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Daniel Kotrych, Andrea Angelini, Andrzej Bohatyrewicz, and Pietro Ruggieri

  • Satisfactory results in terms of functional and oncological outcomes can be obtained in sacral and pelvic malignant bone tumors.

  • Preoperative planning, adequate imaging, and a multidisciplinary approach are needed.

  • 3D-printed prostheses have to fulfill several requirements: (i) mechanical stability, (ii) biocompatibility, (iii) implantability, and (iv) diagnostic compatibility.

  • In this review, we highlight current standards in the use of 3D-printed technology for sacropelvic reconstruction.

Emanuele Diquattro, Sonja Jahnke, Francesco Traina, Francesco Perdisa, Roland Becker, and Sebastian Kopf

  • Despite the general success of anterior cruciate ligament reconstructions (ACL-R), there are still studies reporting a high failure rate. Orthopedic surgeons are therefore increasingly confronted with the treatment of ACL retears, which are often accompanied by other lesions, such as meniscus tears and cartilage damage and which, if overlooked, can lead to poor postoperative clinical outcomes.

  • The literature shows a wide variety of causes for ACL-R failure. Main causes are further trauma and possible technical errors during surgery, among which the position of the femoral tunnel is thought to be one of the most important.

  • A successful postoperative outcome after ACL-revision surgery requires good preoperative planning, including a thorough evaluation of patient's medical history, e.g. instability during daily or sports activity, increased general joint laxity, and hints for a low-grade infection. A careful clinical examination should be performed. Additionally, comprehensive imaging is necessary. Besides a magnetic resonance imaging, a CT scan is helpful to determine location of tunnel apertures and to analyze for tunnel enlargement. A lateral knee radiograph is helpful to determine the tibial slope.

  • The range of surgical options for the treatment of ACL-R failure is broad today. Orthopedic surgeons and experts in Sports Medicine must deal with various possible associated injuries of the knee or unfavorable anatomical conditions for ACL-R.

  • The aim of this review was to highlight predictors and reasons of failures of ACL-R as well as describe diagnostic procedures to individualize treatment strategies for improved outcome after revision ACL-R.

Michael J Raschke, Sabine Ochman, and Alexander Milstrey

  • The relevance of geriatric ankle fractures is continuously increasing.

  • Treatment of these patients remains challenging and requires adapted diagnostic and therapeutic strategies, as compliance to partial weight bearing is difficult to maintain compared to younger patients.

  • In addition, in the elderly even low impact injuries may lead to severe soft tissue trauma, influencing timing and operative strategies.

  • Recently, the direct posterolateral approach and plate fixation techniques, angular stable implants as well as intramedullary nailing of the distal fibula have been found to improve stategical concepts.

  • This article aims to provide a comprehensive overview of the diagnostic and recent aspects with respect to how this difficult entity of injuries should be approached.

Juan Carlos Monllau, Simone Perelli, and Giuseppe Gianluca Costa

  • Anterior cruciate ligament (ACL) reconstruction failure can be defined as abnormal knee function due to graft insufficiency with abnormal laxity or failure to recreate a functional knee according to the expected outcome.

  • Traumatic ruptures have been reported as the most common reason for failure. They are followed by technical errors, missed concomitant knee injuries, and biological failures.

  • An in-depth preoperative examination that includes a medical history, clinical examinations, advanced imaging, and other appropriate methods is of utmost importance.

  • There is still no consensus as to the ideal graft, but autografts are the favorite choice even in ACL revision.

  • Concomitant meniscal treatment, ligamentous reconstruction, and osteotomies can be performed in the same surgical session to remove anatomical or biomechanical risk factors for the failure.

  • Patient expectations should be managed since outcomes after ACL revision are not as good as those following primary ACL reconstruction.

Agnieszka Halm-Pozniak, Christoph H Lohmann, Luigi Zagra, Benedikt Braun, Max Gordon, and Bernd Grimm

  • Digitization in orthopaedics and traumatology is an enormously fast-evolving field with numerous players and stakeholders. It will be of utmost importance that the different groups of technologists, users, patients, and actors in the healthcare systems learn to communicate in a language with a common basis.

  • Understanding the requirements of technologies, the potentials of digital application, their interplay, and the combined aim to improve health of patients, would lead to an extraordinary chance to improve health care.

  • Patients' expectations and surgeons’ capacities to use digital technologies must be transparent and accepted by both sides.

  • The management of big data needs tremendous care as well as concepts for the ethics in handling data and technologies have to be established while also considering the impact of withholding or delaying benefits thereof.

  • This review focuses on the available technologies such as Apps, wearables, robotics, artificial intelligence, virtual and augmented reality, smart implants, and telemedicine.

  • It will be necessary to closely follow the future developments and carefully pay attention to ethical aspects and transparency.

Paul L Rodham, Vasileios P Giannoudis, Nikolaos K Kanakaris, and Peter V Giannoudis

  • The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss.

  • Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth.

  • Autologous bone graft remains the gold standard, providing all of these qualities. Limitations to this technique include low graft volume and donor site morbidity, with alternative techniques including the use of allograft or xenograft.

  • Artificial scaffolds can provide an osteoconductive construct, however fail to provide an osteoinductive stimulus, and frequently have poor mechanical properties.

  • Recombinant bone morphogenetic proteins can provide an osteoinductive stimulus; however, their licencing is limited and larger studies are required to clarify their role.

  • For recalcitricant non-unions or high-risk cases, the use of composite graft combining the above techniques provides the highest chances of successfully achieving bony union.

Martin McNally, Irene Sigmund, Andrew Hotchen, and Ricardo Sousa

  • Prosthetic joint infections (PJI) can be difficult to diagnose.

  • Studies have shown that we are missing many infections, possibly due to poor diagnostic workup and the presence of culture-negative infection.

  • PJI diagnosis requires a methodical approach and a standardised set of criteria.

  • Multiple PJI definitions have been published with improved accuracy in recent years.

  • The new European Bone and Joint Infection Society definition offers some advantages in clinical practice. It identifies more clinically important infections and accurately defines those with the highest risk of treatment failure. It reduces the number of patients with uncertain diagnoses.

  • Classification of PJIs may offer a better understanding of treatment outcomes and risk factors for failure.

Mark F Siemensma, Anna E van der Windt, Eline M van Es, Joost W Colaris, and Denise Eygendaal

  • The elbow is prone to stiffness due to its unique anatomy and profound capsular reaction to inflammation. The resulting movement impairment may significantly interfere with a patient’s activities of daily living.

  • Trauma (including surgery for trauma), posttraumatic arthritis, and heterotopic ossification (HO) are the most common causes of elbow stiffness.

  • In stiffness caused by soft tissue contractures, initial conservative treatment with physiotherapy (PT) and splinting is advised. In cases in which osseous deformities limit range of motion (e.g. malunion, osseous impingement, or HO), early surgical intervention is recommended.

  • Open and arthroscopic arthrolysis are the primary surgical options. Arthroscopic arthrolysis has a lower complication and revision rate but has narrower indications.

  • Early active mobilization using PT after surgery is recommended in postoperative rehabilitation and may be complemented by splinting or continuous passive motion therapy. Most results are gained within the first few months but can continue to improve until 12 months.

  • This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness.

Ilse Degreef, Kira Vande Voorde, and Maarten Van Nuffel

  • In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren’s contracture.

  • The risk for complications is significant, certainly in recurrent disease and in the presence of abundant scar tissue.

  • Meticulous surgical technique is mandatory.

  • Microsurgery increases magnification from four times (with surgical loupes) up to 40 times.

  • Using the microscope in Dupuytren’s surgery, a technique named microfasciectomy is likely to increase both safety and efficiency by preventing instead of treating surgical complications.

  • Increased experience with microsurgery will benefit Dupuytren’s treatment and hand surgery in general.

T Gosens and B L den Oudsten

  • Mental health is important as a predictor of outcomes after orthopedic treatment.

  • Psychological parameters (e.g. expectations, coping strategies, personality) are as important as biological and mechanical factors in the severity of musculoskeletal complaints and treatment results.

  • Orthopedic surgeons should not only treat physical conditions but also address psychosocial factors. If necessary, they should refer to clinical psychologists.

  • Multidisciplinary approach, patient-oriented treatment, (psycho)education, emotional support, and teaching coping strategies are elements of psychosocial attention within orthopedics and traumatology.