Could a three-dimensional contralateral meniscus segmentation for allograft or scaffold sizing be possible? A prospective study.

PURPOSE: Meniscal allografts and biodegradable meniscal implants are attractive surgical options for painful subtotal or total meniscectomies. In order to get the best results, these should be as similar as possible to the original meniscus in terms of shape, structure, and volume. Three-dimensional meniscus sizing could be an approach to improve the accuracy of meniscus matching. Therefore, the aims of this study were to perform a comparative morphological and volumetric analysis of the healthy meniscus based on manual tri-planar segmentation and to demonstrate that the menisci from the contralateral knee could be used as a reference in the sizing of a meniscal graft or a scaffold. METHODS: Three-dimensional meniscal models were created based on 120 MRIs in 60 healthy subjects (bilateral knees). The differences between the pairs of menisci concerning the widths, thicknesses, lateromedial distances, anteroposterior distances, angles of coverage, and meniscal volumes were evaluated. T-Student tests were used to compare the quantitative numerical variables of the different groups. Pearson's linear regression was used to determine if correlations existed between demographic variables (age, gender, height, weight) and anatomical parameters. Statistical significance was set at p < 0.05. RESULTS: Comparing the 120 pairs of menisci of each subject, there was no statistically significant difference for all parameters studied for both the medial and lateral meniscus. When the measurements were stratified by gender, statistically significant differences were observed for all parameters except meniscal coverage angles. We observed that anteroposterior and lateromedial distances were positively correlated with height and body mass index both at the level of the medial meniscus (r = 0.68; r = 0.66; r = 0.65; and r = 0.63) and lateral (r = 0.68; r = 0.69; r = 0.61; and r = 0.60). CONCLUSION: Our study demonstrated that the intra-individual 3D shapes of the left and right menisci are very similar. Therefore, the contralateral side could be used as a template for the 3D sizing of meniscal allografts or meniscal implants.

Prospective randomized study of the vitamin C effect on pain and complex pain regional syndrome after total knee arthroplasty.

PURPOSE: Complex regional pain syndrome (CRPS) type I, formerly known as reflex sympathetic dystrophy (RSD) or algodystrophy, is a condition with chronic pain condition following a trauma or surgery. The physiopathology of this syndrome remained incompletely known. Due to the lack of effective curative treatment, prevention of this complication is important. Therefore, we evaluated the efficacy of vitamin C in preventing this complication. MATERIAL AND METHODS: Between January 2018 and July 2019, we conducted a prospective randomized study on the efficiency of vitamin C (one group with and one without vitamin C) on prevention of CRPS risk in patients operated in our institution with TKA. Patients with a VAS pain score > 4 performed a three-phase bone scintigraphy. The diagnostic of CRPS was made by using the Budapest criteria associated to a bone scintigraphy. Statistical significance was set at p < 0.05 RESULTS: One hundred fifty-three patients were included in the vitamin C group, 139 in the control group without vitamin C. For the entire cohort, the prevalence of complex regional pain syndrome was 7.9% (23 of 292). The prevalence of complex regional pain syndrome was 3.9% (six of 153) in the vitamin C group and 12.2% (seventeen of 139) in the control group (p = 0.008). After multivariate regression, vitamin C was found to be an independent preventive factor of CRPS and there was a significant difference between the vitamin C group and the control group (relative risk, 0.27; 95% confidence interval, 0.1-0.8; p = 0.015). CONCLUSION: Taking 1 g per day of vitamin C during 40 days after a TKA reduces the risk of CRPS.

Psychometric properties of the Cumulated Ambulation Score French translation.

OBJECTIVE: To examine measurement properties (inter-rater reliability, agreement, validity, and responsiveness) of the Cumulated Ambulation Score French translation in patients with hip fracture. DESIGN: Methodological study. SETTING: A 20-bed orthopedic unit and 20-bed geriatric unit. SUBJECTS: About 140 consecutive patients with a mean (SD) age of 83 (12) years. INTERVENTIONS: The English version of the Cumulated Ambulation Score used to evaluate basic mobility was translated into French following international guidelines. Two raters independently assessed all patients on postoperative days one, two, three, and 30 after a hip fracture surgery. Relative and absolute inter-rater reliability and responsiveness (effect size for improvement from postoperative day two to 30) were evaluated. Convergent validity was analyzed by Spearman's correlation coefficient comparing the Cumulated Ambulation Score with two other measures on postoperative day two and 30. MAIN MEASURE: Cumulated Ambulation Score. RESULTS: The weighted Kappa value ranged from 0.89 to 1.0. The standard error of measurement and the smallest real difference of the Cumulated Ambulation Score ranged, respectively, from 0.12 to 0.23 and from 0.32 to 0.6 points, while the effect size reached 1.03 (95% CI 0.87-1.26). There was a strong positive correlation comparing the Cumulated Ambulation Score with the French Tinetti Assessment Tool (r ⩾ 0.83) and the French Mini Motor Test (r ⩾ 0.79). CONCLUSIONS: Our findings indicate that the Cumulated Ambulation Score's French version is a reliable and valid tool to assess patients' basic mobility with hip fractures.