Achilles tendinopathy is classically defined as a tendinosis devoid of an inflammatory cell population. However, recent literature suggests inflammation as a mediator in the pathogenesis. These finding were mainly based on semi-quantative immunohistochemistry. We therefore used flow cytometry to obatain a more accurate identification and quantification of the different cell types involved. Thirty-two samples were obtained from twelve patients with chronic tendinopathic lesions undergoing Achilles tendon surgery. Samples obtained from three patients with hemiplegia requiring surgical release due to spastic Achilles tendons served as control. We used two panels to identify the myeloid and lymphoid population targeting the following markers: CD45, CD3, CD8, CD4, CD19, CD11b, CD56, CD14, CD16, Vα7.2, 6b11, CD161, TCRγδ. To assess the presence of fibroblasts CD90 was targeted. The mean count of CD45+ hematopoietic cells in the tendinopathic samples was significantly higher than in the control samples, respectively 13.27% and 3.24% of the total cell count (P<0.001). The mean fraction of CD3+ cells present in the complete cell population was significantly higher in pathological samples than in control samples, respectively 1.70% and 0.37% (P<0.05). Presence of CD19+ B cells was not reported. The mean fraction of γδ T cells was significantly higher in tendinopathic samples compared to blood samples of the same patient and consisted of 12.9% and 5.8% γδ T cells respectively (P<0.05). These findings support an inflammatory cell infiltration in midportion Achilles tendinopathy that show similarities to enthesitis in SpA. This implies a potential target to investigate in novel treatment modalities.

Aims: Surgical management of hallux rigidus remains a controversial subject. The purpose of the study is to compare the results of arthroscopic and open cheilectomie in a prospective and randomised manner. Method: Between October 2000 and December 2001, 26 patients (29 feet) were operated because of grade 1 and 2 hallux rigidus. Mean age was 54.8 (36–71). Patients were operated using arthroscopic cheilectomy and release or open cheilectomy. Standard technique was used in both groups. Type of technique was choosen in a randomised manner. Preoperative evaluation was performed with standard x-rays and x-rays in maximum dorsißexion and plantarßexion. Mean preoperative AOFAS score was 60.83/100. Both groups had the same preoperative prothorn;le. Results: Mean postoperative score was 90.5/100 in the open group and 83.1/100 in the arthroscopic group (p< 0.05). Hospital stay was shorter. The arthroscopy group had better results in mobility because they had less pain and were able to perform more intensiþed rehabilitation (p> 0.05). All patients had improved function and mobility (p< 0.05). Conclusion: Management of moderate hallux rigidus with cheilectomy is a reliable method for relieving pain and increase mobility on short terms. Arthroscopic treatment has a considerable learning curve which inßuences the outcome. We think that more experience in the þeld of arthroscopy of the þrst mtp joint leads to less pain in the postoperative phase allowing for more intensiþed rehabilitation, shorter hospital stay, better cosmetic result, less problems with shoe wear and quicker restart of professional activities.

There are many reports of treatment for intraarticular fractures of the calcaneus using different methods. Results are very difficult to compare. For this reason a prospective study was designed to compare the outcome of the same type of fracture treated with Stein-mann pinning or plate osteosynthesis.

Between January 1995 and March 1999 31 patients with two-part intraarticular fractures of the calcaneus, type IIB according to the Sanders classification, were treated operatively with either transcalcaneal pinning (12 fractures) or with open reduction and internal plate and screw fixation using a lateral approach (19 fractures). After a mean follow-up of 26 months all patients were assessed. A comparison was made between the two modes of treatment. The global score averaged 78.3 ± 12.1; 79.3 ± 11.14 for the patients treated with plate and screw fixation, and 76.6 ± 13.2 for the patients who underwent pinning. Lateral X-rays showed no difference in anatomical reduction between both methods. A positive correlation was demonstrated between the AOFAS Ankle-Hindfoot score and Böhler’s angle. The restoration of the congruity of the posterior subtalar joint was assessed postoperatively by means of a CT scan. The angle between the undersurface of the talus and the lateral fragment of the two-part fracture was evaluated. No statistically significant difference was found between both groups.

The authors conclude that there is no difference in functional outcome between both modes of treatment. Plate osteosynthesis has the advantage that the shape of the hindfoot and midfoot is restored, but the higher complication rate is a drawback.