Association of Increased Lateral Femoral Condylar Ratio With Lateral Meniscus Posterior Root Tear in Noncontact ACL Injury.

Background: In the setting of anterior cruciate ligament (ACL) injury, lateral meniscus posterior root tears (LMPRTs) are less readily diagnosed on preoperative magnetic resonance imaging (MRI). Therefore, to predict LMPRTs in ACL injuries, it is necessary to understand the risk factors associated with them. Purpose/Hypothesis: The purpose of this study was to investigate the association of lateral femoral condylar ratio (LFCR) with LMPRTs in ACL injuries. It was hypothesized that an increased LFCR would be associated with LMPRTs in noncontact ACL injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Enrolled were consecutive patients who underwent primary acute (<6 weeks from injury) ACL reconstruction after noncontact injury and had LMPRT confirmed on preoperative MRI and arthroscopically (combined group; n = 62) as well as patients who underwent isolated acute ACL reconstruction (isolated group; n = 80) who were matched to the combined group by age, height, and body mass index (BMI). All patients underwent surgery between January 1999 and November 2021. LFCR and posterior tibial slope (PTS) were measured and compared between the isolated and combined groups. The area under the receiver operating characteristic curve (AUC) was calculated to determine the cutoff for detecting increased risk of LMPRTs. Results: The demographic characteristics of the 2 groups did not differ significantly, nor did the PTS. The LFCR was a significant factor (odds ratio [OR], 1.23; P = .001) associated with LMPRT. Patient age, height, BMI, and PTS were not associated with LMPRT. The AUC (0.66; 95% CI, 0.57-0.75) for LFCR had a sensitivity of 39% and specificity of 90% to predict LMPRT. The calculated cutoff associated with an increased risk for LMPRT when compared with the isolated group was 67.0% (OR, 4.98; 95% CI, 2.10-11.79). Conclusion: Increased LFCR was associated with the presence of LMPRTs in patients with acute ACL injuries. The LFCR may provide surgeons with additional information regarding the risk of having a concomitant LMPRT when planning ACL reconstructions.

Clinical and Magnetic Resonance Imaging Outcomes After Human Cord Blood-Derived Mesenchymal Stem Cell Implantation for Chondral Defects of the Knee.

Background: There is a paucity of literature reporting clinical and magnetic resonance imaging (MRI) outcomes after allogeneic umbilical cord blood-derived mesenchymal stem cell (UCB-MSC) implantation for chondral defects of the knee. Purpose: To report clinical and MRI outcomes after UCB-MSC implantation for chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: Inclusion criteria were patients aged between 40 and 70 years with focal chondral lesions of grade 3 or 4 on the medial femoral condyle, defect sizes >4 cm2, and intact ligaments. Exclusion criteria were patients who required realignment osteotomy or who had a meniscal deficiency, ligamentous instability, or a concomitant full-thickness chondral defect in the lateral or patellofemoral compartment. A mixture of human UCB-MSCs and sodium hyaluronate was implanted into the chondral defect through mini-arthrotomy. MRI at 1-year follow-up was performed to evaluate repaired cartilage hypertrophy. Repaired cartilage thickness was measured, and hypertrophy was classified as grade 1 (<125%), grade 2 (<150%), or grade 3 (<200%). Patient-reported outcomes (PROs; International Knee Documentation Committee, visual analog scale for pain, and Western Ontario and McMaster Universities Osteoarthritis Index) were evaluated preoperatively and at 1, 2, and 3 years postoperatively. Repaired cartilage hypertrophy was evaluated for a correlation with PRO scores. Results: Enrolled were 85 patients with a mean age of 56.8 ± 6.1 years and a mean chondral defect size of 6.7 ± 2.0 cm2. At follow-up, a significant improvement in all PRO scores was seen compared with preoperatively (P < .001 for all). MRI at 1-year follow-up demonstrated that 28 patients had grade 1 repaired cartilage hypertrophy, 41 patients had grade 2, and 16 patients had grade 3. MRI performed in 11 patients at 2 years after surgery indicated no difference in repaired cartilage hypertrophy between the 1- and 2-year time points. The grade of repaired cartilage hypertrophy did not correlate with PRO scores. Conclusion: Clinical outcomes improved significantly at short-term follow-up after UCB-MSC implantation. Although all patients showed repaired cartilage hypertrophy, it did not correlate with clinical outcomes.

Correlation Between Anatomic Landmarks and Bony Trough Position in Lateral Meniscal Allograft Transplant.

Background: Determining the rotational axis of the bony trough during lateral meniscal allograft transplant (MAT) is difficult. The use of anatomic landmarks may help a surgeon determine the rotational alignment of the graft during the procedure. Purpose: To investigate the association between the knee's anatomic landmarks and the position of the bony trough to prevent extrusion after lateral MAT. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled were 44 patients who underwent lateral MAT between July 2000 and February 2011. The patients' mean age at the time of surgery was 30.8 years. Extrusion was measured on magnetic resonance imaging (MRI) scans at a mean of 3.6 months postoperatively, and patients were divided into an extrusion group (n = 15) and a no-extrusion group (n = 29). Three coronal MRI scans from each patient were selected, each from the region at the level of the tibial tuberosity (TT), the anterior bony trough, and the posterior bony trough. We measured the distance between the center of the anterior bony trough and the center of the TT (the TT distance) and the distance between the center of the posterior bony trough and the medial border of the lateral femoral condyle (LFC) (the LFC distance). Results: The mean center of the anterior bony trough was in a more medial position relative to the center of the TT in the no-extrusion group (-2.9 ± 4.8 mm) compared with the extrusion group (1.3 ± 4.9 mm; P = .010). The mean center of the posterior bony trough was in a more medial position relative to the medial border of the LFC in the no-extrusion group (-1.7 ± 3.9 mm) compared with the extrusion group (1.0 ± 3.2 mm; P = .027). Both TT distance and LFC distance were significantly correlated with extrusion (P = .005 and .025, respectively). The cutoff value was -0.24 mm for the anterior bony trough and -0.58 mm for the posterior bony trough (negative values indicate that the trough was medial to the respective landmarks). Conclusion: To prevent extrusion of the allograft, the center of the anterior bony trough needs to be aligned with the center of the TT, and the center of the posterior bony trough needs to be aligned with the medial border of the LFC.

Accuracy of the Arthroscopic Location of the Center of the Anterior Horn During Lateral Meniscal Allograft Transplantation.

Background: Anatomic placement of the meniscal allograft is imperative to achieve satisfactory outcomes after meniscal allograft transplantation (MAT). Few studies have reported on the accuracy of the provisional location of the center of the anterior horn of the lateral meniscus (AHLM). Hypothesis: The authors hypothesized that the provisional center would not coincide with the anatomic center of the AHLM. Study Design: Descriptive laboratory study. Methods: Tibial plateaus were retrieved from 93 consecutive patients who underwent total knee arthroplasty. A complete radial cut was made 2 cm lateral to the insertion of the AHLM on the retrieved tibial plateau. While moving the stump of the anterior horn with forceps, the center of the insertion was determined, and a Kirschner wire (provisional wire) was drilled into the location. The insertion area of the AHLM was dissected carefully, and the periphery of the insertion area of the anterior horn was marked. Another Kirschner wire (anatomic wire) was drilled into the center of the dissected anterior horn. The resected tibial plateau was positioned so that the longitudinal line of the tibial plateau was aligned on a plastic ruler. The distance between the provisional and anatomic wires was measured by a digital caliper along the longitudinal and vertical axes. Results: The mean distance between the provisional and anatomic wires was 2.5 ± 1.2 mm. The provisional wire in 14 patients (15%) was placed at the anatomic center. In 36 patients (39%), the provisional wire was drilled anterolateral to the anatomic center, and in 18 patients (19%), the wire was drilled anteromedial to the anatomic center. In 21 patients (23%), the provisional wire was located within 2 mm of the anatomic center, and in 62 patients (67%), the wire was located within 3 mm of the anatomic center. Conclusion: The provisional wire was located a mean of 2.5 mm from the anatomic center, and only 23% of patients had wires that were located within 2 mm of the anatomic center. In 39% of patients, the provisional wire was drilled anterolateral to the anatomic center. This finding needs to be considered during lateral MAT. Clinical Relevance: Without dissection of the AHLM, the determination of the anatomic center of the anterior horn is not accurate during lateral MAT.

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction.

BACKGROUND: Biomechanical studies have demonstrated significant loosening of the adjustable-loop device as compared with the fixed-loop device used in anterior cruciate ligament reconstruction. Retensioning of the adjustable loop has been recommended; however, the timing of the retensioning is unknown. HYPOTHESIS: Early (ER) and late retensioning (LR) will show similar gapping between the femoral tunnel and graft on follow-up magnetic resonance imaging (MRI) and similar clinical outcomes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 101 patients who underwent hamstring anterior cruciate ligament reconstruction using the adjustable-loop device for femoral fixation between June 2016 and January 2018. All patients a had follow-up MRI on postoperative day 1. Patients with revision surgery and those with reinjury after reconstruction were excluded. In the ER group, retensioning and knot tying of the initially tightened adjustable loop were performed after the flip of the button and before the graft was fixed at the tibia. In the LR group, retensioning and knot tying were performed after initial tightening of the adjustable loop and graft fixation at the tibial side. The tunnel-graft gap measured on multiplanar reformatted images of MRI scans was compared between the groups, as were clinical outcomes. RESULTS: The mean age of the patients at the time of surgery was 30.3 years (range, 14-61 years). ER and knot tying were performed in 56 patients and LR and knot tying in 45. Preoperative characteristics of the 2 groups showed no significant differences. The mean ± SD tunnel-graft gap was 1.5 ± 2.0 mm in the ER group and 5.4 ± 4.0 mm in the LR group (P < .001). There were no significant differences in clinical outcomes between the groups. CONCLUSION: ER and knot tying demonstrated less tunnel-graft gap than that of LR. However, there were no differences in clinical outcomes according to the timing of retensioning.

Ring-shaped lateral meniscus combined with an accessory meniscus: A rare anatomical variant.

A ring-shaped meniscus is a very rare anatomical variant among all meniscal abnormalities. Additionally, an accessory meniscus is extremely rare, and only a few cases have been reported. We herein report a case involving the combination of these two features in a single lateral meniscus. These abnormalities were found during arthroscopic surgery for removal of an osteochondral fragment that had detached from the patellar bone and plication of the medial patellofemoral ligament in a patient with acute patellar dislocation. To our knowledge, each variant is extremely rare and the combination of the two variants has not been reported.

ICT-Based Comprehensive Health and Social-Needs Assessment System for Supporting Person-Centered Community Care.

OBJECTIVES: This study developed an information and communication technology (ICT)-based comprehensive health and social-needs assessment (CHSNA) system based on the International Classification of Functioning, Disability, and Health (ICF) with the aim of enhancing person-centered community care for community residents and supporting healthcare professionals and social workers who provide healthcare and social services in the community. METHODS: Items related to a CHSNA tool were developed and mapped with ICF codes. Experts validated the CHSNA system design and process using the Delphi method, and a pilot test of the initial version of the system was conducted. RESULTS: The following three steps of CHSNA were embedded in the system, which had a user-friendly screen and images: basic health assessment, life and activity assessment, and in-depth health assessment. The assessment results for the community residents were presented with visualized health profiles, including images, graphs, and an ICF model. CONCLUSIONS: The developed CHSNA system can be used by healthcare professionals, social workers, and community residents to evaluate the reasoning underlying health and social needs, to facilitate the identification of more appropriate healthcare plans, and to guide community residents to receive the best healthcare services. A CHSNA system can improve the implementation of standardized terminology utilizing the ICF and the accuracy of needs assessments of community residents.

Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor.

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.

Lateral Meniscal Allograft Transplant via a Medial Approach Leads to Less Extrusion.

BACKGROUND: Accurate positioning of the bony bridge is crucial to prevent extrusion of meniscal allografts after transplant. However, oblique or lateralized placement of the bony bridge of the lateral meniscal allograft may occur due to technical error or a limited visual field. The patellar tendon may be an obstacle to approaching the anterior horn of the lateral meniscus, resulting in a laterally placed allograft. Therefore, lateral meniscal transplant through a medial arthrotomy would be an alternative approach. However, no report exists regarding allograft extrusion when comparing medial and lateral arthrotomy techniques in lateral meniscal transplants. HYPOTHESIS: Extrusion of the midbody of the allograft is less severe and the rotation of the bony bridge is less oblique in lateral meniscal allograft transplants through the medial parapatellar approach than those through the lateral approach. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A bony bridge was used to perform 55 lateral meniscal transplants through either a medial or a lateral arthrotomy. Thirty-two allografts were transplanted through a medial arthrotomy and 23 were transplanted through a lateral arthrotomy, not randomly. Because correct positioning of the bony trough through the medial arthrotomy was easier than that through the lateral arthrotomy, the method of the arthrotomy was changed for the latter. The procedure for both groups was identical except for the arthrotomy technique, and rehabilitation was identical for both groups. Follow-up magnetic resonance imaging was conducted for all patients to measure the postoperative extrusion and obliquity of the bony bridge of the allograft. On the coronal view, extrusion was measured as the distance between the outer edge of the articular cartilage of the lateral tibial plateau and the outer edge of the meniscal allograft. On the axial view, a line (line B) was drawn along the longitudinal axis of the bony bridge. The posterior tibial condylar tangential line was drawn between the medial and lateral posterior tibial condylar cortices. A line (line T) was drawn perpendicular to the posterior tibial condylar tangential line. The angle (trough angle) between lines B and T was measured. Postoperative extrusion and the trough angle were compared between the medial and lateral arthrotomy groups. RESULTS: The median extrusion of the midbody of the allograft was 2.2 mm (interquartile range [IQR], 2.4 mm; range, 0-4.6 mm) in the medial arthrotomy group and 3.1 mm (IQR, 1.5 mm; range, 0-5.3 mm) in the lateral arthrotomy group ( P = .001). Seven (21.9%) patients demonstrated extrusion in the medial arthrotomy group, and 15 (65.2%) patients had extrusion in the lateral group ( P = .002). The median trough angle was 0.9° (IQR, 9.3°; range, -8.8-15.8°) in the medial arthrotomy group and 11.6° (IQR, 2.8°; range, 3-19.8°) in the lateral arthrotomy group ( P < .001). CONCLUSION: Based on this experience, lateral meniscal allograft transplant through a medial arthrotomy is preferred to decrease postoperative extrusion of the allograft.

The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient.

PURPOSE: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. MATERIALS AND METHODS: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. RESULTS: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. CONCLUSION: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.

Comparison of the insertion of the posterior horn of the lateral meniscus: discoid versus non-discoid.

PURPOSE: The purpose of this study was to compare the insertion sites of the posterior horn between discoid and non-discoid lateral meniscus using magnetic resonance imaging (MRI). METHODS: Two hundred and twenty-seven patients who had MRI scans before surgery and underwent arthroscopy were enroled in this study. A coronal view showing the narrowest width of the midbody of the lateral meniscus was chosen to measure the widths of the entire tibial plateau and the midbody of the lateral meniscus. Considering the ratio of the meniscal width to the tibial plateau width, the patients were divided into non-discoid, incomplete discoid, and complete discoid groups. On a coronal view accurately showing the insertion of the posterior horn of the lateral meniscus, a distance between the peak of the lateral tibial eminence and the centre of the insertion of the posterior horn, and a width of the lateral tibial plateau between the lateral edge of the tibial plateau and the peak of the lateral tibial eminence were measured. RESULTS: The insertion centre of the posterior horn was located more medially in the incomplete and complete discoid groups than in the non-discoid group (p = 0.003, 0.010, respectively). When individual differences in the knee size were corrected, the insertion centre of the posterior horn in the incomplete discoid and complete discoid groups was located more medially than in the non-discoid group (p = 0.009, 0.003, respectively). CONCLUSION: The insertion centre of the posterior horn of the lateral meniscus is located more medially to the apex of the lateral tibial eminence in the discoid group than in the non-discoid group. This finding needs to be considered for an accurate position of the posterior horn of lateral meniscus during the lateral meniscal allograft transplantation. LEVEL OF EVIDENCE: IV.

Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices.

BACKGROUND: Few studies have compared clinical and radiological outcomes after hamstring anterior cruciate ligament (ACL) reconstruction with fixed-loop and adjustable-loop cortical suspension devices. Purpose/Hypothesis: The purpose of this retrospective study was to compare clinical outcomes and tunnel widening after hamstring ACL reconstructions with fixed- and adjustable-loop cortical suspension devices. The hypothesis was that compared with femoral graft fixation with the fixed-loop device, fixation with the adjustable-loop device would show similar clinical outcomes and would result in less tunnel widening after hamstring ACL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 117 consecutive patients underwent hamstring ACL reconstruction at a single institution. The fixed-loop cortical suspension device was used in 67 patients, and the adjustable-loop cortical suspension device was used in 50 patients. All patients were observed for a minimum of 2 years. Postoperative knee laxity was evaluated with the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed by use of the Lysholm score and the Tegner activity scale. On anteroposterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 1 year after surgery were compared with the diameter of the reamer used at surgery. The measured diameters of the tibial tunnel at 1 year after surgery were compared with those taken immediately after surgery. RESULTS: The mean KT-1000 arthrometer laxity measurement was 1.5 ± 1.8 mm in the fixed-loop group and 1.2 ± 2.3 mm in the adjustable-loop group ( P = .530). Results of postoperative knee laxity evaluations and functional outcomes from both groups showed no statistically significant differences. However, the fixed-loop group showed significantly better stability in the pivot-shift test than did the adjustable-loop group ( P = .018). On AP radiographs, the mean diameter of the femoral and tibial tunnels increased by 42.2% ± 15.9% and 37.0% ± 17.8%, respectively, in the fixed-loop group and by 43.0% ± 15.4% and 36.8% ± 18.2% in the adjustable-loop group. On lateral radiographs, the mean diameter of the femoral and tibial tunnels increased by 38.1% ± 14.8% and 39.9% ± 13.8%, respectively, in the fixed-loop group and by 35.8% ± 12.2% and 38.1% ± 21.0% in the adjustable-loop group. No significant differences were found between the 2 groups in postoperative femoral and tibial tunnel widening on AP radiographs ( P = .801 and .951, respectively) or lateral radiographs ( P = .422 and .621, respectively). CONCLUSION: Compared with femoral fixation by use of the fixed-loop device, femoral fixation by use of the adjustable-loop device showed similar clinical outcomes but did not reduce tunnel widening after hamstring ACL reconstructions.

Intraoperative Templating in Lateral Meniscal Allograft Transplantation.

Recently, studies have emphasized the importance of anatomical placement of the lateral meniscal allograft to decrease postoperative extrusion. However, it is infeasible to identify the exact rotation of the allograft during transplantation. We present a patient who underwent a lateral meniscal transplantation using a wire for correct positioning of the allograft. The use of a wire intraoperatively shaped to resemble the contour of the lateral meniscal allograft will aid in more accurate and anatomical graft placement.

The Use of T1 Sagittal Angle in Predicting Cervical Disc Degeneration.

STUDY DESIGN: Retrospective evaluation. PURPOSE: To analyze the effect of T1 slope on degree of degeneration in patients with cervical disc degeneration. OVERVIEW OF LITERATURE: The T1 slope is well known parameter that may be very useful in evaluating sagittal balance. There are no reports on the analysis of the relationship between T1 slope and cervical disc degeneration. We hypothesized that T1 slope has an effect on the degree of cervical degeneration. METHODS: Sixty patients who had cervical spine magnetic resonance imaging (MRI) in our orthopedic clinic were enrolled. Patients were divided into two groups according to T1 slope. Radiologic parameters obtained from radiography and cervical spine MRI were compared between low T1 slope group (≤25) and high T1 slope group (>25). RESULTS: Among low T1 slope group, average degeneration grade of each cervical segment was 2.65 in C2-3, 2.50 in C3-4, 2.62 in C4-5, 3.23 in C5-6, and 2.81 in C6-7. And that of high T1 group was 2.35 in C2-3, 2.32 in C3-4, 2.59 in C4-5, 2.79 in C5-6, and 2.32 in C6-7. Grade of degeneration of low T1 group was significantly higher, as compared with high T1 group in C5-6 (p=0.028) and C6-7 (p=0.009). Percentage of high grade degeneration of more than grand III was 65.4% in low T1 group and 32.4% in high T1 group (p=0.018). Risk of high grade degeneration of C6-7 was significantly higher in low T1 group (odds ratio, 5.63; 95% confidence interval, 1.665-19.057; p=0.005). CONCLUSIONS: Patients with low T1 slope had higher grade of degeneration regardless of age and gender. Low T1 slope is a potential risk factor of cervical spondylosis especially in the C6-7 cervical segment.