Introduction. The arch of the foot has been described as a truss where the plantar fascia (PF) acts as the tensile element. Its role in maintaining the arch has likely been underestimated because it only rarely torn in patients with progressive collapsing foot deformity (PCFD). We hypothesized that elongation of the plantar fascia would be a necessary and sufficient precursor of arch collapse. Method. We used a validated finite element model of the foot reconstructed from CT scan of a female cadaver. Isolated and combined simulated ligament transection models were created for each combination of the ligaments. A collapsed foot model was created by simulated transection of all the arch supporting ligaments and unloading of the posterior tibial tendon. Foot alignment angles, changes in force and displacement within each of the ligaments were compared between the intact, isolated ligament transection, and complete collapse conditions. Result. Isolated release of the PF did not cause deformity, but lead to increased force in the long (142%) and short plantar (156%), deltoid (45%), and spring ligaments (60%). The PF was the structure most able to prevent arch collapse and played a secondary role in preventing hindfoot valgus and forefoot abduction deformities. Arch collapse was associated with substantial attenuation of the spring (strain= 41%) and interosseous talocalcaneal ligaments (strain= 27%), but only a small amount in the plantar fascia (strain= 10%). Conclusion. Isolated PF release did not cause arch collapse, but arch collapse could not occur without at least 10% elongation of the PF. Simulated transection of the PF led to substantial increase in the force in the other arch supporting ligaments, putting the foot at risk of arch collapse over time. Chronic degeneration of the PF leading to plantar fasciitis may be an early sign of impending PCFD

Introduction and Objective. The treatment of severe deformities often requiring aggressive techniques such as vertebral resection and osteotomies with high comorbidity. To mitigate this risk, several methods have been used to achieve a partial reduction of stiff curves. The objective of this study was to evaluate and quantify the effectiveness of the Perioperative Halo-Gravity Traction (HGT) in the Treatment of Severe Spinal Deformity in Children. Materials and Methods. A historical cohort of consecutive childs with severe spinal deformity who underwent to a perioperative HGT as a part of the treatment protocol. Minimum follow-up of 2 years. Demographic, clinical and radiological data, including time duration of perioperative HGT and Cobb angle in the coronal and sagittal plane. The radiological variables were measured before the placement of the halo, after placement of the halo, at the end of the period of traction, after surgery and in the final follow-up. Results. Seventeen males (57%) and twenty females (43%) were included in the final analysis. The mean age was 6.5 years (SD 4.8). The most frequent etiology for the spinal deformity was syndromic (13 patients). The average preoperative Cobb angle was 88º (range, 12–135). HGT was used in 17 cases prior to a primary surgery and in 20 cases prior to a revision surgery. After the HGT, an average correction of 34% of the deformity was achieved (p <0.05). After the surgery this correction improved. At 2-year follow-up there was a correction loss of 20% (p <0.05). There were 3 complications (8.1%): 2 pin infections and cervical subluxation. Conclusions. The application of HGT in cases of severe rigid deformity is useful allowing a correction of the preoperative deformity of 34%, facilitating surgery. Preoperative HGT seems to be a safe and effective intervention in pediatric patients with high degree deformity

A medializing calcaneal osteotomy (MCO) is one of the key inframalleolar osteotomies to correct progressive collapsing foot deformity (PCFD). While many studies were able to determine the hind- and midfoot alignment after PCFD correction, the subtalar joint remained obscured by superposition on plain radiography. Therefore, we aimed to perform a 3D measurement assessment of the hind- and subtalar joint alignment pre- compared to post-operatively using weightbearing CT (WBCT) imaging. Fifteen patients with a mean age of 44,3 years (range 17-65yrs) were retrospectively analyzed in a pre-post study design. Inclusion criteria consisted of PCFD deformity correct by MCO and imaged by WBCT. Exclusion criteria were patients who had concomitant midfoot fusions or hindfoot coalitions. Image data were used to generate 3D models and compute the hindfoot - and talocalcaneal angle as well as distance maps. Pre-operative radiographic parameters of the hindfoot and subtalar joint alignment improved significantly relative to the post-operative position (HA, MA. Sa. , and MA. Co. ). The post-operative talus showed significant inversion, abduction, and dorsiflexion of the talus (2.79° ±1.72, 1.32° ±1.98, 2.11°±1.47) compared to the pre-operative position. The talus shifted significantly different from 0 in the posterior and superior direction (0.62mm ±0.52 and 0.35mm ±0.32). The distance between the talus and calcaneum at the sinus tarsi increased significantly (0.64mm ±0.44). This study found pre-dominantly changes in the sagittal, axial and coronal plane alignment of the subtalar joint, which corresponded to a decompression of the sinus tarsi. These findings demonstrate the amount of alternation in the subtalar joint alignment that can be expected after MCO. However, further studies are needed to determine at what stage a calcaneal lengthening osteotomy or corrective arthrodesis is indicated to obtain a higher degree of subtalar joint alignment correction

Abstract. Objectives. A damaged vertebral body can exhibit accelerated ‘creep’ under constant load, leading to progressive vertebral deformity. However, the risk of this happening is not easy to predict in clinical practice. The present cadaveric study aimed to identify morphometric measurements in a damaged vertebral body that can predict a susceptibility to accelerated creep. Methods. Mechanical testing of 28 human spinal motion segments (three vertebrae and intervening soft tissues) showed how the rate of creep of a damaged vertebral body increases with increasing “damage intensity” in its trabecular bone. Damage intensity was calculated from vertebral body residual strain following initial compressive overload. The calculations used additional data from 27 small samples of vertebral trabecular bone, which examined the relationship between trabecular bone damage intensity and residual strain. Results. Calculations from trabecular bone samples showed a strong non-linear relationship between residual strain and trabecular bone damage intensity (R. 2. = 0.78, P < 0.001). In damaged vertebral bodies, damage intensity as calculated from residual strain was then related to vertebral creep rate (R. 2. = 0.39, P = 0.001). This procedure enabled accelerated vertebral body creep to be predicted from morphological changes (residual strains) in the damaged vertebral body. Conclusion. These findings suggest that morphometric measurements obtained from fractured vertebrae can be used to quantify vertebral damage intensity and hence to predict progressive vertebral deformity

The aim of this study was to evaluate the time of return to play of elite basketball and voleyball players (both grouped together as jumper) with Haglund deformity after surgical resection of the prominence in the postero-superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative techniques. In this study, we evaluated the duration that is needed to reach a level that a player perform regularly in a competition. This study consists of players operated by the same surgeon with same technique from 2011 to 2019. Twenty eight feet of 22 patients underwent resection of Haglund deformity with lateral approach and the outcome was analysed using AOFAS Ankle-Hind Foot Scale for hindfoot and time to restart a full range regular training was reported. All players received one dose (5–6 cc) platelet rich fibrin to attachement site of Achilles tendon peroperatively just after decompression of prominence. The mean AOFAS score at the follow up was 90/100, at the end of first year and the majority of players returned to play at 4th to 8th month of follow-up. Only two players with deformity of three feet could start to perform after one year. We conclude that minimal invasive approach ostectomy is an effective treatment for players suffering from Haglund deformity and the results were from good to excellent. However, the player should be well informed that the recovery and returning to play can take a longer time than they expect

Lower limb mal-alignment due to deformity is a significant cause of early degenerative change and dysfunction. Standard techniques are available to determine the centre of rotation of angulation (CORA) and extent of the majority of deformities, however distal femoral deformity is difficult to assess because of the difference between anatomic and mechanical axes. We found the described technique involving constructing a line perpendicular to a line from the tip of the greater trochanter to the centre of the femoral head inaccurate, particularly if the trochanter is abnormal. We devised a novel technique which accurately determines the CORA and extent of distal femoral deformity, allowing accurate correction. Using standard leg alignment views of the normal femur, the distal femoral metaphysis and joint line are stylized as a block. A line bisecting the axis of the proximal femur is then extended distally to intersect the joint. The angle (Θ) between the joint and the proximal femoral axis and the position (p) where the extended proximal femoral axis intersects the joint line are calculated. These measurements can then be reproduced on the abnormal distal femur in order to calculate the CORA and extent of the deformity, permitting accurate correction. We examined the utility and reproducibility of the new method using 100 normal femora. Θ = 81 ± sd 2.5. As expected, Θ correlated with femoral length (r=0.74). P (expressed as the percentage of the distance from the lateral edge of the joint block to the intersection) = 61% ± sd 8%. P was not correlated with Θ. Intra-and inter-observer errors for these measurements are within acceptable limits and observations of 30-paired normal femora demonstrate similar values for Θ and p on the two sides. We have found this technique to be universally applicable and reliable in a variety of distal femoral deformities

Hindfoot disorders are complex 3D deformities. Current literature has assessed their influence on the full leg alignment, but the superposition of the hindfoot on plain radiographs resulted in different measurement errors. Therefore, the aim of this study is to assess the hindfoot alignment on Weight-Bearing CT (WBCT) and its influence on the radiographic Hip-Knee-Ankle (HKA) angle. A retrospective analysis was performed on a study population of 109 patients (mean age of 53 years ± 14,49) with a varus or valgus hindfoot deformity. The hindfoot angle (HA) was measured on the WBCT while the HKA angle, and the anatomical tibia axis angle towards the vertical (TA. X. ) were analysed on the Full Leg radiographs. The mean HA in the valgus hindfoot group was 9,19°±7.94, in the varus hindfoot group −7,29°±6.09. The mean TA. X. was 3,32°±2.17 in the group with a valgus hindfoot and 1,89°±2.63 in the group with a varus hindfoot, which showed to be statistically different (p<0.05). The mean HKA Angle was −1,35°±2.73 in the valgus hindfoot group and 0,4°±2.89 in the varus hindfoot group, which showed to be statistically different (p<0.05). This study demonstrates a higher varus in both the HKA and TA. X. in valgus hindfoot and a higher tibia valgus in varus hindfoot. This contradicts the previous assumption that a varus hindfoot is associated with a varus knee or vice versa. In clinical practice, these findings contribute to a better understanding of deformity corrections of both the hindfoot and the knee

Summary Statement. We present a simple and useful geometrical equation system to carry out the pre-operative planning and intra-operative assessments for total knee arthroplasty. These methods are extremely helpful in severely deformed lower limbs. Introduction. Total knee arthroplasty is a highly successful surgery for most of the patients with knee osteoarthritis. With commercial instruments and jigs, most surgeons can correct the deformity and provided satisfactory results. However, in cases with severe extra-articular deformity, the instruments may mislead surgeons in making judgment of the true mechanical axis. We developed a geometrical equation system for pre-operative planning and intra-operative measurement to perform correct bony cuts and achieve good post-operative axis. Patients & Methods. From 2008 to 2012, twenty-four patients with severe extra-articular deformities of low limbs underwent total knee arthroplasties for osteoarthritis. The deformities included malunion of femoral or tibial shafts with angulation, non-union of femoral supracondylar fractures, failed high tibia osteotomies, severe bowing of femurs, and other post-traumatic sequelae. The intra-medullary or extra-medullary guide devices were not possible to provide correct axis in these cases. For pre-operative planning, we analyzed the deformities on triple-film scanography and standing anterior-posterior and lateral X-ray films. The angles needed to be corrected in coronal and sagittal planes were measured. A geometrical equation system was applied to calculate the thickness of the proximal tibia cut and distal femoral cut. If the flexion contracture was presented, the degree of necessary elevation of joint line was also calculated. Intra-operatively, the degree of rotation of anterior and posterior femoral cuts was assessed after proximal tibial and distal femoral cuts. The sizes of prosthesis were judged according to the balance between flexion and extension gaps. A 3-in-1 jig was used for chamfering of the femur. After fine-tuning of bony cuts and balancing of soft tissue, the prostheses were cemented. The conventional intra-medullary and extra-medullary guiding devices were not used during the whole procedure. Results. All of the patients achieved satisfactory results in the aspect of pain relief and functional outcomes. All patients had good post-operative axis in coronal plane (varus or valgus deformity < 3 degrees). Twenty-two patients (92%) achieved good sagittal alignments (deformity < 3 degrees). The results were compatible with those in the patient population without those severe deformities. There was no major complication among these patients. Discussion/Conclusion. In this series, we present a simple and useful geometrical equation system to carry out the pre-operative planning and intra-operative assessments for total knee arthroplasty. These methods are extremely helpful in severely deformed lower limbs. Optimal post-operative alignments were achieved in this series and no major complication was found

Introduction. Vertebral osteoporotic fracture increases both elastic and time-dependent ('creep') deformations of the fractured vertebral body during subsequent loading. The accelerated rate of creep deformation is especially marked in central and anterior regions of the vertebral body where bone mineral density is lowest. In life, subsequent loading of damaged vertebrae may cause anterior wedging of the vertebral body which could contribute to the development of kyphotic deformity. The aim of this study was to determine whether gradual creep deformations of damaged vertebrae can be reduced by vertebroplasty. Methods. Fourteen pairs of spine specimens, each comprising three vertebrae and the intervening soft tissue, were obtained from cadavers aged 67-92 yr. Specimens were loaded in combined bending and compression until one of the vertebral bodies was damaged. Damaged vertebrae were then augmented so that one of each pair underwent vertebroplasty with polymethylmethacrylate cement, the other with a resin (Cortoss). A 1kN compressive force was applied for 1 hr before fracture, after fracture, and after vertebroplasty, while creep deformation was measured in anterior, middle and posterior regions of each vertebral body, using a MacReflex optical tracking system. Results. Cement type had little influence on creep deformation, so data from all 28 specimens were pooled. After fracture, creep in the anterior vertebral body increased from 4,513 (STD 4766) to 54,107 (STD 54,845) microstrains (P<0.001), and creep in the central region of the vertebral body increased from 885 (STD 5,169) to 34,378 (STD 40,762) microstrain (P<0.001). (10,000 microstrains = 1% deformation.) Following vertebroplasty, creep deformations were reduced by 61% (P=0.002) and 66% (P=0.006) in anterior and central regions respectively. Conclusion. Creep deformations of the anterior and central regions of vertebral bodies increase markedly as a result of fracture but are then reduced by vertebroplasty. In life, vertebroplasty could help to slow or prevent the gradual development of kyphotic deformity following vertebral osteoporotic fracture, as well as increase vertebral stiffness and strength

Flexion Deformity of knee is the most common deformity in post polio residual deformity. Wilson's release, supracondylar osteotomy etc have been described for its treatment. We present our result of fractional hamstring lengthening followed by gradual distraction using threaded rod in hollow tube to treat flexion deformity of knee. This retrospective study included 150 cases (80 males and 70 females) with the mean of 15 years (8-22yrs). The mean duration of deformity was 6 years (2 – 14yrs) with mean follow up 0f 3 years. The mean preoperative flexion deformity was 45degree (110 – 30 degree) with a mean pre operative further flexion of 110 degree (130 – 90) .20 cases were had a crawling gait and 10 cases were wheel chair bound. Flexion got corrected to 0 degree in 110 cases (P value <0.01). Post operative mean arc of motion was 80degree We had 10 cases who could not tolerate plaster and hence were put on traction . 20 cases had knee stiffness on removal of plaster which could not improve on physiotherapy. 10 cases had superficial infection cured with dressings. Our findings indicate that this method is very effective in the treatment of flexion deformity of knee with complication of knee stiffness in older cases

Previous studies of the Ilizarov procedure have concentrated on musculoskeletal assessments rather than the opinions of patients. In a prospective trial of 25 consecutive patients, we evaluated the effect of Ilizarov reconstruction of post-traumatic deformity on general health status using the SF36 and Nottingham Health Profile (NHP). The patients had very low preoperative scores, which remained low during treatment and correction, but increased postoperatively. The mean overall SF36 score improved from 36 ± 3 to 58 ± 7 (p = 0.031) and the NHP score from 39 ± 11 to 67 ± 10 (p = 0.002). The improvements in scores were not limited to the physical components and were equal or better than the improvements reported for other orthopaedic procedures, including total joint arthroplasty. Ilizarov-type reconstruction of deformity of the lower limb not only restores bony configuration, but also produces a large improvement in the general health status of patients

Children with cerebral palsy (CP) often present femoral bone deformities not accounted for in generic musculoskeletal models [1,2]. MRI-based models can be used to include subject-specific muscle paths [3,4], although this is a time-demanding process. Recently, non-rigid deformation techniques have been used to transform generic bone geometry, including muscle points, onto personalized bones [5]. However, it is still unknown to what extent such an approximation of subject-specific detail affects calculated hip contact forces (HCFs) during gait in CP children. Seven children diagnosed with diplegic CP walked independently at self-selected speed. 3D marker trajectories were captured using Vicon (Oxford Metrics, UK) and force data was measured using two AMTI force platforms (Watertown, MA). MR-images were acquired (Philips Ingenia 1.5T) of all subjects lying supine. Firstly, a generic model [6] was scaled using the marker positions of a static pose. Secondly, a MRI-model containing the subject-specific bone structures and muscle paths of all hip and upper leg muscles was created [3]. Thirdly, the generic femur and pelvis geometries and muscle points were transformed onto the image-based femur and pelvis using an advanced non-rigid deformation procedure (Materialise N.V.). For all models, further analyses were performed in OpenSim 3.1 [7]. A kalman smoother procedure was used to calculate joint angles [8]. Muscle forces were calculated using a static optimization minimizing the sum of squared muscle activities. Next, HCFs were calculated and normalized to body weight (BW). First and second peak HCFs were determined and used for a Kruskal-Wallis test to determine differences between models. In case of a significant difference, a post-hoc rank-based multiple comparison test with Bonferonni adjustment was used. Further, average absolute differences in muscle points between the models was calculated, as well as average differences in moment arm lengths (MALs), reflecting muscle function. Where the scaled generic muscle points differed on average 2.49cm from the MRI points, the non-rigidly deformed points differed 1.54cm from the MRI muscle points. Specifically, the tensor fascia latae differed most between the deformed and MRI models (11.7cm). When considering MALs, the gluteii muscles present an altered function for the generic and deformed models compared to the MRI model for all degrees of freedom of the hip at the time of both HCF peaks. The differences between models resulted in a significantly increased second peak HCF for the MRI models compared to the generic models (first peak average HCF: 3.88BW, 3.95BW and 4.90BW; second peak average HCF: 3.03BW, 4.89BW and 5.32BW for the generic, MRI and non-rigidly deformed models respectively). Although not significantly different, the deformed models calculated slightly increased HCFs compare to the MRI models. The generic models underestimated HCFs compared to the MRI models, while the non-rigidly deformed models slightly overestimated HCFs. However, differences between the deformed and MRI models in terms of muscle points and MALs remain, specifically for the gluteii muscles. Therefore, further user-guided modification of the model based on MR-images will be necessary

It is still difficult to determine an appropriate hinge position to prevent fracture in the lateral cortex of tibia in the process of making an open wedge during biplane open wedge high tibial osteotomy. The objective of this study was to present a biomechanical basis for determining the hinge position as varus deformity. T Three-dimensional lower extremity models were constructed using Mimics. The tibial wedge started at 40 mm distal to the medial tibial plateau, and osteotomy for three hinge positions was performed toward the head of the fibula, 5 mm proximal from the head of the fibula, and 5 mm distal from the head of the fibula. The three tibial models were made with varus deformity of 5, 10, 15 degrees with heterogeneous material properties. These properties were set to heterogeneous material properties which converted from Hounsfield's unit to Young's modulus by applying empirical equation in existing studies. For a loading condition, displacement at the posterior cut plane was applied referring to Hernigou's table considering varus deformity angle. All computational analyses were performed to calculate von-mises stresses on the tibial wedges. The maximum stress increased to an average of 213±9% when the varus angle was 10 degrees compared to 5 degrees and increased to an average of 154±8.9% when the varus angle was 15 degrees compared to 10 degrees. In addition, the maximum stress of the distal position was 19 times higher than that of the mid position and 5 times higher than that of the proximal position on average. Conclusion:. For varus deformity angles, the maximum stress of the tibial wedge tended to increase as the varus deformity angle increased. For hinge position of tibial wedge, maximum stress was the lowest in the mid position, while the highest in the distal position. *This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (NRF-2022R1A2C1009995)

Introduction. Current treatments of rotational deformities of long bones in children are osteotomies and fixations. In recent years, the use of guided growth for correction of rotational deformities has been reported in several pre-clinical and clinical studies. Various techniques have been used, and different adverse effects, like growth retardation and articular deformities, have been reported. We tested a novel plate concept intended for correction of rotational deformities of long bones by guided growth, with sliding screw holes to allow for longitudinal growth, in a porcine model. Method. Twelve, 12-week-old female porcines were included in the study. Surgery was performed on the left femur. The right femur was used as control. Plates were placed distally to induce external rotation, as longitudinal growth occurred. CT-scans of the femurs were processed to 3-D models and used for measuring rotation. Result. The plates rotated as intended in all 12 porcines. One porcine was excluded due to congenital deformity of the proximal part of the femurs. Two porcines had cut-out of the proximal screw on the lateral side, observed at the end of the intervention. These two porcines were included in the results. We observed a Δrotation of 5.7° ± 2° in external direction (CI: 3.7°– 7.7°). ΔFemur length was -0.4 cm [-0.7 cm – 0 cm] equal to 1.5% shortening of the operated femur. No significant difference was observed in coronal or sagittal plane. Conclusion. Significant external rotation was achieved with minimal effect on longitudinal growth. While the use of guided growth for correction of rotational deformities is already being used clinically, it is still to be considered an experimental procedure with sparse evidence. This study shows promising results for the feasibility of the method in a large animal model and is an important first step in validating the technique and detecting possible adverse effects, before future clinical studies

The aim of this scoping review is to understand the extent and type of evidence in relation to the use of guided growth for correcting rotational deformities of long bones. Guided growth is routinely used to correct angular deformities in long bones in children. It has also been proven to be a viable method to correct rotational deformities, but the concept is not yet fully examined. Databases searched include Medline, Embase, Cochrane Library, Web of Science and Google Scholar. All identified citations were uploaded into Rayyan.ai and screened by at least two reviewers. The search resulted in 3569 hits. 14 studies were included: 1 review, 3 clinical trials and 10 pre-clinical trials. Clinical trials: a total of 21 children (32 femurs and 5 tibiae) were included. Surgical methods were 2 canulated screws connected by cable, PediPlates obliquely oriented, and separated Hinge Plates connected by FiberTape. Rotation was achieved in all but 1 child. Adverse effects reported include limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. 2 pre-clinical studies were ex-vivo studies, 1 using 8-plates on Sawbones and 1 using a novel z-shaped plates on human cadaver femurs. There were 5 lapine studies (2 using femoral plates, 2 using tibial plates and 1 using an external device on tibia), 1 ovine (external device on tibia), 1 bovine (screws and cable on metacarp) and a case-report on a dog that had an external device spanning from femur to tibia. Rotation was achieved in all studies. Adverse effects reported include implant extrusions, LLD, articular deformities, joint stiffness and rebound. All included studies conclude that guided growth is a viable treatment for rotational deformities of long bones, but there is great variation in models and surgical methods used, and in reported adverse effects

Paediatric musculoskeletal (MSK) disorders often produce severe limb deformities, that may require surgical correction. This may be challenging, especially in case of multiplanar, multifocal and/or multilevel deformities. The increasing implementation of novel technologies, such as virtual surgical planning (VSP), computer aided surgical simulation (CASS) and 3D-printing is rapidly gaining traction for a range of surgical applications in paediatric orthopaedics, allowing for extreme personalization and accuracy of the correction, by also reducing operative times and complications. However, prompt availability and accessible costs of this technology remain a concern. Here, we report our experience using an in-hospital low-cost desk workstation for VSP and rapid prototyping in the field of paediatric orthopaedic surgery. From April 2018 to September 2022 20 children presenting with congenital or post-traumatic deformities of the limbs requiring corrective osteotomies were included in the study. A conversion procedure was applied to transform the CT scan into a 3D model. The surgery was planned using the 3D generated model. The simulation consisted of a virtual process of correction of the alignment, rotation, lengthening of the bones and choosing the level, shape and direction of the osteotomies. We also simulated and calculated the size and position of hardware and customized massive allografts that were shaped in clean room at the hospital bone bank. Sterilizable 3D models and PSI were printed in high-temperature poly-lactic acid (HTPLA), using a low-cost 3D-printer. Twenty-three operations in twenty patients were performed by using VSP and CASS. The sites of correction were: leg (9 cases) hip (5 cases) elbow/forearm (5 cases) foot (5 cases) The 3D printed sterilizable models were used in 21 cases while HTPLA-PSI were used in five cases. customized massive bone allografts were implanted in 4 cases. No complications related to the use of 3D printed models or cutting guides within the surgical field were observed. Post-operative good or excellent radiographic correction was achieved in 21 cases. In conclusion, the application of VSP, CASS and 3D-printing technology can improve the surgical correction of complex limb deformities in children, helping the surgeon to identify the correct landmarks for the osteotomy, to achieve the desired degree of correction, accurately modelling and positioning hardware and bone grafts when required. The implementation of in-hospital low-cost desk workstations for VSP, CASS and 3D-Printing is an effective and cost-advantageous solution for facilitating the use of these technologies in daily clinical and surgical practice

There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis. This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included pain (visual analogue scale VAS), rate of Popeye deformity, and operative time. 860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.14, 95% CI −0.04 to 0.32; p=0.13). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. There was no significant difference for pain (VAS). Tenodesis resulted in a lower rate of Popeye deformity (OR 0.29, 95% CI 0.19 to 0.45, p < 0.00001). Tenotomy demonstrated a shorter operative time (MD 15.21, 95% CI 1.06 to 29.36, p < 0.00001). Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. A large multi-centre clinical effectiveness randomised controlled trial is needed to provide clarity in this area

Developments in the field of additive manufacturing have allowed significant improvements in the design and production of scaffolds with biologically relevant features to treat bone defects. Unfortunately, the workflow to generate personalized scaffolds is source of inaccuracies leading to a poor fit between the implant and patients' bone defects. In addition, scaffolds are often brittle and fragile, uneasing their handling by surgeons, with significant risks of fracture during their insertion in the defect. Consequently, we developed organo-mineral cementitious scaffolds displaying evolutive mechanical properties which are currently being evaluated to treat maxillofacial bone deformities in veterinary clinics. Treatment of dog patients was approved by ethic and welfare committees (CERVO-2022-14-V). To date, 8 puppies with cleft palate/lip deformities received the following treatment. Two weeks prior surgery, CT-scan of patient's skull was performed to allow for surgical planning and scaffold designing. Organo-mineral printable pastes were formulated by mixing an inorganic cement precursor (α-Ca3(PO4)2) to a self-reticulating hydrogel (silanized hyaluronic acid) supplemented with a viscosifier (hydroxymethylpropylcellulose). Scaffolds were produced by robocasting of these pastes. Surgical interventions included the reconstruction of soft tissues, and the insertion of the scaffold soaked with autologous bone marrow. Bone formation was monitored 3 and 6 months after reconstruction, and a biopsy at 6 months was performed for more detailed analyses. Scaffolds displayed great handling properties and were inserted within bone defects without significant issue with a relevant bone edges/scaffold contact. Osteointegration of the scaffolds was observed after 3 months, and regeneration of the defect at 6 months seemed quite promising. Preliminary results have demonstrated a potential of the set-up strategy to treat cleft lip/palate deformities in real, spontaneous clinical setting. Translation of these innovative scaffolds to orthopedics is planned for a near future

Several emerging reports suggest an important involvement of the hindfoot alignment in the outcome of knee osteotomy. At present, studies lack a comprehensive overview. Therefore, we aimed to systematically review all biomechanical and clinical studies investigating the role of the hindfoot alignment in the setting of osteotomies around the knee. A systematic literature search was conducted on multiple databases combining “knee osteotomy” and “hindfoot/ankle alignment” search terms. Articles were screened and included according to the PRISMA guidelines. A quality assessment was conducted using the Quality Appraisal for Cadaveric Studies (QUACS) - and modified methodologic index for non-randomized studies (MINORS) scales. Three cadaveric, fourteen retrospective cohort and two case-control studies were eligible for review. Biomechanical hindfoot characteristics were positively affected (n=4), except in rigid subtalar joint (n=1) or talar tilt (n=1) deformity. Patient symptoms and/or radiographic alignment at the level of the hindfoot did also improve after knee osteotomy (n=13), except in case of a small pre-operative lateral distal tibia- and hip knee ankle (HKA) angulation or in case of a large HKA correction (>14.5°). Additionally, a pre-existent hindfoot deformity (>15.9°) was associated with undercorrection of lower limb alignment following knee osteotomy. The mean QUACS score was 61.3% (range: 46–69%) and mean MINORS score was 9.2 out of 16 (range 6–12) for non-comparative and 16.5 out of 24 (range 15–18) for comparative studies. Osteotomies performed to correct knee deformity have also an impact on biomechanical and clinical outcomes of the hindfoot. In general, these are reported to be beneficial, but several parameters were identified that are associated with newly onset – or deterioration of hindfoot symptoms following knee osteotomy. Further prospective studies are warranted to assess how diagnostic and therapeutic algorithms based on the identified criteria could be implemented to optimize the overall outcome of knee osteotomy. Remark: Aline Van Oevelen and Arne Burssens contributed equally to this work

The concept of guided growth was proposed by Andry in 1741. In the last decades the concept has been widely used as implants has been introduced that can modulate the growth of the bone and pediatric longitudinal and angular deformities is widely treated by this technique. However, there is there is a huge variation in techniques and implants used and high-quality clinical trials is still lacking. Recently implants correcting rotational bony deformities have been proposed and clinical case series have been published. The current status of guided growth will be presented in this narrative review and preliminary experiences with rotational guided growth will be shared. Is guided growth to be considered a safe treatment at this time point?