Anatomical knee variables result in worse outcomes of lateral meniscal allograft transplantation with discoid lateral menisci than with nondiscoid lateral menisci.

PURPOSE: To compare the clinical results of meniscal allograft transplantation (MAT) between patients with discoid lateral meniscus (DLM) and non-DLM (NDLM) and to analyse whether anatomical deformities cause worse clinical results in DLM patients. METHODS: Patients who underwent unilateral MAT from 2005 to 2017, including 115 patients with DLMs or NDLMs, were included in this study. Clinical outcomes [International Knee Documentation Committee (IKDC) scores, Lysholm scores, Tegner scores, and visual analogue scale (VAS) scores] and radiographic and MRI data were assessed. Clinical outcomes and anatomical knee variables were analysed by multivariate stepwise regression. RESULTS: After more than 2 years of follow-up, 9 patients were lost to follow-up, and 59 patients with DLM and 47 patients with NDLM were included. The mean postoperative results were significantly better than the preoperative data (P < 0.05) in both the DLM and NDLM groups. In addition, postoperative IKDC, Lysholm, and VAS scores but not Tegner scores were better in the NDLM group than in the DLM group. Several anatomical knee variables differed significantly between the NDLM and DLM groups and were associated with MAT outcomes. The condylar prominence ratio of the lateral and medial femoral condyles adjacent to the intercondylar notch and squaring of the lateral femoral condyle (the distance of the straight articular condylar surface) were independent factors significantly correlated with the Lysholm scores for MAT at last follow-up. CONCLUSION: MAT improved knee function in both patients with DLM and patients with NDLM, but patients NDLM had better clinical outcomes than patients with DLM. The condylar prominence ratio and squaring of the lateral femoral condyle may underlie this result. LEVEL OF EVIDENCE: III.

Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable.

PURPOSE: The study aimed to compare modified arthroscopic subscapularis augmentation (MASA) with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction (Group A) or Bankart repair (Group B) for recurrent anterior shoulder instability (RASI). METHODS: A retrospective series of 49 patients underwent primary surgery for RASI with glenoid bone loss (GBL) < 25%. Outcomes included the Oxford Shoulder Instability Score (OSIS), Visual Analogue Scale (VAS) score, Rowe score, and American Shoulder and Elbow Surgeons (ASES) functional outcome scale score. Recurrent instability, sports activity level, and range of motion (ROM) were also analysed. RESULTS: No significant differences were observed at baseline. Forty-six patients were available for more than 2 years of follow-up. At the last follow-up after surgery, the patients in both groups had experienced significant improvements in all outcome scores (P < 0.05 for all), and obvious decreases in forward flexion and external rotation were noted in both groups (P < 0.05 for all). Group A had superior ASES scores, VAS scores, and OSISs (P < 0.05) but did not experience significant differences in either the Rowe score or ROM compared to Group B. Group A had lower rates of recurrent instability and superior outcomes for the return to sports activities. One patient in Group A had subluxation, and 4 patients in Group B had dislocation or subluxation. No patients in either group experienced neurovascular injury, joint stiffness, or surgical wound infection. CONCLUSION: For RASI with GBL < 25%, MASA with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction was a safe technique that produced better outcomes in terms of ASES scores, VAS scores, OSISs, the return to sports, and postoperative recurrent instability and did not decrease the ROM compared to that achieved by arthroscopic Bankart repair. LEVEL OF EVIDENCE: III.

Transglenoid Fixation Technique for Arthroscopic Subscapularis Augmentation Using an Adjustable-Length Loop Cortical Suspensory Fixation Device.

The optimal surgical management of anterior shoulder instability remains controversial. Although it has low recurrence rates and good clinical results, the Latarjet procedure has some disadvantages and is considered "overtreatment" in inactive patients with moderate glenoid bone loss. Several studies have described an arthroscopic technique called arthroscopic subscapularis augmentation. We developed a technical variation of the arthroscopic subscapularis augmentation technique involving tenodesis of the upper third of the subscapularis tendon using a graft. This technique uses a transglenoid fixation-immobilization with 2 knotless TightRope devices instead of anchors.

Relationship Between Number of Lateral Intercondylar Ridges and Area of Denser Bone on the Lateral Intercondylar Wall.

Background: A deeper understanding of the anatomy of the intercondylar notch of the femur may help reduce technical errors during anatomic anterior cruciate ligament (ACL) reconstruction. Purposes: To classify the number of ridges on the lateral intercondylar wall, identify factors influencing the number of ridges, and define the relationship between the area of denser bone on the lateral intercondylar wall and the lateral intercondylar ridge. Study Design: Descriptive laboratory study. Methods: Included were 89 patients with computed tomography (CT) images of the knee joint. On full lateral view of the lateral femoral condyle, the authors evaluated for the presence of a lateral intercondylar ridge. The height and area of the lateral intercondylar wall (notch height and lateral notch area) and the length of Blumensaat line were calculated. Notch outlet length, axial notch area, notch width index, and transepicondylar length were also calculated using 3-dimensional CT. Maximum intensity projection was used to identify the area of denser bone on the femoral lateral intercondylar wall, and the relationship between this area and the lateral intercondylar ridge was investigated. Results: The lateral intercondylar ridge exhibited 3 types of morphological variations. The invisible type (no ridge) was observed in 20 knees (22.5%); the ridge type (1 ridge), in 23 knees (25.8%); and the plateau type (2 ridges), in 46 knees (51.7%). There were significant differences in notch height, lateral notch area, Blumensaat line length, and denser bone area among the ridge types (P ≤ .031 for all). The locations of the anterior ridge of the plateau type and of all 23 ridges of the ridge type corresponded to the anterior margin line of the area of denser bone. Conclusion: Significant differences were seen in the 3 types of lateral intercondylar ridges. The anterior margin line of the denser bone area on the lateral intercondylar wall was found to correspond to the anterior border of the plateau type and the ridge type. Clinical Relevance: The variations in the lateral intercondylar ridge may affect measurement accuracy during evaluation of ACL tunnel position while using the ridge as a landmark. The plateau-type ridge and the area of denser bone on the lateral intercondylar wall may provide a new way for surgeons to determine the femoral tunnel.

Deep Learning-Based Image Feature with Arthroscopy-Aided Early Diagnosis and Treatment of Meniscus Injury of Knee Joint.

The aim of this study is to explore the clinical effect of deep learning-based MRI-assisted arthroscopy in the early treatment of knee meniscus sports injury. Based on convolutional neural network algorithm, Adam algorithm was introduced to optimize it, and the magnetic resonance imaging (MRI) image super-resolution reconstruction model (SRCNN) was established. Peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) were compared between SRCNN and other algorithms. Sixty patients with meniscus injury of knee joint were studied. Arthroscopic surgery was performed according to the patients' actual type of injury, and knee scores were evaluated for all patients. Then, postoperative scores and MRI results were analyzed. The results showed that the PSNR and SSIM values of the SRCNN algorithm were (42.19 ± 4.37) dB and 0.9951, respectively, which were significantly higher than those of other algorithms (P < 0.05). Among patients with meniscus injury, 17 cases (28.33%) were treated with meniscus suture, 39 cases (65.00%) underwent secondary resection, 3 cases (5.00%) underwent partial resection, and 1 case (1.67%) underwent full resection. After meniscus suture, secondary resection, partial resection, and total resection, the knee function scores of patients after treatment were (83.17 ± 8.63), (80.06 ± 7.96), (84.34 ± 7.74), and (85.52 ± 5.97), respectively. There was no great difference in knee function scores after different methods of treatment (P > 0.05), and there were considerable differences compared with those before treatment (P < 0.01). Compared with the results of arthroscopy, there was no significant difference in the grading of meniscus injury by MRI (P > 0.05). To sum up, the SRCNN algorithm based on the deep convolutional network algorithm improved the MRI image quality and the diagnosis of knee meniscus injuries. Arthroscopic knee surgery had good results and had great clinical application and promotion value.

Deep Learning-Based Magnetic Resonance Imaging Image Features for Diagnosis of Anterior Cruciate Ligament Injury.

To study and explore the adoption value of magnetic resonance imaging (MRI) in the diagnosis of anterior cruciate ligament (ACL) injuries, a multimodal feature fusion model based on deep learning was proposed for MRI diagnosis. After the related performance of the proposed algorithm was evaluated, it was utilized in the diagnosis of knee joint injuries. Thirty patients with knee joint injuries who came to our hospital for treatment were selected, and all patients were diagnosed with MRI based on deep learning multimodal feature fusion model (MRI group) and arthroscopy (arthroscopy group). The results showed that deep learning-based MRI sagittal plane detection had a great advantage and a high accuracy of 96.28% in the prediction task of ACL tearing. The sensitivity, specificity, and accuracy of MRI in the diagnosis of ACL injury was 96.78%, 90.62%, and 92.17%, respectively, and there was no considerable difference in contrast to the results obtained through arthroscopy (P > 0.05). The positive rate of acute ACL patients with bone contusion and medial collateral ligament injury was substantially superior to that of chronic injury. Moreover, the incidence of chronic injury ACL injury with meniscus tear and cartilage injury was notably higher than that of acute injury, with remarkable differences (P < 0.05). In summary, MRI images based on deep learning improved the sensitivity, specificity, and accuracy of ACL injury diagnosis and can accurately determined the type of ACL injury. In addition, it can provide reference information for clinical treatment plan selection and surgery and can be applied and promoted in clinical diagnosis.

A Bone-Hamstring Autograft for Arthroscopic Anterior Cruciate Ligament Reconstruction.

We describe a bone-hamstring autograft for anterior cruciate ligament reconstruction (ACLR). The semitendinosus and gracilis tendons are harvested using an open tendon stripper, keeping these distal tibial insertions intact. The bone-hamstring autograft is harvested using an oscillating saw. This modified autograft has the following advantages: (1) It possesses the potential for healing with the femur owing to its bone plug; (2) it is perfectly suited for various single-bundle reconstruction methods including oval-tunnel and rectangular-tunnel ACLR, as well as other flat ACLR methods; and (3) it is an attractive option for both primary ACLR and revision ACLR owing to its unique characteristics.

Correlation analysis of potential factors influencing graft maturity based on MRI after lateral meniscal allograft transplantation.

The aim of this respective study was to assess the graft signal/noise quotient (SNQ) value and associated factors based on magnetic resonance imaging (MRI) after lateral meniscal allograft transplantation (LMAT). Patients with LMAT were included. The SNQ, width of the anterior horn (WAH), width of the midbody (WMB), width of the posterior horn (WPH) of each lateral meniscus, coronal graft extrusion (CGE), the anterior cartilage meniscus distance (ACMD) and the posterior cartilage meniscus distance (PCMD) were measured using MRI and tested by multivariate stepwise regression analysis. The relative percentage of extrusion (PRE) was calculated. Seventy-one male patients were examined, and 7 patients were lost to follow-up. The SNQ of the meniscus increased from immediately after surgery to 6 months postoperatively, decreased from 6 to 12 months, increased from 12 to 24 months, and increased from 24 to 36 months. The mean SNQ had a significant negative association with the WPH and CGE at 6 months (p < 0.05), the WPH at 1 year (p < 0.05), the PRE of CGE (CPRE) at 2 years (p < 0.05), and the PCMD, CPRE, and PRE of the PCMD (PPRE) at 3 years (p < 0.01) postoperatively. Multivariate stepwise regression analysis showed that the WPH at 6 months, WPH at 1 year, WMD and PCMD at 2 years, and WMD, ACMD and CGE at 3 years were significant independent factors correlated with the mean SNQ of grafts in different periods. Maturation of meniscal grafts fluctuated with time. The maturation process occupied the main role before 1 year postoperatively, but after the maturation process, tearing of the meniscal allograft played the leading role. Changes in an allograft's location had an obvious association with the SNQ. The WPH influenced the graft SNQ value at 6 months and 1 year postoperatively, but after the maturation process, the WMB and graft extrusion played the same roles.

A possible prediction of dystocia at the time of cesarean delivery: Gluteal muscle contracture, a single center experience from China.

The study assessed the pelvic dimensions by computed tomography (CT) performed for gluteal muscle contracture women, and evaluated the impact of malformations on several essential obstetric parameters.The CT pelvimetry was retrospectively performed in 25 gluteal muscle contracture women selected consecutively whether they had delivery history or not. Among the pelvic inlet plane, the mid plane and the outlet plane, 12 indicators including the transverse diameter of the pelvic inlet, the conjugate vera, the diagonal conjugate, the biischial diameter, the anteroposterior diameter of the middle pelvis, transverse outlet, the posterior sagittal diameter of outlet, the conjugate of the outlet, the anterior sagittal diameter of the outlet, the curvature and length of the sacrum, the angle of pubic arch were collected.Finally, the mean age of these women was 26.6 ±â€Š5.0 years. Most pelvises had anteroposterior elliptical appearance in inlet and size of the female pelvis. The most statistically different and most clinically significant indicator was the biischial diameter, gluteal muscle contracture women were 95.6 ±â€Š9.3 mm and the normal women from other study were 105.0 ±â€Š7.9 mm, the comparison showed a significant difference (P < .001).Generally, most gluteal muscle contracture women had features of anthropoid pelvis which were quite different from normal Chinese female. These results may serve as a basis for future studies to assess its utility and prognostic value for a safe vaginal delivery in gluteal muscle contracture women.

The characteristic arthroscopic 'eyelid- turnup' sign indicated for partial-thickness longitudinal medial meniscus tear.

BACKGROUND: Medial posterior horn meniscal tear is difficult to be visualized in full view during arthroscopy and is occasionally undetected when the superior surface seems intact. OBJECTIVE: The purpose of this study is to describe a characteristic arthroscopic sign indicating the occult partial-thickness longitudinal medial meniscus tear extending only to the inferior articular surface. METHODS: This study was a retrospective analysis of available arthroscopic knee surgery between January 2016 and December 2017. The videos were studied and data was recorded for the number of cases showing the presence of 'eyelid-turnup' sign and coexisting partial-thickness medial meniscus tear. Sensitivity and positive predictive value of the sign were calculated. RESULTS: Of all the 491 videos of medial meniscal tear available for review, partial-thickness longitudinal medial meniscus was torn in 26 cases. Six out of 26 patients could be diagnosed with partial-thickness longitudinal tear under direct vision. Of the other 20 patients which could not be diagnosed under direct vision during arthroscopy until the tear was pressed by a probe, 17 patients were diagnosed by the positive 'eyelid-turnup' sign. The other 3 patients showed negative 'eyelid-turnup' sign and were then diagnosed by the hints of preoperative MRI and intra-operative exploration. The sensitivity of the sign was 85%; the positive predictive value was 89.5%. CONCLUSIONS: The 'eyelid-turnup' sign of meniscus pressed by a probe at arthroscopy is a characteristic indicator for occult inferior partial-thickness longitudinal tears of midbody and posterior horn. Early identification of this special sign may help reduce the likelihood that the occult partial-thickness longitudinal tear will be missed during arthroscopy.

Bevacizumab tested for treatment of knee osteoarthritis via inhibition of synovial vascular hyperplasia in rabbits.

BACKGROUND/OBJECTIVE: Osteoarthritis (OA) is the most common joint disorder. Angiogenesis and synovial hyperplasia are important factors in the development of OA. Previous studies demonstrated that bevacizumab, an antibody against vascular endothelial growth factor in angiogenesis for cancer treatment, might be a potential candidate for the treatment of OA. However, experimental studies were lacking in whether bevacizumab would be able to attenuate the severity of OA. In this study, we used normal New Zealand rabbits and a rabbit knee immobilization model of OA, to investigate the toxicity and efficacy of bevacizumab. METHODS: In the safety test of bevacizumab, sixteen rabbits were randomly divided into 2 groups: control group and bevacizumab group (n = 8 per group). We evaluated the blood chemistry and histology of normal rabbit joints after bevacizumab treatment. In the efficacy test of bevacizumab, thirty-two rabbits were used for establishing OA model and then randomly divided into 4 groups: bevacizumab group, sodium hyaluronate (SH) group, triamcinolone acetonide (TA) group and control group (n = 8 per group). We used histological evaluations and immunohistochemistry to examine the responses to bevacizumab treatment in a rabbit model of knee immobilization-induced OA. RESULTS: Bevacizumab treatment did not show any adverse effects histologically on normal joints. Blood tests and Mankin's score of cartilage revealed no significant difference between the bevacizumab and control groups (p > 0.05). The bevacizumab, SH, and TA groups attenuated articular cartilage degeneration and showed less synovial hyperplasia compared to the control group macroscopically and histologically, while the effect of the bevacizumab group was most obvious (p < 0.05). Immunohistochemistry revealed significantly lower vascular endothelial growth factor (VEGF) expression in the synovium and matrix metalloproteinase-1 (MMP-1) in the cartilage in the bevacizumab, SH, and TA groups compared to the control group (p < 0.05), while the expression of VEGF and MMP-1 in the bevacizumab group was the lowest among the four groups (p < 0.05). CONCLUSIONS: Intra-articular injection of 4-mg bevacizumab in rabbit knees did not show adverse effects. The bevacizumab treatment prevented joint inflammation in terms of inhibition of reduced angiogenesis, inhibited synovial proliferation, and reduced VEGF and MMP-1 expression. Compared with SH and TA, bevacizumab protected the cartilage and produced a better therapeutic effect on primary knee OA in rabbits, which imply that bevacizumab, an anticancer drug, may become a potentially effective drug for the treatment of OA. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Our study confirmed the therapeutic effect of bevacizumab on rabbit primary knee OA. This study demonstrated that bevacizumab may have clinical implications and contribute to the development of new OA treatments.

Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up.

OBJECTIVE: To evaluate the clinical and radiologic outcomes of meniscal allograft transplantation (MAT) using a modified bone plug technique. METHODS: We conducted a retrospective single-center study of 73 patients who underwent MAT between January 2007 and December 2013. The International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score, visual analogue scale (VAS), and physical examinations were retrospectively reviewed to measure clinical outcomes after MAT, and questionnaires regarding activity and factors were analyzed. Magnetic resonance imaging (MRI) was used to assess the cartilage status and meniscal extrusion. RESULTS: The mean follow-up was 37 months for 61 patients (65 knees), and 12 patients were lost to follow-up. The mean meniscal extrusion was 3.39 ± 0.90 mm, the relative percentage of extrusion (RPE) was 34.82% ± 12.71%, and arthrosis progression was observed in 8 of 61 cases (13.1%). The mean results for VAS, IKDC, and Lysholm scores were significantly improved after MAT (P < 0.05), but there were no significant differences in the range of motion or Tegner score (P > 0.05). Thirty-eight (62.3%) patients were able to return to their previous level of activity, and 23 (37.7%) patients reached a mean 76.7% of the previous level of activity. Of the 23 patients reporting a decrease in activity, 10 reported a fear of reinjury as the primary factor limiting activity. The patient satisfaction rate in the study was 78.7%. CONCLUSION: Our modified bone plug method with anatomical meniscal root reinsertion was an effective surgical method, and the majority of active patients with meniscal disorders returned to preinjury levels of activity.

[DIAGNOSTIC SIGNIFICANCE OF MEDIAL MENISCUS INJURY IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION FAILURE].

OBJECTIVE: To explore the relationship between anterior cruciate ligament (ACL) reconstruction failure and medial meniscus injury and decide whether medial meniscus injury could be the judgment index for ACL reconstruction failure without trauma history. METHODS: Between March 2011 and December 2015, 117 patients underwent ACL reconstruction, and the clinical data were analyzed retrospectively. All patients had no trauma history after ACL resconstruction. MRI examination showed medial meniscus injury in 56 cases (observation group) and no medial meniscus injury in 61 cases (control group). There was no significant difference in gender, age, side, reconstructive surgery, and follow-up time between 2 groups (P>0.05). The KT-2000 arthrometer was used to measure the difference value of tibial anterior displacement between two knees in 30° knee flexion. Then wether the ACL reconsruction failure was judged according to the evaluation criteria proposed by Rijke et al. RESULTS: In observation group, the difference value of tibial anterior displacement was <3 mm in 7 patients, 3-5 mm in 11 patients, and >5 mm in 38 patients. In control group, the difference value of tibial anterior displacement was <3 mm in 31 patients, 3-5 mm in 18 patients, and >5 mm in 12 patients. The ACL reconstruction failure rate of observation group (67.9%) was significantly higher than that of control group (19.7%) (χ2=27.700, P=0.000). CONCLUSIONS: After ACL reconstruction, medial meniscus injury occurs under no trauma history circumstances, indicating ACL reconstruction failure.

[ANATOMICAL RESEARCH OF TIBIAL INSERTION OF ANTERIOR CRUCIATE LIGAMENT IN CHINESE ADULTS].

OBJECTIVE: To observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament (ACL) in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. METHODS: Fifteen adult cadaveric knees (8 left knees and 7 right knees) were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years (mean, 32.4 years). All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion (direct and indirect insertions) were anatomically measured. RESULTS: In all specimens, the ACL was flat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc-shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was (11.2 ± 2.4) mm; the thickness was (3.0 ± 0.3) mm; and the cross-sectional area was (28.8 ± 7.8) mm2. And the left-right diameter of the whole insertion was (9.5 ± 1.8) mm; anteroposterior diameter was (11.9 ± 0.6) mm; and the cross-sectional area was (117.8 ± 12.5) mm2. The width of the anterior horn of lateral meniscus was (12.3 ± 2.0) mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. CONCLUSION: Anatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.