No abstract

Review of literature, level of evidence IV.

Using the lateral malleolus as the cutaneous reference for the distal insertion of the CFL seems to be more reliable than the pure arthroscopic technique. This study describes a percutaneous technique to obtain a calcaneal tunnel for distal insertion of the CFL. The sural nerve is at the greatest risk of injury with this technique and requires careful subcutaneous incision to prevent injury. This new percutaneous technique is less invasive than a purely arthroscopic technique and more accurately identifies the location of the tunnel. It can be used to do calcaneal tunnel in clinical practice during anatomic ligament reconstruction for chronic ankle instability.

Anatomical reconstruction of the lateral ankle ligaments has become a pivotal component of the treatment strategy for chronic ankle instability. The recently described arthroscopic version of this procedure is indispensable to ensure that concomitant lesions are appropriately managed, yet remains technically demanding. Here, we describe a simplified variant involving percutaneous creation of the calcaneal tunnel for the distal attachment of the calcaneo-fibular ligament. The rationale for this technical stratagem was provided by a preliminary cadaver study that demonstrated a correlation between the lateral malleolus and the distal footprint of the calcaneo-fibular ligament. The main objectives are simplification of the operative technique and decreased injury to tissues whose function is crucial to the recovery of proprioception.

Polyethylene micro‐sized wear particles released from orthopedic implants promote inflammation and osteolysis; however, less is known about the bioactivity of polyethylene nanosized wear particles released from the last generation of polymer‐bearing surfaces. We aim to assess the internalization of fluorescent polyethylene‐like nanoparticles by both human macrophages and osteoclasts and also, to determine their effects in osteoclastogenesis in vitro. Human macrophages and osteoclasts were incubated with several ratios of fluorescent polyethylene‐like nanoparticles between 1 and 72 h, and 4 h, 2, 4, 6, and 9 days, respectively. The internalization of nanoparticles was quantified by flow cytometry and followed by both confocal and video time‐lapse microscopy. Osteoclast differentiation and activity was semiquantified by tartrate‐resistant acid phosphatase (TRAP) staining, TRAP mRNA relative expression, and pit resorption assay, respectively. Macrophages, osteoclast precursors and mature osteoclasts internalized nanoparticles in a dose‐ and time‐dependent manner and maintained their resorptive activity. In addition, nanoparticles significantly increased the osteoclastogenesis as shown by upregulation of the TRAP expressing cell number. We conclude that polyethylene‐like nanosized wear particles promote osteoclast differentiation without alteration of bone resorptive activity of mature osteoclasts and they could be considered as important actors in periprosthetic osteolysis of the last new generation of polymer‐bearing surfaces. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2649–2657, 2016.