Arthroscopic gel-type autologous chondrocyte implantation presents histologic evidence of regenerating hyaline-like cartilage in the knee with articular cartilage defect.

PURPOSE: To investigate the clinical, radiological, and histological results of arthroscopic gel-type autologous chondrocyte implantation (GACI) in treating chondral defects of the knee. METHODS: This study prospectively examined five males and five females with a mean age of 40.3 ± 10.3 years who underwent arthroscopic GACI between March 2012 and February 2013. The gel comprised a mixture of 1 ml of fibrinogen plus 0.1-0.2 ml of thrombin. The mean size of chondral defect was 2.9 ± 1.2 cm2 (range 1.2-5.4 cm2). International knee documentation committee (IKDC) subjective score, knee injury and osteoarthritis outcome score (KOOS), knee society score, and visual analog scale (VAS) for pain were assessed preoperatively and during regular follow-up examinations performed for up to 5 years postoperatively. Serial magnetic resonance imaging was performed for up to 2 years after the surgery to observe healing, using the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In eight patients, second-look arthroscopy was performed at 1 year after the implantation to assess the status of treated cartilage, and a portion of regenerated cartilage was harvested for histologic evaluation. RESULTS: The mean VAS score (p = 0.045), IKDC subjective score (p = 0.041), KOOS pain (p = 0.025), KOOS activities of daily living (p = 0.048), and KOOS quality of life (p = 0.029) showed significant improvement at 5 years after the surgery. The modified MOCART evaluation showed that the scores were 59.5 ± 29.4 and 85.0 ± 8.0 at 12 weeks and 2 years after the operation, respectively. Histologic examination demonstrated a mean regenerated cartilage thickness of 3.5 ± 0.8 mm and a mean Oswestry score of 8.2 ± 1.8. Immunohistochemistry analysis showed that the expression of collagen type II was more evident and more evenly distributed than collagen type I in regenerated cartilage. There was a significant correlation between Oswestry score and change in VAS scale from postoperative 2-5 years. CONCLUSIONS: Arthroscopic GACI produces satisfactory clinical and radiologic outcomes, and histologic evaluation confirms sufficient regeneration of hyaline-like cartilage that correlates with improved symptoms. Therefore, it is an acceptable, minimally invasive, and technically simple option for the restoration of cartilage defects of the knee. LEVEL OF EVIDENCE: IV.

Arthroscopic treatment of a one-fourth anteroinferior glenoid comminuted fracture-dislocation with concomitant three-part complex proximal humerus fracture in a middle-aged man: a case report.

INTRODUCTION: Proximal humeral fracture-dislocations can occur in high-energy traumas. This injury can be accompanied by a glenoid fracture; however, it is a rare type of complex injury in patients aged under 60 years. MATERIALS AND METHODS: A 53-year-old man presented with a three-part fracture-dislocation of the proximal humerus and a severely comminuted glenoid fracture. For the glenohumeral dislocation and proximal humeral fracture, we performed closed reduction using a threaded Steinman pin and fixation with percutaneous cannulated screws. Using arthroscopy, while maintaining humeral traction with the Steinman pin, the intra-articular glenoid fragments were reduced and then fixed with a buttressing headless screw and one suture anchor. After a 6-week immobilization with a shoulder spica cast, rehabilitation was initiated. RESULTS: We confirmed bony union of the fracture sites after 6 months post-surgery. The patient showed excellent clinical outcomes with a nearly full range of motion without instability CONCLUSIONS: We reported a successful outcome for a complex proximal humeral fracture involving the glenoid using closed reduction and fixation for the proximal humeral fracture and arthroscopic reduction and fixation for the comminuted anteroinferior glenoid fracture.

The Treatment of Periprosthetic Fracture Revision of the Humerus with "Bamboo Support" Structural Allograft Technique-Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report.

Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic non-union after plate osteosynthesis for a periprosthetic fracture associated with RTSA. Fixation failure was evident 3 months after the surgical intervention; the patient underwent a 3-month course of arm sling immobilization. However, bone resorption continued, and varus angulation of the fracture developed. In this case, surgical strategy involved the use of long proximal humerus internal locked system plate (DePuy Synthes, Paoli, PA, USA), augmented with autologous iliac bone graft and allogenic humerus structural bone graft with the "bamboo support technique", fixed with Cable System (DePuy Synthes, Paoli, PA, USA). No reports have addressed the management of failed periprosthetic fractures using allogeneic humeral strut bone grafts. This report aims to fill the gap by presenting a novel surgical technique for the management of periprosthetic fractures associated with RTSA in case of treatment failure.

Association Between the Severity of Periodontitis and Osteoarthritis in Middle-Aged and Older Patients With Type 2 Diabetes Mellitus: A Nationwide Population-Based Study.

OBJECTIVE: Periodontitis and osteoarthritis are major public health concerns that result in decreased quality of life among middle-aged and older adults. We sought to examine whether the severity of periodontitis is related to osteoarthritis according to the presence of type 2 diabetes mellitus. METHODS: This study included 3,527 participants age ≥50 years from the Korean National Health and Nutrition Examination Survey. Periodontitis was assessed using the Community Periodontal Index; severe periodontitis was defined as periodontal tissue forming deep periodontal pockets ≥6-mm depth. Osteoarthritis was defined as Kellgren/Lawrence grade ≥2 on radiographic images of the knee or hip area with joint pain. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for osteoarthritis according to the severity of periodontitis, stratified by type 2 diabetes mellitus, were calculated using multiple logistic regression analyses. RESULTS: Participants with type 2 diabetes mellitus were more likely to have osteoarthritis as the severity of periodontitis increased (nonsevere periodontitis OR 1.23 [95% CI 0.67-2.32]; severe periodontitis OR 3.01 [95% CI 1.51-5.84]) after adjusting for age, sex, body mass index, smoking status, alcohol consumption, regular exercise, education level, household income, hypertension, and frequent tooth-brushing. However, this positive association was not found in individuals without type 2 diabetes mellitus after adjusting for the same covariables. CONCLUSION: Severe periodontitis was positively and significantly associated with osteoarthritis in middle-aged and older individuals with type 2 diabetes mellitus. Our findings suggest that the oral inflammation manifesting in periodontitis may be at least partly involved in the pathogenesis of osteoarthritis, particularly in patients with type 2 diabetes mellitus.

A biomechanical comparison of 3 reconstruction techniques for posterolateral instability of the knee in a cadaveric model.

PURPOSE: The objective of this study was to compare the varus and external rotatory laxity of reconstructed knees by use of 3 different reconstruction techniques that address posterolateral instability of the knee: popliteus tendon (PT) and lateral collateral ligament (LCL) reconstruction, PT and popliteofibular ligament (PFL) reconstruction, and PFL and LCL reconstruction. METHODS: We divided 36 fresh-frozen cadaveric knees into 3 groups of 12, and each group was assigned to a reconstruction technique: PT-LCL reconstruction with the posterior tibialis tendon, PT-PFL reconstruction with the patellar tendon and bone (Warren technique), and PFL-LCL reconstruction with the semitendinosus tendon (Larson technique). Each specimen was fixed with an Ilizarov external fixator and mounted on a custom-designed apparatus that was made to measure posterolateral instability of the knee, that is, external rotatory and varus laxity in the intact state, after cutting, and in the postoperative state at every 30 degrees from 0 degrees to 90 degrees . RESULTS: There were no significant differences between the 3 techniques with external rotation and varus laxity in all specimens. CONCLUSIONS: PT-LCL reconstruction was comparable to the other 2 established techniques: PT-PFL reconstruction (Warren technique) and PFL-LCL reconstruction (Larson technique). However, the original strength of the native knee could not be achieved with any of the techniques. CLINICAL RELEVANCE: All techniques restored the posterolateral stability of the knee to near normal, with none of them being superior.

Knee osteoarthritis and its association with mental health and health-related quality of life: A nationwide cross-sectional study.

AIM: To investigate the relationship between knee osteoarthritis, mental health and health-related quality of life (QoL). METHODS: This study included 6343 men and women aged ≥50 years from the Korean National Health and Nutrition Examination Survey. Osteoarthritis was defined as Kellgren-Lawrence grade ≥2 in the knee on radiographic images with knee pain. Mental health and health-related QoL were assessed according to three dimensions (depressive mood, psychological distress and suicidal ideation) and five domains (impaired mobility, impaired self-care, impaired usual activities, pain/discomfort and anxiety/depression). The odds ratios and 95% confidence intervals (CI) for mental health and health-related QoL were calculated using multiple logistic regression analyses. RESULTS: Compared with the control group, the odds ratios for depressive mood, psychological distress and suicidal ideation in the osteoarthritis group were 2.80 (95% CI 1.31-3.31), 1.92 (95% CI 1.21-3.05) and 1.97 (95% CI 1.31-2.94) in men, and 1.51 (95% CI 1.16-1.95), 1.36 (95% CI 1.07-1.72) and 1.92 (95% CI 1.49-2.46) in women after adjusting for potential confounding variables. Similarly, the odds ratios for impaired mobility, impaired self-care, impaired usual activities, pain/discomfort and anxiety/depression in the osteoarthritis group were 12.37 (95% CI 8.17-18.72), 3.02 (95% CI 1.84-4.94), 7.33 (95% CI 4.89-10.98), 8.92 (95% CI 5.92-13.45) and 2.56 (95% CI 1.52-4.29) in men, and 8.29 (95% CI 6.41-10.73), 2.53 (95% CI 1.74-3.69), 4.40 (95% CI 3.33-5.80), 4.79 (95% CI 3.72-6.17) and 1.85 (1.44-2.37) in women after adjusting for the same covariables. CONCLUSIONS: Knee osteoarthritis was significantly associated with deteriorated mental health and health-related QoL in middle-aged and older men and women. Geriatr Gerontol Int 2020; 20: 379-383.

Association between platelet count and osteoarthritis in women older than 50 years.

BACKGROUND: Osteoarthritis (OA) is a multifactorial disease involving inflammatory processes. Platelets play important roles in both hemostasis and the inflammatory response; however, the relationship between platelet count and OA is unclear. Our aim was to evaluate the association between platelet count and knee and hip OA in Korean women. METHODS: In this cross-sectional designed study, we included a total of 6011 women aged ⩾50 years from the 2010-2013 Korea National Health and Nutrition Examination Survey. Knee and hip OA were defined as Kellgren-Lawrence grade ⩾2 and presence of knee or hip pain, respectively. Platelet counts were divided into quartiles as follows: Q1, 150-212 (103/µl); Q2, 213-246 (103/µl); Q3, 247-283 (103/µl); and Q4, 284-450 (103/µl). Multiple logistic-regression analysis was conducted to calculate odds ratios and 95% confidence intervals. Receiver operating characteristic analysis was performed to determine the optimal platelet count cut-off with which to discriminate participants with knee and/hip OA versus those without OA. RESULTS: Of the 6011 participants, 1141 (18.1%) had knee or hip OA. The mean age of participants without OA was 60.6 years, and that of participants with OA was 68.0 years. Compared with the lowest quartile, odds ratios (95% confidence intervals) for OA were 1.08 (0.84-1.39) for Q2, 0.94 (0.73-1.23) for Q3, and 1.35 (1.08-1.69) for Q4 after adjusting for confounders. The prevalence of OA was significantly higher with platelet counts ⩾288 × 103/µl, compared with platelet counts <288 × 103/µl. CONCLUSION: High platelet counts within the normal range are significantly associated with knee and hip OA.

Cluster analysis of nutritional factors associated with low muscle mass index in middle-aged and older adults.

BACKGROUND & AIMS: Sarcopenia, or age-related muscle loss, is an enormous health problem in an aging world because of its many clinical and societal adverse effects. The uncovering of healthy dietary patterns is an important strategy to prevent or delay sarcopenia. We used K-means clustering to identify subgroups of men and women based on nutritional and health-related factors and investigated risk factors for low muscle mass in the subgroups and in the study population as a whole. METHODS: We analyzed a total 10,863 participants over 40 years of age who participated in the Korea National Health and Nutrition Survey from 2008 to 2011. Dual energy X-ray absorptiometry was used to determine the appendicular lean mass (ALM) of the participants. Participants with low ALM adjusted BMI (ALM/BMI) were then identified using the criteria of the Foundation for the National Institutes of Health sarcopenia project. K-means clustering and multivariate logistic regression were used to analyze associations between nutritional and health-related variables and low ALM/BMI in the population as a whole and in the individual clusters. RESULTS: A total of 712 (15.8%) men and 869 (13.7%) women had low ALM/BMI. Five clusters were identified in men and women, respectively. Two clusters of men and one cluster of women exhibited an increased risk of low ALM/BMI. Old age, low total energy intake, low levels of physical activity, and a high number of chronic diseases were consistent risk factors for low ALM/BMI in all Korean men and women. Low protein was a common risk factor for low ALM/BMI in men. After dividing all subjects by the K-means clustering algorithm, two risk factors (high fat intake and smoking) and four factors (low intakes of carbohydrate, protein and fat, and high alcohol consumption) were additionally proposed in Korean men and women, respectively. CONCLUSIONS: Age, low total energy intake, low level of physical activity, and an increased number of chronic diseases were consistent risk factors for low ALM/BMI in men and women. Cluster-specific risk factors were also noted in men and women.

The relationship between platelet count and bone mineral density: results from two independent population-based studies.

In two population-based study of middle-aged and older people, we investigated if platelet count was associated with bone mineral density and determined whether the association remained over time. Highest platelet counts within the normal range are significantly associated with osteopenia and osteoporosis in middle-aged and elderly people. PURPOSE: Recently, platelets were found to play a role in bone remodeling. However, data on the association between platelet count and osteoporosis are lacking. Our study aimed to investigate the association between platelet counts, osteopenia, and osteoporosis in middle-aged and elderly Koreans. METHODS: We analyzed cross-sectional data from 5181 adults (postmenopausal women and men over 50 years of age) in the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES) and longitudinal prospective data from 3312 adults over 50 years of age in the Korean Genome and Epidemiology Study (KoGES). Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry in the KNHANES and quantitative ultrasound in the KoGES. The platelet counts were categorized into quintiles within normal ranges (150-450 × 103 µL). The associations between platelet counts, osteopenia, and osteoporosis were estimated using a multinomial logistic model. RESULTS: BMD of the femur neck, total femur, and lumbar spine all decreased with increasing platelet counts. The cut-off points of the platelet counts to differentiate normal BMD from osteopenia and osteopenia from osteoporosis were 217 × 103/µL and 269 × 103/µL, respectively. The odds ratios (95% confidence intervals) in the highest platelet quartile were 1.39 (1.03-1.88) for osteopenia and 1.60 (1.07-2.37) for osteoporosis after adjusting for confounding factors. The distal radius T-score was significantly decreased in the highest platelet tertile group at a follow-up of 10 years. CONCLUSION: Highest platelet counts within the normal range are significantly associated with osteopenia and osteoporosis in middle-aged and elderly people.

Influence of Orthodontic Anchor Screw Anchorage Method on the Stability of Artificial Bone: An In Vitro Study.

This study aims to compare the torque values for various lengths of the titanium-based orthodontic anchor screw (OAS), different anchorage methods and varying artificial bone densities after predrilling. Furthermore, the effects of these parameters on bone stability are evaluated. A total of 144 OASs were prepared with a diameter of 1.6 mm and heights of 6, 8 and 10 mm. Artificial bones were selected according to their density, corresponding to Grades 50, 40 and 30. Torque values for the automatic device and manual anchorage methods exhibited a statistically significant difference for the same-sized OAS, according to the bone density of the artificial bones (p < 0.05). However, when insertion torque was at the maximum rotations, there was no significant difference in the torque values for the Grade 30 artificial bone (p > 0.05). When the torque values of both anchorage methods were statistically compared with the mean difference for each group, the results of the manual anchorage method were significantly higher than those of the automatic device anchorage method (p < 0.05). A statistically significant difference was observed in the bone stability resulting from different OAS anchorage methods and artificial bone lengths. These findings suggest that the automatic anchorage method should be used when fixing the OAS.

Platelet and white blood cell count are independently associated with sarcopenia: A nationwide population-based study.

INTRODUCTION: Sarcopenia is attracting increasing attention due to its harmful impacts on health. Chronic inflammation is proposed to be a major cause of sarcopenia. Here, we aimed to identify whether white blood cell (WBC) and platelet count have independent roles in sarcopenia occurrence. METHOD AND MATERIALS: This cross-sectional study analyzed 10,092 adults (4293 men and 5799 women) from the 2008-2011 Korea National Health and Nutrition Survey. Cut-off values for sarcopenia were defined as a skeletal muscle mass index <0.789 for men and <0.512 for women. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis after adjusting for confounding variables. ROC curve analysis was used to evaluate the ability of platelet count and white blood cell count to discriminate the presence of sarcopenia. RESULTS: After adjusting for possible confounders, the OR (95% CI) for sarcopenia occurrence according to platelet counts was 1.62 (1.20-2.19) for the T3 group in men and 1.72 (1.28-2.31) for the T3 group in women, relative to the lowest platelet count tertile. After adjusting for same confounders, the ORs (95% CI) for sarcopenia occurrence according to WBC counts was 1.86 (1.35-2.57) for the T3 group in men, and 2.36 (1.77-3.13) for the T3 group in women, relative to the lowest WBC count tertile. We also found independent significant associations between platelet count, WBC count, and sarcopenia. CONCLUSIONS: Higher platelet and WBC counts within the normal range are each independently associated with sarcopenia in Korean men and women. The inclusion of platelet, WBC, or combined platelet and WBC counts significantly improved the power to discriminate sarcopenia.

Hemoglobin levels and low bone mineral density in non-anemic older adults: Secondary analysis of the Korean National Health and Nutrition Examination Survey.

BACKGROUND: Although, previous studies have reported a positive association between hemoglobin levels and bone mineral density (BMD), the majority of the studies were limited in patients with chronic hypoxemic conditions and findings concerning the association among non-anemic populations are inconclusive. We aimed to examine the association between hemoglobin levels and BMD in non-anemic healthy adults. METHODS: This cross-sectional study included 3626 non-anemic men and women aged ≥ 60 years who participated in the Korean National Health and Nutrition Examination Survey (KNHANES). The BMD of the lumbar spine and both femurs was measured by dual-energy X-ray absorptiometry (DXA). Participants with T-score for BMD < -1.0 SD were defined as having low BMD. The odds ratios (ORs) and 95% confidence intervals (CIs) for low BMD were calculated using multiple logistic regression analyses across sex-specific hemoglobin quartiles. RESULTS: The prevalence of low BMD gradually decreased in accordance with hemoglobin quartiles in both sexes. Compared with the group in the lowest quartile, the OR (95% CI) for low BMD in the lumbar spine was 0.78 (0.54-0.93) for men and 0.67 (0.50-0.93) for women after adjusting for age, BMI, tobacco smoking, alcohol intake, physical activity, walking difficulty, household income, total calorie intake, calcium intake, iron intake, 25(OH)D, alkaline phosphatase, and parathyroid hormone levels. However, these positive associations were not found in femur after adjusting for the same co-variables. CONCLUSIONS: Hemoglobin levels were inversely associated with low BMD in lumbar spine among non-anemic adults.

Relationship between Sleep Duration and Osteoarthritis in Middle-Aged and Older Women: A Nationwide Population-Based Study.

(1) Background: Both long and short sleep durations have been associated with negative health outcomes, particularly in middle-aged and older adults. To date, there has been little research on the association between sleep and osteoarthritis. This study aimed to evaluate the relationship between sleep duration and radiographically confirmed osteoarthritis in middle-aged and older women. (2) Methods: This study included 5268 women aged ≥50 years from the Korea National Health and Nutrition Examination Survey. Sleep duration was categorized into four groups (≤5 h, 6 h, 7⁻8 h, and ≥9 h) using responses from a self-reported questionnaire, and 7⁻8 h was set as an appropriate sleep duration. Osteoarthritis was defined as Kellgren⁻Lawrence grade ≥2 in the knee or hip area in radiographic images with knee or hip joint pain. The odds ratios (ORs) and 95% confidence intervals (CIs) of osteoarthritis according to sleep duration were calculated using multiple logistic regression analyses. (3) Results: The prevalence of osteoarthritis according to sleep duration showed a U-shaped curve, with the nadir in the appropriate sleep category (7⁻8 h). Compared with the 7⁻8 h sleep duration, the ORs (95% CIs) of osteoarthritis in the short sleep duration (≤5 h/day) and long sleep duration (≥9 h/day) were 1.343 (1.072⁻1.682) and 1.388 (1.020⁻1.889), respectively, after adjusting for age, body mass index, current smoking, alcohol consumption, regular exercise, occupation, residential area, hypertension, type 2 diabetes, cardiovascular disease, and stroke. (4) Conclusions: Short and long sleep duration were positively associated with osteoarthritis in middle-aged and older women.

Three-Dimensional Fast Spin-Echo Imaging without Fat Suppression of the Knee: Diagnostic Accuracy Comparison to Fat-Suppressed Imaging on 1.5T MRI.

PURPOSE: To evaluate the diagnostic performance of three-dimensional fast spin-echo (3D FSE-Cube) without fat suppression (NFS) for detecting knee lesions, using comparison to 3D FSE-Cube with fat suppression (FS). MATERIALS AND METHODS: One hundred twenty-four patients who underwent 1.5T knee magnetic resonance imaging (MRI) scans and 25 subsequent arthroscopic surgeries were retrospectively reviewed. Using arthroscopic results and two-dimensional images as reference standards, diagnostic performances of 3D FSE-Cube-NFS and FS imaging about lesions of ligament, meniscus, subchondral bone marrow edema (BME), and cartilage were compared. Scan parameters of 3D FSE-Cube imaging were previously optimized by a porcine knee phantom. RESULTS: No significant differences were observed between detection rates of NFS and FS imaging for detecting lesions of meniscus and cartilage (p>0.05). However, NFS imaging had lower sensitivity for detection of medial collateral ligament (MCL) tears, and lower sensitivity and specificity for detection of BME lesions, compared to FS imaging (p<0.05). CONCLUSION: 3D FSE-Cube-NFS imaging showed similar diagnostic performance for detecting lesions of meniscus or cartilage compared to FS imaging, unlike MCL or BME lesions.

Surgical treatment of malignant and aggressive bone tumors around the knee by segmental resection and rotationplasty.

In patients having malignant or aggressive bone tumors around the knee joint and requiring amputation, segmental resection and rotationplasty was performed and the clinical results were analyzed. Twenty-six patients underwent segmental resection and rotationplasty between February 1988 and June 1994. The mean follow-up period was 57 (6 - 120) months and the average age of patients was 21.4 (5 - 37) years. Out of 26 patients, there were 18 osteosarcomas (>/= stage IIB), 2 synovial sarcomas, and 6 giant cell tumors. Clinical results were evaluated by the Shriner's rating system. Four patients were excluded due to death or amputation and the remaining twenty-two patients were included for assessment. Eighteen patients had excellent results, 3 good, and 1 fair. Range of motion of the ankle joint was -11 (dorsiflexion) - 80 (plantarflexion) degrees and daily walking activity was possible. Local recurrence developed in 2 patients and distant metastasis in 10. Early complications include 3 thromboses and 1 sepsis, and late complications were 6 nonunion, 2 malrotation and 1 stiffness of the ankle joint. Rotationplasty, which is functionally excellent, may serve as an effective partial limb salvage procedure, especially in patients younger than 10 years old who are expected to have leg length discrepancy or loosening of the tumor prosthesis due to the growth of the medullary cavity or when amputation is inevitable for a wide resection margin.

Arthroscopic posterior cruciate ligament tibial inlay reconstruction.

Tibial inlay posterior cruciate ligament (PCL) reconstruction was developed to avoid "killer turn" of the tibial tunnel. It requires a surgical dissection to popliteal fossa and changing of the patient's position during operation. We report an arthroscopic tibial inlay PCL reconstruction technique to avoid morbidity from an open procedure. Achilles tendon-bone allograft was used for reconstruction, and bone plug was designed in a cylindrical shape vertical to the tendon direction for tibial fixation. The intra-articular length of PCL is measured, and the proximal graft is prepared with a whipstitch and an EndoPearl (Linvatec, Largo, FL) is connected for enhancing femoral fixation. After tibial graft fixation with an absorbable interference screw, tibial site fixation was reinforced with suture anchoring to a washer on the anterolateral surface of the tibia. Femoral fixation was done with another screw. It was possible to reproduce the original concept of PCL tibial inlay graft with our arthroscopic technique.

Osteosynthesis of symptomatic nonunions of type II fractures of the distal clavicle using modified locking T-plate and bone grafting.

BACKGROUND: Type II distal clavicle fractures are generally unstable and hence prone to nonunion because of their specific biomechanical configuration. Nonunion of type II distal clavicle fractures sometimes poses a difficult problem causing pain and functional impairment of the shoulder girdle and upper limb. Therefore, operative treatment should be performed for symptomatic nonunions. However, there is very little information in the literature on nonunions of type II distal clavicle fractures to date. METHODS: Ten consecutive patients with symptomatic nonunions of type II fractures of the distal clavicle were enrolled with a minimum follow-up of 24 months. The primary indication for surgery was pain on activity and osteosynthesis using modified oblique locking T-plate, and autogenous iliac bone graft without repair or reconstruction of coracoclavicular ligament was performed in all cases. Functional outcomes were assessed preoperatively and at final follow-up using Constant score, Modified Shoulder Rating Scale score, and the visual analog scale score. RESULTS: In all cases, bony union was achieved at a mean of 14.7 weeks. No patients had pain during any of the activities at the latest follow-up but two, who complained of mild discomfort during strenuous activity. All but one patient regained full range of motion of the operated shoulder. Constant score improved from 76.3 to 92.3, and similarly, Modified Shoulder Rating Scale score increased from 11.3 to 18.2 after surgery. These functional assessments revealed seven excellent and three good outcomes with functional improvement. Preoperative visual analog scale score of a mean 3.8 decreased to 0.3 after the operation. CONCLUSION: Osteosynthesis using modified oblique locking T-plate and autogenous iliac bone graft results in good to excellent outcomes with the functional improvement for symptomatic nonunions of type II fractures of the distal clavicle. Our method may be primarily considered an useful alternative for symptomatic nonunions of type II distal clavicle fractures, and bone grafting should be considered in all cases.

Evaluation of the mechanical properties of posterolateral structures and supporting posterolateral instability of the knee.

The objectives of this study are to evaluate the contributions of the popliteofibular ligament (PFL), the popliteus tendon (PT), and the lateral (fibular) collateral ligament (LCL) to the posterolateral stability of the knee by changing the sequence of selective transection. Twelve fresh-frozen cadaveric knees were divided into two groups. Group 1 has a cutting sequence as follows: PFL, PT, LCL. Group 2 has a cutting sequence as follows: PT, PFL, LCL. Each specimen was mounted on the apparatuses using the Ilizarov external fixator for measuring external rotatory and varus laxities at every 30 degrees from 0 degrees to 90 degrees of knee flexion. In both groups, there was no significant difference between the PFL and PT in the increment of respective external rotatory laxity after transection at each knee flexion angle, except 0 degrees in group 2. The transection of the LCL significantly increased the external rotation laxity at 0 degrees and 30 degrees . Varus instability was increased significantly only after cutting the LCL at every knee flexion angle. In conclusion, both the PFL and PT equally contribute to the external rotatory stability. The LCL also contributes to the external rotatory stability at early range of knee flexion. The LCL is a main structure for varus stability in the knee.