The transepicondylar distance is a reliable and easily measured parameter for estimating femoral cartilage surface area using MRI.

PURPOSE: Different cartilage repair techniques are widely used to regenerate cartilage, such as autologous chondrocyte implantation (ACI), osteochondral autograft transfer, microfracturing and minced cartilage. Defect size is a key parameter for selecting the best procedure to repair cartilage. However, the defect's size is not related to the patient's total cartilage surface. This is because assessing the femoral cartilage surface area is time-consuming and therefore unsuitable in the daily clinical routine. It has been proposed that the femur's total cartilage area correlates positively with the transepicondylar distance (TEA). METHODS: The knees of 40 subjects were analysed. Their average age was 30.1 ± 8.6 years. Twenty-four female and 16 male subjects were examined. Their mean body height was 176.2 ± 8.8 cm. MRI scans were performed via 3-Tesla MRI. These data were postprocessed and quantified using the browser-based, customizable SATORI platform (Fraunhofer MEVIS). This software computed the femoral cartilage surface area (FeCA), the patella cartilage surface area (PCA), the TEA and the patella length. RESULTS: Body height reveals a good correlation (r = 0.722, p < 0.001) with the distal femur's cartilage area surface. However, regression analysis shows only moderate dependence (R2: 0.514). A very good correlation (r = 0.830, p < 0.001) was observed between the TEA distance and the total cartilage surface area of the distal femur. The regression analysis yields a good value (R2: 0.684). The cranio-caudal length of the patella was chosen as a suitably measurable two-dimensional parameter for correlation analysis with the patella's total cartilage surface area. Those results yield a poor correlation (r = 0.577, p < 0.001) between the two parameters, and regression analysis reveals a low value (R2: 0.384). CONCLUSION: The TEA is a reliable parameter for estimating the femur's cartilage area using MRI. A simple determination of this parameter allows the estimation of the femur's total cartilage area as well as the surface-corrected defect size (SCDS) in daily routine. LEVEL OF EVIDENCE: Level II.

Prediction of the Hamstring Graft Size for ACL Reconstruction Using Different Axial Layers in Preoperative MRI.

BACKGROUND: In ACL reconstruction, it is desirable to assess preoperatively whether a sufficient graft diameter can be achieved with the planned tendon graft. The present study investigated the effect of the location of the cross-sectional area (CSA) measurement of the hamstring tendons in preoperative MRI on the correlation of the CSA with the intraoperative graft diameter. In addition, we analyzed whether the measurement results of examiners with different skill levels were comparable. METHODS: A total of 32 subjects undergoing a single bundle ACL reconstruction using an autologous ipsilateral quadrupled hamstring graft (STGT) were included. The CSA of the semitendinosus and gracilis tendon was determined in preoperative MRI on six defined levels by three examiners. The intraclass correlation coefficient between the measurements of these observers was determined. The correlation between the sum of the CSA of both tendons (CSA STGT) and the graft diameter was investigated. RESULTS: The interrater reliability was excellent on most of the investigated levels. A significant correlation between CSA STGT and the graft diameter was seen on all levels. The strongest correlation was found on the level 10 mm above the joint line. CONCLUSIONS: The measurement of the CSA STGT in the preoperative MRI 10 mm above the joint line enabled a good assessment of the achievable graft diameter in ACL reconstruction, independent of the examiners' training level.

Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis.

Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss - all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery. Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients. Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 - 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19-2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51-1.85; P = 0.92). Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon's experience.

Discrimination of finger movements by magnetomyography with optically pumped magnetometers.

Optically pumped magnetometers (OPM) are quantum sensors that offer new possibilities to measure biomagnetic signals. Compared to the current standard surface electromyography (EMG), in magnetomyography (MMG), OPM sensors offer the advantage of contactless measurements of muscle activity. However, little is known about the relative performance of OPM-MMG and EMG, e.g. in their ability to detect and classify finger movements. To address this in a proof-of-principle study, we recorded simultaneous OPM-MMG and EMG of finger flexor muscles for the discrimination of individual finger movements on a single human participant. Using a deep learning model for movement classification, we found that both sensor modalities were able to discriminate finger movements with above 89% accuracy. Furthermore, model predictions for the two sensor modalities showed high agreement in movement detection (85% agreement; Cohen's kappa: 0.45). Our findings show that OPM sensors can be employed for contactless discrimination of finger movements and incentivize future applications of OPM in magnetomyography.

Abstract perceptual choice signals during action-linked decisions in the human brain.

Humans can make abstract choices independent of motor actions. However, in laboratory tasks, choices are typically reported with an associated action. Consequentially, knowledge about the neural representation of abstract choices is sparse, and choices are often thought to evolve as motor intentions. Here, we show that in the human brain, perceptual choices are represented in an abstract, motor-independent manner, even when they are directly linked to an action. We measured MEG signals while participants made choices with known or unknown motor response mapping. Using multivariate decoding, we quantified stimulus, perceptual choice, and motor response information with distinct cortical distributions. Choice representations were invariant to whether the response mapping was known during stimulus presentation, and they occupied a distinct representational space from motor signals. As expected from an internal decision variable, they were informed by the stimuli, and their strength predicted decision confidence and accuracy. Our results demonstrate abstract neural choice signals that generalize to action-linked decisions, suggesting a general role of an abstract choice stage in human decision-making.

[Influence of the quadriceps muscles on the patellofemoral contact in patients with low flexion patellofemoral instability after MPFL reconstruction]. / Einfluss der Quadrizepsmuskulatur auf den patellofemoralen Kontaktmechanismus bei Patienten mit strecknaher patellofemoraler Instabilität nach MPFL-Rekonstruktion.

INTRODUCTION: MPFL reconstruction represents one of the most important surgical treatment options for recurrent patellar dislocations at low flexion angles associated with low flexion patellofemoral instability. Nevertheless, the role of quadriceps muscles in patients with patellofemoral instability before and after patellofemoral stabilization using MPFL reconstruction has not been fully elucidated. The present study investigates the influence of quadriceps muscles on the patellofemoral contact in patients with low flexion patellofemoral instability (PFI) before and after surgical patellofemoral stabilization using MPFL reconstruction using 3 T MRI datasets in early degrees of flexion (0-30°). METHODS: In this prospective cohort study, 15 patients with low flexion PFI before and after MPFL reconstruction and 15 subjects with healthy knee joints were studied using dynamic MRI scans. MRI scans were performed in a custom-made pneumatic knee loading device to determine the patellofemoral cartilage contact area (CCA) with and without quadriceps activation (50 N). Comparative measurements were performed using 3D cartilage and bone meshes in 0-30° knee flexion in the patients with patellofemoral instability preoperatively and postoperatively. RESULTS: The preoperative patellofemoral CCA of patients with low flexion PFI was 67.3 ± 47.3 mm2 in 0° flexion, 118.9 ± 56.6 mm2 in 15° flexion, and 267.6 ± 96.1 mm2 in 30° flexion. With activated quadriceps muscles (50 N), the contact area was 72.4 ± 45.9 mm2 in extension, 112.5 ± 54.9 mm2 in 15° flexion, and 286.1 ± 92.7 mm2 in 30° flexion without statistical significance. Postoperatively determined CCA revealed 159.3 ± 51.4 mm2 , 189.6 ± 62.2 mm2 and 347.3 ± 52.1 mm2 in 0°, 15° and 30° flexion. Quadriceps activation with 50 N showed a contact area in extension of 141.0 ± 63.8 mm2, 206.6 ± 67.7 mm2 in 15° flexion, and 353.5 ± 64.6 mm2 in 30° flexion, also without statistical difference compared with unloaded CCAs. Subjects with healthy knee joints showed an increase of 10.3% in CCA at 30° of flexion (p = 0.003). CONCLUSION: Although patellofemoral CCA increases significantly after isolated MPFL reconstruction in patients with low flexion patellofemoral instability, there is no significant influence of quadriceps muscles either preoperatively or postoperatively.

Testing the generalization of neural representations.

Multivariate analysis methods are widely used in neuroscience to investigate the presence and structure of neural representations. Representational similarities across time or contexts are often investigated using pattern generalization, e.g. by training and testing multivariate decoders in different contexts, or by comparable pattern-based encoding methods. It is however unclear what conclusions can be validly drawn on the underlying neural representations when significant pattern generalization is found in mass signals such as LFP, EEG, MEG, or fMRI. Using simulations, we show how signal mixing and dependencies between measurements can drive significant pattern generalization even though the true underlying representations are orthogonal. We suggest that, using an accurate estimate of the expected pattern generalization given identical representations, it is nonetheless possible to test meaningful hypotheses about the generalization of neural representations. We offer such an estimate of the expected magnitude of pattern generalization and demonstrate how this measure can be used to assess the similarity and differences of neural representations across time and contexts.

Neural representations of the content and production of human vocalization.

Speech, as the spoken form of language, is fundamental for human communication. The phenomenon of covert inner speech implies functional independence of speech content and motor production. However, it remains unclear how a flexible mapping between speech content and production is achieved on the neural level. To address this, we recorded magnetoencephalography in humans performing a rule-based vocalization task. On each trial, vocalization content (one of two vowels) and production form (overt or covert) were instructed independently. Using multivariate pattern analysis, we found robust neural information about vocalization content and production, mostly originating from speech areas of the left hemisphere. Production signals dynamically transformed upon presentation of the content cue, whereas content signals remained largely stable throughout the trial. In sum, our results show dissociable neural representations of vocalization content and production in the human brain and provide insights into the neural dynamics underlying human vocalization.

Influence of Medial Patellofemoral Ligament Reconstruction on Patellofemoral Contact in Patients With Low-Flexion Patellar Instability: An MRI Study.

Background: Medial patellofemoral ligament (MPFL) reconstruction is a well-established procedure for the treatment of patients with patellofemoral instability (PFI) at low flexion angles (0°-30°). Little is known about the effect of MPFL surgery on patellofemoral cartilage contact area (CCA) during the first 30° of knee flexion. Purpose/Hypothesis: The purpose of this study was to investigate the effect of MPFL reconstruction on CCA using magnetic resonance imaging (MRI). We hypothesized that patients with PFI would have a lower CCA than patients with healthy knees and that CCA would increase after MPFL reconstruction over the course of low knee flexion. Study Design: Cohort study; Level of evidence, 2. Methods: In a prospective matched-paired cohort study, the CCA of 13 patients with low-flexion PFI was determined before and after MPFL reconstruction, and the data were compared with those of 13 healthy volunteers (controls). MRI was performed with the knee at 0°, 15°, and 30° of flexion in a custom-designed knee-positioning device. To suppress motion artifacts, motion correction was performed using a Moiré Phase Tracking system via a tracking marker attached to the patella. The CCA was calculated on the basis of semiautomatic cartilage and bone segmentation and registration. Results: The CCA (mean ± SD) at 0°, 15°, and 30° of flexion for the control participants was 1.38 ± 0.62, 1.91 ± 0.98, and 3.68 ± 0.92 cm2, respectively. In patients with PFI, the CCA at 0°, 15°, and 30° of flexion was 0.77 ± 0.49, 1.26 ± 0.60, and 2.89 ± 0.89 cm2 preoperatively and 1.65 ± 0.55, 1.97 ± 0.68, and 3.52 ± 0.57 cm2 postoperatively. Patients with PFI exhibited a significantly reduced preoperative CCA at all 3 flexion angles when compared with controls (P ≤ .045 for all). Postoperatively, there was a significant increase in CCA at 0° of flexion (P = .001), 15° of flexion (P = .019) and 30° of flexion (P = .026). There were no significant postoperative differences in CCA between patients with PFI and controls at any flexion angle. Conclusion: Patients with low-flexion patellar instability showed a significant reduction in patellofemoral CCA at 0°, 15°, and 30° of flexion. MPFL reconstruction increased the contact area significantly at all angles.

Change in Descriptive Kinematic Parameters of Patients with Patellofemoral Instability When Compared to Individuals with Healthy Knees-A 3D MRI In Vivo Analysis.

BACKGROUND: Patellofemoral instability (PFI) leads to chronic knee pain, reduced performance and chondromalacia patellae with consecutive osteoarthritis. Therefore, determining the exact patellofemoral contact mechanism, as well as the factors leading to PFI, is of great importance. The present study compares in vivo patellofemoral kinematic parameters and the contact mechanism of volunteers with healthy knees and patients with low flexion patellofemoral instability (PFI). The study was performed with a high-resolution dynamic MRI. MATERIAL/METHODS: In a prospective cohort study, the patellar shift, patella rotation and the patellofemoral cartilage contact areas (CCA) of 17 patients with low flexion PFI were analyzed and compared with 17 healthy volunteers, matched via the TEA distance and sex, in unloaded and loaded conditions. MRI scans were carried out for 0°, 15° and 30° knee flexion in a custom-designed knee loading device. To suppress motion artifacts, motion correction was performed using a moiré phase tracking system with a tracking marker attached to the patella. The patellofemoral kinematic parameters and the CCA was calculated on the basis of semi-automated cartilage and bone segmentation and registrations. RESULTS: Patients with low flexion PFI showed a significant reduction in patellofemoral CCA for 0° (unloaded: p = 0.002, loaded: p = 0.004), 15° (unloaded: p = 0.014, loaded: p = 0.001) and 30° (unloaded: p = 0.008; loaded: p = 0.001) flexion compared to healthy subjects. Additionally, patients with PFI revealed a significantly increased patellar shift when compared to volunteers with healthy knees at 0° (unloaded: p = 0.033; loaded: p = 0.031), 15° (unloaded: p = 0.025; loaded: p = 0.014) and 30° flexion (unloaded: p = 0.030; loaded: p = 0.034) There were no significant differences for patella rotation between patients with PFI and the volunteers, except when, under load at 0° flexion, PFI patients showed increased patellar rotation (p = 0.005. The influence of quadriceps activation on the patellofemoral CCA is reduced in patients with low flexion PFI. CONCLUSION: Patients with PFI showed different patellofemoral kinematics at low flexion angles in both unloaded and loaded conditions compared to volunteers with healthy knees. Increased patellar shifts and decreased patellofemoral CCAs were observed in low flexion angles. The influence of the quadriceps muscle is diminished in patients with low flexion PFI. Therefore, the goal of patellofemoral stabilizing therapy should be to restore a physiologic contact mechanism and improve patellofemoral congruity for low flexion angles.

Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction.

INTRODUCTION: The influence of the MPFL graft in cases of patella instability with dysplastic trochlea is a controversial topic. The effect of the MPFL reconstruction as single therapy is under investigation, especially with severely dysplastic trochlea (Dejour types C and D). The purpose of this study was to evaluate the impact of trochlear dysplasia on patellar kinematics in patients suffering from low flexion patellar instability under weight-bearing conditions after isolated MPFL reconstruction. MATERIAL AND METHODS: Thirteen patients were included in this study, among them were eight patients with mild dysplasia (Dejour type A and B) and five patients with severe dysplasia (Dejour type C and D). By performing a knee MRI with in situ loading, patella kinematics and the patellofemoral cartilage contact area could be measured under the activation of the quadriceps musculature in knee flexion angles of 0°, 15° and 30°. To mitigate MRI motion artefacts, prospective motion correction based on optical tracking was applied. Bone and cartilage segmentation were performed semi-automatically for further data analysis. Cartilage contact area (CCA) and patella tilt were the main outcome measures for this study. Pre- and post-surgery measures were compared for each group. RESULTS: Data visualized a trending lower patella tilt after MPFL graft installation in both groups and flexion angles of the knee. There were no significant changes in patella tilt at 0° (unloaded pre-surgery: 22.6 ± 15.2; post-surgery: 17.7 ± 14.3; p = 0.110) and unloaded 15° flexion (pre-surgery: 18.9 ± 12.7; post-surgery: 12.2 ± 13.0; p = 0.052) of the knee in patients with mild dysplasia, whereas in patients with severe dysplasia of the trochlea the results happened not to be significant in the same angles with loading of 5 kg (0° flexion pre-surgery: 34.4 ± 12.1; post-surgery: 31.2 ± 16.1; p = 0.5; 15° flexion pre-surgery: 33.3 ± 6.1; post-surgery: 23.4 ± 8.6; p = 0.068). CCA increased in every flexion angle and group, but significant increase was seen only between 0°-15° (unloaded and loaded) in mild dysplasia of the trochlea, where significant increase in Dejour type C and D group was seen with unloaded full extension of the knee (0° flexion) and 30° flexion (unloaded and loaded). CONCLUSION: This study proves a significant effect of the MPFL graft to cartilage contact area, as well as an improvement of the patella tilt in patients with mild dysplasia of the trochlea. Thus, the MPFL can be used as a single treatment for patient with Dejour type A and B dysplasia. However, in patients with severe dysplasia the MPFL graft alone does not significantly increase CCA.

Optically pumped magnetometers detect altered maximal muscle activity in neuromuscular disease.

Optically pumped magnetometers (OPM) are quantum sensors that enable the contactless, non-invasive measurement of biomagnetic muscle signals, i.e., magnetomyography (MMG). Due to the contactless recording, OPM-MMG might be preferable to standard electromyography (EMG) for patients with neuromuscular diseases, particularly when repetitive recordings for diagnostic and therapeutic monitoring are mandatory. OPM-MMG studies have focused on recording physiological muscle activity in healthy individuals, whereas research on neuromuscular patients with pathological altered muscle activity is non-existent. Here, we report a proof-of-principle study on the application of OPM-MMG in patients with neuromuscular diseases. Specifically, we compare the muscular activity during maximal isometric contraction of the left rectus femoris muscle in three neuromuscular patients with severe (Transthyretin Amyloidosis in combination with Pompe's disease), mild (Charcot-Marie-Tooth disease, type 2), and without neurogenic, but myogenic, damage (Myotonia Congenita). Seven healthy young participants served as the control group. As expected, and confirmed by using simultaneous surface electromyography (sEMG), a time-series analysis revealed a dispersed interference pattern during maximal contraction with high amplitudes. Furthermore, both patients with neurogenic damage (ATTR and CMT2) showed a reduced variability of the MMG signal, quantified as the signal standard deviation of the main component of the frequency spectrum, highlighting the reduced possibility of motor unit recruitment due to the loss of motor neurons. Our results show that recording pathologically altered voluntary muscle activity with OPM-MMG is possible, paving the way for the potential use of OPM-MMG in larger studies to explore the potential benefits in clinical neurophysiology.

Minced Cartilage Is a One-Step Cartilage Repair Procedure for Small Defects in the Knee-A Systematic-Review and Meta-Analysis.

Purpose: Approximately 60% of patients undergoing arthroscopy of the knee present with chondral defects. If left untreated, osteochondral lesions can trigger an early onset of osteoarthritis. Many cartilage repair techniques are mainly differentiated in techniques aiming for bone marrow stimulation, or cell-based methods. Cartilage repair can also be categorized in one- and two-stage procedures. Some two-stage procedures come with a high cost for scaffolds, extensive cell-processing, strict regulatory requirements, and limited logistical availability. Minced cartilage, however, is a one-stage procedure delivering promising results in short term follow-up, as noted in recent investigations. However, there is no available literature summarizing or synthesizing clinical data. The purpose of this study was to analyze and synthesize data from the latest literature in a meta-analysis of outcomes after the minced cartilage procedure and to compare its effectiveness to standard repair techniques. Methods: We conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were the modified Coleman methodology Score (mCMS) >60, cartilaginous knee-joint defects, and adult patients. Patient age < 18 years, biomechanical and animal studies were excluded. Relevant articles were reviewed independently by referring to title and abstract. In a systematic review, we compared three studies and 52 patients with a total of 63 lesions. Results: Analysis of Knee Injury and Osteoarthritis Outcome Score (KOOS) sub scores at 12 and 24 months showed a significant score increase in every sub score. Highest mean difference was seen in KOOS sport, lowest in KOOS symptoms (12 month: KOOS sport (Mean difference: 35.35 [28.16, 42.53]; p < 0.0001), lowest in KOOS symptoms (Mean difference: 20.12 [15.43, 24.80]; p < 0.0001)). A comparison of International Knee Documentation Committee (IKDC ) scores visualized a significant score increase for both time points too ((12 month: pooled total mean: 73.00 ± 14.65; Mean difference: 34.33 [26.84, 41.82]; p < 0.00001) (24 month: pooled total mean: 77.64 ± 14.46; mean difference: 35.20 [39.49, 40.92]; p < 0.00001)). Conclusion: Due to no need for separate cell-processing, and thanks to being a one-step procedure, minced cartilage is a promising method for cartilage repair in small defect sizes (mean 2.77 cm2, range 1.3−4.7 cm2). However, the most recent evidence is scarce, and takes only results two years post-surgery into account. Summarized, minced cartilage presents nearly equal short-term improvement of clinical scores (IKDC, KOOS) compared to standard cartilage repair techniques.

Multistage classification identifies altered cortical phase- and amplitude-coupling in Multiple Sclerosis.

Distinguishing groups of subjects or experimental conditions in a high-dimensional feature space is a common goal in modern neuroimaging studies. Successful classification depends on the selection of relevant features as not every neuronal signal component or parameter is informative about the research question at hand. Here, we developed a novel unsupervised multistage analysis approach that combines dimensionality reduction, bootstrap aggregating and multivariate classification to select relevant neuronal features. We tested the approach by identifying changes of brain-wide electrophysiological coupling in Multiple Sclerosis. Multiple Sclerosis is a demyelinating disease of the central nervous system that can result in cognitive decline and physical disability. However, related changes in large-scale brain interactions remain poorly understood and corresponding non-invasive biomarkers are sparse. We thus compared brain-wide phase- and amplitude-coupling of frequency specific neuronal activity in relapsing-remitting Multiple Sclerosis patients (n = 17) and healthy controls (n = 17) using magnetoencephalography. Changes in this dataset included both, increased and decreased phase- and amplitude-coupling in wide-spread, bilateral neuronal networks across a broad range of frequencies. These changes allowed to successfully classify patients and controls with an accuracy of 84%. Furthermore, classification confidence predicted behavioral scores of disease severity. In sum, our results unravel systematic changes of large-scale phase- and amplitude coupling in Multiple Sclerosis. Furthermore, our results establish a new analysis approach to efficiently contrast high-dimensional neuroimaging data between experimental groups or conditions.

In-vivo assessment of meniscal movement in the knee joint during internal and external rotation under load.

PURPOSE: The menisci transmit load between femur and tibia and thus play a crucial role in the functionality of the knee joint. Knee joint movements have a major impact on the position of the menisci. However, these meniscus movements have not yet been assessed in a validated setting. The objective of this study is to evaluate the meniscal movements in MRI with prospective motion correction based on optical tracking under loading via internal and external tibial torques.  METHODS: Thirty-one healthy volunteers were recruited for this study. MRI scans were performed in internal and external rotation induced by a torque of 5 Nm, using a 3 T MRI. A validated software used the generated images to calculate the absolute meniscus movements as the sum of all vectors. Differences between subgroups were analyzed by using a Wilcoxon signed-rank test.  RESULTS: The MM shows an average movement of 1.79 mm in anterior-lateral direction under internal rotation and 6.01 mm in posterior-lateral direction under external rotation, whereas the LM moves an average of 4.55 mm in posterior-medial direction under internal rotation and 3.58 mm in anterior-medial direction under external rotation. When comparing the overall meniscus movements between internal and external rotation, statistically significant differences were found for total vector length and the direction of meniscus movements for medial and lateral meniscus. The comparison between medial and lateral meniscus movements also showed statistically significant differences in all categories for internal and external rotation. CONCLUSIONS: Overall, the MM and LM movements in internal and external rotation differ significantly in extent and direction, although MM and LM movements in opposite directions during internal and external rotation can be observed. In internal rotation, most meniscus movements were found in the IHLM. In external rotation, the IHMM showed the greatest mobility. Segment analysis of internal vs. external rotation showed less difference in LM movements than MM. LEVEL OF EVIDENCE: Level II.

Spectral Fingerprints of Cortical Neuromodulation.

Pupil size has been established as a versatile marker of noradrenergic and cholinergic neuromodulation, which has profound effects on neuronal processing, cognition, and behavior. However, little is known about the cortical control and effects of pupil-linked neuromodulation. Here, we show that pupil dynamics are tightly coupled to temporally, spectrally, and spatially specific modulations of local and large-scale cortical population activity in the human brain. We quantified the dynamics of band-limited cortical population activity in resting human subjects using magnetoencephalography and investigated how neural dynamics were linked to simultaneously recorded pupil dynamics. Our results show that pupil-linked neuromodulation does not merely affect cortical population activity in a stereotypical fashion. Instead, we identified three frontal, precentral, and occipitoparietal networks, in which local population activity with distinct spectral profiles in the theta, beta, and alpha bands temporally preceded and followed changes in pupil size. Furthermore, we found that amplitude coupling at ∼16 Hz in a large-scale frontoparietal network predicted pupil dynamics. Our results unravel network-specific spectral fingerprints of cortical neuromodulation in the human brain that likely reflect both the causes and effects of neuromodulation.SIGNIFICANCE STATEMENT Brain function is constantly affected by modulatory neurotransmitters. Pupil size has been established as a versatile marker of noradrenergic and cholinergic neuromodulation. However, because the cortical correlates of pupil dynamics are largely unknown, fundamental questions remain unresolved. Which cortical networks control pupil-linked neuromodulation? Does neuromodulation affect cortical activity in a stereotypical or region-specific fashion? To address this, we quantified the dynamics of cortical population activity in human subjects using magnetoencephalography. We found that pupil dynamics are coupled to highly specific modulations of local and large-scale cortical activity in the human brain. We identified four cortical networks with distinct spectral profiles that temporally predicted and followed pupil size dynamics. These effects likely reflect both the cortical control and effect of neuromodulation.

Individual Concepts in Foot Surgery: A Comparison of Xenogeneic and Autologous Bone Grafts Used in Adults for Lateral Calcaneus-Lengthening Osteotomy According to Evans.

BACKGROUND: Xenogeneic bone grafts, when compared to autologous grafts, are supposed to provide structural benefits without donor site morbidity. To date, there have been divergent results in the use of xenogeneic grafts in foot surgery, primarily in pediatric patient cohorts. The present study examines the incorporation and maintenance of the achieved correction using autologous and xenogeneic bone grafts in adult patients with a six-month follow-up period. MATERIAL/METHODS: In this retrospective study, 31 adult patients (43 feet in total) treated in our clinic by a lateral calcaneus-lengthening osteotomy, according to Evans, between 01/2006 and 12/2020 were included. The patients were assigned to study groups according to the use of xenogeneic or autologous bone grafts. The osseous incorporation following the criteria of Worth et al., correction maintenance by measuring the talo-navicular coverage angle (TNCA), the talo-first metatarsal angle (TFMA), the calcaneal pitch angle (PCA) and necessary revisions six months after surgery were extracted from the medical files retrospectively. Furthermore, the medical files were screened for the relevant comorbidities, nicotine abuse, BMI, sex and age. RESULTS: In total, 27 autogenous (iliac crest) and 16 xenogeneic bone grafts of bovine origin were used. The evaluation of the radiographs at follow-up demonstrated that there was a mean incorporation rate of 96.3% for the autologous grafts and 57% for the patients treated with xenogeneic grafts (p = 0.002). Compared to the autologous group, xenogeneic grafts did not increase the loss of hindfoot alignment in the postoperative course, regardless of being incorporated or not. ΔTNCA, ΔTFMA and ΔPCA displayed no significant differences in both groups (p = 0.45, p = 0.42 and p = 0.10). CONCLUSION: Despite a significantly lower incorporation rate, the use of xenogeneic grafts was not accompanied with a greater risk of hindfoot alignment loss in the first six months after surgery. Early revision after a postoperative course of six months should not be motivated solely by the radiographic picture of incomplete osseous integration.

Measuring standing hindfoot alignment: reliability of different approaches in conventional x-ray and cone-beam CT.

INTRODUCTION: Currently there is no consensus how hindfoot alignment (HA) should be assessed in CBCT scans. The aim of this study is to investigate how the reliability is affected by the anatomical structures chosen for the measurement. MATERIALS AND METHODS: Datasets consisting of a Saltzman View (SV) and a CBCT of the same foot were acquired prospectively and independently assessed by five raters regarding HA. In SVs the HA was estimated as follows: transversal shift between tibial shaft axis and heel contact point (1); angle between tibial shaft axis and a tangent at the medial (2) or lateral (3) calcaneal wall. In CBCT the HA was estimated as follows: transversal shift between the centre of the talus and the heel contact point (4); angle between a perpendicular line and a tangent at the medial (5) or lateral (6) calcaneal wall; angle between the distal tibial surface and a tangent at the medial calcaneal wall (7). Intraclass correlation coefficients (ICC) were calculated to assess inter-rater reliability. A linear regression was performed to compare the different measurement regarding their correlation. RESULTS: 32 patients were included in the study. The ICCs for the measurements 1-7 were as follows: (1) 0.924 [95% CI 0.876-0.959] (2) 0.533 [95% CI 0.377-0.692], (3) 0.553 [95% CI 0.399-0.708], (4) 0.930 [95% CI 0.866-0.962], (5) 0.00 [95% CI - 0.111 to 0.096], (6) 0.00 [95% CI - 0.103 to 0.111], (7) 0.152 [95% CI 0.027-0.330]. A linear regression between measurement 1 and 4 showed a correlation of 0.272 (p = 0.036). CONCLUSIONS: It could be shown that reliability of measuring HA depends on the investigated anatomical structure. Placing a tangent along the calcaneus (2, 3, 5, 6, 7) was shown to be unreliable, whereas determining the weight-bearing heel point (1, 4) appeared to be a reliable approach. The correlation of the measurement workflows is significant (p = 0.036), but too weak (0.272) to be used clinically.

Interobserver reliability is higher for assessments with 3D software-generated models than with conventional MRI images in the classification of trochlear dysplasia.

PURPOSE: Trochlear dysplasia is a significant risk factor for patellofemoral instability. The severity of trochlear dysplasia is commonly evaluated based on the Dejour classification in axial MRI slices. However, this often leads to heterogeneous assessments. A software to generate MRI-based 3D models of the knee was developed to ensure more standardized visualization of knee structures. The purpose of this study was to assess the intra- and interobserver agreements of 2D axial MRI slices and an MRI-based 3D software generated model in classification of trochlear dysplasia as described by Dejour. METHODS: Four investigators independently assessed 38 axial MRI scans for trochlear dysplasia. Analysis was made according to Dejour's 4 grade classification as well as differentiating between 2 grades: low-grade (types A + B) and high-grade trochlear dysplasia (types C + D). Assessments were repeated following a one-week interval. The inter- and intraobserver agreement was determined using Cohen's kappa (κ) and Fleiss kappa statistic (κ). In addition, the proportion of observed agreement (po) was calculated for assessment of intraobserver agreement. RESULTS: The assessment of the intraobserver reliability with regard to the Dejour-classification showed moderate agreement values both in the 2D (κ = 0.59 ± 0.08 SD) and in the 3D analysis (κ = 0.57 ± 0.08 SD). Considering the 2-grade classification, the 2D (κ = 0.62 ± 0.12 SD) and 3D analysis (κ = 0.61 ± 0.19 SD) each showed good intraobserver matches. The analysis of the interobserver reliability also showed moderate agreement values with differences in the subgroups (2D vs. 3D). The 2D evaluation showed correspondences of κ = 0.48 (Dejour) and κ = 0.46 (high / low). In the assessment based on the 3D models, correspondence values of κ = 0.53 (Dejour) and κ = 0.59 (high / low) were documented. CONCLUSION: Overall, moderate-to-good agreement values were found in all groups. The analysis of the intraobserver reliability showed no relevant differences between 2 and 3D representation, but better agreement values were found in the 2-degree classification. In the analysis of interobserver reliability, better agreement values were found in the 3D compared to the 2D representation. The clinical relevance of this study lies in the superiority of the 3D representation in the assessment of trochlear dysplasia, which is relevant for future analytical procedures as well as surgical planning. LEVEL OF EVIDENCE: Level II.

Cortical correlation structure of aperiodic neuronal population activity.

Electrophysiological population signals contain oscillatory and non-oscillatory aperiodic (1/frequency-like) components. So far research has largely focused on oscillatory activity, and only recently, interest in aperiodic population activity has gained momentum. Accordingly, while the cortical correlation structure of oscillatory population activity has been characterized, little is known about the correlation of aperiodic neuronal activity. To address this, we investigated aperiodic neuronal population activity in the human brain using resting-state magnetoencephalography (MEG). We combined source-analysis, signal orthogonalization and irregular-resampling auto-spectral analysis (IRASA) to systematically characterize the cortical distribution and correlation of aperiodic neuronal activity. We found that aperiodic population activity is robustly correlated across the cortex and that this correlation is spatially well structured. Furthermore, we found that the cortical correlation structure of aperiodic activity is similar but distinct from the correlation structure of oscillatory neuronal activity. Anterior cortical regions showed the strongest differences between oscillatory and aperiodic correlation patterns. Our results suggest that correlations of aperiodic population activity serve as robust markers of cortical network interactions. Furthermore, our results show that aperiodic and oscillatory signal components provide non-redundant information about large-scale neuronal correlations. This may reflect at least partly distinct neuronal mechanisms underlying and reflected by oscillatory and aperiodic neuronal population activity.