Modified technique for unipolar allograft ankle replacement: midterm follow-up. A case report

The management of tibiotalar arthritis remains a clinical challenge. Conventional treatment relies primarily upon arthrodesis or prosthetic arthroplasty. Fresh osteochondral total ankle allograft transplantation has been reported in limited cases. We report the case of a 42-year-old male who underwent a tibial refrigerated osteochondral allograft and a talar refrigerated osteochondral mosiacplasty. At 66-month follow-up, the patient demonstrated no limp with walking and was able to participate in tennis and snow skiing with no pain. His Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, total WOMAC score, and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were 0, 94, and 98, respectively. The final radiograph showed complete integration of the allograft with mild joint space narrowing. Osteochondral allografting for ankle arthritis may be considered an option in select patients.     

Inter-segment foot kinematics during cross-slope running

Cross-slopes are a common terrain characteristic, however there is no biomechanical knowledge of the intra-foot adaptations required for running on these surface inclinations. The purpose of this study was to evaluate the kinematic changes induced within the foot while running on a transversely inclined surface. A three-segment foot model distinguishing between the hindfoot, forefoot, and hallux was used for this purpose. Nine healthy experienced male runners volunteered to perform level (0°) and cross-slope (10°) running trials barefoot at a moderate speed. Multivariate analysis of variance (MANOVA) for repeated measures was used to analyze the kinematics of the hindfoot with respect to tibia (HF/TB), forefoot with respect to hindfoot (FF/HF), and hallux with respect to forefoot (HX/FF) during level running (LR), incline running up-slope (IRU), and incline running down-slope (IRD) conditions. In the sagittal plane, the FF/HF angle showed greater dorsiflexion at peak vertical force production (MaxFz) in IRD compared to LR (p=0.042). The HX/FF was significantly more extended during IRU than LR at foot strike (p=0.027). More importantly, frontal plane asymmetries were also found. HF/TB angles revealed greater inversion at foot strike followed by greater eversion at MaxFz for IRU compared to IRD (p=0.042 and p=0.018, respectively). For the FF/HF angle, maximum eversion was greater during IRD than LR (p=0.035). Data suggests that running on cross-slopes can induce substantial intra-foot kinematic adaptations, whether this represents a risk of injury to both recreational and professional runners remains to be determined.     

Single‐Dose,Randomized, Double‐Blind,Placebo‐Controlled Study of ACE‐011 (ActRIIA‐IgG1) in Postmenopausal Women

The effects of ACE‐011 on safety, pharmacokinetics, and bone biomarkers were evaluated in healthy, postmenopausal women. Our data indicate that ACE‐011 results in a sustained increase in biomarkers of bone formation and reduction in markers of bone resorption. The activin type IIA receptor (ActRIIA) is the high‐affinity receptor for activin. ACE‐011 is a dimeric fusion protein consisting of the extracellular domain of the human ActRIIA linked to the Fc portion of human IgG1. ACE‐011 binds to activin, preventing activin from binding endogenous receptors. A randomized, double‐blind, placebo‐controlled study was conducted to evaluate the safety and tolerability of ACE‐011. Forty‐eight healthy, postmenopausal women were randomized to receive either a single dose of ACE‐011 or placebo and were followed for 4 mo. Dose levels ranged from 0.01 to 3.0 mg/kg intravenously and from 0.03 to 0.1 mg/kg subcutaneously. Safety and pharmacokinetic (PK) analyses and the biological activity of ACE‐011, as assessed by markers of bone turnover, and follicle stimulating hormone (FSH) levels were measured. No serious adverse events (AEs) were reported. AEs were generally mild and transient. The PK of ACE‐011 was linear over the dose range studied, with a mean half‐life of 24–32 days. The absorption after subcutaneous dosing was essentially complete. ACE‐011 caused a rapid and sustained dose‐dependent increase in serum levels of bone‐specific alkaline phosphatase (BSALP) and a dose‐dependent decrease in C‐terminal type 1 collagen telopeptide (CTX) and TRACP‐5b levels. There was also a dose‐dependent decrease in serum FSH levels consistent with inhibition of activin. ACE‐011 is a novel agent with biological evidence of both an increase in bone formation and a decrease in bone resorption. ACE‐011 may be an effective therapy in a variety of diseases involving bone loss.     

The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up

Background  

To prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears.