Chondromyxoid Fibroma of the Calcaneus: A Rare Case Report.

Chondromyxoid fibroma (CMF) of the calcaneus is extremely rare. We report a case of CMF of the calcaneus in a 34-year-old female. She had foot pain for one year and had increased pain for the last two months. The patient complained of limping due to the pain she felt. CMF of the calcaneus was treated with curettage and bone grafting. The patient was allowed to mobilize the very next day of surgery with weight bearing as much as she could tolerate. No recurrence was encountered during the 18-month follow-up of the patient. The patient could perform activities in her daily life painlessly. Carefully performed curettage and bone grafting is an effective treatment method in the treatment of CMF of the calcaneus. CMF in the calcaneus may not be as rare as it is thought, and should be considered in the differential diagnosis.

Anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior lesions: A cadaveric study and preliminary report.

OBJECTIVE: This study aims to investigate the anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior (SLAP) lesions in a human cadaveric model. METHODS: In this anatomic study, bilateral shoulder girdles of 12 adult formalin embalmed cadavers were used. All cadavers were male, and the mean age was 63.4±7.3 years. The portal entry point was determined as midway between the anterior and posterior borders of the acromion, approximately 1 cm lateral from the edge of the acromion. After a guidewire was placed in the glenoid cavity at the 12 o'clock position where the SLAP lesion typically occurs, a switching stick was inserted there. Each glenoid was then drilled with a 2.4 mm drill through an arthroscopic cannula. Subsequently, anatomical dissection was executed to assess the relationship of the transmuscular portal with the suprascapular nerve, axillary nerve, supraspinatus tendon, acromion, and biceps tendon. Lastly, the shortest distance between the aforementioned structures with the drill was measured by a sensitive caliper to determine whether there was a penetration of the structures. Differences between the right and left sides were analyzed. RESULTS: The mean distance between the portal and the axillary nerve was 55.5 mm±6.0 mm, and the mean length of the suprascapular nerve was 61.2 mm±7.0 mm. The mean distance between the portal and the supraspinatus tendon was 2.8 mm±1.5 mm. No penetration of the axillary nerve, suprascapular nerve, and supraspinatus tendon was observed in any cadaver. No differences were detected for measured anatomical parameters between the right and left sides (p>0.05). CONCLUSION: Findings from this cadaveric study revealed that the transmuscular portal may allow for a reliable anchor placement without any nerve or tendon penetration during arthroscopic SLAP repair. LEVEL OF EVIDENCE: Level V.

Posterior Border Distance: An Effective Diagnostic Measurement for Carpal Tunnel Syndrome Using Ultrasonography.

Purpose The purpose of this study was to define posterior border distance (PBD), which represents an ultrasonographic diagnosing method of carpal tunnel syndrome (CTS), and to determine the reliability of PBD in comparison with electromyography (EMG) results. Methods Thirty-three patients (mean age: 51.8 ± 9.5 years; 27 females and six males) with CTS were included in this study. Ultrasonography (US) and EMG were performed under blinded conditions. PBD was evaluated by measuring the length of the perpendicular line between the posterior border of the median nerve and the line between the hook of the hamate and trapezoid tubercle. The cross-sectional area, anteroposterior (AP), and transverse diameter of the median nerve were measured. Control US was performed in 20 patients who were available at the first year postoperative follow-up and the results compared with preoperative US values. Correlation analyzes were performed to determine the relationship between electrodiagnostic results and ultrasonographic measurements. Results According to the results of preoperative and postoperative first-year US, there were statistically significant differences in the results of PBD (preoperative: 3.309±1.7472 mm, postoperative: 2.290±0.7867 mm p: 0.013) and AP diameter of the median nerve (preoperative: 3.012±0.7865 mm, postoperative: 2.680±0,5578 mm p: 0.017). There was no statistically significant difference in transverse diameter (preoperative: 6.585±1.9505 mm, postoperative: 6.955±2.2128 mm) and cross-sectional area (preoperative: 14.33±6.513 mm2, postoperative: 11.20±5.830 mm2) results (p>0.05). The cut-off value of PBD was ≥3.6 mm, it yielded 81.48% specificity and 83.33% sensitivity in the diagnosis of CTS. PBD was correlated with motor and sensory latency, anteromedial, and transverse diameter of the median nerve (p<0.05). There was no correlation between EMG values and the results of the cross-sectional area, transverse diameter, and AP diameter of the median nerve (p>0.05). Conclusion PBD is suggested as a reliable ultrasonographic measurement method for the diagnosis of CTS.

Effects of intraarticular ketamine combined with periarticular bupivacaine on postoperative pain after arthroscopic meniscectomy.

OBJECTIVES: This study aims to evaluate the effects of two different doses of intraarticular ketamine on visual analog scale (VAS) scores at rest and movement, time to first analgesic requirement, and 24-h morphine consumption in patients undergoing arthroscopic meniscectomy as well as to assess the frequency of postoperative nausea&vomiting, respiratory depression, pruritus, urinary retention, and constipation and to compare the time to discharge. PATIENTS AND METHODS: This prospective randomized double-blind study was performed between August 2013 and August 2014 on 75 patients (32 males, 43 females; mean age 46.7±13 years; range, 18 to 75 years) with American Society of Anesthesiologists scores of I-II scheduled for unilateral meniscectomy. Patients were randomized to receive 0.5 mg.kg-1 ketamine (group K1), 1 mg.kg-1 ketamine (group K2) or saline (group S) to a total volume of 20 mL intraarticularly at the end of the surgery. All patients were performed periarticular 10 mL 0.5% bupivacaine infiltration. Visual analog scale at rest and during passive knee movement was used to evaluate pain both preoperatively and at postoperative 0, 30 min, and 1, 2, 4, 6, 12, and 24 h. Time to first analgesic requirement and morphine consumption were recorded. RESULTS: Visual analog scale scores at rest and during movement at postoperative 0 were significantly reduced in group K2 compared with group S (p<0.05). The first analgesic requirement time was significantly longer in group K1 (76.9±25.2 min) and group K2 (93.4±26.1 min) than group S (29.3±7.1 min). Morphine consumption was lower in group K2 compared to group K1 and group S at postoperative 30 min, and 1 and 2 h. However, 24-h morphine consumption was similar in all groups. CONCLUSION: Intraarticular injection of 0.5 mg.kg-1 and 1 mg.kg-1 ketamine for postoperative pain management provided similar analgesic efficacy. However, high dose ketamine more noticeably decreased opioid requirement in the early postoperative period.

The effect of platelet-rich plasma on fracture healing in long-bone pseudoarthrosis.

PURPOSE: The aim of this study was to investigate the effects of platelet-rich plasma (PRP) on fracture union rate and fracture union time in pseudoarthrosis surgery and to evaluate the clinical and functional results of the patients. METHODS: The patients who were undergone pseudoarthrosis surgery between 2011 and 2014 were evaluated retrospectively. Twenty-four patients were included in the study. Patients were divided into two groups with used PRP and not used PRP during surgery. There were 14 patients in the PRP group and 10 patients in the control group. The two groups were compared in terms of demographic characteristics, fracture union time, and functional scores of the Lower Extremity Functional Scale and Upper Extremity Functional Index. RESULTS: Fractures were healed in both groups, and no complications were encountered. A statistically significant difference was found between the two groups in terms of fracture union time. The mean time of union was 5.3 months in the PRP group and 11.3 months in the control group (p: 0.000). There was no statistically significant difference between the two groups in terms of functional scores (p: 0.250). CONCLUSION: As a result of our study, we concluded that PRP is an effective and safe method in pseudoarthrosis surgery that reduces fracture union time. Controlled studies with more patient numbers are needed.

Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique.

OBJECTIVE: The aim of the study was to compare the outcomes of the transtibial and anatomical femoral single tunnel surgical techniques in ACL reconstruction. METHODS: A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) with anatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age: 29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluated with isokinetic tests at an angular velocity of 60°/s and 180°/s and the IKDC and Lysholm tests were performed preoperatively and in third, sixth, and 12th months postoperatively. The results were compared between the groups. The mean follow-up time was 17.1 ± 6.48 months. RESULTS: Postoperative third month changes in extension parameters of peak torque (AFT: -93.286, TT: -61.500), peak work (AFT: -77.071, TT: -47.500), peak torque ext/kg (AFT: -1.182, TT: -0.773), peak work ext/kg (AFT: -0.982, TT: -0.604), peak work (AFT: -55.143 TT: -33.063) at an angular velocity of 60°/s and postoperative third month change in extension parameter of peak power (AFT: -86.786 TT: -54.875) at an angular velocity of 180°/s were found to be better in the transtibial group (p < 0.05) and postoperative sixth month peak torque (AFT: 1.429, TT: -5.688) value at an angular velocity of 60°/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671, TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoral single-tunnel group were better than the transtibial group regarding to the postoperative final follow-up. There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r = 0.539; p = 0.031), and preoperative peak power extension (r = 0.541; p = 0.030) at the both angular velocity of 60°/s and 180°/s in the transtibial group. There was no significant difference between the two groups with regards to the Lachman, anterior drawer and pivot shift tests (p < 0.05). CONCLUSION: There were differences in terms of isokinetic parameters in early outcomes but there was no statistical difference between isokinetic parameters at the end of 1st year between two groups. There were some correlations between IKDC and Lysholm scores with some isokinetic parameters. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Endoscopic versus Open Bursectomy for Prepatellar and Olecranon Bursitis.

Objectives Bursitis of the olecranon and the patella are not rare disorders, and conservative management is successful in most cases. However, when patients do not respond to conservative treatment, open excisional surgery or, recently, endoscopic bursectomy, can be used. The aim of this study was to evaluate the results of open and endoscopic treatments of olecranon and prepatellar bursitis. Patients and methods Forty-nine patients (37 male and 12 female), who were treated with endoscopic bursectomy (25 patients) or open bursectomy (24 patients) were included in this study. Thirty patients had olecranon bursitis, while 19 patients had prepatellar bursitis. The patients' average age was 61.1 ± 12.3 (range 33-81) years. All of the patients' hospitalization and surgery times were recorded. The satisfaction of the patients was evaluated with a satisfaction scoring system, as well as by evaluating residual pain, the range of joint movement, and the cosmetic results of the procedure. Results The average follow-up time was 16 ± 9 months (range 12-27). The median operation time was 23.2 ± 3.5 minutes for the endoscopic bursectomy group and 26.4 ± 6.8 minutes for the open bursectomy group. The median hospitalization time was 0.56 ± 0.5 days (range 0-1 day) for the endoscopic group and 1 ± 0 days for the open bursectomy group (P<0.01). According to the patient satisfaction questionnaire, the endoscopic bursectomy group's score was 8.5 ± 1.3 (range 5-10), and the open bursectomy group's score was 5.29 ± 1.8 (range 1-9) (P<0.01). Conclusion Endoscopic bursectomy is a time-saving and efficient surgical treatment option for patients with prepatellar and olecranon bursitis.

Thenar Compartment Syndrome: What If a Compartment Pressure Measuring Device is Absent?

Compartment syndrome (CS) is a threatening condition characterized by excessive tissue pressure accumulation associated with acute trauma. Compartment syndrome causes a significant reduction in blood flow with subsequent muscle and nerve ischemic necrosis. Recently, reports have described the importance of intramuscular pressure measurements as a basis for CS diagnosis. Unfortunately, the measuring devices that were utilized produced results with unsatisfactory reliability, making a diagnosis and subsequent treatment challenging. Here, we report the use of an anesthesia pressure monitoring device with greater precision for pressure measurements, as well as real-time monitoring of intraoperative compartment pressure decompression efficacy. This device enabled the accurate diagnosis and rapid treatment of a thenar compartment syndrome (TCS) in the left hand of a diabetic female in an emergency setting. She presented extreme pain in the thumb flexion-extension (FE). Her condition was complicated by diabetic cellulitis, primarily of Staphylococcus aureus. Consequently, successful microsurgery in the thenar space, together with debridement, resulted in remarkable pain relief during FE of the thumb metacarpophalangeal (MCP) and interphalangeal (IP) joints, as well as the disappearance of the infection by Day 10. Subsequent one- to two-year follow-up assessments revealed marked recovery.

Outcomes of anatomic shoulder arthroplasty in primary osteoarthritis in type B glenoids.

BACKGROUND: Primary glenohumeral osteoarthritis with posterior wear of the glenoid and posterior subluxation of the humerus (Walch type B) presents a challenge to the treating surgeon. Our hypothesis was that glenoids with biconcavity (B2) would be associated with worse outcomes (functional scores and complications) than B1 glenoids. MATERIALS AND METHODS: We retrospectively analyzed prospectively collected data on 112 anatomic total shoulder arthroplasties (104 patients) with B glenoids. Preoperative computed tomography identified 64 B1 glenoids and 48 B2 glenoids (50 and 37 available for follow-up). RESULTS: A significant difference between B1 and B2 glenoids was noted in average retroversion (11° vs. 16°; P < .001) and average posterior humeral subluxation (65% vs. 75%; P < .001). No significant difference was seen in mean age (69.5 vs. 69.2 years) or body mass index (28.5 vs. 27.4) at time of surgery. At average follow-up of 60 months (range, 23-120 months), glenoid component radiolucencies (51.6%, B1; 47.9%, B2), range of motion, preoperative and postoperative scores of the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire, and patient satisfaction were not significantly different between the 2 groups. Four revisions (4.6%) were documented for acute postoperative infection (2.3%), subscapularis failure (1.1%), and glenoid loosening (1.1%). CONCLUSIONS: Although biconcave glenoids commonly have more severe retroversion and posterior subluxation of the humerus, we were unable to find a clinical or radiographic difference in outcome of patients with B1 or B2 glenoids treated with anatomic total shoulder arthroplasty at intermediate-term follow-up. Continued clinical and radiographic follow-up of these cohorts will be necessary to assess any future divergence in outcome.

Osteochondral Allograft MRI Scoring System (OCAMRISS) in the Knee: Interobserver Agreement and Clinical Application.

INTRODUCTION: Osteochondral allograft (OCA) transplantation is a suitable treatment option for large osteochondral defects. Magnetic resonance imaging (MRI) is an objective, reproducible, noninvasive monitoring tool for postoperative assessment after cartilage surgery. OBJECTIVE: To correlate Osteochondral Allograft MRI Scoring System (OCAMRISS) in patients undergoing OCA transplantation in the knee with clinical outcomes and determine interobserver agreement of this scoring system. METHODS: Fifteen patients underwent OCA transplantation in the knee and received a postoperative MRI. Four examiners read each MRI and completed an OCAMRISS. Interobserver agreement and intraclass correlation coefficients (ICCs) were assessed. Clinical outcomes were evaluated. Correlation between the OCAMRISS and clinical outcomes was calculated using Spearman's correlation coefficients. RESULTS: Interobserver agreement on individual features of the OCAMRISS was superior (κ = 0.81-1.0) in 65% of comparisons, substantial (κ = 0.61-0.8) in 14%, moderate (κ = 0.41-0.6) in 18%, and fair (κ = 0.21-0.4) in 3%. Agreement among readers was very strong for the cartilage, bone, ancillary, and total scores with 96% of comparisons having an ICC >0.80. International Knee Documentation Committee (IKDC) function scores were correlated with OCAMRISS cartilage score (ρ = 0.53, P = 0.044) and total score (ρ = 0.67, P = 0.006). The Knee injury and Osteoarthritis Outcome Score (KOOS) sports/recreation subscale was correlated with OCAMRISS ancillary score (ρ = 0.58, P = 0.049) and total score (ρ = 0.64, P = 0.024). No correlation was observed with subchondral bone features of OCAMRISS and any of the outcome scores. CONCLUSIONS: The recently described OCAMRISS is a reproducible grading system for in vivo evaluation after osteochondral allograft transplantation.

Osteochondral Allograft Transplantation for Knee Lesions after Failure of Cartilage Repair Surgery.

OBJECTIVE: The objective of this study was to assess the outcome of osteochondral allograft (OCA) transplantation as a salvage procedure after various cartilage repair surgeries. DESIGN: One hundred sixty-four knees in 163 patients (mean age = 32.6 years; range = 11-59 years; 55% males) were treated with OCA transplantation after subchondral marrow stimulation (SMS), osteochondral autograft transplantation (OAT), and autologous chondrocyte implantation (ACI). The majority of previous procedures were isolated SMS in 145 knees (88.4%). Mean allograft size was 8.5 ± 7.9 cm(2). The most common location was in femoral condyle. The number and type of reoperations on the operative knee were assessed. Failure of the OCA transplantation was defined as any reoperation resulting in removal of the allograft. Functional outcomes were evaluated. RESULTS: Sixty-eight knees had reoperations after OCA transplantation. Thirty-one knees (18.9%) were classified as allograft failures. The median time to failure was 2.6 ± 6.8 years (range = 0.7-23.4 years). Survivorship of the graft was 82% at 10 years and 74.9% at 15 years. Patients whose grafts were still in situ had a mean of 8.5 ± 5.6 years of follow-up. Scores on all functional outcomes scales improved significantly from preoperatively to latest follow-up. Eighty-nine percent of OCA transplantation patients reported being "extremely satisfied" or "satisfied." CONCLUSION: Despite the high reoperation rate, OCA transplantation is a successful salvage surgical treatment after cartilage repair procedures. This cohort showed improved survivorship and functional outcomes of OCA transplantation after SMS, ACI, and OAT.

Variability in Distal Femoral Anatomy in Patients Undergoing Total Knee Arthroplasty: Measurements on 13,546 Computed Tomography Scans.

Proper mechanical and rotational alignment plays an important role in achieving the success of the total knee arthroplasty (TKA). The purpose of the present study was to retrospectively determine with computed tomography (CT) the distal femoral valgus angle (DFVA) and femoral rotation angle (FRA). Our cohort included 13,546 CT scans of patients undergoing TKA. The average DFVA was 5.7 ± 2.3° (range from 1 to -16°) with 13.8% of patients identified as outliers. The distal FRA angle average was 3.3 ± 1.5° (range from -3 to 11°) with 2.8% of patients identified as outliers. These data can be useful in making orthopedic surgeons aware of the variability of femoral anatomy. Using the same cutting angle may lead to malposition of the femoral component.

Utilization of the bicipital groove axis for confirming alignment of the humerus with transepicondylar and ulnar shaft axes during intramedullary nailing.

OBJECTIVE: Intramedullary nailing is the preferred surgical treatment of humerus shaft fractures. The purpose of this study was to investigate the relationship between the bicipital groove and specific anatomical landmarks in achieving correct alignment of the humerus during intramedullary nailing, and to describe these anatomical landmarks. METHODS: Thirty (15 right; 15 left) total upper cadaver extremities were used in this study. After the anatomical landmarks were identified and marked, humeral head axis, transepicondylar axis, ulnar shaft axis, bicipital groove axis, and angular measurements of these were obtained. RESULTS: The mean angle between the bicipital groove axis and transepicondylar axis was 48.17°±12.35º (range: 20.10º to 74.6º). The mean angle between the bicipital groove axis and ulna diaphysis axis was 41.82º±11.56 º (range: 17.91º to 68.27º). The mean angle between the humeral head axis and bicipital groove axis was 20.53°±3.90º (range: 11.85º to 31.81º). The mean retroversion angle between the humeral head axis and transepicondylar axis was 27.52±11.37º (range: 4.26º to 49.36º). The mean angle between the humeral head axis and ulna diaphysis axis was 61.73º±12.08º (range: 33.97º to 86.37º). The mean torsion angle was 62.58º±11.28 º (range: 40.74º to 85.74º). CONCLUSION: Measurement and utilization of the relationship between the bicipital groove, ulna diaphysis and transepicondylar axes may be used for restoring humeral rotation.

The BstUI and DpnII Variants of the COL5A1 Gene Are Associated With Tennis Elbow.

BACKGROUND: Tennis elbow entails pain and tenderness over the lateral epicondyle. The exact cause of the condition is not fully understood. Type V collagen is a minor fibrillar collagen that intercalates with type I collagen and forms collagen fibrils. It is encoded by the COL5A1 gene. Sequence variants within COL5A1 3'-UTR have been implicated in musculoskeletal diseases. PURPOSE: To determine whether rs12722 (BstUI C414T polymorphism) and rs13946 (DpnII C230T polymorphism) of the COL5A1 gene are associated with an increased risk of tennis elbow. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 152 patients with tennis elbow and 195 healthy participants were enrolled in this study. The rs12722 (BstUI C414T) and rs13946 (DpnII C230T) polymorphisms were investigated with the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There was a significant difference in both BstUI and DpnII genotype frequencies between patients with tennis elbow and healthy participants. The A2 allele of BstUI and the B1 allele of DpnII were significantly underrepresented in the patient group. CONCLUSION: Individuals with the BstUI A1 allele and DpnII B2 allele of the COL5A1 gene have a high likelihood of developing symptoms of the tennis elbow. This is the first study reporting that rs12722 and rs13946 SNPs (single nucleotide polymorphisms) are genetic risk factors for tennis elbow.

Fresh osteochondral allografts in the knee: comparison of primary transplantation versus transplantation after failure of previous subchondral marrow stimulation.

BACKGROUND: In most treatment algorithms, osteochondral allograft (OCA) transplantation is regarded as an alternative salvage procedure when other, previous reparative treatments have failed. PURPOSE: To compare the outcomes of a retrospective matched-pair cohort of (1) primary OCA transplantation and (2) OCA transplantation after failure of previous subchondral marrow stimulation. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: An OCA database was used to identify 46 knees that had OCA transplantation performed as a primary treatment (group 1) and 46 knees that underwent OCA transplantation after failure of previous subchondral marrow stimulation (group 2). All patients had a minimum of 2 years' follow-up. Patients in each group were matched for age (±5 years), diagnosis (osteochondral lesion, degenerative chondral lesion, traumatic chondral injury), and graft size (small, <5 cm2; medium, 5-10 cm2; large, >10 cm2). The groups had similar body mass indexes, sex distributions, and graft locations (femoral condyle, patella, and trochlea. The number and type of further surgeries after the OCA transplantation were assessed; failure was defined as any reoperation resulting in removal of the graft. Functional outcomes were evaluated by use of the modified Merle d'Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Knee injury and Osteoarthritis Outcomes Score (KOOS), and the Knee Society function (KS-F) scale. Patient satisfaction, according to a 5-point scale from "extremely satisfied" to "dissatisfied," was recorded at the latest follow-up. RESULTS: Eleven of 46 knees (24%) in group 1 had reoperations, compared with 20 of 46 knees (44%) in group 2 (P = .04). The OCA was classified as a failure in 5 knees (11%) in group 1 and 7 knees (15%) in group 2 (P = .53). At 10 years of follow-up, survivorship of the graft was 87.4% and 86% in groups 1 and 2, respectively. Both groups showed improvement in pain and function on all subjective scores from preoperatively to the latest follow-up (all P < .001). Results showed that 87% of patients in group 1 and 97% in group 2 were "satisfied" or "extremely satisfied" with the OCA transplantation. CONCLUSION: Favorable results were shown in both groups with significant improvement of functional scores and excellent survivorship. Despite the higher reoperation rate in the previously treated group, previous subchondral marrow stimulation did not adversely affect the survivorship and functional outcome of OCA transplantation.

Tibial Slope is Highly Variable in Patients Undergoing Primary Total Knee Arthroplasty: Analysis of 13,546 Computed Tomography Scans.

The purpose of this study was to retrospectively measure with computed tomography (CT) the posterior tibial slope (PTS) to establish the average anatomy and the incidence of outliers in patients undergoing total knee arthroplasty (TKA). Our cohort included 13,546 arthritic patients: 8241 (61%) female; 5305 (39%) male. The average PTS angle was 7.2°±3.7° (range, -5° to 25°). The average of PTS angle of the males was 7.17°±3.82° and females was 7.24°±3.57°. A significant number of patients 35.0% (4149) were identified outliers in PTS. 1568 (11.6%) patients' PTS angle was less than 4°, 2581 (19.1%) patients' PTS angle was more than 10°. These data can be useful to determine optimum techniques and methodology to perform more accurate TKA.

Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee.

BACKGROUND: Osteochondral allograft (OCA) transplantation is an effective treatment option for chondral and osteochondral defects of the knee. HYPOTHESIS: Patients treated with OCAs for reciprocal bipolar lesions of the knee would demonstrate significant clinical improvement. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1983 and 2010, OCAs were implanted for bipolar chondral lesions in 46 patients (48 knees). The 21 male and 25 female patients averaged 40 years of age (range, 15-66 years). Thirty-four lesions were tibiofemoral, and 14 were patellofemoral. Forty-two knees (88%) had undergone a mean of 3.4 previous surgeries (range, 1-8). The mean allograft area was 19.2 cm(2). Clinical evaluation included the modified Merle d'Aubigné-Postel (18-point), International Knee Documentation Committee (IKDC) pain and function, and Knee Society function (KS-F) scores. Further surgeries on the operative joint were documented. RESULTS: Survivorship of the bipolar OCA was 64.1% at 5 years. Thirty knees underwent further surgery; 22 knees (46%) were considered failures (3 OCA revisions, 14 total knee arthroplasties, 2 unicondylar arthroplasties, 2 arthrodeses, and 1 patellectomy). Among patients whose OCA was still in situ at follow-up, the mean follow-up was 7 years (range, 2.0-19.7 years). The mean 18-point score improved from 12.1 to 16.1; 88% (23/26 knees) of surviving allografts scored ≥15. The mean IKDC pain score improved from 7.5 to 4.7, and the mean IKDC function score improved from 3.4 to 7.0. The mean KS-F score improved from 70.5 to 84.1. CONCLUSION: Osteochondral allograft transplantation is a useful salvage treatment option for reciprocal bipolar cartilage lesions of the knee. High reoperation and failure rates were observed, but patients with surviving allografts showed significant clinical improvement.