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Purpose: During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values. Methods: Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards. Results: Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X‐ray, while body mass index had a significant relation with D3 (p < 0.05). Conclusion: In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane. Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up. Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion. [ABSTRACT FROM AUTHOR]

Extramedullary devices are used extensively to stabilize fractures in long bones. The type of pin–bone anchorage is a determining factor in fixation properties, which differ between mono-cortical and bi-cortical stabilizations. This computational study compares the effects of mono-cortical and bi-cortical pins of a unilateral uniplanar external fixator on the construct stiffness, the early phase of bone healing, and pin loosening. Eight finite element models were established for a simple transverse tibia fracture, treated with a unilateral uniplanar external fixator with surgical variations in the pin-bone anchorage. Each model was subjected to a partial body weight, and axial stiffness was calculated. A deviatoric strain-based mechano-regulation algorithm was applied, and tissue differentiation in the callus was predicted. Finally, a strain-based failure criterion was employed to assess the risk of pin loosening. The axial stiffnesses of bi-cortical structures were slightly larger than the results of the mono-cortical sets. Regardless of the number of pins, bi-cortical systems produce a more uniform distribution of differentiated tissue than the corresponding mono-cortical constructs. Finally, both mono-cortical and bi-cortical groups held the critical strains of the pin–bone interface within the acceptable ranges and provided a protected construct against the risk of pin loosening. Based on the findings of this study, mono-cortical pins could be considered potential alternatives to bi-cortical fixations at the early stage of healing. Nevertheless, successful management of diaphyseal fracture through mono-cortical fixation needs to be assessed in further studies over the full period of healing. [ABSTRACT FROM AUTHOR]

The authors discuss a report about a novel approach to using eight evidence-based criteria for giving feedback to medical students. Topics covered include selection of four common limb fracture surgeries that residents face during their two months period rotation, the cycle of learning a new psychomotor skill revealed through the four components of Kolb's experiential learning cycle, and a semistructured interview completed for attaining the view of orthopedic residents about feedback.

Objective: Osteoarthritis (OA) is the most common cause of chronic disability in joints among older individuals. The primary goal of OA treatment is pain relief to improve the quality of life. Inflammation and aging are involved in the pathogenesis of pain in OA. In this study, we evaluated the ability of metformin to regulate microRNAs, such as miR-451 and miR-15b, and their target proteins, CXCL16 and B cell leukemia/lymphoma 2 (BCL-2), involved in inflammation and apoptosis., Methods: In this double-blind placebo-controlled clinical trial, patients were randomly divided into two groups: one receiving metformin and the other receiving a placebo for four months (starting at 0.5 g/day for the first week, increasing to 1 g/day for the second week, and increasing to 1.5 g/day for the remaining period). In addition to evaluating the clinical response using the Knee Injury and Osteoarthritis Outcome Score questionnaire, miR-451 and miR-15b expression levels were detected using real-time polymerase chain reaction. The serum levels of CXCL16 and BCL-2 were evaluated using enzyme-linked immunosorbent assay kits before (time zero) and after treatment (month four)., Results: Metformin increased miR-451 expression levels simultaneously with pain reduction, whereas miR-15b expression did not change significantly after four months of treatment. Also, metformin decreased the serum levels of BCL-2 and CXCL16 in patients with OA., Conclusion: The effects of metformin in reducing pain can be attributed to many factors, including its anti-inflammatory and antiaging effects. Our findings suggest that metformin may reduce pain and inflammation in patients with OA through the regulation of miR-451/CXCL16 and BCL-2., (© 2024 The Author(s). ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Surgical reattachment of medial meniscus posterior root tear (MMPRT) with transtibial sutures can delay the presence of medial knee joint compartment osteoarthritis. Most suture configurations are placed five mm away from the torn margin in the meniscal substance which is already degenerated and may decrease the pull out strengths of repair construct. The number of meniscus penetration may also be important considering meniscus tissue damage with more complex suture techniques impose the risk of suture cut out through the meniscus substance. We introduce our loop postsuture construct technique which is simple, cheap and reproducible., (COPYRIGHT 2020 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Background: Effects of estrogen on bone metabolism and its protective role on prevention of osteoporosis are well documented. However, the efficacy of estrogen treatment on bone healing is not well investigated. The drug can be delivered both systemically or locally to the bone with differences in concentrations and side effects. The aim of this study was to investigate the effect of local and systemic administration of estrogen on the fracture healing process., Methods: Standardized tibial fractures with 4 millimeter gaps were created in twenty four adult male Dutch rabbits. Fractures were fixed using intramedullary wires and long leg casts. Rabbits were randomly divided into three groups. Group A was treated with twice a week administration of long acting systemic estrogen; group B was treated with a similar regimen given locally at the fracture gap; and group C received sham normal saline injections (control). Fracture healing was assessed at six weeks post fracture by gross examination, radiographic and histomorphometric analysis., Results: Group B had significantly higher gross stability, radiographic union and gap reduction than the two other groups. Histomorphometric analysis showed higher cartilaginous proportion of periosteal callus area in the control group., Conclusions: Our results showed that estrogen may enhance fracture healing of long bone in rabbits. Furthermore, local estrogen treatment might have better effect than systemic treatment.

Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury.