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Articles by M Citak
Total Records ( 2 ) for M Citak
  J Geerling , S Zech , D Kendoff , M Citak , P. F O'Loughlin , T Hufner , C Krettek and M. Richter

In operative treatment of Berndt and Harty stage 1 and stage 2 osteochondral lesions of the talus, the goal is revascularization. The use of computer-assisted guided retrograde drilling of osteochondral lesions has been described as a new technique with promising results.


This study reports the follow-up assessment of patients treated with Iso-C-3D-navigated retrograde drilling. Its aim was to establish whether the greater precision of computer-assisted drilling results in satisfactory clinical outcomes.

Study Design:

Case series; Level of evidence, 4.


Patients who underwent navigated Iso-C-3D-based retrograde drilling between June 1, 2003, and July 31, 2005, were included in the follow-up study. Clinical outcomes were measured using (1) the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society and (2) the Visual Analogue Scale–Foot and Ankle. Radiological outcomes were assessed via radiographs and magnetic resonance imaging. Surgeon satisfaction was assessed using a simple 0 to 10 rating scheme for feasibility, accuracy, and clinical benefit.


Average follow-up time was 25 months (range, 20–34). Twenty patients satisfied the inclusion criteria: 12 men and 8 women; mean age, 35 years (range, 19–58). One patient was excluded because he required a cartilage restoration procedure. All scores improved at the time of follow-up—Ankle-Hindfoot Scale, from 76 to 90 (P < .001); Visual Analogue Scale–Foot and Ankle, from 79 to 92 (P < .001). The average ratings of the operating surgeons (n = 3) were as follows: feasibility 9.0 (range, 7.3–10.0); accuracy, 8.5 (range, 5.8–10.0); and clinical benefit, 8.5 (5.7–10.0). At follow-up, magnetic resonance imaging revealed an improvement of the Hepple score in 80% of patients.


Arthroscopic treatment of osteochondral lesions of the talus is well established. A retrograde approach does not breach the overlying intact talar cartilage. The results of this follow-up study of 3-dimensional computer navigated drilling are promising.

  V Musahl , M Citak , P. F O'Loughlin , D Choi , A Bedi and A. D. Pearle

Background: The pivot shift is a dynamic test of knee stability that involves a pathologic, multiplanar motion path elicited by a combination of axial load and valgus force during a knee flexion from an extended position.

Purpose: To assess the stabilizing effect of the medial and lateral meniscus on anterior cruciate ligament-deficient (ACL-D) knees during the pivot shift examination.

Study Design: Controlled laboratory study.

Methods: A Lachman and a mechanized pivot shift test were performed on 16 fresh-frozen cadaveric hip-to-toe lower extremity specimens. The knee was tested intact, ACL-D, and after sectioning the medial meniscus (ACL/MM-D; n = 8), lateral meniscus (ACL/LM-D; n = 8), and both (ACL/LM/MM-D; n = 16). A navigation system recorded the resultant anterior tibial translations (ATTs). For statistical analysis an analysis of variance was used; significance was set at P < .05.

Results: The ATT significantly increased in the ACL-D knee after lateral meniscectomy (ACL/LM-D; P < .05) during the pivot shift maneuver. In the lateral compartment of the knee, ATT in the ACL-D knee increased by 6 mm after lateral meniscectomy during the pivot shift (16.6 ± 6.0 vs 10.5 ± 3.5 mm, P < .01 for ACL/LM out vs ACL out). Medial meniscectomy, conversely, had no significant effect on ATT in the ACL-D knee during pivot shift examination (P > .05). With standardized Lachman examination, however, ATT significantly increased after medial but not lateral meniscectomy compared with the ACL-D knee (P < .001).

Conclusion: Although the medial meniscus functions as a critical secondary stabilizer to anteriorly directed forces on the tibia during a Lachman examination, the lateral meniscus appears to be a more important restraint to anterior tibial translation during combined valgus and rotatory loads applied during a pivoting maneuver.

Clinical Relevance: This model may have implications in the evaluation of surgical reconstruction procedures in complex knee injuries.

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