Arthroscopic Measurements Research Articles

Articular cartilage debridement results in short-term significant improvements in patient-reported outcomes for large areas of cartilage loss of the femur in the setting of mild to moderate knee osteoarthritis

IntroductionChondroplasty is a surgical option for chondral defects, but its effect on larger cartilage defects in the setting of knee osteoarthritis remains unclear. ObjectivesThis study aims to evaluate patient-reported outcomes (PROs) following chondroplasty in patients with larger chondral defects (≥2 cm2) of the femur in the setting of osteoarthritis. Materials and methodsRetrospective review of patients who underwent chondroplasty of the femur. All patients had Kellgren-Lawrence (KL) grades of 2 or 3 and a minimum of 1-year postoperative follow-up. Chondral loss was estimated by arthroscopic measurements and by Magnetic Resonance Imaging (MRI). PROs included the International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and the Veterans Rand-12 Item. Statistical analysis was performed using paired t tests to compare baseline and follow-up data, as well as linear regressions to correlate lesion size with symptom improvement. Results39 patients with 20 KL grade 2 and 19 KL grade 3 knees were included. At both 1- and 2-year follow-ups, significant improvements were noted in International Knee Documentation Committee (34.9 ± 13.5 preoperative, 55.6 ± 18.8 at 2 years, P = .0025), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (56.3 ± 14.7 preoperative, 64.5 ± 17.0 at 2 years, P = .0243), and Veterans Rand-12 Item Physical Component Scores (38.0 ± 12.7 preoperative, 43.8 ± 8.6 at 2 years, P = .0044). Four (10.3%) conversions to arthroplasty were noted at most recent follow-up. ConclusionsArticular cartilage debridement for large areas of cartilage loss of the femur in the setting of mild to moderate osteoarthritis results in significant improvements in physical function and knee-specific PROs at 1- and 2-year follow-ups.

Application of intra-articular graft length measurement in total anterior cruciate ligament reconstruction

To investigate the clinical efficacy of arthroscopic measurement of intra-articular graft length in the application of total internal reconstruction of the anterior cruciate ligament(ACL). The 60 patients with ACL injury treated between January 2020 and January 2022 were retrospectively analyzed. There were 37 males and 23 females, aged from 22 to 44 years. According to the different surgical methods, they were divided into two groups:conventional surgery group (conventional group) and pull-line measurement group (measurement group), with 30 cases in each group. In the conventional group, there were 20 males and 10 females, with an average age of (30.00±3.95) years old;the body mass index (BMI) was (22.58±1.41) kg·m-2;there were 9 cases on the left side and 21 cases on the right side;the time from injury to operation was (3. 00±1.35) days. In the measurement group, there were 17 males and 13 females, with an average of(32.00±4.29) years;BMI was (23.29±1.39) kg·m-2;there were 12 cases on the left side and 18 cases on the right side;the time from injury to operation was (3.00±1.27) days. The clinical data of the patients before surgery, 6 months after surgery and 12 months after surgery were collected and recorded. The clinical efficacy of the two methods was compared in terms of postoperative VAS, KOOS, Lysholm score, IKDC score, knee stability (Lachman test, anterior drawer test and axial shift test), the degree of widening of bone tunnel diameter measured by CT at different stages of the postoperative period and MRI scoring system. At 12 months after surgery, the VAS of the measurement group was lower than that of the conventional group(P<0.001). At 12 months after surgery, KOOS scores in the measurement group were higher than those in the conventional group, and there were statistically significant differences in all scores except symptom scores (P<0.05). Six months after operation, Lysholm total score and IKDC total score in the measurement group were higher than those in the conventional group, and the difference was statistically significant (P<0.05). At 12 months after surgery, knee stability tests were performed, and the differences between the Lachman test, anterior drawer test and axial shift test measurement group and the conventional group were not statistically significant (P>0.05). However, overall knee instability analysis showed that the knee stability of the measurement group was better than that of the control group, and the difference between the groups was statistically significant (P=0.038). The imaging assessment of patients in both groups at 6 months after surgery showed that the widening of tendon tunnel diameter in both femur and tibia was reduced in the measurement group compared with the conventional group after surgery, and the difference was statistically significant(P<0.05);MRI scores were higher in all patients in the measurement group those in the conventional group, at 6 months and 12 months agter surgery(P<0.05). Arthroscopic measurement of intra-articular cavity graft length in total internal technique for ACL reconstruction, high tendon utilization, good stability, the knee joint function has recovered satisfactorily within one year, and the therapeutic effect is affirmed.

Arthroscopic Measurements Predict Knee Chondral Lesion Size More Accurately Than Magnetic Resonance Imaging, and Mechanism of Injury Influences Ability of Either Technique to Predict Graft Size

PurposeTo compare osteochondral defect size measurements and characteristics across magnetic resonance imaging (MRI), arthroscopy, and at the time of implantation with osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI). MethodsPatients who underwent ACI and OCA transplantation at a single institution between 2015 and 2019 were retrospectively identified. Patients were excluded if they had severe osteoarthritis, if MRIs were not available for review, if surgical records did not include defect sizing necessary for analysis, and if operative reports were not available. Osteochondral lesion characteristics including size were collected preoperatively from MRI and arthroscopy and at the time of definitive open surgical intervention. Subgroup analysis was performed comparing measurement techniques depending on the corrective surgical approach used as well as depending on the mechanism of chondral injury to determine if these had any effect on the ability of arthroscopy or MRI to predict graft size. ResultsOverall, 136 chondral lesions were addressed with restoration procedures in 117 patients (mean age 32.5 years). Average difference between final graft size and lesion area measured with index arthroscopy was 116 mm2, while average difference between final graft size and lesion size measured with preoperative MRI was 182 mm2 (P < .001). Depending on surgical technique, measurements with MRI were more similar to final graft size when a patient underwent OCA transplantation versus ACI (P = .007). Depending on mechanism of injury, MRI measurements of lesions were closer to graft area when lesions resulted from trauma (P = .047). ConclusionChondral lesion size determined by preoperative MRI imaging is less accurate than arthroscopic measurements. The mechanism injury leading to chondral damage and degree of damage may influence the ability of MRI and arthroscopy to accurately measure chondral lesions and predict the final graft size used in surgical correction. Level of EvidenceRetrospective Cohort Study (Level III)

Anterior Mobility of the Posterior Horn of the Lateral Meniscus Is Associated With Abnormal Magnetic Resonance Imaging Findings of Anteroinferior Popliteomeniscal Fascicle and Posterosuperior Popliteomeniscal Fascicle as Well as a Clinical History of Catching or Locking Symptoms

PurposeWhen symptoms caused by hypermobility of the posterior horn of the lateral meniscus (PHLM) emerge, it is difficult to know which restraints should be treated. To identify predictors of anterior mobility of the PHLM among patient demographics (age, sex), clinical characteristics (a history of catching or locking symptoms [CLS], body mass index, alignment of limb), and magnetic resonance imaging (MRI) findings of four restraints (anteroinferior popliteomeniscal fascicle [aiPMF], posterosuperior popliteomeniscal fascicle [psPMF], posteroinferior popliteomeniscal fascicle [piPMF], meniscofibular ligament [MFibL]). MethodsBetween October 2010 and December 2014 patients who underwent arthroscopic measurement of mobility of the PHLM were identified. The Sakai classification was used to classify aiPMF and psPMF on MRI into the following three types: type A, the fascicle was depicted with obvious continuity and with a low-intensity band; type B, depicted with continuity but with an ambiguous intensity structure; and type C, depicted with discontinuity or not visible. Magnetic resonance images of the piPMF and MFibL were evaluated as presence or absence. The mobility of the PHLM was measured arthroscopically at traction forces of 10 and 20 N. ResultsA total of 73 patients (47 men, mean age 41.8 ± 19.3 years) were included. Multivariate regression analyses revealed aiPMF type C and psPMF types B and C to be independent factors associated with mobility at both traction forces, and CLS was an independent factor at a traction force of 20 N. Compared with that of type A, the increased mobility of aiPMF type C was 5.0 mm (P = .019) and 5.6 mm (P = .011) at 10 and 20 N, respectively, the increased mobility of psPMF type B was 2.5 mm (P = .007) and 3.5 mm (P = .0003), respectively, and the increased mobility of psPMF type C was 3.3 mm (P = .021) and 3.6 mm (P = .014), respectively. The increased mobility associated with CLS was 3.5 mm at 20 N (P = .022). ConclusionsAnterior displacement of the PHLM induced by an external traction force at 90-degree flexion of the knee joint was associated with abnormal MRI findings of anteroinferior popliteomeniscal fascicle and posterosuperior popliteomeniscal fascicle, and a history of catching or locking symptoms. Clinical RelevanceUnderstanding signs and symptoms and associated pathology in patients with symptomatic anterior mobility of the posterior horn of the lateral meniscus may help guide best treatment.

Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment.

Failure after isolated Bankart repair has led surgeons to consider when to address the Hill-Sachs lesion, which is thought to be a contributor to recurrent instability. One approach utilizes the glenoid track concept to determine whether a Hill-Sachs lesion is classified as "off-track," suggesting that the addition of a remplissage procedure may aid stability. However, the accuracy and reliability of using this approach require validation using an appropriate reference. To determine the accuracy and reliability of using the glenoid track concept against dynamic arthroscopic assessment of Hill-Sachs lesion engagement. Cohort study (diagnosis); Level of evidence, 3. A total of 49 patients undergoing arthroscopic Bankart repair surgery for recurrent traumatic anterior shoulder instability were enrolled in this diagnostic validation study. Shoulders were classified as on-track or off-track using 3-dimensional computed tomography (3DCT) and static arthroscopic measurements. These classifications were compared with dynamic arthroscopic assessment (engagement of the Hill-Sachs lesion on the anterior glenoid rim in the 'athletic position') to determine their accuracy and reliability. The 3DCT-based measurements to determine glenoid track status had a higher positive predictive value (66% vs 42%), higher specificity (47% vs 42%), and higher accuracy (65% vs 59%) compared with static arthroscopic measurements. Static arthroscopic measurements to determine glenoid track status had a higher negative predictive value (96% vs 64%) and higher sensitivity (96% vs 81%) compared with 3DCT-based measurements. Interrater reliability (Krippendorff α) was 'fair' for determining the glenoid track status using 3DCT (0.368; 95% CI, 0.217-0.519) and 'moderate' for static arthroscopic measurements (0.523; 95% CI, 0.364-0.666). Intrarater reliability (intraclass correlation coefficient [ICC] 3,k) was 'moderate' for 3DCT measurements (0.660; 95% CI, 0.444-0.798) and 'good' for static arthroscopic measurements (0.769; 95% CI, 0.629-0.862). Determining glenoid track status using either 3DCT or static arthroscopic measurements yielded moderate accuracy and reliability. Surgeons using the glenoid track concept to aid surgical decision-making in traumatic recurrent anterior shoulder instability should utilize 3DCT or static arthroscopic measurements with caution.

Arthroscopic assessment for lateral collateral ligament complex deficiency of the elbow: a cadaveric study.

To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy. Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow. The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P = .008; Stage 0 vs. Stage 3: P = .010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P = .010; Stage 0 vs. Stage 3: P = .011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P = .157). Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more.

Can three-dimensional models enhance understanding and knowledge of rotator cuff tears?

ObjectivesMagnetic resonance imaging (MRI) is currently the standard diagnostic tool for rotator cuff tears. However, its two-dimensional (2D) output, displayed on a monitor, can complicate the interpretation of anatomy. Three-dimensional (3D) imaging may offer a solution to this issue. This study aimed to demonstrate the diagnostic and interpretive value of a 3D model in assessing lesion anatomy. The hypothesis was that 3D models, compared to 2D MRI, can enhance the comprehension and knowledge of rotator cuff injuries, improve the application of classifications for total tears, and provide a more precise definition of the size and type of tear. MethodsA prospective single-centre study was conducted. 3D models for rotator cuff tears were created and analysed in conjunction with preoperative MRI for each patient up to 2 months before surgery. The 3D models were based on the preoperative MRI. Collected data included 2D plane measurements by MRI in coronal and sagittal planes, descriptions of 3D lesion geometry (new shapes), 3D measurements in coronal and sagittal planes, arthroscopic classifications of rotator cuff injuries, and arthroscopic measurements in coronal and sagittal planes. ResultsAfter examining 25 cases, 3D imaging demonstrated similar arthroscopic values post-bursectomy in the sagittal plane (16.70 ​mm for 3D and 18.28 ​mm for post-bursectomy, p-value ​= ​0.189), although these measurements did not align with those of MRI (which underestimated measurements, p-value ​= ​0.010). Both MRI measurement and 3D imaging showed similar measurement accuracy in the coronal plane when compared to arthroscopic measurements taken before and after bursectomy. The creation of 3D objects enabled the analysis of new geometries, including the length, width, and depth of each lesion. These geometries included the rectangle, rectangular trapezoid, scalene trapezoid, irregular pentagon, and irregular hexagon. Conclusions3D models can enhance the understanding and knowledge of rotator cuff injuries. They can be a promising tool for diagnosing and interpreting the anatomy of the injury, particularly in the sagittal plane. The new 3D understanding of the pathological process has led to the description of new geometric features not visible in conventional 2D MRI. Level of evidenceII – Development of diagnostic criteria on consecutive patients (all compared to “gold” standard).

Gross Measurement of Intraarticular Graft Length in All-Inside Anterior Cruciate Ligament Reconstruction.

Intra articular length (IAL) of the graft has not been measured yet in anatomic, single bundle, anterior cruciate ligament (ACL) reconstruction. Especially in the all-inside ACL reconstruction technique, the IAL of the graft is of great importance due to the philosophy of the technique and the risk of graft "bottoming out". We present a simple arthroscopic measurement of the IAL of the ACL graft in anatomic, single bundle ACL reconstruction, that will allow optimal application of the all-inside technique.

Combined Margin Convergence Repair and Subacromial Balloon Spacer for the Treatment of Massive Rotator Cuff Tears

Background: Current joint-sparing treatment options for massive, irreparable rotator cuff tears aim to prevent superior migration of the humeral head and maintain the subacromial space. Although options such as superior capsular reconstruction and posterosuperior tendon transfer may appropriately restore function and reduce pain, these procedures harbor significant comorbidity and intense postoperative rehabilitation. Recently, studies have demonstrated excellent results from a subacromial balloon spacer composed of a biocompatible copolymer that degrades over the 12 months following implantation. This spacer enables a more anatomic position of the humeral head to restore normal shoulder biomechanics. Indications: The subacromial balloon spacer is primarily indicated in patients with massive, irreparable rotator cuff tears who demonstrate proximal humeral migration. Contraindications include subscapularis or teres minor tendon tears, deltoid dysfunction, and pseudoparalysis. Technique Description: Standard arthroscopic portals are established, and a diagnostic arthroscopy is performed to assess the glenohumeral joint space and subscapularis tendon. A subacromial bursectomy is performed without proceeding medial to the superior glenoid rim. The subacromial space is measured utilizing an arthroscopic measurement probe to ensure that the selected spacer will lie slightly medial to the glenoid. The rotator cuff is then reapproximated from the lateral to medial aspect of the tear and repaired via a side-to-side manner with high strength, nonabsorbable tape, and a self-capturing suture device. Following repair, the deployment device is inserted through the lateral portal, placed slightly medial to the glenoid, and inflated with saline. Results: Utilization of the described subacromial balloon augmentation provides significant pain relief by restoring glenohumeral biomechanics, improvements in range of motion, and an enhancement in quality of life. Discussion: This case report and video review of a technique for utilizing a subacromial balloon spacer demonstrates an effective, simple, and safe treatment for massive, irreparable rotator cuff tears. Positive results rely on appropriate inflation and secure fixation. Recent clinical trial data suggest that functional outcomes for the subacromial balloon spacer are noninferior to that of partial rotator cuff repair. These promising results suggest that the subacromial balloon spacer may prove an essential tool for joint-preserving surgery following massive, irreparable rotator cuff tears.

The apex of the deep cartilage is a stable landmark to evaluate the femoral tunnel position in ACL reconstruction.

To develop a simple and effective method for evaluating the femoral tunnel position using the apex of the deep cartilage (ADC) as the landmark. A total of 52 patients who underwent arthroscopic ACL reconstruction were recruited between June and September 2021. The femoral tunnel was placed on the central point of the anteromedial footprint with an accessory anteromedial and a high anterolateral portal. Then, the length from the ADC to the shallow cartilage margin (L1) and to the center of the femoral tunnel (l1), as well as the center to the low cartilage margin (H1, intraoperative height), was measured under arthroscopy and on postoperative CT scans (L2, l2 and H2). Moreover, intraoperative and postoperative cartilage ratios were equivalent to l1/L1 and l2/L2, respectively. Linear regression, Pearson correlation and Bland-Altman analysis were performed to evaluate the consistency between these two measurements of cartilage ratio (l/L) and height (H). The mean age at the time of surgery was 28.7years; 42 patients were male, and 17 patients were hurt in the left knee among 52 patients. The intraoperative cartilage ratio was 0.37 ± 0.04, and the height was 8.1 ± 1.1mm with almost perfect inter-observer reproducibility. After the surgery, the cartilage ratio and height were measured as 0.39 ± 0.04 and 8.2 ± 1.3mm on 3D-CT, respectively, with almost perfect intra- and inter-observer reproducibility. Significant positive correlations and linear regression were detected in the cartilage ratio (r = 0.844, p < 0.001), and height (r = 0.926, p < 0.001) intraoperatively and postoperatively. The Bland-Altman plot also showed excellent consistency between arthroscopy and 3D-CT. The ADC is a good landmark in the assessment of femoral tunnel position, with excellent consistency between intraoperative arthroscopic measurements and postoperative 3D-CT. gov Identifier: NCT04937517. Level III.

Application of an indentation sensor for the arthroscopic measurement of articular cartilage stiffness.

Direct measurement of cartilage stiffness provides useful clinical information and enables us to develop treatment strategies for patients. We applied an indentation sensor to evaluate cartilage stiffness under arthroscopic control. The purpose of this study was to validate the arthroscopic indentation sensor using cadaver knees and to measure cartilage stiffness in clinical cases. The stiffness of a material with known properties was measured at thicknesses from 2 mm to 10 mm with a 2-mm interval. This was repeated three times at each thickness to evaluate repeatability. The articular cartilage stiffness of the medial and lateral femoral condyles of five human cadaveric knees was measured. The sensor was inclined from 0° to 20° with 1° intervals. The stiffness value at each degree of inclination was compared to evaluate the acceptable measuring angle. Additionally, articular cartilage stiffness was measured in 23 adolescent and 11 adult patients under arthroscopy. Young's moduli of the material were 1.15-1.24 (mean 1.20) MPa. Inter-class correlation coefficients in repeated measurements using the material were 0.83-0.99. There were no differences in the cartilage stiffness between the medial and lateral femoral condyles of the cadaver knees. All condyles showed a nonlinear relationship between force and displacement. The force decreased in all condyles when the tip of the sensor system was tilted. The range of error was < 97.1% within 5° inclination. There was a moderate negative correlation between age and cartilage stiffness in adolescent patients, and a moderate positive correlation in adult patients. Since the sensor system is manually held during measurement, the validity and repeatability to assess material properties of the cartilage may be inaccurate. This study has proven that the instrument can measure the stiffness of joint cartilage reliably and is a useful clinical tool under arthroscopic control.

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study.

BACKGROUNDArthroscopic procedures are commonly performed for rotator cuff pathology. Repair of rotator cuff tears is a commonly performed procedure. The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair.AIMTo compare the arthroscopic and open measurements with the real dimensions of three different patterns of simulated rotator cuff tears of known size using a plastic shoulder model.METHODSWe created three sizes and patterns of simulated supraspinatus tears on a plastic shoulder model (small and large U-shaped, oval-shaped). Six orthopaedic surgeons with three levels of experience measured the dimensions of the tears arthroscopically, using a 5 mm probe, repeating the procedure three times, and then using a ruler (open technique). Arthroscopic, open and computerized measurements were compared.RESULTSA constant underestimation of specific dimensions of the tears was found when measured with an arthroscope, compared to both the open and computerized measurements (mean differences up to -7.5 ± 5.8 mm, P < 0.001). No differences were observed between the open and computerized measurements (mean difference -0.4 ± 1.6 mm). The accuracy of arthroscopic and open measurements was 90.5% and 98.5%, respectively. When comparing between levels of experience, senior residents reported smaller tear dimensions when compared both to staff surgeons and fellows.CONCLUSIONThis study suggests that arthroscopic measurements of full-thickness rotator cuff tears constantly underestimate the dimensions of the tears. Development of more precise arthroscopic techniques or tools for the evaluation of the size and type of rotator cuff tears are necessary.

Radial Width of the Lateral Meniscus at the Popliteal Hiatus: Relevance to Saucerization of Discoid Lateral Menisci

Background: A discoid lateral meniscus (DLM) is a congenital anomaly of the knee in which the lateral meniscus has an “O” shape and contains irregular, abnormal collagenous tissue. A DLM can cause mechanical symptoms and pain. Treatment of a symptomatic DLM is arthroscopic saucerization to reshape the meniscus to a more normal contour. Enough tissue must be removed to eliminate mechanical symptoms but not too much to create instability. The residual width of the meniscus is crucial at the popliteus hiatus because here the peripheral rim is unattached at the capsule. Reports in the literature recommend a residual width of 6 to 8 mm. Purpose/Hypothesis: The purpose of this research was to determine the width of the lateral meniscus at the popliteal hiatus in normal specimens. Our null hypothesis was that a residual width of 6 to 8 mm will be sufficient to approximate normal anatomy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We made direct measurements of the radial width of the lateral meniscus from the outer rim at the popliteal hiatus to the inner edge in 19 specimens (age, 2-120 months.) We measured one 4-year-old specimen with a bilateral complete DLM. We also measured 39 digital images of specimens (age, 1-132 months) using ImageJ. Finally, we made direct arthroscopic measurements of 8 skeletally mature specimens. Results: The average width of specimens <3 years old was 5.5 mm. The average width of the 10-year-old specimens was 12 mm. The average width of the skeletally mature specimens was 16 mm. A 4-year-old DLM specimen measured 19 mm. Conclusion: We rejected our null hypothesis. Direct measurements suggest that a residual width of 6 to 8 mm is insufficient for children ≥8 years old. A width of at least a full centimeter approximates the normal for 8-year-olds and at least 15 mm for adolescents.

Do Coronal or Sagittal Plane Measurements Have the Highest Accuracy to Arthroscopically Diagnose Syndesmotic Instability?

To compare the accuracy of arthroscopic sagittal versus coronal plane distal tibiofibular motion toward diagnosing syndesmotic instability. Arthroscopic assessment of the syndesmosis was performed on 21 above-knee cadaveric specimens, first with all ligaments intact and subsequently with sequential transection of the anterior inferior tibiofibular ligament, the interosseous ligament, the posterior inferior tibiofibular ligament, and the deltoid ligament. A lateral hook test, an anterior-to-posterior (AP) translation test, and a posterior-to-anterior (PA) translation test were performed under 100 N of applied force. Anterior and posterior third coronal plane diastasis and AP and PA sagittal plane fibular translations were measured relative to the static tibia. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was higher for the combined AP and PA sagittal measurements (AUC, 0.91; accuracy, 83.5%; sensitivity, 78%; specificity, 89%) than the coronal plane measurements (anterior third: AUC, 0.65; accuracy, 60.5%; sensitivity, 63%; specificity, 59%; posterior third: AUC, 0.73; accuracy, 68.5%; sensitivity, 80%; specificity, 57%) (P < .001), underscoring the higher accuracy of sagittal plane measurements. Arthroscopic measurement of sagittal plane fibular translation is more accurate than coronal plane diastasis for evaluating syndesmotic instability. Clinicians should focus on distal tibiofibular motion in the sagittal plane when arthroscopically evaluating suspected syndesmotic instability. Biomechanical cadaveric study.

Relation of arthroscopic measurement of tibial footprint with the height, weight, or gender of patients: A pilot study on Indian subject

Objectives: A prospective study performed to evaluate whether any correlation exists between tibial footprint size (length and width) of anterior cruciate ligament (ACL) with the height, weight, or gender of patients. Materials and Methods: A total of 53 patients presenting with an ACL tear (54 knees) in 8 months duration who underwent ACL reconstruction were evaluated for height, weight, and gender. Arthroscopic measurement of ACL footprint’s length and width with calibrated probe and measuring scale was done and the average of those measurements was recorded and compared using SPSS software. Results: Out of 53 Patients, 45 were male with a mean age of 28.73 years and a mean height of 66.67 inches. Their mean ACL footprint dimension was 17.40 mm × 7.67 mm2. The remaining eight were female patients with a mean age of 29.2 years and a mean height of 66.17 inches. Their mean ACL footprint dimension was 17.35 mm × 7.61 mm2. Correlation between ACL tibia footprint length versus width was found to be statistically significant. However, the correlation between the patient’s height or weight versus ACL tibial footprint (length and width) was not significant statistically. Conclusion: ACL footprint size cannot be predicted from the height, weight, or gender of patients.

Application of CT Three-Dimensional Image in the Diagnostic Evaluation and Treatment of Sports Knee Ligament Strain

Objective: This paper explores the value of CT three-dimensional reconstruction image technology in the diagnosis and treatment of anterior cruciate ligament injury of the knee joint. Methods: The paper selected March 2017–April 2018 to treat and diagnose the reconstructed images in our hospital and imported them into MIMICSl0.01 for 3D reconstruction of the knee joint, and segmented and isolated the anterior cruciate ligament model. The lengths of the anterior and posterior outer edges of the anterior cruciate ligament separated at 0° and 90° were measured respectively: the angles between the anterior and posterior cruciate ligament at 90° to the horizontal plane. Comparison and analysis of CT 3D reconstruction measurement data with recognized autopsy data and arthroscopy measurement data. Results: The positive rate of "anterior cruciate ligament injury" diagnosed by three-dimensional CT was 93.33%. The CT 3D reconstruction measurement data is not significantly different from the accepted anterior cruciate ligament cadaver measurement data. There is no statistically significant difference between the CT 3D measurement data and arthroscopic measurement data. Conclusion: Three-dimensional CT reconstruction plays a significant role in the early diagnosis of anterior cruciate ligament injury of the knee joint. CT three-dimensional reconstruction can be used as an anatomical method in the study of normal human anatomy. CT three-dimensional reconstruction of the anterior cruciate ligament of the knee joint plays an important role in guiding anterior cruciate ligament reconstruction under knee arthroscopy.

The change of joint space width after medial open wedge high tibial osteotomy

Purpose: After medial open wedge high tibial osteotomy (MOWHTO), an increase in the joint space width(JSW) of the medial compartment of the knee joint is commonly observed in clinical practice. Since the JSW is regarded as a surrogate measure for cartilage thickness, it has been suggested that the increment of the medial JSW observed after MOWHTO would have resulted from the cartilage regeneration. However, the association between the change of medial JSW after MOWHTO and cartilage regeneration has not investigated with the second-look arthroscopic examination, which could provide an actual status of the cartilage status. Moreover, the possibility that change in JSW is due to the shift of the weight-bearing axis of the lower limb cannot be excluded. The aim of the present study was to investigate the relevant factors that affect the change of JSW after MOWHTO. It was hypothesized that the change of JSW after MOWHTO would be associated with the change of the weight-bearing condition. Methods: A total of 100 patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were classified into two groups according to the change of medial JSW between at the time of primary operation(MOWHTO) and at the time of second-look operation: group 1(the patients with increased medial JSW) and group 2 (the patients with maintained or reduced medial JSW). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups. In addition, for the statistically significant variables, the characteristics of JSW of the knee were further evaluated. Results: There were no differences between the two groups in the preoperative clinical scores as well as the postoperative clinical scores evaluated at the time of second-look operation. Furthermore, there were no significant differences between the two groups regarding the change of cartilage lesion size between the two-time points as well as the cartilage regeneration status. However, the postoperative load-axis deviation and the postoperative medial proximal tibial angle were significantly higher in group 1, suggesting that the increase in medial JSW is possibly related to the postoperative weight-bearing condition. Accordingly, an additional analysis was performed to evaluate whether there were differences in JSW characteristics (medial JSW, lateral JSW, and joint-line convergence angle) according to the position of the postoperative load-axis deviation. The patients were further divided into three groups (group U, under-correction group; group A; acceptable correction group; group O; over-correction group). As a result, there was a statistically significant difference in the postoperative medial JSW and the degree of change in medial JSW, in which the medial JSW increased as the postoperative load-axis deviation located laterally. Medial JSW increased over time in group A and O, whereas it showed a tendency to decrease in group U. On the contrary, there were no differences in lateral JSW and joint-line convergence angle between the groups. Conclusions: The increase in the medial JSW observed after MOWHTO was affected by the postoperative weight-bearing condition, rather than the cartilage regeneration status. Therefore, changes in JSW observed after MOWHTO should not be used as a surrogate measure for cartilage thickness. In addition, for a clinical perspective, it could be recommended to aim the post-operative weight-bearing line to be located at 60-70% of the tibial articular surface from the medial border of the tibia, considering postoperative medial JSW as well as other biomechanical aspects of the knee.

Can preoperative magnetic resonance arthrography accurately predict intraoperative hip labral thickness?

ObjectiveThere is limited literature investigating the reliability of magnetic resonance-based assessments of labral size. The goal of this study was to validate the reliability of magnetic resonance arthrography-based labral size measurements with intra-operative arthroscopic measurements. MethodsPatients undergoing hip arthroscopy for femoroacetabular impingement and labral tears were prospectively enrolled. Preoperative magnetic resonance arthrograms were used to determine labral size at the anterior-superior portion (zone 2), mid-superior portion (zone 3), and posterior-superior portion (zone 4). Intra-operative labral widths were measured at the same anatomical zones of the acetabulum using an arthroscopic probe. Mean labral size was determined for each location and a Pearson correlation was used to determine the correlation between imaging-based measurements and intra-operative measurements. Results117 patients were enrolled with 70% being female, an average age of 39.1 ± 13.3, and an average body mass index was 26.5 ± 5.4. The average labral sizes based on intraoperative measurements were 6.85 mm in zone 2, 7.45 mm in zone 3, and 7.29 mm in zone 4. The average labral sizes based on MRA were 6.95 mm in zone 2, 7.24 mm in zone 3, and 6.71 mm in zone 4. There was a poor correlation between MRA and intraoperative measurements in zones 2 and 3 (zone 2: R = 0.171, p = 0.065; zone 3: R = 0.335, p = 0.00022) and no correlation in zone 4 (R = −0.22, p = 0.82). ConclusionThis study demonstrates a poor correlation in labral measurements between magnetic resonance arthrogram imaging and intraoperative measurements, suggesting that this imaging modality may be insufficient in providing accurate measurements of labral size.

Intercondylar Notch Size Can Be Predicted on Preoperative Magnetic Resonance Imaging

PurposeTo develop a standardized method of intercondylar notch measurement on preoperative radiographs and magnetic resonance imaging (MRI) and validate that it could predict intraoperative notch measurements.MethodsThe charts and imaging of 50 patients undergoing anterior cruciate ligament reconstruction were reviewed. A standardized method of intercondylar notch measurement on radiographs and MRI was used by 3 blinded reviewers. Arthroscopic measurements were made by the surgeon who was blinded to the imaging measurements. Interrater reliability was determined between reviewers and between imaging and arthroscopic measurements using interclass correlation coefficients (r).ResultsThe average notch base width was 16.5 (± 2.7) mm on MRI, 19.0 (± 3.4) mm on radiographs, and 15.8 (± 3.0) mm on arthroscopic measurement. The radiographic notch base width measurements were on average 1.2 times greater than the arthroscopic measurements. There was no significant difference between males and females in notch base width (16.7 mm vs 15.3 mm, P = .19) or area (312.5 mm2 vs 284.3 mm2, P = .17). Interrater reliability was excellent between the reviewers for notch base width measurement on both MRI (r = 0.91) and radiographs (r = 0.95). Good-to-excellent interrater reliability between notch base width measurements on MRI and arthroscopy (r = 0.78, 0.73, 0.7) and fair-to-good interrater reliability between notch base width measurements on radiographs and arthroscopy were found (r = 0.61, 0.58, 0.55).ConclusionsThis study introduces a reliable method of using preoperative MRI to predict intercondylar notch width during arthroscopy. This data can be used to identify patients with narrow notches preoperatively.Level of EvidenceLevel III, diagnostic study.

The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status

BackgroundAlthough it has been known that medial open wedge high tibial osteotomy (MOWHTO) would adversely affect the patellofemoral joint, no previous study examined the surgical outcome of MOWHTO according to the preexisting cartilage status of the patellofemoral joint. The aim of this study was to investigate the effect of MOWHTO on the patellofemoral joint with regard to objective and subjective aspects according to the preexisting cartilage status.MethodsNinety-two patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were divided into two groups according to the preexisting cartilage status of the patellofemoral joint: group 1 (International Cartilage Repair Society [ICRS] grade 2 or 3) and group 2 (ICRS grade 0 or 1). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups.ResultsClinical outcomes showed overall improvement from baseline to the time of second-look operation, with no significant difference between the two groups at each time point. There were no significant differences in radiographic parameters between the two groups. Radiographic grade of patellofemoral osteoarthritis in both groups showed a tendency to progress, without statistical significance. In arthroscopic assessment, the size of the cartilage lesion on the patellofemoral joint increased with time in both groups (P = 0.003), but the degree of change over time between the two groups was not statistically significant. Consistently, there was no significant difference in the frequency of progression of cartilage lesion grade in the patellofemoral joint between the two groups.ConclusionsMOWHTO would contribute to osteoarthritis progression of the patellofemoral joint regardless of the preexisting cartilage status, without an association with clinical outcomes in short-term follow-up.