Required force for distraction during medial opening wedge high tibial osteotomy may serve as a predictive indicator for lateral hinge fracture.

Introduction: Medial open wedge high tibial osteotomy is a biological procedure for treating unicompartmental knee osteoarthritis. The literature repeatedly highlights the significance of preserving an intact lateral hinge during this procedure. We investigated the temporal course of distraction forces during distraction at the osteotomy site, aiming to quantitatively measure and analyse temporal changes in distraction forces at different distraction points for intact and fractured lateral hinges. Materials and Methods: This biomechanical study was conducted on 10 human cadavers, which were divided into two groups: one with preserved 1 cm intact lateral cortexes (ILCs) and the other with completely osteotomised fractured lateral cortexes (FLCs). An experimental setup was custom designed to facilitate the required force measurement during distraction. The distraction forces were recorded with a force gauge at 0.5-mm intervals throughout the distraction. Results: There was a significant difference between the ILC and FLC groups in distraction forces at all points (8-15 mm). The ILC group consistently exhibited higher distraction force values, with FLC recording values ranging from 8.8% to 13.2% of ILC's. Lateral hinge fractures caused an 86.7% reduction in the initial required force for distraction, significantly impacting the force required for distraction. The ILC group displayed a linear increase in the required distraction force up to 12.5 mm of distraction, which reached 3.7 times the initial value at 12.5 mm of distraction. The FLC group had lower baseline required distraction forces, following a relatively linear trend with more limited increases. Conclusion: FLCs in medial opening wedge osteotomy are associated with significant reductions in the force required for distraction, and a sudden decrease in distraction force during distraction may indicate a lateral hinge fracture. Force measurement devices for use during distraction could offer valuable insights and provide surgeons with immediate warnings for LHFs. Level of Evidence: Level IV.

Use of polyglycolic acid-hyaluronic acid/ß-tricalcium phosphate scaffold with or without mesenchymal stem cells found ineffective in treating osteochondral lesions in rabbit knees.

OBJECTIVE: In this experimental animal study, a novel bilayered scaffold used in the treatment of osteochondral defects in rabbit knees was evaluated. This novel scaffold's upper (cartilage) layer consists of polyglycolic acid and hyaluronic acid, and the lower (bone) layer consists of ß-tricalcium phosphate. The purpose of this study was to evaluate the efficacy of this novel scaffold, combined with or without mesenchymal stem cells (MSCs), in the treatment of osteochondral defects in rabbit knees. METHODS: Osteochondral defects were created in the left femoral trochlea of 30 rabbits. In group A, defects were treated with scaffold combined with MSCs; in group B, defects were treated with cell-free scaffolds; and group C was a control group with defects left untreated. In the 12th week, animals were sacrificed for macroscopic evaluation. RESULTS: The mean International Cartilage Repair Society (ICRS) macroscopic scores were 4.95 for group A, 6.16 for group B, and 8.25 for group C. The mean Oswestry Arthroscopic Scores (OAS) were 1.65 for group A, 3.39 for group B, and 6.05 for group C. The macroscopic scores were significantly higher in group C than group A for ICRS scores and group A and group B for OAS (P < .001, P < .000, P < .022). CONCLUSION: In essence, our findings indicate that the newly developed osteochondral scaffold, when tested in a rabbit model, is not as effective as expected in repairing full-thickness osteochondral defects, with or without the supplementation of MSCs. Further investigation is required to enhance the effectiveness of this novel combination.

Isolated popliteus tendon injury in a young patient: A case report.

Isolated popliteus injury is a rare clinical condition which can be treated either surgically or conservatively. Factors such as the patient's age, activity level, and cooperation with the medical team are determinants to choose the most optimal treatment option. A 29-year-old female patient presented with a knee injury caused by a low-speed motorcycle accident. Further examination suggested an isolated popliteus injury without any concomitant knee injury. We opted for surgical treatment, as it allowed us to act more confidently in the postoperative follow-up and the patient did not inspire confidence in the medical team in terms of close follow-up and compliance with the physical therapy protocols that would be required, if conservative treatment was chosen. In conclusion, isolated popliteus injury is a rare condition with no consensus on the treatment algorithm. Both surgical and conservative treatments can yield good to excellent results. Surgical treatment may be considered in selected cases where an optimal close follow-up regimen seems to be unlikely.

Artifical intelligence use in orthopedics: an ethical point of view.

Artificial intelligence (AI) is increasingly being utilized in orthopedics practice. Ethical concerns have arisen alongside marked improvements and widespread utilization of AI. Patient privacy, consent, data protection, cybersecurity, data safety and monitoring, bias, and accountability are some of the ethical concerns.

Management of an Unusual Post-arthroscopic Complication: Subquadricipital Hematoma in the Presence of Complete Suprapatellar Plica.

Complete suprapatellar plica is a rare congenital anomaly that separates the suprapatellar bursa from the knee joint cavity. Although the pathological incidence of this condition is not known, it can cause patellofemoral symptoms, anterior knee pain, and rarely hemarthrosis. We report a patient with a hematoma in an unusual location just three weeks after an arthroscopic procedure, associated with a complete suprapatellar plica undetected during primary surgery. The hematoma was not in the synovial cavity, rather between the quadriceps tendon and the synovial membrane and presenting with pain and catching. This unusual location has not been reported before. Repeat arthroscopic surgery with drainage of hematoma and plica resection relieved the symptoms.

How Long Do Octogenarians Benefit From Knee Arthroplasty?

Introduction Elderly patients are more prone to surgical risk regardless of the procedure. The overall mortality rate is expected to be high in this population. The aim of this study was to evaluate the survival rates of octogenarians who underwent knee arthroplasty procedures. Methods Sixty-two knee arthroplasties were performed on 52 patients who were >80 years of age at the time of the operation between November 1996 and May 2014. The preoperative American Society of Anesthesiologists (ASA) classes were available for 45 procedures. The database of the Civil Registry Service was used to assess whether the patients were alive at the time of the study. If they were deceased, their dates of death were recorded. The five-, 10-, and 15-year survival rates of patients were determined. Results Thirty patients (57.69%) were alive and 22 (42.31%) were deceased at the time of analysis. Based on the 62 procedures, the mean age of the patients at the time of the operation was 82.56 ± 2.18 years. The mean time span between the operation and death of patients who passed away was 6.4 ± 4.66 years. The mean age of the patients who were alive at the time of the study was 86.63 ± 3.60 years. The mean time that had passed since the operation was 4.41 ± 2.9 years for living patients. Only one patient died during the first 90 days postoperatively. The one-year mortality rate was 4.84% (three patients). A Kaplan-Meier survival analysis revealed that the mean survival time of the patients was 6.4 years, and the median survival time was 5.6 years. The five-year survival rate was 59%, the 10-year rate was 19%, and the 15-year rate was 7%. Conclusion Octogenarians benefitted from knee replacement longer than expected. Early mortality risks can be avoided with proper patient selection.

Stress radiography findings in medial meniscus posterior root tears.

BACKGROUND: The present study aimed to evaluate stress radiography and magnetic resonance imaging (MRI) findings in medial meniscus posterior root tears (MMPRTs). METHODS: The study included 27 patients (26 females, mean age, 53.52 years) who underwent high tibial osteotomy and in whom medial menisci were concurrently examined arthroscopically. Preoperative stress radiographs and MRI series in 14 cases with root tears (MMPRT group, detected arthroscopically) and in 13 cases without tears (control group) were evaluated. Joint spaces measured on the stress radiographs were compared between the operated and opposite knees in each group. RESULTS: On the varus stress radiographs, the mean lateral joint space of the operated knees was significantly wider than that of the opposite knees in the MMPRT group (P = 0.007). Upon MRI studies, meniscal extrusion was significantly more common in the MMPRT group than in the control group. Moreover, the amount of meniscal extrusion was correlated with the tear size. CONCLUSIONS: Widening of the lateral joint space on the varus stress radiography was higher in the cases with root tears. Therefore, we propose that stress radiographs can be helpful in the diagnosis of MMPRT.

Role of Arthroscopic Debridement of Hemophilic Ankles.

BACKGROUND: Arthroscopic debridement has been used in the treatment of early stages of hemophilic ankle arthropathy. The aim of this procedure is to alleviate pain, improve function, and diminish bleeding episodes. Evaluation of patient-reported outcomes of arthroscopic debridement for hemophilic ankle arthropathies was evaluated in this study. METHODS: Fifteen patients with hemophilia who had undergone arthroscopic debridement between 2008 and 2017 were included in this study. Preoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Foot Function Index (FFI) with its subscales were obtained. Patient-reported outcome was measured using FFI at the latest follow-up. Radiologic severity of hemophilic arthropathy was assessed with the Pettersson score. Preoperative and postoperative intraarticular bleeding frequencies of the hemophilic patients were compared. RESULTS: Patients experienced statistically significant improvements of FFI and its subscales. Median preoperative FFI scores dropped from 42.2% to 22.2% postoperatively. Median value for the Pettersson score was 3. Annual median bleeding frequency of the study group was 18 preoperatively and 1.5 postoperatively ( P = .002). CONCLUSION: By assessing patient-reported outcomes, pain and functional restrictions associated with hemophilic ankle arthropathy were improved following arthroscopic debridement. By means of subjective measures, this procedure was effective. LEVEL OF EVIDENCE: Level IV, retrospective case series.

The relationship between the level of lesion and progression in Reimer's index of spina bifida patients.

AIM: We aimed to evaluate the influence of the lesion level and acetabular displasia on the progression of hip dislocation in patients with spina bifida. MATERIAL AND METHOD: Two hundred twelve hips of 106 cases with spina bifida were evaluated both clinically and radiologically. Their vertebral level of lesions, clinical examinations, radiological migration index, and acetabulum terms were noted and were evaluated in terms of their relations with the level of lesion-migration and dysplasia. Data analysis method was evaluated using SPSS 22.0 program. RESULTS: Deficiency of acetabulum was present in 33 % of the cases with spina bifida. Dysplastic floor was found to be as equally important as the level of lesion in the progression of hip dislocation (p = 0.002). Progression and dislocation incidences were observed to be higher in the thoracic level (p = 0.008). Reimer's progression index was seen to be a reliable way of assesment. CONCLUSION: The development of hip dislocation and progression are not solely connected with muscle imbalance. Encountered more frequently in these cases, acetabular dysplasia is a factor that is as important as the level of lesion in the formation of hip dislocation and progression. Hip dislocation is associated with more progression in the higher level lesions. Reimer's index is a reliable assessment criteria.

Central defect type partial ACL injury model on goat knees: the effect of infrapatellar fat pad excision.

BACKGROUND: The mid-substance central defect injury has been used to investigate the primary healing capacity of the anterior cruciate ligament (ACL) in a goat model. The sagittal plane stability on this model has not been confirmed, and possible effects of fat pad excision on healing have not been evaluated. We hypothesize that excising the fat pad tissue results in poorer ligament healing as assessed histologically and decreased tensile strength of the healing ligament. We further hypothesize that the creation of a central defect does not affect sagittal plane knee stability. METHODS: A mid-substance central defect was created with a 4-mm arthroscopic punch in the ACLs of right knees of all the subjects through a medial mini-arthrotomy. Goats were assigned to groups based on whether the fat pad was preserved (group 1, n = 5) or excised completely (group 2, n = 5). The left knees served as controls in each goat. Histopathology of the defect area along with measurement of type I collagen in one goat from each group were performed at 10th week postoperatively. The remaining knees were evaluated biomechanically at the 12th week, by measuring anterior tibial translation (ATT) of the knee joints at 90° of flexion and testing tensile properties (ultimate tensile load (UTL), ultimate elongation (UE), stiffness (S), failure mode (FM)) of the femur-ACL-tibia complex. RESULTS AND DISCUSSION: Histopathology analysis revealed that the central defect area was fully filled macroscopically and microscopically. However, myxoid degeneration and fibrosis were observed in group 2 and increased collagen type I content was noted in group 2. There were no significant differences within and between groups in terms of ATT values (p = 0.715 and p = 0.149, respectively). There were no significance between or within groups in terms of ultimate tensile load and ultimate elongation; however, group 2 demonstrated greater stiffness than group 1 that was correlated with the fibrotic changes detected microscopically (p = 0.043). CONCLUSIONS: The central defect type injury model was confirmed to be biomechanically stable in a goat model. Resection of the fat pad was noted to negatively affect defect healing and increase ligament stiffness in the central defect injury model.

The effect of 2 adhesive products on skin integrity used for fixation of hip and knee surgical dressings: a randomized controlled trial.

PURPOSE: The aim of this study was to compare effects of 2 adhesive products, a nonwoven porous adhesive bandage (NPAB) and transparent film adhesive bandage (TFAB), on skin integrity for fixation of hip and knee surgical dressings. MATERIALS AND METHODS: A prospective, randomized study was conducted on 300 patients who underwent hip and knee surgery (arthroplasty, fixation of fractures, tumor operations, etc). Participants were randomized into 2 equal groups according to the applied surgical dressing fixation product (NPAB or TFAB). Skin changes (edema, erythema, blister, peeling of blister, mechanical peeling, and maceration), drying of incision, serous discharge, and early infection symptoms were evaluated. RESULTS: The skin integrity was found to be impaired in 4.0% (n = 6) of the 150 NPAB patients and in 10.7% (n = 16) of the 150 TFAB patients (P = .02). Logistic regression analysis showed that the risk of impaired skin integrity increased 2.5-fold when TFAB was applied (P = .03). CONCLUSION: The NPAB was associated with a reduced likelihood of impaired skin integrity following hip and knee surgery.

Sagittal flexion angle of the femoral component in unicompartmental knee arthroplasty: is it same for both medial and lateral UKAs?

The flexion of the femoral component in the sagittal plane in unicompartmental knee arthroplasty (UKA) was analyzed radiographically in this study. Thirty medial and 30 lateral UKAs were included. The sagittal flexion angles were measured both relative to the posterior femoral cortex and midline sagittal distal femoral axis. Both of the measurement methods revealed that the femoral components were inserted in a significantly more flexed fashion in the medial UKA group. Neither preoperative nor postoperative tibial slope did have any significant effect on the sagittal flexion angle. To the best of our knowledge, this is the first study demonstrating an angular difference in the sagittal flexion of the femoral components between medial and lateral UKAs.