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Background: Data are limited regarding the surgical technique or outcomes of double-level osteotomy (DLO) combining medial closing-wedge distal femoral osteotomy and medial closing-wedge high tibial osteotomy in patients with moderate-to-severe valgus deformity. Purpose/Hypothesis: To describe the surgical technique and assess the short-term outcomes and surgical accuracy of DLO in patients with a moderate or severe valgus deformity. It was hypothesized that this technique would result in good clinical outcomes with precise deformity correction. Study Design: Case series; Level of evidence, 4. Methods: Eight patients (mean age, 44.2 ± 10.9 years) with a moderate or severe valgus knee treated with DLO (9 knees; mechanical tibiofemoral angle [mTFA], 10.3°± 3.5°) were included. The mean follow-up was 25.1 ± 11.1 months. Preoperative to postoperative changes in radiographic parameters (mTFA, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle) and clinical scores (Hospital for Special Surgery score, Oxford Knee Score, Lysholm score) were assessed. Surgical accuracy was calculated by subtracting the achieved postoperative correction from the preoperatively planned targeted correction. Results: The mTFA changed significantly from 10.3°± 3.5° preoperatively to –1.8°± 3.4° postoperatively (P <.001); the mechanical lateral distal femoral angle and mechanical medial proximal tibial angle changed significantly by 5.1°± 2.7° and 5.9°± 2.2°, respectively (P <.001 for both); and the posterior distal femoral angle decreased significantly from 85.9°± 3.1° to 84.2°± 2.4° (P <.01). There was no significant difference between pre- and postoperative joint line convergence angles (3.3°± 2.3° to 2.6°± 2.1°). The accuracy of the correction was high: the mTFA achieved postoperatively differed from the mTFA planned preoperatively by a mean of 2.7°± 1.9° (range, 0.6°-6.6°). Significant pre- to postoperative improvement was seen for all outcome scores (Hospital for Special Surgery, from 67 ± 11 to 93 ± 4; Oxford Knee Score, from 29 ± 7 to 43 ± 3; Lysholm, from 41 ± 24 to 89 ± 8; P <.001 for all). Conclusion: High surgical accuracy was achieved, and patients who underwent varus DLO for valgus knees showed improved knee function at short-term follow-up. Varus DLO can be a surgical option to restore the optimal alignment and joint line obliquity in patients with moderate or severe valgus malalignment. [ABSTRACT FROM AUTHOR]

Context: Excessive knee valgus on landing can cause anterior cruciate ligament injury. Therefore, knee valgus alignment may show characteristic energy absorption patterns during landings with lateral movement that impose greater impact forces on the knee joint compared with landings in other alignments. Objective: To investigate the energy absorption strategy in lower-extremities during side steps in females with knee valgus alignment. Design: Controlled laboratory study. Setting: University research laboratory. Participants: A total of 34 female college students participated in this experiment. Interventions: Participants performed single-leg drop vertical jump and side steps. All participants were divided into valgus (n = 13), neutral (n = 9), and varus (n = 12) groups according to knee position during landing in single-leg drop vertical jumps. Main Outcome Measures: Lower-extremity joint angles, moments, and negative works were calculated during landing in side steps, and 1-way analysis of variance and post hoc tests were used to determine between-group differences. Results: Negative works of hip extensors, knee abductors, and ankle plantar flexors during landing in side steps were significantly smaller in the valgus than in the varus group; however, negative work of the knee extensors was significantly greater in the valgus group than in varus group. Conclusions: The findings of this study indicated that landing with knee valgus induced the characteristic energy absorption strategy in the lower-extremity. Knee extensors contributed more to energy absorption when landing in knee valgus than in knee varus alignment. Learning to land in knee varus alignment might reduce the impact on the knee joint by increasing the energy absorption capacities of hip extensors, knee abductors, and ankle plantar flexors. [ABSTRACT FROM AUTHOR]

Background: Primary hyperparathyroidism which is rare in adolescents presents commonly with non-specific symptoms and systemic complaints. Though there are few reported cases of genu valgus, genu valgus progressing to extensive bone disease despite mildly elevated calcium had not been reported before. Case presentation: A 12-year-old male had been evaluated for bilateral (left > right) genu valgus and short stature. Serum calcium and phosphate levels had been normal. X-ray of the femora and pelvic bones had not shown additional abnormalities. Valgus deformity progressed despite left femoral plating, and a left distal femoral medial closed wedge osteotomy had been performed at 15 years. Plain imaging at that time had shown localised osteopaenia. At the age of 17 years, he developed multiple fragility fractures of his left hip rendering him wheelchair-bound. Further evaluation revealed a serum PTH level of 2571 (10–65) pg/mL with calcium of 2.82 (2.2–2.6) mmol/L and inorganic phosphate of 1.7 (2.2–4.7) mg/dL. The lumbar spine DXA scan showed a Z-score of -5.8. A left parathyroid adenoma was localised and there was evidence of hyperparathyroid bone disease including brown tumours. He underwent left parathyroidectomy and left thyroid lobectomy after which his PTH level dropped to 4.03 pg/mL. He developed hypocalcaemia which was managed successfully with calcium and alfacalcidol replacement. Conclusions: Primary hyperparathyroidism can present with genu valgus in adolescents. Initial normocalcaemia which could be due to concomitant vitamin D deficiency could mask this leading to delayed diagnosis until severe irreversible bone disease ensues. [ABSTRACT FROM AUTHOR]

Context: Patellar tendinopathy (PT) is prevalent in physically active populations, and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for PT; however, their contributions to self-reported dysfunction remain unclear. Objective: The purpose of this investigation was to determine if strength, flexibility, and various lower-extremity static alignments contributed to self-reported function and influence the severity of PT. Design: Cross-sectional research design. Setting: University laboratory. Participants: A total of 30 participants with PT volunteered for this study (age: 23.4 [3.6] y, height: 1.8 [0.1] m, mass: 80.0 [20.3] kg, body mass index: 25.7 [4.3]). Main Outcome Measures: Participants completed 7 different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q-angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson's correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. Results: Correlation analysis found significant relationships between questionnaires and body mass index (r = −.35–.46), normalized knee extension (r =.38–.50) and flexion strength (r = −.34–.50), flexibility (r =.32–.38, q-angle (r =.38–.56), and pelvic tilt (r = −.40). Regression models (R2 =.22–.54) identified thigh musculature strength and supine q-angle to have greatest predictability for severity in patient-reported outcomes. Conclusions: These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, and posterior flexibility in PT patients. [ABSTRACT FROM AUTHOR]

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Congenital knee dislocation (CKD) is a rare disease with an estimated incidence of 1 per 100,000 live births, characterized by a rare musculoskeletal malformation in genu recurvatum deformity present at birth, affecting one or both lower limbs. The diagnosis may be suspected during ultrasound when observing that the situation of the extremities is not correct, and is confirmed by physical examination at birth, with plain radiography being helpful to establish the degree of severity. At present there are controversies regarding treatment and there is no definitive protocol. We present a new case of CKD, observed in the city of Manizales, diagnosed immediately after birth. [ABSTRACT FROM AUTHOR]

Using time-frequency representation techniques, projecting 1D sEMG signals onto a 2D image space can help diagnose several muscle activities. The acquired sEMG signal can provide valuable representative information about the muscle activity firing rates during muscle contraction. Different phases of muscle activity can be discernible via the sEMG signals by extracting discriminating features. The behavior of muscle activity was acquired in measurements of five muscles, i.e., RF, BF, VM, ST, and FX. Previous attempts to visualize lower limb analysis to extract sEMG features adopted One-dimensional (1D) sEMG segments. This work proposes a comparative experiment between three time-frequency representation techniques. The three time-frequency representation techniques, scalogram, spectrogram, and persistence spectrum, were used to map muscles' (1D) sEMG signal straightening the knee. The two-dimensional (2D) projected images are then fed into a convolutional neural network (CNN) model for detecting knee abnormality. The experiments are performed via 10-fold cross-validation. The number of kernels is incremented along with model layers. The fully connected layers were adjusted according to the loss value. Besides, tuning the hyper-parameters of the dropout parameters and the ReLU activation function to verify optimal performance. This research shows that the scalogram image representation gives significantly better performance than the spectrogram and persistence spectrum in recognizing knee abnormality. In addition, this study may help in guiding the diagnosis of several human muscle activities via the sEMG signal. A more diverse of muscles can be further investigated and can be useful for future work to enhance the diagnosis accuracy. [ABSTRACT FROM AUTHOR]

Background Although dynamic knee valgus can be visually identified using the 2D frontal plane projection angle (FPPA), the validity of the FPPA in terms of predicting frontal plane knee kinematics has been questioned. The biomechanical utility of the FPPA may lie in its ability to predict frontal plane knee moments. Hypothesis/Purpose The purpose of the current study was to comprehensively evaluate the ability of the FPPA to predict the frontal plane knee kinetics (peak moment, average moment, and moment at peak knee flexion) across a wide range of tasks (stepping, landing, and change of direction). Design Crossover Study Design. Methods Three-dimensional lower-extremity kinetics and 2D video were obtained from 39 healthy athletes (15 males and 24 females) during execution of six tasks (step down, drop jump, lateral shuffle, deceleration, triple hop, side-step-cut). Linear regression analysis was performed to determine if the 2D FPPA at peak knee flexion predicted frontal plane knee moment variables during the deceleration phase of each task (peak moment, average moment, moment at peak knee flexion). Results The FPPA was found to significantly predict the peak frontal plane knee moment for two tasks (deceleration and side-step-cut, R² = 12% to 25%), average frontal plane knee moment for five tasks (drop jump, shuffle, deceleration, triple hop, side-step-cut, R² = 15% to 40%), and frontal plane knee moment at peak knee flexion for five tasks (drop jump, shuffle, deceleration, triple hop, side-step-cut, R² = 16% to 45%). Conclusion An increased FPPA (medial knee collapse) predicted increased knee valgus moments (or decreased knee varus moments) during landing and change of direction tasks (but not stepping). However, the predictive ability of the FPPA was weak to moderate. [ABSTRACT FROM AUTHOR]

This study compares the functional results and survivorship of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with an external fixator for medial compartment osteoarthritis (OA) of the knee. Two cohorts of patients aged less than 60 years who had undergone either a cemented medial mobile-bearing UKA or an HTO with an external fixator were included in the study. The first cohort included patients undergoing a series of 197 consecutive medial UKA procedures (UKA group). The second cohort consisted of 60 consecutive patients undergoing HTO with an external fixator (HTO group). Each patient was assessed based on the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Subjective International Knee Documentation Committee (IKDC) score/questionnaire. A clinical evaluation was conducted on the day of the surgery (T 0) and at the follow-up visit (T 1) (minimum follow-up time was 60 months). Complications and failures resulting from the surgery were recorded for each patient. Only the age of the patients at the pre-operative time differed significantly between the two groups, with the HTO group being significantly younger (47.7 ± 8.0 versus 55.8 ± 2.2). After the final follow-up visit, all scores improved in both groups (p < 0.05). IKDC and Oxford scores were higher for the UKA group (p < 0.05). In the HTO group, three complications occurred (5%), including two superficial infections and one deep infection. On the other hand, the UKA group reported four complications (2%): three aseptic mobilisations and one infection requiring revision surgery. There was no difference in the complication rate between the two groups (p = 0.208). In young patients (<60 years) with an isolated medial knee OA, both HTO and UKA led to good to excellent clinical results with a low rate of complications at mid-term follow-up; both surgical procedures may be considered in this patient population. Level III. [ABSTRACT FROM AUTHOR]

Purpose: Placement of prosthetic components and limb alignment can be adversely impacted by errors in identification of registration points in digitally assisted knee arthroplasty. The purpose of this study was to trigonometrically analyze the impact on the accuracy of coronal tibial component and limb alignment of discrepancy between the registered midpoint of the proximal bony tibia vis-à-vis the radiographic medio-lateral center of the lateralized final tibial implant in certain varus-deformed knees. Methods: We analyzed trigonometrically the angular difference θ in coronal alignment of tibial component and hip–knee–ankle angle resulting from lateral translation of the medio-lateral center of the final tibial implant, with respect to the initial registered midpoint of the proximal bony tibia. θ was calculated using the equation tan(θ ) = d/t, where d is the numerical distance between the registered point and the center of the final tibial tray position and t is the length of tibia distal to the resection. Results: One degree of varus malpositioning of the tibial component and the limb can occur for every 6.3 mm of lateral translation of the tibial implant with respect to the midpoint of the proximal bony tibia of average reported length (372 mm). The magnitude of this error is inversely proportional to tibial length and the patient's height. Conclusions: Coronal malalignment of the tibial component and the limb is directly proportional to the amount of lateral translation of the tibial tray with respect to the registered midpoint of the proximal bony tibia and inversely proportional to the patient's height. This may occur in cases with tibial extra-articular deformity, those undergoing reduction osteotomy, downsizing of the tray, or inadvertently during tibial preparation. The error can be avoided by initial registration of the tibial midpoint more laterally by templating, re-registering the new center of the resected tibial surface or osteotomy for extra-articular deformity. [ABSTRACT FROM AUTHOR]

Background and Aim: The aim of this study was to compare the musculoskeletal disorders of students of Imam Ali Military (AS) University with different military training history. Methods: To conduct this study, 90 students of the officer university in three new entrance groups of first year (number: 30 people, age: 20.06 ± 1.31 years, height: 1.80 ± 0.05 m, weight: 72.40 ± 8.98 Kg, BMI: 22.21 ± 2.43 kg/²); second year (number: 30 people, age: 21.00 ± 1.59 years, height: 1.78 ± 0.04 m, weight: 73.66 ± 6.68 kg, BMI: 23.24 ± 1.82 kg/²) and third year (number: 30 people, age: 21.53 ± 1.45 years, height: 1.78 ± 0.06 m, weight: 72.23 ± 9.66 kg, BMI: 22.73 ± 2.55 kg/²) were selected. In this cross-sectional study, the photography method was used to measure the angle of the forward head and forward shoulders. The angle of kyphosis and lumbar lordosis were also determined by using a flexible ruler. Also, the arch of the foot was determined by the navicular drop method, the amount of genu varum or genu valgum assessed by a caliper, and the amount of hyperextension of knee evaluated by a goniometer. Shapiro-Wilk test was used to determine the type of data distribution. One-way analysis of variance (ANOVA) was used to examine between-group differences and the Bonferroni post hoc test was used to compare the two groups. All analyzes were performed by using SPSS software version 26. Results: The results of the present study showed that there were significant differences between the three groups of the first year, second year, and third year in the variables of forward head, forward shoulder, kyphosis, lordosis, amount of genu recurvatum, and foot arch (P = 0.001). The results of the Bonferroni test showed that there was a significant difference in the variables of forward head and forward shoulder between the groups of the first year-third year (P<0.01) and also between the second year - third year (P = 0.001). Also, there were significant difference in the kyphosis variable between the groups of the first year - third year (P = 0.04) and also the second year-third year (P = 0.001) that in the lordosis variable, this difference was significant between the first year and third year groups (P = 0.001). In addition, there was a significant difference in the variables of genu recurvatum and foot arch between the groups of the first year- second year, first year-third year, and second year-third year (P = 0.001), but this difference in other variables was not significant between different groups. Conclusion: The results of the present study showed that the participation of military university students in military and educational training may be associated with increased forward head, forward shoulder, kyphosis, lordosis, genu recurvatum, and flat foot. Accordingly, corrective exercises are recommended for these students to prevent these musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Résumé: La prise en charge d'une entorse grave du genou est très peu standardisée et s'appuie sur un recours important à l'IRM en première intention. Une meilleure maîtrise des tests de laxité et la connaissance de la laximétrie dynamique automatisée (LDA) pourraient réduire directement la durée de prise en charge, de l'arrêt de travail et des sports. La LDA permettrait aussi de s'associer à l'examen clinique pour confirmer des lésions périphériques (examen dynamique en translation et rotatoire) ou de subvenir à l'IRM (examen anatomique) permettant parfois à cette dernière de réaliser plus rapidement des examens complémentaires pour des pathologies plus graves (cancers...). Notre étude a permis d'élaborer un arbre décisionnel pour les suspicions d'atteinte du pivot central du genou. Rupture of the anterior cruciate ligament is one of the most common and severe injuries to the knee. The initial management of knee trauma with suspected central pivot impairment is not standardized. We compared the responses of general practitioners from the department of Mayenne to two clinical cases, separated by training and adaptation time in real conditions. After training, it was found that general practitioners tested patients, prescribed fewer MRIs in favor of automated dynamic laximetry, and requested fewer specialist consultations. The study showed the possibility of significant changes in the practices of general practitioners from the department of Mayenne for suspected central pivot impairment, after training. This more coherent control of care included a medico-economic dimension. The combination of the literature and the results of this study resulted in the drafting of an efficient decision-making tree of initial management of patients suspected of anterior cruciate ligament rupture. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dynamic knee valgus (DKV) is a known risk factor for acute and chronic knee injuries and is more frequently diagnosed in females. A real-time single-leg squat test (SLST) could screen for DKV to prevent injuries. OBJECTIVE: To compare the differences in lower extremity strength and range of motion (ROM) in female soccer athletes with and without DKV during an SLST. METHODS: Eighteen subjects with DKV (DKV group) and 18 subjects without DKV (control group) during a single-leg squat were included. Hip strength (flexion, extension, abduction, adduction, internal rotation, and external rotation) was measured with a hand-held dynamometer. Hip ROM (internal and external rotation), and ankle ROM (dorsiflexion with the knee flexed and extended) were measured. Independent t-test was used to compare the averages of the groups. RESULTS: There were significant differences in hip abduction to adduction strength ratio (DKV: 1.48 ± 0.3, control: 1.22 ± 0.26, p < 0.01) and ankle dorsiflexion with knee flexed (DKV: 17.22 ± 6.82, control: 21.22 ± 4.55, p < 0.05) and extended (DKV: 10.14 ± 4.23, control: 14.75 ± 3.40, p < 0.001) between the groups. CONCLUSION: The hip abduction to adduction strength ratio and gastrocnemius and soleus flexibility may be associated factors in dynamic knee valgus and therefore should be assessed and treated, if indicated, as a possible preventive measure in female athletes with this variation. [ABSTRACT FROM AUTHOR]

Introduction: Postsurgical opioid utilization may be directly and indirectly associated with a range of patient-related and surgery-related factors, above and beyond pain intensity. However, most studies examine postsurgical opioid utilization without accounting for the multitude of co-occurring relationships among predictors. Therefore, this study aimed to identify factors associated with opioid utilization in the first 2 weeks after arthroscopic surgery and examine the relationship between discharge opioid prescription doses and acute postsurgical outcomes., Methods: In this prospective longitudinal observational study, 110 participants undergoing shoulder or knee arthroscopies from August 2016 to August 2018 at Walter Reed National Military Medical Center completed self-report measures before and at 14 days postoperatively. The association between opioid utilization and both patient-level and surgery-related factors was modeled using structural equation model path analysis., Results: Participants who were prescribed more opioids took more opioids, which was associated with worse physical function and sleep problems at day 14, as indicated by the significant indirect effects of discharge opioid dose on day 14 outcomes. Additional patient-level and surgery-related factors were also significantly related to opioid utilization dose and day 14 outcomes. Most participants had opioid medications leftover at day 14., Conclusion: Excess opioid prescribing was common, did not result in improved pain alleviation, and was associated with poorer physical function and sleep 14 days after surgery. As such, higher prescribed opioid doses could reduce subacute functioning after surgery, without benefit in reducing pain. Future patient-centered studies to tailor opioid postsurgical prescribing are needed., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Congenital constriction band syndrome has varied clinical presentations ranging from small, incomplete skin deep constriction band to in utero amputation. Pseudarthrosis of underlying bone most commonly tibia has been reported by many authors. We report the first case of congenital pseudarthrosis of the femur with congenital constriction band syndrome. Nine-day-old female presented with the constriction band in the left thigh with open pseudarthrosis of the femur. The left femur had gross recurvatum deformity and the posterior apex of the pseudarthrosis was exposed via skin ulceration. She had an ipsilateral paralytic clubfoot. She was treated with single-stage excision of constriction band and Z-plasty. Spontaneous union of the femur was achieved at 3 months. Procurvatum deformity of the femur improved gradually over 3 years. This happens to be the first and only reported case of congenital pseudarthrosis of the femur with sciatic nerve palsy due to congenital constriction band. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine the acute effects of high-intensity jack-knife stretching for 60 s on flexibility of the hamstrings. Twelve healthy participants underwent jack-knife stretching for 60 s (3 repetitions of 20 s stretching with 30 s intervals) at two different intensities based on the point of discomfort (POD and PODmax). To examine any change in flexibility, knee extension range of motion (ROM), passive torque at end ROM, and muscle–tendon unit stiffness were measured before and after stretching. To evaluate hamstrings pain, a numerical rating scale (NRS) was described. The knee extension ROM (p < 0.01) and passive torque at end ROM (p < 0.05) were significantly increased at both intensities. The muscle–tendon unit stiffness was significantly decreased in PODmax intensity (p < 0.01), but there was no change in POD intensity (p = 0.18). The median values of NRS during the stretching were 0 and 6–7 in POD and PODmax intensity, respectively, although it was 0 immediately after the stretching protocol in both intensities. These data suggested that high-intensity jack-knife stretching is an effective and safe method to decrease muscle–tendon unit stiffness of the hamstrings. [ABSTRACT FROM AUTHOR]

Purpose: Ultrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions. Methods: A total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed. Results: Thirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p < 0.05). With rising age, a significant increased change of medial joint space width between unloaded and loaded conditions could be demonstrated in 0° (p = 0.032). No significant correlation between BMI and medial joint width in US could be found. Conclusion: Mean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy and safety of intra-articular injection of low-dose compound betamethasone in the treatment of mild knee osteoarthritis. Methods: From September 2018 to December 2019, 90 patients with mild knee osteoarthritis were divided into complete dose group and low dose group according to the treatment sequence, 45 cases in each group. The complete dose group was treated with intra-artiular injection of betamethasone(1ml) and sodium hyaluronate(2ml), once a week, three times as a course of treatment. The low dose group was treated with intra-artiular injection of betamethasone(0.3ml) and sodium hyaluronate(2ml), once a week, three times as a course of treatment. Lysholm scores? the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) were compared between the two groups before and after treatment, and the efficacy and safety of the two groups were evaluated. Results: 80 patients were followed up with an average of (4.96 ± 1.50) months ranging from 3 to 8 months, and 10 cases (11.11%) were dropped out, including 2 cases in the complete dose group, 2 cases in the midway withdrawal group, and 1 case in the treatment course less than the treatment course; 3 cases in the low dose group lost the follow-up, and 2 cases dropped out. Compared with that before treatment, Lysholm scores were significantly improved, WOMAC scores and VAS scores were significantly decreased in the two groups at 3 weeks, 6 weeks and 12 weeks after treatment (P < 0.001). The Lysholm scores of low dose group were78.10 ± 2.16, 86.78 ± 2.55, 80.90 ± 2.26, WOMAC scores were 61.00±1.38, 39.03±1.98, 45.76±1.66 and VAS scores were 2.23±0.89, 0.78±0.73 and 1.05±0.85 in low dose group at 3 weeks, 6 weeks and 12 weeks after treatment. There was no significant difference between the two groups (P > 0.05). No drugrelated adverse reactions occurred in both groups. Conclusion: The curative effect of low dose compound betamethasone intra-articular injection in the treatment of mild knee osteoarthritis is equivalent to that of complete dose compound betamethasone. It can improve the function and symptoms of knee joint, and is safe and effective. [ABSTRACT FROM AUTHOR]

The causes of snapping knee include meniscal instability, but dynamic ultrasonographic findings have rarely been reported. Here, we report a case of snapping knee due to direct trauma to the right knee of a 79-year-old woman. Dynamic ultrasonography is used to confirm the snapping phenomenon caused by the anterosuperior displacement of the truncated posterior horn and body of the right medial meniscus. [ABSTRACT FROM AUTHOR]

When compared to meniscectomy, meniscus allograft transplantation (MAT) may provide superior long-term benefits to young, active patient populations who have lost meniscal function because of irreparable damage, such as, an avascular tear, previous repair failure, and unsalvageable tear types. Positive outcomes are most likely to be achieved when meniscus allograft transplantation is performed in appropriately selected patients. Indications include patients younger than 50 years of age, with a history of subtotal or total meniscectomy without concomitant articular cartilage defects, uncorrectable joint malalignment, and/or knee instability. Outcomes for meniscal allograft transplantation are promising with studies reporting long-term graft survivorship as high as 89% at 10 years and significant improvements in multiple patient reported outcome measures. LEVEL OF EVIDENCE: Level V. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to measure resected surfaces of the medial tibial plateau and to provide accurate anatomical parameters for the Chinese population and improve the unicompartmental knee arthroplasty (UKA) component design in the future.Methods: This study measured different dimensions of the medial tibial plateau on MRIs of 1000 consecutive healthy Chinese people without knee deformity. The anteroposterior (AP) dimension and mediolateral dimensions at defined points (recorded as WA, WB, WC) of the medial tibial plateau were measured. The aspect ratio (WB/AP, recorded as AR) was also recorded. The measured results were grouped to compare with the dimensions of the Oxford Phase III tibial component. An independent t test was used to compare the differences between the males and females.Results: The Oxford Phase III tibial component showed mediolateral overhang or undersize for the whole range of measured anteroposterior dimensions of the resected medial tibial plateau. A total of 71.3% patients' resected surface did not match the Oxford Phase III tibial component well. The study also found a decrease in the aspect ratio (WB/AP) with an increase in the AP dimension in the medial tibial plateau.Conclusions: There is a difference between the morphology of the Chinese knee joint and the configuration of the Oxford Phase III tibial components. The results of this study provided accurate anatomical parameters for Chinese and guidelines for designing UKA components suitable for the Chinese population.Level Of Evidence: Retrospective comparative study, Level III. [ABSTRACT FROM AUTHOR]

The article reports that there is an increase in number of diagnosed anterior cruciate ligament (ACL) injuries. Topics discussed include restoring knee function and returning to athletic activity requires intact rotatory knee stability; early surgery claimed to increase risks of arthrofibrosis and an open technique for ACL reconstruction associated with more postoperative pain.

This study assesses the outcome of hemi epiphysiodesis with a 2-holed reconstruction plate using the tension band principle in angular deformities of the knee and variables influencing the outcome. Prospective study from 2012 to 2016 included 23 children with coronal deformities of the knee joint. IMD, ICD, BMI, mLDFA, mMPTA, mTFA, Mechanical axis deviation, Perpendicular mechanical axis ratio, and screw angle measured. Correction and rate of correction compared with BMI, age, etiology, PMAR and MAD, deformity, a segment of bone and the screw angle. Total 65 segments operated in 23 children with 40 knees. Out of the total 65, 36 plates were kept in distal femur physis and 29 in the proximal tibial physis. Thirteen knees had genu varum and 27 had genu valgum. The mean age at the time of surgery was 11.25 months. The mean follow-up of 36 months and the average time for correction was 18.64 months. 77.5% correction achieved with ROC maximum in the initial 6 months. ROC in TFA per year were 7.80(femur), 50(tibia), and 120(femur with tibia). Complications included broken implant, screw back out, screw irritation and rebound phenomenon. 2-holed reconstruction plate gives similar correction to that of the 8-plate within a comparable period without additional complications. It has the advantage of being cost effective and readily available. Age, BMI, type of deformity, amount of initial deformity, do not play a significant role in the outcome of correction. Screw placement may have a role in the final correction of the deformity. Level 3. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increased genu recurvatum (GR) angle is a risk factor for knee injury. Identification of factors causing GR is important for the prevention and rehabilitation of GR. Few studies have investigated the association between muscle strength and GR. OBJECTIVE: To examine the association between GR angle and hip and knee muscle strength in standing workers METHODS: The participants in this study were 110 healthy volunteers (59 male, 51 female) who performed standing work in a theme park. The GR angle, muscle strength, and strength ratio of the lower extremities were measured to determine their associations with GR. The GR angle was measured using a Smart KEMA motion sensor, and muscle strength was assessed using a Smart KEMA strength sensor. Stepwise multiple regression models were used to investigate which muscles contributed most to the extent of the GR angle. RESULTS: Stepwise multiple regression analysis showed that the decreased hip external rotator to hip internal rotator ratio, increased knee extensor to knee flexor ratio, and young age were associated with an increased GR angle. CONCLUSIONS: Many factors are known to increase the GR angle. However, this study investigated the roles of only hip and knee muscle strength. The results suggest that muscle strength ratios are more important than the weakness of any muscle. [ABSTRACT FROM AUTHOR]

Background: Benign Joint Hypermobility Syndrome (BJHS) is a relatively prevalent condition of the spectrum of heritable connective tissue disorders, with musculoskeletal, visceral and psychological manifestations. The conservative management of the musculoskeletal symptomatology must be modified for optimal effectiveness and minimal sequelae. Purpose: To provide an overview of the presentation, assessment, chiropractic management, and outcomes of patients with BJHS. Study Design: Case series Discussion: Recognizing joint hypermobility as a significant contributing factor in patients presenting with musculoskeletal complaints is often challenging. The lack of awareness of BJHS may delay the diagnosis as well as effective management. Manual therapy should be used judiciously; active exercise is an essential element of care. We provide an overview of the presentations, assessment, chiropractic management, and outcomes of three patients with BJHS. Future clinical trials are necessary to determine effective clinical management strategies for patients with BJHS. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to investigate the mid-term outcomes of a single-stage cell-based procedure in patients with knee focal symptomatic cartilage defects using matrix-induced culture-expanded autologous AD-MSCs. It was hypothesised that the increased number of autologous AD-MSCs after culture expansion is a safe and efficient cartilage repair procedure, which improves overtime chondrogenesis in cartilage lesions METHODS: Twenty-five consecutive patients treated for a symptomatic cartilage defect were prospectively followed for 3 years. The median age of patients was 30.5 (range 16-43) with a median BMI of 23.6 kg/m2 (range 19-29) and an average size of the lesion of 3.5 cm2 (range 2-6). All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Pre-operative and post-operative evaluation included knee-related clinical and functional evaluation based on objective and subjective scores at 6, 12, 24 and 36 months and MRI evaluation of the repair tissue using the MOCART score at 12 and 24 months.Results: Clinical outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as following: all subcategories of KOOS Score, the IKDC subjective from 40.9 (range 20.7-65.6) to 76.9 (range 42-90.3), Tegner Activity Score from 3 (range 2-4) to 4 (range 3-4), VAS for pain from 6 (range 4-8) to 1 (range 0-3). All patients improve significantly their IKDC objective scores. The MRI findings showed complete filling of the defect and integration to the border zone for 65% of the patients. Two patients underwent post-operative biopsies and the histological analysis demonstrated the presence of hyaline-like tissue.Conclusions: Adipose-derived culture-expanded mesenchymal stem cells were shown to be an efficient and safe single-stage cell-based procedure for symptomatic, full-thickness knee chondral lesions. The findings of the present study demonstrate that all patients presented significant mid-term clinical, functional and radiological improvement.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: Third-generation autologous chondrocyte implantation (ACI) is an established and frequently used method and successful method for the treatment of full-thickness cartilage defects in the knee. There are also an increasing number of patients with autologous chondrocyte implantation as a second-line therapy that is used after failed bone marrow stimulation in the patient's history. The purpose of this study is to investigate the effect of previous bone marrow stimulation on subsequent autologous chondrocyte implantation therapy. In this study, the clinical results after the matrix-based autologous chondrocyte implantation in the knee in a follow-up over 3 years postoperatively were analysed.Methods: Forty patients were included in this study. A total of 20 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D) as first-line therapy. The mean defect size was 5.4 cm2 (SD 2.6). IKDC subjective score and VAS were used for clinical evaluation after 6, 12, 24 and 36 months postoperatively. The results of these patients were compared with 20 matched patients with autologous chondrocyte implantation as second-line therapy. Matched pair analysis was performed by numbers of treated defects, defect location, defect size, gender, age and BMI.Results: Both the first-line (Group I) and second-line group (Group II) showed significantly better clinical results in IKDC score and VAS score in the follow-up over 3 years compared with the preoperative findings. In addition, Group I showed significantly better results in the IKDC and VAS during the whole postoperative follow-up after 6, 12, 24 and 36 months compared to Group II with second-line autologous chondrocyte implantation (IKDC 6 months p = 0.015, 1 year p = 0.001, 2 years p = 0.001, 3 years p = 0.011). Additionally, we found a lower failure rate in Group I. No revision surgery was performed in Group I. The failure rate in the second-line Group II was 30%.Conclusion: This study showed that third-generation autologous chondrocyte implantation is a suitable method for the treatment of full-thickness cartilage defects. Both, Group I and Group II showed significant improvement in our follow-up. However, in comparing the results of the two groups, autologous chondrocyte implantation after failed bone marrow stimulation leads to worse clinical results.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. The role and function that proprioception plays in movement and motor learning have been debated since the 19th century but can be difficult to isolate and study. Lesions at various points along the proprioceptive pathway result in afferent paresis that can be significantly disabling. Compensatory mechanisms can help with successful rehabilitation and provide an opportunity to study the role of these mechanisms in sensory feedback. Here, we present two cases of adult patients with complete hemisensory loss after a stroke: one patient with a cortical stroke and the other one with a thalamic stroke. First, we see that that motor learning can occur without proprioception, with the help of visual feedback. Second, proprioception plays an important role in movement: in the upper limb, it can facilitate individual finger movements, and in the lower limb, it maintains sufficient knee flexion to prevent the knee from going into recurvatum (backward bending) during ambulation. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the influence of the mechanical medial proximal tibial angle (MPTA) on anterior cruciate ligament (ACL) degeneration following open wedge high tibial osteotomy (OWHTO). It was hypothesised that an excessive increase in MPTA would be associated with ACL degeneration following OWHTO.Methods: Seventy-four knees treated with OWHTO were retrospectively examined. Arthroscopic ACL grading [0 (intact) to 4 (complete rupture)], anterior tibial translation (ATT) test at the time of OWHTO with the index arthroscopy and at plate removal with the second-look arthroscopy, clinical assessments using the Knee Society Score (KSS), and radiographic evaluations of MPTA were performed. The relationship between MPTA and the ACL condition was analysed using Spearman's correlation.Results: The time from the index arthroscopy to the second-look arthroscopy was 15.0 ± 4.4 months; the total follow-up was 31.0 ± 6.5 months. ACL grade significantly increased from 0.6 ± 0.8 (index arthroscopy) to 1.1 ± 1.2 (second-look arthroscopy) (p < 0.0018). ATT on the operated side significantly decreased from 7.1 ± 2.6 mm preoperatively to 5.3 ± 2.3 mm at the time of plate removal (p < 0.001). No significant difference was observed in KSS for ACL grades in the steady and progression groups. Changes in MPTA from the preoperative to postoperative period were significantly higher in the progression group (p = 0.0155). Changes in ACL grades were significantly correlated with preoperative MPTA and changes in MPTA (r = - 0.365 and 0.343, respectively; p < 0.01).Conclusions: Excessively increased MPTA led to ACL degeneration following OWHTO. ACL degeneration was not associated with short-term clinical outcomes. Excessive correction of MPTA should be avoided to prevent ACL degeneration following OWHTO.Level Of Evidence: Therapeutic case series, Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Posterior tibial slope (PTS) represents an important risk factor for anterior cruciate ligament (ACL) graft failure, as seen in clinical studies. An anterior closing wedge osteotomy for slope reduction was performed to investigate the effect on ACL-graft forces and femoro-tibial kinematics in an ACL-deficient and ACL-reconstructed knee in a biomechanical setup.Methods: Ten cadaveric knees with a relatively high native slope (mean ± SD): (slope 10° ± 1.4°, age 48.2 years ± 5.8) were selected based on prior CT measurements. A 10° anterior closing-wedge osteotomy was fixed with an external fixator in the ACL-deficient and ACL-reconstructed knee (quadruple Semi-T/Gracilis-allograft). Each condition was randomly tested with both the native tibial slope and the post-osteotomy reduced slope. Axial loads (200 N, 400 N), anterior tibial draw (134 N), and combined loads were applied to the tibia while mounted on a free moving and rotating X-Y table. Throughout testing, 3D motion tracking captured anterior tibial translation (ATT) and internal tibial rotation (ITR). Change of forces on the reconstructed ACL-graft (via an attached load-cell) were recorded, as well.Results: ATT was significantly decreased after slope reduction in the ACL-deficient knee by 4.3 mm ± 3.6 (p < 0.001) at 200 N and 6.2 mm ± 4.3 (p < 0.001) at 400N of axial load. An increase of ITR of 2.3° ±2.8 (p < 0.001) at 200 N and by 4.0° ±4.1 (p < 0.001) at 400 N was observed after the osteotomy. In the ACL-reconstructed knee, ACL-graft forces decreased after slope reduction osteotomy by a mean of 14.7 N ± 9.8 (p < 0.001) at 200 N and 33.8 N ± 16.3 (p < 0.001) at 400N axial load, which equaled a relative decrease by a mean of 17.0% (SD ± 9.8%), and 33.1% (SD ± 18.1%), respectively. ATT and ITR were not significantly changed in the ACL-reconstructed knee. Testing of a tibial anterior drawing force in the ACL-deficient knee led to a significantly increased ATT by 2.7 mm ± 3.6 (p < 0.001) after the osteotomy. The ACL-reconstructed knee did not show a significant change (n.s.) in ATT after the osteotomy. However, ACL-graft forces detected a significant increase by 13.0 N ± 8.3 (p < 0.001) after the osteotomy with a tibial anterior drawer force, whereas the additional axial loading reduced this difference due to the osteotomy (5.3 N ± 12.6 (n.s.)).Conclusions: Slope-reducing osteotomy decreased anterior tibial translation in the ACL-deficient and ACL-reconstructed knee under axial load, while internal rotation of the tibia increased in the ACL-deficient status after osteotomy. Especially in ACL revision surgery, the osteotomy protects the reconstructed ACL with significantly lower forces on the graft under axial load. [ABSTRACT FROM AUTHOR]

BACKGROUND: Four hemiplegia post-stroke patients with 10 ∘ –30 ∘ genu recurvatum recruited for three-dimensional gait analysis to investigate optimum inclination in a Rigid Tuned Ankle Foot Orthosis (RT-AFO). OBJECTIVE: 1) To investigate the optimum inclination in a Rigid Tuned Ankle Foot Orthosis (RT-AFO) in order to stabilize stance knee kinematics in the sagittal plane for stroke patients with 10 ∘ –30 ∘ genu recurvatum, and 2) to compare the effects of RT-AFO with different inclinations on spatio-temporal parameters. METHODS: Three dimensional gait measurements were performed in five conditions for four participants: walk without AFO (T1), walk with RT-AFO in 0 ∘ inclination (T2), walk with RT-AFO in 5 ∘ inclination (T3), walk with RT-AFO in 10 ∘ inclination (T4), and walk with RT-AFO in 15 ∘ inclination (T5). RESULT: Application of tibial inclination in the AFO reduced the genu recurvatum in participants who experienced stroke. Genu recurvatum was significantly reduced in conditions T3, T4 (p < 0.001) and in T5 (p < 0.05). Optimum inclination was found at 15 ∘ tibial inclination measured during mid-stance. This study reported a statistically significant improvement in cadence in condition T4 (RT-AFO 10 ∘) (p < 0.01). There were no significant results for improvement of walking speed and stride length. CONCLUSION: These results highlight the potential to optimize inclination of a Rigid Tuned Ankle Foot Orthosis for patients affected by stroke and also indicate the potential clinical applications of tuning the AFO in rehabilitation treatment of stroke patients. [ABSTRACT FROM AUTHOR]

Background: A biomechanical analysis can provide valuable information on osteoarthritis (OA) gait, but important multidimensional interactions are often ignored. The Gait Deviation Index (GDI) was designed to address the issue of data complexity in gait analyses by providing a single, encompassing, value for one's deviation from a normative reference group.Research Question: The primary aim of this study was to examine differences in a knee-specific GDI among young adults, and older individuals with and without knee OA. Secondarily, we aimed to examine these differences while controlling for gait speed.Method: Sagittal and frontal plane knee joint angles and moments were used in the computation of a GDI among young adults, and older individuals with and without knee OA. The GDI was calculated such that scores ≥100% were considered typical young-healthy gait and a 10% decrease below 100 equated to 1 standard deviation from typical gait. Scores were first examined using a one-way analysis of variance, and examined again after correcting for gait speed.Results: The GDI was calculated for three groups: young-healthy adults (n = 52), older individuals without knee OA (n = 56), and individuals with knee OA (n = 191). Those with knee osteoarthritis exhibited a mean GDI of 87.2 (11.1), which was significantly lower than young adults (99.6 (10.6); p < 0.001) and older individuals without knee OA (94.3 (11.0); p < 0.001). Differences in GDI remained consistent after controlling for gait speed. Knee OA gait waveforms displayed significant variability across similar GDIs, specifically in frontal plane patterns.Conclusion: Those with knee osteoarthritis exhibited lower (worse) GDIs compared to those without knee osteoarthritis and young, healthy individuals. After correcting for gait speed, these findings did not change. The GDI highlighted the significant variability in gait waveforms within individuals with knee OA, but the clinical utility of the GDI score itself remains limited. [ABSTRACT FROM AUTHOR]

Background: Achieving a neutral static Hip-Knee-Ankle angle (sHKA) measured on radiographs has been considered a factor of success for total knee arthroplasty (TKA). However, recent studies have shown that sHKA seems to have no effect on TKA survivorship. sHKA is not representative of the dynamic loading occurring during gait, unlike the dynamic HKA (dHKA).Research Question: The primary objective was to see if the sHKA is predictive of the dynamic HKA (dHKA). A secondary objective was to document to what degree the dHKA changes during gait.Methods: We analysed 3D knee kinematics during gait of a cohort of 90 healthy individuals with the KneeKG™ system. dHKA was calculated and compared with sHKA. Knees were considered "Stable" if the dHKA remained in valgus or varus for greater than 95% of the corresponding phase, and "Changer" otherwise. Patient characteristics of the Stable and Changer knees were compared to find associated factors.Results: Absolute variation of dHKA during gait was 10.9 ± 5.3° for the whole cohort. The variation was less for the varus knees (10.3 ± 4.8°), than for the valgus knees (12.8 ± 6.1°, p = 0.008). We found low to moderate correlations (r = 0.266 to 0.553, p < 0.001) between sHKA and dHKA values for varus knees and no significant correlation for valgus knees. Twenty two percent (36/165) of the knees were considered Changers. The proportion of knees that were Changers was 15% of the varus versus 39% of the valgus (p < 0.001).Significance: Lower limb radiographic measures of coronal alignment have limited value for predicting dynamic measures of alignment during gait. [ABSTRACT FROM AUTHOR]

Purpose: Bilateral total knee arthroplasty (TKA) is being performed more frequently. However, a consensus on whether simultaneous or staged procedures should be performed is not available. This study reviewed the clinical course of contralateral knees in patients who underwent unilateral TKA (UTKA) to determine which patients are candidates for simultaneous bilateral TKA (BTKA).Methods: One hundred eighty-six patients with osteoarthritis who underwent UTKA at a single hospital between 2006 and 2009 (follow-up mean, 10.1 years) were retrospectively investigated. Age, sex, obesity, contralateral knee pain, Hospital for Special Surgery score, femorotibial angle (FTA), and Kellgren-Lawrence grades at the time of initial surgery were used to evaluate the risk for requiring contralateral TKA. Survival analysis and receiver-operating characteristic (ROC) analysis were performed.Results: Ninety-one patients (48.9%) underwent contralateral TKA. The FTA of the contralateral knee (CFTA) was an independent related factor (hazard ratio, 1.15; p < 0.001), and the CFTA cut-off value for the next surgery was 183° (area under the curve, 0.85; sensitivity, 80.7%; specificity, 76.2%). The 10-year Kaplan-Meier survival rates for the CFTA < 183° group and the CFTA ≥ 183° group were 79.1% and 27.0%, respectively. In the CFTA ≥ 183° group, age was the predictor of future TKA, and elderly patients tended to not require a second procedure. The age cut-off value for the next surgery was 76 years.Conclusions: Varus deformities in the contralateral knee predicted additional contralateral TKA. Patients with CFTA ≥ 183° and aged 75 years or younger are considered reasonable candidates for simultaneous BTKA.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: A modified technique referred to as a medial femoral epicondyle upsliding osteotomy was proposed to address severe valgus deformity with unconstrained posterior stabilized (PS) arthroplasty. The study compared the effectiveness of the technique and PS arthroplasty with constrained arthroplasty during primary total knee arthroplasty (TKA).Methods: Fifty-three patients presenting with valgus knees with a mean valgus angle (VA) greater than 30° were prospectively randomized and divided into two groups, and both groups received primary TKA. Upsliding osteotomy with PS arthroplasty was performed on the knees of 27 patients (group A), while the remaining 26 patients (group B) received a constrained arthroplasty. The Knee Society function score (KSF), Hospital for Special Surgery knee score (HSS), range of motion (ROM), mediolateral stability and hospitalization expenses were recorded. The hip-knee-ankle angle (HKA), femorotibial angle (FTA) and VA were analysed. Complications were also recorded.Results: The patients received follow-up care for more than 50 months. The postoperative KSF, HSS and ROM showed marked improvement in both groups (p < 0.05). Radiological assessments showed that HKA, FTA and VA for group A were restored to (179.9 ± 3.0)°, (173.0 ± 2.4)° and (7.0 ± 2.4)°, respectively. For group B, the HKA, FTA and VA were restored to (181.5 ± 2.3)°, (172.5 ± 2.3)° and (7.5 ± 2.3)°, respectively. Only two patients from group A demonstrated mild medial laxity in their knees, and the remaining patients from both groups were stable medially and laterally. However, the total hospitalization expenses and material expenses of group A were less than those of group B because of the more expensive constrained prosthesis and stems. No late-onset loosening or recurrent valgus deformity was displayed.Conclusions: Both medial femoral epicondyle upsliding osteotomy with PS arthroplasty and constrained arthroplasty showed good outcomes for the restoration of neutral limb alignment and soft tissue balance, which are demonstrated to be safe and effective techniques for correcting severely valgus knees. Therefore, the clinically important finding of this study is that medial femoral epicondyle upsliding osteotomy with PS arthroplasty can be an alternative method for correcting severe valgus knees.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Accurate measurement of knee alignment, quantified by the hip-knee-ankle (HKA) angle (varus-valgus), serves as an essential biomarker in the diagnosis of various orthopaedic conditions and selection of appropriate therapies. Such angular deformities are assessed from standing X-ray panoramas. However, the limited field-of-view of traditional X-ray imaging systems necessitates the acquisition of several sector images to capture an individual's standing posture, and their subsequent 'stitching' to reconstruct a panoramic image. Such panoramas are typically constructed manually by an X-ray imaging technician, often using various external markers attached to the individual's clothing and visible in two adjacent sector images. To eliminate human error, user-induced variability, improve consistency and reproducibility, and reduce the time associated with the traditional manual 'stitching' protocol, here we propose an automatic panorama construction method that only relies on anatomical features reliably detected in the images, eliminating the need for any external markers or manual input from the technician. The method first performs a rough segmentation of the femur and the tibia, then the sector images are registered by evaluating a distance metric between the corresponding bones along their medial edge. The identified translations are then used to generate the standing panorama image. The method was evaluated on 95 patient image datasets from a database of X-ray images acquired across 10 clinical sites as part of the screening process for a multi-site clinical trial. The panorama reconstruction parameters yielded by the proposed method were compared to those used for the manual panorama construction, which served as gold-standard. The horizontal translation differences were mm mm for the femur and tibia respectively, while the vertical translation differences were mm and mm for the femur and tibia, respectively. Our results showed no statistically significant differences between the HKA angles measured using the automated vs. the manually generated panoramas, and also led to similar decisions with regards to the patient inclusion/exclusion in the clinical trial. Thus, the proposed method was shown to provide comparable performance to manual panorama construction, with increased efficiency, consistency and robustness. [ABSTRACT FROM AUTHOR]

Objective: Human adipose-derived mesenchymal progenitor cells (haMPCs) are stem cells with multiple differentiation potential and immunomodulatory function. Re-Join® comprises in vitro expanded haMPCs from adipose tissue of patients combined with cell suspension solution. This study was undertaken to evaluate the efficacy and safety of Re-Join® in patients with symptomatic knee osteoarthritis (OA). Methods: Patients with Kellgren–Lawrence grade 1–3 knee OA were recruited from two centers and randomized to receive intra-articular injection of Re-Join® or HA. Pain and function were assessed by using WOMAC score, VAS, and SF-36. Magnetic resonance imaging (MRI) analysis was performed to measure cartilage repair. Adverse events (AEs) were collected. Results: Fifty-three patients were randomized. Significant improvements in WOMAC, VAS, and SF-36 scores were observed in both groups at months 6 and 12 compared with baseline. Compared with the HA group, significantly more patients achieved 50% improvement of WOMAC and a trend of more patients achieved a 70% improvement rate in Re-Join® group after 12 months. Meanwhile, there was notably more increase in articular cartilage volume of both knees in the Re-Join® group than in the HA group after 12 months as measured by MRI. AEs were comparable between two groups. Most AEs were mild and moderate except one SAE of right knee joint infection in the HA group. Conclusions: Significant improvements in joint function, pain, quality of life, and cartilage regeneration were observed in Re-Join®-treated knee OA patients with good tolerance in a period of 12 months. Trial registration: ClinicalTrials.gov Identifier: NCT02162693. Registered 13 June 2014. [ABSTRACT FROM AUTHOR]

Purpose: In the present study, the early results of sensor-assisted versus manually balanced posterior-stabilized total knee arthroplasty (TKA) for osteoarthritis with varus deformities were prospectively compared.Methods: Fifty patients undergoing sensor-assisted TKA (group S) and 50 patients receiving manually balanced TKA (group M) were prospectively compared. The groups did not differ in terms of demographics, preoperative clinical status, or severity of deformity. The knee and function scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM) were evaluated clinically. The mechanical axes and positions of components were assessed radiographically. In sensor-assisted TKA, the medial and lateral compartment loads were compared based on the patellar positions of inversion and eversion.Results: There was no between-group difference in the postoperative KS or FS (n.s., respectively). The average postoperative WOMAC score was 17.0 in group S and 18.0 in group M (n.s.). The ROM was 131.2° in group S and 130.8° in group M (n.s.). Neither the postoperative alignment of the mechanical axis nor the component positioning differed between the groups (n.s.). In sensor-assisted TKA, the difference between the medial and lateral compartment loads was less than 15 lbs (6.8 kg) in each knee. The lateral compartment load increased after patellar eversion (p < 0.001).Conclusion: There are concerns about the cost-benefit ratio of the intraoperative load sensor, despite its advantage of more precisely assessing ligament balance without patellar eversion, which resulted in a smaller lateral gap. A long-term follow-up study with a large cohort is required.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual surgery. It was hypothesized that (1) Akagi's Line could result in high accuracy and low variability in varus osteoarthritic knees; (2) anteroposterior axes defined by using the tibial bony cutting surface as a landmark might be good substitutes for Akagi's Line; and (3) extra-articular bony landmarks might influence the variability of the anteroposterior axis.Methods: Three-dimensional bone models were reconstructed from the preoperative computed tomography data of 111 osteoarthritic knees with varus deformities. Seven different anteroposterior axes of the tibial component were defined: Akagi's Line, Axis MED, Axis 1/6MED, Axis 1/3MED, Axis of Oval Shape, Axis of Anterior Crest, and Axis Second Metatarsus. The rotational mismatch angle was measured between the tibial anteroposterior axis and the line perpendicular to the transepicondylar axis projected on the cutting surface (positive value: external rotation of the tibial anteroposterior axis).Results: The average rotational mismatch angles (referring to the projected anatomical/surgical epicondylar axes) were - 2.7° ± 5.8°/1.0° ± 6.0° (Akagi's Line), - 4.2° ± 7.7°/- 0.5° ± 7.8°, 2.9° ± 7.2°/6.6° ± 7.2°, 9.8° ± 7.0°/13.5° ± 6.8° (Axis MED, Axis 1/6MED, Axis 1/3MED), - 5.1° ± 7.9°/- 1.4° ± 7.8° (Axis of Oval Shape), and 19.3 ± 9.5°/23.0° ± 9.6°, - 2.0° ± 11.3°/1.7° ± 11.4° (Axis Anterior Crest, Axis Second Metatarsus), respectively.Conclusions: Akagi's Line provided the best accuracy and least variability in varus osteoarthritic knees. Axis 1/6MED and Axis MED are good substitutes for Akagi's Line due to the difficulty of identifying the attachment site of the posterior cruciate ligament after the proximal tibia has been cut. Extra-articular bony landmarks should not be used for alignment due to their high variability. This study will aid surgeons in choosing the proper anteroposterior axis of the tibial component to reduce rotational mismatch and thus achieve good clinical knee outcomes.Levels Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Numerous studies demonstrated that prosthetic overhang and over-sizing cause pain and stiffness following total knee arthroplasty (TKA), but none considered volume changes within the joint capsule. This study was designed to investigate differences in volumes of resected bone compared to implanted components in TKA, and to determine the incidence and factors related to 'over-voluming'.Methods: Three-dimensional reconstructions were created from 100 magnetic resonance imaging scans taken to design patient-specific instruments for TKA. The preoperative simulations were used to calculate the volume ratio (VR) by dividing volume of planned components by that of planned bone resections. Uni- and multi-variable linear regressions were performed to determine associations between 'over-voluming' (VR > 1.0) and gender, implant size and version (standard versus narrow), osteophytes, resection levels, external rotation of the femoral component, hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA).Results: The overall implant/bone volume ratio was 0.91 ± 0.11 (range 0.63-1.16) with 'over-voluming' observed in 24 knees. Multi-variable regression confirmed over-voluming to be associated with lower mLDFA (OR 0.66; CI 0.45-0.93; p = 0.026) and extensive osteophytes (OR 0.14; CI 0.03-0.61; p = 0.014), but not HKA angle (OR 0.98; CI 0.76-1.26; p = n.s.).Conclusions: Over-voluming was observed in 24% of knees, in which the implant volume exceeded the resected volume by up to 16%. Over-voluming was associated with intra-articular femoral valgus (low mLDFA), but not directly associated with tibial deformity (mMPTA) or HKA angle. Over-voluming could be associated with prosthetic overhang or excessive tensions within the joint capsule, and, therefore, contribute to unexplained pain and stiffness following TKA.Level Of Evidence: IV, Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Ossifying fasciitis is a very rare disease of reactive character; however, it can mimic malignant lesions, especially osteosarcoma. We report a case of a 30-year-old woman, who experienced a rapidly growing painful lesion of the left knee joint, preceded by a trauma. The tumor was resected, and the histopathological image suggested a malignant lesion with features of an osteosarcoma. A detailed correlation with a clinicopathological and radiological analysis led to the final diagnosis of ossifying fasciitis at an extraordinary site of patellar retinaculum. Our case shows that the close similarity between ossifying fasciitis and osteosarcoma may be challenging. [ABSTRACT FROM AUTHOR]

Severe post-traumatic genu recurvatum is an uncommon condition in orthopedics. The typical symptoms are pain, weakness, and instability. For severe and symptomatic genu recurvatum patient, the surgical correction should be performed to relieve symptoms and prevent progression of deformity. Many procedures were proposed to treat this condition, but there are some complications such as patella baja, secondary deformity, skin complication, and inadequate correction. Most of the procedures need an additional procedure such as tibial tuberosity transfer to correct the patellar height. In this case, the authors report a new technique in which the osteotomy was performed near the center of rotation angulation. And, the correction did not influence the patellar height. [ABSTRACT FROM AUTHOR]

Background: Despite our knowledge of several biomechanical risk factors related to anterior cruciate ligament (ACL) injury, such as decreased knee flexion, increased knee abduction, and increased hip flexion, adduction and internal rotation during walking, jogging, and landing from a jump, the incidence of ACL tears remains high. Quantifying variability in the lower extremity provides a continuous measure of joint coordination and function that may elicit an additional aspect of ACL injury mechanisms.Research Question: The aim of this study was to assess joint coordination patterns and variability in individuals following ACL reconstruction (ACLR).Methods: Twenty participants with unilateral ACLR and twenty uninjured participants matched by sex and body mass index (BMI) walked over-ground at self-selected speed. Two force plates embedded in the walking platform recorded ground reaction forces (GRF), and a motion capture system collected kinematic data. Vector coding was used to describe coordination patterns and measure coordination variability in hip-knee and knee-ankle coupled motion.Results: Individuals with ACLR had greater variability in hip-knee coordination compared to their healthy counterparts for both the reconstructed and contralateral limbs. The individuals with ACLR also exhibited altered coordination patterns, one of which was characterized by constrained hip motion.Significance: These results are evidence that differences in joint coordination exist between individuals with and without ACLR, even after the former are cleared to return to sport. This new insight into coordinative function after ACLR may be useful for improving rehabilitation strategies as well as identifying those at risk of injury during return to sport testing. [ABSTRACT FROM AUTHOR]

Background: Classification of sagittal gait patterns in unilateral spastic cerebral palsy (CP) provides direct implication for treatment. Five types are described: type 0 has minor gait deviation; type 1 has inadequate ankle dorsiflexion in swing; type 2 has inadequate ankle dorsiflexion throughout the gait cycle; types 3 and 4 have abnormal function of the knee and hip joint respectively. During gait analysis of children with unilateral spastic CP we observed frequently that a knee flexion deficit disappeared during running. That may have an impact on classification and treatment.Research Question: Does the classification type change while running and how do patients' kinematics adapt to running?Methods: 64 children with unilateral spastic CP were classified using instrumented gait analysis for walking and running. The deviation of four parameters from typically developing children (TD) were used to distinguish between types: peak ankle dorsiflexion in swing for type 1, peak ankle dorsiflexion in stance for type 2, knee range of motion for type 3, and hip range of motion for type 4. A three-factor ANOVA for factors group (CP/TD), locomotion (walk/run) and limb side (in-/uninvolved) was conducted.Results: The number of patients with type 1, 3 and 4 decreased considerably from walking to running, whereas, the number of type 0 and 2 patients increased. The ANOVA showed that three of four parameters of patients' pathologic limb adapt similarly to TD to running, except for the ankle dorsiflexion in stance.Significance: Running shows that there is a natural way to resolve abnormalities. Therefore, recommended treatments of hip and knee joint abnormalities based on the walking classification can be questioned and additional running analysis may be important for surgical decision making. [ABSTRACT FROM AUTHOR]

Background: The Lower Quarter Y Balance Test (YBT-LQ) has been widely used in the field to assess dynamic balance performance in various populations. However, no study has demonstrated test-retest reliability of the YBT-LQ in adolescents including several age cohorts, even though reliability is necessary to provide repeatable performance data.Objective: Thus, we examined test-retest reliability of the YBT-LQ in healthy adolescents.Methods: In a school setting, 178 secondary school students (93 female, 85 male) in sixth to eleventh grades (11-19 years) performed the YBT-LQ twice, 7 days apart. Normalized maximal reach distances (% leg length) for all three directions (i.e., anterior, posterolateral, posteromedial) and both legs and the composite score were used as outcome measures. Intraclass correlation coefficient (ICC3,1) and standard error of measurement (SEM) were calculated to assess relative and absolute test-retest reliability, respectively. Practical relevance of the YBT-LQ was determined by calculating the minimal detectable change (MDC95%).Results: Irrespective of grade, test-retest reliability for all distances reached was predominately "excellent" (i.e., ICC3,1 > 0.75) and the rather small SEM values ranged from 1.77 to 5.81%. Depending on grade and reach direction, MDC values of 4.90 to 16.10% represent the minimum amount of change needed to identify clinically relevant effects in repeated measurements of the YBT-LQ performance.Conclusions: The observed values suggest that the YBT-LQ is a reliable test and suitable to detect changes of dynamic balance performance in healthy adolescents from grade six to eleven (i.e., aged 11-19 years). [ABSTRACT FROM AUTHOR]

Background: Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.Research Question: 1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session?Methods: Seventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 min of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane.Results: Before training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 min of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p < 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05).Significance: A short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate T 2 mapping as a possible marker for low-grade human articular cartilage lesions during a one-year follow-up, possible changes during the follow-up and compare the reliability and sensitivity of these measurements on high-field (3 T) and ultra-high-field (7 T) MRI scanners. Design Twenty-one patients with femoral, tibial and patellar cartilage defect in the knee joint participated in the study. The MRI protocol consisted of morphological, as well as three-dimensional triple-echo steady-state (3D-TESS) T 2 mapping sequences with similar parameters at 3T and 7T. Patients were scanned at five time-points up to 12 months. T 2 values were evaluated in the lesion and healthy-appearing regions for superficial and deep cartilage zone. The repeated ANOVA was used to determine differences in T 2 values at various time points. Results A significant decrease in T 2 values was observed between baseline and six months in the superficial layer of the lesion in patients at 3 T (decrease from 41.89 ± 9.3 ms to 31.21 ± 7.2 ms, which is a difference of −5.67 ± 2.2 ms (p = 0.031)), and at 12 months in the superficial layer of the lesion in patients at 3 T (decrease from 41.89 ± 9.3 ms to 35.28 ± 4.9 ms, which is a difference of −6.60 ± 4.4 ms (p = 0.044). No significant differences were recorded at 7 T. Conclusion The change in T 2 values acquired with 3 T 3D-TESS appears to be reflecting subtle changes of cartilage composition in the course of low-grade lesion development. 7 T T 2 mapping does not reflect these changes probably due to completely decayed short T 2 component. [ABSTRACT FROM AUTHOR]

Purpose: Weight-bearing sports might influence the alignment of the lower extremities during growth. The relationship between participation in weight-bearing sports and the alignment of the lower extremities in adolescents has not been adequately studied yet. The aim of the study was to investigate whether sports participation during growth in early adolescence is correlated with the development of genu varum.Methods: The design was a correlation study in which 1008 (564 boys, 444 girls) healthy adolescents (from 12 to 19 years of age) were recruited in secondary schools. The alignment of the knee was determined by measuring the intercondylar (IC) and intermalleolar (IM) distance using a specially designed instrument and an inside calliper. The degree of sports participation of the participants was determined by a questionnaire in which they were asked how many hours a week they participated in sports and for how many years in total.Results: The results of this study revealed a significant correlation between participation in weight-bearing sports and genu varum in each of three different age groups, both for boys and girls.Conclusion: Our results show that there is an association between the alignment of the knee joint and participation in weight-bearing sports during early adolescence. [ABSTRACT FROM AUTHOR]