Labral Augmentation With Either Iliotibial Band Allograft or Dermis Allograft Perform Similarly Regarding Peak Force, Displacement, and Work to Labral Repair in Suction Seal Restoration: A Biomechanical Study.

PURPOSE: To investigate whether allograft substitutes may be used to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties of the labral suction seal under several scenarios, including: (1) intact labrum, (2) rim preparation, (3) labral repair, (4) labral augmentation with iliotibial band (ITB), and (5) labral augmentation with a dermis allograft. METHODS: Eleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the 5 labral states, 3 testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen. RESULTS: Eleven specimens were tested and 8 specimens (age: 58.6 ± 5.4 years, body mass index: 28.6 ± 6.8 kg/m2; 4 female patients; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0% ± 0% for all), rim preparation (89.0% ± 9.2%, 93.3% ± 20.6%, 85.1% ± 9.0%), repair (61.3% ± 17.9%, 88.4% ± 36.9%, 58.1% ± 16.7%), ITB allograft (62.7% ± 24.9%, 83.9% ± 21.6%, 59.4% ± 22.4%), and dermis allograft (57.8% ± 27.2%, 88.2% ± 29.5%, 50.0% ± 20.1%). Regarding peak force, intact state was significantly greater compared with the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (P < .001). No significant differences were demonstrated between displacement at peak force (P = .561). Regarding work, both intact state and rim preparation states were significantly greater than the repair, ITB augmentation, and dermis allograft augmentation states (P < .001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state. CONCLUSIONS: Labral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared with the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero. CLINICAL RELEVANCE: This study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation, which can be used for surgical decision-making.

Capsular Management at the Time of Hip Arthroscopy for Femoroacetabular Impingement Syndrome Varies With Geography and Surgeon Subspecialty Training: A Cross-Sectional, Multinational Surgeon Survey.

PURPOSE: To perform a multinational survey and identify patterns in capsular management at the time of hip arthroscopy. METHODS: An anonymous, nonvalidated survey was distributed by the American Orthopaedic Society for Sports Medicine; Arthroscopy Association of North America; European Society of Sports Traumatology, Knee Surgery & Arthroscopy; International Society for Hip Arthroscopy; and Turkish Society of Sports Traumatology, Arthroscopy, and Knee Surgery. The questions were broken down into 6 categories: demographic characteristics, capsulotomy preference, traction stitches, capsular closure, postoperative rehabilitation, and postoperative complications. RESULTS: The survey was completed by 157 surgeons. Surgeons who performed half or full T-type capsulotomies had 2.4 higher odds of using traction sutures for managing both the peripheral and central compartments during hip arthroscopy for femoroacetabular impingement (P = .024). Surgeons who believed that there was sufficient literature regarding the importance of hip capsular closure had 1.9 higher odds of routinely performing complete closure of the capsule (P = .044). Additionally, surgeons who practiced in the United States had 8.1 higher odds of routinely closing the capsule relative to international surgeons (P < .001). Moreover, surgeons who received hip arthroscopy training in residency or fellowship had 2.4 higher odds of closing the capsule completely compared with surgeons who did not have exposure to hip arthroscopy during their training (P = .009). CONCLUSIONS: Geographic and surgeon-related variables correlate with capsular management preferences during hip arthroscopy. Surgeons who perform half or full T-capsulotomies more often use traction stitches for managing both the peripheral and central compartments. Surgeons performing routine capsular closure are more likely to believe that sufficient evidence is available to support the practice, with surgeons in the United States being more likely to perform routine capsular closure in comparison to their international colleagues. CLINICAL RELEVANCE: As the field of hip preservation continues to evolve, capsular management will likely continue to play an important role in access, instrumentation, and postoperative outcomes.

No significant difference in thick versus thin osteochondral flap trochleoplasty in the treatment of trochlear dysplasia: A systematic review.

PURPOSE: Trochleoplasty has become increasingly utilised to address patellar instability in the setting of severe trochlear dysplasia. There remains a paucity of literature on the outcomes of 'thick'- versus 'thin'-osteochondral flap trochleoplasty. The purpose of this study is to compare clinical and radiographic outcomes between patients with patellar instability with symptomatic trochlear dysplasia treated using a 'thick' versus 'thin' osteochondral flap trochleoplasty. METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PRISMA checklist. Quality assessment of final articles was conducted by two blinded reviewers. Articles were separated based on the use of a 'thick' versus 'thin' flap trochleoplasty. Data collection consisted of recording the following variables: patient demographics, indications for trochleoplasty, mean follow-up time, additional procedures performed during trochleoplasty, patient-reported outcome measures (PROMs), radiographic outcomes (tibial tubercle-trochlear groove [TT-TG] distance, Caton-Deschamps Index [CDI] and sulcus angle [SA]) and the incidence of any postoperative complications and patellar redislocation rates. RESULTS: A total of 24 studies, consisting of 927 patients, were identified as meeting inclusion criteria. A total of five papers described a 'thick' flap technique, while 19 papers described the use of a 'thin' flap technique. No significant difference in the mean improvement of Kujala scores was appreciated when comparing 'thick' versus 'thin' techniques (p > 0.05). Improvements in mean radiographic outcomes based on TT-TG, CDI and SA were observed in both 'thick' and 'thin' flap trochleoplasty groups. The overall redislocation rate was 0.35%. CONCLUSION: No significant difference in Kujala scores was observed in patients undergoing trochleoplasty utilising 'thick' versus 'thin' technique, while improvements in mean TT-TG, CDI and SA were noted in both technique groups, with an overall redislocation rate of 0.35%. LEVEL OF EVIDENCE: Level IV.

Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus.

Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.

Ultrasound Demonstrates Potential in Identifying Proximal Femoral Morphology Before and After Cam Resection: A Cadaveric Study.

PURPOSE: (1) To compare alpha angles measured on fluoroscopy with those measured on ultrasound pre- and postosteoplasty and (2) to determine whether ultrasound can adequately assess cam deformity correction. METHODS: Twelve full-body specimens (20 hips) were analyzed. Images using fluoroscopy and ultrasound were captured of the operative hip with the hip in 6 consistent positions: 3 views in hip extension (neutral [N], 30° internal rotation [IR], and 30° external rotation [ER]) and 3 views in hip flexion of 50° (neutral [F-N], 40° external rotation [F-ER40], and 60° external rotation [F-ER60]). A curved-array ultrasound transducer probe was used with the transducer placed in line with the femoral neck to evaluate the proximal femoral morphology. An open femoral osteoplasty using an anterior approach was performed. Fluoroscopy and ultrasound were again used to capture images with the hip in the same 6 positions. Bland-Altman plots were used to determine whether fluoroscopic and ultrasound alpha angles agreed at each position. Independent t-tests were used to compare the alpha angles between the 2 modalities at each position, and paired t-tests were used to compare preoperative and postoperative alpha angles at each position. RESULTS: No significant differences between the alpha angle on fluoroscopy and ultrasound at all 6 positions were appreciated preosteoplasty. The mean preoperative alpha angle on ultrasound in each position was as follows: N (55.4° ± 5.9° vs 43.0° ± 2.1°), IR (55.1° ± 5.3° vs 43.9° ± 5.5°), ER (58.6° ± 5.6° vs 42.8° ± 3.0°), F-N (53.9° ± 5.5° vs 41.6° ± 3.3°), F-ER40 (55.5° ± 4.6° vs 41.5° ± 2.7°), and F-ER60 (57.9° ± 6.5° vs 41.2° ± 4.2°). The mean preoperative and postoperative alpha angle on fluoroscopy in each position were as follows: N (56.0 ± 12.8° vs 43.1 ± 2.1°), IR (54.1 ± 13.4° vs 41.9 ± 2.9°), ER (61.2 ± 11.0° vs 44.2 ± 1.9°), F-N (57.9 ± 10.6° vs 44.0 ± 2.3°), F-ER40 (59 ± 8.2° vs 42 ± 2.2°), and F-ER60 (55 ± 7.6° vs 41.1 ± 2.6°). Postosteoplasty, there was no significant difference between the mean alpha angle on fluoroscopy versus ultrasound in any position except F-N (44.0 ± 2.3 vs 41.6 ± 3.3, P = .015). Bland-Altman plots showed a high level of agreement between alpha angle values on fluoroscopy and ultrasound at all positions pre- and postosteoplasty. There was a significant reduction in alpha angle measured on ultrasound and fluoroscopy at each position following osteoplasty. There were no significant differences in the delta of the pre- and postosteoplasty alpha angle measurements between fluoroscopy and ultrasound. CONCLUSIONS: Ultrasound is a useful tool for assessing a cam deformity in patients with femoroacetabular impingement syndrome and for determining adequate resection of a cam deformity intraoperatively. CLINICAL RELEVANCE: Due to the inherent limitations and risks of the fluoroscopy, it is worth evaluating other nonionizing imaging modalities. Ultrasound has potential to be an accessible, cost-effective, and safe imaging modality that lacks radiation and is commonly used for intra-articular hip injections and dynamic examination of the hip.

Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction restores joint mechanics to the intact state and improves clinical function: a systematic review of biomechanical and clinical outcomes.

PURPOSE: To perform a systematic review of biomechanical and clinical outcomes following lateral meniscus posterior root (LMPR) repair with concomitant anterior cruciate ligament reconstruction (ACLR). METHODS: A literature search was performed systematically using PubMed, Embase, and Medline databases in April 2022. The search included the following terms combined with Boolean operators: 'Meniscus repairs', 'Meniscal Repair', 'Posterior Horn', 'Root', 'Radial'. Inclusion criteria consisted of level I-IV human clinical and biomechanical studies reporting biomechanical data and/or outcomes following LMPR repair in the setting of ACLR. RESULTS: Three biomechanical studies, all utilizing a transtibial pullout technique, were identified, all of which reported significant improvement in joint contact pressures and mechanics and 3/4 of which reported significant improvement in anterior or rotational stability with LMPR repair. Five clinical studies, consisting of 146 patients (mean age 28.5 ± 1.1 years) undergoing LMPR repair, were identified with an average follow-up of 19.1 months (range 6.2-46 months). Across all clinical studies, Lysholm and International Knee Documentation Committee (IKDC) scores were found to improve postoperatively, with 3/4 reporting significant improvement in Lysholm (all, p ≤ 0.001) scores and 3/5 reporting significant improvement in IKDC scores when compared to preoperative values (all, p ≥ 0.004). Meniscal extrusion decreased significantly following repair in 2/4 studies (all, p ≤ 0.001). CONCLUSIONS: Biomechanically, transtibial pullout repair of the LMPR restored joint contact pressures and joint mechanics to intact levels when performed with concomitant ACLR. Clinically, LMPR repair with concurrent ACLR resulted in improved Lysholm and IKDC scores. These findings enable surgeons to determine optimal treatment plans and discuss realistic outcomes with patients when encountering LMPR injuries. LEVEL OF EVIDENCE: IV.

Patients Follow 3 Different Rate-of-Recovery Patterns After Anterior Cruciate Ligament Reconstruction Based on International Knee Documentation Committee Score.

PURPOSE: To determine whether subgroups of patients exist based on the rate-of-recovery pattern of International Knee Documentation Committee (IKDC) scores after anterior cruciate ligament reconstruction (ACLR) and to determine clinical predictors for these subgroups. METHODS: Patients who underwent primary or revision ACLR at a single institution from January 2014 to January 2019 were identified. Latent class growth analyses and growth mixture models (GMMs) with 1 to 6 classes were used to identify subgroups of patients based on functional rate-of-recovery patterns by use of preoperative, 1-year postoperative, and 2-year postoperative IKDC scores. RESULTS: A total of 245 patients who underwent ACLR were included in the analysis. A 3-class GMM was chosen as the final model after 6 different models were run. Class 1, showing improvement from preoperatively to 1-year follow-up, with sustained improvement from 1 to 2 years postoperatively, constituted 77.1% of the study population (n = 189), whereas class 2, showing functional improvement between 1- and 2-year follow-up, was the smallest class, constituting 10.2% of the study population (n = 25), and class 3, showing slight improvement at 1-year follow-up, with a subsequent decline in IKDC scores between 1- and 2-year follow-up, constituted 12.7% of the study population (n = 31). Revision surgery (P = .005), a psychiatric history (P = .025), preoperative chronic knee pain (P = .024), and a subsequent knee injury within the follow-up period (P = .011) were the predictors of class 2 and class 3 rate-of-recovery patterns. Patient demographic characteristics, graft type, and concomitant ligament, meniscus, or cartilage injury at the time of surgery were not associated with the different recovery patterns described in this study. CONCLUSIONS: Patients may follow different rate-of-recovery patterns after ACLR. By use of the GMMs, 3 different rate-of-recovery patterns based on IKDC scores were identified. Although most patients follow a more ideal rate-of-recovery pattern, fewer patients may follow less favorable patterns. Revision surgery, a history of psychiatric illness, preoperative chronic knee pain, and a subsequent knee injury within the follow-up period were predictive of less favorable rate-of-recovery patterns. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Editorial Commentary: Peripheral Blood Stem Cells Mobilization Using Granulocyte Colony-Stimulating Factor for Articular Cartilage Injuries: Wake Them Up and Make Them Come to You!

Articular cartilage injuries constitute a prevalent musculoskeletal problem in the general population. Restorative cartilage procedures are specifically challenging, as recapitulating hyaline cartilage can be difficult, thus compromising clinical outcomes. Progenitor cells for the treatment of articular cartilage injuries constitute a promising therapeutic method that has been increasing exponentially. Progenitor cells can be obtained from many different human tissues, such as bone marrow, adipose tissue, and muscle, as well as from peripheral blood after mobilizing stem cells from bone marrow with granulocyte colony-stimulating factor simulation. The minimally invasiveness, low complication rate, and efficacy of peripheral blood stem cells has gained significant attention and rapidly has become a promising source of progenitor cell delivery in the past decade.

Local curvature mismatch may worsen the midterm functional outcomes of osteochondral allograft transplantation.

PURPOSE: This study aimed to determine the magnitude of local curvature matching in the sagittal plane between an implanted graft and the condylar region receiving the graft and to analyze its effect on clinical outcomes in patients undergoing osteochondral allograft transplantation (OCA). METHODS: Patients who underwent knee OCA between 2016 and 2019 without circumferential step-off and were matched with a donor in accordance with the conventional matching process were included. The magnitude of donor-host local curvature matching was measured using postoperative sagittal magnetic resonance imaging data with Syngo (Siemens Medical Solutions, Forchheim, Germany) and GeoGebra (GeoGebra GmbH, Linz, AU) software. In addition to radiological evaluation, ROC analysis was performed to compare the patient-reported outcome measures (PROMs) obtained during the 2-year follow-up period among the patients in the SagA group, who had a graft match in the sagittal plane; SagB group, who had low convexity of the graft in the sagittal plane; and SagC group, who had high convexity of the graft in the sagittal plane in accordance with the determined indices. RESULTS: The study included 27 patients who fulfilled the inclusion criteria, and the mean clinical scores of the SagC group were not statistically significantly higher than those of the other groups at any timepoint during the follow-up. The mean Tegner, IKDC, total KOOS and SF-12 physical and mental health scores of the SagC group were lower than those of the other two groups at various follow-up time points, particularly at month 24 (p < 0.05). There were no significant differences between the SagA and SagB groups in the PROMs at any of the follow-up time points (n.s.). The significant differences observed between the SagC group and the other groups in the mean KOOS scores for function in daily living and function in sport and recreation were also observed between the SagA and SagB groups at the follow-ups (p < 0.05). CONCLUSION: During OCA, a local curvature mismatch between the donor and the host involving large graft convexity may have a negative impact on midterm clinical outcomes. A preoperative analysis of the convexity relationship between the defect site and the graft region in the hemicondylar allograft to be used may enhance donor-host matching. The local analysis method described in the current study may also facilitate graft supply by ensuring donor-host matching without condyle-side and size matching. LEVEL OF EVIDENCE: III.

Microarray analysis of cartilage: comparison between damaged and non-weight-bearing healthy cartilage.

AIM: A limited healing response to focal cartilage lesions is frequently encountered in the clinical cartilage pathology. This study compares the gene expression patterns of damaged and undamaged regions of cartilage obtained from the same patient with focal cartilage lesions. The aim of this study is to provide new genes and proteins, which may be a potential future target of research. METHODS: During the autologous chondrocyte implantation (MACI) surgery, cartilage tissues (healthy non-weight bearing and Damaged-lesion side) were obtained from 10 patients with knee focal cartilage lesions. The degeneration status of the cartilage was characterized according to ICRS criteria. Whole genome microarray gene expression profiling was performed and some of the differentially regulated genes were validated with RT-PCR. RESULTS: Damaged and undamaged non-weight bearing cartilage showed distinct gene expression profiles. Genes involved in cell signaling, matrix degradation, hypoxia, and the inflammatory response showed significant up- or down-regulation. In the focal lesions, expression of genes such as HIF1α, TIMP-2, EID1, EID2, NCOA3, NBR1, SP100, and HSP90AA1 was significantly higher compared to healthy non-weight bearing cartilage from the same joint, whereas TIMP-4 was lower. CONCLUSION: The genes examined in this study differ distinctly between focal cartilage (ICRS 3-4) lesions and undamaged sites of the same joint. We believe that the data set forth in this study may be used for clinical purposes and be a guide in the development of new biological approaches for therapy.

Radiographs are not sufficient for evaluation of component fit in subtle knee pain after total knee arthroplasty.

PURPOSE: To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain. METHODS: The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding the tibial and femoral components, and the results were noted. The Knee Society Clinical Rating System and The Western Ontario and McMaster Universities Arthritis Index pain scale score forms were completed for all patients. Radiologic evaluation was performed using computed tomography and anteroposterior, lateral, and oblique radiographs to determine component overhang/underhang status at these nine regions. Overhang, underhang, and cortical fit groups were created based on the position of the component at the bone margin. A statistical relationship was sought between the clinical scores and the values measured to determine which imaging method showed the best correlation with clinical scores. Consistency of CT and Rx measurements was compared using the McNemar-Bowker test. Comparisons between groups were made using Student's t test for normally distributed data, and the Mann-Whitney U test. RESULTS: Computed tomography and radiographic measurements were similar in the medial, anterior, and lateral tibial regions. However, no similarities were observed in the anteromedial, anterolateral, posteromedial, and posterolateral tibial regions, and in the distal-medial and distal-lateral aspects of the femur. Statistical relationships among decreased clinical scores, pain with palpation, and the presence of overhang/underhang were only observed in the medial tibial region for imaging using radiography. A statistically significant relationship was observed in the medial, posteromedial, and posterolateral tibial regions, and in the distal-medial region of the femur for imaging based on computed tomography. CONCLUSIONS: Radiography could only aid in assessing the component fit in the anteromedial, medial, and lateral regions of the tibia in patients with residual knee pain following knee arthroplasty, but it was not sufficient in comparison with computed tomography in six other regions. LEVEL OF EVIDENCE: Prospective study, level of evidence II.

Definition of a Novel Proximal Femur Classification in the Sagittal Plane According to the Femur Morphometric Analysis.

BACKGROUND: Studies on prosthesis positioning and implant design in total hip arthroplasty (THA) have generally focused on the anatomy of the proximal femur in the coronal plane. The aim of this study was to investigate the proximal femur morphology in the sagittal plane to provide better positioning of the femoral component in THA and contribute to the determination of proximal femur morphology through possible outcomes that can be shown also by considering the sagittal plane in the selection and design of the femoral component. METHODS: Computerized tomography scans were obtained from 270 femoral bones belonging to adult skeletons, followed by 3D reconstruction using Leonardo Dr/Dsa Va30a software (Siemens, Erlangen, Germany) and measurements. Canal widths were measured in the coronal and sagittal planes at the lesser trochanter (LT) level, at 20 millimeters proximal to the LT(LT+20) and at various levels distal to the lesser trochanter in 25 mm jumps up to 200 mm from the lesser trochanter. RESULTS: The average width was wider at the level of the lesser trochanter and all points distal to it in the sagittal plane compared to the coronal plane except LT-200 mm. At each levels from LT-25 to LT-175, the differences were statistically significant (P < .05). The ratio of the femoral width at the lesser trochanter level to the width 50 mm distal to the LT was stated as the most prevalent one, and a novel classification in the sagittal plane was developed in accordance with these findings. CONCLUSION: A novel and simple classification in the sagittal plane was developed based on the findings of this study, and this classification may improve the accuracy, validity, and reliability of femoral stem fixation in total hip arthroplasty.

Does inflammatory joint diseases affect the accuracy of infection biomarkers in patients with periprosthetic joint infections? A prospective comparative reliability study.

BACKGROUND: The diagnosis of periprosthetic joint infections (PJI) in patients with inflammatory joint diseases (IJD) could be challenging. Several tests used for diagnosing PJI may be inaccurate due to baseline inflammatory characteristics of such diseases. We aimed to evaluate the accuracy of several infection biomarkers, in a specific subgroup of patients with PJI and IJD. METHODS: From January 2014 to August 2017, patients with resisting pain at the relevant site, following total knee arthroplasty were evaluated prospectively. A total of 38 patients were undergone revision arthroplasty. Patients were categorized in terms of MSIS criteria: Patients with PJI (Group 1, n = 17) and patients without PJI (Group 2, n = 21). Serum ESR, CRP, Procalcitonin, synovial cell count, percentage of neutrophils in synovial fluid, synovial CRP, Lactoferrin, ELA-2, Thiol - Disulphide levels, BPI and the Alpha defensin test results were obtained. The results of two groups were compared and the diagnostic accuracy of each variable was evaluated. RESULTS: There were 22 women, 16 men with a mean age of 67.8 ± 6.9 years. The differences were significant in all evaluated biomarkers in terms of PJI (p values of all biomarker were <0.001). Alpha defensin, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP were the most accurate tests with area under curve >0.90. CONCLUSIONS: Our results demonstrated that IJD may not affect the accuracy of infection biomarkers in patients with PJI. Alpha defensin test, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP can be used in the diagnosis of PJI in patients with IJD.

Sonoelastography of the knee joint.

Magnetic resonance imaging (MRI) is generally the preferred method for assessing lesions of the knee cartilage and subchondral bone. There have been a few cartilage imaging studies using real-time elastosonography (RTE), which has increased in importance and range of use in recent years. The aim of this cadaveric study was to assess the efficacy of a new diagnostic method combining USG and RTE and also to perform intra-articular examinations together with arthroscopy. A total of 12 fresh unpaired human knees were examined. The laparoscopic ultrasound transducer was deployed using standard anteromedial and anterolateral arthroscopic portals. Iatrogenic defects were examined using mosaicplasty tools in healthy-looking areas of cartilage, and strain in those areas was measured using RTE. The median strain value of the pathological femoral cartilage region was significantly higher than that of the normal cartilage region (1.23 [0.71-2.24] vs. 0.01 [0.01-0.01], P = 0.002, respectively). Arthroscopic study of cartilage using RTE can be a guide for orthopedic surgeons and use of intra-articular probes could be universalized. Clin. Anat. 32:99-104, 2019. © 2018 Wiley Periodicals, Inc.

Good clinical results can be obtained along with reduced risk of tunnel communication with a new technique in concomitant meniscus transplantation and ACL reconstruction.

PURPOSE: The purpose of this study was to introduce our technical modification for concomitant meniscus transplantation and ACL reconstruction with preliminary results of our cases. METHODS: The current study comprised of two sections: first is the cadaveric study of 20 specimens. The distances between tunnel entry and exit points of tunnels for 27 meniscal transplants and ACL reconstruction in CT slices were measured. The second section was evaluation of our cases including six patients. The selected patients were scored preoperatively and post-operatively with KOOS, Lysholm and VAS Scoring systems, joint ROM and stability. RESULTS: In cadaveric study section, the minimum distance between tunnels was found 1.9 ± 0.4 cm on tibia plateau and 1.8 ± 0.9 cm on tibial crest. No overlapping or communication of the tunnels was seen on any CT slice. In case series section, the mean age of patients was 36 ± 12.7 years and mean follow-up period was 30.8 ± 11.3 months. The KOOS total, VAS and Lysholm scores of the patients were significantly increased (p = 0.012, 0.036 and 0.001, respectively). The stability of operated knees was normal or near normal. CONCLUSION: The results of this study have demonstrated that our technical modification seems to be an effective method in concomitant medial meniscus transplantation and ACL reconstruction. There is a reduced risk of tunnel communication, and the medial bone stock is protected so the risk of potential fracture in the medial tibia plateau and revision rates may be reduced. Although it seems successful in respect of the short-term results, further studies with a greater number of patients would provide clearer results.

Fixed-bearing unicompartmental knee arthroplasty tolerates higher variance in tibial implant rotation than mobile-bearing designs.

BACKGROUND: UKA necessitates a learning period. From this point of view, it would be logical to prefer the design that tolerates suboptimal tibial rotations better, especially for inexperienced surgeons. The aim of this study was to evaluate and compare the clinical and radiological results of mobile-bearing and fix-bearing UKA designs in case of suboptimal tibial rotations. METHODS: A retrospective case-control evaluation was made of all the patients with medial compartment osteoarthritis, treated between January 2011 and January 2015. 324 patients ideal femoral rotation were enrolled in the study. 153 patients (Group 1) were treated with fix-bearing design with a mean 28.8 ± 11.3 month follow-up and 171 patients (Group 2) were treated with mobile-bearing design with a 31 ± 14.3 month follow-up. Each patient in groups was subdivided into (A): optimal tibial rotation, (B): external rotation of tibial component > 5°, (C): internal rotation of tibial component > 5° subgroups. WOMAC and KSS scores of each patient at preoperative and postoperative final control were compared between groups and subgroups. RESULTS: No significant differences were determined between the groups in terms of mean follow-up time (p = 0.0612), preoperative WOMAC, and KSS scores (p = 0.754 and p = 0.832, respectively). No significant differences were determined between subgroups 1A and 2A in terms of WOMAC and KSS scores at the final evaluation (p = 0.314 and p = 0.546, respectively). A significant difference was determined between subgroups 1B and 2B in terms of WOMAC and KSS scores (p = 0.021 and p = 0.012, respectively). In addition, the difference between subgroups 1C and 2C was significant (p = 0.047 and p = 0.034, respectively) at the final evaluation. CONCLUSION: Both mobile- and fix-bearing designs are beneficial in the treatment of medial compartment osteoarthritis of the knee. However, in case of both tibial internal or external suboptimal tibial rotations, fix-bearing design have better results compared to mobile-bearing design. STUDY DESIGN: Level III retrospective comparative clinical study.

Posterolateral overhang affects patient quality of life after total knee arthroplasty.

PURPOSE: To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity. METHOD: A retrospective evaluation was made of 146 consecutive total knee arthroplasties. The posterolateral overhang, rotational alignment and coverage of the tibial component were measured on a post-operative CT scan and the effect of posterolateral overhang on clinical outcomes was analysed 3 years after surgery. RESULTS: Complaints of local pain in the posterolateral corner were determined in 76 (52.1%) patients. At the Posterolateral corner, overhang was determined in 111 (76%) patients, in the cortical border in 11 (7.6%) patients and underhang in 24 (16.4%) patients. In 71 (48.6%) patients, pain was determined together with oversize and in the evaluation of the overhang of the tibial component in the posterolateral region and the rotation status, there was determined to be overhang in 75 (96.2%) patients where the tibial component was placed in ideal rotation, in 25 (100%) where placement was in external rotation and in 11 (25.6%) where placement was in internal rotation. The mean KSS, KSS-F and WOMAC-P scores were 83.9 ± 6.3, 83.3 ± 7.8 and 4.6 ± 2.9, respectively, in those with posterolateral overhang of the tibial component .The mean KSS, KSS-F and WOMAC-P scores were 86.6 ± 8.4, 89.5 ± 7.8 and 2.8 ± 2.1, respectively, in those with no overhang and the difference was determined to be statistically significant. The amount of overhang was determined as mean 3.6 ± 2.0 mm in those with posterolateral pain and 0.02 ± 3.4 mm in those without pain and the difference was statistically significant. CONCLUSIONS: This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.

Total and intercondylar notch bone resection in posterior stabilized knee arthroplasty: analysis of five manufacturer designs.

PURPOSE: The study aimed to volumetrically measure and compare the bone amount removed through the intercondylar femoral notch and the total bone amount removed through five different brands of implant design in order to provide orthopaedic surgeons with opinions in respect of implant selection. METHODS: Ten implants from five different total knee arthroplasty implant manufacturers, namely Nex-Gen Legacy, Genesis 2 PS, Vanguard, Sigma PS and Scorpio NRG PS, were applied to a total of 50 sawbone models. Equal or the closest sizes of each brand on the anteroposterior plane were selected, and cuts were made following the standard technique. The removed bone pieces were measured in terms of volume and length in three planes, and were statistically analysed. RESULTS: The comparison made by excluding femoral notch cuts did not produce any statistically significant difference between the amounts of bone removed. The following data were volumetrically obtained from the intercondylar femoral notch cut: Vanguard (3.6 ± 0.4 cm3), Nex-Gen (3.7 ± 0.5 cm3), Sigma (5.7 ± 0.4 cm3), Genesis 2 (6.3 ± 0.3 cm3) and Scorpio NRG (6.7 ± 0.7 cm3). There was no statistical difference between Genesis 2 and Scorpio NRG (n.s.), or between Nex-Gen and Vanguard (n.s.). The smallest volumetric value measured in the removed intercondylar femoral notch cut was obtained using Vanguard. CONCLUSION: There are significant differences between implant designs in terms of preserving bone stock, and a large proportion of the difference arises from the intercondylar femoral notch cut.

Toward the Turkish National Registry System: A Prevalence Study of Total Knee Arthroplasty in Turkey.

BACKGROUND: The aim of this pilot study was to analyze the data obtained from a retrospective examination of the records of the existing reimbursement system and through the identification of gaps in the data to create a foundation for a reliable, descriptive national registry system for our country. METHODS: The Social Security Institution Medical Messenger (MEDULA) records were scanned for the years 2010-2014, and the numbers of total knee arthroplasty applied for a diagnosis of gonarthrosis and the numbers of revision knee arthroplasty were recorded for the country in general. The patients were classified according to age, gender, and bilateral or unilateral surgery. The institution where the surgery was applied, the geographic region and the province were also recorded. RESULTS: A total of 283,400 primary and 9900 revision knee arthroplasty operations were applied in Turkey between 2010 and 2014. Numbers were recorded for each year, and there was found to be an increase between years. For primary knee arthroplasty, the female:male ratio was 67 of 33, and surgery was applied most often between the ages of 60-69 years. Both types of surgery were determined to have been applied most often in second-stage state hospitals. Geographically, both types of surgery were applied most in the Marmara region, with the highest frequency of primary knee arthroplasty in Istanbul and the highest frequency of revision surgery in Ankara. CONCLUSIONS: The data obtained from this study will contribute to the creation of the basis for a National Registry System and thereby define more scientific treatment approaches.