Publicaties 2002
- Rotatory instability associated with ACL rupture
- Osteotomy in ligamentous injury
- Clinical assessment and surgical planning of acute multiple ligamentous injuries.
- Fixation avec ou sans ciment dans les prothèses totales du genou.
- Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty
- Fixation strength of meniscal repair devices
- Onderzoek naar predisponerende factoren met betrekking tot het functioneel resultaat na een voorste kruisbandreconstructie.
- Research letter. Human homologues of Osr1 and Osr2 are not involved in a syndrome with distal limb deficiencies, oral abnormalities, and renal defects.
- Unilateral absence of the trapezius and pectoralis major muscle: a variant of Poland syndrome.
- Genes and orthopedics: from gene to clinic and vice versa.
- Involvement of a palindromic chromosome 22-specific low-copy repeat in a constitutional t(X;22)(q27;q11).
- The fibulin-1 gene (FBLN1) is disrupted in a t(12;22) associated with a complex type of synpolydactyly.
- How correctly does an intramedullary rod represent the longitudinal tibial axes?
- De processie van kreupelen naar Jeroen Bosch (ca. 1450-1516): een historische analyse.
- Apparently new autosomal dominant spondyloepimetaphyseal dysplasia: gonadal mosaicism onset.
- Common foot problems in elderly men.
- Isolated fracture of the capitate: the value of MRI in diagnosis and follow up.
- Evaluation of rotational gait deviations in children with CP.
- Marche et toxine tobulique.
- Physiotherapy and tone reduction based on gait analysis.
- The influence of BTX-A treatment on the walking pattern of the more involved child with CP.
- Median and ulnar nerve compression at the wrist caused by anomalous muscles.
- Pitfalls in wrist arthroscopy.
- Synovial chondromatosis of the elbow presenting as a soft tissue tumour.
- Frakturen van de carpus.
- Subperiosteal osteoid osteoma of the triquetrum mimicking an avascular necrosis.
- What is the TFCC?
- First approach to a child with a congenital difference of the upper limb.
- Classification for congenital anomalies of the hand: the IFSSH classification and the JSSH modification.
- Coincidental rupture of the scapholunate and lunotriquetral ligaments with volar intercalated segment instability complicating a closed distal forearm fracture in an adolescent.
- Unilateral absent scaphoid in a patient with 'Holt-Oram' syndrome.
- Fetal hydantoin syndrome with unilateral atypical cleft hand: additional evidence for vascular disruption.
- Traumatic divergent dislocation of the extensor tendons over the metacarpophalangeal joint.
- Multifocal glomus tumours of the fingers in two patients with neurofibromatosis type 1.
- Pedicled fat flap coverage of the median nerve after failed carpal tunnel decompression.
- Lunotriquetral arthrodesis, a procedure with a high failure rate.
- Ligament reconstruction
- Multilevel botulinum toxin injections after the range of muscle action during gait in CP children.
- Pre-axial polydactyly: Outcome of the Surgical treatment.
- Avascualr Necrosis of the talus in children with haemophilia.
- Factors affecting the mechanical and viscoelastic properties of acrylic bone cement.
- DFSG 2001, A report.
- Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist.
- Evidence-based botulinum toxin. A treatment of children with cerebral palsy: an integrated multilevel approach.
- Is the dynamic approach in the treatment of clubfeet worthwhile to do? An objective gait evaluation.
- Influence of tone reduction on the natural history of gait patterns in children with CP.
- Marche et pied bot varus équin.
- Partial medial epicondylectomy for cubital tunnel syndrome: outcome and complications.
- Medical image based, preformed titanium membranes for bone reconstructions: design study and first clinical evaluation.
- Posterior transosseous capsulotendinous repair in total hip arthroplasty
- Correlation between clinicopathological features and karyotype in 100 cartilaginous and chordoid tumours.
- Outcome of TFCC sutures of peripheral tears.
- One-stage bilateral total hip replacement: a retrospective study of 70 patients.
- Which factors predict outcome in the treatment program of anterior knee pain?
- Open versus closed kinetic chain exercises in patellofemoral pain: a prospective randomized study.
- A correlation study of objective functionality and WOMAC in total knee arthroplasty.
Rotatory instability associated with ACL rupture
J. BELLEMANS
Rotatory instability associated with ACL rupture.
The Knee 2002, 9, 365.
Anteromedial rotatory instability (AMRI) was originally defined by J. Hughston as the abnormal opening of the medial joint space in abduction, with simultaneous anteromedial rotatory subluxation of the medial tibial condyle on the central axis of the intact PCL. The precise aetiology for this injury is the combination of both an abduction and external rotation moment on the knee joint, leading to sequential rupture of the deep MCL, superficial MCL, and ACL, as demonstrated by Kennedy and Fowler in 1971. Sports activities prone to this injury are; (a) the tackle on the knee from the lateral side, with the foot positioned in external rotation, (b) the so-called 'cutting manoeuvre', and (c) the backward fall in skiing with the ski-tips moving up- and outwards. The posterior oblique ligament (POL) plays an important role in AMRI. In case of isolated MCL + ACL injury with intact POL, abduction laxity, anterior laxity, and external rotation laxity are all moderately increased. Associated injury of the POL, however, will further increase each of them to a dramatic extent (Haimes et al., 1994).
Osteotomy in ligamentous injury
J. BELLEMANS
Osteotomy in ligamentous injury.
The Knee 2002, 9, 359-369 (12).
Valgus osteotomy still has an important place in the treatment of chronic ligamentous knee injury. Its effectiveness towards ligamentous laxity is based upon 3 working mechanisms; (1) reduction of the adduction moment of the knee, (2) the induction of peri-articular fibrosis, and (3) the influence of tibial slope on anteroposterior stability. Bonnin has already shown in 1990 that anterior translation increases 0.6 mm for every degree increase in posterior tibial slope. Reducing the tibial slope with 10°, by performing an asymmetric posteriorly converging closed wedge osteotomy, or a posteriorly diverging open wedge osteotomy, will therefore reduce anterior tibial translation with 6 mm. Likewise, posterior translation can be improved in the chronic PCL deficient knee by increasing the natural slope.
This mechanism makes osteotomy one of the key treatment strategies when dealing with chronic isolated or combined cruciates - collateral ligament injuries, in patients with moderate or advanced medial compartment disease.
Clinical assessment and surgical planning of acute multiple ligamentous injuries.
J. BELLEMANS
Clinical assessment and surgical planning of acute multiple ligamentous injuries.
The Knee 2002, 9, 359-369 (10).
The patient with a multiligament injured knee, requires in the first instance careful vascular and neural examination. The incidence of vascular injury can be as high as 40% in high-velocity dislocations. It is important to realise that arteriography may be positive for vascular damage in 40% of patients with normal peripheral pulses. A low threshold for arteriography is therefore appropriate.
We advocate urgent consultation of the vascular surgeon in every case with less than normal pulsation, and of course when arteriography is positive. In case of vascular repair, the patient remains under vascular supervision until cleared, while meanwhile the knee is stabilized by splinting or external fixation, usually for 2 weeks.
Fixation avec ou sans ciment dans les prothèses totales du genou.
J. BELLEMANS
Fixation avec ou sans ciment dans les prothèses totales du genou.
Boek: La gonarthrose, Michel Bonnin, Pierre Chambat. Approach pratique en orthopédie-traumatologie. Springer-Verlag France, Paris, 2003 ISBN 2-287-59730-1, p. 646-657.
La plupart des auteurs considèrent actuellement que la prothèse totale de genou (PTG) cimentée est le gold standard, compte tenu de ses excellents résultats publiés, avec des bons et très bons résultats dans 88 à 95% des cas. Si l'on prend la 'reprise chirurgicale' comme critère d'échec, le taux de survie des PTG cimentées est de 90% à 95% à 10 ou 15 ans et peut même aller à 91% à 21 ans. Ainsi, la fixation avec ciment donne d'excellents résultats et ceci, quel que soit le type de prothèse avec des taux de descellement faibles, qu'il s'agisse de prothèses conservant le ligament croisé postérieur (LCP) de prothèse sacrifiant le LCP ou de prothèses postéro-stabilisées.
Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty
J. BELLEMANS, S. Banks, J. Victor, H. Vandenneucker, A. Moermans
Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty.
J Bone Joint Surg (Br) 2002,84-B, 50-53.
Abstract:
Our purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty.
Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72 % of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion.
In view of this finding we defined a new parameter termed the 'posterior condylar offset'. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion.
Total knee arthroplasty (TKA) gives good subjective and objective results during the first 15 years after implantation.
Nevertheless, it is clear that the function and subjective findings do not match those of the normal knee. The range of flexion of the knee obtained after TKA is often limited and may be determined by several factors, including the length of the quadriceps, capsular tightness, surgical technique, postoperative physiotherapy and the design of the implant.
Our aim was to identify the factors limiting the range of active flexion after TKA and to compare our findings with those obtained in a larger group of 150 consecutive patients who had undergone primary posterior-cruciate-ligament (PCL)-retaining TKA.
Fixation strength of meniscal repair devices
J. BELLEMANS, H. Vandenneucker, L. Labey, R. Van Audekercke
Fixation strength of meniscal repair devices.
The Knee 9 (2002), 11-14.
Abstract
The aim of this study was to measure and compare the ultimate failure strengths and cyclic fatigue strengths of currently available meniscal suturing devices.
No statistically significant difference in failure load was found between a vertical loop suture (mean 46,3 N), a horizontal mattress suture (52,5 N), the T-fix Device® (47,5 N), and the 16 mm (39,2 N) and 13 mm (32,8 N) Bionix Arrow®. Statistically inferior results were seen with the 10 mm Bionix Arrow® (18,8 N), the S.D. Sorb Stapler® (4,3 N), and the 12 mm Arthrex Meniscal Dart® (10,5 N) (p < 0.01). The Mitek Meniscal Repair System® (28,1 N) performed intermediate, with significantly better results than the S.D. Sorb Stapler® and the 12 mm Arthrex Dart®, but significantly worse than the vertical and horizontal sutures, the T-fix® and Bionix 16 mm Device® (p < 0.01). Cyclic fatigue strength was significantly less for the 10 mm Bionix Arrow®, the S.D. Sorb Stapler®, and the 12 mm Arthrex Meniscal Dart® (p < 0.01) compared to all other devices.
We conclude that the 13 and 16 mm Bionix Arrow® and the T-fix Device® have comparable ultimate failure strengths and cyclic fatigue strengths to conventional meniscal suturing techniques. The 10 mm Bionix Arrow®, S.D. Sorb Stapler®, and the 12 mm Arthrex Meniscal Dart® however have far inferior failure and cyclic fatigue strengths and their clinical application should be questioned.
Onderzoek naar predisponerende factoren met betrekking tot het functioneel resultaat na een voorste kruisbandreconstructie.
P. Coorevits, E. Witvrouw, J. BELLEMANS, D. Cambier, M. Van Seeveren, K. Peers
Onderzoek naar predisponerende factoren met betrekking tot het functioneel resultaat na een voorste kruisbandreconstructie.
Vlaams Tijdschrift voor Sportgeneeskunde en Wetenschappen, nr. 89, Dec. -Jan.-Febr. 2001/2002, P. 7-10
Inleiding:
Een ruptuur van de voorste kruisband leidt tot instabiliteit van het kniegewricht wat op zijn beurt een invloed zal hebben op de functionele activiteiten van de betrokkene.
In een poging de anterieure stabiliteit te herstellen, wordt voornamelijk bij actieve patiënten overgegaan tot een voorstekruisbandreconstructie. Het meest frequent worden de autogene patellapees en de hamstringsgreffe gebruikt om de voorste kruisband te vervangen. Hoewel sommige auteurs beweren dat de patellapeesgreffe een betere stabiliteit biedt, zijn de functionele resultaten voor beide greffes gelijkaardig. Minder kans op complicaties echter zouden bereikt worden met het gebruik van de hamstringgreffe omdat op die manier het extensiemechanisme van de knie niet beschadigd wordt.
Het ideale tijdstip om de reconstructie uit te voeren, ligt volgens sommige auteurs in de subacute fase, dit is drie à vier weken na het letsel. Tijdens deze periode kan reeds gestart worden met het revalidatie-programma waarbij de aandacht voornamelijk gevestigd wordt op het verminderen van de aanwezige zwelling en pijn, het bereiken van een zo normaal mogelijke bewegingsamplitude, een zo normaal mogelijk gangpatroon en ten slotte de mentale voorbereiding van de patiënt.
Postoperatief speelt het revalidatie-programma een belangrijke rol in het al dan niet bereiken van bevredigende resultaten. Verschillende studies hebben aangetoond dat men met een meer agressief revalidatieprogramma minder kans heeft op postoperatieve complicaties en sneller goede resultaten bereikt. Dit programma legt de nadruk op onmiddellijke passieve mobilisatie van de knie, volledige knie-extensie, onmiddellijke steunname afhankelijk van de zwelling en pijn en een mogelijke terugkeer naar het pre-operatieve activiteitsniveau vanaf vijf maanden. Verder blijkt dat dit intensievere oefenprogramma de stabiliteit niet in gevaar brengt.
Bekijken we de resultaten na een voorstekruisbandreconstructie in verschillende studies, dan blijkt dat de stabiliteit grotendeels hersteld is maar dat er enorme interindividuele verschillen bestaan in de functionele activiteiten. Sommige patiënten zijn in staat hun vroegere activiteiten op hetzelfde niveau te hervatten, anderen niet, onafhankelijk van de beïnvloedende factoren zoals hierboven vermeld.
De vraag die oprees was wat deze functionele verschillen mogelijk kon verklaren. Bestaan er pre-operatieve variabelen die het ons mogelijk maken de postoperatieve functionele resultaten te voorspellen? Het doel van deze studie bestond er dan ook in een verband te zoeken tussen de pre-operatieve variabelen en de postoperatieve functionele resultaten.
Research letter. Human homologues of Osr1 and Osr2 are not involved in a syndrome with distal limb deficiencies, oral abnormalities, and renal defects.
P. DEBEER
Research letter. Human homologues of Osr1 and Osr2 are not involved in a syndrome with distal limb deficiencies, oral abnormalities, and renal defects.
American Journal of Medical Genetics 2002, Vol. 111, 455-456.
In 1987, Buttiens and Fryns described a new autosomal recessive syndrome of mental retardation, distal limb deficiencies, oral involvement, and renal defects in two sibs. Both patients had microretronathia, microstomia, a normal tongue, and symmetric transverse limb deficiencies. The limb defects were described as a radial/preaxial defect. The male also had severe myopia and oligomeganephronia, whereas his sister had short stature with a disproportional large head. Both had moderate mental retardation. In 2000, a third patient with similar malformations was described (Keymolen et al., 2000). This boy also had symmetric distal limb defects, micrognathia, maxillary hypoplasia, cleft palate, severe myopia, nystagmus, a small tongue, bilateral hearing loss, and bilateral renal hypoplasia. This distinctive phenotype was classified in the Online Mendelian Inheritance in Man (OMIM) database as 'distal limb deficiencies with micrognathia' (OMIM 246560). Classification of limb and oro-mandibular anomalies has always been a difficult problem. No classification system has been accepted unanimously and there is a large amount of clinical overlap between the different subtypes (Boutsen et al., 1987). The discovery of novel genes involved in craniofacial and limb development will be helpful in differentiating between this spectrum of disorders.
Unilateral absence of the trapezius and pectoralis major muscle: a variant of Poland syndrome.
P. DEBEER, P. Brys, L. De Smet, J.P. Fryns
Unilateral absence of the trapezius and pectoralis major muscle: a variant of Poland syndrome.
Genetic Counseling 2002, Vol. 13, N° 4, 449-453.
Summary
We report a female patient with unilateral absence of the trapezius and pectoralis major muscles without other associated limb abnormalities. We believe that this anomaly belongs to the spectrum of anomalies resulting from disruption of the blood supply in the embryonic subclavian and vertebral arteries, as suggested in Poland syndrome.
Genes and orthopedics: from gene to clinic and vice versa.
P. DEBEER, L. De Smet, W.J.M. Van de Ven, G. Fabry; J.P. Fryns
Genes and orthopedics: from gene to clinic and vice versa.
Acta Orthopaedica Belgica 2002, Vol. 68, Nr. 3, 203-214.
Abstract
Recent advances in molecular biology have greatly helped in understanding the mechanisms involved in normal skeletal morphogenesis. Multiple genes involved in normal skeletal development have been identified, but several others still await discovery. Mutations in these genes are often responsible for the congenital skeletal malformations that we see in the orthopedic clinics. In this overview we would like to emphasize the importance of the interaction between orthopaedic surgeons, molecular biologists and geneticists.
The embryonic development of the skeleton and limbs is an intriguing and complex process, which involves a cascade of molecular interactions. More specifically, differentiation, proliferation and programmed cell death play an important role. Much of what we know about the general mechanism underlying skeletal morphogenesis is the result of animal studies. The consequences of spontaneous or induced mutations in the fruitfly, worm, zebra fish, frog, chicken and mouse have lead to the identification of a multitude of genes involved in normal skeletal development. Congenital deformations in humans, isolated or as part of a syndrome, also provide us with the unique opportunity to identify novel genes. Recent technical advances in molecular biology and the completion of the Human Genome Project, which involved sequencing the three million base pairs of the human genome, have significantly facilitated the possibility to locate and identify genes responsible for normal skeletal development. Further characterization of these genes and elucidation of the function of the corresponding proteints will undoubtedly provide us with more information regarding their role in normal limb- and skeletal development.
In this review, we present a brief overview of the current knowledge of the molecular aspects of skeletal disease and illustrate how the recent advances in genetics may have practical implications for patients with orthopaedic problems.
Involvement of a palindromic chromosome 22-specific low-copy repeat in a constitutional t(X;22)(q27;q11).
P. DEBEER, R. Mols, C. Huysmans, K. Devriendt, W.J.M. Van de Ven, J.P. Fryns
Involvement of a palindromic chromosome 22-specific low-copy repeat in a constitutional t(X;22)(q27;q11).
Clin. Genet. 2002, Vol. 62, 410-414.
Abstract
Segmental duplications or low-copy repeats (LCRs) on chromosome 22q11 have been implicated in several chromosomal rearrangements. The presence of AT-rich regions in these duplications may lead to the formation of hairpin structures, which facilitate chromosomal rearrangement. Here we report the involvement of such a low-copy repeat in a t(X;22) associated with a neural tube defect. Molecular analysis of the chromosomal breakpoints revealed that the chromosome 22 breakpoint maps in the palindromic non-AT-rich NF1-like region of low-copy repeat B (LCR-B). No palindromic region was encountered near the breakpoint on chromosome X. Our findings confirm that there is no single mechanism leading to translocations with chromosome 22q11 involvement. Because LCR-B does not contain genes involved in neural tube development, we believe that the gene responsible for the observed phenotype is most likely localized on chromosome X.
The fibulin-1 gene (FBLN1) is disrupted in a t(12;22) associated with a complex type of synpolydactyly.
P. DEBEER, E.F.P.M. Schoenmakers, W.O. Twal, W.S. Argraves; L. De Smet, J.P. Fryns, W.J.M. Van de Ven
The fibulin-1 gene (FBLN1) is disrupted in a t(12;22) associated with a complex type of synpolydactyly.
Journal of Medical Genetics, February 2002, Vol 39, nr. 2, p. 98-104
Abstract
Molecular analysis of the reciprocal chromosomal translocation t(12;22)(pl 1.2;q13.3) cosegregating with a complex type of synpolydactyly showed involvement of an alternatively spliced exon of the fibulin?1 gene (FBLN1 located in 22q13.3) and the C12orf2 (HoJ?1) gene on the short arm of chromosome 12. Investigation of the possible functional involvement of the fibulin?1 protein (FBLNI) in the observed phenotype showed that FBLN1 is expreseed in the extracellular matrix (ECM) in association with the digits in the developing limb. Furthermore, fibroblasts derived from patients with the complex type of synpolydactyly displayed alterations in the level of FBLN 1?D splice variant incorporated into the ECM and secreted into the conditioned culture medium. By contrast, the expression of the FBLN1?C splice variant was not perturbed in the patient fibroblasts. Based on these findings, we propose that the t(12;22) results in haploinsufficiency of the FBLN1?D variant, which could lead to the observed limb malformations.
How correctly does an intramedullary rod represent the longitudinal tibial axes?
K. Denis, G. Van Ham, J. BELLEMANS, L. Labey, J. Vander Sloten, R. Van Audekercke, G. Van der Perre, J. De Schutter.
How correctly does an intramedullary rod represent the longitudinal tibial axes?
Clinical Orthopaedics and Related Research 2002, Nr. 397, 424-433.
Abstract
In a robot-assisted procedure for preparing the tibia in total knee arthroplasty, developed in the author's laboratory, an intramedullary rod is used to register the tibia. In 18 formalin-fixed tibias, the difference in orientation was calculated between the intramedullary rod and several longitudinal tibial axes used in clinical practice. This was done using roentgenstereophotogrammetric analysis. Three tibial axes and two insertion techniques were considered. In three-dimensional space, small differences between the axes are observed. The results showed a high standard deviation, indicating the importance of anatomic differences. In the frontal plane, the difference in orientation between rod and tibial axes never exceeded ± 2°. In the sagittal plane, the observed differences were larger. Significant differences between the considered axes appeared. The results of the two insertion techniques were not significantly different. Because an intramedullary rod frequently is used for alignment of the tibia in conventional surgery, these results also are valuable for conventional surgery. In the current study, the accuracy of the intramedullary alignment is examined, without influences of the sawing procedure. Moreover, the study is not limited to the frontal plane; the total accuracy in three-dimensional space, and the accuracy in the frontal and the sagittal planes were studied.
De processie van kreupelen naar Jeroen Bosch (ca. 1450-1516): een historische analyse.
J. Dequeker, G. FABRY, L. Vanopdenbosch
De processie van kreupelen naar Jeroen Bosch (ca. 1450-1516): een historische analyse.
Millenium, tijdschrift voor middeleeuwse studies. Jaargang 12 (2001), nummer 2, 140-153.
Inleiding
Kunstwerken, in het bijzonder schilderijen en tekeningen, kunnen in associatie met historische gegevens een belangrijke bron zijn voor de ziekteleer van het verleden, het paleopathologisch wetenschappelijk onderzoek. Ziekteherkenning op historische kunstwerken kan aldus een bijdrage leveren aan een betere kennis van de oorzaak en het natuurlijk verloop van een ziekte. Het spreekwoord 'men ziet wat men kent' is in deze tak van de wetenschap bijzonder waar. In de dagelijkse praktijk van een geneesheer zijn immers kennis, vaardigheid en attitude de pijlers waarop de klinische diagnose zonder technische hulpmiddelen is gebaseerd.
In de laatmiddeleeuwse beeldende kunst komen vaak kreupelen voor, in het bijzonder veel geamputeerden van de onderste ledematen. In de literatuur wijt men deze afwijkingen van de kreupelen vooral aan melaatsheid, maar sluit men niet uit dat tuberculose, artritis, osteomyelitis (infectie van het bot), syfilis (een geslachtsziekte), of oorlogswonden de oorzaak kunnen zijn.
De processie van kreupelen, getekend door een navolger van Jeroen of Jheronimus Bosch ('s Hertogenbosch, ca. 1450-1516), is een mooi voorbeeld van het voorkomen (prevalentie) van kreupelen in de eerste helft van de zestiende eeuw. Gebaseerd op voorbeelden van Bosch of in ieder geval in de stijl van Bosch tekende de auteur van het schetsblad dat in de Albertina te Wenen wordt bewaard, omstreeks 1530-1540 een beeld van hen die in de leprozen - of Lazarushuizen in de Lage landen verbleven. De tekenaar lijkt haast een indruk te geven van een processie zoals die rondtrok om geld in te zamelen voor het melaatsenhuis bij de jaarlijkse tweedaagse ommegang op de maandag en dinsdag na het feest van Driekoningen. Ondanks het feit dat melaatsheid in die tijd in volle teruggang was, bleef de leprozerie goed volzet, deels ook door andere 'kreupelen' die wilden genieten van de voordelen die melaatsen hadden, namelijk toelating tot bedelen aan kerken en aan huizen in de stad, en onderkomen in leprozerie. In Amsterdam werd de ommegang van de leprozen officieel opgeheven in 1604.
In het midden van de zestiende eeuw werd de tekening met de 31 kreupele bedelaars te Antwerpen in het uitgevershuis van Hieronymus Cock in prent gebracht. De kopergravure, ongeveer even groot als de tekening, is niet gespiegeld ten opzichte van de voorbeeldtekening die nagenoeg letterlijk werd gekopieerd. Enkele figuren werden door de graveur om compositorische redenen verschoven. Links onder is bovendien een signatuur geplaatst: 'Jer Bosche Invent.', die rechtsonder wordt geflankeerd door de naam van Cocks uitgeverij: 'Aux Quatre Vents'. Waarschijnlijk werd de tekening al vroeg aan Bosch toegeschreven op grond van de vermelding op de prent dat het ontwerp van de hand Jheronimus Bosch was. Losse figuren van de tekening werden wat later in de zestiende eeuw samen met die op een soortgelijk blad van een andere hand dat in de Koninklijke Bibliotheek te Brussel wordt bewaard, gekopieerd door ontwerpers van grootschalige Bosch-achtige wandtapijten.
Apparently new autosomal dominant spondyloepimetaphyseal dysplasia: gonadal mosaicism onset.
T.J.L. De Ravel, L. DE SMET, J.P.F Fryns
Apparently new autosomal dominant spondyloepimetaphyseal dysplasia: gonadal mosaicism onset.
Clinical Dysmorphology 2002, 11, 261-266.
Abstract
We report a family in which an apparently previously undescribed form of Spondyloepimetaphyseal dysplasia (SEMD) presented after probable gonadal mosaicism occurred and is inherited in an autosomal dominant model. The other autosomal dominant SEMDs are compared.
The Spondyloepimetaphyseal (SEMD), Spondylometaphyseal (SMD) and Spondyloepiphyseal (SED) dysplasias are skeletal disorders involving the spine and various sections of the long/tubular bones, and have been clinically grouped according to the bone involvement (Patel et al., 1993). In SEMD there is defective growth and modelling of the spine and long bones, both the epiphyseal and metaphyseal areas. Genetic heterogeneity occurs at the molecular level: dominant mutations in the type II collagen gene, COL2A1, produce the dominantly inherited SEMD, Strudwick type (Tiller et al., 1995), but not the dominantly inherited SEMD, Missouri variant (Gertner et al., 1997). Mutations in the COL2A1 gene however, also lead to other skeletal dysplasias, e.g. Kniest dysplasia and Stickler syndrome type 1 (Byers, 200).
We describe a family in which a couple, neither of whom have a skeletal dysplasia, have two of their three daughters affected with SEMD. One of these affected daughters has a daughter with the SEMD. Gonadal mosaicism is thus likely to be present. We compare the various SEMDs inherited in an autosomal dominant fashion.
Common foot problems in elderly men.
Dr G. DEREYMAEKER and Jan Mievis
Common foot problems in elderly men.
Chapter45, p. 476-486 Book: Textbook of Men's health.
The parthenon publishing group, ISBN 1842140116
Isolated fracture of the capitate: the value of MRI in diagnosis and follow up.
F. De Schrijver, L. DE SMET
Isolated fracture of the capitate: the value of MRI in diagnosis and follow up.
Acta Orthopaedica Belgica 2002, Vol. 68, Nr. 3, 310-315.
Abstract
We report 2 new cases of isolated fracture of the capitate. The diagnosis and follow-up were made with MRI. Conventional radiographs initially failed to reveal the fracture.
Both fractures were treated conservatively; one healed completely; the other went on to a welltolerated nonunion.
Fractures of the capitate are considered uncommon injuries of the wrist. They are usually associated with other carpal bone fractures and/or ligamentous injuries; the naviculocapitate syndrome of Fenton falls into this group. Delay in diagnosis in these cases may however result in prolonged disability and avascular necrosis.
Isolated, usually non-displaced, fractures are extremely rare. We report two cases in which MRI provided the key to diagnosis.
Evaluation of rotational gait deviations in children with CP.
K. De Sloovere, G. MOLENAERS, K. Corten, I. Jonkers, J. Nijs.
Evaluation of rotational gait deviations in children with CP.
Gait and Posture 2002, 16(1), S119-S120.
Summary
The objectives of this study were to evaluate how rotational deviations in children with CP appear in gait analysis. Groups of children with CP were compared to look for typical rotational gait patterns, related to clinically measured rotational deformities. Increased clinically measured femoral anteversion is related to increased pelvis rotation, more than to increased hip rotation. The results illustrate that rotational gait deviations can be caused by shortening of the ventral hip joint capsule. We further found that increased femoral anteversion and shortening of the joint capsule contribute to typical rotational gait deviations, expressed by correlated motions in the sagittal and transverse plane.
Marche et toxine tobulique.
K. De Sloovere, G. MOLENAERS, J. De Cat
Marche et toxine tobulique.
In: La marche de l'enfant. Eds. A. Dimeglio, Ch. Herisson, L. Simon, Sauramps Médical, 2002, I.S.B.N. 2-84023-296-0,: 141-144.
Introduction
L'infirmité motrice cérébrale - IMC (Cerebral Plasy - CP) a été décrite par Mercer Rang comme 'an insult of the developing brain that produces a disorder of movement and posture that is permanent but not unchanging': Bien que cette définition parle pour elle-même, nous en retenons principalement que l'IMC est incurable. Les enfants avec IMC se battent avec divers problèmes de motricité, ce qui se traduit dans leur marche particulière. Ces problèmes sont en partie directement liés aux dommages cérébraux et influencent le tonus musculaire, l'équilibre, la force et la sélectivité (problèmes primaires). Des contractures musculaires statiques et des déformations bénignes (problèmes secondaires) se développent progressivement comme une suite des problèmes primaires et de la croissance. De plus, un enfant avec IMC développe également nombre de mécanismes compensatoires en marchant, afin de contourner les problèmes primaires et secondaires. Il existe plusieurs options de traitement pour aborder ces problèmes de motricité. Les problèmes primaires peuvent dans un certain sens être traités par médication orale, par blocage neuromusculaire, par rhizotomie dorsale sélective (RDS) et baclofène intrathécal (BIT). Les problèmes secondaires doivent être abordés via des interventions chirurgicales techniques qui comprennent l'allongement des tendons et des corrections des dysfonctions bénignes du bras de levier. Une physiothérapie adaptée et une gestion des aides orthopédiques jouent un rôle crucial lors de ces interventions.
Un traitement global multi-étagé par de la BTX-A est capable de réduire la spasticité des jeunes enfants atteints d'IMC et d'améliorer leur marche. Bien que ce soit au niveau de l'articulation de la cheville que les plus amples améliorations ont été constatées, les patients traités de façon multi-étagée ont corrigé leur mode d'utilisation des genoux, des hanches et du bassin au cours de la marche.
Physiotherapy and tone reduction based on gait analysis.
K. Desloovere, G.MOLENAERS, J. De Cat
Physiotherapy and tone reduction based on gait analysis.
Turk. J. Phys. Med., Rehab., 2002, 48(2), 38-42.
Introduction
Objective gait analysis is now generally accepted in the pre-treatment assessment of patients with cerebral palsy. It allows the specific description of the pattern of motion at each joint and the identification of muscles that cause the pathological pattern, according to which treatment can be modified (Gage 1991).
At the University Hospital of Pellenberg, objective observation of gait, in combination with extensive clinical examination followed by an additional examination under mask anaesthesia, provides decesive information for identification of target muscles during multilevel botulinim toxin A (BTX-A) treatment. Hence, all children with cerebral palsy in whom BTX-A treatment is being considered, are referred for comprehensive gait analysis including kinematics, kinetics and surface EMG.
A follow up gait analysis after BTX-A treatment allows for an objective evaluation of outcomes. In the post BTX-A treatment evaluation, we are interested in the individual's treatment result, and also in evaluating the treatment hypothesis.
The influence of BTX-A treatment on the walking pattern of the more involved child with CP.
K. Desloovere, G. MOLENAERS, J. Nijs, L. De Borre, P. Pauwels, M. Eyssen, P. De Cock.
The influence of BTX-A treatment on the walking pattern of the more involved child with CP.
Gait and Posture, 2002, 16(1), S124.
Summary
The aim of the present study was to evaluate the effect of a multilevel botulinum toxin A (BTX-A) treatment on objective gait parameters for the more involved child with CP (walking with assistive devices). Integrated multilevel treatment with BTX-A for the more involved child with CP results in improved walking performance 2 months after treatment. Similar as for ambulant children, children walking with assistive devices, improve significantly at the level of the ankle joint. More involved children typically show significantly improved kinematics in the transverse and frontal plane. Until now, this could only be confirmed for a subgroup of ambulant children with CP in previous studies.
Median and ulnar nerve compression at the wrist caused by anomalous muscles.
L. DE SMET
Median and ulnar nerve compression at the wrist caused by anomalous muscles.
Acta Orthopaedica Belgica, 2002, Vol. 68, N° 5, 413-438.
Abstract
Compression of the median and ulnar nerves at the wrist is frequently encountered. Carpal tunnel syndrome usually occurs without any obvious extrinsic cause; several cases have however been reported caused by anomalous or hypertrophic muscles. A survey of the literature shows that compression neuropathy of the median nerve have been reported in relation with anomalies affecting three muscles: the first (or second) lumbrical, the palmaris longus and its anatomic variants and the superficial flexor of the index finger. In the ulnar tunnel the situation is thoroughly different: so called idiopathic ulnar tunnel syndrome is rare and an extrinsic compressing structure can usually be disclosed. Anomalous muscles belong to the palmaris longus/abductor digiti minimi group; the flexor carpi ulnaris is sometimes involved.
One can suspect the presence of such an anomalous muscle when the compression syndrome concerns a patient who is not within the 'usual' age group with symptoms initiated or aggravated by physical exercice.
Pitfalls in wrist arthroscopy.
L. DE SMET
Pitfalls in wrist arthroscopy.
Acta Orthopaedica Belgica, 2000, Vol. 68, N°4,325-329.
Abstract
Arthroscopy of the wrist is a well-established procedure; however complications, problems and difficulties are possible.
The complication rate is estimated to be about 2%, of which equipment failure is probably the most frequent. Injury of the overlying tendons, nerves and even the radial artery has also been described.
The anatomy of certain wrists can cause considerable difficulties in obtaining a clear view. The major problem however is the correlation between the clinical and radiographic findings, and the arthroscopic findings.
There are some abnormalities which do not have any significance since most of them can be considered as normal ageing phenomena.
Synovial chondromatosis of the elbow presenting as a soft tissue tumour.
L. DE SMET
Synovial chondromatosis of the elbow presenting as a soft tissue tumour.
Clin. Rheumatol., 2002, 21, 403-404.
Abstract
Synovial chondromatosis of the elbow is not common. Bursitis, neurocompression and locking are the usual symptoms. We describe a case which was initially thought to be a soft tissue tumour, i.e. a synovial sarcoma.
Synovial chondromatosis is a monoarticular condition with metaplastic changes in the synovial membrane. Intrasynovial (osteo)chondral nodules are formed, some of which become loose bodies. The most affected joints are the hip and knee, but it has also been reported in other joints. In the elbow this condition presents with locking, neurocompression or localised bursitis. We present a case in which a (malignant) soft tissue tumour was suspected.
Frakturen van de carpus.
L. DE SMET
Frakturen van de carpus.
Callus 24/2002, p. 6-15
Inleiding
De carpale beenderen vormen een zeer complex geheel. Hun anatomie, de onderlinge verbindingen en de beweeglijkheid van elk bot in functie van de globale beweeglijkheid van de pols is zeer verschillend. De ganse carpus is enerzijds vrij strak met elkaar verbonden, doch anderzijds is er een vrij grote beweeglijkheid mogelijk. Letsels in de carpus ziet men onder verschillende vormen. Vooreerst zijn er de fracturen van de verschillende carpale beentjes, maar ook de ligamentaire letsels van de verbindingen tussen deze beentjes of met de carpus en de radius en tenslotte zijn er de complexe letsels waarbij er zowel fracturen als luxaties op verschillende niveaus en in verschillende rijen kunnen voorkomen. Van alle carpale fracturen is het scaphoid zonder twijfel het meest getroffene (ongeveer 79%). Verder in volgorde ziet men dat het triquetrum het meest gelaedeerde is. Fracturen van os lunatum, os trapezium, os capitatum, os hamatum en os pisiforme zijn ongeveer tussen de 1 en de 2% van alle fracturen. Fracturen van het trapezoid zijn bijzonder zeldzaam (0,2%). De letsels welke in deze tekst worden behandeld betreffen hier de geïsoleerde fracturen van de verschillende carpusbeentjes
Subperiosteal osteoid osteoma of the triquetrum mimicking an avascular necrosis.
L. DE SMET
Subperiosteal osteoid osteoma of the triquetrum mimicking an avascular necrosis.
Chirurgie de la main 2002, 21, 140-142.
Osteoid osteoma is a wellknown bone tumor. The diagnosis is often straightforeward based on standard X-rays and CT-scans. MRI has only a limited value. Localization in one of the carpal bones is often atypical. We present an unusual localization: a subperiosteal osteoid osteoma of the triquetrum with associated wrist synovitis.
What is the TFCC?
L. DE SMET, M.D. Ph.D.
What is the TFCC?
Vlaams Tijdschrift voor Sportgeneeskunde en sportwetenschappen, nr. 90, 23ste jg, maart-april 2002, p. 21-27
Inleiding
Er is de laatste twee decennia heel wat interesse voor het polsgewricht. Zo werd er meer aandacht besteed aan de ligamentaire structuren, hun anatomie, hun functie en hun pathologie.
Heel wat meer pathologie blijkt aanwezig te zijn dan voorheen gedacht. De ontwikkeling van de medische beeldvorming en voornamelijk van de arthroscopie heeft daartoe heel wat bijgedragen.
De verhoogde sportactiviteiten, op recreationeel en (semi)professioneel niveau, in het bijzonder van de zogenaamde racketsporten heeft ook gezorgd voor meer letsels en hogere verwachtingen inzake de behandeling.
Het TFCC (triangular fibrocartilagineous complex) is één van de structuren die verantwoordelijk worden geacht in de veel voorkomende ulnaire (mediale) polspijn. Nochtans bestaan er veel misverstanden en is er een overmaat in diagnose en behandeling. Ulnaire polspijn wordt dan ook de lage rugpijn van de pols genoemd.
First approach to a child with a congenital difference of the upper limb.
L. DE SMET
First approach to a child with a congenital difference of the upper limb.
The Pediatric Upper Limb. Ed. Steven Hovius in collaboration with Guy Foucher, Piero L. Raimondi. Federation of European Societies for Surgery of the Hand, 2002, 57-63.
The confrontation of (healthy) parents with their newborn child with a hand anomaly (or malformation or difference) is usually a great shock. The deformity is obvious and visible for them, their family, and others. The first expert advice is crucial and of utmost importance - based on his (or her) explanation they will be able to cope with the child and its hand problem, to help their child in its development, and its adaptation to the environment and support it through the (surgical) treatments and rehabilitation.
Congenital hand malformations are not very frequent and the hand surgeon is supposed not only to be a surgeon, but also a geneticist, a dysmorphologist, a rehabilitation expert, a psychologist, and a social worker, ready to answer all the questions of the parents, to provide the necessary information and to execute a perfect reconstruction.
Only a few departments have the luxury of an organized multi-disciplinary outpatient clinic, where different interested and motivated experts are gathered around one patient. Mostly however, the lonely hand surgeon is confronted with anxious, disappointed parents and their child. It is this first approach that will influence how these parents will react and accept any treatment - they're not only just interested in what surgery can do, more often than not all they want are some answers to some basic questions.
Classification for congenital anomalies of the hand: the IFSSH classification and the JSSH modification.
L. DE SMET
Classification for congenital anomalies of the hand: the IFSSH classification and the JSSH modification.
Genetic Counseling, 2002, Vol. 13, Nr. 3, 331-338.
Summary
Classification for congenital anomalies of the hand: the IFSSH classification and the JSSH modification: The purpose of a classification for clinical problems which, except for a few specialized centers, occur only sporadically is to provide a system where these cases can be stored. This should allow all involved investigators to speak the same language; so-doing syndromes can be delinated, frequencies of occurence established and results of - different - treatments compared. A classification system should be simple to use, reliable and uniformly accepted. It should allow space for adaptations and/or extensions. The IFSSH proposed a 7 categories classification based on the proposed classification of Swanson et al in 1976. This classification, was based on, which was thought in the seventies, etiopathogenic pathways. These 7 groups are: I. Failure of formation; transverse (A), or longitudinal (B); II. Failure of differentiation; III. Polydactyly; IV. Overgrowth; V. Undergrowth; VI. Amniotic band syndrome; VII. Generalized skeletal symdromes.
The extended classification proposed by IFSSH was used to classify 1013 hand differences in 925 hands of 650 patients. We found associated anomalies in 26.7%. The classification was straightforward in 86%, difficult in 6.6% and not possible in 7.8%. Group II was the most numerous group including 513 anomalies. We propose to include in this group the Madelung deformity, the Kirner deformity and congenital trigger fingers and trigger thumbs. In group I the radial and ulnar deficiencies, limited to the hand without forearm deficiencies should be included. Triphalangeal thumbs are a problem, we suggest it to be listed in group III and consider it as a duplication in length. It is not always possible to evaluate the (transverse) absence of the fingers or hand. Longitudinal deficienceis (group IIB), symbrachydactyly (group V), and amniotic bands (group IV) occasionally develop a phenotye similar to the genuine transverse deficiencey (group IA). Recently, the Japanese Society for Surgery of the Hand (JSSH) proposed an extension/modification of the IFSSH classification. Based on newer knowledge on teratology, symbrachydactyly in all stages were transfered to group I. Two new groups were introduced. A group 'failure of finger ray induction' including typical cleft hand (IC), central polydactyly (III) and (bony) syndactyly (II) - was included. Also a group of 'unclassifiable' cases was added. This Japanese proposed classification is a real improvement and most clinicians and surgeons tend to use it in the future.
Coincidental rupture of the scapholunate and lunotriquetral ligaments with volar intercalated segment instability complicating a closed distal forearm fracture in an adolescent.
L. DE SMET
Coincidental rupture of the scapholunate and lunotriquetral ligaments with volar intercalated segment instability complicating a closed distal forearm fracture in an adolescent.
The Journal of Hand Surgery, 2002, Vol. 27-A, 735-738.
Abstract
A 15-year-old boy is described with concomitant scapholunate and lunotriquetral ligament injuries of the wrist, complicating a closed forearm fracture. The rotatory dislocation could be reduced and stabilized with a soft-tissue procedure.
Ligamentous injuries of the wrist in children and teenagers are rare. Some cases have been published. Most of them are scapholunate dissociations. Giddins and Shaw reported a nondissociative midcarpal instability in association with a Salter Harris type 2 fracture of the distal radius. Concomitant scapholunate ligament (SL) and lunotriquetral ligament (LT) ruptures without perilunate dislocations are rarely reported. In the series of Pin et al the youngest patient was 20 years. I report a 15-year-old boy with a concomitant SL and LT ligament ruptures, a distal forearm fracture, and an ulnar nerve neuropraxia (or partial axonotmesis).
Unilateral absent scaphoid in a patient with 'Holt-Oram' syndrome.
L. DE SMET
Unilateral absent scaphoid in a patient with 'Holt-Oram' syndrome.
Genetic Counseling, 2002, Vol. 13, Nr. 3, 327-329.
Summary
Unilateral absent scaphoid in a patient with 'Holt Oram' syndrome: The absence of the scaphoid in a patient with Holt-Oram syndrome is reported. Only a few similar cases have been published.
The Holt-Oram syndrome consists of a spectrum of cardiac and upper limb abnormalities. It is genetically heterogeneous with one locus mapping on chromosome 12q. The cardiac abnormalities include various problems; septal defects, electrocardiographic abnormalities and even sudden death. The upper limb malformations are also heterogeneous with in typical cases a radial dysplasia, radial (proximal) hand deficiencies: thumb hypoplasia, triphalangeal thumb and duplicated thumbs.
The carpal abnormalities were described by Poznanzki et al and include abnormal shaped scaphoids and hyperplastic pisiforms. We report a patient with an absent scaphoid.
Fetal hydantoin syndrome with unilateral atypical cleft hand: additional evidence for vascular disruption.
L. DE SMET, Ph. Debeer
Fetal hydantoin syndrome with unilateral atypical cleft hand: additional evidence for vascular disruption.
Genetic Counseling, 2002, Vol. 13, Nr. 2, 157-161.
Summary
Fetal hydantoin syndrome with unilateral atypical cleft hand: additional evidence for vascular disruption: We report on 2 children of a mother treated with phenylhydantoine for post-surgical epilepsy. The hand malformation in one of them was indicative for a vascular disruption sequence.
The teratogenic effect of early in utero hydantoin exposure results in a pattern of malformations including cardiac malformation, cleft lip and palate, facial dysmorphism, with or without mental retardation. The typical anomalies of the hands are hypoplasia of the distal phalanges, nail hypoplasia, abnormal dermal ridges and fingerlike thumbs. Ohter hand malformations have been reported: hyperphalangism, adactyly and biphalangeal fingers, polydactyly and biphalangeal fingers, polydactyly and acheiria (absent hand). We report on 2 sons from a mother treated phenylhydantoine for post-surgical epilepsy. One of the boys had only minor handanomalies, while the other had an atypical cleft hand.
Traumatic divergent dislocation of the extensor tendons over the metacarpophalangeal joint.
L. DE SMET, S. Heirweg, W. Vandesande
Traumatic divergent dislocation of the extensor tendons over the metacarpophalangeal joint.
J. Orthop. Trauma, 2002, Vol. 16, Nr. 3, 207-209.
Abstract
Dislocation of the extensor tendon over the metacarpophalangeal joint (MCP) is rare. Involvement of the fifth ray is even more exceptional. The authors of the present study describe such a case that occurred in a professional musician. We report a divergent dislocation of both extensor tendons over the metacarpophalangeal joint of the fifth finger.
Multifocal glomus tumours of the fingers in two patients with neurofibromatosis type 1.
L. DE SMET, R. Sciot, E. Legius
Multifocal glomus tumours of the fingers in two patients with neurofibromatosis type 1.
J. Med. Genet., 2002, Vol. 39.
Pedicled fat flap coverage of the median nerve after failed carpal tunnel decompression.
L. DE SMET, G. Vandeputte
Pedicled fat flap coverage of the median nerve after failed carpal tunnel decompression.
Journal of Hand Surgery, (British and European), 2002, Vol. 27-B, Nr. 4, 350-353.
Introduction
Persistence or recurrence of symptoms after carpal tunnel surgery occurs in 0-19% of patients, of whom up to 12% require revision surgery. The causes include incomplete section of the flexor retinaculum, scarring and recurrent tenosynovitis (Becker and Gilbert, 1988; Langloh and Linscheid, 1972).
The outcome of secondary carpal tunnel surgery is only fair (Langloh and Linscheid, 1972), and many procedures are possible. These include external neurolysis, local muscle flaps, fat grafts and flaps, vein wrapping and synovial flaps (Chang and Dellon, 1993; Condamine et al., 1998; Fellon and Mackinnon, 1984; Duclos and Sokolow, 1998; Giuta et al., 1998; Hunter, 1996; Langloh and Linscheid, 1972; Mathoulin et al., 2000; McClinton, 1996; Plancher et al., 1996; Rose, 1996; Rose et al., 1991; Spokevicius and Kleinert, 1996; Strickland et al., 1996; Tham et al., 1996; Wulle, 1996, 1987).
Lunotriquetral arthrodesis, a procedure with a high failure rate.
L. DE SMET, W. Vandesande.
Lunotriquetral arthrodesis, a procedure with a high failure rate.
The Journal of Hand Surgery, 2002, Vol. 27-B, Suppl. 1, 44(95).
Abstract
The lunotriquetral (LT) arthrodesis is a standard procedure for LT ligament injury.
We reviewed our cases since the clinical impression was not favourable.
The authors retrospectively reviewed 29 patients with chronic lunotriquetral ligament tears who were treated with lunotriquetral arthrodesis. Arthrography confirmed the diagnosis in 17 cases, arthroscopy in 18. The fusion was carried out with staples in five cases, a Herbert screw in 17, a Kirschner wire in six. Bone grafts were used in 24 cases. In 15 cases additional procedures were performed. As for the subjective outcome, 5 patients were fully satisfied, 10 had reservation and 14 were not satisfied; 17 patients would repeat the procedure. The average Pellenberg wrist score for pain and function was 59/80. Mean grip force was 69% and lateral pinch force was 79%. Flexion loss averaged 24°, and extension loss 21°. Fusion was achieved in 16 cases. Twelve important complications were noted. In 17 cases the wrist remained painful. Three patients went on to complete wrist arthrodesis.
In the light of these results the effectiveness of this procedure has to be reconsidered compared to other alternatives, such as ligamentoplasty and extended arthrodesis.
Ligament reconstruction
L. DE SMET, L. Vanfleteren, W. Sioen, D. Spaepen, H. Van Ransbeeck
Ligament reconstruction / tendon interposition arthroplasty for thumb basal joint osteoarthritis. Preliminary results of a prospective outcome study.
Acta Orthopaedica, Vol. 68, nr. 1, 2002, p. 20-23.
Abstract
Ligament reconstruction/tendon interposition arthroplasty (LRTIA) is a common procedure for basal joint osteoarthritis of the thumb. We evaluated 31 operations in 30 patients, 28 females, 2 males with a mean age of 57 years. The mean follow-up was 24 months (range 8 to 46 months). Pain reduction was 75 % on average, with good preservation of motion and of first web space. Twenty-six patients were satisfied; five were not. The grip strength and key-pinch strength increased postoperatively, albeit not significantly.
Osteoarthritis of the basal (or carpometacarpal (CMC) or trapeziometacarpal) joint of the thumb, also called rhizarthrosis, is not uncommon. Postmenopausal women are most frequently affected. The condition is characterized by pain and crepitus, joint instability, loss of motion and strength, and finally severe adduction contracture of the first web and hyperextension deformity of the metacarpophalangeal (MCP) joint occurs.
Although the condidion has been called self-limiting in time, no evidence for this statement has been provided. The same can be said of nonoperative treatment. Many operations have been described, including ligamentous stabilization, denervation, arthrodesis, resection arthroplasty with and without interposition and with or without stabilization and total joint arthroplasty.
In 1949 Gervis described simple trapeziectomy as an effective treatment. Since then several interpositions have been reported (tendon rolls, gelfoam, silicone). In 1986 Burton and Pellegrini designed a procedure with trapezium excision, tendon interposition and ligamentous reconstruction to address the potential carpometacarpal instability.
The purpose of this study is to report the outcome of this procedure called ligament reconstruction/tendon interposition arthroplasty (LRTIA). This study is part of an ongoing prospective study on treatment modalities for rhizarthrosis.
Multilevel botulinum toxin injections after the range of muscle action during gait in CP children.
I. Jonckers, C. Stewart, K. De Sloovere, G. MOLENAERS, L. Deborre, J. De Cat, M. Eyssen, P. Pauwels, A. Spaepen
Multilevel botulinum toxin injections after the range of muscle action during gait in CP children.
Gait and Posture, 2002, 16(1), S123-S124.
Summary
The present study uses musculoskeletal modelling techniques in order to explore the effect of multi-level Botulinum toxin injections on muscle length during gait in a cohort of CP children. The present results reveal a significant increase in maximal muscle length during gait. However, the plantarflexors presented a prominent decrease in muscle excursion. This may be due to the larger effect of the toxin in reducing minimal muscle length rather than actual increasing the maximal muscle lengths during gait.
Pre-axial polydactyly: Outcome of the Surgical treatment.
S. Kemnitz M.D., L. DE SMET M.D., Ph. D.
Pre-axial polydactyly: Outcome of the Surgical treatment.
Journal of Orthopaedics Pediatrics, 2002, 11B, 79-84.
Summary:
From 1988 to 1999 we operated on 22 patients for pre-axial polydactyly. We retrospectively reviewed all files and we clinically reviewed 16 patients. We report on the epidemiology,
The surgical technique, the outcome and the complications. All patients were operated on by the same hand surgeon (L.D.S.) and reviewed by an independent observer (S.K.). Aesthetic and functional outcome is reported. In general the surgical treatment for pre-axial duplications gives excellent functional and good aesthetic results. According to the Egawa score, 13 patients obtained an excellent, one a fair and two a poor result. The overall satisfaction rate is very high for both patient and parents and the complication rate was low. The functional outcome seems to be related to the stability of the interphalangeal and metacarpo-phalangeal joints. The most frequent aesthetic problem is a deviation of the axis. Loss of mobility of the thumb seems to be of less importance.
Avascualr Necrosis of the talus in children with haemophilia.
S. Kemnitz, M.D., P. MOENS, M.D., K. Peerlinck, M.D. Ph.D. and G. FABRY, M.D. Ph.D.
Avascualr Necrosis of the talus in children with haemophilia.
Journal of Orthopaedics Pediatrics, 2002, 11B, 73-78.
Summary:
Patients who have haemophilia often present with joint problems. Haemarthrosis can occur spontaneously or after minor trauma. Later, degenerative changes can cause pain and loss of motion. Avascular necrosis of the talus has a high incidence after serious trauma. Furthermore avascular necrosis of the talus has been associated with multiple systemic conditions. The association of haemophilia and avascular necrosis of the femoral head has been described. This study reports three cases (four ankles) where we suspect an avascular necrosis of the talus in children with haemophilia. To the authors' knowledge, the possible association of haemophilia and avascular necrosis of the talus has not yet been described in children.
Haemophilia A and B are inherited in a sex-linked recessive way. The genes are located on the X chromosome. Haemophilia A (factor VIII deficiencey) is five times more common than haemophilia B, also known as factor IX deficiency or Christmas disease. The incidence is estimated as 10 per 100.000 births. The clinical severity of bleeding is related to the residual clotting factor activity. Patients with less than 1% residual activity have severe haemophilia: they bleed spontaneously in their joints and muscles. In patients with mild haemophilia (factor levels between 5% and 40%), bleeding generally occurs only after trauma or surgery. Patients with moderately severe haemophilia (1% - 5% clotting factor activity) have a clinical picture between mild and severe haemophilia. The major chronic complication of haemophilia is severe arthropathy, which is caused by repeated joint bleeding.
The ankle joint is the most frequently affected joint after the knee and the elbow.
Factors affecting the mechanical and viscoelastic properties of acrylic bone cement.
A.J.C. Lee, R.S.M. Ling, S. Gheduzzi, J.P. SIMON, R.J. Renfro
Factors affecting the mechanical and viscoelastic properties of acrylic bone cement.
Journal of Material Science: Materials in medicine, 2002, 13, 723-733.
Abstract
The aim of this paper is to report a series of experiments investigating the factors that influence the viscoelastic properties of acrylic bone cement. The effects of the brand of cement, the length of time since mixing, temperature, the hydration of the cement, and the influence of fat and or blood in the environment on the creep and stress relaxation behavior of the cement have been studied in laboratory-prepared specimens in tension, compression and four point bending. Although there are significant differences in the viscoelastic behavior of some of the different brands of polymethylmethacrylate based cements, these differences are small by comparison with the major effects that can be exerted by the length of time since mixing and some environmental factors. These effects have important practical consequences, especially with regard to the ability of bench top and theoretical studies to predict reliably the mechanical and viscoelastic behavior of acrylic cement in vivo.
DFSG 2001, A report.
G. MATRICALI
DFSG 2001, A report.
E.F.A.S. on the Move, 2002, Vol. 5, 2-3.
Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist.
P. MILLANTS, L. De Smet, H. Van Ransbeeck
Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist.
Chirurgie de la main, 2002, Vol. 21, 298-300.
Abstract
Introduction: Ulnar wrist pain due to a TFCC lesion is frequent. Based on studies of the vascularity, ulnar avulsion can be sutured. Arthroscopic techniques have been designed but results are sparsely published.
Materials and methods: This is a retrospective study of 35 patients with an ulnar avulsion of the TFCC. All the patients were treated with an originally designed arthroscopical technique. The evaluation was focused on the subjective and functional outcome. A pain score and a DASH score were used.
Results: The general impression was positive with a mean DASH score of 15 points. Two-thirds of the patients had a DASH score totaling less than 20. Twenty-nine patients had a good outcome, six were fair or poor.
Conclusion: Arthroscopical repair of the TFCC is a reliable and useful technique.
Evidence-based botulinum toxin. A treatment of children with cerebral palsy: an integrated multilevel approach.
G. MOLENAERS, K. DESLOOVERE
Evidence-based botulinum toxin. A treatment of children with cerebral palsy: an integrated multilevel approach.
Türk Fiz Tip Rehab Derg, 2002, 48(2), 20-21.
Tone reduction for a child with CP.
Cerebral palsy (CP) has been described by Mercer Rang as 'an insult of the developing brain that produces a disorder of movement and posture that is permanent but not unchanging'. Although this definition speaks for itself, one certainly needs to keep in mind that CP is incurable.
Children with CP may present with a variety of motor problems. Some are directly related to the damage to the central nervous system, influencing muscle tone, balance, strength and selectivity (primary problems), whereas static muscle contractures and bony deformities (secondary problems) develop slowly over time is response to the primary problems and to growth (Gage 1991). Furthermore, the child often develops adaptive mechanisms or 'coping responses' in gait to overcome the primary and secondary problems.
Is the dynamic approach in the treatment of clubfeet worthwhile to do? An objective gait evaluation.
G. MOLENAERS, K. Desloovere, P. Moens, L. De Borre, A. Van Campenhout, G. Fabry.
Is the dynamic approach in the treatment of clubfeet worthwhile to do? An objective gait evaluation.
Gait and Posture, 2002, 16(1), S135.
Summary
The purpose of this study was to analyse objectively the outcome success of different types of treatment of clubfeet (all group III according to Dimeglio), using 3D gait analysis, and dynamic foot pressure measures. Chldren with clubfeet show clear gait deviations 4-6 year post treatment, with specific gait patterns related with each treatment option. Operatively treated clubfeet are characterized by a decreased push-off and a significantly lateralised COP with regards to the conservatively treated feet.
Influence of tone reduction on the natural history of gait patterns in children with CP.
G. MOLENAERS, K. Desloovere, J. Nijs, F. Fabry, CP team of the University Hospital of Leuven.
Influence of tone reduction on the natural history of gait patterns in children with CP.
Summary
The short and medium term outcome of BTX-A treatment has been described previously. The purpose of this study is to evaluate the benefit of BTX-A treatment for children with cerebral palsy (CP), within a longitudinal view, and with regards to the overall treatment of children with CP. The gait of two matched groups of children with CP were compared at a certain moment in motor development. Both groups were treated according to the same principles. Only one group received repeated BTX-A treatments, started at a young age. The results of this study indicate that children who received BTX-A, starting at a young age, have a gait pattern which is less defined by secondary problems (muscle contractures and bony deformities) than children who never received BTX-A treatments. The benefits of BTX-A in the development of the walking pattern were seen at all levels, but mainly at the hip and ankle joint.
Marche et pied bot varus équin.
G. MOLENAERS, G. Fabry, K. Desloovere
Marche et pied bot varus équin.
In: La marche de l'enfant. Eds.: A. Dimeglio, Ch. Hérisson, L. Simon. Sauramps Médical, 2002, ISBN 2-84023-296-0, p. 169-172.
Introduction
Le traitement du pied bot représente un important domaine de l'orthopédie pédiatrique. Le nombre de publications est considérable. La question du meilleur traitement reste posé. Plusieurs options thérapeutiques sont possibles, depuis le traitement chirurgical jusqu'au traitement conservateur. La plupart des auteurs pensent que le traitement initial du pied bot doit être conservateur, qu'il faut éviter la chirurgie, que le traitement conservateur doit commencer dès la naissance. Quand le traitement conservateur échoue, il faut envisager une intervention chirurgicale, l'objectif est de toujours corriger le pied en un seul temps chirurgical. Plusieurs tactiques possibles, depuis la chirurgie proposée par Mc Kay, que nous utilisons dans notre équipe, et qui consiste à libérer de façon circonférentielle l'articulation sous-astragalienne. Que le traitement ait été non-opératoire ou chirurgical, des complications sont toujours possibles. L'équipe de Pellenberg, Professeur Fabry, s'est engagée dans un programme de recherche depuis plus de 20 ans, en essayant de cerner l'action des traitements par manipulations aussi bien que le traitement chirurgical. Le traitement conservateur est organisé par une équipe multidisciplinaire qui fait intervenir les pédiatres, les chirurgiens orthopédiques et les kinésithérapeutes. Les kinésithérapeutes mobilisent le pied dans les 3 plans de l'espace, avec des plâtres, des appareillages, avec un bandage associé à la machine de mobilisation. L'objectif a été de diminuer autant que faire se peut la chirurgie pour un meilleur résultat. Le traitement chirurgical consiste, lui, la plupart du temps en des libérations tendineuses, et quelquefois en des ostéotomies extra-articulaires. Le but de cette étude est d'analyser objectivement les résultats des différents types de traitement, en utilisant le laboratoire de marche et la mesure dynamique de pression; puisque nous avons à comparer différentes déformations, pour plus de clarté, nous avons utilisé la classification de Dimeglio qui a une grande valeur, et qui nous permet de comparer les résultats.
Partial medial epicondylectomy for cubital tunnel syndrome: outcome and complications.
S. Muermans, L. DE SMET
Partial medial epicondylectomy for cubital tunnel syndrome: outcome and complications.
H. Schoulder Elbow surgery, 2002, Vol. 11, Nr. 3: 248-252.
Abstract
The results of partial medial epicondylectomy for cubital tunnel syndrome were evaluated in 60 elbows of 54 patients. Preoperatively, 8 patients were grade I, 24 grade IIA, 16 grade IIB, and 12 grade III according to the modified McGowan score. Mean follow-up was 38.8 months. Special emphasis was placed on evaluation of 5 commonly reported drawbacks: medial elbow pain was related to the end result (P < 0.1), nerve vulnerability/subluxation might contribute to pain (P < .05), loss of force (approximately 15%) had no clinical implication, and flexion contracture and valgus instability were present in only 1 elbow. Eighthy-three percent of our patients were better according to the Wilson and Krout score, with 75% having excellent and good results. An improvement of at least 1 McGowan grade was obtained in 88.3%. The chance for complete recovery was inversely related to the initial neuropathy grade, as is consistently found throughout the literature for all types of cubital tunnel surgery. Partial medial epicondylectomy is a valuable surgical procedure for treating grade I to IIB ulnar neuropathy.
Medical image based, preformed titanium membranes for bone reconstructions: design study and first clinical evaluation.
V. Pattijn, I. SAMSON, J. Vander Sloten, R. Van Audekercke, B. Swaelens and V. De Buck
Medical image based, preformed titanium membranes for bone reconstructions: design study and first clinical evaluation.
Proc Instn Mech Engrs Vol 216 Part H: engineering in Medicine, 2002, p 13-21.
Abstract:
The currently used intralesional or marginal surgical treatment of a bone tumour in the extremities shows some shortcomings in providing a restoration of the mechanical strength of the bone and the containment of the used filling materials. The use of a medical image based, preformed and custom-made titanium membrane screwed onto the periosteal side of the bone is introduced. This study looks in detail into the design process and the biomechanical evaluation of such a membrane. The buckling strength of the membrane, the strength at the perforation holes and the strength of the screw-bone fixation are tested experimentally. The two latter experiments are performed with different screw types. From the performed tests it appears that a titanium membrane without a wave pattern, of 0.3 mm thickness, fixed to the bone with seven trabecular bone screws (4 mm diameter and 28 mm length) is capable of carrying the anticipated mechanical loads on the reconstructed tibia. The medical image based design methodology and the first clinical application of such a preformed and custom-made titanium membrane are reported and discussed. The feasibility of preformed titanium membranes for bone reconstruction in tumour surgery is demonstrated.
Posterior transosseous capsulotendinous repair in total hip arthroplasty
W. Sioen, J.P. SIMON, D.L. Labey, R. Van Audekercke
Posterior transosseous capsulotendinous repair in total hip arthroplasty.
The Journal of Bone and Joint Surgery (Am.), 2002, 84, 1793-1798.
Abstract
While recent clinical articles have reported a dramatic reduction in rates of total hip dislocation after posterior transosseous repair, we are not aware of any published biomechanical data to support this finding. The objectives of this study were to investigate the functional anatomy of the posterior transosseous repair and its effect on stability after total hip replacement.
Six total hip prostheses were implanted into three fresh cadavera. Three different repair situations (no repair, soft-tissue repair, and transosseous fixation) were then consecutively tested on each hip. Values for torque resistance and the angular range of motion at dislocation were recorded. Each repair was tested twice, yielding a total of thirty-six torque values and thirty-six angles of rotation.
The transosseous repair was superior with regard to both torsion strength (four times stronger than that after no repair (p = 0.0002) and more than twice as strong as that after soft-tissue repair (p = 0.002) and the magnitude of the angle of rotation observed prior to dislocation (an increase of 83% in comparison with that after no repair (p = 0.0005) and an increase of 46% in comparison with that after soft-tissue repair (p = 0.004).
In a cadaver model, posterior transosseous repair provides superior stability of a total hip replacement. Optimal surgical technique with a slightly modified approach allows greater retention of capsule and tendon length and a more anatomical reinsertion of the soft tissue.
Correlation between clinicopathological features and karyotype in 100 cartilaginous and chordoid tumours.
G. Tailini, H. Dorfman, P. Brys, P. Dal Cin, I. De Wever, C.D.M. Fletcher, K. Johnson, N. Mandahl, lF. Mertens, F. Mitelman, J. Rosai, A. Rydholm, I. SAMSON, R. Sciot, H. Van den Berghe; R. Vanni, H. Willen.
Correlation between clinicopathological features and karyotype in 100 cartilaginous and chordoid tumours. A report from the chromosomes and morphology (CHAM) collaborative study group.
J. Pathol., 2002, 196, 194-203.
Abstract
The evaluation of chondroid lesions requires full integration of clinical, radiographic, and pathological data; tumour typing is often a challenge for the diagnostic pathologist. Although a variety of chromosomal abnormalities have been documented in chondroid lesions, the potential usefulness of cytogenetic analysis remains unclear. This study has critically reviewed and analysed 117 karyotyped samples from 100 patients with cartilaginous and chordoid tumours. Cases were selected based on successful chromosomal analysis and adequacy of clinical, radiographic, and pathological information. To ensure objective evaluation, the cytogenetic results were correlated in a double-blind setting with consensus diagnoses independently determined on each case, after complete review of the histological, radiographic, and clinical findings. Karyotypic aberrations were identified in 41/92 cartilaginous tumours (5/11 osteochondromas, 2/3 chondromyxoid fibromas, 0/4 chondroblastomas, 11/29 chondromas, 0/3 chondroid tumours of undetermined malignant potential, 22/40 chondrosarcomas and 1/2 miscellaneous cartilaginous lesions) and 5/8 chordomas. Complex karyotypic changes were a feature of malignant tumours (chondrosarcoma and chordoma) and of chondrosarcoma among cartilaginous tumours, where they correlated with high tumour grade. Among primary well-differentiated cartilaginous lesions of bone, the finding of an abnormal karyotype was consistently associated with a grade 1 chondrosarcoma diagnosis. Among karyotypically abnormal cartilaginous tumours, loss of distal 8q was associated with osteochondroma, +5 with synovial chondroma/chondromatosis and parosteal or soft tissue chondroma, alterations of chromosome arm 6q with condromyxoid fibroma, 87 with bone chondrosarcoma, and 17p1 alterations with grade 3 chondrosarcoma. Alterations involving 12q13 characterized synovial chondroma/chondromatosis in the chondroma group and myxoid chondrosarcoma of bone in the chondrosarcoma group. In conclusion, cytogenetic abnormalities in chondroid lesions are common and are not randomly distributed. They are associated with malignancy/tumour grade as well as with specific diagnosis in many cases, and can therefore be of potential value for tumour typing.
Outcome of TFCC sutures of peripheral tears.
H. VAN RANSBEECK, P. Milants
Outcome of TFCC sutures of peripheral tears.
The Journal of Hand Surgery, 2002, Vol. 27-B, Suppl. 1, 2-2.
Abstract
Introduction: Peripheral TFCC tears are disabling in activities of daily living, work and sports. Pain is the most common symptom.
Aim: Review of the outcome of TFCC repairs.
Material and methods: We performed an arthroscopical suture of the tear, followed by an immobilization of 6 weeks. We reviewed 35 patients with a peripheral tear of TFCC, 15 men and 20 women. Mean age was 31 years. The mean follow-up was 58 months. The general outcome was good. The mean DASH score was 15.5 points. The VAS pain score improved in all.
Discussion and conclusion: Arthroscopic repair of ulnar avulsions of the TFCC is a reliable and reproducible treatment.
One-stage bilateral total hip replacement: a retrospective study of 70 patients.
H. Welters, I. Jansen, J.P. SIMON, J. Devos
One-stage bilateral total hip replacement: a retrospective study of 70 patients.
Acta Orthopaedica Belgica, 2002; Vol. 68, Nr. 3, 235-241.
Abstract
In this study, we retrospectively reviewed 70 patients who had a one-stage bilateral total hip replacement in our institution, between 1992 and 1998. Different variables were considered such as gender, age, length of hospital stay, pre-operative diagnosis, duration of the operation and anesthesia, type of prosthesis, complications and amount of blood loss, pre- and postoperative range of motion, incidence of periarticular heterotopic ossifications and postoperative pain and walking distance.
In our group of patients one-stage bilateral total hip replacement was found to have resulted in good objective results. Patients with a rheumatoid condition had the highest gain in postoperative hip mobility. In comparison with existing literature there were no more intra- or postoperative complications, making one-stage bilateral total hip replacement a safe procedure in well-selected cases.
Which factors predict outcome in the treatment program of anterior knee pain?
E. Witvrouw, R. Lysens, J. BELLEMANS, D. Cambier, A. Cools, L. Danneels, J. Bourgois
Which factors predict outcome in the treatment program of anterior knee pain?
Scand. J. Med. Sci. Sports, 2002, 12, 40-46.
Abstract
The goal of this prospective study was to determine the outcome-predictive role of various parameters in the non-operative treatment of chronic anterior knee pain patients. Thirty patients followed a five-week treatment program, which consisted out of only closed kinetic chain exercises. Prior to this treatment all subjects were evaluated on muscular characteristics, subjective symptoms, weight, sex, duration of symptoms and functional performance. A multiple stepwise regression analysis revealed that the reflex response time of m. vastus medialis obliquus (VMO) (P=0.041; 0.026), and the duration of symptoms (P=0.019; 0.045) were the only two parameters which were significantly associated with the outcome (evaluated by the Kujala score) at five weeks, and at three months. The shorter the duration of symptoms, or the faster the reflex response time of VMO prior to the treatment, the better the outcome after a closed kinetic chain exercise program. The statistical significance of these parameters in this study may be seen as an indication of the importance of these variables as predictors of the outcome of a closed kinetic chain strengthening program. Using this information, it seem clinically important to begin the treatment program before the anterior knee pain becomes more chronic and treatment results become less good.
Open versus closed kinetic chain exercises in patellofemoral pain: a prospective randomized study.
E. Witvrouw, R. Lysens, J. BELLEMANS, K. Peers, G. Vanderstraeten.
Open versus closed kinetic chain exercises in patellofemoral pain: a prospective randomized study.
Vlaams Tijdschrift voor Sportgeneeskunde en Wetenschappen, 2002, 93, december 2000.
Abstract
The goal of this prospective study was to evaluate the efficacy of the open versus closed kinetic chain exercices in the conservative management of patellofemoral pain. Sixty patients were randomized into a 5-week conservative program, which consisted out of only closed kinetic chain exercises, or only open kinetic chain exercises. Assessment of muscular characteristics, subjective symptoms and functional performance were evaluated in this study at the time of initial physical examination, at the end of the treatment period, and three months later. Both groups experienced a statistically significant decrease in pain and increase in functional performance. This study shows that both open and closed kinetic chain exercise programs lead to an improved subjective and clinical outcome in patients with anterior knee pain. The few better functional results for some of the tested parameters in the closed kinetic chain group suggest that this type of treatment tends to be a little more effective than the open kinetic chain program in the treatment of these patients.
A correlation study of objective functionality and WOMAC in total knee arthroplasty.
E. Witvrouw, J. Victor, J. BELLEMANS, B. Rock, R. Van Lummel, R. van der Slikke, R. Verdonk.
A correlation study of objective functionality and WOMAC in total knee arthroplasty.
Knee Surg., Sports Traumatol., Arthrosc., 2002, 10, 347-351.
Abstract
Function studies after total knee arthroplasty (TKA) generally use either self-reported instruments or objective quantitative measurements of walking activities, but it is unclear how objective factors influence self-reports. This retrospective multicenter study assessed the impact of objective variables on subjective self-reported functional outcome after TKA in 128 patients at a mean of 41 months after TKA. Self-reported disability was measured by the Western Ontario and McMaster University (WOMAC) scale, and the quality of walking and representative daily activities were determined objectively by the DynaPort knee test. Objective assessment was found to be a poor predictor of WOMAC abnormality, with correlations of 0.343, 0.246 and 0.269 with WOMAC function, stiffness, and pain, respectively. The results of WOMAC are thus strongly influenced by factors other than quantitative parameters of the lower extremity. These findings provide support for including an objective assessment of activities of daily living together with a subjective self-report.
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