Ultrasound imaging of the posterior lateral corner of the knee: a pictorial review of anatomy and pathologies.

Assessment of the posterior lateral knee pain poses diagnostic challenges, requiring accurate evaluation of various structures in light of the medical history and physical examination. Despite substantial progress in the ultrasonographic diagnosis of musculoskeletal disorders, the current protocol (EURO-MUSCULUS/USPRM. Basic scanning protocols for knee) fails to conduct a comprehensive investigation into the intricate, tendons, and ligaments of the posterior lateral knee. This pictorial review aims to bridge this gap by offering a systematic approach to utilize ultrasound examination of the less-discussed structures in this specific region. Providing cadaveric and magnetic resonance images, this essay demonstrates the efficacy of ultrasound in diagnosing posterior lateral knee pain. Notably, pathologies such as ligamentous sprains and tears are clearly discernible. Moreover, the integration of ultrasound guidance plays a vital role in reducing the risk of inadvertent neurovascular injury during injection, such as the common peroneal nerve and lateral genicular artery. This comprehensive approach will enhance clinicians' understanding and equip them with effective management strategies for posterior lateral knee pain.Critical relevance statement In this visual exposition, we delve into the intricacies of the posterior lateral corner of the knee. Offering a methodical approach to employ ultrasound for visualization of the less-explored structures within this region, the authors aim to enhance the diagnosis in posterior lateral knee pain.Key points1. Ultrasound excels at revealing intricate structures in the posterior lateral knee.2. Due to proximity of vital structures, extreme caution is crucial during injections.3. Employing dynamic scan and understanding ligaments enables a comprehensive exploration of pathologies.

Optimal assessment for anterior talofibular ligament injury utilizing stress ultrasound entails internal rotation during plantarflexion.

OBJECTIVES: An optimal load and ankle position for stress ultrasound of the injured anterior talofibular ligament (ATFL) are unknown. The objectives of this study were to compare stress ultrasound and ankle kinematics from a 6 degree-of-freedom (6-DOF) robotic testing system as a reference standard for the evaluation of injured ATFL and suggest cut-off values for ultrasound diagnosis. METHODS: Ten fresh-frozen human cadaveric ankles were used. Loads and ankle positions examined by the 6-DOF robotic testing system were: 40 N anterior load, 1.7 Nm inversion, and 1.7 Nm internal rotation torques at 30° plantarflexion, 15° plantarflexion, and 0° plantarflexion. Bony translations were measured by ultrasound and a robotic testing system under the above conditions. After measuring the intact ankle, ATFL was transected at its fibular attachment under arthroscopy. Correlations between ultrasound and robotic testing systems were calculated with Pearson correlation coefficients. Paired t-tests were performed for comparison of ultrasound measurements of translation between intact and transected ATFL and unloaded and loaded conditions in transected ATFL. RESULTS: Good agreement between ultrasound measurement and that of the robotic testing system was found only in internal rotation at 30° plantarflexion (ICC â€‹= â€‹0.77; 95% confidence interval 0.27-0.94). At 30° plantarflexion, significant differences in ultrasound measurements of translation between intact and transected ATFL (p â€‹< â€‹0.01) were found in response to 1.7 Nm internal rotation torque and nonstress and stress with internal rotation (p â€‹< â€‹0.01) with mean differences of 2.4 â€‹mm and 1.9 â€‹mm, respectively. CONCLUSION: Based on the data of this study, moderate internal rotation and plantarflexion are optimal to evaluate the effects of ATFL injury when clinicians utilize stress ultrasound in patients. LEVEL OF EVIDENCE: III.

Ultrasound-guided injection of the ankle joint: cadaveric investigation of the anterolateral approach.

OBJECTIVE: Injection of the tibiotalar (TT) joint is commonly performed in clinical practice under ultrasound (US) guidance using an anteromedial approach. However, in some patients, this approach may be technically challenging due to post-traumatic and/or degenerative bony changes. Therefore, the aim of this cadaveric investigation was to demonstrate the feasibility of the ultrasound-guided (USG) injection of the ankle joint via the anterolateral sulcus (ALS) by confirming the dye placement/distribution inside the articular space. Likewise, the safety of the procedure has also been evaluated by measuring the distance between the needle and the intermediate dorsal cutaneous nerve of the foot. DESIGN: A descriptive laboratory study with eight embalmed cadaveric ankles using the Fix for Life (F4L) method was performed at the setting of an academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced into the TT joint through the ALS under US guidance, i.e., in-plane anterior-to-posterior approach. With the objective to confirm its correct placement, the needle was kept in situ and-to demonstrate the location of the dye inside the articular space-all eight ankles were injected with 3 mL of green color dye. Thereafter, a layer-by-layer anatomical dissection was performed on all four cadavers. RESULTS: The position of the needle's tip within the ALS was confirmed in all specimens. Accurate placement of the dye inside the articular space of the ankle was confirmed in seven of the eight cadaveric ankles, with 87.5% of accuracy. Herewith, unintentional spilling of the dye within the superficial soft tissues was reported in two of the eight ankles (25.0%). The mean distance between the needle and the intermediate dorsal cutaneous nerve of the foot, measured in all eight procedures, was 3 cm. CONCLUSION: USG injection of the ALS using the in-plane, anterior-to-posterior approach can accurately place the injectate inside the articular space. CLINICAL RELEVANCE: This cadaveric investigation described the accuracy and potential pitfalls of USG injection of the ankle via the anterolateral approach which represents an alternative technique in patients with reduced accessibility of the anteromedial recess due to degenerative and/or post-traumatic bony changes.

Harvest location has a minimal impact on differences in cross-sectional area of quadriceps tendon in anterior cruciate ligament reconstruction.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon (QT) has been gaining popularity. However, it is unknown how differences in harvest location of the QT affect its thickness and cross-sectional area (CSA). The present study aimed to clarify the differences in thickness and CSA of the QT based on location of tendon harvesting. METHODS: Patients scheduled for, or who underwent, ACL reconstruction were prospectively included in the study. The short-axis images on ultrasound were used to assess the CSA of the QT at 30 and 60 mm proximal to the superior pole of the patella. QT autografts with CSAs greater than or equal to 10 mm of width were included and measured at three different locations, namely the center, medial one-third, and lateral one-third at the widest diameter of the QT. Patients with less than 10-mm width of the QT at 60 mm proximal to the superior pole of the patella were excluded. The thickness and CSA were compared based on the location of tendon harvest. RESULTS: Thirty-seven patients were recruited for the study. The mean thickness and CSA were larger in the center of the QT compared to the lateral one-third at 30 mm proximal to the superior pole of the patella (thickness, 6.7 ± 1.3 mm vs. 5.9 ± 1.3 mm; P = 0.009; CSA, 65.6 ± 11.4 mm2 vs. 58.8 ± 11.9 mm2; P = 0.036). There were no significant differences in thickness and CSA of the QT among the three assessment locations at 60 mm proximal to the superior pole of the patella (n.s.). CONCLUSION: The thickness and CSA of QT was greater in the center compared to the lateral one-third at 30 mm proximal to the QT insertion point. However, the difference in value was clinically non-significant, and therefore, harvest location of the QT autograft may not meaningfully impact intraoperative graft diameter. As a result, surgeons may choose the harvest location without concern for resultant graft diameter as long as the enough length of QT is secured. LEVEL OF EVIDENCE: III.

Angiogenesis and Tissue Repair Depend on Platelet Dosing and Bioformulation Strategies Following Orthobiological Platelet-Rich Plasma Procedures: A Narrative Review.

Angiogenesis is the formation of new blood vessel from existing vessels and is a critical first step in tissue repair following chronic disturbances in healing and degenerative tissues. Chronic pathoanatomic tissues are characterized by a high number of inflammatory cells; an overexpression of inflammatory mediators; such as tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1); the presence of mast cells, T cells, reactive oxygen species, and matrix metalloproteinases; and a decreased angiogenic capacity. Multiple studies have demonstrated that autologous orthobiological cellular preparations (e.g., platelet-rich plasma (PRP)) improve tissue repair and regenerate tissues. There are many PRP devices on the market. Unfortunately, they differ greatly in platelet numbers, cellular composition, and bioformulation. PRP is a platelet concentrate consisting of a high concentration of platelets, with or without certain leukocytes, platelet-derived growth factors (PGFs), cytokines, molecules, and signaling cells. Several PRP products have immunomodulatory capacities that can influence resident cells in a diseased microenvironment, inducing tissue repair or regeneration. Generally, PRP is a blood-derived product, regardless of its platelet number and bioformulation, and the literature indicates both positive and negative patient treatment outcomes. Strangely, the literature does not designate specific PRP preparation qualifications that can potentially contribute to tissue repair. Moreover, the literature scarcely addresses the impact of platelets and leukocytes in PRP on (neo)angiogenesis, other than a general one-size-fits-all statement that "PRP has angiogenic capabilities". Here, we review the cellular composition of all PRP constituents, including leukocytes, and describe the importance of platelet dosing and bioformulation strategies in orthobiological applications to initiate angiogenic pathways that re-establish microvasculature networks, facilitating the supply of oxygen and nutrients to impaired tissues.

Three-Month Complication Rate of Ultrasound-Guided Soft Tissue Surgical Procedures Across Six Sports Medicine Clinics.

OBJECTIVES: To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications. METHODS: A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates. RESULTS: Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified. CONCLUSION: This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.

The International Olympic Committee Venue Ultrasound Program: A Pilot Study From Tokyo 2020 Olympic Games.

ABSTRACT: The objective of this pilot investigation was to describe the novel use of venue ultrasound at the 2020 Tokyo Olympic Games. Portable laptop ultrasound machines were made available to cover seven Olympic sports at seven venues. The responses by both the National Olympic Committee personnel accompanying the medical room visits and by the examining physicians were recorded. Athletes were followed up until the end of the Olympic Games and the ultrasound diagnostic accuracy was evaluated. Fourteen athletes were evaluated using venue ultrasound and the recorded injuries included seven soft tissue, five osseous, and two nonmusculoskeletal injuries. From these, eight athletes were evaluated further by other imaging modalities, which indicated that the ultrasound provided an accurate diagnosis in all cases. All National Olympics Committee personnel reported increased diagnostic confidence and felt that venue ultrasound should be considered for future sports events. Furthermore, all evaluating physicians felt ultrasound was helpful in refining the diagnosis. The average years of sports ultrasound experience was 8.4 yrs and the average years of clinical sports medicine experience was 9.3 yrs among the physicians. In conclusion, the International Olympic Committee Venue Ultrasound Pilot Program showed promise in improving venue triaging, suggesting its role at future sports events.

Emerging Treatment Options for Chronic Tendinopathy of the Foot: A Clinical Vignette.

ABSTRACT: The patient is a 65-year-old female recreational skier and avid walker who presented with a several-month history of right ankle and foot pain. The patient's pain began without inciting event and was described as a constant aching pain aggravated by downhill walking and alleviated with rest. She was diagnosed with right distal tibialis anterior tendinopathy with partial thickness tear noted on magnetic resonance imaging and musculoskeletal ultrasound. Given symptoms recalcitrant to conservative measures, the patient opted to pursue an ultrasound-guided prolotherapy injection and a course of physical therapy; unfortunately, she did not have any improvement in symptoms. The patient subsequently underwent ultrasound-guided percutaneous ultrasonic tenotomy and debridement of the distal tibialis anterior tendon, followed by a postprocedure rehabilitation protocol of physical therapy with transition to home exercise program with complete resolution of her pain. Prolotherapy, and percutaneous ultrasonic tenotomy and debridement are two treatment modalities that show promise in the treatment of painful, chronic tendinopathy.

Metformin improves tendon degeneration by blocking translocation of HMGB1 and suppressing tendon inflammation and senescence in aging mice.

This study aimed to characterize aging-induced tendinopathy in mouse Achilles tendon and also to assess the treatment effects of metformin (Met) on aging tendon. We showed that compared to young tendon, aging tendon was in an inflammatory and senescent state as shown by increased expression of inflammatory disulfide HMGB1 (dsHMGB1), inflammatory macrophage marker CD68, and senescent cell markers SA-ß-gal, p53, and p16. Moreover, aging tendon was degenerated marked by accumulation of proteoglycans and lipids in its interior. However, treatment of aging tendon by intraperitoneal (IP) injection of Met, a specific inhibitor of HMGB1, reduced dsHMGB1 levels, decreased the expression of CD68, SA-ß-gal, CCN1, and p16 in vitro and in vivo. Furthermore, Met treatment also increased the number of NS, SSEA-1, and CD73 positive stem cells in culture and improved the tendon structure in aging mouse. These findings of this study indicate that Met exerts anti-inflammatory and anti-senescent effects on aging tendon.

Orthobiologic Interventions for Muscle Injuries.

Muscle injuries represent a common problem in active populations. Orthobiologics continue to be studied for their ability to improve muscle healing. To date, the basic science research for treating muscle injuries with platelet-rich plasma or stem cell remains novel. Furthermore, there are even fewer clinical studies on these topics, and their findings are inconclusive. Reviewing the literature, muscle injuries treated with ultrasound-guided leukocyte-rich PRP injections appear to have the strongest evidence. Scar formation remains a major barrier in muscle injury healing, and there is optimism for future orthobiologic treatments that target the downregulation of TGF-B, resulting in decreased scar development.

The lateral meniscus extrudes with and without root tear evaluated using ultrasound.

PURPOSE: The purpose of the current study was to measure extrusion of the intact lateral meniscus as a function of knee flexion angle and loading condition and to compare the changes in extrusion with a posterior root tear using a robotic testing system and ultrasound. STUDY DESIGN: Controlled laboratory study. METHODS: Eight fresh-frozen cadaveric knees were subjected to external loading conditions (passive path position (no external load), 200 axial compression, 5-N-m internal tibial torque, 5-N-m valgus torque) at full extension, 30°, 60° and 90° of flexion using a robotic testing system. A linear array transducer was placed in the longitudinal orientation. Extrusion and kinematics data were recorded for two meniscus states: intact and posterior lateral root deficiency. Therefore, a complete radial root tear in the lateral meniscus at 10 mm from the tibial insertion was made in all 8 cadaveric knees using arthroscopy. The resultant forces in the lateral meniscus were also quantified by reproducing recorded paths after the removal of the lateral meniscus. RESULTS: A lateral meniscus root tear resulted in a statistically significant increase (up to 250%) of extrusion for the lateral meniscus (p < 0.05) in comparison to the intact lateral meniscus for all externally applied loads. Without external load (passive path position), significant differences were also found between the intact and posterior lateral root deficient meniscus except at full extension (1.0 ± 0.7 mm vs. 1.9 ± 0.4 mm) and 30° of flexion (1.4 ± 0.5 mm vs. 1.8 ± 0.5 mm). Overall, with increasing flexion angle, lateral meniscus extrusion decreased for the intact as well as for the posterior lateral root deficient meniscus, with the lowest measurements in response to internal tibial torque at 90° of flexion (-3.3 ± 1.1 mm). Knee kinematics were similar whether intact or posterior lateral root tear (n.s.). Ultrasound measurement of lateral meniscus extrusion showed good inter-rater (0.65 [0.30-0.97]-0.71 [0.34-0.94]) and excellent intra-rater reliability (0.81 [0.43-0.99]). CONCLUSION: Dynamic Ultrasound is a reliable diagnostic modality to measure the lateral meniscus extrusion which can be helpful in the diagnosis and quantification of lateral meniscal root tears. LEVEL OF EVIDENCE: III.

Ultrasound-Guided Anterior Talofibular Ligament Repair With Augmentation Can Restore Ankle Kinematics: A Cadaveric Biomechanical Study.

Background: Anterior talofibular ligament (ATFL) repair of the ankle is a common surgical procedure. Ultrasound (US)-guided anchor placement for ATFL repair can be performed anatomically and accurately. However, to our knowledge, no study has investigated ankle kinematics after US-guided ATFL repair. Hypothesis: US-guided ATFL repair with and without inferior extensor retinaculum (IER) augmentation will restore ankle kinematics. Study Design: Controlled laboratory study; Level of evidence, 4. Methods: A 6 degrees of freedom robotic testing system was used to apply multidirectional loads to fresh-frozen cadaveric ankles (N = 9). The following ankle states were evaluated: ATFL intact, ATFL deficient, combined ATFL repair and IER augmentation, and isolated US-guided ATFL repair. Three loading conditions (internal-external rotation torque, anterior-posterior load, and inversion-eversion torque) were applied at 4 ankle positions: 30° of plantarflexion, 15° of plantarflexion, 0° of plantarflexion, and 15° of dorsiflexion. The resulting kinematics were recorded and compared using a 1-way repeated-measures analysis of variance with the Benjamini-Hochberg test. Results: Anterior translation in response to an internal rotation torque significantly increased in the ATFL-deficient state compared with the ATFL-intact state at 30° and 15° of plantarflexion (P = .022 and .03, respectively). After the combined US-guided ATFL repair and augmentation, anterior translation was reduced significantly compared with the ATFL-deficient state at 30° and 15° of plantarflexion (P = .0012 and .005, respectively). Anterior translation was not significantly different for the isolated ATFL-repair state compared with the ATFL-deficient or ATFL-intact states at 30° and 15° of plantarflexion. Conclusion: Combined US-guided ATFL repair with augmentation of the IER reduced lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair did not reduce laxity due to ATFL deficiency, nor did it increase instability compared with the intact ankle. Clinical Relevance: US-guided ATFL repair with IER augmentation is a minimally-invasive technique to reduce lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair may be a viable option if accompanied by a period of immobilization.

Imaging-detected bone stress injuries at the Tokyo 2020 summer Olympics: epidemiology, injury onset, and competition withdrawal rate.

BACKGROUND: Prevention and early detection of injuries are essential in optimising sport participation and performance. The aim of this study is to investigate the epidemiology, athlete injury history, and competition withdrawal rate of imaging-detected bone stress injuries during the Tokyo 2020 Olympic Games. METHODS: We collected and analysed imaging and clinical information in athletes with bone stress injuries diagnosed in the Olympic Village polyclinic during the Games. Two physicians independently and retrospectively reviewed all imaging examinations of bone stress injuries. RESULTS: A total of 11,315 individual athletes from 206 National Olympic Committees competed at the Games, during which 567 MRIs and 352 X-rays were performed at the Olympic Village polyclinic. Radiology examinations revealed four stress fractures and 38 stress reactions in 29 athletes (median age 24 years, range 18-35 years). Of these, 72% of athletes (n = 21) had symptoms before entering the Olympic Village. Bone stress injuries were most common in women (55%), the lower extremities (66%), and track and field athletes (45%). Six athletes (21%) did not start or did not finish their competitions. CONCLUSIONS: This study revealed 42 imaging-detected bone stress injuries in the polyclinic of the Tokyo 2020 Olympic Village. The high proportion of athletes with symptoms before entering the village and the high proportion of competition withdrawals suggests the usefulness of an early MRI examination.

The Utility of Ultrasound in the Evaluation of Traumatic Hallux Valgus.

Isolated disruption of the medial collateral ligament of the great toe is rare and often misdiagnosed as turf toe. It may progress to acquired traumatic hallux valgus, often requiring operative intervention and a longer return to play. This case of a grade II medial collateral ligament injury highlights the importance of a thorough physical examination and consideration of the mechanism of injury. It demonstrates the utility of diagnostic musculoskeletal ultrasound in establishing a specific diagnosis upon initial patient presentation with great toe pain. It is an example of the use of ultrasound in guiding treatment and monitoring interval healing. In this case, differentiation of the injury from the classic "turf toe" led to proper stabilization with a toe spacer and activity modification, thus preventing progression of traumatic hallux valgus and leading to successful nonoperative treatment with full return to sport. LEVEL OF EVIDENCE: Level V.

The anterolateral capsule is infrequently damaged as evaluated arthroscopically in patients undergoing anatomic ACL reconstruction.

OBJECTIVES: Concomitant anterolateral complex (ALC) injury may contribute to persistent rotatory knee instability following anterior cruciate ligament (ACL) reconstruction. There is no consensus on how to best identify concomitant ALC injury preoperatively, nor how well ALC injury identified on imaging modalities correlates with clinical examination of knee instability. The purpose of this retrospective study was to determine the incidence of concomitant ALC injury in ACL-injured knees, as determined by arthroscopy to preoperative radiography, ultrasound, and MRI. METHODS: A total of 117 patients with a unilateral primary ACL injury who underwent individualized anatomic ACLR between June 2016 and May 2019 were enrolled. Preoperative imaging modalities, including X-ray, ultrasound, and MRI, were evaluated for concomitant ALC injury. Clinical examination under anesthesia, including the anterior drawer, Lachman, and pivot shift tests were performed. Anterolateral capsule injury, as defined by hemorrhage and/or capsular tearing on diagnostic arthroscopy, was also determined. Correlative analyses of ALC injury incidence and severity were performed across imaging modalities and against clinical examination grades. RESULTS: ALC injury incidence across imaging modalities was as follows: X-ray (3%), arthroscopy (19%), MRI (53%), and US (63%). The ALC injury rate on arthroscopy was significantly less than MRI (p < 0.001) or ultrasound (p < 0.001). ALC injury incidence and severity were significantly correlated between MRI and US grading scales (p = 0.02), but no correlations among other imaging modalities were found. Similarly, no imaging modality meaningfully correlated with physical examination maneuvers. CONCLUSION: The incidence of ALC injury varies across imaging modalities, with lower injury rates found on arthroscopy (19%) compared to MRI (53%) and US (63%). Increasing ALC injury severity grades on imaging does not predict increasing anterolateral knee laxity on clinical examination. LEVEL OF EVIDENCE: V, retrospective case series.

Within-subject effects of standardized prosthetic socket modifications on physical function and patient-reported outcomes.

BACKGROUND: Among the challenges of living with lower limb loss is the increased risk of long-term health problems that can be either attributed directly to the amputation surgery and/or prosthetic rehabilitation or indirectly to a disability-induced sedentary lifestyle. These problems are exacerbated by poorly fit prosthetic sockets. There is a knowledge gap regarding how the socket design affects in-socket mechanics and how in-socket mechanics affect patient-reported comfort and function. The objectives of this study are (1) to gain a better understanding of how in-socket mechanics of the residual limb in transfemoral amputees are related to patient-reported comfort and function, (2) to identify clinical tests that can streamline the socket design process, and (3) to evaluate the efficacy and cost of a novel, quantitatively informed socket optimization process. METHODS: Users of transfemoral prostheses will be asked to walk on a treadmill wearing their current socket plus 8 different check sockets with designed changes in different structural measurements that are likely to induce changes in residual limb motion, skin strain, and pressure distribution within the socket. Dynamic biplane radiography and pressure sensors will be used to measure in-socket residual limb mechanics. Patient-reported outcomes will also be collected after wearing each socket. The effects of in-socket mechanics on both physical function and patient-reported outcomes (aim 1) will be assessed using a generalized linear model. Partial correlation analysis will be used to examine the association between research-grade measurements and readily available clinical measurements (aim 2). In order to compare the new quantitative design method to the standard of care, patient-reported outcomes and cost will be compared between the two methods, utilizing the Wilcoxon-Mann-Whitney non-parametric test (aim 3). DISCUSSION: Knowledge on how prosthetic socket modifications affect residual bone and skin biomechanics itself can be applied to devise future socket designs, and the methodology can be used to investigate and improve such designs, past and present. Apart from saving time and costs, this may result in better prosthetic socket fit for a large patient population, thus increasing their mobility, participation, and overall health-related quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05041998 . Date of registration: Sept 13, 2021.

Comparison of Clinically Relevant Adipose Preparations on Articular Chondrocyte Phenotype in a Novel In Vitro Co-Culture Model.

Adipose therapeutics, including isolated cell fractions and tissue emulsifications, have been explored for osteoarthritis (OA) treatment; however, the optimal preparation method and bioactive tissue component for healing has yet to be determined. This in vitro study compared the effects of adipose preparations on cultured knee chondrocytes. De-identified human articular chondrocytes were co-cultured with adipose preparations for 36 or 72 h. Human adipose tissues were obtained from abdominal panniculectomy procedures and processed using three different techniques: enzymatic digestion to release stromal vascular fraction (SVF), emulsification with luer-to-luer transfer (nanofat), and processing in a bead-mill (Lipogems, Lipogems International SpA, Milan, Italy). Gene expression in both chondrocytes and adipose preparations was measured to assess cellular inflammation, catabolism, and anabolism. Results demonstrated that chondrocytes cultured with SVF consistently showed increased inflammatory and catabolic gene expression compared with control chondrocytes at both 36- and 72-h timepoints. Alternatively, chondrocytes co-cultured with either nanofat or bead-mill processed adipose derivatives yielded minimal pro-inflammatory effects and instead increased anabolism and regeneration of cartilage extracellular matrix. Interestingly, nanofat preparations induced transient matrix anabolism while Lipogems adipose consistently demonstrated increased matrix synthesis at both study timepoints after co-culture. This evaluation of the regenerative potential of adipose-derived preparations as a clinical tool for knee OA treatment suggests that mechanically processed preparations may be more efficacious than an isolated SVF cell preparation.

Recommended Musculoskeletal and Sports Ultrasound Terminology: A Delphi-Based Consensus Statement.

OBJECTIVES: The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS: A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS: Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS: The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.