Large chondral defect not covered by meniscal allograft is associated with inferior graft survivorship after lateral meniscal allograft transplantation.

PURPOSE: This study aimed to evaluate graft survivorship according to the size and location of chondral defects and its effect on clinical outcomes after meniscal allograft transplantation (MAT). It was hypothesized that large chondral defects would be associated with inferior outcomes. METHODS: Patients who underwent lateral MAT with fresh-frozen allografts between 2007 and 2016 were retrospectively reviewed. The inclusion criteria were patients with femoral or tibial chondral defects (International Cartilage Repair Society grade 4) who were followed up more than 2 years with 3.0-T magnetic resonance imaging (MRI) scans. Maximal lesion diameter and location were assessed on MRI. The patients were divided into two groups, with chondral defects of < 3 and ≥ 3 cm2 on the tibial side. Graft survivorship was compared between the two groups. Graft failure was defined as revisional MAT, meniscal tear or meniscectomy greater than one-third of the allograft on MRI. Clinical outcomes were evaluated using the modified Lysholm score. RESULTS: Twenty-eight knees in 26 patients (mean age 37.4 ± 10.3 years) with a mean follow-up of 3.6 ± 1.0 (range 2.0-5.4) years were identified. Nineteen knees in 17 patients had both femoral and tibial chondral defects, 7 knees in 7 patients had only femoral chondral defects, and 2 knees in 2 patients had only tibial chondral defects. The mean preoperative femoral and tibial chondral defect sizes were 1.7 ± 1.2 and 3.0 ± 1.4 cm2, respectively. Among the seven graft failures, no graft failure occurred in the cases with tibial chondral defects of < 3 cm2. Tibial chondral defects of ≥ 3 cm2 were significantly associated with graft failure (P = 0.004; odds ratio 28.3; 95% confidence interval 2.5-4006.7). Defects of < 3 cm2 were located primarily in the posterior aspect of the lateral tibial plateau, and most lesions were covered by allograft (7/9, 77.8%). The modified Lysholm scores significantly improved irrespective of chondral defects size (P < 0.001). CONCLUSIONS: Larger chondral defects, more than 3 cm2 on the tibial side, were associated with inferior graft survivorship but did not influence the clinical outcomes after MAT at the 3.6-year follow-up. Chondral defect location was associated with defect size. LEVEL OF EVIDENCE: IV.

Volumetric assessment of extrusion in medial meniscus posterior root tears through semi-automatic segmentation on 3-tesla magnetic resonance images.

BACKGROUND: Many reports have described the relationship between medial meniscus posterior root tears (MMPRTs) and meniscal extrusion on coronal magnetic resonance (MR) images. However, volumetric assessment of meniscal extrusion has not been performed, and the correlation between extrusion length and volume remains unclear. HYPOTHESIS: Extrusion in both length and volume would be greater in MMPRTs than that in the normal medial meniscus, and the extrusion length measured on coronal MR images would be correlated with the extrusion volume. PATIENTS AND METHODS: A total of 20 knees who underwent isolated MMPRTs without trauma history were included in the MMPRT group, and another 20 knees with normal medial meniscus were selected as the control group. All 40 knees underwent 3-tesla MR imaging. The extrusion length of the medial meniscus was measured using coronal MR images only. Volumetric assessments of the meniscus were performed and analyzed via a semi-automatic segmentation. Group-wise comparisons of the extrusion length and volumetric values were conducted, and the correlation between the two measures in both groups was evaluated. RESULTS: The mean extrusion length of the medial meniscus in the MMPRT group was significantly longer (2.60 vs. 0.63mm; p<0.001) than that in the control group. The mean extrusion volume was also significantly higher in the MMPRT than that in the control group (770.93 vs. 193.80 mm3; p<0.001). The extrusion length was significantly and positively correlated with the extrusion volume in both groups (R=0.64; p=0.002 in MMPRT, R=0.73; p<0.001 in the control group). DISCUSSION: Semi-automatic segmentation was used to measure the volume of meniscal extrusion, which had previously only been estimated indirectly with the extrusion length on coronal MR images. MMPRTs significantly increased the extrusion in both measures. The extrusion length measured on coronal MR images was positively correlated with the extrusion volume in both groups. LEVEL OF EVIDENCE: III, Case-control study.

There Is No Difference in Radiographic Outcomes After Average 9 Years After Arthroscopic Partial Medial Meniscectomy for Both Posterior Horn Tears and Posterior Horn Root Tears.

PURPOSE: To compare the serial changes in radiographic outcomes in terms of the mechanical axis (MA) angle and medial joint space width (JSW) between medial meniscus posterior root tear (MM PRT) and non-root tear (MM NRT) after arthroscopic partial meniscectomy (APM). METHODS: Patients who underwent APM for degenerative MM PRT or MM NRT from January 1999 to July 2012 were retrospectively reviewed. One hundred ten patients each in the MM PRT group and the MM NRT group, who were matched through propensity score matching (adjusting for confounding factors such as age, sex, body mass index, anatomic axis, cartilage state of the medial compartment, and follow-up period), were included in the study. The MA angle on weightbearing whole-leg radiographs and the medial JSW on weightbearing 45° flexion posteroanterior radiographs were measured to evaluate the radiographic outcomes. The serial changes were compared between radiographs taken before surgery, at postoperative 3 to 5 years, and at postoperative 5 years to the last follow-up. The linear mixed model was used to compare the changes in radiographic outcomes during the follow-up period between groups. RESULTS: The 2 groups were balanced with standardized mean differences of <0.2 after propensity score matching. Both the MM PRT and NRT groups showed increased varus alignment after surgery. However, there was no significant difference in the change in the MA angle during the follow-up period between groups (P = .182). The medial JSW also showed progression of joint space narrowing after surgery in both groups; however, there was no significant difference in the change in medial JSW during the follow-up period between groups (P = .270). CONCLUSION: The radiographic outcomes after partial meniscectomy in terms of the MA angle and medial JSW show comparable results between degenerative MM PRT and NRT after proper matching of confounding factors. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Postoperative alignment but not femoral coronal bowing is a significant longevity factor after total knee arthroplasty.

BACKGROUND: Femoral coronal bowing (FCB) has been reported to be a risk factor for mechanical malalignment after total knee arthroplasty (TKA). However, the effects of FCB on the long-term survivorship (when postoperative mechanical alignment (MA) is neutral after TKA) have not been determined. HYPOTHESIS: The effects of FCB on the cumulative survivorship after TKA may be significantly smaller compared with those of MA. PATIENTS AND METHODS: Consecutive 328 knees of 211 patients (10 males, 201 females) who underwent TKA between 1995 and 2009 (mean age of 64.2±6.7 years at the time of TKA, mean follow-up period of 11.9±2.5 years) were retrospectively evaluated. FCB and MA were evaluated using preoperative and immediate postoperative whole-leg anteroposterior radiographs, respectively. The patients were grouped according to FCB and postoperative MA, which included group A (FCB≤5°, MA≤3°), B (FCB>5°, MA≤3°), C (FCB>5°, MA>3°), and D (FCB≤5°, MA>3°). Primary end-point was defined as aseptic mechanical failures requiring revision TKA. Survivorship was assessed using the Kaplan-Meier method and compared using log-rank tests. Factors associated with the risk of aseptic mechanical failures were analyzed by Cox regression analysis. Preoperative and final follow-up clinical outcomes were assessed using Hospital for Special Surgery (HSS) scores. RESULTS: Group A, B, C, and D included 190, 73, 40, and 25 knees, respectively. The 10-year survivorship was similar between group A and B (96.3±1.4% vs. 98.6±1.4%; p=0.733) and group C and D (87.3±5.3 vs. 87.6±6.7%; p=0.974); however, it was significantly higher in group B than in group C (p=0.036) and in group A than in group D (p=0.005). Age (OR=0.991; 95% CI 0.906-1.085; p=0.002) and MA>3° (OR=3.645; 95% CI 1.744-7.604; p=0.001) were associated with the risk of aseptic mechanical failures. The mean preoperative and final HSS scores in the four groups were not significantly different. DISCUSSION: Marked FCB was not associated with long-term survivorship for knees with neutral alignment after TKA. However, non-neutral postoperative alignment reduced long-term survivorship for knees with marked FCB. LEVEL OF EVIDENCE: III, Retrospective comparative cohort study.

Degenerative medial meniscus posterior root tear and non-root tear do not show differences in joint survival and clinical outcome after partial meniscectomy.

PURPOSE: No comparative studies of outcomes between degenerative medial meniscus posterior root tear (MM PRT) and non-root tear (NRT) have been conducted. This study aimed to compare joint survival and clinical outcome between MM PRT and MM NRT after partial meniscectomy with proper control of confounding factors. METHODS: One hundred and ten patients each in MM PRT and MM NRT groups who underwent arthroscopic partial meniscectomy were retrospectively evaluated through propensity score matching. Joint survival was assessed on the basis of surgical and radiographic failures. Clinical outcomes were assessed using the Lysholm score. RESULTS: The confounding variables were well balanced between the groups, with standardized mean differences of < 0.2 after propensity score matching. Failures occurred in 30 (27.3%) and 35 patients (31.8%) in the MM PRT group and MM NRT group, respectively. The estimated mean survival times were 12.5 years (95% confidence interval [CI] 11.5-13.5) and 11.7 years (10.7-12.7), respectively. There were no significant differences in the overall survival rate and Lysholm score between the two groups (n.s.). CONCLUSION: In middle-aged patients with degenerative MM PRT, joint survival and clinical outcome showed comparable results with those with MM NRT after partial meniscectomy. Arthroscopic partial meniscectomy is one of the effective treatments for MM PRT with consideration of various patient factors. LEVEL OF EVIDENCE: III.

Morphologic MRI changes of the anterior cruciate ligament are associated with an increase in the medial tibial plateau bony slope after medial opening wedge high tibial osteotomy in a non-injured ACL population.

BACKGROUND: Medial opening wedge high tibial osteotomy (OWHTO) is a useful treatment for medial osteoarthritis. However, OWHTO sometimes causes a change in tibial slope in the sagittal plane. Although several studies have described the effects of the tibial slope on the biomechanics of the knee, including the anterior cruciate ligament (ACL), there has been little study of the magnetic resonance imaging (MRI) visible changes occurring to the native ACL and the factors affecting them after OWHTO. HYPOTHESIS: We hypothesized that morphologic MRI changes to an uninjured ACL after OWHTO would be associated with increased medial tibial plateau bony slope. PATIENTS AND METHODS: Thirty-three patients who underwent OWHTO and pre/postoperative MRI were included in this retrospective study. The mean period of follow-up MRI was 22.35 (±14.78) months. The patients were divided into two groups according to the occurrence of postoperative ACL morphologic MRI changes defined as mucoid degeneration, ganglion cyst occurrence, or change in the ACL fiber shape (stationary group n=21, altered group n=12). The medial tibial plateau bony slope (MTS) and anterior tibial translation (ATT) were evaluated on MRI. Logistic regression analysis was used to determine factors affecting the occurrence of postoperative ACL morphologic changes. RESULTS: Postoperative MTS and the difference between pre- and post values (ΔMTS), postoperative ATT and the difference between pre- and post values (ΔATT) were significantly different between stationary and altered groups. ΔMTS was associated with postoperative morphologic changes to the ACL (odds ratio: 0.30, 95% confidence interval=0.11-0.82, p=0.019). CONCLUSION: The occurrence of morphologic ACL change after OWHTO is associated with the amount of MTS change. LEVEL OF EVIDENCE: III, Retrospective comparative study.

The analysis of treatment of aggressive fibromatosis using oral methotrexate chemotherapy.

BACKGROUND: Aggressive fibromatosis is a rare but invasive tumor infiltrating widely between fascia and muscle fibers. It has a high tendency to be locally recurrent despite complete resection. Effectiveness of adjuvant treatment for aggressive fibromatosis including radiotherapy, pharmacological agents, hormonal treatments, and chemotherapy have been previously reported. The purpose of this article was to collect and analyze all information regarding the effectiveness and side effects of oral methotrexate in aggressive fibromatosis. METHODS: From 2005 to 2011, eleven patients with aggressive fibromatosis treated with oral methotrexate at our institution were analyzed in this study. Oral methotrexate was administered once per week at 10 mg per week. Authors collected information about effectiveness concerning cases of local recurrence and metastasis. RESULTS: Eleven patients had remission, two patients had local recurrence. Fatal complications or toxicity were not observed. CONCLUSIONS: Oral methotrexate given at this dose and schedule was considered as a useful treatment in primary inoperable fibromatosis and recurrent fibromatosis.