High failure rate after medial meniscus bucket handle tears repair in the stable knee.

BACKGROUND: It is nowadays recommended to "Save the meniscus". This paradigm is based on the affirmation that an extended meniscectomy exposes to the risk of long-term secondary osteoarthritis and the global failure rate of a longitudinal tear repair remains low, whether it is the medial or lateral meniscus, with or without anterior cruciate ligament (ACL) reconstruction. However, each kind of lesion has to be studied separate. PURPOSE: The study aimed to focus on a homogeneous population of isolated repair of the bucket handle tear (BHT) of the medial meniscus (MM) in patients with stable knees to evaluate failure rate at a minimum of three years of follow-up. The secondary objectives were to evaluate any risk factors or protective factors of failure, clinical outcomes, and secondary amount of meniscectomy in failure cases compared to the amount of meniscus fixed in the first surgery. METHODS: All patients who underwent arthroscopic repair of a BHT of the MM situated in the red-on-red or red-on white (RW) zone on a stable knee between January 2010 and December 2018 were evaluated retrospectively. Failure was defined as a need for reoperation for recurrence of meniscal symptoms (pain, locking) on the medial side with per-operative confirmation of the absence of healing. The following parameters were studied: demographics (age, gender, BMI), time from injury to surgery, clinical scores (Tegner, Lysholm, International Knee Documentation Committee [IKDC]), surgical findings (extent and zone of the tear), surgical management (number and type of suture). RESULTS: Thirty-nine patients were included. The mean follow-up was 77.2±24.4 [36-141] months. Twenty-seven (69%) failures were recorded. In 56% (15/27) of the reoperations, the meniscectomy amount was smaller than what it would have been done in the first surgery. All clinical scores improved significantly from pre- to post-operatively; all patients met minimal clinically important differences for all the scores. No risk factors were found significant in the multivariate analysis. CONCLUSION: Repairing an isolated BHT of the MM is associated with a high failure rate. Despite the failure, we observed that the meniscectomy area was smaller than documented in the primary surgery in most of the cases and repair must still be considered as the first option. LEVEL OF EVIDENCE: IV; retrospective cohort series.

Robotic-arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five-year follow-up.

PURPOSE: This study reports the five-year functional outcomes from a prospective cohort study comparing robotic-arm assisted total knee arthroplasty (RO TKA) versus conventional manual total knee arthroplasty (CO TKA). METHODS: This prospective single-surgeon study included 120 patients with symptomatic end-stage knee arthritis undergoing primary TKA. This included 60 consecutive patients undergoing CO TKA followed by 60 consecutive patients undergoing RO TKA using a semi-automated robotic device. Study patients were reviewed at one, two, and five years after surgery and the following outcomes recorded: The University of California at Los Angeles activity-level (UCLA), Knee Society Score (KSS), Oxford Knee Score (OKS) Forgotten Joint Score (FJS), and any complications. RESULTS: There were no statistical differences between RO TKA and CO TKA in the median UCLA score (p = N.S), median KSS (p = N.S), and median OKS (p = N.S) at five-year follow-up. RO-TKA was associated with statistically significant improvements in the FJS at one (p = 0.001), two (p = 0.003), and five (p = 0.025) years of follow-up compared with CO TKA. There was no statistical difference in the incidence of knee stiffness requiring manipulation under anesthesia between the two treatment groups (p = N.S). CONCLUSION: Patients in both treatment groups had excellent functional outcomes with comparable patient reported outcomes at five-year follow-up. RO TKA was associated with statistically significant improvements in the FJS compared with CO TKA, but these differences did not reach the minimal clinically important difference at any follow-up interval. There was no overall difference in complications between the two treatment groups at five-year follow-up. LEVEL OF EVIDENCE: II (Prospective cohort study).

Nano-biochar: recent progress, challenges, and opportunities for sustainable environmental remediation.

Biochar is a carbonaceous by-product of lignocellulosic biomass developed by various thermochemical processes. Biochar can be transformed into "nano-biochar" by size reduction to nano-meters level. Nano-biochar presents remarkable physico-chemical behavior in comparison to macro-biochar including; higher stability, unique nanostructure, higher catalytic ability, larger specific surface area, higher porosity, improved surface functionality, and surface active sites. Nano-biochar efficiently regulates the transport and absorption of vital micro-and macro-nutrients, in addition to toxic contaminants (heavy metals, pesticides, antibiotics). However an extensive understanding of the recent nano-biochar studies is essential for large scale implementations, including development, physico-chemical properties and targeted use. Nano-biochar toxicity on different organisms and its in-direct effect on humans is an important issue of concern and needs to be extensively evaluated for large scale applications. This review provides a detailed insight on nanobiochar research for (1) development methodologies, (2) compositions and properties, (3) characterization methods, (4) potentiality as emerging sorbent, photocatalyst, enzyme carrier for environmental application, and (5) environmental concerns.

2-Year Radiostereometric Analysis Evaluation of a Short, Proximally Coated, Triple-Taper Blade Femoral Stem Versus a Quadrangular-Taper Stem With Reinforced Proximal Body: A Randomized Controlled Trial.

BACKGROUND: Cementless stem designs with proximal metaphyseal fixation aim to achieve better load distribution, reduce stress shielding, and improve primary stability. The purpose of this prospective, randomized controlled trial was to evaluate the 2-year migration and clinical outcomes of two cementless femoral stems. METHODS: A total of 60 participants undergoing primary total hip arthroplasty for any cause were randomly allocated to receiving either a proximally coated, short blade stem or a quadrangular-taper stem with a reinforced proximal body. Radiostereometric analysis radiographs were performed postoperatively and at 6 weeks, 6 months, 1 year and 2 years. The Harris Hip Score, Oxford Hip Score and the EuroQol five-dimension were also collected. RESULTS: At two years, the median subsidence of the short-blade stem was 0.097 millimeters (mm) [Interquartile range (IQR) -0.67 to 0.08)] versus 0.086 mm(IQR, -0.29 to 0.005, P = .683); medial translation 0.023 mm (IQR 0.08 to 0.12) versus 0.029 mm(IQR -0.07 to 0.10, P = .907); anterior translation 0.035 mm (IQR -0.23 to 0.33) versus 0.07 mm (IQR -0.13 to 0.08, P = .268). At 24 months postoperatively, there were no stem revisions and Patient-Reported Outcome Measures (PROMs) were comparable between groups. CONCLUSION: Both cementless stems exhibited a predictable migration pattern and achieved initial stability. There was no difference in migration across the three Cartesian axes at any time point. Clinical outcomes and PROMs were also comparable. Biological fixation of both implants evidenced by the radiostereometric analysis and excellent PROMs are likely to translate to longer-term stability, which would need to be corroborated by longer-term outcome studies.

No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up.

INTRODUCTION: Despite its excellent results in preventing dislocation, the dual mobility cup (DMC) is still struggling to be adopted by some teams due to premature wear and loosening reported on first-generation implants. Therefore, this study aimed to assess the mid-term survivorship of a modern DMC with a pre-impacted head and the radio-clinical results at a minimum follow-up of 5 years. METHODS: This was a retrospective single-centre study performed on patients who had a primary total hip replacement for osteoarthritis in 2016. The cup was a third-generation DMC with a pre-impacted femoral head. Clinical (harris hip score (HHS)) and radiological (cup abduction, anteversion, overhang, and radiolucent lines) results were recorded, as well as complications, particularly dislocations and survivorship. A minimum of five years of follow-ups was required. RESULTS: One hundred and seventy-five hips (167 patients) met the inclusion criteria. Five hips (2.9%, 5/175) were lost to follow-up and excluded from the postoperative analysis. The mean follow-up period was 70 ± 2.9 months [63.6-76.5]. Three cups needed revision surgery (1.8%, 3/170): one for septic loosening, and two for chronic infection. At 77 months, the global survival probability was 98.2% ± 1, and the survival probability excluding septic aetiology was 100%. There was a significant improvement in the HHS from pre-operatively (48.3 ± 6.0 [14.0-70.0]) to post-operatively (96 ± 4.5 [50-100]) (p < 0.0001). There were no postoperative dislocations recorded, nor any iliopsoas-impingement or symptomatic cam-effect. DISCUSSION: This study showed excellent survival and good radiological and clinical results of this dual mobility cup at a mid-term follow-up. None of the patients had dislocation or any specific complication feared with dual mobility cups.

Periprosthetic joint infection: what next?

Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there are still many unanswered questions. We now have a workable definition that everyone should align to, but we need to continue to focus on identifying the organisms involved. Surgical strategies are evolving and care is becoming more patient-centred. There are some good studies under way. There are, however, still numerous problems to resolve, and the challenge of PJI remains a major one for the orthopaedic community. This annotation provides some up-to-date thoughts about where we are, and the way forward. There is still scope for plenty of research in this area.Cite this article: Bone Joint J 2022;104-B(11):1193-1195.

Surgical Repair of Stener-like Injuries of the Medial Collateral Ligament of the Knee in Professional Athletes.

BACKGROUND: A "Stener-like" lesion of the knee is defined as a distal avulsion of the superficial medial collateral ligament (sMCL) with interposition of the pes anserinus between the ligament and its tibial insertion-a displacement impeding anatomic healing. Because of the scarcity of these injuries, the literature is limited to case reports and small case series. PURPOSE: To assess the effect of surgical repair of acute Stener-like lesions of the sMCL on the following outcomes: return to preinjury level of sporting function; time to return to preinjury level of sporting function; functional performance; injury recurrence; and any other complications. STUDY DESIGN: Case series: Level of evidence, 4. METHODS: This prospective single-surgeon study included 23 elite athletes with a mean age of 27.2 years (range, 19-37 years). Of the participants, 20 were men (87%) and 3 were women (13%). The mean body mass index was 23.1 ± 2.3. A total of 16 athletes were soccer players (70%) and 7 were rugby players (30%), with isolated acute, traumatic Stener-like lesions of the sMCL of the knee confirmed on preoperative magnetic resonance imaging. Surgical repair was undertaken with primary suture anchor repair with ligament repair or reconstruction system (LARS) augmentation. Predefined outcomes were recorded at regular intervals after surgery. The minimum follow-up time was 24 months (range, 24-108 months) from the date of surgery. RESULTS: The mean time from injury to surgical intervention was 9 days (range, 3-28 days). Overall, 15 (65%) athletes had isolated distal sMCL injuries requiring anatomic suture anchor repair at the distal tibial insertion site only, and 8 (35%) athletes had concomitant injuries of the proximal and distal sMCL and required anatomic suture anchor repair at the proximal and distal attachment sites. Ten athletes required LARS augmentation at the time of the index operation. All study patients returned to their preinjury level of sporting activity in professional soccer or rugby. The mean time from surgical intervention to return to full sporting activity was 16.8 ± 2.7 weeks. At 6 and 24 months' follow-up, all patients had Tegner scores of 10. At a 2-year follow-up, all study patients were still participating at their preinjury level of sporting activity. Three patients developed complications around the LARS that required further surgery to remove synthetic material; however, this did not affect function. CONCLUSION: Surgical repair of acute Stener-like lesions of the sMCL is associated with a high return to preinjury level of sporting function, excellent functional performance, and a low risk of recurrence at short-term follow-up in elite athletes.

Safe intramedullary fixation of displaced midshaft clavicle fractures with 2.5mm Kirschner wires - technique description and a two-part versus multifragmentary fracture fixation outcome comparison.

INTRODUCTION: The aim of this study was to present a modified Murray and Schwarz 2.5-mm Kirschner wire (K-wire) intramedullary (IM) technique for fixation of displaced midshaft clavicle fractures (DMCF), and to compare the differences in treatment outcome of two-part (Robinson 2B.1) and multifragmentary (Robinson 2B.2) DMCF. METHODS: A retrospective analysis of 91 patients who underwent IM fixation with a 2.5-mm K-wire for DMCF and had a 1-year post-operative follow-up between 2000 and 2012 was performed. The patients were allocated into two groups: Robinson 2B.1 (n = 64) and Robinson 2B.2 (n = 27). Assessed outcomes were non-union, reoperation rate, wire migration and infection. RESULTS: There was no statistically significant difference in the rate of non-union (2B.1,2B.2; 3.13%, 7.41%; p = 0.365), reoperation (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365), K-wire migration (2B.1, 2B.2; 0.00%, 0.00%; p = 1.00) and clavicle shortening at 12-months (2B.1, 2B.2; 3.13%, 7.41%; p = 0.365). CONCLUSION: Intramedullary clavicle fixation with a 2.5-mm K-wire is a safe surgical technique. 2B.1 injuries treated with 2.5-mm IM K-wire fixation have relatively improved outcome compared with displaced 2B.2 fractures for both non-union and reoperation rates. There were no occurrences of implant migration with either 2B.1 or 2B.2 injuries, and a non-significant difference in implant irritation was documented with IM K-fixation. The non-union rate with K-wire IM fixation of 2B.1 injuries concords with the published results of other IM devices and thus this technique should be added to the surgeon's armamentarium when considering surgical treatment of such injuries.

A Selective Galactose-Coumarin-Derived Galectin-3 Inhibitor Demonstrates Involvement of Galectin-3-glycan Interactions in a Pulmonary Fibrosis Model.

Synthesis of doubly 3-O-coumarylmethyl-substituted thiodigalactosides from bis-3-O-propargyl-thiodigalactoside resulted in highly selective and high affinity galectin-3 inhibitors. Mutant studies, structural analysis, and molecular modeling revealed that the coumaryl substituents stack onto arginine side chains. One inhibitor displayed efficacy in a murine model of bleomycin-induced lung fibrosis similar to that of a known nonselective galectin-1/galectin-3 inhibitor, which strongly suggests that blocking galectin-3 glycan recognition is an important antifibrotic drug target.

Galectin-3-Binding Glycomimetics that Strongly Reduce Bleomycin-Induced Lung Fibrosis and Modulate Intracellular Glycan Recognition.

Discovery of glycan-competitive galectin-3-binding compounds that attenuate lung fibrosis in a murine model and that block intracellular galectin-3 accumulation at damaged vesicles, hence revealing galectin-3-glycan interactions involved in fibrosis progression and in intracellular galectin-3 activities, is reported. 3,3'-Bis-(4-aryltriazol-1-yl)thiodigalactosides were synthesized and evaluated as antagonists of galectin-1, -2, -3, and -4 N-terminal, -4 C-terminal, -7 and -8 N-terminal, -9 N-terminal, and -9 C-terminal domains. Compounds displaying low-nanomolar affinities for galectins-1 and -3 were identified in a competitive fluorescence anisotropy assay. X-ray structural analysis of selected compounds in complex with galectin-3, together with galectin-3 mutant binding experiments, revealed that both the aryltriazolyl moieties and fluoro substituents on the compounds are involved in key interactions responsible for exceptional affinities towards galectin-3. The most potent galectin-3 antagonist was demonstrated to act in an assay monitoring galectin-3 accumulation upon amitriptyline-induced vesicle damage, visualizing a biochemically/medically relevant intracellular lectin-carbohydrate binding event and that it can be blocked by a small molecule. The same antagonist administered intratracheally attenuated bleomycin-induced pulmonary fibrosis in a mouse model with a dose/response profile comparing favorably with that of oral administration of the marketed antifibrotic compound pirfenidone.

Synthesis and evaluation of iminocoumaryl and coumaryl derivatized glycosides as galectin antagonists.

A collection of iminocoumarylmethyl glycoside derivatives have been prepared by copper-catalyzed multi-component reaction of carbohydrate propargyl derivatives, sulfonyl azides, and salicylaldehyde or o-hydroxy acetophenone. The method is simple, versatile to all three components, and exceptionally high yielding. The carbohydrate N-sulfonyl iminocoumarine hybrid molecules were evaluated for binding galectin-1, -2, -3, -4N, -4C, -7, -8N, -9N, and 9C using a competitive fluorescence polarization assay. Selective compounds were identified against galectin-3, 7, 8N, and 9N with up to 40-fold affinity enhancements relative to methyl α-d-galactopyranoside due to the coumarylmethyl moieties.

Concise synthesis of a pentasaccharide related to the anti-leishmanial triterpenoid saponin isolated from Maesa balansae.

Concise synthesis of the glycone part (a pentasaccharide) of the anti-leishmanial triterpenoid saponin isolated from Maesa balansae is reported. A late-stage TEMPO-mediated oxidation of a primary hydroxyl group to carboxylic acid has been achieved under phase-transfer conditions. Glycosylations were performed either by thioglycoside or glycosyl trichloroacetimidate activation using sulfuric acid immobilized on silica (H2SO4-silica) in conjunction with N-iodosuccinimide and alone, respectively. H2SO4-silica was proved to be a better choice as promoter than conventional Lewis acid promoters such as TfOH or TMSOTf.