Navigation of femoral and popliteal artery around the knee with CT angiography: implications for surgical interventions.

PURPOSE: Uncertainty about the exact position of the femoral and popliteal arteries in the medial thigh and posterior knee might increase vascular complications in surgical procedures. This study aimed to document femoral and popliteal arteries in the medial thigh and around the knee to assist surgeons in developing safer surgical approaches. METHODS: The study included 120 patients-180 lower limbs-who underwent CT angiography (CTA) of the lower extremity. The distance from the femoral artery to the anterior border, midsagittal axis, and posterior border of the femur and the popliteal artery to the medial, lateral, and midpoint posterior cortex of the proximal tibia was measured in two- and three-dimensional CTA images. RESULTS: The femoral artery was found to be on average 236.93 ± 29.61 mm, 195.34 ± 26.12 mm, and 146.28 ± 33.18 mm away from the adductor tubercle at the anterior, midsagittal axis, and posterior borders of the femur, correspondingly. The popliteal artery was to be located on average 5.40 ± 2.50 mm posterior to the midpoint of the plateau tibia at the joint line. CONCLUSION: Considering the mentioned femoral/popliteal artery distances to the femur and proximal tibia would direct surgeons to the safe zones for more accurate surgical approaches in the medial thigh and around the knee when performing osteotomies, knee arthroplasty, arthroscopy, and trauma surgeries, to reduce possible vascular damages. LEVEL OF EVIDENCE: IV.

Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty.

BACKGROUND: Coronal alignment after total knee arthroplasty (TKA) would influence the implant survival. Coronal alignment could be measured on short and full-length X-rays. The goal of the current study was to assess the correlation of short and full-length X-rays to accurate prediction of the true Hip-Knee-Ankle alignment after TKA in the Iranian population. METHODS: Lateral distal femoral and medial proximal tibial angles, FTA, HKA, in 180 Iranian patients (243 knees without extra-articular deformities) were measured and compared on short and full-length standing X-rays of primary TKA pre/postoperatively. RESULTS: The correlation between the preoperative FTA-short and FTA-long, FTA-short and HKA, and FTA-long and HKA values in degrees were fair, good and good (r = 0.64) (r = 0.73), (r = 0.76), respectively. This correlation for postoperative aMPTA and mMPTA (r = 0.73), and FTA-short and HKA (r = 0.76) values were good and significant (P = 0.001). Also, assessing coronal alignment based on short and full-length measurements would result in varying pre/postoperative alignments (varus, neutral and valgus). CONCLUSION: Full length X-rays could not be replaced by short knee X-rays to asses true coronal alignment in TKA; considerable portion of our cases were missorted as varus, neutral or valgus based on the FTA versus the HKA. Intraoperative fixed 5° valgus angle cut of distal femur did not result in postoperative favorable neutral alignment in all cases. LEVEL OF EVIDENCE: IV.

Outcomes of Repair and Reconstruction of the Acute Posterolateral Corner Injuries of the Knee Combined with Cruciate Ligaments Injuries.

Background: This study aimed to report objective and subjective knee stability scores for patients who underwent acute repair of avulsed posterolateral corner (PLC) structures or acute reconstruction of midsubstance tears combined with delayed reconstruction of cruciate ligaments. Methods: A total of 48 sport and vehicle accident traumatic patients were enrolled in a three-year follow-up study. The patients were investigated by clinical exams, subjective and objective International Knee Documentation Committee (IKDC) score, Tegner score, Lysholm score, and stress imaging. All scores were compared between the reconstruction and repair groups. Results: Subjective IKDC scores were obtained at 83.3±9.6 and 88.3±4.39 for the reconstruction and repair groups, respectively. Only two patients in the reconstruction group had abnormal objective IKDC scores. Based on the Tegner score, 15 out of 18 patients in the repair group and 20 out of 24 patients in the reconstruction group regained their pre-injury functional level. Mean Lysholm scores for the reconstruction and repair groups were estimated at 83.4±8.2 and 88.2±4.1, respectively. Mean lateral joint opening differences between two knees in the reconstruction and repair groups were -0.2±0.1mm and 0.5±0.1mm, respectively. There were no statistically significant differences between groups outcomes. We had no failure of treatment at the final follow-up. Conclusion: Acute intervention within 3 weeks after PLC injuries combined with delayed cruciate ligaments reconstructions showed favorable outcomes. Both repair and reconstruction are effective when deciding based on the type of injury (i.e., avulsion and midsubstance tear).

Hip Tenosynovial Giant Cell Tumor without Recurrence in a 9-Year Follow-Up.

BACKGROUND: Tenosynovial giant cell tumors are a benign but rare condition with potentially aggressive tumor-like traits which should be considered in young patients with monoarticular joint involvement. Case Presentation. This report presents a 31-year-old otherwise healthy woman with a right hip pain. Clinical and histopathological investigations revealed the diagnosis of diffuse-type tenosynovial giant cell tumor of the hip (the diffuse intra-articular form of PVNS). Open synovectomy and tumor resection and surgical dislocation of the hip were performed. She was free of symptoms and recurrence within a 9-year-follow-up period. CONCLUSION: Open synovectomy and tumor resection through surgical dislocation of the hip without adjutant radiotherapy could be a reliable choice for the localization of the hip.

Assessment of Bone Mineral Density in Patients Undergoing Hemodialysis; An Iranian Population-Based Study.

BACKGROUND: End-stage renal disease (ESRD) is a condition in which bone turnover and metabolism is impaired; thus, osteoporosis and low bone density are subsequently inevitable. We aimed to determine bone mineral density (BMD) and biochemical markers, and associated factors in hemodialysis (HD) patients. METHODS: Patients aged 30-70 years undergoing HD between 2015 to 2019 were enrolled in this cross-sectional study. BMD measured by dual energy x-ray absorptiometry (DEXA) and biochemical laboratory tests were assessed in 200 patients undergoing HD. Statistical analysis was based on t test, Pearson, regression and Mann-Whitney tests using SPSS 16. RESULTS: Two hundred patients were investigated. Sixty percent of the patients were female. Mean ± SD of participants' age was 58.6 (±11.63) years and mean ± SD for duration of HD was 45.69 (± 43.76) months. Osteoporosis was found in 48% (n=96) and low bone density in 36% (n=76) of our patients. General osteoporosis was more frequent in those undergoing HD for more than 3 years, although not significantly (P=0.093, odds ratio [OR]=0.37). However, regional osteoporosis in hip and femoral neck, but not spine vertebrae, were significantly higher after three years of HD (P=0.036, OR=0.27; P=0.042, OR=0.27; and P=0.344, OR=0.56, respectively). Increased body mass index (BMI) correlated negatively with osteoporosis (P=0.050). CONCLUSION: With increasing age and duration of HD, BMD decreases. Higher BMI was associated with higher bone mass density. Bone density assessment seems to be necessary in patients undergoing HD.

Extracellular vesicles as novel approaches for the treatment of osteoarthritis: a narrative review on potential mechanisms.

Osteoarthritis (OA) is a progressive degeneration of articular cartilage with involvement of synovial membrane, and subchondral bone. Current treatment approaches have focused on controlling the OA symptoms, pain, and inflammation. Recently, cell-based therapies, including the application of stem cells such as mesenchymal stem cells (MSCs), have been introduced for restoration of the articular cartilage. Despite promising outcomes, there are some limitations in the application of MSCs for OA treatment. It has been demonstrated that the regenerative potential of stem cells is related to the production of paracrine factors. Extracellular vehicles (EVs), the main component of cell secretome, are membrane-bounded structures that deliver biologically active agents. The delivery of molecules (e.g., nucleic acids, proteins, and lipids) leads to cell-to-cell communication and the alteration of cell functions. In this review, general characteristics of EVs, as well as their potential mechanisms in the prevention and treatment of OA were considered. Based on in vitro and in vivo studies, EVs have shown to contribute to cartilage regeneration via suppression of degenerative factors and regulation of chondrocyte function in the synthesis of extracellular matrix components. Also, they inhibit the progression of OA or protect the cartilage from degradation via their impact on inflammatory cytokines. The different signaling pathways of EVs against the pathologic features of OA were summarized in this review. According to the results obtained from several investigations, more investigations should be design to prove the safety and effectiveness of EVs in the treatment and prevention of OA progression.

The Prevalence, Zone, and Type of the Meniscus Tear in Patients with Anterior Cruciate Ligament (ACL) Injury; Does Delayed ACL Reconstruction Affects the Meniscal Injury?

BACKGROUND: Meniscus tear is a common finding in patients with anterior cruciate ligament (ACL) injury and may affect the natural history of the injury and the outcomes of treatment. In the current study, the characteristics of meniscus tears in patients who underwent arthroscopic ACL reconstruction were investigated. METHODS: The hospital records of 1022 patients were reviewed. The measured variables included the presence of meniscus tear, ramp and root injury, the zone of injury based on the Cooper classification, and the type of tear. The ACL tears with delay more than 3 months for ACLR were recorded as chronic injuries. RESULTS: The incidence of meniscus tear was 44.4%; among whom, bucket-handle injury was the most common type (30.4%) and the ramp lesion was found in 20.5%. The meniscus was repaired in 56.6%. The incidence of medial meniscus injury was significantly higher in chronic ACL tears and vice versa (P<0.001). The incidence of ramp lesion (9.1% Vs 20.5%) and root tear (1.3% Vs 2.9%) were significantly higher in the chronic and acute tears, respectively (P<0.001). CONCLUSION: Delay more than 3 months in ACLR was associated with the increased incidence of meniscal injury, specially the medial meniscus, and ramp lesion. It seems that early ACLR may be more helpful for the patients.

A Case Report of Cornelia De Lange Syndrome in Northern Iran; A Clinical and Diagnostic Study.

As a rare multisystem congenital anomaly disorder, Cornelia de Lange syndrome (CdLS) is featured by delayed growth and development, distinct facial dimorphism, limb malformations and multiple organ defects. CdLS is a genetic syndrome affecting 1/10000-1/60000 neonates with unknown genetic basis. Delayed growth and development, hirsute, structural anomalies of the limbs and distinct facial dimorphism are considered as its main clinical characteristics. Introducing CdLS cases of different ethnic backgrounds could add distinctions to the phenotypic picture of the syndrome and be useful in diagnosis. Early diagnosis and decreased death rates are achievable through enhanced awareness on this syndrome. We present here a 45-day-old girl, as the first case of Cornelia in Golestan (Northern Iran), referred to our hospital with the symptoms as mentioned above.