Tibial Spine Research Articles

Plain Radiographs Have Limited Utility in the Evaluation of Discoid Lateral Meniscus

Background:Debate persists regarding which radiographic measurements are important when investigating a possible discoid lateral meniscus and the utility of x-rays in the diagnostic workup.Hypothesis/Purpose:The purpose of this study was to identify differences in various measurements between healthy knees and those with a discoid meniscus while controlling for other patient characteristics.Methods:Radiographs of patients with a confirmed discoid lateral meniscus were matched by age and sex to those with a healthy knee (verified by magnetic resonance imaging). The following parameters were associated with discoid meniscus in previous studies and were measured on x-ray for each subject: lateral joint space height (both in the central and medial portion of the compartment; LJSH-C and LJSH-M, respectively), medial joint space height, fibular head height (FHH), lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). Ratios were calculated between LJSH-C/M and medial joint space height. Univariate analysis was followed by multivariate regression to adjust for confounders.Results:The study included 57 patients with a discoid meniscus and 55 controls with a mean age of 11.0±3.5 years (50% female). The median LJSH-C for subjects with a discoid meniscus was 7.3 mm [interquartile range (IQR) 2.1] compared to 5.8 mm (IQR 2.2) in normal knees (p<0.001). A similar difference was found for LJSH-M [6.9 mm (IQR 2.9) vs. 5.4 mm (IQR 2.4), p=0.002]. Mean FHH was lower for discoid menisci than controls (12.5±4.0 mm vs. 14.9±5.9 mm, p=0.01). No other radiographic measurements were significantly different between cases and controls. When adjusting for covariates in regression analysis, the presence of a discoid meniscus was predictive of a higher LJSH-C and LJSH-M and lower FHH. Of note, age and sex were also significantly predictive in these models. Patients with a discoid meniscus had 3.5 times higher odds of LJSH-C ≥7 mm [95% confidence interval (CI) 1.5-8.3, p=0.005), 3.3 times higher odds of LJSH-M ≥6 mm (95% CI 1.4-7.9, p=0.006), and 3.1 times higher odds of FHH <16 mm (95% CI 1.2-7.8, p=0.02).Conclusion:After controlling for other factors, LJSH-C, LJSCH-M, and FHH on plain radiographs were associated with a discoid lateral meniscus. However, many previously reported measurements were not predictive. While these parameters may aid diagnostic decision making when there is suspicion for a discoid meniscus, age and sex must also be considered. Advanced imaging may be required to confirm the diagnosis.

Pediatric Tibial Spine Fractures: Exploring Case Burden by Age and Sex

Background:Pediatric tibial spine fractures (TSFs) are a well-known clinical entity, but the epidemiology of these injuries is not fully understood. Further, there is limited data on outcomes after TSF treatment, specifically the proportion of patients that go on to require subsequent ACL reconstruction after completing their initial treatment course.Purpose/Hypothesis:To describe the distribution of TSF case burden by age and sex, and to determine the proportion of patients who undergo subsequent ACL reconstruction or develop ACL insufficiency.Methods:The Truven Marketscan database was queried to identify patients aged 7-18 years with TSFs during the time period of 2016-2018. Diagnosis and initial treatment (surgical vs. nonoperative) was recorded based on database coding. Case burden by age and sex was calculated. The database, which includes longitudinal data, was then queried for subsequent diagnoses of ACL insufficiency as well as subsequent ACL reconstruction procedures performed among the subjects.Results:We found 876 cases of TSF, 71.3% of which were treated nonoperatively. The male:female ratio for case burden was 2.2. Cases peaked at age 13-14 for males and age 11-12 for females (Figure 1). Of all cases identified, 3.7% also had either a diagnosis code for ACL laxity entered in a delayed fashion into the database or a later procedure code for ACL reconstruction (considered together to represent subsequent “ACL insufficiency”). Only 15 subsequent ACL reconstructions were found; all of which were among males, and 9 of which were among males 13-14 years old (Figure 2).Conclusion:This longitudinal study is the largest epidemiologic analysis of pediatric TSFs to date. We found low rates of subsequent ACL insufficiency and ACL reconstruction in general, with males aged 13-14 accounting for the most cases and exhibiting the highest rates of subsequent ACL insufficiency and ACL reconstruction. Rates of subsequent ACL reconstruction were lower than previously reported. Males accounted for about twice as many cases as females.Figure 1.Tibial spine fracture case numbers from the Truven database, broken down by sex, age group, and initial treatment approach.Figure 2.Subsequent ACL insufficiency, broken down by sex and age group.

Morphologic Risk Factor for ACL Rupture in Children Younger than Age 12: An Mri-Based Comparison

Background:There are findings in the adult and adolescent literature regarding anatomic variation that may lead to traumatic disruption of the anterior cruciate ligament (ACL). Previous studies have found an interaction between age and various morphologic risk factors but have been underpowered in assessing younger pediatric patients.Hypothesis/Purpose:The purpose of this study was to evaluate morphologic features of the knee in younger children to determine if any of these factors may contribute to risk of ACL injury in this age group.Methods:A retrospective review of knee MRIs was performed on pediatric patients evaluated at our facility for confirmed ACL rupture. Seven measures were performed and three ratios were calculated, which were compared to an age-matched control cohort previously used to establish and publish normative data of childhood knee MRIs. They were then grouped for statistical purposes by age: “child” aged 5 – 11 years, and “adolescents” aged 12 – 19 years. A generalized linear model was used to assess interaction between age and ACL status.Results:A total of 49 children age <12 years with ACL rupture were identified during the data collection period that met criteria for review. While intercondylar width and notch height index (NHI) were significant in the ACL-torn cohort at large (p=0.015 and p=0.001 respectively), this difference was not present in children. Conversely, tibial plateau to anterior tibial spine (ATS) height was different in ACL-torn children but not in adolescents (p=0.003). Notch Width Index (NWI) was significantly smaller in ACL torn children and adolescents (p<0.0001). When comparing age groups, NWI was the only variable that had minimal to no difference in the normal group, but a significant difference between children and adolescents in the ACL-torn group. No difference was found in Critical Notch Stenosis.Conclusion:Children and adolescents demonstrate the effect of multiple morphologic parameters on ACL tear risk. While there is overlap, there are risk factors specific to each age group. Uniquely, increased TP to ATS height was a risk factor for ACL tear in children. Despite the effect of age and ACL tear on NWI, there was no difference for Critical Notch Stenosis, suggesting that the current definition of critical notch stenosis should be adjusted. Given the difference between NWI in children and adolescents with ACL tear, it may be more appropriate to have age-based cutoffs for critical notch stenosis.

Meniscus Tear Types and Early Failures in Pediaric Patients: Descriptive EPIDemiologic Analysis from the Score Multi-Center Quality Imrovment Project.

Background:Meniscal tears have been reported at higher rates in the pediatric patient in recent years. Meniscus repair to restore meniscus function may be invaluable to the long-term health of the knee.Hypothesis/Purpose:To describe demographic characteristics, tear types, and surgical techniques for meniscus repair in pediatric patients, including risk factors for early repair failure.Methods:A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of meniscus repairs was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Each meniscus repair case with a complication form was secondarily reviewed to ensure consistency of identification and grading. Demographics, tear type, repair technique, and implant type, when applicable, were included, and a common cause analysis was performed to evaluate risk factors for early repair failures.Results:1230 meniscus repair cases (mean age 15.2, 5-19; Female 43.8%) were identified, consisting of 49.0% lateral meniscus repair (LMR), 36.0% medial meniscus repair (MMR), and 15.0% LMR+MMR. The majority (69.7%) were performed in conjunction with either ACL reconstruction (ACLr) or tibial spine repair (TSr). In both LMR and MMR, the most common tear type, technique, and implant were longitudinal/vertical tear (50.3%, 80.0%, respectively), all-inside repair (69.3%, 68.9%, respectively), and Smith & Nephew Fast-Fix 360 (37.8%, 36.8%, respectively). An inside-out repair was performed twice as often in both LMR and MMR when performed in isolation without an ACLr or TSr. For both LMR and MMR, surgeons used an average of 2 sutures/devices (38.0%) with 6.5% involving 10+ sutures/implants. Variation in meniscus repair techniques was seen between tear types, displacement, and location (Tables 1, 2). Radial tears were uncommon in the MM (2.7%), but were commonly treated in the LM (12.32%) using all-inside (42.1%), inside-out (30.2%), and outside-in (19.7%) techniques. Meniscus tears with displacement were seen in 35.2% of MM tears and 25.3% of LM tears, with anterior displacement being the most common direction. For both LMR and MMR, the most common technique for tears with displacement was all-inside (58.4%). There were 15 early (<8 months) repair failures (1.2%), most common type and technique of which were MMR (73.3%) and all-inside (73.3%).Conclusion:The techniques utilized for pediatric meniscus tears depend upon tear type, displacement, and whether performed in conjunction with an ACLr or TSr. MMR performed with all-inside technique may be at risk for early failure.Table 1: Pediatric Lateral Meniscus tear and repair types from SCORE (a multi-center quality improvement registry)Table 2:Pediatric Medial Meniscus tear and repair types from SCORE (a multi-center quality improvement registry)

Type I Tibial Spine Fractures: Not So Simple to Classify, Not So Easy to Treat; A Multicenter Study

Background:Type I tibial spine fractures are non-displaced or minimally displaced (≤ 2mm displacement) fractures of the tibial eminence and ACL insertion traditionally managed nonoperatively with immobilization.Hypothesis/Purpose:We hypothesized that type I fractures do not carry significant risk of associated injuries and therefore do not require additional interventions aside from immobilization.Methods:We reviewed 52 patients classified by their treating institution with type I tibial spine fractures presenting between January 1, 2000 and January 31, 2019 at 10 institutions. Patients of age ≤ 18 years with pre-treatment plain radiographs and at least one year of follow-up were included. Data was collected on patient demographics, injury mechanism, treatment details, presence of concomitant injuries, range of motion (ROM) at final follow-up, treatment complications, and any return to the operating room for the injured knee. Pre-treatment imaging was reviewed by four authors to assess agreement of classification among the treating institutions. Patients were subclassified into two groups to ensure outcomes represented classic type I fracture patterns. Any patient with universal agreement among the four authors that the fracture did not appear consistent with a type I classification were assigned to Type 1+ Group (T1+). All other patients were assigned to the True Type I Group (TT1). We evaluated concomitant injury, need for operative intervention, and treatment outcomes overall and for each group independently.Results:48 patients met inclusion criteria. 40/48 were TT1 fractures, while 8/48 were T1+ fractures, indicating less than universal agreement among sports specialists in classification of these fractures. Among TT1 patients, 7 of 40 (18.4%) underwent surgical treatment, though this represented 35.7% (5/14) of those who had undergone pretreatment advanced imaging. In the T1+ group, 6 of 8 (75%) underwent surgical treatment, 50% of whom (3/6) had pretreatment advanced imaging. Overall, twelve of 48 patients (25%) had concomitant injuries, nine TT1 patients and three T1+ patients (p=0.77), with 7 concomitant injuries requiring additional surgical management.Conclusions:Classification of type I fractures can be challenging. Nonetheless, a substantial percentage of patients with these fractures (>20%) were found to have concomitant injuries by advanced pretreatment imaging, with surgical management indicated in 58.3% of these patients. Contrary to traditional thought, type I tibial spine fractures do carry a risk of associated injuries. Simple cast immobilization may not be the ideal treatment in all cases. Advanced imaging would be beneficial for those whose plan of care may initially be non-operative treatment.

A Multicenter Comparison of Open Versus Arthroscopic Fixation for Pediatric Tibial Spine Fractures

Background:When operative treatment is indicated, tibial spine fractures can be successfully managed with open or arthroscopic reduction and internal fixation.Hypothesis/Purpose:We hypothesized both approaches can lead to satisfactory outcomes for fracture healing, but that open treatment without preoperative advanced imaging can potentially lead to missed concomitant injuries.Methods:We performed an Institutional Review Board (IRB)-approved retrospective cohort study of pediatric tibial spine fractures presenting between January 1, 2000 and January 31, 2019 at 10 institutions. Patients were categorized into two cohorts based on treatment: arthroscopic reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF). Surgical outcomes, the incidence of concomitant injuries, and surgeon demographics were compared between groups.Results:There were 477 patients with tibial spine fractures who met inclusion criteria, 420 of whom (88.1%) were treated with ARIF, while 57 (11.9%) were treated with ORIF. Patients treated with ARIF were more likely to have an identified concomitant injury (41.4%) compared to those treated with ORIF (24.6%, p=0.021). Patients treated with ARIF were also more likely to have pre-treatment MRI (41.7% vs. 22.8%, p =0.010). Most concomitant injuries (74.5%) required surgical intervention. The most common treatment complications included arthrofibrosis (6.9% in ARIF patients, 7.0% in ORIF patients, p=1.00) and subsequent ACL injury (2.1% in ARIF patients and 3.5% in ORIF, p=0.86). The rate of complications, return to the operating room, and failure to return to full range of motion were similar between groups. Twenty surgeons with sports subspecialty training completed 85.0% of ARIF cases; the remaining 15.0% were performed by 12 surgeons without additional sports training. The majority (56.1%) of ORIF cases were completed by 14 surgeons without sports subspecialty training.Conclusion:This is the largest study comparing ARIF to ORIF in pediatric tibial spine fractures. This study demonstrated no difference in outcomes or nonunion following ARIF or ORIF for pediatric tibial spine fractures. There were significantly higher rates of concomitant injuries in patients treated with ARIF, however, these patients also had a higher rate of pre-treatment MRI. The majority of these concomitant injuries (74.5%) required surgical intervention. Pre-treatment MRI should be considered in the workup of tibial spine fractures to increase identification of concomitant injury. Concomitant injuries may be missed in tibial spine fractures treated with an open approach, especially in cases where preoperative advanced imaging is not obtained. Surgeon preference and training may impact treatment approach and identification and treatment of concomitant injury.

What are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures?

Background:The uncommon nature of tibial spine fractures may result in delayed presentation, diagnosis, and treatment. Elucidation of the contributing factors to such delays may provide an opportunity to improve patient care. Additionally, the outcomes of delayed surgery are unknown.Hypothesis/Purpose:The purpose of this study is to evaluate risk factors for, and consequences of, delayed surgical treatment of pediatric tibial spine fractures.Methods:We performed a retrospective cohort study of tibial spine fractures treated surgically at 10 institutions between 2000 and 2019. Demographic and pre-operative data were collected, as was intra-operative information and post-operative complications. Attention was focused on delays in evaluation and treatment, which were treated as both continuous and categorical variables. Surgery ≥21 days after injury was considered “delayed”. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.Results:A total of 368 subjects (mean age 11.7±2.9 years) were included, 21.2% of which underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF 1 or more weeks after injury [95% confidence interval (CI) 1.1-14.3, p=0.04], 2.3 times higher odds of having seen multiple clinicians prior to the treating surgeon (95% CI 1.1-4.8, p=0.02), 5.8 times higher odds of having magnetic resonance imaging 1 or more weeks after injury (MRI; 95% CI 1.6-20.8, p<0.007), and were 2.4 times more likely to have public insurance (95% CI 1.3-4.2, p=0.003). Meniscal injuries were encountered intra-operatively in 42.3% of those that had delayed surgery compared to 16.6% of patients that did not (p<0.001), resulting in 2.8 times higher odds in multivariate analysis (95% CI 1.6-5.0, p<0.001). Delayed surgery was also a risk factor for procedure duration longer than 2.5 hours (odds ratio 3.3, 95% CI 1.4-7.9; p=0.006). Patients who experienced delayed surgical management and an operation longer than 2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI 1.1-12.5, p=0.03).Conclusion:When surgery for a TSF was performed ≥21 days after injury, patients were at increased risk for concomitant meniscal pathology, longer case duration, and possibly post-operative arthrofibrosis. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery. These results provide an opportunity to optimize care for children that are at highest risk for delayed treatment.

Surgical treatment for a combined anterior cruciate ligament and posterior cruciate ligament avulsion fracture: A case report

BACKGROUNDIndependent avulsion fractures with anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) attachment are relatively common among tibial intercondylar eminence fractures, and their postoperative outcomes are generally favorable. Conversely, huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare, and the reported clinical outcomes are poor.CASE SUMMARYWe describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL, together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place. All of these injuries were treated surgically, with anatomical reduction and stable fixation. The limb function at 1 year post-surgery was excellent (Lysholm score: 100 points).CONCLUSIONAlthough this patient's complete surgical repair was complex, it should be performed in similar cases for an excellent final clinical outcome.

Accuracy and Validity of Sharma's Venn Diagram Method for Assessment of Tibial Component Rotation in Total Knee Arthroplasty.

Malrotation of the tibial component in a total knee replacement leads to anterior knee pain, patella dislocations, extensor mechanism disruptions, knee stiffness and prosthesis loosening. Techniques like free-floating technique, medial 1/3 rd of the tibial tubercle, medial border of the tibial tuberosity, Akagi's line, transcondylar line of tibia, posterior condylar line of tibia, midsulcus of tibial spines, curve on curve technique have been advocated. None of these have been shown to be accurate and reproducible. We developed a novel 'Sharma's Venn Diagram' method to assess the tibial component rotation. Fifty-two consecutive knee replacements were included in a prospective observational study. The average age of the study group was 53.6years (48-76 years) Thirty-one were females and 3 were males. The patients were followed a minimum of one years (max 2 years, average 1.8 years). 'Sharma's Venn diagram Method (C)' was compared to free-floating method (F) and post-op CT scans using Berger protocol (B). Tibial rotation calculated using Sharma's Venn diagram method (C) coincided with the final component placement in 50/52 knees. The free floating method (F) coincided with method (C) in 30/52 knees with an average 4.8° external rotation in 5 knees and an average of 5.2° internal rotation in 17 knees. Bland Altman method was used to compare method (C) with Method (F), The difference was statistically significant p < 0.0001. Sharma's Venn diagram method is reliable, accurate and easily reproducible by any surgeon performing tkr and correlates with postoperative 2D CT-based assessment of tibial component rotation. Prospective observational study.

Prospective study of functional outcome of arthroscopic suture pull out fixation of displaced tibial spine avulsion fracture

Background: Tibial eminence avulsion fractures commonly occur in children and adolescents aged between 8 and 14 years. A valgus-directed force associated with an external torsion when the knee is in hyperextension is the most frequently referred mechanism, which closely resembles the one for anterior cruciate ligament (ACL) tears. This happens because the epiphyseal ossification process reaches the tibial eminence only in late childhood or adolescence, leaving this area more vulnerable to tensile forces than the ACL itself. In adults, this lesion is rare and associated either with high- energy trauma, boot-induced injuries in skiers or forced internal rotation with a flexed knee. Avulsion fractures may either involve the intercondylar depression where the ACL insertion lies only or, less frequently, the entire tibial spine with medial and lateral plateau.Materials and Methods: From November 2019 to December 2020, an intervention clinical study was carried out at Sanjay Gandhi institute of trauma and orthopaedics, A number of 30 patients having avulsion tibial spine fracture classified Meyers & McKeever Type II, TYPE III and IV were involved in our study.Results: Fractures were united within 3 months after surgery in all 30 cases. The Lysholm score was improved to 98(98.17 ± 1.599). In 2 patients, post operative knee stiffness was noted and arthrolysis was done for the same. All patients returned to their pre-injury physical activities at the last follow-up. Conclusion: Arthroscopic suture pull-out fixation for type III and IV tibial spine avulsion results in excellent clinical and radiological outcomes in patients with open and closed physis without any significant complications.

Contact Characteristics of Knee-joint Cartilage During Gait Based on Finite Element Analysis

Background: As a common clinical disease, knee osteoarthritis (KOA) is characterized by chronic changes and articular cartilage wear, while the in vivo cartilage contact characteristics of the knee joint during walking are still unclear. It is difficult to implement real-time assistance and treatment for KOA patients accurately. Objective: To investigate the contact biomechanics of knee cartilage during gait and predict the mechanism and location of cartilage damage, aiming to provide theoretical support for real-time rehabilitation assistance for KOA patients. Method: In this study, the subject-specific finite element (FE) method was used to predict the contact characteristics during the stance phase of the gait. A healthy volunteer prepared an intact geometric left knee model based on magnetic resonance scans. The kinematic and dynamic data were collected in a gait experiment and simulated using the personalized musculoskeletal model. Results: Throughout the gait cycle, the contact pressure, contact area and principal Green- Lagrangian strain in the tibiofemoral joint show two obvious peaks concentrated on the 25% and 75% stance phase. The maximum values were 15.32 MPa, 400.607 mm2, and 24.35% on the tibial side, while 15.58 MPa, 683.538 mm2, and 29.68% on the femoral side, respectively. The contact characteristics were significantly greater in the medial compartment than in the lateral. Conclusion: A FE simulation method was developed in this study to forecast the contact characteristics of the human knee joint. The prevention, rehabilitation, and treatment of KOA should focus more on the medial compartment close to the intercondylar eminence, both for the femoral and tibial cartilages.

ANALYSIS OF COMPLICATIONS FOLLOWING UNICOMPARTMENTAL KNEE ARTHROPLASTY

Purpose: the aim of the present study is to evaluate the intra- and postoperative complications following unicondylar knee arthroplasty and subsequent outcome. Material and methods: For the period from 2008 to 2018, we operated on 450 patients with isolated osteoarthritis of the knee joint. In the majority of cases, patients had arthrosis of the medial compartment of the joint due to antero-medial osteoarthritis or osteonecrosis and, in smaller percentage, osteoarthritis in the lateral part of the joint. Results: Various complications were registered which we divided into intraoperative and postoperative, monitoring during the follow-up of patients. Intraoperative include fracture of the tibial plateau during implantation of the component, partial resection of the intercondylar eminence during the preparation of the tibial plateau, incorrect hole placement in the femoral condyle, which led to malalignment positioning of the femoral component in varus or valgus, resection of more bone substance from the tibia leading to subsidence of the implanted component. The postoperative complications include: aseptic loosening, polyethylene wear, impingement, progression of osteoarthritis in the opposite part of the knee joint, periprosthetic infection and arthrofibrosis. Conclusion: Unicompartmental knee arthroplasty is a minimally invasive procedure for the treatment of isolated osteoarthritis of the knee joint and is associated with excellent and good long-term results. Complications could be reduced by using a meticulous surgical technique, selection of suitable implants and last but not least proper indications for surgery.

Enhancing the radiological classification system from the distal femur to the proximal tibia.

Objectives This study aims to identify anatomical variants of the proximal tibia shaft and to develop a novel classification system for proximal tibia.Patients and methods Between October 2019 and April 2020, a total of 200 patients with standard knee anteroposterior radiographs were included in this study. We measured the inner diameter of the tibia 16 cm distally from the tibial plateau and 3 cm distally from the tibial spine. The ratio between these two measurements was applied as the novel index ratio.Results A total number of 197 patients (100 males and 97 females) with a median age of 68 years (range, 21 to 89 years) were included in the final analysis. According to the 25th and 75th percentiles, three groups were clustered for each sex. A higher distribution of the type B pattern was found in female and male patients. However, type A with a narrow inner diaphyseal diameter was less common in female patients. The median intraobserver reliability for rater 1 was 0.998. The inter-observer reliability was high (intraclass correlation coefficient: 0.998). There was a moderate correlation between the anteroposterior (AP) diameter and height (r=0.568) and a low correlation between the AP diameter and weight (r=0.376). The novel index shows no significant correlation between the index ratio and height (r=0.082), weight (r=0.014) or body mass index (r=-0.038).Conclusion The novel classification presents three different types of tibia for each sex: type C has a wider inner diaphyseal diameter compared to type A with a narrow inner diaphyseal diameter. Type B has the widest distribution among the subjects.

Patients with isolated posterior cruciate ligament rupture had a higher posterior intercondylar eminence

BackgroundTo evaluate the anatomic geometry of the posterior intercondylar eminence and its association with PCL injury risk.MethodsPatients who underwent primary PCL reconstruction from 2015 to 2018 were retrospectively analyzed. The control group included inpatients diagnosed with ACL rupture because of a sports-related accident during the same period, matched by age, gender, height, weight, and side of injury. Measurements of the height of the apex of the posterior intercondylar eminence (HPIE), the slope length (SLPIE) and the slope angle (SAPIE) of the posterior intercondylar eminence were performed using conventional MRI scans assessed by 2 blinded, independent raters. Intraclass correlation coefficients (ICCs) was used to evaluate the consistency of measurement results. Independent sample t tests, Chi-square tests, and logistic analyses were used to compare the two group, with P < 0.05 considered statistically significant.ResultsFifty-five patients with PCL rupture met the inclusion criteria and 55 PCL-intact matched controls were included. There were no significant differences between the groups in gender (P = 1.000), limb side (P = 0.848), age (P = 0.291), BMI (P = 0.444) or height (P = 0.290). Inter-observer reproducibility was excellent agreement in HPIE, SLPIE and SAPIE of case and control groups (ICC: HPIE = 0.81, SLPIE = 0.77, SAPIE = 0.85). Patients with PCL rupture had significantly greater HPIE, SAPIE (both P < 0.001), and SLPIE (P < 0.05) than PCL-intact patients. The multivariable analysis showed that HPIE (OR, 1.62 [95% CI, 1.24–2.11], P < 0.001) and SAPIE (OR, 1.17 [95% CI, 1.05–1.31], P < 0.001) were independent factors associated with PCL rupture.ConclusionThrough this retrospective observational study, we found that patients with PCL rupture may have a higher posterior intercondylar eminence compared to PCL-intact patients.Level of evidenceIII.

Tibial reference point in total knee arthroplasty in patient with proximal tibia vara: A case report.

IntroductionCenter of the intercondylar eminence at the proximal tibia had been widely used as a reference point for tibial bone cut in the Total Knee Arthroplasty (TKA) procedure. However, in the presence of preexisting tibia vara, the center of intercondylar eminence as tibial bone cut reference point often leads to varus malalignment after TKA procedure.Case report75 years old male patient complained of worsening pain on the left knee. The patient has had a history of knee osteoarthritis for the past seven years. The radiograph on the right knee revealed osteoarthritis grade 3 and left knee osteoarthritis grade 4, both with tibia vara. We planned to perform total knee arthroplasty surgery on his left knee with a preoperative planning tibial reference point of 10 mm lateral to the center. Six months after the knee replacement, there was minimal pain on activity, and full ROM was achieved on his left knee. On the radiographic X-ray evaluation, the alignment between the tibial implant surface and mechanical axis is 0.43 degrees valgus.Clinical discussionIn a varus knee malignment, the mechanical axis passes through one-third of the medial side of the knee, which makes the medial side of the implant wear off faster, resulting in the collapse of the medial tibia, thus decreasing implant survival and increasing the need for revision for TKA.ConclusionIn patients with preexisting tibia vara, tibial bone cut reference point planning before TKA procedure is important to provide longevity of implant survival and better quality of life.

Is femoral cartilage thickness associated with rectus femoris thickness and thigh muscle strength in adolescent female basketball players?

Objective: To measure femoral cartilage (FC) thickness and to evaluate the association between FC thickness and isokinetic muscle strength and rectus femoris (RF) muscle thickness in adolescent female basketball players. Materials and Methods A total of 31 female adolescent basketball athletes with a mean age of 12.3 years (SD: 0.9) were included. Isokinetic measurements were performed on quadriceps and hamstring muscles bilaterally using a dynamometer. Bilateral RF and FC thicknesses were evaluated by ultrasonography. For FC thickness, three mid-point measurements were taken bilaterally from each knee as follows: lateral condyle, intercondylar area, and medial condyle. Mean FC thickness for each knee was calculated by values pertaining to the medial and lateral condyles, and the intercondylar area. Results: Right and left mean FC thickness values were 0.23 (SD: 0.03) cm and 0.22 (SD: 0.03) cm. While there was a significant positive correlation between right and left FC thicknesses (r = 0.79, p &lt; 0.001), no correlations were observed between FC and RF thicknesses or between the FC thickness and isokinetic quadriceps and hamstring strength. Conclusion: The mean FC thickness does not seem to correlate either with the RF thickness or with the thigh muscle strength in adolescent female basketball players.

Arthroscopic suture-fixation of anterior tibial intercondylar eminence fractures by retensioning of the ACL and hollowing of the tibial footprint: Objective and subjective clinical results in a paediatric population

IntroductionAnterior tibial intercondylar eminence fractures (ATIEF) of the knee are rare in children. They are associated with prefracture intraligamental distention of the anterior cruciate ligament (ACL). ObjectiveThe objective of this study was to evaluate the subjective and objective clinical results of an arthroscopic surgical technique by suture-fixation of the fracture and tensioning of the ACL through hollowing of the tibial footprint. HypothesisSuture-tensioning of ATIEF arthroscopically helps to achieve treatment objectives by leaving the knee joint free of any hardware. Materials and methodsThis single-operator monocentric retrospective study involved twenty children operated on over a period of 2-years and 10 months, from March 2013, and with a minimum of one-year follow-up. Surgery was indicated for Stage II to IV fractures according to the Meyers and McKeever classification. Type I fractures were excluded. Seventeen out of 20 patients were reviewed. The median age was 12 years at the time of surgery and the mean follow-up was 28 months. The fractures were 5 of stage II, 9 of III and 3 of IV. The scores of Lysholm, objective and subjective IKDC were collected. Residual objective laxity was measured using the GNRB arthrometer at 150N. A standard X-ray evaluation permitted detection of possible growth disorders. ResultsAt 28 months of mean follow-up, the mean scores of Lysholm and subjective IKDC were 99 (95; 100) and 97 (92; 100), respectively. As for the objective IKDC, 14 knees were rated A and 3 were rated B. The mean differential residual laxity via GNRB was 0.94mm (0; 2.4). No radiological growth disorder was observed at the last follow-up. ConclusionThe ACL suture-tensioning technique is simple and reliable. It also preserves the joint of the adult to remain free of any residual hardware. Level of evidenceIV; retrospective cohort study.

Ultrasonographic Measurement of Femoral Cartilage Thickness in Patients with Knee Osteoarthritis

The aim of this study was to investigate the femoral cartilage thickness (FCT) by ultrasound in patients with knee osteoarthritis and compare them with those of healthy subjects. Methods and Results: This cross-sectional study included 44 patients diagnosed with knee OA and 49 healthy subjects. The thickness of the femoral articular cartilage was measured using an L5-18 MHz linear probe. Measurements were taken from both knee joints in three regions: the medial condyle, lateral condyle, and intercondylar area. Our results showed thinner cartilage in OA patients than in the healthy subjects at the three examined locations bilaterally (medial condyle, lateral condyle, intercondylar area). Conclusion: Our study revealed thinner FCT in patients with knee OA than in healthy subjects. Further studies considering the stratification of different stages of OA could yield better results.

Native tibia valga: a potential source of varus malreduction during intramedullary tibial nail fixation of tibial shaft fractures.

To determine the effect of native tibia valga on intramedullary nail (IMN) fixation of tibial shaft fractures. Retrospective comparative cohort analysis of 110 consecutive patients with tibial shaft fractures undergoing IMN fixation at an urban level one trauma centrewas performed. Medical records and radiographs were reviewed for demographics, tibia centre of rotation of angulation (CORA), nail starting point, incidence of varus malreduction, and nail/canal proportional fit. Tibia valga (CORA of ≥ 3 degrees) was present in 37 (33.6%) patients. The anatomic nail starting point distance (in relation to the lateral tibial spine) was significantly greater in the tibia valga group (12.0mm vs. 5.0mm, mean difference: 7.1mm, 95% CI: 5.8 to 8.3mm, p < 0.0001). Varus malreduction was more common in the tibia valga group (10.8% vs. 1.4%, proportional difference: 9.4%, 95% CI: - 1.0 to 21.3%, p = 0.04). Varus malreduction in the tibia valga group was associated with a decreased nail width/inner canal width proportion on multivariate analysis (OR = 0.683, 95% CI: 0.468 to 0.995, p = 0.0004). Native tibia valga is common, and the use of a standard coronal IMN starting point with poor nail fit can lead to iatrogenic varus malreduction. In patients with tibia valga, maximizing nail fit or utilization of a medial starting point should be considered.

Meniscal tears and entrapment in intercondylar eminence fractures in children: a systematic review of the literature

Objectives:Although they may be related to ACL tears in adults, there are few publications on meniscal injuries after intercondylar eminence fractures in children.Methods:The main objective of this systematic review of the literature was to measure the incidence of meniscal injuries as well as concomitant tissue involvement in tibial eminence fractures (TEF) in children. The secondary objectives were to determine a diagnostic and therapeutic strategy to anticipate difficulties in reduction and to treat associated meniscal tears. The PubMed and Scopus database subject search included MeSH indexing terms: "intercondylar tibial fracture*" OR "tibial spine fracture*" OR “tibial spinal fracture” OR "tibial eminence fracture*" OR "intercondylar eminence fracture*". Only series of pediatric tibial eminence fractures with the presence of data on possible meniscal damage were selected. Case reports, mixed adult and child series and duplicates were excluded.Results:789 references were chosen with 91 eligible articles. Only 26 articles reported on the rates of meniscal tears and entrapment after these fractures. Of a total of 997 cases, 227 (22.8%) had a concomitant injury (osteochondral, ACL, PCL and/or meniscal), including 180 cases of meniscal tears (18.1%). Meniscal or intermeniscal ligament entrapment was present in 20.1% (n = 201) of the patients. 2 groups of diagnostic analyses of these injuries were compared: during the arthroscopy, or previously on MRI imaging. Meniscal tears were present in 20.9% of the patients in the arthroscopy group, compared with 26.1% in the group with a prior MRI (p = .06), and the proportion of meniscal tears was 18.6% in the arthroscopy group alone compared to 17.1% in the MRI group (p = .55). However, statistically, the proportion of entrapment noted was significantly higher in the arthroscopy group (17.8% vs 6.2%; p <.0001).Conclusion:This review of the literature reports a high incidence of meniscal tears and tissue entrapment in children. Although it would appear that MRI tends to improve the assessment of associated injuries, the rate of meniscal or intermeniscal ligament entrapment is low compared to the rate reported by arthroscopic diagnosis.