Shoulder MR Arthrography: Comparative Evaluation of Three Different Contrast Injection Techniques Using an Anterior Approach.

BACKGROUND: MR arthrography (MRA) is commonly used in the assessment of shoulder internal derangements. Correct intra-articular contrast injection is required for this modality. Anterior injections under fluoroscopic, ultrasound-guidance, or without image-guidance have been described in the literature. However, no simultaneous comparison has been performed between the three techniques. PURPOSE: To compare the accuracy and performance of fluoroscopy (FL)-guided, ultrasound (US)-guided and non-image-guided intra-articular contrast injection via an anterior approach for performing shoulder MRA. STUDY TYPE: Prospective. SUBJECTS: Two-hundred and ten patients (180 men and 30 women; mean age, 33 ± 12 years; range 20-60 years) with clinically suspected shoulder pathology. FIELD STRENGTH/SEQUENCE: 1.5T/fat-suppressed T1 -weighted, T2 -weighted, and 3D-gradient-echo images. ASSESSMENT: Patients underwent shoulder MRA after anterior intra-articular contrast injection under FL- or US-guidance or without image-guidance. Patients were randomized among the three techniques with each group comprising 70. The techniques were compared according to the accuracy of intra-articular needle placement, attempts success rate, pain during and 24 hours after injection, procedure times, contrast extravasation rate, joint distension, and MRA diagnostic efficacy. Pain was assessed by the visual analog scale (VAS) pain-score. STATISTICAL TESTS: Pearson's chi-squared and Kruskal-Wallis tests. RESULTS: FL- and US-guided injections (100% accuracy) were significantly more accurate than non-image-guided (85.7% accuracy) (P < 0.05). US-guidance was the least painful, with statistical differences between image-guided and non-image-guided techniques regarding the first attempt success rate (95.7% and 92.8% for FL- and US-guided vs. 78.6% for blinded), VAS-score 24 hours-post-procedure (1.7 ± 1.7, and 1.5 ± 1.4 vs. 2.2 ± 1.4), procedure time (11.9 ± 1.6, and 7.4 ± 1.7 vs. 4.3 ± 0.76 minutes), and contrast extravasation rate (5.7%, and 8.6% vs. 30%) (all P < 0.05). Procedure time was also significantly different between FL and US-guidance (P < 0.05). DATA CONCLUSION: Imaging-guided injections are more accurate and tolerable than non-image-guided and should be considered to confirm intra-articular needle position, hence adequate capsular distension and good diagnostic quality of shoulder MRA. US guidance is a less painful, rapid, and safe alternative to the FL approach. Evidence Level: 2 Technical Efficacy Stage: 5. J. MAGN. RESON. IMAGING 2021;53:481-490.

Orthopaedic publications from Egypt in the last five years: a bibliometric report.

INTRODUCTION: This review was done to find the trend for orthopaedic publications from Egypt in the last 5 years, detailing the specialties that are most published and comparing this with the surrounding Middle East region. METHODS: The search included orthopaedic-related articles published in journals that are listed in PubMed, including author affiliation from Egypt between 2013 and 2017. RESULTS: Four hundred eighty-one publications were found. The results showed that Trauma was the highest published branch while Arthroscopy has shown the highest increase since 2013 to become as Trauma by 2017. Two hundred seventy-two articles were published in Q1 and Q2 journals which represents 56.54% from the total publications. There were 1243 citations for these publications. The country ranking was between the fourth and fifth in Middle East region over the last five years. DISCUSSION: Publications are an important part of each country's research work. The trend for orthopaedic publication is showing an increase in subspecialty publications with a gradual increase in number of publications per year, while Egypt's position remains in the top five in the region.

In vivo molecular imaging of HER2 expression in a rat model of Barrett's esophagus adenocarcinoma.

Human epidermal growth factor receptor 2 (HER2) is involved in the malignant progression of several human cancers, including esophageal adenocarcinoma (EAC). The purpose of this study was to evaluate HER2 overexpression and to explore the feasibility of confocal laser endomicroscopy for in vivo molecular imaging of HER2 status in an animal model of Barrett's-related EAC. Rats underwent esophagojejunostomy with gastric preservation. At 30 weeks post-surgery, the esophagus of 46 rats was studied; endoscopic and histological findings were correlated with HER2 immunofluorescence on excised biopsies and gross specimens. At this age, 23/46 rats developed Barrett's esophagus (BE), and 6/46 had cancer (four EAC and two squamous cell carcinomas). A significant overexpression of HER2 was observed in esophageal adenocarcinoma compared with normal squamous esophagus (9.4-fold) and BE (6.0-fold). AKT and its phosphorylated form were also overexpressed in cancer areas. Molecular imaging was performed at 80 weeks post-surgery in four rats after tail injection of fluorescent-labeled anti-HER2 antibody. At this age, 3/4 rats developed advance adenocarcinoma and showed in vivo overexpression of HER2 by molecular confocal laser endomicroscopy with heterogeneous distribution within cancer; no HER2 signal was observed in normal or Barrett's tissues. Therefore, HER2 overexpression is a typical feature of the surgical induced model of EAC that can be easily quantified in vivo using an innovative mini-invasive approach including confocal endomicroscopy; this approach may avoid limits of histological evaluation of HER2 status on 'blinded' biopsies.

Modified subpectoral biceps tenodesis.

PURPOSE: The proximal part of the long head of the biceps muscle has become a recognized cause of significant shoulder pain. Tenodesis of the long head of the biceps has been advocated as a treatment for pain resulting from biceps tendonopathy, biceps instability, and biceps tendon tears. All of these pathologies may be encountered during rotator cuff, SLAP or Bankart surgery, or in isolation. Several techniques have been described for this tenodesis, including various arthroscopic and subpectoral methods. METHODS: We present a modified bone bridge technique of Mazzocca et al., for subpectoral biceps tenodesis. In this technique we tenodese the tendon through two bone tunnels back over the muscle itself without implants. RESULTS: Application of this technique on 30 patients (ages 25-48 years) with short-term follow-up of 12-18 months showed statistically significant improvement (P value < 0.05) of the mean Constant and Oxford shoulder scores (pre-operative mean scores were 39.03 and 21.3, respectively, while postoperative mean scores were 76.43 and 44.8, respectively). CONCLUSION: This technique has potential advantages as it allows the possibility of adjusting the tension of the biceps tendon before final suturing, in addition to quicker soft tissue healing.

Burnout syndrome (BOS) among resident doctors in an Egyptian tertiary care university hospital: Prevalence and determinants during the COVID-19 pandemic.

OBJECTIVES: The current study aimed to detect the BOS prevalence and determinants among residents working during the second wave of the COVID-19 pandemic in an Egyptian tertiary university referral hospital. METHODS: A cross-sectional study evaluating the working period from June to November 2020 during the COVID-19 pandemic second wave, through a five sections questionnaire evaluating: 1 - sociodemographic characteristics, 2 - job characteristics, 3 - negative thoughts related to their job, 4 - resident's health problems, and 5 - evaluating BOS through Maslach Burnout Inventory (MBI) scale (including emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA] as subscales). RESULTS: We included 230 residents with a median age of 27 years. The median MBI sub-scales (IQ Range) values were 30.0 (20, 39), 21.0 (15, 30), and 29.5 (22, 36) for EE, DP, and PA, respectively. About 51.0% and 83.0% of the residents were high in EE and DP, while 8.7% were low in PA. The median EE and DP were higher in younger age (⩽27 years; p = .002 and .024), males (p = .001 and <.001), working >90 hours weekly (p = .016 and <.001), exposure to harassment (p < .001), and having COVID-19 infection (p = .002 and .001). Residents working in surgical departments reported higher DP scores than those in non-surgical departments (p = .03). There was a mild positive correlation between working hours per week and the total scores in EE and DP, r = .24 (p < .001) and r = .23 (p = .001) respectively, while it was found to have a negative correlation with the PA (r = -.133 and p = .044). CONCLUSIONS: The BOS is evident and considerably high among the residents working during the COVID-19 pandemic. Younger age, males, working in surgical departments, and those who got COVID-19 infection were most vulnerable.

Bacterial Compositional Shifts of Gut Microbiomes in Patients with Rheumatoid Arthritis in Association with Disease Activity.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disabling autoimmune disorder. Little is known regarding the association between the gut microbiome and etiopathogenesis of RA. We aimed to dissect the differences in gut microbiomes associated with RA in comparison to healthy individuals and, in addition, to identify the shifts in the bacterial community in association with disease activity; Methods: In order to identify compositional shifts in gut microbiomes of RA patients, V3-V4 hypervariable regions of 16S rRNA were sequenced using Illumina MiSeq. In total, sixty stool samples were collected from 45 patients with RA besides 15 matched healthy subjects; Results: Notably, RA microbiomes were significantly associated with diverse bacterial communities compared with healthy individuals. Likewise, a direct association between bacterial diversity and disease activity was detected in RA patients (Kruskal Wallis; p = 0.00047). In general, genus-level analysis revealed a positive coexistence between RA and Megasphaera, Adlercreutzia, Ruminococcus, Bacteroides, Collinsella, and Acidaminococcus. Furthermore, Spearman correlation analysis significantly stratified the most dominant genera into distinct clusters that were mainly based on disease activity (r ≥ 0.6; p ≤ 0.05). The predictive metabolic profile of bacterial communities associated with RA could support the potential impact of gut microbiomes in either the development or recovery of RA; Conclusions: The overall shifts in bacterial composition at different disease statuses could confirm the cross-linking of certain genera either to causation or progression of RA.

Vascular obstruction at the level of the ankle joint as a complication of hip arthroscopy.

We report a case of foot vascular obstruction as a complication of hip arthroscopy. A 23-year-old female patient underwent hip arthroscopy for femoroacetabular impingement. The duration of the procedure was 80 minutes, including 20 minutes with traction for arthroscopy of the central compartment and 60 minutes without traction for cam treatment in the peripheral compartment. Three days postoperatively, the patient complained of a cold foot and pain and paresthesia during leg and foot elevation with continuous passive motion therapy. With persisting symptoms, she was seen by the referring physician 4 days postoperatively. Pulselessness at the level of the ankle and reduced capillary perfusion were observed. Doppler sonography and magnetic resonance angiography showed an occlusion of the peroneal, posterior tibial, and anterior tibial arteries at the level of the right ankle. The patient was readmitted to the hospital and underwent intravenous prostaglandin E1 therapy for 9 days, followed by oral clopidogrel treatment for 6 weeks. After 8 weeks, follow-up Doppler sonographic findings were normal. Subjective paresthesia and sensation of coldness resolved completely after 6 months. Possible theories for this complication and strategies on how to avoid it are discussed.

Multidetector CT for thorn (wooden) foreign bodies of the knee.

PURPOSE: Thorn (wooden) foreign bodies of the knee present a challenge in their diagnosis. Partly because of inaccurate history and sometimes a long duration of symptoms, radiographs are negative and MRI may show synovitis without a specific pathology. METHODS: We report a case of a 16-year-old male patient with a date palm thorn foreign body, which caused septic arthritis. He underwent two open surgeries. Both failed to detect the loose body. An MRI of the knee showed a high signal in the posterolateral compartment; however, the pathology could not be confirmed except by 64 Multidetector CT (MDCT) that clearly identified the thorn and its location. RESULTS: Arthroscopic removal and synovectomy were done by a 4-portal technique. The patient went on to complete recovery. CONCLUSION: Multidetector CT has proven very useful in identifying wooden foreign bodies, their size and location.

Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ.

METHODS: Fourteen patients with aseptic fractures that failed to unite after intramedullary nailing (IMN) of the femur were treated by augmentation of fixation by dynamic compression plate (DCP) with the nail in situ. In six of them that had axial or rotational malalignment, direct reduction of the bone fragments and plating were done. Iliac bone grafting was performed in nine cases, when there were gaps between the fragments and in atrophic non-unions. Patients were followed-up for an average of 26 months. RESULTS: All patients had radiological union in an average of 4.3 months with an improvement in alignment, range of motion and shortening. CONCLUSIONS: For failed IMN of the femur, augmentation of fixation by compression plate, with the nail in situ, is a good line of treatment. In cases with malalignment, correction was possible followed by plate augmentation.

Fibula-pro-tibia in plating tibial non-unions.

PURPOSE: Plating non-unions of the tibial diaphysis often presents the technical problem of poor purchase of screws due to osteoporosis. To improve the stabilization, insertion of one or more screws through the plate across the tibio-fibular space to the fibula (fibula-pro-tibia plating) has been practiced. The aim of this study is to evaluate the effectiveness of the fibula-pro-tibia plating technique in managing difficult diaphyseal tibial non-unions. METHODS: Between 2000 and 2008, 30 patients with diaphyseal non-union of tibia were managed with this technique. The time between injury and index operation ranged between six and 24 months (average, 11 months). Sixteen patients had three surgical procedures before the index operation, ten had two procedures and four patients had one. RESULTS: The duration of follow-up ranged between ten and 38 months (average 26 months). The mean healing time was 3.5 months. Complications were minimal and included two cases of delayed union which required regrafting after four months and two cases, which had infected nonunion, had reactivation of the infection, which resolved completely after achieving union and removing the plates. There was no negative effect from this fixation technique on the ankle joint motion. CONCLUSION: The fibula-pro-tibia plating technique is an effective variation in plating diaphyseal tibial non-unions.

SCRT1 is a novel beta cell transcription factor with insulin regulatory properties.

Here we show that scratch family transcriptional repressor 1 (SCRT1), a zinc finger transcriptional regulator, is a novel regulator of beta cell function. SCRT1 was found to be expressed in beta cells in rodent and human islets. In human islets, expression of SCRT1 correlated with insulin secretion capacity and the expression of the insulin (INS) gene. Furthermore, SCRT1 mRNA expression was lower in beta cells from T2D patients. siRNA-mediated Scrt1 silencing in INS-1832/13 cells, mouse- and human islets resulted in impaired glucose-stimulated insulin secretion and decreased expression of the insulin gene. This is most likely due to binding of SCRT1 to E-boxes of the Ins1 gene as shown with ChIP. Scrt1 silencing also reduced the expression of several key beta cell transcription factors. Moreover, Scrt1 mRNA expression was reduced by glucose and SCRT1 protein was found to translocate between the nucleus and the cytosol in a glucose-dependent fashion in INS-1832/13 cells as well as in a rodent model of T2D. SCRT1 was also regulated by a GSK3ß-dependent SCRT1-serine phosphorylation. Taken together, SCRT1 is a novel beta cell transcription factor that regulates insulin secretion and is affected in T2D.

Does arthroscopic patellar denervation with high tibial osteotomy improve anterior knee pain?

PURPOSE: Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. METHODS: Forty-five patients [females/males, 27/18; age, 30-59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. RESULTS: After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p < 0.001). For group A, the average KOOS improved from 42.73 to 72.38 (p < 0.001) and the Kujala score improved from 42 to 74.1 (p < 0.001), whereas in group B, the average KOOS improved from 39.22 to 56.84 (p < 0.001) and the Kujala score improved from 39.7 to 56.4 (p < 0.001). CONCLUSION: Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. LEVEL OF EVIDENCE: Level I prospective randomised control clinical trial.

Opening-wedge high tibial osteotomy without bone graft.

Open wedge high tibial osteotomy has become the trend for correction of varus knee deformities. The drawbacks were the need of autogenous bone graft with its associated morbidity, and later the use of bone substitutes with their cost and delayed healing. In this study, a total of 58 consecutive patients underwent high tibial osteotomy with internal fixation by wedge (toothed) plate and screws without bone graft, from 2004 to 2008. Age of the patients ranged from 24 to 65 years. There were 37 women and 21 men. The osteotomy opening size ranged from 8 to 14 mm. The mean follow-up was 38 months. The osteotomy united in all patients. Average time to union was 12.4 weeks (range 8-16 weeks). Partial loss of correction occurred in one osteotomy. There was significant difference between the healing time and the size of the osteotomy opening. The results at the final follow-up using the HSS score were excellent in 51 knees (88%) and good in seven knees (12%). Despite the routine addition of bone graft as a part of the high tibial osteotomy procedure, this study supports medial opening-wedge high tibial osteotomy up to 14 mm without bone graft or bone substitutes, which shortens the operative time and avoids unnecessary morbidity.

Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck.

Non-union of femoral neck fractures may occur due to mechanical and biological factors. Valgus intertrochanteric osteotomy (VITO) alters hip biomechanics and enhances fracture union. The double-angled 120° plate is usually used for internal fixation of the osteotomy. It allows the osteotomy to heal with medialisation and verticalisation of the femoral shaft. This deformity causes medial ligament strain of the knee joint, genu valgum and ultimately osteoarthritis. This work presents our experience in treating vertical fractures and non-unions of the femoral neck by VITO and fixation by a single-angled 130º plate. Thirty-six patients presented with 19 recent vertical femoral neck fractures, and 17 non-unions were included. They were 26 men and ten women, and their ages averaged 37 years. Preoperative planning and VITO technique are described. Union was achieved in 35 patients (97%), and one recent fracture failed to unite (3%). Time to fracture union averaged four months in recent fractures and eight months in un-united fractures. All patients with united fractures had an almost normal configuration of the upper femur. Avascular necrosis of the femoral head was reported in five patients. Twenty-two patients (61%) were pain free, nine (25%) had hip pain on lengthy walks and the remaining five (14%) had persistent pain. Preoperative limb shortening averaged 2.5 cm, and post-operative shortening averaged 0.5 cm. We recommend VITO and fixation by a single-angled 130º plate for vertical femoral neck fractures and non-unions in relatively young adult patients.

Technique and short-term results of ankle arthrodesis using anterior plating.

Clinical and biomechanical trials have shown that rigid internal fixation during ankle arthrodesis leads to increased rates of union and is associated with a reduced infection rate, union time, discomfort and earlier mobilisation compared with other methods. We describe our technique of ankle arthrodesis using anterior plating with a narrow dynamic compression plate (DCP). Between 2004 and 2007, 29 patients with a mean age of 24.4 years (range 18-42) had ankle arthrodesis using an anteriorly placed narrow DCP. Twenty-two patients were post-traumatic and seven were paralytic (five after spine fracture and two after common peroneal nerve injury). Follow-up was between 12 and 18 months (average 14 months). A rate of fusion of 100% was achieved at an average of 12.2 weeks. According to the Mazur ankle score, 65.5% had excellent, 20.7% good and 13.8% fair results. Ankle arthrodesis using an anteriorly placed narrow DCP is a good method to achieve ankle fusion in many types of ankle arthropathies.

The Efficacy of Resin Infiltrant and Casein Phosphopeptide-amorphous Calcium Fluoride Phosphate in Treatment of White Spot Lesions (Comparative Study).

BACKGROUND: White spot lesions (WSLs) are considered as the first sign of the progression of dental caries that can be reversed. Casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) varnish can promote remineralization process of the demineralized tooth structure. Also, WSLs can be managed by using caries infiltrant (ICON), which infiltrates etched enamel surface of the WSLs. OBJECTIVES: The main aim was to evaluate and compare the efficacy of ICON versus CPP-ACFP varnish to treat WSLs in the same oral environments. MATERIALS AND METHODS: A total of 30 participants aged 20-40 years with at least two WSLs have participated in this trial. Split-mouth technique has been used in this trial where WSLs on the left side have been treated with ICON, whereas WSLs on the right side have been treated with CPP-ACFP varnish. Clinical evaluation using DIAGNOdent was carried out at baseline, 1 week, 1, 3, 6, and 12 months after application to determine the effectiveness of these materials in treating WSLs. RESULTS: Significant differences were observed between all follow-up DIAGNOdent scores compared to baseline readings of both ICON and CPP-ACFP (P = 0.000 for all comparisons). Statistically significant differences were observed between DIAGNOdent scores of ICON compared to CPP-ACFP at all follow-up intervals (P = 0.006, 0.008, 0.045, 0.036, and 0.000). CONCLUSION: Both ICON and CPP-ACFP were effective in the treatment of WSLs of smooth surfaces but the efficacy of CPP-ACFP was better than ICON.

Results of meniscal injuries repair using different arthroscopic techniques.

AIM: Evaluation of clinical and radiological outcomes following meniscal repair using different arthroscopic techniques for all meniscal tears amenable for repair. METHODS: Sixty-one patients were involved in a prospective study; all cases presented with meniscal tears underwent arthroscopic meniscal repair from December 2016 to December 2017. Outcomes involved the site of tear, the repair technique, and associated injuries. The International Knee Documentation Committee Score (IKDC) and Tegner Lysholm Knee Score were used to analyze the clinical and functional outcomes postoperatively. RESULTS: Of the 61 patients, 50 patients (81.9%) had meniscal tear associated with isolated ligamentous ACL injury, 6 cases had corrective osteotomy with ACL reconstruction to correct concomitant genu varus, 2 cases (3.3%) had meniscal tear associated with isolated ligamentous PCL injury, and 9 patients (14.8%) presented with isolated meniscal tear; IKDC was preoperatively (44.52 ± 8.79), postoperatively at 6 months (90.97 ± 6.75) and at 12 months (92.27 ± 2.68) with P-value (0.001). Tegner Lysholm score was preoperatively (52.16 ± 12.22), postoperatively at 6 months (88.03 ± 6.84) and at 12 months (93.26 ± 2.95) with P-value (0.001). Fifty eight patients (95.1%) had no postoperative symptoms at 6 and 12 months' follow-up. The remaining 3 cases (4.9%) underwent partial meniscectomy due to persistent postoperative clinical symptoms with no signs of healing in MRI. CONCLUSIONS: Our study concluded that arthroscopic meniscal repair is an effective way in the management of meniscal tears regarding clinical and functional outcomes.

Delayed union of multifragmentary diaphyseal fractures after bridge-plate fixation.

Despite recent developments in fracture treatment, cases of non-union after long bone fractures are still encountered. This work aims at evaluating the active management of delayed union after the bridge-plate fixation of multifragmentary diaphyseal fractures by a limited surgical interference. Nineteen patients were included. All had revision surgery for delayed union of multifragmentary diaphyseal fractures after bridge-plate fixation. The period between primary and revision surgery was 12-20 weeks. Increasing stability was performed by adding more screws in all cases. Interfragmentary compression was performed in 16 patients. Axial compression of the fracture was applied in two patients, while one patient had the plate exchanged for a longer one. Bone grafting was added in nine patients. Union was achieved in all patients 8-16 weeks after re-operation. This work is a message for timely surgical interference in delayed union after bridge-plate fixation by a limited surgical procedure, before complete failure of the fracture stabilisation or non-union.

Arabic translation and validation of three knee scores, Lysholm Knee Score (LKS), Oxford Knee Score (OKS), and International Knee Documentation Committee Subjective Knee Form (IKDC).

AIM OF THE WORK: Translation and validation of three commonly used knee scores to Arabic language: the Lysholm Knee Score (LKS), the Oxford Knee Score (OKS), and IKDC Subjective Knee Form. METHODS: Our work focused on translation and validation of the LKS, OKS and IKDC. Construct validity was assessed by comparing the LKS, OKS, and IKDC Subjective Knee Form and previous Arabic translated version of Knee injury and Osteoarthritis Outcome Score (KOOS). Test-retest reliability, internal consistency, and construct validity were assessed, using Intraclass Correlation Coefficient (ICC), Cronbach's alpha, and Pearson correlation coefficient (r). RESULTS: Reliability was excellent for the Arabic IKDC subjective form (0.95), while the Arabic LKS and the Arabic OKS were good: 0.8 and 0.85, respectively. The Cronbach's ά was excellent for the Arabic LKS and Arabic OKS: 0.9 and 0.90, respectively, while the Arabic IKDC subjective form was good (0.89). Construct validity was high for the Arabic LKS and the Arabic OKS: 0.7 and 0.913, respectively, while the Arabic IKDC was moderate (0.4) in cases of ACL and meniscus injuries and mild (0.18) in cases of osteoarthritis. CONCLUSION: Arabic LKS and Arabic OKS were reliable and valid scores for patients complaining of ligamentous injuries, meniscus injuries, and osteoarthritis to be used for Arabic-speaking people, while the Arabic IKDC had excellent reliability and mild validity in cases of osteoarthritis and moderate validity in cases of ACL and meniscus injuries.