Knee meniscal retears after repair: A systematic review comparing diagnostic imaging modalities.

The meniscus is a relatively avascular fibrocartilaginous structure that provides a key role in shock absorption and load transmission. However, accurate diagnosis of meniscal retear can present a clinical challenge. The purpose of this study was to conduct a systematic review on the available literature, which compare the sensitivities, specificities, and accuracies of different diagnostic modalities of diagnosing knee meniscal retears in patients who have undergone surgical meniscal repair, such as Magnetic Resonance Imaging (MRI), Magnetic Resonance Arthrography with intraarticular contrast (direct MRA), and a combination of MRI and direct MRA. Two authors independently searched two databases (PubMed and Scopus) for literature related to knee meniscus retear according to the PRISMA guidelines. Four studies were found, which resulted in 291 patients with 293 menisci. All studies were published in 2008 and 2014. In our analysis, we calculated sensitivity to be 78.79% (95% CI, 64.07-93.51), specificity to be 56.58% (95% CI, 20.21-92.94), and overall accuracy to be 66.25% (95% CI, 54.29-78.22) for MRI and sensitivity to be 87.84% (95% CI, 83.93-91.74), specificity to be 88.68% (95% CI, 81.93-95.43), and overall accuracy to be 87.22% (95% CI, 82.22-91.62) for direct MRA. We recommend the use of direct MRA for the diagnosis of meniscal retears due to its higher sensitivity, specificity, and accuracy as compared to MRI and its reduced cost and invasive nature as compared to second-look arthroscopy. However, our review is limited by the number of studies available on this topic. More studies using study designs such as randomized controlled trials, involving MRI, direct MRA, and combinations of such techniques, should be performed to accurately assess the different techniques and aid in designing guidelines to guide the diagnosis of meniscal retears following meniscal repair.

Gap Non-union Patella Fractures: Case Report and Review of the Literature.

INTRODUCTION: Gap non-union patella fractures are rare but can be particularly challenging for the orthopedic surgeon. We report a case of a 12 cm gap non-union patella fracture in a patient with osteoporosis and its surgical management, functional outcome, and implications on clinical practice. CASE REPORT: A 73-year-old fully independent female with a background of osteoporosis was referred to our outpatient knee clinic. She reported a fall from stairs following an initial soft-tissue injury to the left knee 6 months prior. She has had progressive decline in mobility since the injury and was restricted to a wheelchair when she was seen in clinic. On examination, she had significant wasting of the quadriceps on the left side. Her range of movement was from 40° extensor lag to 90° flexion actively. Passive movements of the knee were preserved. She was unable to straight leg raise. Plain radiographs revealed a 12 cm gap non-union of her left patella. The patient was managed operatively in a two-staged approach. The first stage involved application of ring fixator device to achieve gradual skeletal traction from 5 to 12 lbs over a period of 10 days. The second stage involved conventional tension band wiring. CONCLUSION: At 1-year follow-up, the patient achieved full independent mobility. This case highlights the efficacy of a two-staged approach in the management of gap non-union patella fractures in patients with poor bone quality.

Platelet-rich plasma (PRP) for knee disorders.

Platelet-rich plasma (PRP) is an autologous blood product with platelet concentrations above baseline values. The process involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets by plasmapheresis. It then undergoes a two-stage centrifugation process to separate the solid and liquid components of the anticoagulated blood. PRP owes its therapeutic use to the growth factors released by the platelets which are claimed to possess multiple regenerative properties.In the knee, PRP has been used in patients with articular cartilage pathology, ligamentous and meniscal injuries.There is a growing body of evidence to support its use in selected indications and this review looks at the most recent evidence. We also look at the current UK National Institute of Health & Clinical Excellence (NICE) guidelines with respect to osteoarthritis and the use of PRP in the knee. Cite this article: EFORT Open Rev 2017;2:28-34. DOI: 10.1302/2058-5241.2.160004.

Variability of Measurement of Patellofemoral Indices with Knee Flexion and Quadriceps Contraction: An MRI-Based Anatomical Study.

PURPOSE: The purpose of this study was to investigate the impact of varying knee flexion and quadriceps activity on patellofemoral indices measured on magnetic resonance imaging (MRI). MATERIALS AND METHODS: MRI of the knee was performed in 20 patients for indications other than patellar or patellofemoral pathology. Axial and sagittal sequences were performed in full extension of the knee with the quadriceps relaxed, full extension of the knee with the quadriceps contracted, 30° flexion of the knee with the quadriceps relaxed, and 30° flexion with the quadriceps contracted. Bisect offset, patella tilt angle, Insall-Salvati ratio and Caton-Deschamps index were measured. RESULTS: With the knee flexed to 30° and quadriceps relaxed, the mean values of patellar tilt angle, bisect offset, Insall-Salvati ratio and Caton-Deschamps index were all within normal limits. With the knee extended and quadriceps contracted, the mean patellar tilt angle (normal value, <15°) was 14.6° and the bisect offset (normal value, <65%) was 65%, while the Caton-Deschamps index was 1.34 (normal range, 0.6 to 1.3). With the knee extended and quadriceps relaxed, the mean Caton-Deschamps index was 1.31. CONCLUSIONS: MRI scanning of the knee in extension with the quadriceps contracted leads to elevated patellofemoral indices. MRI taken with the knee in 30° of flexion allows more reliable assessment of the patellofemoral joint and minimises the confounding effect of quadriceps contraction.

Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature.

The primary objectives of this systematic review were to define the indications, functional outcomes, survivorship and complications associated with distal femoral varus osteotomy (DFVO).Cumulative survival with arthroplasty as the endpoint ranged from 64 to 82% at 10 years, and 45% at 15 years. The mean pre-operative HSS score ranged from 46 to 65 and this improved at latest follow up to means of between 72 and 88. Pooled results show an overall complication rate of 5.8% (5/86) for unanticipated re-operation due to a complication.Poor reporting of included studies and considerable heterogeneity between them precluded any statistical analysis. Further study is required to determine the precise indications for DFVO, optimum surgical technique, implant of choice and post-operative rehabilitation regimen as all of these factors may significantly affect the complication profile and outcomes of this procedure.DFVO is technically demanding and requires a significant period of rehabilitation for the patient. However, long-term survivorship and good function have been demonstrated and it remains a potential option for valgus osteoarthritis in carefully selected patients.