Aims The aim of this study was to evaluate antegrade autologous bone grafting with the preservation of articular cartilage in the treatment of symptomatic osteochondral lesions of the talus with ...subchondral cysts. Patients and Methods The study involved seven men and five women; their mean age was 35.9 years (14 to 70). All lesions included full-thickness articular cartilage extending through subchondral bone and were associated with subchondral cysts. Medial lesions were exposed through an oblique medial malleolar osteotomy, and one lateral lesion was exposed by expanding an anterolateral arthroscopic portal. After refreshing the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis. The fragments of cartilage were fixed with 5-0 nylon sutures to the surrounding cartilage. Function was assessed at a mean follow-up of 25.3 months (15 to 50), using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot outcome score. The radiological outcome was assessed using MRI and CT scans. Results The mean AOFAS score improved from 65.7 (47 to 81) preoperatively to 92 (90 to 100) at final follow-up, with 100% patient satisfaction. The radiolucent area of the cysts almost disappeared on plain radiographs in all patients immediately after surgery, and there were no recurrences at the most recent follow-up. The medial malleolar screws were removed in seven patients, although none had symptoms. At this time, further arthroscopy was undertaken, when it was found that the mean International Cartilage Repair Society (ICRS) arthroscopic score represented near-normal cartilage. Conclusion Autologous bone grafting with fixation of chondral fragments preserves the original cartilage in the short term, and could be considered in the treatment for adult patients with symptomatic osteochondral defect and subchondral cysts. Cite this article: Bone Joint J 2018;100-B:590-5.
The Telescope Array (TA) collaboration has measured the energy spectrum of ultra-high energy cosmic rays (UHECRs) with primary energies above 1.6 x 10 super(18) eV. This measurement is based upon ...four years of observation by the surface detector component of TA. The spectrum shows a dip at an energy of 4.6 x 10 super(18) eV and a steepening at 5.4 x 10 super(19) eV which is consistent with the expectation from the GZK cutoff. We present the results of a technique, new to the analysis of UHECR surface detector data, that involves generating a complete simulation of UHECRs striking the TA surface detector. The procedure starts with shower simulations using the CORSIKA Monte Carlo program where we have solved the problems caused by use of the "thinning" approximation. This simulation method allows us to make an accurate calculation of the acceptance of the detector for the energies concerned.
We study the anisotropy of Ultra-High Energy Cosmic Ray (UHECR) events collected by the Telescope Array (TA) detector in the first 40 months of operation. Following earlier studies, we examine event ...sets with energy thresholds of 10 EeV, 40 EeV, and 57 EeV. We find that the distributions of the events in right ascension and declination are compatible with an isotropic distribution in all three sets. We then compare with previously reported clustering of the UHECR events at small angular scales. No significant clustering is found in the TA data. We then check the events with E > 57 EeV for correlations with nearby active galactic nuclei. No significant correlation is found. Finally, we examine all three sets for correlations with the large-scale structure (LSS) of the universe. We find that the two higher-energy sets are compatible with both an isotropic distribution and the hypothesis that UHECR sources follow the matter distribution of the universe (the LSS hypothesis), while the event set with E > 10 EeV is compatible with isotropy and is not compatible with the LSS hypothesis at 95% CL unless large deflection angles are also assumed. We show that accounting for UHECR deflections in a realistic model of the Galactic magnetic field can make this set compatible with the LSS hypothesis.
We measure the spectrum of cosmic rays with energies greater than 1018.2eV with the fluorescence detectors (FDs) and the surface detectors (SDs) of the Telescope Array Experiment using the data taken ...in our first 2.3-year observation from May 27, 2008 to September 7, 2010. A hybrid air shower reconstruction technique is employed to improve accuracies in determination of arrival directions and primary energies of cosmic rays using both FD and SD data. The energy spectrum presented here is in agreement with our previously published spectra and the HiRes results.
We search for correlations between the positions of extragalactic objects and the arrival directions of ultra-high energy cosmic rays (UHECRs) with primary energy E > or =, slanted 40 EeV as observed ...by the surface detector array of the Telescope Array (TA) experiment during the first 40 months of operation. We examine several public astronomical object catalogs, including the Veron-Cetty and Veron catalog of active galactic nuclei. We count the number of TA events correlated with objects in each catalog as a function of three parameters: the maximum angular separation between a TA event and an object, the minimum energy of the events, and the maximum redshift of the objects. We determine the combination of these parameters that maximizes the correlations, and we calculate the probability of having the same levels of correlations from an isotropic distribution of UHECR arrival directions. No statistically significant correlations are found when penalties for scanning over the above parameters and for searching in several catalogs are taken into account.
In thirty elbows that had an established non-union of a fracture of the lateral humeral condyle that had occurred more than five years before, treatment consisted of one of three operations: anterior ...transposition of the ulnar nerve (nine patients), corrective osteotomy of the humerus and anterior transposition of the ulnar nerve (four patients), or osteosynthesis of the non-union combined with neurolysis and anterior transposition of the ulnar nerve, with or without corrective osteotomy of the humerus (seventeen patients). Of the thirty patients, fifteen had been apprehensive when using the elbow, due to lateral instability, or had had pain in the elbow. In thirteen of these fifteen patients, the non-union was treated by osteosynthesis. Afterward, the pain and apprehension disappeared, but the range of motion of the elbow decreased in all but three patients. Three patients had clicking between the humerus and radius, and the bone failed to unite in three others. Osteosynthesis is indicated for the treatment of non-union of the lateral humeral condyle only if the patient has serious pain in the elbow or apprehension when using the elbow, due to lateral instability.
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