New Horizons in the Diagnosis of Tuberculosis of the Spine: The Role of Whole Genome Sequencing.

STUDY DESIGN: Prospective study. PURPOSE: To evaluate the utility of whole genome sequencing (WGS) in drug resistance testing, lineage of the organisms, and organism- related factors responsible for bacilli settling in the spine. OVERVIEW OF LITERATURE: The workstream for the diagnosis of tuberculosis (TB) involves isolation and culture of the organism and drug resistance testing using phenotypic methods. Xpert MTB/RIF Ultra is a genetic-based method that detects for Mycobacterium tuberculosis DNA in the rpoB gene. Meanwhile, WGS is a newer genetic-based method that assesses the whole genome of the bacterium. Very few studies have reported the use of WGS for extrapulmonary TB. Herein, we used WGS to diagnose spinal TB. METHODS: Tissues from 61 patients undergoing surgery for spinal TB underwent histologic examination, Xpert MTB/RIF Ultra, and culture and sensitivity testing. DNA from the cultured bacteria was sent for WGS. The test bacterial genome was compared to a reference strain of pulmonary TB. RESULTS: Acid-fast bacilli were observed in 9/58 specimens. Meanwhile, histology confirmed TB in all the patients. Bacilli were cultured in 28 patients (48.3%), and the average time to culture was 18.7 days. Xpert MTB/RIF Ultra was positive in 47 patients (85%). WGS was performed in 23 specimens. Overall, 45% of the strains belonged to lineage 2 (East Asian). There was one case of multidrug- resistant TB and two cases of non-tuberculous mycobacteria on WGS. We could not confirm any genomic difference between pulmonary and spinal TB strains. CONCLUSIONS: Xpert MTB/RIF Ultra of tissues or pus is the investigation of choice when diagnosing spinal TB. Meanwhile, WGS can diagnose multidrug-resistant TB and non-tuberculous mycobacteria more accurately. No mutations were identified in spinal and pulmonary TB bacteria.

Increased Posterior Slope of the Medial and Lateral Meniscus Posterior Horn Is Associated With Anterior Cruciate Ligament Injuries.

PURPOSE: To measure the slope of the medial and lateral posterior horn of the meniscus and its contribution to the overall resulting posterior tibial slope (bone and meniscus combined slope) in anterior cruciate ligament-intact (ACLI) and -deficient (ACLD) knees. METHODS: Magnetic resonance images of intact menisci in patients 16 to 60 years old were included. Posterior tibial bone slope (PTS) and meniscus slope (MS) were measured 25%, 50%, and 75% from the medial and lateral borders of the tibial plateau. Analysis of variance was used to determine differences in posterior tibial slopes between ACLD and ACLI knees and between sexes for ACLD and ACLI knees. RESULTS: 192 ACLI patients (age 35.2 ± 9.6 years, mean ± standard deviation) and 159 ACLD patients (age 34.2 ± 10.3 years) were included. Medial and lateral PTS in ACLD was significantly (P = .00001) higher at 25%, 50%, and 75%. Medial and lateral MS in ACLD was significantly (P = .00001) lower at 25%, 50%, and 75%. There were no significant sex differences for medial or lateral MS in ACLD or ACLI patients (P = .51). The resultant combined medial and lateral slope in ACLD patients was significantly (P = .00001) lower at 25%, 50%, and 75%. There were no significant sex differences in PTS (P = .68), MS (P = .51), or resultant slope (P = .79) CONCLUSIONS: The results of this study strongly suggest that lower meniscal slopes of both the medial and lateral posterior horns are associated with ACL injuries in both males and females. Although the posterior horns reversed the bone PTS to an anterior inclined slope in both ACLD and ACLI patients, both the meniscus slope and the combined resultant slope were significantly lower and more positive at all 6 measured locations in ACLD knees. LEVEL OF EVIDENCE: III, retrospective cohort study.

Medial and Lateral Posterior Tibial Slope Are Independent Risk Factors for Noncontact ACL Injury in Both Men and Women.

BACKGROUND: Higher posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) injury in men and women. The individual contribution of the lateral (LPTS) and medial (MPTS) slope has not yet been investigated. PURPOSE: To determine whether either the LPTS or the MPTS is an independent risk factor for ACL injury, and to determine sex-specific differences between patients with ACL-deficient and ACL-intact knees. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We reviewed knee magnetic resonance (MR) images performed on ACL-deficient and ACL-intact knees between January 2018 and June 2020 at a single institution. Inclusion criteria were isolated ACL injury and noncontact mechanism (ACL-deficient group) and nonspecific knee pain and no history of injury (ACL-intact group). Exclusion criteria for both groups were the following: previous knee surgery; meniscal, collateral ligament, posterior cruciate ligament, or multiligamentous injuries; radiological evidence of osteoarthritis; and chondral damage on the tibia. The MR images were used to establish the posterior bony slope at 25%, 50%, and 75% from the medial and/or lateral border of the tibial plateau with respect to the proximal tibial anatomic axis. One-way analysis of variance (ANOVA) was used to determine differences in PTS at the 25%, 50%, and 75% distances for the medial and lateral tibial plateau between the groups and between the sexes. RESULTS: Overall, 325 images were included (mean age, 36.1 ± 11.1 years; 142 ACL-deficient images [82 men and 60 women]; 183 ACL-intact images [112 men and 71 women]). MPTS and LPTS were significantly higher at 25%, 50%, and 75% in the ACL-deficient group (range, -2.7° to -5.7°) compared with the ACL-intact group (range, -2.1° to 1.5°; P = .00001). Similarly, MPTS and LPTS were significantly different in men versus women (P = .00001). ANOVA revealed that there were no significant differences in PTS between men and women for all measures (MPTS, LPTS, ACL-deficient, ACL-intact; P = .68). CONCLUSION: The study results demonstrated that higher MPTS and LPTS is a potential risk factor for ACL injury in both men and women. However, despite being highly statistically significant, the differences between groups and sexes were small and may not be clinically relevant.

The posterior horn of the medial and lateral meniscus both reduce the effective posterior tibial slope: a radiographic MRI study.

PURPOSE: The purpose of this study was to quantify the posterior horn meniscal slope and determine its contribution to the reduction in posterior tibial slope. METHODS: Patients aged between 16 and 60 years and had intact menisci with no evidence of previous injury or surgery were included. Patients with radiological evidence of osteoarthritis Grade II-IV, any acute or chronic meniscus injuries, fractures, and ligamentous injuries were excluded. The posterior bony slope (PTS) and the meniscus slope (MS) of the posterior horns were measured at 25, 50, and 75% from the medial and lateral borders of the tibial plateau. RESULTS: 325 MR images (mean age 37.1 ± 10.9 years) were included. There were 194 males and 131 females, with 162 left and 163 right knees. The PTS in the medial compartment ranged from (-) 2.8° to 3.7° and from (-) 1.3° to 1.9° in the lateral compartment (p = 0.0001). The MS in the medial compartment ranged from 27.4° to 28.2°, and from 27.8° to 28.7° in the lateral compartment (p > 0.05). The differences between the medial and lateral knee compartment were statistically significant. At the 25% interval the p level was 0.037, at 50% p = 0.00001, and at 75% p = 0.0001. There were no significant between gender differences. CONCLUSIONS: The results of this study demonstrated a significant reduction in posterior tibial bone slope by the posterior horns of both the medial and lateral meniscus, from a mean of (-) 1° to 2° to a more horizontal anterior slope. The posterior bone slope was larger in the medial compartment by 1°, resulting in a smaller slope reduction in the lateral compartment.