Matthias Pallamar

Background/Objectives: Hip ultrasound is the standard screening method for developmental dysplasia of the hip (DDH) in infants, yet sonographic acetabular rim irregularities (SARIs) remain understudied regarding their prevalence and clinical associations. Methods: A total of 1010 infants within the first four months of life, referred to a specialized pediatric orthopedic hip clinic between 2014 and 2019 for suspected or confirmed DDH, were included in this retrospective cohort study. Hip ultrasound was performed using the standardized Graf technique. Clinical, demographic, and sonographic data were extracted from patient records. Two pediatric orthopedic specialists assessed all ultrasound hip images for the presence of an SARI and measured its relative size (d/D). Associations among SARI, patient characteristics, and sonographic parameters were analyzed using appropriate univariate and multivariable statistical methods (p < 0.05). Results: We identified SARI in 9.11% of all hips and in 13.07% of all infants, with many developing during Pavlik harness treatment. Univariate and multivariate analyses revealed cesarean delivery as an independent factor associated with SARI occurrence. SARIs that developed over time had a significantly larger d/D ratio compared with those that were visible from the very beginning (p = 0.04). Conclusions: These findings establish a baseline prevalence and highlight potential risk markers for SARI in a dysplasia-enriched cohort. Further prospective studies are warranted to elucidate the clinical significance of SARI and its impact on treatment outcomes and hip development.

Resection of tarsal coalitions aims to relieve pain and restore hindfoot mobility, especially in young, active patients over the long term. This study investigated (1) long-term differences in clinical outcomes between calcaneonavicular (CN) and talocalcaneal (TC) coalition resections; (2) the frequency and clinical relevance of re-ossification; and (3) radiological signs of osteoarthritis in adjacent hindfoot joints. In this case series, 29 feet from 24 patients with a minimum follow-up of 80 months after tarsal coalition resection were examined. Clinical assessments included range of motion, AOFAS hindfoot score, FAOS, FFI, VAS, and Tegner activity scale. Bilateral standing radiographs and computed tomography (CT) scans were evaluated for re-ossification and degenerative changes. There were no significant differences in pain, function, or range of motion between CN and TC resections. Re-ossification at the resection site was observed in 14 of 29 feet and was associated with poorer FAOS (p = 0.007) and reduced passive supination (p = 0.030). Degenerative changes (I°-III° osteoarthritis) in the calcaneocuboid joint were significantly more frequent after CN resection (15 of 22 feet, p = 0.001). Tarsal coalition resection in paediatric patients can result in good long-term clinical outcomes. However, partial or complete re-ossification is a frequent CT finding and is associated with pain and reduced function. Degenerative changes in the calcaneocuboid (CC) joint are more commonly observed in CN coalitions than in TC coalitions. This study highlights the need for improved strategies to prevent re-ossification and the need for long-term monitoring for joint degeneration after tarsal coalition resection in children and adolescents.

Background/Objectives: Juvenile osteochondritis dissecans (JOCD) of the knee is commonly treated using conservative or joint-preserving surgical techniques. While clinical outcomes are generally favorable, the risk of early cartilage degeneration remains unclear. Joint space width (JSW) on weight-bearing radiographs serves as an indirect marker of cartilage health. Artificial intelligence (AI)-based JSW assessment may enable sensitive and reproducible detection of early degenerative changes. Methods: This cross-sectional feasibility study included 21 skeletally immature patients treated for JOCD of the distal femur between 2002 and 2017. Treatment modalities comprised conservative management, retrograde drilling, and fragment refixation. Fully automated JSW measurements were performed on standardized anteroposterior knee radiographs using a validated AI-based software IB Lab KOALA™, Version 2.4. JSW of the affected compartment was compared with the contralateral knee and between treatment groups. Clinical outcomes were assessed using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score. Additionally, a systematic review of the literature on post-treatment degenerative changes following OCD therapy was conducted according to PRISMA guidelines. Results: Compared with manually reviewing images, the software IB Lab KOALA™, Version 2.4 as easy to implement. AI-based analysis revealed no significant differences in JSW between the affected and contralateral knees, nor between treatment modalities. Average JSW exceeded 6 mm in all groups after a median follow-up of 64 (min. 27, max. 177) months. Clinical scores were high and comparable across treatments. A moderate positive correlation was observed between the JSW and Lysholm score, while increasing age and longer follow-up were associated with a reduced JSW. The systematic review identified ten relevant studies, reporting generally favorable long-term clinical outcomes with a low but present risk of osteoarthritis progression. Conclusions: Our AI-based analysis showed no differences in JSW between conservative and joint-preserving surgical treatments of JOCD in the follow-up. This technology can provide a valuable tool for standardized and sensitive radiographic monitoring in young patients.

Background: Osteotomies around the knee aim to correct varus or valgus malalignment and improve biomechanics. However, little is known about their effect on knee phenotypes, as defined by the Coronal-Plane-Alignment-of-the-Knee (CPAK) and Hirschmann’s functional classification. This study evaluated pre- and postoperative phenotypes in patients undergoing high-tibial-osteotomy (HTO) or distal-femoral-osteotomy (DFO). Methods: We retrospectively analysed 214 osteotomies around the knee (HTO: 145; DFO: 69) of 188 patients from our institutional registry. Radiographic parameters were measured using a validated artificial intelligence software, with phenotypes classified by CPAK and Hirschmann classification. Preoperative osteotomy planning was compared to postoperative alignment. Regression was used to assess the influence of demographic and radiographic factors. Results: CPAK types changed in 95.3% of cases. Medial opening HTOs most frequently shifted from CPAK type I (73.8%) to VI (42.3%), while medial closing DFOs transitioned from type III (81.5%) to V (24.1%). Concordance between planned and achieved CPAK types was highest for types III, IV, and V. Postoperative angles were generally smaller than planned for joint-line-obliquity (JLO), lateral-distal-femur-angle, and medial-proximal-tibial-angle (p < 0.001). Neutral JLO was restored in only 48.1%. Preoperative phenotypes NEUmLDFA0° (40.1%) and VARmMPTA3° (32.3%) were most common, while postoperative phenotypes included VALmLDFA3° (52.4%) and VALmMPTA3° (37.7%). Age, sex, and BMI significantly influenced alignment outcomes. Conclusions: Postoperative CPAK classifications shifted significantly across all osteotomy types, with minimal retention of preoperative types. Although most procedures achieved correction within the target HKA range, restoration of a neutral JLO was observed in only half of the cases, emphasizing the importance of phenotype-specific planning and highlight potential limitations of CPAK classification.

Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis. 284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19-77 weeks after the first application of ESWT. 76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors. Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions. In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed.