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Current concepts in arthritis
Foot Ankle Clin N Am 8 (2003) xvii – xviii
Preface
Current concepts in arthritis
Mark E. Easley, MD Guest Editor
With great pleasure I am honored to serve as guest editor for this edition of Foot and Ankle Clinics focusing on ankle arthritis. While the topic is rather broad, I have attempted to address all facets of the management of ankle arthritis. The effectiveness of this edition rests entirely on the contributions of the individual authors. Fortunately, this issue was completed by very talented, academically-committed physicians who dedicated their time to make this a truly outstanding edition. Without exception, the contributing authors are authorities in each of their respective topics. In order to adequately cover the spectrum of disorders that affect the ankle’s articular cartilage and their treatment options, this issue includes focal and diffuse ankle arthritis and nonoperative and operative management. The majority of Foot and Ankle Clinics readers are surgeons who are generally familiar with current surgical techniques for ankle anthritis but often are less familiar with nonoperative measures. Therefore, I have included three articles on conservative treatment. Virginia Kraus covers Cox-2 inhibitors, Mark Hungerford addresses glucosamine/chondroitin sulfate, and Wayne Marshall adds his expertise on viscosupplementation. I am sure readers will find these contributions useful as an educational tool to accurately inform their patients about these nonsurgical treatments. The management of focal osteochondral lesions of the talus (OLTs) has evolved considerably over the past decade, due in large part to the surgical techniques and academic contributions of the authors included in this issue. Niek van Dijk and his group provide an excellent overview of treatment strategies for OLTs; Richard Ferkel describes traditional surgical management with debride1083-7515/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S1083-7515(03)00039-1
xviii
M.E. Easley / Foot Ankle Clin N Am 8 (2003) xvii–xviii
ment and drilling/microfracture; La´zlo´ Hangody and Pierce Scranton detail their respective techniques of autologous osteochondral graft transplantation; and Lars Peterson and his team share their method of autologous chondrocyte transplantation. As the knee currently serves as the most feasible donor site for cartilage transfer to the talar dome, I am excited to include the work of Ada Cole and her group who provide compelling information about the distinctions of ankle and knee articular cartilage. Finally, surgical management of more diffuse ankle osteoarthritis is addressed. Mark Myerson and his associates address joint-preserving periarticular osteotomies; Peter van Roermund and his group highlight his technique of distraction arthroplasty; and Steve Raikin discusses surgical techniques for ankle arthrodesis. This issue also includes what I consider ‘‘cutting-edge’’ orthopaedic management of ankle arthritis from Michael Brage and colleagues with his methods of implanting fresh allograft to resurface weightbearing surfaces of the ankle joint. I am honored to have Beat Hintcrmann and his college address total ankle arthroplasty, with his vast clinical and basic science experience using multiple different prosthetic designs, including his own implant, the Hintegra. In my opinion the future in the management of ankle arthritis is gene-modified tissue engineering, an exciting area of orthopaedic research. As tissue engineering enters the clinical arena, I am sure that some of our current treatment methods will be improved or replaced. Until that time, the management included in this issue remains the ‘‘state-of-the-art.’’ My friend, Mark Myerson, taught me invaluable skills in the management of foot and ankle disorders, and I respect him for his clinical expertise. However, I most admire is his unrelenting commitment to expanding nationally and internationally the fund of knowledge of orthopaedic foot and ankle surgeons. If my edition exhibits even a fraction of Mark’s passion, I trust that it will serve as a useful reference for physicians treating ankle arthritis. Mark E. Easley, MD Assistant Professor Division of Orthopaedic Surgery Duke University Medical Center Duke South, Orange Zone Room 5530, Box 2950 Durham, NC 27710, USA
Preface
Current concepts in arthritis
Mark E. Easley, MD Guest Editor
With great pleasure I am honored to serve as guest editor for this edition of Foot and Ankle Clinics focusing on ankle arthritis. While the topic is rather broad, I have attempted to address all facets of the management of ankle arthritis. The effectiveness of this edition rests entirely on the contributions of the individual authors. Fortunately, this issue was completed by very talented, academically-committed physicians who dedicated their time to make this a truly outstanding edition. Without exception, the contributing authors are authorities in each of their respective topics. In order to adequately cover the spectrum of disorders that affect the ankle’s articular cartilage and their treatment options, this issue includes focal and diffuse ankle arthritis and nonoperative and operative management. The majority of Foot and Ankle Clinics readers are surgeons who are generally familiar with current surgical techniques for ankle anthritis but often are less familiar with nonoperative measures. Therefore, I have included three articles on conservative treatment. Virginia Kraus covers Cox-2 inhibitors, Mark Hungerford addresses glucosamine/chondroitin sulfate, and Wayne Marshall adds his expertise on viscosupplementation. I am sure readers will find these contributions useful as an educational tool to accurately inform their patients about these nonsurgical treatments. The management of focal osteochondral lesions of the talus (OLTs) has evolved considerably over the past decade, due in large part to the surgical techniques and academic contributions of the authors included in this issue. Niek van Dijk and his group provide an excellent overview of treatment strategies for OLTs; Richard Ferkel describes traditional surgical management with debride1083-7515/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S1083-7515(03)00039-1
xviii
M.E. Easley / Foot Ankle Clin N Am 8 (2003) xvii–xviii
ment and drilling/microfracture; La´zlo´ Hangody and Pierce Scranton detail their respective techniques of autologous osteochondral graft transplantation; and Lars Peterson and his team share their method of autologous chondrocyte transplantation. As the knee currently serves as the most feasible donor site for cartilage transfer to the talar dome, I am excited to include the work of Ada Cole and her group who provide compelling information about the distinctions of ankle and knee articular cartilage. Finally, surgical management of more diffuse ankle osteoarthritis is addressed. Mark Myerson and his associates address joint-preserving periarticular osteotomies; Peter van Roermund and his group highlight his technique of distraction arthroplasty; and Steve Raikin discusses surgical techniques for ankle arthrodesis. This issue also includes what I consider ‘‘cutting-edge’’ orthopaedic management of ankle arthritis from Michael Brage and colleagues with his methods of implanting fresh allograft to resurface weightbearing surfaces of the ankle joint. I am honored to have Beat Hintcrmann and his college address total ankle arthroplasty, with his vast clinical and basic science experience using multiple different prosthetic designs, including his own implant, the Hintegra. In my opinion the future in the management of ankle arthritis is gene-modified tissue engineering, an exciting area of orthopaedic research. As tissue engineering enters the clinical arena, I am sure that some of our current treatment methods will be improved or replaced. Until that time, the management included in this issue remains the ‘‘state-of-the-art.’’ My friend, Mark Myerson, taught me invaluable skills in the management of foot and ankle disorders, and I respect him for his clinical expertise. However, I most admire is his unrelenting commitment to expanding nationally and internationally the fund of knowledge of orthopaedic foot and ankle surgeons. If my edition exhibits even a fraction of Mark’s passion, I trust that it will serve as a useful reference for physicians treating ankle arthritis. Mark E. Easley, MD Assistant Professor Division of Orthopaedic Surgery Duke University Medical Center Duke South, Orange Zone Room 5530, Box 2950 Durham, NC 27710, USA