Search

Background: Platelet-rich plasma (PRP) has emerged as the forerunner among disease-modifying treatment options for early osteoarthritis (OA) of the knee. However, no consensus is available regarding optimum dosing schedules. Purpose: To determine whether multiple injections of PRP (3 injections) provide better short-term and long-term results than a single injection of PRP in a guinea pig model of knee OA. Study Design: Controlled laboratory study. Methods: 36 Dunkin-Hartley guinea pigs (weighing ~600-800 g) were chosen for this study. The animals were assigned to group DC (disease control group), group G1 (single-PRP group), and group G2 (multiple-PRP group) containing 10, 10, and 12 animals, respectively. Another 4 animals were used for preparation of allogenic PRP. Groups G1 and G2 received 1 and 3 injections of PRP, respectively, at weekly intervals in the intervention knee while the contralateral knee was injected with normal saline. Group DC received no intervention in either knee. Half of the animals from each group (subgroups DC.3, G1.3, and G2.3) were sacrificed at 3 months, and the remaining half (subgroups DC.6, G1.6, and G2.6) were sacrificed at 6 months after intervention. Both knee joints were harvested for histological assessment of articular cartilage and synovium. Results: The mean synovial scores for groups G1 and G2 were significantly better than those for group DC at 3 months. No difference was found between groups G1 and G2 at 3 months. At 6 months, group G2 had significantly better mean synovial scores than group G1 and group DC. The mean articular cartilage scores in group G2 were significantly better than those in group DC at 3 months. However, at 6 months, no significant difference was found among any of the groups in terms of mean articular scores. Conclusion: Both single and multiple injections of PRP exert similar anti-inflammatory effects on the synovium in the short term. However, this effect is sustained in the long term only for multiple injections. Multiple injections of PRP exert a chondroprotective effect, but only in the short term. This effect is not seen with a single injection of PRP. Clinical Relevance: This study provides insight into the histological basis for the superiority of multiple injections of PRP. [ABSTRACT FROM AUTHOR]

Posterior column fractures of the tibial plateau have been considered problem injury as many authors reported poor outcome. Commonly used surgical approaches have limitations in addressing complex fractures involving the posterior column, leading to malreduction and subsequent leading to chronic posteroinferior subluxation, arthritis and chronic pain. There is thus a need for a surgical approach, which can provide adequate exposure to both quadrant of posterior column, in addition to allowing sufficient space for fracture manipulation and implant placement. The authors have evaluated the applicability of the posterior midline gastrocnemius raphe split approach to deal with coomplex posterior column fragment in tibial plateau fractures. A midline gastrocnemius splitting approach was used alone or along with other approaches in 22 patients with tibial plateau fractures involving the posterior column. The mean age of the patients was 36 years and the female to male ratio was 1:6 (3 and 18). At an average follow up of 12 months (Range 6-14 months), Radiological evidence of union was noted at an average 13 weeks (Range, 10-15weeks) and no loss of reduction was seen at follow-up. All cases had regained painless knee flexion that averaged 120°. The midline gastrocnemius splitting approach is a versatile approach, which allows adequate exposure on either side of the posterior tibial plateau. This can easily combined with other approaches, where the anteromedial and anterolateral coloumn or associated ligament injury demand attention. [ABSTRACT FROM AUTHOR]

Purpose: Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods: This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results: Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions: The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee. [ABSTRACT FROM AUTHOR]

This article discusses a study that compared the effectiveness of ultrasound-guided pulsed radiofrequency ablation (PRF) of the suprascapular nerve to local anesthetics with steroids for chronic shoulder pain. The study found that both treatments provided significant pain relief and improved scores for shoulder pain and disability. However, the group that received the local anesthetic and steroid injection had lower pain levels during the 2-week follow-up period. The study suggests that both treatments can be effective options for managing chronic shoulder pain. [Extracted from the article]

Background: Evaluation of the ortho-anesthetic geriatric care pathway for patients with proximal femur fracture in a tertiary care referral center was done by reporting the peri-operative morbidity and mortality. Clinical and demographic predictors of mortality were also identified in this cohort. Material and Methods: This prospective observational study was conducted between August 2017 and November 2018. Demographic, anesthetic and surgical characteristics were recorded. Telephonic post-discharge follow-up was done for a period of 2 years. Factors predicting mortality were estimated using multivariate logistic regression. Results: The cohort was characterized by frailty, high ASA physical status, NYHA class and Charlson co-morbidity index. The delay in presentation to hospital and subsequent surgical fixation was 7 (1–8) and 8 (5–13) days, respectively. The 30, 60, 90-day, 1-year and 2-year mortality was 13.6%, 21.8%, 25.45%, 36.5% and 44%, respectively. Intra-operative blood transfusion was a predictor of 30-day mortality (OR 9.2, 95% CI 1.02–83.17; p = 0.048). Pre-operative respiratory dysfunction predicted 60-day (OR 11.245, 95% CI 1.38–91.58; p = 0.024) and 90-day (OR 11.654, 95% CI 1.91–71.1; p = 0.008) mortality. Post-operative morbidity was reported in 31 (28.1%) patients; incidence of pneumonia (n = 9), sepsis (n = 8), MI (n = 6), PTE (n = 5) and ARF (n = 3) were 8.18%, 7.27%, 5.45%, 4.54% and 2.72%, respectively. Conclusion: Existing pathway facilitated surgical fixation with median delay of 8 days which should be shortened to 48 h. High mortality in our cohort needs to be decreased by preventing admission delays and aggressively managing co-morbidities. Acceptable benchmark goals for pre-operative optimization of lung disease and decrease in intra-operative blood transfusion need to be incorporated in existing care pathway. [ABSTRACT FROM AUTHOR]

As a nutshell, an early diagnosis of Knee Osteoarthritis (KOA) enhances the likelihood of an individual receiving treatment at its onset and prevents joint replacement surgery. Computer‐Aided‐Diagnosis (CAD) from the radiograph images have gained a wide‐spread attention in automated grading of KOA severity. But radiograph images have certain limitations, such as presence of too much noise and uneven contrast distribution across the image that impacts the accuracy and reliability of CAD systems. Therefore, a novel three‐stage pre‐processing method has been proposed using a combination of different techniques applied at sequential stages such as noise‐reduction using gaussian‐filter, normalization using pixel‐centering method, and balanced contrast enhancement technique. A transfer‐learning based VGG16 architecture has been used for severity classification. Our classification framework outperforms the existing state‐of‐the‐art methods achieving an excellent accuracy of 89.95\%. Therefore, our system can be used by the radiologists and physicians as a decision‐support tool in their daily diagnosis procedure. [ABSTRACT FROM AUTHOR]

Purpose: To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). Materials and Methods: A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. Results: Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4º predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4º, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. Conclusions: A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4º is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases. [ABSTRACT FROM AUTHOR]

Patellar dislocation is a disorder in the human knee where patella slips out of its expected position. The orthopedic experts need to manually measure the parameters indicating patellar instability from knee scans, which is a laborious and time‐consuming task. An automated method for measuring these parameters can resolve the issue of inter‐observer and intra‐observer variations and significantly lessen the burden of the experts. Therefore, in this work, a two‐step approach has been proposed for the automated measurement of the sulcus angle from knee magnetic resonance (MR) images to assist the experts in the diagnosis of patellar dislocation. Firstly, a variant of U‐Net architecture has been proposed harnessing the capabilities of the residual network to segment the region of interest (ROI) from the axial knee MR images. Secondly, the contour of ROI is used for the detection of key points required to compute sulcus angle. A T2‐weighted knee magnetic resonance imaging dataset of 50 patients obtained from Post Graduate Institute of Medical Education & Research, Chandigarh, has been used. Out of 50 patients, the randomly selected knee MR images of 25 patients have been used to train the segmentation model. The intersection over union and dice similarity coefficient values of 94.71% and 97.28%, respectively, were achieved for the proposed segmentation model. The automated measurement of the sulcus angle resulted in a mean error of 2.52 ± 1.52° when tested on another set of axial knee MR images of 25 patients. The proposed framework produced results comparable to the manual expert measurements. [ABSTRACT FROM AUTHOR]

Knee disorders are common among the human population. Knee osteoarthritis (OA) is the most widespread knee joint disorder, which may require surgical treatment. The detection and diagnosis of knee joint disorders from medical images demand enormous human effort and time. The development of a computer‐aided diagnosis (CAD) system can notably minimise the burden of medical experts and remove the intra‐observer and inter‐observer variations. To achieve the goal, the highly challenging research problem of knee image segmentation has been frequently paid attention in past years, which can be efficiently applied in the development of the CAD system. Knee image segmentation is a challenging task owing to the image contrasts, intensity variations, shape irregularities, and the presence of thin cartilage structures. Therefore, this paper presents a literature review of automated segmentation approaches mainly focused on the segmentation of knee cartilage and bone, with respect to the underlying technical aspects, datasets used, and the performance reported. The paper also presents the growth from classical segmentation approaches towards the deep learning approaches in the knee image segmentation. Owing to the varying quality and complexity of different knee image datasets, this paper abstains from doing a rigorous comparative evaluation of image segmentation approaches. [ABSTRACT FROM AUTHOR]