Three-dimensional motion analysis of ten common Asian sitting positions in daily living and factors affect range of hip motions.

BACKGROUND: Sitting involves many activities of daily life and requires most motion in the hip joint. Asians have more hip flexion and external rotation motions than Westerners owing to cultural and lifestyle differences. Being aware of the normal range of hip motion is essential in clinical practice. Limited research has focused on the hip motions of common sitting positions. The objective was to determine the hip motions of 10 common sitting positions, and to determine whether gender or being overweight affects the range of hip motions. METHODS: An experimental cross-sectional study was conducted to determine hip motions by using a standard, three-dimensional, motion-analysis system. Healthy subjects performed 10 sitting positions during 3 trials. All hip-kinematic data were measured on the dominant leg of each participant, except for the right- and left-monk positions (both hips were analyzed). Density plots were constructed and statistical analyses were performed to detect the differences between groups (male and female; non-overweight and overweight). RESULTS: The 48 participants comprised 24 males and 24 females. Most were right-leg dominant (45 participants, 93.8%). Of the 22 participants in the overweight group (body mass index ≥23 kg/m2), 18 (75%) were male. Squatting showed the highest flexion angle (99.7°, 47.3°-122°). Cross-legged sitting had the highest abduction angle (28.9°, 9.9°-45.7°) and the largest external rotation angle (62°, 37.6°-81.7°). In the female group, there were trends toward a greater flexion angle (4 out of 10 sitting positions) and a smaller abduction angle (6 out of 9 positions), with P values < 0.05. As to body weight, the overweight participants had a smaller flexion angle but a greater abduction angle, with 5 out of 9 positions having a P value < 0.05. Kinematic data of the transverse plane revealed that the heterogeneity of the rotational angles depended on the sitting position. CONCLUSIONS: This study provided the functional hip motions of common Asian sitting positions. The kinematic data can be utilized in clinical practice as reference values to determine safe positions. Gender and being overweight affected the hip angles in the sagittal and frontal planes. TRIAL REGISTRATION: Number TCTR20181021004 , retrospectively registered at the Thai Clinical Trials Registry (http//:www.clinicaltrials.in.th).

Validity and reliability of smartphone applications for measurement of hip rotation, compared with three-dimensional motion analysis.

BACKGROUND: Measurement of hip rotation is a crucial clinical parameter for the identification of hip problems and the monitoring of symptoms. The objective of this study was to determine whether the use of two smartphone applications is valid and reliable for the measurement of hip rotation. METHODS: An experimental, cross-sectional study was undertaken to assess passive hip internal and external rotation in three positions by two examiners. The hip rotational angles were measured by a smartphone clinometer application in the sitting and prone positions, and by a smartphone compass application in the supine position; their results were compared with those of the standard, three-dimensional, motion analysis system. The validities and inter-rater and intra-rater reliabilities of the smartphone applications were evaluated. RESULTS: The study involved 24 participants. The validities were good to excellent for the internal rotation angles in all positions (ICC 0.81-0.94), good for the external rotation angles in the prone position (ICC 0.79), and fair for the sitting and supine positions (ICC 0.70-0.73). The measurement of the hip internal rotation in the supine position had the highest ICC value of 0.94 (0.91, 0.96). The two smartphone applications showed good-to-excellent intra-rater reliability, but good-to-excellent inter-rater reliability for only three of the six positions (two other positions had fair reliability, while one position demonstrated poor reliability). CONCLUSIONS: The two smartphone applications have good-to-excellent validity and intra-rater reliability, but only fair-to-good inter-rater reliability for the measurement of the hip rotational angle. The most valid hip rotational position in this study was the supine IR angle measurement, while the lowest validity was the ER angle measurement in the sitting position. The smartphone application is one of the practical measurements in hip rotational angles. TRIAL REGISTRATION: Number 20181022003 at the Thai Clinical Trials Registry ( http://www.clinicaltrials.in.th ) which was retrospectively registered at 2018-10-18 15:30:29.

Anterolateral ligament anatomy: a comparative anatomical study.

PURPOSE: Some anatomical studies have indicated that the anterolateral ligament (ALL) of the knee is distinct ligamentous structure in humans. The purpose of this study is to compare the lateral anatomy of the knee among human and various animal specimens. METHODS: Fifty-eight fresh-frozen knee specimens, from 24 different animal species, were used for this anatomical study. The same researchers dissected all the specimens in this study, and dissections were performed in a careful and standardized manner. RESULTS: An ALL was not found in any of the 58 knees dissected. Another interesting finding in this study is that some primate species (the prosimians: the red and black and white lemurs) have two LCLs. CONCLUSION: The clinical relevance of this study is the lack of isolation of the ALL as a unique structure in animal species. Therefore, precaution is recommended before assessing the need for surgery to reconstruct the ALL as a singular ligament.

Biomechanical evaluation contribution of the acetabular labrum to hip stability.

PURPOSE: Knowledge of the effect of hip pathologies on hip biomechanics is important to the understanding of the development of osteoarthritis, and the contribution of the labrum to hip joint stability has had limited study. The purpose of this study was to evaluate the effect of labral injury to stability of the femoral head in the acetabular socket. METHODS: Ten cadaver hip specimens were tested using a robotic system under four different loading conditions: axial loading (80 N) along the femoral axis and axial loading (80 N) combined with either anterior, posterior or lateral loading (60 N). The hip states were examined were intact, with a 1.5 cm capsulotomy and with a 1 cm resection of the anterosuperior labrum. RESULTS: At 30° of flexion, under axial load, the displacement of the hip with capsulotomy and labral resection (9.6 ± 2.5 mm) was significantly larger then the hip with capsulotomy alone (5.6 ± 4.1 mm, p = 0.005) and the intact hip (5.2 ± 3.8 mm, p = 0.005). Also, at 30° of flexion, the displacement under combined axial and anterior/posterior load was increased with capsulotomy and labral resection. CONCLUSION: The acetabular labrum provides stability to the hip joint in response to a distraction force and combined distraction and translation forces. One centimetre of labral resection caused significant displacement ("wobbling" effect) of the femoral head within the acetabulum with normal range of motion. Successful labral repair could be crucial for restoration of the hip biomechanics and prevention of coxarthrosis.

Efficacy of a Single Intra-Articular Injection of 2% Sodium Hyaluronate Plus 0.5% Mannitol in Patients with Symptomatic Osteoarthritis of the Knee: A Preliminary Report.

Background: Intra-articular injection of hyaluronic acid is widely used as a treatment for osteoarthritis of the knee. The recommended dosing regimens have generally ranged from 3 to 5 injections. Objective: To assess efficacy and safety of a single intra-articular injection of 2% sodium hyaluronate plus 0.5% mannitol in patients with symptomatic osteoarthritis of the knee. Material and Method: Twenty patients between 40-70 years of age with osteoarthritis of the knee (Kellgren-Lawrence grade II or III) were included in the study. After a 2-week NSAIDs washout period, ten patients in the intervention group received a single intra-articular 2 ml dose of the combination of 2% sodium hyaluronate and 0.5% mannitol and ten patients in the control group received no injection. No other pain-killer medication was allowed during the study except diclofenac as rescue pain medication in both groups. The efficacy parameters were the WOMAC Index and diclofenac consumption. All adverse events were recorded. Results: Patients who received a single intra-articular injection of 2% sodium hyaluronate plus 0.5% mannitol had a significant improvement from baseline in all WOMAC subscales over 24 weeks (p<0.001). Pain, stiffness, and physical function subscales were significantly lower in the intervention group than in the control group until Week 20, 12, and 16, respectively (p<0.05). Patients who received sodium hyaluronate also required significantly lower amounts of diclofenac (p<0.05). No serious adverse event related to the intervention was reported. Conclusion: Symptomatic OA knee patients who received a single intra-articular injection of 2% sodium hyaluronate plus 0.5% mannitol had better outcomes over the 24-week follow-up period than control group patients who received no injection intervention.

Prevalence of Radiographic Osteoarthritis and Structural Abnormalities of the Hip in Patients with Contralateral Hip Fractures.

Background: The prevalence of osteoarthritis (OA) of the hip varies considerably among different races and ethnicities. Some bony abnormalities associated with the development of hip OA. Objective: To determine the prevalence of radiographic OA and structural abnormalities of the hip in patients with contralateral hip fractures. Material and Method: Pelvic AP radiographs of patients more than 60 years of age who had contralateral hip fractures were reviewed. Radiographic diagnosis of hip OA was determined by minimum joint space width <2 mm. Kellgren-Lawrence classification was also used for evaluation. Structural abnormalities of the acetabulum and proximal femur regarding femoroacetabular impingement were also assessed. Results: Plain radiographs of 152 patients with an average age of 77.4 years were included. One hundred and thirteen patients (74.3%) were female. Prevalence of radiographic OA of the hip (minimum joint space width <2 mm) was 9.9%. In addition, 9.2% of hips were Kellgren-Lawrence grade 2 or higher. Pistol grip deformity was found in 6 patients and all were male. Five patients (3.3%) had cross-over sign. No protrusio acetabuli was detected. Coxaprofunda was identified in 72 patients (47.4%). Average center-edgeangle was 37.1+6.2 degrees in hips with coxaprofunda, and 35.9+5.3 degrees in hips without coxaprofunda (p = 0.180). Conclusion: Prevalence of radiographic OA of the hip in patients with contralateral hip fractures was 9.9%. Coxaprofunda was a common radiographic finding.

Femoral Nerve Block versus Intra-Articular Infiltration: A Preliminary Study of Analgesic Effects and Quadriceps Strength in Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Adequate analgesia and early rehabilitation is necessary for arthroscopic anterior cruciate ligament reconstruction (A CLR) surgery. OBJECTIVE: To compare analgesia and quadriceps strength after femoral nerve block (FNB) with intra-articular infiltration (IA) using 0.25% bupivacaine for ACLR with patella tendon graft. MATERIAL AND METHOD: Forty patients were randomized to receive FNB under ultrasound guidance with 20 mL of bupivacaine or IA with 15 mL of bupivacaine into the knee joint and 5 mL infiltrated along the incision sites including portal sites at the end of surgery. All patients received intravenous ketorolac at wound closure. Data regarding demographic, time to first pain, time to first morphine requirement, morphine usage, pain scores and quadriceps strength were recorded. RESULTS: Significant difference in quadriceps strength was shown. Ninety percent of patients in Group IA and fifty-five percent of patients in Group FNB had good ability to extend knee at 24 hours after surgery (p = 0.013). No differences were found in demographic data, time to first pain, time to first morphine requirement, post operative pain scores and morphine consumption, CONCLUSION: The preliminary results demonstrated that IA has an effect on quadriceps strength less than FNB while provide comparable postoperative analgesia after patellar tendon graft ACLR.

Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction.

PURPOSE: Recent reports have highlighted the importance of an anatomic tunnel placement for anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the effect of different tunnel positions for single-bundle ACL reconstruction on knee biomechanics. METHODS: Sixteen fresh-frozen cadaver knees were used. In one group (n = 8), the following techniques were used for knee surgery: (1) anteromedial (AM) bundle reconstruction (AM-AM), (2) posterolateral (PL) bundle reconstruction (PL-PL) and (3) conventional vertical single-bundle reconstruction (PL-high AM). In the other group (n = 8), anatomic mid-position single-bundle reconstruction (MID-MID) was performed. A robotic/universal force-moment sensor system was used to test the knees. An anterior load of 89 N was applied for anterior tibial translation (ATT) at 0°, 15°, 30° and 60° of knee flexion. Subsequently, a combined rotatory load (5 Nm internal rotation and 7 Nm valgus moment) was applied at 0°, 15°, 30° and 45° of knee flexion. The ATT and in situ forces during the application of the external loads were measured. RESULTS: Compared with the intact ACL, all reconstructed knees had a higher ATT under anterior load at all flexion angles and a lower in situ force during the anterior load at 60° of knee flexion. In the case of combined rotatory loading, the highest ATT was achieved with PL-high AM; the in situ force was most closely restored with MIDMID, and the in situ force was the highest AM-AM at each knee flexion angle. CONCLUSION: Among the techniques, AM-AM afforded the highest in situ force and the least ATT.

Responsiveness and Minimal Clinically Important Difference of the Thai Version of the International Knee Documentation Committee Subjective Knee Form in Patients With Anterior Cruciate Ligament Injury.

Background: The International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) is a knee-specific patient-reported outcome (PRO) measure that is commonly used to evaluate patients with various knee disorders. The Thai version of the IKDC-SKF (Thai IKDC-SKF) was shown to have good validity and reliability; nonetheless, no data regarding its responsiveness are available. Purpose: To evaluate the responsiveness of the Thai IKDC-SKF for assessing patients with anterior cruciate ligament (ACL) injury and determine the minimal clinically important difference (MCID) for this PRO measure. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: This prospective study included ACL-injured patients who were scheduled for ACL reconstruction (ACLR) at a single institution. The patients completed the Thai IKDC-SKF at the baseline and the 6-month postoperative follow-up. The global rating of change scale was an anchor question that evaluated patients' overall perception of a clinical change compared with their preoperative condition. The effect size and standardized response mean were calculated. The MCID was identified with an anchor-based approach by plotting a receiver operating characteristic curve and calculating the value that maximized the Youden index. Results: Of 59 enrolled patients, 53 patients (89.8%) completed the preoperative and 6-month postoperative Thai IKDC-SKF. The mean (±SD) age of the participants was 32.3 ± 10.3 years, and 86.8% were men. The mean Thai IKDC-SKF score improved significantly from preoperatively to the 6-month follow-up (from 56.3 ± 14.9 to 70.8 ± 14.1, respectively; P < .001), with an effect size of 0.975 and a standardized response mean of 0.977. A receiver operating characteristic curve was generated to determine the ability of the Thai IKDC-SKF to distinguish between improved patients and unimproved patients, and the area under the curve was 0.80 (95% CI, 0.68-0.92), which was considered excellent. The MCID was 15.5, which yielded a sensitivity and specificity of 0.55 and 1, respectively. Conclusion: This study confirmed the responsiveness of the Thai IKDC-SKF for detecting a clinical change in ACL-injured patients after ACLR. The identified MCID of 15.5 can be used to calculate the significant clinical change and sample size in future studies.

Biomechanics of the human triple-bundle anterior cruciate ligament.

PURPOSE: To investigate the biomechanics of the intermediate (IM), anteromedial (AM), and posterolateral (PL) bundles in the human anterior cruciate ligament (ACL). METHODS: Eighteen human cadaveric knees were tested with a robotic/universal force-moment sensor testing system. Anterior tibial translation (ATT) was determined under an 89-N anterior tibial load. Coupled ATT was determined under a combined rotatory load of 7-Nm valgus and 5-Nm internal rotation torque (pivot moment). Each bundle's in situ forces were measured under identical external loading conditions. RESULTS: Under anterior load, the PL bundle's in situ force was highest at 0° and decreased during flexion. Under the anterior load, the AM bundle's in situ force was significantly higher than the IM and PL bundles' force at 15°, 30°, and 60°. Under the pivot moment, the AM bundle's in situ force was significantly higher than the PL and IM bundles' force at 0° and 15°, and the IM bundle had the lowest in situ force at 0° but higher in situ force than the AM and PL bundles at 30° and 45°. IM and AM bundle removal increased ATT under the anterior load at all angles. Cutting the PL bundle after IM and AM bundle removal (whole ACL removal) significantly increased ATT under the anterior load at 0°, 15°, and 30° of knee flexion and increased coupled ATT under the pivot moment at 0° and 15°. CONCLUSIONS: The biomechanical role of each of the 3 ACL bundles (AM, IM, and PL) was measured with a robotic/universal force-moment sensor testing system. The AM bundle stabilized the knee against both the anterior and rotatory loads. The PL bundle stabilized the knee especially near full extension. The IM bundle supported the AM and PL bundles through all flexion angles, especially from 30° to 45°, against the rotatory load. CLINICAL RELEVANCE: Knowledge of functions of the different ACL bundles will help improve ACL reconstruction techniques to enable restoration of normal knee function.

Prevalence of acetabular labral tears and sublabral sulci: a cadaveric study.

OBJECTIVE: The objective of the present study was to evaluate the prevalence and location of acetabular labral tears and sublabral sulci in cadaveric hips. MATERIAL AND METHOD: Fifty hips of 25 embalmed cadavers with the mean age of 55 years (range, 18-85 years) were studied. All labral lesions were documented in their morphologic features, size and anatomic locations. RESULTS: Thirty-eight labral tears were found in 33 (66%) of 50 hips with the mean length of 17 mm (range, 8-36 mm). Twenty-two (58%) tears were located in the anterosuperior quadrant and 13 (34%) tears were identified in the posterosuperior quadrant. Thirty-one (82%) tears were detachments of the labrum form the bony acetabulum. Eight sublabral sulci were seen bilaterally in 8 hips of 4 cadavers (16%). Of these, 4 (50%) were located anterosuperiorly, 2 (25%) anteroinferiorly and 2 (25%) posteroinferiorly. CONCLUSION: The acetabular labral tears were common findings with a high prevalence. They were most commonly located in the anterosuperior quadrant of the acetabulum. Sublabral sulci are anatomic variants that can be found bilaterally in different quadrants of the hips.

Synovial osteochondromatosis mimicking juvenile idiopathic arthritis in an adolescent: a case-based review.

Synovial osteochondromatosis is an extremely rare benign condition in children and adolescents that have joint pain as a presenting manifestation. It is usually monoarticular with the knee as the most common affected joint. In this article, we describe the case of a female adolescent suffering from debilitating chronic right knee pain initially mimicking juvenile idiopathic arthritis, who was subsequently diagnosed with primary synovial osteochondromatosis. We present a review of synovial osteochondromatosis focusing on the clinical manifestations, radiographic features, histopathologic findings, and treatment, with a summarized review of pediatric patients with initial musculoskeletal presentations who were ultimately diagnosed as synovial osteochondromatosis. Although synovial osteochondromatosis is rare in children and adolescents, this condition should be included in the differential diagnosis of joint pain and may mimic juvenile idiopathic arthritis. Appropriate diagnostic radiography, including both plain radiography and magnetic resonance imaging, is necessary to accurately diagnose this condition. We also emphasize the importance of a multidisciplinary team approach to managing patients with synovial osteochondromatosis.

Cutoff Value for the Patient Acceptable Symptom State of the Thai IKDC Subjective Knee Form in Patients After Primary ACL Reconstruction.

Background: The Patient Acceptable Symptom State (PASS) cutoff is the value on a patient-reported outcome measure beyond which patients consider themselves to be "feeling well." There are limited data regarding the PASS threshold for non-English versions of the International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF). Purpose: To establish the PASS cutoff for the Thai version of the IKDC-SKF for patients undergoing primary anterior cruciate ligament reconstruction (ACLR) and to identify factors to achieve PASS after surgery. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included in this study were patients aged 18 to 50 years who had undergone primary unilateral ACLR between January 2016 and February 2020. After enrollment, patients completed the Thai IKDC-SKF and answered the anchor question for determining the PASS. Results: Questionnaires were sent to 321 patients, of whom 173 (53.9%) responded. The vast majority (156 patients; 90.2%) considered themselves to have achieved the PASS. This group of patients had significantly higher IKDC scores than did those who did not have an acceptable symptom state (79.6 ± 14.2 vs 60.7 ± 16.5; P < .001). The receiver operating characteristic curve of the IKDC score for predicting the PASS had an area under the curve of 0.82 (95% CI, 0.72-0.91). The optimum PASS cutoff of the Thai IKDC-SKF was a score of 74.2 (sensitivity, 0.72; specificity, 0.82). Factors that provided favorable odds for achieving the PASS were the use of a hamstring tendon autograft (odds ratio, 4.1; 95% CI, 1.5-20.6) and the absence of a patellofemoral chondral lesion (odds ratio, 3.8; 95% CI, 1.03-14.1). Conclusion: For patients undergoing ACLR, the cutoff for the PASS of the Thai version of the IKDC-SKF was a score of 74.2. Two surgery-related factors provided favorable odds for achieving the PASS: the use of a hamstring tendon autograft and the absence of a patellofemoral chondral lesion.

Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography.

PURPOSE: The purpose of this study was to evaluate intraobserver and interobserver reliability of anterior cruciate ligament tunnel location measurement by use of 3-dimensional reconstructed computed tomography (CT). METHODS: Three-dimensional reconstructed CT images of 31 cadaveric knees were used in this study. Twenty-one knees were operated on with a double-bundle technique, and ten knees were operated on with a single-bundle technique. Femoral tunnel location was measured with 3 methods on the medial-lateral view of the lateral femoral condyle in the strictly lateral position. Tibial tunnel location was measured in the top view of the proximal tibia. The images were evaluated independently by 2 orthopaedic surgeons. A second measurement was performed, by both testers, after a 4-week interval. RESULTS: The 3 methods of femoral tunnel location measurement had intraobserver intraclass correlation coefficients (ICCs) that ranged from 0.963 to 0.998 and interobserver ICCs that ranged from 0.993 to 0.999. Tibial tunnel measurement had intraobserver ICCs that varied between 0.957 and 0.998 and interobserver ICCs that varied between 0.993 and 0.996. CONCLUSIONS: The measurement of the anterior cruciate ligament tunnel location on 3-dimensional reconstructed CT provided excellent intraobserver and interobserver reliability. CLINICAL RELEVANCE: Three-dimensional reconstructed CT can be used for further studies to assess the effect of tunnel position on knee stability and patient outcomes.

Correlation between the 2-dimensional notch width and the 3-dimensional notch volume: a cadaveric study.

PURPOSE: The purpose of this study was to compare the size of the entrance of the notch, as measured arthroscopically (2-dimensionally), with the volume of the notch as measured by use of computed tomography (CT) (3-dimensionally). METHODS: For 20 cadaveric knees, the dimensions of the notch entrance were measured arthroscopically, and the notch volume was measured by use of CT. The correlation between the size of the notch entrance and the notch volume was calculated. Intraobserver reliability and interobserver reliability of the arthroscopic and CT measurements were tested. RESULTS: The Pearson correlation coefficients between CT-assessed notch volume and arthroscopically assessed notch height and width at the bottom, middle, and top of the notch were 0.603, 0.506, 0.551, and 0.642, respectively. The intraobserver reliability and interobserver reliability of the arthroscopic measurements were above 0.962 and 0.819, respectively, and 0.983 and 0.975, respectively, for the CT measurements. CONCLUSIONS: There were only moderate correlations between arthroscopic notch measurements and notch volume. Both the arthroscopic and CT measurements proved highly reliable. CLINICAL RELEVANCE: The moderate correlation between 2-dimensional and 3-dimensional notch measurements warrants caution concerning the use of either measurement for assessing risk for anterior cruciate ligament injury or as justification for notchplasty until studies between the relation of 3-dimensional notch volume and anterior cruciate ligament injury are conducted.

A biomechanical comparison of 2 femoral fixation techniques for anterior cruciate ligament reconstruction in skeletally immature patients: over-the-top fixation versus transphyseal technique.

PURPOSE: The purpose of this study was to compare knee kinematics and in situ forces of the graft between 2 femoral fixation techniques of anterior cruciate ligament (ACL) reconstruction: the over-the-top (OTT) fixation and transphyseal (TP) techniques. METHODS: ACL reconstruction in skeletally immature patients is a challenging procedure. Regarding the femoral fixation techniques, 2 methods are commonly used: the OTT fixation and TP techniques. Ten cadaveric knees (mean age, 57 years; range, 48 to 65 years) were tested with the robotic/universal force-moment sensor system by use of (1) an 89-N anterior tibial load at full extension and 15°, 30°, 60°, and 90° of knee flexion and (2) a combined 7-Nm valgus torque and 5-Nm internal tibial rotation torque at 15° and 30° of knee flexion. RESULTS: Both OTT and TP ACL reconstruction techniques closely restored the intact knee kinematics and had a significant reduction in anterior tibial translation under an anterior tibial load and in coupled anterior tibial translation under a combined rotatory load when compared with an ACL-deficient knee. When both ACL reconstruction techniques were compared, the only difference found was that the in situ force of the ACL graft reconstructed with the OTT technique in response to a combined rotatory load at 30° of flexion was significantly lower than the ACL graft reconstructed with the TP technique (5.3 ± 3.3 N and 10.7 ± 6.0 N, respectively; P = .013). CONCLUSIONS: This time 0 testing showed that both ACL reconstruction techniques, OTT and TP, can reproduce the kinematics of the intact knee in response to an anterior tibial load and a combined rotatory load. CLINICAL RELEVANCE: Both femoral fixation techniques exhibited comparable time 0 kinematics when subjected to simulated clinical examination loading conditions.

Validity and Reliability of the Thai Version of the International Hip Outcome Tool in Young to Middle-Aged Physically Active Adults With Hip Disorders.

BACKGROUND: The International Hip Outcome Tool (iHOT-33), which is a self-administered questionnaire that contains 33 questions, was developed to evaluate young to middle-aged physically active adults with hip pathology. PURPOSE: To translate and cross-culturally adapt the iHOT-33 to create a Thai version of the iHOT-33 (TH-iHOT-33) and to determine the validity and reliability of the TH-iHOT-33. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Translation and cross-cultural adaptation of the iHOT-33 were performed according to international guidelines. Patients aged 18 to 60 years with hip disorders who had a score ≥4 on a modified version of the Tegner activity scale completed the TH-iHOT-33 twice, 2 weeks apart. The Thai versions of the HOOS (Hip disability and Osteoarthritis Outcome Score) and EQ-5D-5L (European Quality of Life-5 Dimensions-5 Levels) were also completed at baseline. At 2 weeks, the Global Perceived Effect scale was completed in addition to the TH-iHOT-33. The statistical testing for validity included construct validity and hypotheses testing. Internal consistency, test-retest reliability, and measurement error were analyzed to determine reliability. RESULTS: The iHOT-33 was successfully translated and cross-culturally adapted to create the TH-iHOT-33. Seventy-two patients with various hip disorders participated in this study. Of the predefined hypotheses used for construct validity, 86% were confirmed. A Cronbach alpha of 0.98 (95% CI, 0.97-0.99) demonstrated excellent internal consistency. Test-retest reliability was high, with an intraclass correlation coefficient of 0.83 (95% CI, 0.73-0.90). The standard error of measurement was 5.1 points. The smallest detectable change was 14.2 points at the individual level and 1.9 points at the group level. The minimal important change was 10.9 points. The TH-iHOT-33 had no observable floor or ceiling effects. CONCLUSION: The TH-iHOT-33 is a valid and reliable instrument for assessing the functional status and health-related quality of life of young to middle-aged physically active Thai adults with hip disorders.

Contribution of the meniscofemoral ligament as a restraint to the posterior tibial translation in a porcine knee.

The meniscofemoral ligament (MFL) is a major structure in the posterior aspect of the porcine knee together with the posterior cruciate ligament (PCL). While the porcine knee is a frequently used animal model for biomechanical evaluation of PCL reconstruction techniques, the contribution of the MFL to stability of the porcine knee is not well understood. The purpose of this study is (1) to evaluate the kinematics of the knee after sequential cutting of the PCL and MFL and (2) to determine the in situ forces of the PCL and MFL in response to a posterior tibial load of 89 N using the robotic/universal force-moment sensor system from 15 degrees to 90 degrees of knee flexion. Ten porcine knees were used in this study. The magnitude of posterior tibial translation under a posterior tibial load was significantly increased (P < 0.01) after sequential transection of the PCL and the MFL at each testing angle compared to the intact condition. The in situ force of the PCL was highest at 60 degrees of flexion (82.3 +/- 8.6 N) and lowest at 15 degrees of flexion (45.1 +/- 15.9 N). The in situ force of the MFL was highest at 15 degrees of flexion (24.3 +/- 6.5 N) and lowest at 90 degrees of flexion (12.9 +/- 10.5 N). The findings in this study revealed a biomechanical contribution of the MFL as the secondary restraint to the posterior tibial translation in conjunction with the PCL especially near full extension.

Arthroscopic Treatment of a Large Mass of the Medial Side of the Leg Caused by Distal Extension of a Meniscal Cyst: A Case Report.

CASE: We report a 39-year-old man who presented with a painful mass that had been growing over the anteromedial aspect of his left leg for 2 years and was recurrent after an open excisional biopsy. Magnetic resonance imaging showed a lobulated cyst that extended from the medial meniscus. Arthroscopic cyst decompression, anterior cruciate ligament reconstruction, partial meniscectomy, and repair of the meniscotibial capsule were performed. There was no recurrence during the 1-year follow-up. CONCLUSIONS: Arthroscopic cyst decompression and repair of the posterior meniscotibial capsule is a good and safe alternative procedure for the treatment of large-sized meniscal cysts with distal extensions.

Determination of patellar tendon length for anterior cruciate ligament reconstruction using an anteroposterior knee radiograph.

BACKGROUND/OBJECTIVE: Graft-tunnel length mismatch is a common intraoperative technical problem for anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone graft (BPTB). The patella-to-condyle and the patella-to-notch distances are two measurements in an anteroposterior knee radiograph. The objective of this study was to evaluate the sensitivities, specificities and reliabilities of those 2 measurements for detecting patients who had a patellar tendon length exceeding 45 mm. METHODS: Preoperative plain radiographs of patients who underwent ACLR with a BPTB graft were evaluated independently by two orthopaedic surgeons 3 times each at 2-weekly intervals. The sensitivities and specificities of the two measurements for detecting patients who have a patellar tendon length exceeding 45 mm were calculated. The optimal cutoff point was estimated using Youden index, and the receiver operating characteristic (ROC) curve and area under the curve (AUC) were evaluated with a 95% CI. As for the inter- and intra-rater reliabilities, intraclass correlation coefficients (ICC) were determined. RESULTS: One hundred and twenty-seven patients with an average age of 29.5 years old were evaluated. The mean patellar tendon length was 41.3 ±â€¯5.0 mm. Patients with a length more than 45 mm (20 patients, 16%) had significantly higher patella-to-condyle and patella-to-notch distances, and more frequent use of bone staples for distal graft fixation than patients with a length ≤ 45 mm. To detect patients with a patellar tendon length over 45 mm, the optimal cutoff point for the patella-to-condyle distance was set at 14.5 mm, which had a sensitivity of 80%, specificity of 71%, and AUC of 0.76. In the case of the patella-to-notch distance, the cutoff point of 5.5 mm had a sensitivity of 80%, specificity of 66%, and AUC of 0.73. The intra- and inter-rater reliabilities of the two measurements were excellent, with ICCs of over 0.90. CONCLUSIONS: Preoperative measurements of the patella-to-condyle and the patella-to-notch distances in AP knee radiographs can be valuable tools, with good sensitivities and specificities, for the determination of the patellar tendon length when using a BPTB graft for an ACLR. They had an acceptable level of discrimination capability and excellent reliability.