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BACKGROUND: Stress radiography techniques have been shown to be superior to the arthrometer and clinical examination in evaluating the posterior cruciate ligament-deficient knee, but no precise relationship has been established between the extent of the lesion and the laxity measured by stress radiography. HYPOTHESIS: It is possible to establish a precise relation between posterior laxity and the anatomical lesions of the posterior cruciate ligament and posterior structures using stress radiography. STUDY DESIGN: Controlled laboratory study. METHODS: Measurements were performed on 15 fresh-frozen cadaveric knee specimens. A partial posterior cruciate ligament lesion was created by sectioning the anterolateral bundle, followed by a complete section. Then the lateral collateral ligament and the posterolateral corner were transected, and finally the medial collateral ligament and the posteromedial corner were sectioned. Stress radiography was performed first on the intact knee and again after each lesion was created using 4 techniques: Gravity Sag View, PCL-Press, Telos at 80 degrees , and Telos at 30 degrees of flexion. RESULTS: Telos 30 and Telos 80 revealed the best overall performance as a diagnostic test in terms of accuracy in discriminating between the different types of lesions. Using the Telos device, we determined the following cut-off points: for a partial lesion, less than 3 mm at 30 degrees and less than 6 mm at 80 degrees ; for a complete lesion, between 4 mm and 9 mm at 30 degrees and between 7 mm and 12 mm at 80 degrees ; for associated peripheral lesions, more than 9 mm at 30 degrees and more than 12 mm at 80 degrees . CONCLUSION: The Telos 30 degrees and 80 degrees allow us to accurately distinguish between the different types of lesion and permit grading of posterior knee laxity. CLINICAL RELEVANCE: Stress radiography allows characterization of posterior knee injuries and helps to determine treatment strategy. [ABSTRACT FROM AUTHOR]

Posterior laxity of the knee can be assessed clinically, but interpretation of the amount of displacement is highly subjective. Mechanical methods are more efficacious for measuring anterior laxity. Radiologic techniques are available for measurement in a lateral projection, but some variables may interfere with their accuracy. We undertook a trigonometric analysis of the axial view to confirm that it can be used to reliably measure posterior displacement. The ideal radiologic conditions consist of 80 degrees of knee flexion in both knees maintained with a knee support and a 26 degrees x-ray beam incidence with respect to the tibia. Although such accuracy is rarely obtained in routine clinical practice, even with a variability of +/- 10 degrees in the x-ray beam incidence the error factor will be less than 10%. Such a degree of error is in the same range (+/- 2 mm) as noted by investigators using the lateral radiograph to measure anteroposterior displacement. We believe that our study validates the use of a single axial radiograph of both knees to assess the state of the posterior cruciate ligament of an injured knee as compared with a normal knee. [ABSTRACT FROM AUTHOR]

Ankle injuries frequently occur in dancers. Among these injuries, only a few cases of talar subluxation have been reported in the literature. In our series, we diagnosed and treated 25 subtalar subluxations over a 1-year period in the Ballet Bejart Lausanne company. The subluxations occurred after a grand plie on pointes or at the landing of a jump on demi-pointes, without any mechanism of ankle sprain. The dancer usually noted a sudden and sharp pain in the talonavicular joint and hindfoot with a feeling of 'forward displacement' of the foot. At palpation, the talonavicular ligament, the anterior talofibular ligament, and the posteromedial part of the subtalar joint were painful. A limitation of the ankle extension and a clear hypomobility of the subtalar joint were noted. Under the effect of shearing forces on the midtarsal joint, a posteromedial subtalar subluxation occurred. Treatment consisted of a manipulation that reduced the subluxation. Continuous taping, which locks the talonavicular joint in the anterior direction, was recommended for 6 weeks. Dancing could be resumed in a swimming pool after 2 weeks, and on the ground after 3 to 4 weeks. We found that subluxation could recur, and that it could eventually become chronic. [ABSTRACT FROM AUTHOR]

The aim of our study was to advance the knowledge about the biological differences in the healing of the anterior cruciate ligament (ACL) versus the medial collateral ligament (MCL). We quantified α-smooth muscle actin (α-SMA) expression and TGF-β receptor I (TGF-βRI) expression in experimentally injured rabbit ligaments (from day 3 to 12 weeks post-injury). Myofibroblasts (α-SMA positive cells) were identified as early as the third day post-injury in MCL and their density increased steadily up to day 21. Myofibroblasts were also detected in injured ACL but their density remained very low at all time points. The percentage of positive TGF-βRI area significantly increased in both injured ligaments compared to controls, with a peak expression at day 21; however, it remained constantly lower in ACL compared to MCL. A significant correlation was found between the percentage of TGF-βRI positive cells and the percentage of α-SMA expression only in injured MCL. These results provide evidence that myofibroblasts are important players in MCL remodelling after injury. The combined presence of myofibroblasts and TGF-βRI in the first 3 weeks post-MCL injury may partially explain the difference in the MCL and ACL healing process. [ABSTRACT FROM AUTHOR]

Background: Ice hockey injuries epidemiology is still poorly understood and very few studies are focused on it, especially about professional players., Methods: Our prospective study collected all injuries occurring on ice during practice and games over 7 years (2006-2013) in a professional hockey team playing in the 1st division championship in Switzerland., Results: During the 7 seasons, we recorded a total of 525 injuries and 190 injuries with time loss (TL). Mean injuries incidence was 5.93 (95% CI 5.28 to 6.27) injuries/1000 h/player and with time loss 2.14 (95% CI 1.79 to 2.39) injuries/1000 h/player. The lower limb was the most affected part of the body, with a total of 40.4% of all injuries, mostly knee Medial Collateral Ligament tear and muscle adductors/abdominal sprain. For the upper limb, shoulder was the most affected joint with mostly acromioclavicular sprain and shoulder dislocation. Forwards had a significant (p < 0.05) higher risk than defensemen for knee Medial Collateral Ligament (MCL) tear. There was no significant difference in the concussion risk between forwards and defensemen, but defensemen had a significant higher risk (p < 0.05) to have a more severe concussion., Conclusion: This study provides a better understanding about professional ice hockey epidemiology, which is still insufficiently researched and understood. We also found some significant risk factors, being a forward for knee MCL tear, being a defensemen for concussion severity. Concussion program prevention seems to be effective but it is crucial to continue the follow up of concussion on long term and expand the surveillance system to all the League.

Background: Microfracture (MF) is an established operative treatment for small, localized chondral defects of the knee joint. There is evidence from animal studies that matrix augmentation of bone marrow stimulation (m-BMS) can improve the quality of the repair tissue formation., Purpose: To evaluate the therapeutic outcome of a matrix made of polyglycolic acid and hyaluronan as compared with a conventional MF technique., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: Patients between the ages of 18 and 68 years who had an articular femoral cartilage defect of 0.5 to 3 cm 2 in the weightbearing area of the femoral condyles with indication for MF were included in this study. Patients were randomized and treated with either MF or m-BMS with Chondrotissue. Defect filling, as assessed on magnetic resonance imaging (MRI), at postoperative 12 weeks was defined as the primary outcome measure, with follow-up MRI at weeks 54 and 108. Follow-up data were also collected at 12, 54, and 108 weeks after surgery and included patient-reported clinical scores: visual analog scale for pain, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score, and 36-Item Short Form Health Survey., Results: MRI scans confirmed cartilage repair tissue formation in both groups 12 weeks after treatment. There was no significant difference between the m-BMS and MF groups in the percentage of defect filling at 12, 54, and 108 weeks postoperatively. No significant difference was found in terms of patient-reported clinical scores. Both groups showed significant improvement in 4 KOOS subscales-Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life-at 54 and 108 weeks after treatment., Conclusion: This is the first randomized controlled trial comparing m-BMS with a polyglycolic acid matrix with hyaluronan with MF. The use of the Chondrotissue implant in m-BMS has been proven to be a safe procedure. No difference was found between m-BMS and MF in terms of patient-reported outcome scores and MRI assessment until postoperative 2 years. Long-term follow-up studies including histological assessment are desirable for further investigation., Registration: EUCTR2011-003594-28-DE (EU Clinical Trials Register)., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was sponsored by BioTissue AG Switzerland. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Purpose: Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored., Methods: We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38-203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan-Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis., Results: Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI ≥ 35, a significant increase in revision was noted. Comparing BMI ≥ 35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2-3.3, p = 0.009], and the adjusted HR was 2.1 (95 % CI 1.2-3.6, p = 0.008)., Conclusion: All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI <35.

Purpose: We evaluated whether synovial fluid (SF) leptin concentrations correlate with pain severity in patients with hip or knee endstage osteoarthritis (OA) and whether they mediate the association between increased joint pain and (1) female gender and (2) obesity., Methods: We conducted a cross-sectional study including patients with primary hip and knee OA undergoing joint replacement between January and December 2010. SF leptin concentrations obtained on the day of surgery were assessed. Main outcome was pain severity measured pre-operatively using WOMAC and VAS pain scales., Results: A total of 219 patients were included, 123 hip and 96 knee arthroplasties. Mean age was 72 years, 59% were women. Mean SF leptin levels were 22.9 (±25.6) ng/ml in women and 5.4 (±5.9) ng/ml in men. Levels >19.6 ng/ml (highest quartile) were significantly associated with increased pain on both WOMAC (mean difference -9.6, 95% CI -15.1 to -4.0) and VAS scale (mean difference 0.8, 95% CI 0.2-1.3). Associations remained unchanged after adjusting for age, co-morbidities, contra-lateral arthritic joint, OA site, and disability. The associations observed between increased pain and female gender or obesity were substantially reduced after adjusting for SF leptin., Conclusion: Joint pain is associated with SF leptin concentrations. Increased pre-operative pain observed in women and obese may be related to high intra-articular leptin levels.