The edition · Orthopaedics
The osteosarcoma gap opens before the diagnosis
Patients from the most deprived areas carried symptoms for 13 weeks against six, and arrived through emergency care twice as often - but once diagnosed, their treatment ran to the same timetable as everyone else's. Plus slope-reducing osteotomy in elite athletes, two tendon measurements for patellofemoral instability, and bioabsorbable screws that behaved themselves for two years.
The edition in brief
Today's orthopaedics desk opens with 19 elite athletes who had a failed anterior cruciate ligament reconstruction and a posterior tibial slope of 10 degrees or more. Revision reconstruction combined with supratuberosity slope-reducing osteotomy brought slope from a mean 14.9 degrees to 4.5 degrees; every athlete returned to their pre-injury level at a mean 12.1 months, IKDC rose from 44.2 to 92.3, and there were no graft failures - all from a level 4 case series with no comparison group. A case-control MRI study of 284 adolescent knees validates two tendon-based markers of patellofemoral instability: patellar tendon-lateral trochlear ridge distance reached an area under the curve of 0.903 with a 4 mm cutoff, and the newly described patellar tendon inclination angle 0.866 with a 16 degree cutoff, both informative even when tibial tubercle-trochlear groove distance was normal. A pilot randomised trial of 30 first metatarsophalangeal arthrodeses found bioabsorbable and titanium screws indistinguishable at two years, with 90% union overall and no implant-related complications. Gluteus minimus indentation appeared in 7% of 392 hips imaged for non-traumatic pain, in 22% of dysplastic hips against 4% of others, and each 5 degree fall in lateral centre-edge angle raised its odds 1.5-fold - though the authors say plainly it should not yet change treatment. The edition closes on 88 patients with high-grade osteosarcoma. Those from the most deprived areas had a median symptom duration of 13 weeks against six and five-year overall survival of 37% against 65%, with deprivation independently associated with death (HR 2.0). Time from diagnosis to treatment did not differ. The gap was made before anyone reached the sarcoma service.
Flattening the slope let every one of these athletes back onto the pitch
In a revision ACL candidate with a posterior tibial slope of 10 degrees or more, adding a slope-reducing osteotomy is a reasonable discussion, with a 10 to 20 month return to sport.
Two tendon measurements that work when TT-TG does not
In an adolescent with recurrent patellar instability and a normal TT-TG, measure the patellar tendon itself before concluding the imaging is unremarkable.
Bioabsorbable screws in first MTP fusion: two years, nothing to report
Bioabsorbable screws did not underperform titanium in first MTP fusion at two years, but 30 patients is a feasibility study, not a reason to switch.
A notch on the femoral head that tracks instability - and should change nothing yet
Worth recognising and recording on hip MR arthrography, and explicitly not worth acting on yet.
Measure the slope on the lateral you already have
Record the posterior tibial slope at the first reconstruction so a revision decision starts from a number.
In osteosarcoma the survival gap is made before diagnosis, not after it
The intervention that would close this gap is a plain radiograph at the first presentation of persistent adolescent bone pain, not anything downstream of diagnosis.
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