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Copyright of Journal of Forensic Medicine / Fayixue Zazhi is the property of Journal of Forensic Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

High tibial osteotomy is an option for the treatment of unilateral osteoarthritis of the knee joint in order to relieve pain, improve function, delay knee replacement and preserve high levels of activity in patients. The key to the success of osteotomy is to select patients strictly, comprehensive medical history and physical examination, precise preoperative planning, at the same time, skilled surgical techniques are required as a guarantee. The use of appropriate fixation techniques and rehabilitation treatment schedule can help to achieve long-term good results. This article reviews the indications for high tibial osteotomy, patient selection, preoperative planning, surgical techniques, fixation methods, complications and clinical outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Double anterior cruciate ligament sign is a imaging performance of the bucket handle tear of lateral meniscus. While, the relationship between double anterior cruciate ligament sign and the tearing type of discoid lateral meniscus is still unclear. OBJECTIVE: To investigate the meaning and value of double anterior cruciate ligament sign on the instability of torn discoid lateral meniscus in adults. METHODS: Clinical and imaging data of 95 cases of torn discoid lateral meniscus were retrospectively reviewed. All MRI images of the knee were observed and analyzed by two chief physicians of radiology. The incidence of double anterior cruciate ligament sign on preoperative MRI was calculated, and the relation between double anterior cruciate ligament sign and tearing type, surgical method and clinical symptoms of torn discoid lateral meniscus were analyzed. RESULTS AND CONCLUSION: (1) Among 95 knees with torn discoid lateral meniscus, 17 knees (18%) were diagnosed as definite double anterior cruciate ligament sign. (2) The incidence of double anterior cruciate ligament sign in complete discoid lateral meniscus was 29%, which was significantly higher than that of 7% in incomplete discoid lateral meniscus (P=0.005). The incidences of longitudinal tear and peripheral tear were 35% and 41% in positive group of double anterior cruciate ligament sign, which were significantly higher than that of 9% (P=0.013) and 14% (P=0.025) in negative group. (3) The cases of preoperative click (P=0.021), extension block (P=0.003), the Visual Analogue Scale score (P=0.008) of the knee and the intraoperative meniscus suture (P=0.010) in positive group of double anterior cruciate ligament sign were significantly higher than those in the negative group, while the Lysholm score was lower than that in the negative group (P=0.020).(4) Our findings indicate that double anterior cruciate ligament sign is a MR imaging feature associated with a displaced tear of the discoid lateral meniscus in adults. Therefore, it may be a reliable indicator for evaluating the tear pattern and the operation method for adult patients with torn discoid lateral meniscus. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite three-dimensional (3D) finite element model is helpful for the analysis of the injury mechanism and mechanical characteristics of knee joint, there are few researches on dynamic movement simulation of knee joint. OBJECTIVE: A 3D finite element model of normal male knee joint was established to dynamically simulate the movement of knee joint and analyze the biomechanical characteristics and relative movement of the tibio-femoral joint under different flexion angles, so as to provide a 3D finite element model for the investigation of knee biomechanics, and provide basis for the design of personalized knee prosthesis and 3D printing. METHODS: The knee joint from a healthy male adult was scanned by CT. Then, a normal 3D finite element model of knee joint was constructed by Mimics, Hypermesh and Abaqus. Simulation and stress analysis of knee joint were carried out under different loads. RESULTS AND CONCLUSION: (1) The constructed finite element model of knee joint could accurately reflect the geometrical structure and biomechanical characteristics of the knee joint, and could simulate multiple movements of knee joint and was effective for biomechanical research of the knee joint. (2) In the process of simulating knee flexion at 0°-60°, the range of knee valgus angle was 3.34°-6.13°, and the range of internal rotation angle was 1.56°-29.17°. The femur had a significant posterior shift relative to tibia, and the shifted distance was from 4.36 mm to 7.23 mm. (3) At knee flexion 0°, the maximum contact stresses of femur cartilage, tibial cartilage and meniscus were 1.45, 1.03 and 2.59 MPa, respectively, and 6.41, 6.73 and 8.65 MPa, respectively at knee flexion 60°. (4) Our findings indicate that in the process of simulating knee flexion at 0°-60°, the range of knee valgus angle is relatively small, and stable, while the range of internal rotation angle is relatively large. In the process of simulating knee flexion at 0°-60°, the contact stress of femoral and tibial cartilage gradually increased with the varied flexion angle, while the changes of contact stress of medial and lateral menisci are different, the changes of medial meniscus are much great, and the contact stress of lateral meniscus is relatively stable. The contact stress of medial meniscus is greater than that of lateral menisci. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of Ilizarov technique in treatment of Tibial infected bone defect ， and analyze the best indications. Methods We retrospectively analysed the data of 15 cases of tibial infected bone defect， from January 2013 to January 2017. The length of bone defect ranged from 4- 7cm， with an average of 5.6cm . All patients were treated by debridement， Ilizarov external fixation， immediately osteotomy， bone transport . Then we recorded the postoperative healing rate， complications and function， and evaluated by Paley criteria. Re s ults Their follow- up periods ranged from 11 to 42 months (mean，28.4 months). Postoperative X- ray radiography examination was taken Regularly to evaluate bone healing process， healing time 5 ~ 13 months， the average 8.6 months. There was no recurrence of tibia infection，skin dragging pain was found in 7 cases ， malposition in 2 cases . The Limb length recovered well，and adjacent joints， function was good. According to Paley criteria for management of infectious tibial defect， 7 cases were rated as excellent and 6 as good ， the excellent rates was 86.7% . Conclusion For treatment of tibial large infected bone defect associated with soft tissue defects，application of Ilizarov Technique can be effective [ABSTRACT FROM AUTHOR]

High tibial osteotomy (HTO) is an effective treatment for knee osteoarthritis. With the application of bi-planer open wedge osteotomy high tibial osteotomy and new angular stable locking plates, HTO has become more accuracy, minimally invasive and standard, achieved satisfactory long-term treatment outcome. The indications of HTO are expanding. We need to comprehensively consider whether the patient has varus deformity, the location and severity of the deformity, the stage of osteoarthritis, age and the demand of activity, as well as individual factors such as weight, gender, bone condition and joint activity, and strive to give the best individualized treatment to osteoarthritis patients in different stages.

Objective: To analyze the incidence of recent complications in patients with osteoarthritis of the knee (OA) after medial opening wedge high tibial osteotomy(MOWHTO) and its influence on clinical effect. Methods: The clinical data of 131 patients with knee OA who received MOWHTO at Department of Sports Medicine and Arthroscopy,Tianjin Hospital from April 2017 to September 2018 were analyzed retrospectively. There were 75 males and 56 females, aged (62.8±5.1) years (range:48 to 70 years). Complications and clinical outcomes of patients were recorded and the proximal medial angle of tibia (MPTA), the International Knee Documentation Committee Subjective Knee Form (IKDC), the Western Ontario and McMaster Universities(WOMAC) Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome score(KOOS) were collected before and 1 year after operation and compared between complication group and non-complication group. Data were analyzed by paired-samples t test, independent samples t test and χ(2) test. Results: The follow-up time was (18.5±3.4) months (range:13 to 22 months). Complications occurred in 22 patients(16.8%), including 8 cases(6.1%) of hematoma, 5 cases(3.8%) of neurosensory abnormality, 4 cases(3.1%) of intramuscular venous thrombosis, 2 cases(1.5%) of deep venous thrombosis, 3 cases(2.3%) of loss of correction angle, 3 cases(2.3%) of superficial infection, 2 cases(1.5%) of deep infection, 2 cases(1.5%) of delayed union of fracture, 1 case(0.8%) of postoperative stiffness, 1 case (0.8%) of hinge point cortex fracture. There were no significant difference in MPTA ((86.5±2.0)° vs . (86.7±2.1)°, t=- 0.41, P= 0.68) , IKDC ((86.4±4.8) vs .(85.5±6.9), t= 0.74, P= 0.50) , WOMAC ((87.7±6.5) vs . (86.1±5.8), t= 1.16, P= 0.25). There were no significant difference in knee scores except for the KOOS pain score ((79.4±4.4) vs . (87.2±5.9), t= -5.90, P <0.01) and sports and recreation score ((83.2±3.0) vs . (88.0±4.7), t=- 6.14, P< 0.01) . Conclusion: Short-term complications of MOWHTO can be managed appropriately through early diagnosis and individualized treatment and have no significant negative effect on knee function recovery of patients.

High tibial osteotomy(HTO) is an effective method for the treatment of knee osteoarthritis by transferring the weight bearing line to the lateral tibial plateau, which can significantly reduce the pressure and cartilage lesion of medial knee compartment.However, under- and over-correction of weight bearing line can lead to early postoperative failure.It is necessary to define the standard of axis correction, make correct preoperative plan, ensure the accuracy of operation and consider the risk factors of under- and over-correction of axis.With the advent of the era of intelligent medicine, the application of patient-specific instrumentation technology based on three dimention printing and navigation technology will help to achieve the precise control of axial alignment in high tibial osteotomy.

Objective: To investigate the tibial baseplate coverage with symmnetrical tibial prosthesis in primary total knee arthroplasty (TKA). Methods: From August 2014 to February 2015, 39 patients (39 knees) with varus knee osteoarthritis were retrospective reviewed in Department of Orthopaedics, Tianjin Xiqing Hospital. Nine males and 30 females; aged 50 to 78 years (67±6 year). 3D tibia models of the knee were built with Mimics 10.01 software, simulated TKA surgeries were performed. The morphology of the proximal tibia was measured, including the mediolateral (ML), anteroposterior (AP) and medial and lateral tibial plateau AP dimensions. 3D models of PFC Sigma tibial prosthesis were imported and the tibial coverage characters were analyzed. Results: The AP and ML dimensions of the tibial resection surface were (45.7± 3.4) mm, (71.7± 4.2) mm respectively, the plateau aspect ration ratio (AP/ML) was 63.8%±3.0%. The medial tibial plateau AP[(46.9± 3.3) mm]was significantly greater than the lateral side[(41.8±3.3) mm, P =0.000], the asymmetric ratio averaged 112.4%±6.9%. The medial tibial plateau, anteromedial, posteromedial, posterolateral unsatisfied coverage ratio were 33.3%, 76.9%, 20.5%, 33.3% respectively. There are 5 cases underhang and 3 cases overhang in the posteromedial side, whereas 1 case underhang and 12 cases overhang posterolateral, the overhang ratio was 30.8%. Posteromedial, posterolateral prosthesis coverage had linear positive correlation to the ipsilateral tibial plateau AP diameter. Conclusions: The medial AP diameter of tibial plateau is significantly lager than the lateral side in varus knee osteoarthritis patients. With symmetrical tibial baseplate placement in TKA, the prosthesis usually lead to medial tibial plateau anterior and posterior underhang and posterolateral overhang.