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BACKGROUND: Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS: Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS: Ninety patients were included. VAS pain scores were significantly (p

The restoration of adequate function and sensation in nerves following an injury is often insufficient. Electrical stimulation (ES) applied during nerve repair can promote axon regeneration, which may enhance the likelihood of successful functional recovery. However, increasing operation time and complexity are associated with limited clinical use of ES. This study aims to better assess whether short-duration ES types (voltage mode vs. current mode) are able to produce enhanced regenerative activity following peripheral nerve repair in rat models. Wistar rats were randomly divided into 3 groups: no ES (control), 30-minute ES with a current pulse, and 30-minute ES with a voltage pulse. All groups underwent sciatic nerve transection and repair using a silicone tube to bridge the 6-mm gap between the stumps. In the 2 groups other than the control, ES was applied after the surgical repair. Outcomes were evaluated using electrophysiology, histology, and serial walking track analysis. Biweekly walking tracks test over 12 weeks revealed that subjects that underwent ES experienced more rapid functional improvement than subjects that underwent repair alone. Electrophysiological analysis of the newly intratubular sciatic nerve at week 12 revealed strong motor function recovery in rats that underwent 30-minute ES. Histologic analysis of the sciatic nerve and its tibial branch at 12 weeks demonstrated robust axon regrowth in all groups. Both types of short-duration ES applied during nerve repair can promote axon regrowth and enhance the chances of successful functional recovery. [ABSTRACT FROM AUTHOR]

Intraoperative mapping of the nervous system is used to identify "eloquent" cortical areas. In this technical report, we describe a novel way of mapping the somatosensory cortex so that injury to those critical pathways can be avoided. An 8-year-old female with drug resistant epilepsy presented for resection of a right posterior parietal focal cortical dysplasia. Left median nerve stimulation was used to record somatosensory evoked potentials (SEPs) directly from the somatosensory cortex with a strip electrode. A handheld monopolar electrode was also used to record both the median and tibial SEP. Total intravenous anesthesia with propofol and remifentanil was used. SEP recordings were obtained from a 4-contact strip electrode placed across the central sulcus. A phase reversal was identified and the most likely post central gyrus was noted. With the strip electrode left in place, a monopolar handheld electrode was used to record the median nerve SEPs from different locations on the postcentral gyrus. The tibial nerve was also stimulated to record where the highest amplitude tibial nerve SEP was present. This map was used delineate functionally "eloquent" areas to avoid during surgery. During resection, the median nerve SEP was recorded from the strip electrode continuously. No significant change in the SEP was noted, and the patient awoke without any sensory deficits. Sensory mapping of the cortex is possible with a handheld monopolar electrode. This technique is easy to perform and can help reduce neurological morbidity. [ABSTRACT FROM AUTHOR]

Abstract Fractures of the tibial tubercle are an uncommon injury, constituting 0.4–2.7% of all epiphyseal injuries. They occur in the adolescent age group, often during sports such as basketball and football. They are often classified using the modified Ogden classification. Understanding the anatomy and pathophysiology is essential in the management of these fractures, to predict complications and counsel patients and families on care. Tibial tubercle fractures generally have favourable overall outcomes when the correct treatment modality is chosen, with a high rate of union and a 98% return to preinjury activities. This article provides a guide for doctors on the classification and management of these injuries, to ensure that appropriate treatment is given according to current literature and best practice. [ABSTRACT FROM AUTHOR]

Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50–54, 55–59 showed the higher number of procedures. In pediatric patients (0–19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were "Varus knee" (736.42 ICD-9-CM code, 33.9%), "Osteoarthrosis, localized, primary, leg region" (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20–24 age class to the 50–54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients. [ABSTRACT FROM AUTHOR]

Objectives: Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard. Methods: This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson's correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings. Results: The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738–0.883 and 0.870–0.975). Conclusions: Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the impact of three different types of intraoperative antibiotic prophylaxis on the risk of postoperative surgical site infection (SSI). Material and Methods: Single-center retrospective cohort study. Patients who underwent surgery for osteosynthesis of a tibial plateau fracture (January 2009–November 2018) in Hospital Clinic i Provincial de Barcelona were included. Three types of prophylaxis during the study period were used: group A (cefuroxime single-dose treatment), group B (meropenem + teicoplanin), and group C (ceftriaxone + teicoplanin). Demographics, co-morbidity, type of fracture, need for external fixation, microbiology data, surgical time, and outcome were recorded. Failure was defined as the need for reintervention due to postoperative surgical site infection. Results: From a total of 148 patients included, 20 cases developed SSI, 8 from group A, 8 from group B, and 4 from group C. Higher ASA scores, Schatzker II classification, need for external fixation, and a prolonged surgical time were associated with a significantly (p < 0.005) increased incidence of SSI. Group C showed the overall highest survival and lowest cumulative risk, but differences were not statistically significant. Conclusions: Group C showed the lowest incidence of infection in this sample. It is necessary to confirm these findings with larger studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE: To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patients outcome at 6-year follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS: An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION: Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.

Purpose: Infrapopliteal lesions are generally complex to treat due to small vessel diameter, long lesion length, multilevel disease, and severe calcification. Therefore, different vessel preparation devices have been developed to contribute to better peri- and postprocedural outcomes. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug-coated balloon (DCB) angioplasty with POBA or DCB alone in infrapopliteal arterial disease. Methods: Medline, EMBASE, and Cochrane databases were searched for studies published between 2000 and 2022 assessing the value of adjunctive vessel preparation in infrapopliteal arterial disease. The primary outcomes were 12-month primary patency and limb salvage. Results: A total of 1685 patients with 1913 lesions were included in 11 POBA studies. Methodological quality was assessed as poor to moderate in these studies. Only 2 studies with 144 patients assessed vessel preparation in conjunction with DCB angioplasty. These randomized trials were assessed as high quality and found no significant benefit of adjunctive atherectomy to DCB angioplasty. The pooled Kaplan-Meier estimates of 12-month primary patency and limb salvage in the POBA studies were 67.8% and 80.9% for POBA, 62.1% and 86.4% for scoring balloons, 67.9% and 79.6% for mechanical atherectomy (MA), and 79.7% and 82.6% for laser atherectomy, respectively. Within the pooled data only scoring balloons and MA demonstrated significantly improved 12-month limb salvage compared to POBA. Conclusions: Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and MA. However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation. Clinical Impact: Infrapopliteal arterial disease is associated with chronic limb-threatening ischemia (CLTI) and generally complex to treat due to small vessel diameter, long lesion length, multilevel disease and severe calcification. A wide range of vessel preparation devices have been developed to contribute to improved peri- and postprocedural outcomes in these complex lesions. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug coated balloon (DCB) angioplasty with POBA or DCB angioplasty alone in infrapopliteal arterial disease. Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and mechanical atherectomy (MA). However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation. [ABSTRACT FROM AUTHOR]

Introduction: Resistance training (RT) is an important part of athletes' preparation exercises with the aim of strengthening physical fitness, creating neuro-muscular adaptations and improving sports performance. The aim of this study was to investigate the effect of resistance training with weights on nerve conduction speed and functional and skill indicators of seven to ten-year-old gymnasts. Methods: In this study, 24 children with two years of experience in gymnastics (age: 8.5±1.5 years, weight: 32.10±9.40 kg, height: 135±13 cm) voluntarily Participated. Subjects were randomly divided into two groups including gymnastics training and gymnastics training + resistance training with weights. And they trained for 10 weeks. During the research, one group did general gymnastics exercises, and the other group did resistance training with weights three times a week in addition to gymnastics exercises. Before and after the exercises, NCV test, Sargent's jump muscle power tests, agility of 9x4m back-and-forth run, Wells' flexibility, and performing half-back, half-turn and balance skills of Angel were performed. Independent t-test was used to analyze the data. And a significance level of P<0.05 was considered. Results: The results showed that the NCV in the tibial and peroneal nerves increased significantly in the weight resistance training group compared to the general gymnastics training group. Also, muscle strength in Sargent's jump, agility in 4x9m back and forth running, and the performance of half-back and half-turn skills increased significantly (P<0.05). However, no significant change was observed in the flexibility with the Wells test (P=0.870) and execution of Angel's balance skill (P=0.552). Conclusions: 10 weeks of resistance training with weights significantly increases neuromuscular adaptations, NCV, muscle power, agility, and implementation of half-back and half-varus skills in gymnast children. [ABSTRACT FROM AUTHOR]

Introduction Tibial plateau fractures are periarticular injuries of the proximal tibia often associated with soft tissue injury. They account for 1-2% of all fractures. Their impact on the articular surfaces and the development of osteoarthritis make them an interesting research topic in the orthopaedic field. With the development of arthroscopic treatment methods, many are thinking of ways to incorporate less invasive methods in the reduction and fixation of these injuries. Review methods English-language scientific literature found in PubMed and Google Scholar was used for the review. Articles were searched based on keywords. Each article was analyzed for knowledge currency and relevance for use in the review. Description of the State of Knowledge After searching the articles, 35 articles were selected for final analysis. The collected data provided the latest information on treatment of tibial plateau fractures (TPF) using arthroscopic tools with studies diving deep into both the technique and longer-term results. Summary The use of arthroscopy in treatment of tibial plateau fractures grows year by year with more and more clinicians being interested in limiting the soft tissue damage and other adverse effects of ORIF Keywords: Schatzker, arthroscopy, tibial plateau fracture

ABSTRACT This study aimed to investigate the effects of different levels of vitamin D3 in broiler diets on performance and bone health. A total of 360 one-day old male Cobb500® broiler chicks were subjected to five treatments of different levels of vitamin D3 in diets during two rearing phases: 0 IU/kg in both phases; 625 IU/kg in starter and 500 IU/kg in grower phase (25% of commercial inclusion); 1,250 IU/kg in starter and 1,000 IU/kg in grower phase (50% of commercial inclusion); 1,875 IU/kg in starter and 1,500 IU/kg in grower phase (75% of commercial inclusion); and 2,500 IU/kg in starter and 2,000 IU/kg in grower phase (100% of commercial inclusion). The traits studied weekly were feed intake, body weight, feed conversion, and viability. At 21 and 35 days of age, tibiae and femurs were removed, dissected, and evaluated for dry matter (DM), ash (%MM), calcium (%Ca), phosphorus (%P) and breaking strength. At 35 days of age, the bones were subjected to histopathological analysis for macro- and microscopic morphological evaluation. Data were subjected to regression analysis, using α = 0.05. The variables of percentage %MM, %Ca, %P, and breaking strength experienced a positive linear effect up to the supplementation levels of approximately 25% of inclusion. The histopathological analysis found that the group that received the diet with 100% inclusion of vitamin D3 presented lesions compatible with osteopetrosis and tibial dyschondroplasia. The observed results showed that for isonutritive diets, reduced levels of vitamin D3 guaranteed performance during the evaluated period while the use of 100% of vitamin D3, as commonly used, can cause bone diseases and harm the welfare of broilers.

Introduction: Percutaneous deep venous arterialisation (DVA) is emerging as a promising alternative for limb salvage in chronic limb threatening ischaemia (CLTI) patients without any reasonable anatomical option for conventional revascularisation techniques. However, its mechanism of action remains incompletely understood. This report aimed to find some of the histological alterations occurring in the limb following DVA. Report: This short report presents the case of a 53 year old female who underwent DVA for Rutherford 5 CLTI. Although the intervention was successful and showed evidence of improved blood flow to the foot, the post-operative course was notable due to worsening infection leading to a below knee amputation four weeks later. The blood vessels were harvested for histological analysis, which found features of venous arterialisation such as smooth muscle cell proliferation and neointimal hyperplasia, even in the paired posterior tibial vein that did not undergo DVA. Discussion: This case demonstrated unexpected histological changes occurring in the paired posterior tibial vein that did not undergo DVA. This warrants further investigations to fully understand the mechanisms at play in DVA and to explore the role of the paired vein in sustaining arterialised flow to the foot.

Objectives: The study aimed to evaluate stiffness and the cross-sectional area (CSA) of the tibial nerve (TN) using shear wave elastography (SWE) and ultrasound (US) and investigate the relationship of these with disease activity, quality of life, and severity of neuropathic pain in patients with systemic sclerosis (SSc). Patients and methods: This cross-sectional study included 28 SSc patients (1 male, 27 females; mean age: 50±11 years; range, 28 to 67 years) and 22 age- and sex-matched healthy controls (4 males, 18 females; mean age: 48±6 years; range, 37 to 66 years) between March and April 2022. US and SWE were performed on the TN, and CSA and nerve stiffness were measured. The TN was examined by a radiologist, 4 cm proximal to the medial malleolus. A few days later, an evaluation was performed in the second session by a second observer to investigate inter-and intraobserver agreement. Interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). The Scleroderma Health Assessment Questionnaire, European League Against Rheumatism European Scleroderma Trial and Research (EUSTAR) group activity index, and Douleur)Neuropathique 4 scores of the patients were evaluated. Correlations between the questionnaires and measurements of nerve stiffness and CSA were assessed. Results: Patients with SSc had significantly higher stiffness and CSA values of the right TN compared to healthy controls (p<0.001 and p=0.015, respectively). The nerve stiffness values of the right TN were positively correlated with the EUSTAR activity index (p=0.004, r=0.552). The CSA of the left TN was larger in patients with SSc (21.3±4.9 mm2 ) than in controls (12.8±3.4 mm2 ), and the nerve elasticity was positively correlated with the EUSTAR activity index (p=0.001, r=0.618). The interobserver agreement was moderate to good for measuring stiffness and CSA of the TN (ICC were 0.660 and 0.818, respectively). There was a good to excellent intraobserver agreement for measuring stiffness and CSA of TN (ICC were 0.843 and 0.940, respectively). Conclusion: The increased disease activity in patients with SSc is associated with TN involvement, which can be demonstrated by US and SWE. [ABSTRACT FROM AUTHOR]

Meniscus tissue deficiency resulting from primary meniscectomy or meniscectomy after failed repair is a clinical challenge because the meniscus has little to no capacity for regeneration. Loss of meniscus tissue has been associated with early-onset knee osteoarthritis due to an increase in joint contact pressures in meniscectomized knees. Clinically available replacement strategies range from allograft transplantation to synthetic implants, including the collagen meniscus implant, ACTIfit, and NUSurface. Although short-term efficacy has been demonstrated with some of these treatments, factors such as long-term durability, chondroprotective efficacy, and return to sport activities in young patients remain unpredictable. Investigations of cell-based and tissue-engineered strategies to treat meniscus tissue deficiency are ongoing.

ObjectiveTo identify joint structural risk factors, measured using quantitative compositional and semiquantitative magnetic resonance imaging (MRI) scoring, associated with the development of accelerated knee osteoarthritis (AKOA) compared with a more normal rate of knee osteoarthritis (OA) development.DesignFrom the Osteoarthritis Initiative we selected knees with no radiographic OA (Kellgren-Lawrence grade [KL] 0/1) that developed advanced-stage OA (KL 3/4; AKOA) within a 4-year timeframe and a comparison group with a more normal rate of OA development (KL 0/1 to KL 2 in 4 years). MRIs at the beginning of the 4-year timeframe were assessed for cartilage T2 values and structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of MRI findings with AKOA versus normal OA were assessed using multivariable logistic regression models.ResultsA total of 106 AKOA and 168 subjects with normal OA development were included. Mean cartilage T2 values were not significantly associated with AKOA (odds ratio [OR] 1.06; 95% confidence interval [CI] 0.82-1.36). Risk factors for AKOA development included higher meniscus maximum scores (OR 1.37; 95% CI 1.11-1.68), presence of meniscal extrusion (OR 6.30; 95% CI 2.57-15.49), presence of root tears (OR 4.64; 95% CI 1.61-13.34), and higher medial tibia cartilage lesion scores (OR 1.96; 95% CI 1.19-3.24).ConclusionsWe identified meniscal damage, especially meniscal extrusion and meniscal root tears as risk factors for AKOA development. These findings contribute to identifying subjects at risk of AKOA at an early stage when preventative measures targeting modifiable risk factors such as meniscal repair surgery could still be effective.

Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50–54, 55–59 showed the higher number of procedures. In pediatric patients (0–19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were “Varus knee” (736.42 ICD-9-CM code, 33.9%), “Osteoarthrosis, localized, primary, leg region” (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20–24 age class to the 50–54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients.

Background: The aim of this study was to compare the impact of three different types of intraoperative antibiotic prophylaxis on the risk of postoperative surgical site infection (SSI). Material and Methods: Single-center retrospective cohort study. Patients who underwent surgery for osteosynthesis of a tibial plateau fracture (January 2009–November 2018) in Hospital Clinic i Provincial de Barcelona were included. Three types of prophylaxis during the study period were used: group A (cefuroxime single-dose treatment), group B (meropenem + teicoplanin), and group C (ceftriaxone + teicoplanin). Demographics, co-morbidity, type of fracture, need for external fixation, microbiology data, surgical time, and outcome were recorded. Failure was defined as the need for reintervention due to postoperative surgical site infection. Results: From a total of 148 patients included, 20 cases developed SSI, 8 from group A, 8 from group B, and 4 from group C. Higher ASA scores, Schatzker II classification, need for external fixation, and a prolonged surgical time were associated with a significantly (p < 0.005) increased incidence of SSI. Group C showed the overall highest survival and lowest cumulative risk, but differences were not statistically significant. Conclusions: Group C showed the lowest incidence of infection in this sample. It is necessary to confirm these findings with larger studies.

ObjectiveMeniscal degeneration is strongly associated with osteoarthritis (OA). We aimed to evaluate a 3D ultrashort-echo-time Cones magnetization transfer (UTE-Cones-MT) sequence for quantification of macromolecular fraction (MMF) and MT ratio (MTR) in menisci of healthy volunteers and patients with different degrees of OA.MethodsPatients with mild OA (n = 19; 37-86 years; 10 males) or advanced OA (n = 12; 52-88 years; 4 males) and healthy volunteers (n = 17; 20-49 years; 7 males) were scanned with T2-FSE and UTE-Cones-MT sequences at 3T. Morphological assessment was performed using meniscal whole-organ magnetic resonance imaging score (WORMS). MMF and MTR were calculated for menisci, and correlated with age and meniscal WORMS scores. The diagnostic efficiency was performed by using receiver operating characteristic (ROC) curve and the area under the curve (AUC) analyses.ResultsDecreased MMF and MTR were observed in menisci of patients with mild or advanced OA compared with healthy subjects, and in menisci with tears (Grade 2-4) compared with normal menisci (Grade 0). Significant negative correlations were observed between MMF (r = -0.769, P

ObjectiveTo evaluate the association of fatty infiltration of the quadriceps and vastus medialis (VM) with an increase in knee cartilage, meniscus, or bone marrow lesions, using magnetic resonance imaging (MRI) in knee osteoarthritis (OA) over 3 years.MethodsParticipants (n = 69) with and without radiographic knee OA underwent MRI at baseline and 3 years later. Chemical shift-based water/fat MRI was used to quantify the intramuscular fat fraction and the lean anatomical cross-sectional area (ACSA) for the VM and entire quadriceps muscles. MRI images of the knee were analyzed using the semiquantitative modified whole-organ MRI score (mWORMS) grading to assess change in lesions in the articular cartilage, meniscus, and bone marrow. Logistic regression was used to assess whether baseline quadriceps and VM fat fraction and lean ACSA were associated with an increase in mWORMS scores. Odds ratios (ORs) were adjusted for age, sex, and body mass index.ResultsOverall, of the 69 subjects, 43 (62%) had an increase in cartilage lesions (26 of 43), meniscus lesions (19 of 43), or bone marrow lesions (22 of 43) scores. The quadriceps (OR 2.13 [95% confidence interval (95% CI) 1.09-4.15]) and VM (OR 2.05 [95% CI 1.25-3.36]) fat fraction were both associated with an increase in cartilage, meniscus, or bone marrow lesion scores over 3 years. The association of quadriceps or VM lean ACSA with the outcomes was not significant.ConclusionThese longitudinal findings using quantitative MRI methods for assessment of muscle adiposity highlight the role of quadriceps adiposity, specifically in the VM, in knee OA progression. However, studies in larger cohorts are needed to confirm these findings.

The purpose of this retrospective case series was to review the demographics of alpine skiers who sustain tibial plateau fractures, evaluate the inter-observer reliability of the Schatzker classification for fractures sustained while alpine skiing, and to evaluate patient-reported outcomes. We hypothesized that most tibial plateau fractures would be low-energy fracture patterns (Schatzker I–III) and occur in women and less-experienced skiers. Charts and radiographs of patients treated surgically for tibial plateau fractures caused by alpine skiing were evaluated. Patients treated less than two years prior to review were excluded. Patients who qualified were contacted to complete a questionnaire regarding their skiing experience, their pain levels experienced following their accident, the weather conditions during the accident, and their return to sport. Forty-seven patients met the inclusion criteria. The mean age was 49, and 60% of the participants were male. There were 28 low-energy fracture patterns (Schatzker I–III) and 19 high-energy patterns (Schatzker IV–VI) with a 95.7% inter-observer reliability. Contrary to the hypothesis, tibial plateau fractures sustained while alpine skiing occurred in older, experienced riders. Approximately 40% were high-energy fractures. Although over 75% of patients reported having no pain or occasional pain at their final follow-ups, less than half of the patients returned to alpine skiing.

Introduction: Given the possibility of higher ground temperatures in the future, the pursuit of a cushioning material that can effectively reduce sports injuries during exercise, particularly one that retains its properties at elevated temperatures, has emerged as a serious concern.Methods: A total of 18 man recreational runners were recruited from Ningbo University and local clubs for participation in this study. Frequency analysis was employed to investigate whether there is a distinction between non-Newtonian (NN) shoes and ethylene vinyl acetate (EVA) shoes.Results: The outcomes indicated that the utilization of NN shoes furnished participants with superior cushioning when engaging in a 90° cutting maneuver subsequent to an outdoor exercise, as opposed to the EVA material. Specifically, participants wearing NN shoes exhibited significantly lower peak resultant acceleration (p = 0.022) and power spectral density (p = 0.010) values at the distal tibia compared to those wearing EVA shoes. Moreover, shock attenuation was significantly greater in subjects wearing NN shoes (p = 0.023) in comparison to EVA shoes. Performing 90° cutting maneuver in NN shoes resulted in significantly lower peak ground reaction force (p = 0.010), vertical average loading rate (p < 0.010), and vertical instantaneous loading rate (p = 0.030) values compared to performing the same maneuvers in EVA shoes.Conclusion: The study found that the PRA and PSD of the distal tibia in NN footwear were significantly lower compared to EVA footwear. Additionally, participants exhibited more positive SA while using NN footwear compared to EVA. Furthermore, during the 90° CM, participants wearing NN shoes showed lower PGRF, VAIL, and VILR compared to those in EVA shoes. All these promising results support the capability of NN footwear to offer additional reductions in potential injury risk to runners, especially in high-temperature conditions.

The purpose of this retrospective case series was to review the demographics of alpine skiers who sustain tibial plateau fractures, evaluate the inter-observer reliability of the Schatzker classification for fractures sustained while alpine skiing, and to evaluate patient-reported outcomes. We hypothesized that most tibial plateau fractures would be low-energy fracture patterns (Schatzker I–III) and occur in women and less-experienced skiers. Charts and radiographs of patients treated surgically for tibial plateau fractures caused by alpine skiing were evaluated. Patients treated less than two years prior to review were excluded. Patients who qualified were contacted to complete a questionnaire regarding their skiing experience, their pain levels experienced following their accident, the weather conditions during the accident, and their return to sport. Forty-seven patients met the inclusion criteria. The mean age was 49, and 60% of the participants were male. There were 28 low-energy fracture patterns (Schatzker I–III) and 19 high-energy patterns (Schatzker IV–VI) with a 95.7% inter-observer reliability. Contrary to the hypothesis, tibial plateau fractures sustained while alpine skiing occurred in older, experienced riders. Approximately 40% were high-energy fractures. Although over 75% of patients reported having no pain or occasional pain at their final follow-ups, less than half of the patients returned to alpine skiing. [ABSTRACT FROM AUTHOR]

Background: There is no consensus regarding the management of posterior cruciate ligament (PCL) avulsion fractures and the expected outcomes after treatment. Purpose: To systematically review clinical outcomes and complications after management of tibial-sided avulsion fractures of the PCL. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search of Scopus, PubMed, Medline, and the Cochrane Central Register for Controlled Trials was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included were studies with evidence levels 1 to 4 that reported clinical outcomes after treatment of PCL tibial-sided avulsion fractures in humans. The quality of the included studies was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. A meta-analysis was performed for patient-reported outcome measures using random-effects modeling with 95% CIs. Results: A total of 58 studies published between 1999 and 2022 were identified. The mean MINORS score was 9.90 ± 4.12, indicating overall low-quality evidence with high risk of bias. The studies comprised 1440 patients (mean age, 32.59 ± 5.69 years; 75.2% males) with a mean follow-up of 26.9 ± 19.6 months (range, 5.3-126 months). Most patients were treated with open surgery (63.6%), followed by arthroscopic surgery (29.7%) and nonoperative treatment (6.7%). All patients reported significant posttreatment improvement in both subjective and objective outcomes (P <.05 for all). Arthroscopic surgery was associated with lower postoperative posterior tibial translation compared with open surgery (range, 0.6-3.2 vs 1.7-3.1 mm), greater preoperative to postoperative improvement in Lysholm score (54.6 vs 48.8; P <.0001), higher postoperative Tegner score (6.64 ± 1.03 vs 6.14 ± 2.29; P =.0448), and a higher rate of return to sport (100% vs 89.5%; P =.009). Nonoperative management was associated with a significantly lower fracture union rate (87% vs 99.1%; P <.0001) and greater postoperative side-to-side posterior translation (4.9 ± 4.3 mm) when compared with operative management. Conclusion: Although nonoperative and surgical management of PCL tibial avulsion fractures resulted in high rates of fracture union and improvement in functional outcome scores and a low incidence of complications, nonoperative treatment yielded a high side-to-side posterior displacement (>4 mm) with a lower rate of fracture union compared to surgical treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND. The extent of medial meniscal extrusion (MME) that is associated with structural and symptomatic progression of knee osteoarthritis has not been defined yet. OBJECTIVE. The purpose of our study was to investigate MRI-based thresholds of MME that are associated with structural progression of knee degenerative disease and symptoms over a period of 4 years. METHODS. We studied 328 knees of 235 participants that were randomly selected from the Osteoarthritis Initiative cohort. MME was quantified on coronal sections of intermediate-weighted MRI sequences obtained at 3 T. Knee pain and cartilage abnormalities were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and the cartilage whole-organ MRI score (WORMS). General estimating equations with logistic regression models were used to correlate baseline MME and changes in pain (WOMAC) and cartilage damage (WORMS). ROC analyses were performed to determine the area under the ROC curve (AUROC). Individual thresholds were determined by maximizing the product of sensitivity and specificity. RESULTS. The AUROC for predicting progression of knee pain, medial compartment cartilage damage, and medial tibial cartilage damage were 0.71, 0.70, and 0.72, respectively, and the individual thresholds for MME were 2.5, 2.7, and 2.8 mm. A single threshold of 2.5 mm was determined by maximizing the mean of the product of sensitivity and specificity of the three outcome variables (knee pain progression, medial compartmental cartilage damage progression, and medial tibial cartilage damage progression). CONCLUSION. MME was associated with knee pain and cartilage damage progression over 4 years. A single threshold of 2.5 mm was found to be the most useful threshold for predicting knee pain, medial compartment cartilage damage progression, and tibial cartilage damage progression over 4 years. CLINICAL IMPACT. This threshold could be used to standardize the diagnostic criterion of extrusion and to better characterize the risk for subsequent structural and symptomatic progression of knee osteoarthritis.

ObjectiveTransforming growth factor β (TGFβ) signaling plays a complex tissue-specific and nonlinear role in osteoarthritis (OA). This study was conducted to determine the osteocytic contributions of TGFβ signaling to OA.MethodsTo identify the role of osteocytic TGFβ signaling in joint homeostasis, we used 16-week-old male mice (n = 9-11 per group) and female mice (n = 7-11 per group) with an osteocyte-intrinsic ablation of TGFβ receptor type II (TβRIIocy-/- mice) and assessed defects in cartilage degeneration, subchondral bone plate (SBP) thickness, and SBP sclerostin expression. To further investigate these mechanisms in 16-week-old male mice, we perturbed joint homeostasis by subjecting 8-week-old mice to medial meniscal/ligamentous injury (MLI), which preferentially disrupts the mechanical environment of the medial joint to induce OA.ResultsIn all contexts, independent of sex, genotype, or medial or lateral joint compartment, increased SBP thickness and SBP sclerostin expression were spatially associated with cartilage degeneration. Male TβRIIocy-/- mice, but not female TβRIIocy-/- mice, had increased cartilage degeneration, increased SBP thickness, and higher levels of SBP sclerostin compared with control mice (all P < 0.05), demonstrating that the role of osteocytic TGFβ signaling on joint homeostasis is sexually dimorphic. With changes in joint mechanics following injury, control mice had increased SBP thickness, subchondral bone volume, and SBP sclerostin expression (all P < 0.05). TβRIIocy-/- mice, however, were insensitive to subchondral bone changes with injury, suggesting that mechanosensation at the SBP requires osteocytic TGFβ signaling.ConclusionOur results provide new evidence that osteocytic TGFβ signaling is required for a mechanosensitive response to injury, and that osteocytes control SBP homeostasis to maintain cartilage health, identifying osteocytic TGFβ signaling as a novel therapeutic target for OA.

ObjectivesTo compare regional differences in subchondral trabecular structure using high-resolution MRI in meniscus-covered/meniscus-uncovered tibia in cadaveric knees with intact/torn menisci.Materials and methods3D proton density CUBE MRI of 6 cadaveric knees without significant osteoarthritis (OA) was acquired, 0.25-mm resolution. Menisci were evaluated and classified intact or torn. MR data were transferred to ImageJ program to segment tibial 3D volume of interest (VOI). Data was subdivided into meniscus-covered/meniscus-uncovered regions. Segmented VOI was classified into binary data, trabeculae/bone marrow. The trabecular bone data was used to measure MR biomarkers (apparent subchondral plate-connected bone density (adapted from spine MR), apparent trabecular bone volume fraction, apparent mean trabecular thickness, apparent connectivity density, and structure model index (SMI)). Mean value of parameters was analyzed for the effects of meniscal tear/tibial coverage.ResultsNine torn menisci and 3 intact menisci were present. MR measures of bone varied significantly due to meniscal coverage/tear. Subchondral plate-connected bone density under covered meniscus regions increased from 10.9 to 23.5% with meniscal tear. Values increased in uncovered regions, 19.3% (intact) and 32.4% (torn). This reflects higher density when uncovered (p = 0.048) with meniscal tear (p = 0.007). Similar patterns were found for trabecular bone fraction (coverage p

Background: Posterior tibial tendon (PTT) tendoscopy and medializing calcaneal osteotomy (MCO) are among the available techniques for patients presenting with symptomatic flexible hindfoot valgus (stage IA) progressive collapsing foot deformity (PCFD). The aim of this study was to determine clinical and radiographic outcomes of combined PTT tendoscopy and MCO for patients presenting with symptomatic stage IA PCFD. Methods: A retrospective cohort study was performed in order to determine clinical and radiographic outcomes of 30 combined PTT tendoscopies and MCO on 27 patients presenting with symptomatic stage IA PCFD, with a minimum follow-up of 24 months. Patient satisfaction was assessed at last available follow-up as very satisfied, satisfied, and unsatisfied. Clinical assessment was performed evaluating preoperative and last available follow-up visual analog scale for pain (VAS-P), Foot and Ankle Outcome Score (FAOS), and the 36-Item Short Form Health Survey (SF-36). Magnetic resonance imaging (MRI) was performed preoperatively on all patients. Standard weightbearing anteroposterior, lateral, and long axial view radiographs of the foot and ankle were taken preoperatively, immediate postoperatively, at 6 weeks, 3 months, 6 months, 1 year postoperatively, and last follow-up evaluation available for each patient. Results: The mean follow-up was 38.6 (range, 26-62) months. We registered 27 very satisfied, 1 satisfied, and 2 unsatisfied patients. There was statistically significant improvement on all clinical scores (VAS-P, FAOS and SF-36), as well as on lateral talo–first metatarsal and hindfoot alignment angles. We found low-grade PTT tears in 5 patients (16.67%) in whom preoperative MRI documented PTT tenosynovitis alone. Conclusion: We found that combined PTT tendoscopy and MCO provide significant clinical and radiographic improvement for patients presenting with symptomatic stage IAB PCFD. PTT tendoscopy should be considered in the treatment of all surgically addressed flexible valgus feet as it detects tendon tears which are frequently missed on an MRI. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Despite increased recognition of coexisting tibial and talar osteochondral lesions (OCLs), the risk factors influencing clinical outcomes remain unclear. Purpose: To report clinical follow-up results after arthroscopic microfracture surgery in patients with OCLs of the distal tibial plafond and talus and assess possible factors affecting these clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 40 patients with coexisting talar and tibial OCLs who underwent arthroscopic microfracture surgery were included. For analysis, the study used the American Orthopaedic Foot & Ankle Society (AOFAS) scale, Karlsson-Peterson scale, and visual analog scale (VAS) for pain for clinical evaluations on the day before surgery, 12 months after surgery, and at the last follow-up. A stepwise regression model and Spearman rank correlation were used to assess possible factors affecting these clinical outcomes. Results: The median follow-up time was 34.5 months (interquartile range [IQR], 26.5-54 months). At the final follow-up, the cohort included 40 patients (26 men and 14 women) with a mean age of 38.8 years (range, 19-60 years). The median AOFAS score increased from 57.5 (IQR, 47-65) before surgery to 88 (IQR, 83-92.5) at the final follow-up, the median Karlsson-Peterson score increased from 48 (IQR, 38.5-67) to 82 (IQR, 76-92), and the median VAS score improved from 5 (IQR, 4-6) to 1 (IQR, 0-2). All scale scores showed significant differences between the preoperative and final follow-up evaluations (P <.001). In the stepwise regression model and Spearman rank correlation analysis, the grade of tibial OCL had a significant independent effect on the final postoperative AOFAS scores of the patients (β = –0.502, P =.001; r = –0.456, P =.003). The size of the tibial lesion also had a significant independent effect on the final postoperative Karlsson-Peterson scores of the patients (β = –0.444, P =.004; r = –0.357, P =.024). Conclusion: Arthroscopic microfracture treatment for coexisting talar and tibial OCLs can achieve good short- to midterm clinical outcomes. The grade and size of tibial OCLs are the main risk factors affecting the prognostic functional scores of such patients. [ABSTRACT FROM AUTHOR]

PurposeTo develop a deep learning-based method for knee menisci segmentation in 3D ultrashort echo time (UTE) cones MR imaging, and to automatically determine MR relaxation times, namely the T1, T1ρ , and T2∗ parameters, which can be used to assess knee osteoarthritis (OA).MethodsWhole knee joint imaging was performed using 3D UTE cones sequences to collect data from 61 human subjects. Regions of interest (ROIs) were outlined by 2 experienced radiologists based on subtracted T1ρ -weighted MR images. Transfer learning was applied to develop 2D attention U-Net convolutional neural networks for the menisci segmentation based on each radiologist's ROIs separately. Dice scores were calculated to assess segmentation performance. Next, the T1, T1ρ , T2∗ relaxations, and ROI areas were determined for the manual and automatic segmentations, then compared.ResultsThe models developed using ROIs provided by 2 radiologists achieved high Dice scores of 0.860 and 0.833, while the radiologists' manual segmentations achieved a Dice score of 0.820. Linear correlation coefficients for the T1, T1ρ , and T2∗ relaxations calculated using the automatic and manual segmentations ranged between 0.90 and 0.97, and there were no associated differences between the estimated average meniscal relaxation parameters. The deep learning models achieved segmentation performance equivalent to the inter-observer variability of 2 radiologists.ConclusionThe proposed deep learning-based approach can be used to efficiently generate automatic segmentations and determine meniscal relaxations times. The method has the potential to help radiologists with the assessment of meniscal diseases, such as OA.

ObjectiveTo compare the extent of cartilage deterioration in knees with prior meniscal resection related to trauma versus knees with resection related to degenerative disease, and to compare cartilage deterioration in knees with meniscal surgery to knees without meniscal surgery, controlling for prior knee trauma.Materials and methodsIn this cross-sectional study, we assessed cartilage deterioration in right knees of Osteoarthritis Initiative participants: (i) with meniscal surgery due to injury (n = 79); (ii) matched control knees with a prior injury but without meniscal surgery (n = 79); (iii) with meniscal surgery but without preceding injury (n = 36); and (iv) matched control knees without meniscal surgery or prior knee injury (n = 36). Cartilage composition was measured using T2 measurements derived using semi-automatic cartilage segmentation of the right. Linear regression analysis was used to compare compartmental values of T2 between groups.ResultsComparing the mean T2 values in surgical cases with and without injury our results did not show significant differences (group i vs. iii, p > 0.05). However, knees with previous meniscal surgery showed significantly (p

ObjectiveTo determine if presence of calcium-containing crystals (CaC) is associated with increased knee joint degeneration over 4 years and assess if total number of CaCs deposited is a useful measure of disease burden.DesignSeventy subjects with CaCs in right knees at baseline were selected from the Osteoarthritis Initiative and matched to 70 subjects without evidence of CaCs. T1-weighted gradient-echo sequences were used to confirm presence of CaCs and count the numbers of distinct circumscribed CaCs. Morphological abnormalities were assessed at baseline and 4-year follow-up using the modified semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS). Linear regression models were used to analyze the associations between presence of CaCs at baseline and changes in WORMS and to analyze the associations between numbers of circumscribed CaCs at baseline and changes in WORMS.ResultsPresence of CaCs was associated with increased cartilage degeneration in the patella (coefficient: 0.33; 95% confidence interval (CI): 0.04-0.63), the medial femur (coefficient: 0.51; 95% CI: 0.18-0.83), the lateral tibia (coefficient: 0.36; 95% CI: 0.01-0.71) as well as the medial and lateral meniscus (coefficient: 0.38; 95% CI: 0.00-0.75 and coefficient: 0.72; 95% CI: 0.12-1.32). Knees with higher numbers of CaCs had increased cartilage degeneration in the patella and medial femur (coefficient: 0.09; 95% CI: 0.05-0.14; P

Aims: The outcomes of total knee arthroplasty (TKA) are affected by many factors. This study aims to evaluate whether changes in the posterior tibial slope (PTS) affect patients’ outcomes after cruciate-retaining TKA by affecting tibiofemoral articular contact kinematics. It was hypothesized that changes in PTS affect the outcomes of PCR TKA by affecting tibiofemoral articular contact kinematics. Methods: A total of 60 knees (30 patients) that underwent posterior cruciate-retaining TKA (with the same size prosthesis) for medial osteoarthritis were assessed preoperatively and one year postoperatively. Before and after TKA, changes in the PTS, as seen on lateral radiographs, were noted. The knees were placed in groups according to these PTS changes (preoperative value − postoperative value): group 1 >3° change and group 2 ≤3° change. Knee kinematics were observed under mid-flexion weight-bearing conditions and were compared between the two groups using the two-dimensional/three-dimensional registration technique. Pain was measured using the visual analog scale, and knee function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS). Results: Group 2 experienced paradoxical anterior motion of the medial femoral condyle postoperatively, but group 1 did not. A comparison of the results of the TKA between the two groups showed a significant difference in pain using the visual analog scale, and knee function of the KSS and the WOMAC (P

BackgroundIn order to determine whether treatments are effective in the treatment of meniscus tears, it is first necessary to understand the natural history of meniscus tears. The purpose of this paper is to review the literature to ascertain the natural history of meniscus tears in children and adolescents.MethodsA search of the Pubmed and Embase databases was performed using the search terms "meniscus tears," "natural history of meniscus tears," "knee meniscus," "discoid meniscus," and "natural history of discoid meniscus tears."ResultsA total of 2567 articles on meniscus tears, 28 articles on natural history of meniscus tears, 8065 articles on "menisci," 396 articles on "discoid meniscus," and only 2 on the "natural history of discoid meniscus" were found. After reviewing the titles of these articles and reviewing the abstracts of 237 articles, it was clear that there was little true long-term natural history data of untreated meniscus tears nor whether treating meniscus tears altered the natural history. Twenty-five articles were chosen as there was some mention of natural history in their studies.ConclusionsThere are few long-term data on untreated meniscal tears or discoid meniscus, or tears in children and adolescents. The literature suggests that there is a higher incidence of chondral injury and subsequent osteoarthritis, but there are many confounding variables which are not controlled for in these relatively short-term papers.

ObjectiveTo determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI.Materials and methodsThree hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined.ResultsSignificantly increased (ANOVA p

ObjectivesTo develop an MR-based semi-quantitative meniscus scoring technique for postoperative assessment of the degree of meniscal resection, to test its reproducibility, and to study the relationship between the amount of resection and degenerative disease burden.MethodsWe studied the right knee of 135 participants from the Osteoarthritis Initiative that underwent meniscal surgery an average of 14 years previously. The amount of meniscal resection was assessed on baseline 3.0-T MRIs and calculated as meniscus resection score (MenRS) with a range of 0 to 18. Knee abnormalities at baseline and 48 months were graded using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Subjects were also stratified according to meniscal resection performed after injury versus without preceding injury. Statistical analysis included intra-class correlation coefficient (ICC) to determine reproducibility as well as regression models and partial correlations to correlate MenRS with WORMS outcomes.ResultsICC values for intra- and inter-observer reproducibility of MenRS were 0.980 and 0.977, respectively. Overall, the amount of meniscal resection showed a significant correlation with baseline WORMS grades: higher MenRS was associated with higher total WORMS grades (p = 0.004) and cartilage (p = 0.004) and ligament (p

Resumen: Introducción: Las fracturas del tercio distal de tibia son en su mayoría consecuencia de un traumatismo de alta energía con importante afectación de partes blandas siendo mas frecuentes en varones.Este tipo de fracturas se diferencian de la fractura articular de pilón tibial en su mecanismo de lesión, manejo y pronóstico.El objetivo del presente estudio fue analizar y comparar los resultados obtenidos en el tratamiento de las fracturas de tercio distal de tibia sin extensión articular mediante placa bloqueada y clavo intramedular. Material y métodos: Realizamos un estudio retrospectivo en el que se incluyeron todos los pacientes con diagnostico «fractura de tercio distal de tibia» segmento 43A según la clasificación propuesta por «Trauma Orthopedic Association» intervenidos entre enero del 2015 y mayo del 2019. Obtuvimos 24 pacientes intervenidos mediante clavo intramedular y 29 mediante placa bloqueada. Resultados: La muestra incluyó 53 pacientes (36 varones y 17 mujeres) con una media de edad de 51 años (rango: 15-77 años). El tiempo de seguimiento medio fue de 6 meses (3-30 meses). No se hallaron diferencias significativas en el tiempo de consolidación de la fractura, aunque el inicio de la deambulación con carga fue mas temprano en el grupo clavo. Discusión: En la actualidad no existe consenso acerca del manejo terapeútico de las fracturas distales de tibia sin extensión articular. Conclusiones: Dados los resultados obtenidos consideramos que tanto la osteosíntesis con clavo intramedular como con placa bloqueada son opciones válidas en el tratamiento de las fracturas del tercio distal de tibia. Abstract: Introduction: Fractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis.The objective of the present study was to analyze and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methods: We carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. Results: The study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15-77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. Discussion: Currently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. Conclusions: After analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.

Background: After failed nonoperative treatment, unicompartmental osteoarthritis can be treated surgically by either unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO). The purpose of this retrospective study is to analyze utilization and demographic trends of UKA and HTO relative to total knee arthroplasty (TKA) over the past decade. Methods: A retrospective review was conducted using the PearlDiver database. Patients that received a UKA or HTO were identified. Trend analyses of surgical procedure utilization were performed with the Mann-Kendall trend test. Demographic data and the rates of various comorbidities were also queried. Results: A total of 103,465 UKAs, 2183 HTOs, and 1,413,425 TKAs, between 2010 and 2021 quarter 1, were analyzed. Trend analyses revealed that relative to TKA utilization, UKA utilization significantly increased (P < .001) while HTO utilization significantly decreased (P < .001). The compound annual growth rate of UKA utilization relative to TKA was +5.16% from 2010 to 2017 but was −10.61% from 2018 to 2021, while that of HTO relative to TKA was −9.69% from 2010 to 2021. Demographic analyses demonstrated the UKA cohort (63.1) was significantly older than the HTO cohort (46.5) (P < .001). Additionally, there were significantly more female patients who underwent UKA than HTO (P < .001). Conclusions: The present study demonstrated that relative to TKA, UKA utilization increased from 2010 to 2017, with a subsequent decrease afterward, whereas HTO utilization decreased since 2010. Demographic differences exist between the 2 operations, with HTOs more commonly performed in younger male patients, and UKAs in older female patients. Level of Evidence: Level III.

Purpose: Reduction and fixation of tibial plateau fractures associated with small, "floating" intra-articular fragments proposes a challenge. We use fully threaded headless compression screws for (interfragmentary) fixation of such fragments before final plate fixation when standard fixation of intra-articular fragments with k-wires or lag screws is deemed insufficient. Our aim is to describe our technique and clinical experience of this two-level fixation. Methods: Between 2006 and 2021, 29 patients with a comminuted tibial plateau fracture were treated with this two-level fixation in this retrospective case series. Clinical baseline and surgical variables were collected for all patients. Clinical outcome variables were available for 28 patients with a median follow-up of 16.5 months (IQR 5–24). Functional outcomes were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and reported by 22 patients at a median of 5.2 years (IQR 3.5–9.8). Results: Reduction was anatomic or good in 82% of cases, fair in 14%, and a malreduction in 4%. Arthrosis was graded as grade 0 in 25% of cases, 1 in 39%, 2 in 21%, and 3 in 14%. Flexion was 110 degrees (IQR 100–130). Five patients had an extension deficit of 5 to 10 degrees. Median KOOS for symptoms and stiffness was 69 points (IQR 45–78), for pain 71 (IQR 45–88), for ADL 85 (IQR 52–95), for sports 30 (IQR 11–55), and for quality of life 34 (IQR 19–56). Conclusion: The use of fully threaded headless compression screws is a simple and helpful addition in the treatment of comminuted tibial plateau fractures. [ABSTRACT FROM AUTHOR]

OBJECTIVE:To determine the relationship of meniscal damage to magnetic resonance imaging (MRI) features of compartment-specific patellofemoral joint (PFJ) osteoarthritis (OA) at baseline and 2 years later. METHOD:Individuals from a prospective cohort of individuals aged 50-79 with or at risk of knee OA were included. At the 60-month and 84-month study visit, Whole-Organ MRI Score (WORMS) was used to assess meniscal tears and extrusions as well as cartilage damage and bone marrow lesions (BMLs) in the medial and lateral patella and trochlea. Worsening of structural features was defined as any increase in WORMS score from 60 to 84 months. Logistic regression was used to determine the cross-sectional and longitudinal relation of meniscus damage to features of compartment-specific PFJ OA. RESULTS:Relative to knees without lateral meniscal pathology at baseline, those with grades 3-4 lateral meniscal tear and extrusion had greater risk of worsening of cartilage damage in the lateral PFJ 2 years later (Risk ratio: 1.7 [95% CI: 1.1-2.7) and (1.7 [1.2-2.5]), respectively. Relative to those without medial meniscal pathology at baseline, those with grades 1-2 (0.6 [0.4-0.9]) and 3-4 (0.7 [0.5-1.0]) medial meniscal tears had lower risk of worsening of BMLs in the medial PFJ 2 years later. CONCLUSION:Meniscal tear and extrusion are associated with increased risk of medial and lateral PFJ OA and more severe meniscal pathology is associated with worsening of PFJ OA 2 years later. Lateral meniscal pathology appears to be more detrimental to the lateral PFJ.

ObjectiveTo evaluate the longitudinal changes in meniscal T1ρ/T2 signal post-reconstruction in patients with acute anterior cruciate ligament (ACL) injury and to investigate the association with T1ρ/T2 signal in articular knee cartilage.MethodIn this prospective study, knees of 37 patients with ACL-injury and reconstruction in addition to 13 healthy controls were scanned using magnetic resonance imaging (MRI) T1ρ/T2 mapping. Quantitative analysis of the meniscus was performed in the anterior/posterior horns of lateral/medial meniscus fourteen sub-compartments of cartilage spanning the medial/lateral area of the tibia and femoral condyles. Meniscus T1ρ/T2 signals were compared between injured, contralateral and control knees at baseline, 6-months, 1-year and 2-years using t-tests for cross-sectional comparisons and a mixed model for longitudinal comparisons. Pearson-partial correlations between meniscal and cartilage T1ρ/T2 were evaluated.ResultsThere was a significant decrease of T1ρ/T2 signal in the posterior horn of lateral meniscus (PHLAT) of injured knees during a 2-year period. In the posterior horn of medial meniscus (PHMED), T1ρ/T2 signal of injured knees was significantly elevated at all time points post-reconstruction compared to contralateral and control knees. Within injured knees, PHMED T1ρ/T2 signal showed significant positive correlations with medial tibia (MT) cartilage T1ρ/T2 signal at all time points.ConclusionA significant decrease in PHLAT T1ρ/T2 signal by 2-years suggests potential tissue recovery after ACL-injury. Elevated T1ρ/T2 signal in the PHMED of injured knees at 2-years correlating with knee cartilage T1ρ/T2 signal elevations suggests involvement of the PHMED in subacute cartilage degeneration after ACL-injury and reconstruction.

BackgroundArticular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage.HypothesisLarger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction.Study designCase-control study; Level of evidence, 3.MethodsSubjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery.ResultsA total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had

ObjectivesTo investigate the association of weight change over 48 months with progression of meniscal intrasubstance degeneration (MID).MethodsWe studied 487 subjects with MID at baseline and after 48 months using 3-T MRI with the same protocol (FSE sequences with and without fat suppression). These participants lost weight (≥3%, n = 141), had moderate weight gain (3-10%, n = 77), substantial weight gain (>10%, n = 15) or maintained stable weight (n = 254). Progression of MID to a meniscal tear was assessed using the WORMS grading system and compared among weight change groups using logistic regression. ANOVA and chi-square tests were used to study the differences in subjects' characteristics.ResultsProgression of MID increased from weight loss to substantial weight gain (p < 0.001) and was significantly more likely with both moderate weight gain (odds ratio [OR], 4.9; 95% confidence interval [CI] 2.4-8.9) and substantial weight gain (OR, 9.5; 95% CI 3.2-28.5) compared to stable weight. Results were similar in both menisci for moderate weight gain (medial: OR, 6.8; 95% CI 3.5-11.3; lateral: OR, 2.6; 95% CI 1.1-6.6) and substantial weight gain (medial: OR, 21.0; 95% CI 5.1-80.7; lateral: OR, 9.7; 95% CI 0.95-100.2).ConclusionWeight gain is associated with an increased likelihood that meniscal intrasubstance degeneration will progress with the risk increasing with greater weight gain.Key points• Subjects who gained weight were more likely to develop meniscal tears. • Greater amount of weight gain was associated with an increasing likelihood of progression. • Prevention of weight gain has health benefits for the meniscus.

Total Knee Arthroplasty (TKA) proposed as an alternative treatment for damaged knee joints of humans is reviewed. The commercial application of TKA can help patients to improve their daily normal activities. Here the high-flex type total knee arthroplasty (High-Flex TKA) is typically designed for the patient’s convenience on which the greater range of motion can be adjusted for extreme activities such as Seiza and Muslim praying. However, the present High-Flex TKAs have not fulfilled the needs of Indonesians for religious activities with a flexion angle of 150°–165°. Therefore, this review aims to examine the flexion range of High-Flex TKAs proposed for the needs of Indonesians. This study is a narrative review, all studies published and reviewed are related to the range of flexion angles on the use of products from many manufacturers and various types that have been used by patients, as well as the development of a CAD-based TKA design. It was proposed in the present study that the flexion angle on High-Flex TKAs may be optimized by thickening the posterior femoral condyle, creating a medial pivot system, and applying a single radius system on the femoral component. Whereas, the tibial insert component could be designed by setting up the posterior tibial slope, and creating a post-cam stabilizer mechanism. Many knowledge gaps related to the population of research objects, lack of research on extreme angles, development of TKA components, are discussed. Further needs of extensive research on TKA in Mongoloid races are anticipated to be introduced for extreme angles and most comprehensive product development for optimization of the flexion angle.

BackgroundPrior studies describe histological and immunohistochemical differences in collagen and proteoglycan content in different meniscal zones. The aim of this study is to evaluate horizontal and vertical zonal differentiation of T1rho and T2 relaxation times of the entire meniscus from volunteers without symptom and imaging abnormality.MethodsTwenty volunteers age between 19 and 38 who have no knee-related clinical symptoms, and no history of prior knee surgeries were enrolled in this study. Two T1rho mapping (b-FFE T1rho and SPGR T1rho) and T2 mapping images were acquired with a 3.0-T MR scanner. Each meniscus was divided manually into superficial and deep zones for horizontal zonal analysis. The anterior and posterior horns of each meniscus were divided manually into white, red-white and red zones for vertical zonal analysis. Zonal differences of average relaxation times among each zone, and both inter- and intra-observer reproducibility were statistically analyzed.ResultsIn horizontal zonal analysis, T1rho relaxation times of the superficial zone tended to be higher than those of the deep zone, and this difference was statistically significant in the medial meniscal segments (84.3 ms vs 76.0 ms on b-FFE, p 0.74) or good (0.60-0.74) in all meniscal segments on both horizontal and vertical zonal analysis, except for inter-class correlation coefficients of the lateral meniscus on SPGR. Compared with SPGR T1rho images, b-FFE T1rho images demonstrated more significant zonal differentiation with higher inter- and intra-observer reproducibility.ConclusionsThere are zonal differences in T1rho and T2 relaxation times of the normal meniscus.