Prevalence of Articular Surface Injuries in Patients Undergoing Meniscal Surgery: A Retrospective Analysis of 758 Cases.

Background and aim Meniscal tears are often associated with articular surface damage, which could be an important factor in the clinical outcome. However, these concomitant lesions are usually reported as binary variables. Reports of the severity/extent of the concomitant lesions and stratification by meniscal tear are scarce in the literature; in addition, sample sizes of previous reports are limited. This study aimed to characterize meniscal lesions, determine the prevalence of articular surface lesions and their severity, and correlate these lesions with meniscal injury characteristics. Methods A cross-sectional study of patients undergoing meniscal surgery between 2017 and 2023 was conducted. Patient characteristics and arthroscopic findings on the location and type of meniscal injury as well as the degree of chondral lesion (sICRS score) were recorded by the surgeon. Statistical analysis included frequency reporting for patient characteristics and study variables, including the median and interquartile range of the sICRS classification of articular surface lesions. Meniscal tear types were categorized as degenerative or non-degenerative to explore associations with chondral injury. Chi-square test and univariate and multivariate logistic regression models were employed to analyze relationships between variables. Results A total of 758 surgeries were analyzed, with a mean age of 39.56 years (SD: 12.71) and 67.90% male participants. Medial meniscus injuries accounted for 57.52%, lateral meniscus 36.02%, and both menisci 6.64%. Significant differences were found in vascular area, topography, and lesion type between isolated medial and lateral meniscus lesions (p<0.01). Chondral lesions were present in 35.22% of cases, with significant differences among meniscal injury types (p<0.01). Degenerative tears showed higher rates of chondral damage compared to non-degenerative tears, particularly in lateral meniscus injuries (p<0.01). Regression analysis identified age, gender, meniscal injury characteristics, and meniscectomy percentage as risk factors for articular surface injuries. Conclusion Articular surface injuries frequently accompany meniscal lesions, with associations between affected menisci and articular damage extent. Femoral condyles show greater involvement corresponding to compartment-specific meniscal lesions, unlike tibial plateaus. Meniscal degeneration is present in about half of articular cartilage injury cases. Some meniscal tear types may relate to more severe articular lesions, but larger studies are needed to confirm these findings and explore other tear patterns.

Health State Utility Values of Type 2 Diabetes Mellitus and Related Complications: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study aims to synthesize health state utility values (HSUVs) of type 2 diabetes mellitus (T2DM) and its related complications published in the literature, conducting a meta-analysis of the data when possible. METHODS: We conducted a systematic search in MEDLINE and School of Health and Related Research Health Utilities Database repository. Studies focused on T2DM and its complications reporting utility values elicited using direct and indirect methods were selected. We categorized the results according to the instrument to describe health and meta-analyzed them accordingly. Data included in the analysis were pooled in a fixed-effect model by the inverse of variance mean and random-effects DerSimonian-Laird method. Two approaches on sensitivity analysis were performed: leave-one-out method and including data of HSUVs obtained by foreign population value sets. RESULTS: We identified 70 studies for the meta-analysis from a total of 467 studies. Sufficient data to pool T2DM HSUVs from EQ-5D instrument, hypoglycemia, and stroke were obtained. HSUVs varied from 0.7 to 0.92 in direct valuations, and the pooled mean of 3-level version of EQ-5D studies was 0.772 (95% confidence interval 0.763-0.78) and of 5-level version of EQ-5D 0.815 (95% confidence interval 0.808-0.823). HSUVs of complications varied from 0.739 to 0.843, or reductions of HSUVs between -0.014 and -0.094. In general, HSUVs obtained from 3-level version of EQ-5D and Health Utility Index 3 instruments were lower than those directly elicited. A considerable amount of heterogeneity was observed. Some complications remained unable to be pooled due to scarce of original articles. CONCLUSIONS: T2DM and its complications have a considerable impact on health-related quality of life. 5-level version of EQ-5D estimates seems comparable with direct elicited HSUVs.

Coordination of the rotational movement of the pelvis and the hip in men without low back pain, with control impairment of the lumbopelvic region in the sagittal plane.

Purpose To assess the presence of control impairment (CI) of the lumbopelvic region in the axial plane in men without low back pain (LBP) with CI in the sagittal plane. Methods : Twenty-four males, between 18 and 23 of age, BMI = normal, who did not report episodes of LBP in the 12 months prior to the study, were studied. Assessment of the sagittal control of the lumbopelvic region was performed during stand to sit. Nine participants demonstrated CI in sagittal plane and 15 did not. An active hip lateral rotation (HLR) test was performed, in which lumbopelvic rotation during HLR was assessed using a three-dimensional motion analysis system. Results : Patients with CI in sagittal plane had a greater percentage of their total lumbopelvic pelvic rotation at 60% of HLR range compared to those without CI (p < 0.05; d = 0.93). No significant differences in the total lumbopelvic and HLR range of motion were found between the groups. Conclusion : Men without LBP who experience CI of the lumbopelvic region in the sagittal plane also show CI in the axial plane. The control deficiencies were not related to the total range of lumbopelvic or HLR range of motion.

Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot.

BACKGROUND: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). METHODS: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. RESULTS: The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. CONCLUSION: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.