errors of the cutting planes (on average 3.01° in extension and 1.18° in external/internal rotation). During a squat and open chain simulation, the patella showed small differences in its articulation with the native trochlea and the replica trochlea, which could partially be explained by the rotational errors of the implants. This study concludes that this method is valid to investigate the effect of knee joint abnormalities with a replica implant as a control condition to account for the influence of material properties and rotational errors of the implant.
    Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine 08/2014; 228(8):833-42. DOI:10.1177/0954411914548242 · 1.14 Impact Factor
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    ABSTRACT: Meniscus replacement is of clinical benefit, but universal efficacy remains elusive. A greater understanding of the biological activity within implanted allografts or synthetic scaffolds may assist the development of improved surgical strategies. Biopsies of fresh-frozen allograft (n = 20), viable allograft (n = 18) and polyurethane scaffolds (n = 20) were obtained at second-look arthroscopy. Histological evaluation of tissue morphology and cell density/distribution was performed using haematoxylin-eosin (H&E) staining. Immunohistochemistry was used to detect the presence of CD34 (on progenitor cells and blood vessels) and smooth muscle actin (SMA)-positive structures and aggrecan. Collagen presence was investigated using picrosirius red staining. Cell density in the deep zone of the meniscus replacement was significantly higher in polyurethane scaffolds versus allograft transplants (p < 0.01) and also significantly higher in viable allograft compared with deep-frozen allograft (p < 0.01). CD34 staining was significantly higher in polyurethane and viable allografts versus deep-frozen allograft (progenitor cells p < 0.05; blood vessels p < 0.01). There were no significant differences in SMA or aggrecan staining across groups. All three specimen types demonstrated strong presence of collagen type I. Both viable allograft and a polyurethane meniscal scaffold show enhanced morphological, cell-distribution and regenerative patterns over deep-frozen allograft following surgical implantation. Given the limitations in viable allograft availability, these findings support the continued development of synthetic scaffolds for meniscus replacement surgery.
    International Orthopaedics 07/2014; 38(9). DOI:10.1007/s00264-014-2426-7 · 2.02 Impact Factor
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    ABSTRACT: Objectives In this pilot study we wanted to evaluate the kinematics of a knee implanted with an artificial polycarbonate-urethane meniscus device, designed for medial meniscus replacement. The static kinematic behavior of the implant was compared to the natural medial meniscus of the non-operated knee. A second goal was to evaluate the motion pattern, the radial displacement and the deformation of the meniscal implant. Materials and Methods Three patients with a polycarbonate-urethane implant were included in this prospective study. An open-MRI was used to track the location of the implant during static weight-bearing conditions, within a range of motion of 0° to 120° knee flexion. Knee kinematics were evaluated by measuring the tibiofemoral contact points and femoral roll-back. Meniscus measurements (both natural and artificial) included anterior-posterior meniscal movement, radial displacement, and meniscal height. Results No difference (p > 0.05) was demonstrated in femoral roll-back and tibiofemoral contact points during knee flexion between the implanted and the non-operated knees. Meniscal measurements showed no significant difference in radial displacement and meniscal height (p > 0.05) at all flexion angles, in both the implanted and non-operated knees. A significant difference (p ≤ 0.05) in anterior-posterior movement during flexion was observed between the two groups. Conclusions In this pilot study, the artificial polycarbonate-urethane implant, indicated for medial meniscus replacement, had no influence on femoral roll-back and tibiofemoral contact points, thus suggesting that the joint maintains its static kinematic properties after implantation. Radial displacement and meniscal height were not different, but anterior-posterior movement was slightly different between the implant and the normal meniscus.
    Clinical Biomechanics 07/2014; 29(8). DOI:10.1016/j.clinbiomech.2014.07.001 · 1.88 Impact Factor
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    ABSTRACT: This study presents the prospective two-year clinical and MRI outcome of autologous matrix-induced chondrogenesis (AMIC) for the treatment of patellofemoral cartilage defects in the knee. Ten patients were clinically prospectively evaluated during 2 years. MRI data were analysed based on the original and modified MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) scoring system. A satisfying clinical improvement became apparent during the 24 months of follow-up. The MOCART scoring system revealed a slight tendency to deterioration on MRI between one and 2 years of follow-up. However, the difference was not statistical significant. All cases showed subchondral lamina changes. The formation of intralesional osteophytes was observed in 3 of the 10 patients (30%). In conclusion, AMIC is safe and feasible for the treatment of symptomatic patellofemoral cartilage defects and resulted in a clinical improvement. However, the favourable clinical outcome of the AMIC technique was not confirmed by the MRI findings.
    Acta orthopaedica Belgica 06/2014; 80(2):251-9. · 0.57 Impact Factor
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    ABSTRACT: This study was designed to describe the clinical and radiographical outcome of the HemiCAP(®) resurfacing system as a salvage treatment for a failed index cartilage procedure. Fourteen patients were treated consecutively and clinically prospectively followed for a mean period of 26.1 ± 12.8 months. All patients were previously treated for their cartilage lesion. Radiographical data were analysed based on the Kellgren and Lawrence system. The patients involved in this study demonstrated a gradual clinical improvement in time. However, radiographically significant osteoarthritic changes were observed during the follow-up period. The position of the HemiCAP(®) resurfacing system was adequate in all cases, and no signs of loosening were observed during the follow-up period. The HemiCAP(®) resurfacing system is feasible as a salvage treatment for a failed index cartilage procedure and resulted in a gradual clinical improvement. However, the favourable clinical outcome was not confirmed by the radiographical findings. LEVEL OF EVIDENCE: IV.
    Knee Surgery Sports Traumatology Arthroscopy 04/2014; 23(8). DOI:10.1007/s00167-014-2999-0 · 2.84 Impact Factor
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    ABSTRACT: Introduction La méniscectomie latérale est source de douleurs résiduelles et d’arthrose secondaire même lorsque les indications sont clairement sélectionnées. Hypothèse La reconstruction de la perte de substance méniscale par un substitut biodégradable diminue la douleur et améliore la fonction du genou. Patients et méthodes Cette étude multicentrique prospective porte sur 54 patients (37 hommes/17 femmes ; âge moyen : 28 ans [16–50]). Tous les patients présentaient un syndrome douloureux post-méniscectomie latérale partielle. Ils ont été traités par mise en place sous contrôle arthroscopique d’un substitut biodégradable en polyuréthane (Actifit® Orteq). Les résultats cliniques ont été analysés à 6,12 et 24 mois par l’échelle visuelle analogique (EVA), l’International knee documentation committee score (IKDC) et le Knee injury and osteoarthritis outcome score (KOOS). Résultats L’EVA passait de 5,5 en préopératoire à 3,6 à 6 mois, 3,4 à 12 mois et 2,9 à 24 mois. L’IKDC passait de 47,0 en préopératoire à 60,2, 67,0 et 67,0 à 6,12 et 24 mois. Tous les items du score KOOS augmentaient entre le préopératoire et le recul à 2 ans. Discussion Les résultats montrent une amélioration statistiquement et cliniquement significative de la douleur et des scores fonctionnels. (EVA, IKDC, et tous les items du score KOOS à l’exception de l’activité sportive) à 6 mois, et de tous les items à 2 ans. Le substitut Actifit® est sûr et efficace pour traiter les défects partiels du ménisque latéral. Niveau de preuve IV ; étude prospective multicentrique de cohorte.
    Revue de Chirurgie Orthopédique et Traumatologique 02/2014; 100(1):126. DOI:10.1016/j.rcot.2013.10.088
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    ABSTRACT: Recent articles have ranked Lateral Release (LR) 47th among all procedures by orthopaedic surgeons [ 9 , 14 ]. Despite its frequency the indications and results of an LR remain controversial. The acceptable results (good and excellent) have a wide range from 14 to 99 % [ 1 , 4 , 12 , 14 ]. LR can be subdivided as both an isolated and an associated procedure (as part of a proximal or distal realignment). The procedure can also be performed as an open, mini-open or arthroscopic procedure [ 14 ]. O'Neill et al. proved that there is no significant difference in outcome between arthroscopic and open LR [ 18 ]. In arthroscopic LR, however, the risk for postoperative hemarthrosis and swelling is considered higher. The use of electrocautery is advised to prevent this major complication. Until today, this study is the only prospective random-ized clinical trial concerning LR. 15.1.1 Anatomy of the Lateral Retinaculum The lateral retinaculum consists of two separate layers (Fig. 15.1): 1. The superfi cial oblique layer: This originates from the iliotibial band and interdigitates with the longitudinal fi bres of vastus lateralis. 2. The deep layer: This consists of the deep transverse retinaculum with the epicondylo-patellar ligament proximally and the patello-tibial ligament distally.
    The Patellofemoral Joint, Edited by A. Gobbi, 01/2014: chapter Surgical Treatment of the Patellofemoral Joint: Lateral Release.: pages 119-126; Springer-Verlag.
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    ABSTRACT: Segmental tissue loss in the lateral meniscus is associated with pain and increased risk of osteoarthritis even when indications have been carefully considered. Repairing the defect using a novel biodegradable scaffold will reduce pain and restore the knee function. In this prospective multicenter study, a total of 54 patients (37 males/17 females; mean age: 28years [16-50]) were enrolled. All patients presented with postmeniscectomy syndrome and segmental lateral meniscus loss, and were treated with a polyurethane biodegradable scaffold (Actifit(®), Orteq) implanted arthroscopically. Clinical outcomes were assessed at 6, 12 and 24months using Visual Analogue Scale (VAS), International Knee Documentation Committee Score (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). VAS decreased from 5.5 at baseline to 3.6 at 6months, 3.4 at 12months and 2.9 at 24months. IKDC improved from 47.0 at baseline to 60.2, 67.0 and 67.0 at 6, 12 and 24months. All KOOS subscores improved between baseline and 24months. Clinical results of this study demonstrate clinically and statistically significant improvements of pain and function scores (VAS, IKDC, and all KOOS subscales except sport), at the 6months follow-up and on all clinical outcomes at the 2-year follow-up. The Actifit(®) scaffold is safe and effective in treating lateral meniscus defects. continuous prospective multicenter study.
    Orthopaedics & Traumatology Surgery & Research 12/2013; 100(1). DOI:10.1016/j.otsr.2013.10.011 · 1.17 Impact Factor
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    ABSTRACT: Trochlear dysplasia is known as the primary predisposing factor for patellar dislocation. Current methods to describe trochlear dysplasia are mainly qualitative or based on a limited number of discrete measurements. The purpose of this study is to apply statistical shape analysis to take the full geometrical complexity of trochlear dysplasia into account. Statistical shape analysis was applied to 20 normal and 20 trochlear dysplastic distal femur models, including the cartilage. This study showed that the trochlea was anteriorized, proximalized and lateralized and that the mediolateral width and the notch width were decreased in the trochlear dysplastic femur compared to the normal femur. The first three principal components of the trochlear dysplastic femurs, accounting for 79.7% of the total variation, were size, sulcus angle and notch width. Automated classification of the trochlear dysplastic and normal femora achieved a sensitivity of 85% and a specificity of 95%. This study shows that shape analysis is an outstanding method to visualise the location and magnitude of shape abnormalities. Improvement of automated classification and subtyping within the trochlear dysplastic group are expected when larger training sets are used. Classification of trochlear dysplasia, especially borderline cases may be facilitated by automated classification. Furthermore, the identification of a decreased notch width in association with an increased sulcus angle can also contribute to the diagnosis of trochlear dysplasia.
    The Knee 12/2013; 21(2). DOI:10.1016/j.knee.2013.11.016 · 1.70 Impact Factor
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    ABSTRACT: The objective of this study was to validate a new technique to safely obtain core biopsy specimens of the anterior cruciate ligament (ACL) without jeopardizing the ACL's biomechanical properties. Eleven pairs of fresh porcine femur-ACL-tibia complexes were tested in a loading frame. The ACL of one knee was biopsied using a spring-loaded core biopsy device, whereas the contralateral ACL was tested as the control. Biomechanical properties of the biopsied and control ACLs were compared. The ultimate load to failure was 1,202 N ± 171.1 N and 1,193 N ± 228.7 N (P = .8984) for biopsied and non-biopsied ACLs, respectively. No significant differences were noted for maximal elongation at failure, maximal strain, absorbed energy, and stiffness between biopsied and non-biopsied ACLs. The results of this study indicate that a new ACL core biopsy technique can be performed while preserving the ligament's structural integrity. The presented core biopsy technique could be regarded as a dedicated tool to elucidate the poorly understood (patho)biological processes occurring in both the native and reconstructed ACLs.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2013; DOI:10.1016/j.arthro.2013.09.003 · 3.19 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2013; 29(10):e51-e52. DOI:10.1016/j.arthro.2013.07.035 · 3.19 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2013; 29(10):e86. DOI:10.1016/j.arthro.2013.07.088 · 3.19 Impact Factor
  • Gregor Vivod, Peter Verdonk, Matej Drobnič
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    ABSTRACT: A retrospective single-centre study was focused on the long-term outcome after different patello-femoral (PF) realignment procedures. Thirty-nine patients treated for recurrent PF instability were examined after a mean post-operative time of 22.5 years. Their 78 knees were divided into: non-operated knees (NON-OPERATED)-N = 24, isolated proximal procedures (PROXIMAL)-N = 22, isolated distal procedures (DISTAL)-N = 10, and combined procedures (COMBINED)-N = 22. PF-related medical history together with clinical, subjective (KOOS and Kujala scores), and radiographic (Caton-Deschamps PF height index, Kellgren-Lawrence scale for tibio-femoral OA, and Iwano classification for PF OA) evaluation was conducted. PF re-dislocation rate was comparable between PROXIMAL (36 %), DISTAL (20 %), and COMBINED (32 %). Isolated proximal procedures revealed less central patella positions (PROXIMAL 64 %; DISTAL 90 %; COMBINED 95 %) and more frequent PF apprehension test (PROXIMAL 82 %; DISTAL 40 %, COMBINED 50 %). KOOS and Kujala scores were similar in all three surgical subgroups, but significantly lower than in NON-OPERATED. Patellas were positioned lower after DISTAL, 0.8 (0.5-1.0) or COMBINED, 0.9 (0.4-1.3). Kellgren-Lawrence scores ≥2 were found in 42 % NON-OPERATED, 37 % PROXIMAL, 70 % DISTAL, and 59 % COMBINED, whereas Iwano classification ≥2 was confirmed in 46 % NON-OPERATED, 64 % PROXIMAL, 80 % DISTAL, and 86 % COMBINED. High PF re-dislocation rates together with a very high incidence of PF OA indicate that PF realignment strategies used traditionally had failed to reach their long-term expectations. The transfer of tibial tuberosity resulted in more constrained PF joints than isolated proximal procedures which allowed for more residual PF instability. Distal procedures additionally increased the likelihood for tibio-femoral OA. LEVEL OF EVIDENCE: III.
    Knee Surgery Sports Traumatology Arthroscopy 09/2013; 22(11). DOI:10.1007/s00167-013-2637-2 · 2.84 Impact Factor
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    ABSTRACT: In 1879, the French surgeon Segond described the existence of a 'pearly, resistant, fibrous band' at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, the enigma surrounding this anatomical structure is reflected in confusing names such as '(mid-third) lateral capsular ligament', 'capsulo-osseous layer of the iliotibial band' or 'anterolateral ligament', and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond's 'pearly band', hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. Its insertion on the anterolateral tibia was grossly located midway between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long-standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.
    Journal of Anatomy 08/2013; 223(4). DOI:10.1111/joa.12087 · 2.23 Impact Factor

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2k Citations
360.73 Total Impact Points


  • 2005–2015
    • Universitair Ziekenhuis Ghent
      • Department of Rheumatology
      Gand, Flanders, Belgium
  • 2003–2015
    • Ghent University
      • • Department of Rehabilitation Sciences and Physiotherapy
      • • Rheumatology
      Gand, Flemish, Belgium
  • 2011–2012
    • Stedelijk Ziekenhuis Roeselare
      Rouselare, Flemish, Belgium
  • 2010
    • University of Angers
      Angers, Pays de la Loire, France
  • 2009
    • Oslo University Hospital
      Kristiania (historical), Oslo, Norway
  • 2007–2009
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • Centre Hospitalier Universitaire de Lyon
      Lyons, Rhône-Alpes, France