Lesions Of Knee Research Articles

Subchondroplasty for treating bone marrow lesions in osteoarthritic knee – initial experience

Subchondroplasty for treating bone marrow lesions in osteoarthritic knee – initial experience

Early Postoperative CT Scan Provides Prognostic Data on Clinical Outcomes of Fresh Osteochondral Transplantation of the Knee

Background: There is a lack of information regarding the ability of imaging studies to predict clinical outcomes after fresh osteochondral allograft (FOCA) transplantation of the knee. Purpose: To determine the value of computed tomography (CT) scans to predict the clinical outcome of FOCA transplantation using the assessment computed tomography osteochondral allograft (ACTOCA) score. Study Design: Cohort study; Level of evidence, 3. Methods: We prospectively collected data from all consecutive patients who underwent FOCA transplantation for osteochondral knee lesions at one institution between August 2017 and August 2019. All patients were followed up for a minimum of 2 years. CT scans performed 6 months after surgery were evaluated by a musculoskeletal radiologist using the ACTOCA scoring system. The radiologist was blinded to the patient’s medical history. Clinical outcomes were assessed preoperatively and at 12 and 30 months postoperatively using the International Knee Documentation Committee (IKDC) score, the Kujala score, the Tegner activity scale, and the Western Ontario Meniscal Evaluation Tool (WOMET) score. Results: A total of 38 cases were included. The ACTOCA score at 6 months after surgery showed a statistically significant correlation with clinical results at 12 and 30 months. The correlation was better at 30 months, showing a high negative correlation with the IKDC score (−0.663) and a moderate negative correlation with the Kujala, WOMET, and Tegner scores (−0.593; −0.547, and −0.593, respectively) (P < .001). Conclusion: A statistically significant correlation between the mean ACTOCA score on CT scans at 6 months and the clinical results measured by the IKDC, Kujala, WOMET, and Tegner scores at 30 months confirmed the predictive value of the ACTOCA score for use in clinical practice.

Winter sports nation Germany-injuries in alpine ski racing and mass sports : Statistics and injury mechanisms in winter sports and current trends in sports science

In Germany, winter sports are very popular. About 7million people go skiing at least 6days per season. The German national winter teams won about 50% of the Olympic medals for the last several Olympic games. The downside of winter sports is the everlasting high number of injuries. This affects both professionals and the large number of amateur skiers. The ASU institute of German insurances and skiing association find adecreasing number of injuries overall and a decreasing number of inpatient stays in hospitals. Still, the knee is the most injured region of the body. There is an increasing number of ACL ruptures within the knee lesions. The numbers in professional teams have been monitored with the FIS surveillance system since 2006. The highest rates of knee injuries (41.3%) are found with the ski world cup teams all over the world. The most common injury mechanism is the slip-catch mechanism. In current sports science examinations of the German skiing association there are extremely high forces of more than three times the body weight found on the body during skiing. Slalom skiing is especially affected. To understand the popular carving ski technology, you must know about the waist and the edge angle of the ski. There can be enormous forces coming along with the skis that can hardly be controlled by the skier.

Incidence of primary patellar dislocation in Colombia

Introduction and objectivesPrimary acute patellar dislocations (PAPD) account for 3% of all traumatic knee lesions, and several studies have estimated the general incidence of patellar dislocation to be between 2 and 77.4 per 100,000 person-years. Few studies have evaluated the incidence of primary lateral patellar dislocation in Latin America. The aim of the study was to evaluate the incidence of patellar dislocation in patients from a reference center in the Colombian southwest, report trends in the incidence of dislocation, and describe the rate of surgical treatment. Materials and methodsWe performed an observational, analytical, cross-sectional study including all patients older than 9 years old with primary lateral patellar dislocation (PLPD), between January 2011 and June 2018, in a tertiary care center in Latin America. ResultsIn our population, the incidence of primary lateral patellar dislocation (PLPD) was 32.38 per 100,000 person-years. The age group between 14 and 18 years old had the highest incidence (187.74 per 100.000). In the 10 to 13-year-old group, females had a significantly higher incidence (179.05 vs 59.85 /100,000, p-value<0.001). ConclusionsWith an incidence of 32.38 per 100,000 person- years, primary patellar dislocation is a frequent orthopaedic injury in our population. The peak incidence by age group was in adolescents between 14 to 18 years old.

Knee Kinematic Patterns and Early Cartilage Lesion Characteristics in Patients with Anterior Cruciate Ligament Reconstruction.

Specific knee kinematic alterations have been theorized to correlate with the progression of cartilage degeneration, and therefore, post-traumatic osteoarthritis in patients with anterior cruciate ligament reconstruction (ACLR). However, how specific knee kinematic alterations contribute to knee joint cartilage degenerations remains to be unclear. To solve this problem, we hypothesized that there are specific cartilage-degenerating kinematic gait patterns that could be supported by the specific areas of cartilage lesions in ACLR knees. Thirty patients with unilateral ACLR knees and 30 healthy controls were recruited for the study. The kinematic differences between the ACLR knees and the healthy control knees during the stance phase were calculated to identify the kinematic patterns. Cartilage lesion distribution characteristics were acquired for patients with ACLR knees to validate the kinematic patterns using magnetic resonance images. Two kinematic patterns were modeled, i.e., sagittal (increased flexion angle and posterior tibial translation) and coronal (increased lateral tibial translation and abduction angle) kinematic patterns. For the sagittal pattern, the cartilage lesion distributions showed that there were more cartilage lesions (CLs) in the superoposterior regions than the posterior regions in the femoral condyles (p = 0.001), and more CLs in the posterior regions than the middle regions in the tibial plateau (p < 0.001). For the coronal pattern, the cartilage lesion distributions showed that there were more CLs in the lateral compartments near the tibial spine than the medial compartments near the tibial spine (tibial sides, p = 0.005 and femoral sides, p = 0.290). To conclude, the cartilage degeneration distribution evidence largely supports that the two kinematic patterns may contribute to cartilage degeneration in ACLR knees. These findings may provide a potential strategy of delaying early cartilage degeneration in ACLR knees by using motion (kinematic) pattern modification or training. However, investigations should be conducted on the actual effects of this potential strategy.

Subcutaneous Nodules in a 28-week-old Girl.

Subcutaneous Nodules in a 28-week-old Girl.

Effect of unicompartmental knee arthroplasty in patients over 75 years old with knee osteoarthritis

To investigate the clinical effect of unicompartmental knee arthroplasty in patients with knee osteoarthritis over 75 years old. From April 2010 to May 2015, 42 patients with knee medial compartment osteoarthritis were treated with Oxford third-generation unicompartmental knee arthroplasty. According to the single and bilateral replacement, the patients were divided into bilateral simultaneous replacement group and unilateral replacement group:11 patients in the simultaneous replacement group, 3 males and 8 females, aged (79.18±3.06) years;There were 31 cases in the unilateral replacement group, 13 males and 18 females, aged (78.16±3.48) years. The survival status of patients with knee prosthesis, the changes of hematocrit before and after operation, and the total amount of blood loss during and after operation were observed and compared;The HSS (Hospital for Special Surgery knee rating) scores of patients before and after operation were compared. There was significant difference in perioperative complications between two groups(P<0.05). All 42 patients were followed up for(5.7±2.3) years. One patient with a history of previous hypertension developed cerebral thrombosis in the 4th month after operation, one patient developed pad dislocation in the 4th month after operation, and two patients died of other medical diseases(1 myocardial infarction and 1 lung cancer) 3 years after operation. The total amount of postoperative blood loss in bilateral simultaneous replacement group was higher than that in unilateral replacement group(P<0.05);Four patients with bilateral simultaneous replacement received 2U blood transfusion after operation. The HSS score and total score of the two groups at 9 months after operation were higher than those before operation(P<0.05). Unicompartmental knee arthroplasty is a feasible surgical treatment for osteoarthritis patients over 75 years old with medial single compartment degeneration. For elderly patients over 75 years old with bilateral knee lesions, bilateral simultaneous unicompartmental knee arthroplasty is more traumatic than unilateral unicompartmental knee arthroplasty, which will increase the incidence of perioperative complications, affect the rapid postoperative recovery and increase the blood loss. Although the long-term effect is equivalent to that of unilateral unicompartmental knee arthroplasty, staged operation is still recommended to ensure the safety of operation.

Modified Lemaire Lateral Extra-articular Tenodesis With the Iliotibial Band Strip Fixed on the Femoral Cortical Surface Reduces Laxity and Causes Less Overconstraint in the Anterolateral Lesioned Knee: A Biomechanical Study

To compare the biomechanical effects of femoral cortical surface fixation and intra-tunnel fixation in modified Lemaire tenodesis on the restoration of native kinematics in anterolateral structure-deficient knees. Eight fresh-frozen cadaveric knees were mounted in a knee-customized jig to evaluate anterior translation in anterior load and internal rotation degree in internal rotation torque at 0°, 30°, 60°, and 90°, as well as anterolateral translation (ALT) in a simulated pivot-shift test at 0°, 15°, 30°, and 45°. Kinematic tests were performed in the following states: intact; anterolateral knee lesion (AL-Les); modified Lemaire lateral extra-articular tenodesis (LET) with the femoral iliotibial band (ITB) strip fixed on the cortical surface (cortical fixation), deep to the lateral collateral ligament (LCL) (deep LET-C); and LET with the femoral ITB strip fixed into a tunnel (intra-tunnel fixation), deep to the LCL (deep LET-IT) or superficial to the LCL (superficial LET-IT). The knee kinematic changes in the AL-Les state and the 3 LET states were compared with each other, with the intact state as the baseline. In the AL-Les state, the increased anterior translation instabilities were significantly mitigated by the 3 LETs at 30°, 60°, and 90° (all P < .001), with overconstraint observed in both the deep LET-IT and superficial LET-IT states at 60° (P= .047 and P < .001, respectively) and 90° (both P < .001). Similarly, the 3 LETs significantly reduced the internal rotation instabilities in the AL-Les state at all flexion angles. The superficial LET-IT state overconstrained the knee at 60° (P= .009) and 90° (P < .001) during internal rotation torque, and the deep LET-IT state did so at 60° (P= .012). Furthermore, the ALT instabilities found in the AL-Les state were significantly reduced by the 3 LETs during the simulated pivot-shift test. At 30° and 45°, these LET states resulted in overconstraint when compared with the intact state, but the superficial LET-IT state (P < .001) or deep LET-IT state (P = .016) presented a larger overconstraint than that in the deep LET-C at 45°, respectively. The 3 Lemaire LET procedures evaluated reduced the anterior, internal rotational, and ALT laxities in AL-Les knees and restored these parameters to the native baseline of the intact state at most flexion angles. However, in deep flexion, some overconstraint occurred in all LETs when compared with the intact state, of which the deep LET-C state resulted in less overconstraint in anterior translation and internal rotation than the deep LET-IT and superficial LET-IT states. This biomechanical study supports using the femoral cortical fixation technique to fix the ITB strip in the modified Lemaire LET, which similarly improves knee kinematic stability and causes less overconstraint compared with conventional intra-tunnel fixation. These findings need more verification in clinical scenarios.

Salvage Procedures: Last Chance Before Arthroplasty

Lower-extremity misalignment hastens the development of chondral and osteochondral knee lesions. In active young patients with bipolar osteochondral lesions, the bipolar fresh osteochondral allograft procedure is a useful salvage treatment option. Although the surgical technique is technically demanding and high reoperation and failure rates are expected, patients with surviving allografts show a significant clinical improvement. Careful patient selection is key to delivering desired results. In this review, we present and discuss recent surgical techniques and developments in bipolar fresh osteochondral allograft procedures.

Different injury patterns exist among patients undergoing operative treatment of isolated PCL, combined PCL/ACL, and isolated ACL injuries: a study from the Swedish National Knee Ligament Registry

PurposeTo compare demographic characteristics and concomitant injury patterns in patients undergoing primary isolated posterior cruciate ligament reconstruction (PCL-R) and combined posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) reconstruction (PCL-R/ACL-R) with isolated ACL reconstruction (ACL-R) as a reference using data from the Swedish National Knee Ligament Registry (SNKLR).MethodsThis cohort study based on the SNKLR comprised patients undergoing either PCL-R, ACL-R, or combined PCL-R/ACL-R between January 1, 2005 and December 31, 2019 in Sweden. Demographic and surgery-related data with regards to injury mechanism, concomitant intraarticular lesions and their treatment, neurovascular damage, and concomitant ligamentous injuries were extracted. Exclusion criteria included concomitant fractures of the femur, fibula, patella or tibia, and quadriceps or patellar tendon injury.ResultsA total of 45,564 patients were included in this study. Isolated PCL-R, combined PCL-R/ACL-R, and isolated ACL-R were performed in 192 (0.4%), 203 (0.5%) and 45,169 (99.1%) patients, respectively. Sports were identified as the cause of 64% of PCL-Rs, 54% of PCL-R/ACL-Rs, and 89% of ACL-Rs, while a traffic-related mechanism was identified in 20% of PCL-Rs, 27% of PCL-R/ACL-Rs and 2% of ACL-Rs. Meniscus injury prevalence was 45% in ACL-Rs, 31% in PCL-R/ACL-Rs and 16% in isolated PCL-Rs (p < 0.001). Cartilage injuries were more common in PCL-R (37%) and PCL-R/ACL-R patients (40%) compared to ACL-R patients (26%, p < 0.001). Concomitant knee ligament injury was identified in 28–44% of PCL-R/ACL-R patients. Neurovascular injuries were present in 9% of PCL-R/ACL-Rs, 1% of PCL-Rs, and 0.3% of ACL-Rs (p < 0.001).ConclusionDifferences in injury mechanisms among patient groups confirm that operatively treated PCL tears are frequently caused by both traffic and sports. Cartilage and ligament injuries were more frequent in patients with PCL-R compared to ACL-R. Consequently, combined PCL and ACL tears should raise suspicion for concomitant knee lesions with clinical relevance during the operative treatment of these complex injuries.Level of evidenceIII.

Meniscal Tear at Knee: Repair or Resect? An Early Experience from a University Hospital in Nepal

Background The meniscus plays an important role in maintaining healthy articular cartilage. Meniscus tear, one of the common intra-articular knee lesions, is treated by either debridement or repair.&#x0D; Objective This study aims at identifying the early outcome of meniscus tears treated by debridement or repair. This study also elaborates on the spectrum of meniscal injuries presented in a tertiary care hospital in Nepal.&#x0D; Method A retrospective descriptive cross-sectional study was conducted at Orthopedic Department of Dhulikhel Hospital from February 2018 until January 2020 among patients who underwent knee arthroscopies for meniscal tears treated either by debridement or repair. Patients having intra articular fractures, osteochondral injuries and multi-ligament injuries were excluded. The meniscal tears were classified according to location and type of tear. Those patients who had at least one-year of follow up were evaluated with Lysholm score for functional outcome. Data were compiled and analyzed with Microsoft Excel 2011.&#x0D; Result One hundred and ten cases of meniscal tears were managed over the study period. Ninety-three cases could be traced for outcome evaluation, which included 50 cases of meniscal debridement and 43 cases of meniscal repair. The mean Lysholm score of the patients who received debridement was 81.5 (SD 10.4) and those who received meniscal repair was 84.9 (SD 9.1) (p=0.105). The population distribution was found to be similar in both the groups according to age and sex distribution and associated ligamentous injuries.&#x0D; Conclusion Good functional outcome was seen for meniscal tears managed with debridement or repair in at least one year follow up and could not establish one modality of management better than the other.

Arthroscopic Drilling for Stable Juvenile Osteochondritis Dissecans of the Knee Is Safe and Patients Reliably Return to Daily Activities by 3 Months

PurposeTo assess the postoperative timeline for the return to activities of daily living (ADLs) in pediatric patients after arthroscopic drilling of a stable osteochondritis dissecans (OCD) lesion of the knee and to determine the rate of and risk factors for complications after the procedure.MethodsIn a retrospective chart review, data from all patients aged 18 years or younger who underwent arthroscopic drilling for a stable OCD lesion of either femoral condyle from May 2009 through July 2017 were collected. Demographic data, lesion characteristics, operative data, postoperative course, radiographic outcomes, and complications were recorded. Statistical analysis was performed to determine the risk factors for reoperations.ResultsA total of 139 knees in 131 patients were evaluated, with a mean age of 12.7 years, of which 102 (73%) were male knees. The average follow-up period was 17.8 ± 13.2 months after surgery. All patients regained full extension and flexion within 5° of the contralateral knee at a mean of 12.9 ± 3.2 weeks postoperatively, with 95% having returned fully to ADLs by the 3-month postoperative visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. A total of 133 knees (95.7%) showed healing on radiographs, whereas 6 knees (4.3%) underwent additional surgical procedures, all of which were performed for treatment failure related to nonhealing lesions (including loose body removal, chondroplasty, and repeated drilling). Lesion size was the only significant risk factor for reoperation (P = .02).ConclusionsOur findings suggest that arthroscopic drilling for stable, intact OCD lesions in the pediatric knee is a safe procedure with reliable outcomes and return to ADLs and a minimal risk of complications. Most patients return to their preoperative daily activity level with a full range of motion of the knee by 3 months after surgery. Complications, including reoperations, are related to the progression of the OCD lesion rather than to the surgical procedure. Each 1-cm2 increase in lesion size increases the likelihood of reoperation by 2.93 times.Level of EvidenceLevel IV, therapeutic case series.

Potential influence of factors for genu valgus with hereditary multiple exostoses.

Genu valgus is one of the most common limb deformities in hereditary multiple exostoses (HME). However, it is easily concealed and may account for subsequent osteoarthritis of the knee. The knees of 56 patients (33 men and 23 women) with HME were investigated bilaterally. Knee valgus was described by the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). We investigated sex, age, BMI, total number of palpable osteochondromas, number of radiographic osteochondromas around the knee, forearm deformities, morphology and distribution of lesions, and correlations between these factors and genu valgus. The measurement of LDFA and MPTA was performed to identify the sources of genu valgus deformity. Based on the measurement of the mechanical axis, limbs were classified as genu valgus (n = 22) or normal mechanical axis groups (n = 90). The different severities of the genu valgus patients were classified by MAD. By bivariate logistic regression, genu valgus was significantly associated with more sessile and flared metaphyseal lesions. However, only the number of flared metaphyseal lesions had a significant influence on the severity of genu valgus. By analyzing the LDFA and MPTA, it was found that abnormalities of both proximal tibia and distal femur play important roles in genu valgus. Early detection of sessile and flared metaphyseal knee lesions in patients with HME can contribute to early intervention of genu valgus. Level of relevance: Level 2.

Accelerating Knee MRI: 3D Modulated Flip-Angle Technique in Refocused Imaging with an Extended Echo Train and Compressed Sensing.

PurposeThe three-dimensional (3D) sequence of magnetic resonance imaging (MRI) plays a critical role in the imaging of musculoskeletal joints; however, its long acquisition time limits its clinical application. In such conditions, compressed sensing (CS) is introduced to accelerate MRI in clinical practice. We aimed to investigate the feasibility of an isotropic 3D variable-flip-angle fast spin echo (FSE) sequence with CS technique (CS-MATRIX) compared to conventional 2D sequences in knee imaging.MethodsImages from different sequences of both the accelerated CS-MATRIX and the corresponding conventional acquisitions were prospectively analyzed and compared. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the structures within the knees were measured for quantitative analysis. The subjective image quality and diagnostic agreement were compared between CS-MATRIX and conventional 2D sequences. Quantitative and subjective image quality scores were statistically analyzed with the paired t-test and Wilcoxon signed-rank test, respectively. Diagnostic agreements of knee substructure were assessed using Cohen’s weighted kappa statistic.ResultsFor quantitative analysis, images from the CS-MATRIX sequence showed a significantly higher SNR than T2-fs 2D sequences for visualizing cartilage, menisci, and ligaments, as well as a higher SNR than proton density (pd) 2D sequences for visualizing menisci and ligaments. There was no significant difference between CS-MATRIX and 2D T2-fs sequences in subjective image quality assessment. The diagnostic agreement was rated as moderate to very good between CS-MATRIX and 2D sequences.ConclusionThis study demonstrates the feasibility and clinical potential of the CS-MATRIX sequence technique for detecting knee lesions The CS-MATRIX sequence allows for faster knee imaging than conventional 2D sequences, yielding similar image quality to 2D sequences.

Sufficient MRI graft structural integrity at 9months after anterior cruciate ligament reconstruction with hamstring tendon autograft.

To assess the MRI-measured structural integrity of hamstring autograft at 9months after anterior cruciate ligament reconstruction (ACLR) surgery. A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group. Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071mm ± 0.926mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (p < 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions. In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3mm) at 9months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling. Level III.

Cyclops Lesion of Non-Operated Knees — A Case Report

Cyclops lesions had been commonly reported after anterior cruciate ligament reconstructive surgeries due to many causes, mostly ACL graft tear or impingements, but the incidence of development of such lesions in non-operated knees of the native ACL, is not clearly described in the literature, this case study presents a Cyclops lesion after partial tear of anterior cruciate ligament in non-operated knee, causing loss of full knee extension with giving way.

On-site Ultrasound Screens out Asymptomatic Knee Lesions in Elite Adolescent Male Basketball Players.

Basketball is a popular sport worldwide with a high injury risk. In this study, we conducted survey composed of clinical symptom reporting scale, physical examination and meticulous portable musculoskeletal ultrasound to 19 elite male high school basketball players and 15 regular male high school students. Our study showed the incidence of ultrasonographic findings of any lesion, suprapatellar effusion and proximal patellar tendinopathy is significantly higher in player group, and the incidence of asymptomatic ultrasonographic lesion is also higher in player group. Screening for asymptomatic lesions bares clinical relevance and plays a role in prevention of symptom development. With the concise and easy-to-perform ultrasonography protocol we performed and being interpreted by sports team physician, the protocol can offer precise diagnosis of common injury and screening for asymptomatic lesion potentially progressive.

Evaluation of role of MRI in knee joint injuries in correlation with arthroscopy

Introduction: Trauma to the knee joint is a major source of morbidity in young active people. An accurate diagnosis concerning the injury is important for early operative as well as non-operative treatment. The most extensively utilised diagnostic techniques to assess knee joint damage are arthroscopy and MRI. Objective: To detect various types of traumatic knee lesions using MRI and to compare the diagnostic accuracy of MRI with arthroscopy in the evaluations of ligamentous and meniscal injuries of the knee joint. Methods: A prospective study was done at the department of orthopaedic. A total of 50 patients (50 knees) were investigated, with 42 males and 11 females ranging in age from 16 to 61 years and presenting with various knee joint injuries. Results: Our comparison of these two methods in knee injuries comes to specific conclusions that are consistent with earlier research. Anterior and medial meniscal injuries are more common than posterior and lateral meniscal injuries. The description of the nature of ACL and PCL injuries by MRI assists the orthopaedic surgeon in deciding whether to proceed with conservative or final reconstruction by arthroscopy. Conclusion: Meniscal and ligamentous injuries are common in people who have had knee trauma. When compared to PCL and LM, the ACL and MM are more usually torn. While ACL and medial collateral ligament tears are associated with MM tears, lateral collateral ligament injuries are strongly associated with LM tears.

Articular Syndrome Characteristics in Children with Mucopolysaccharidosis Type I

Background. Mucopolysaccharidosis type I is disease from the group of lysosomal storage disease developing due to mutations in the IDUA gene. It leads to the accumulation of glycosaminoglycans (GAGs) in organs and tissues. Joints damage in this disease is systemic and progressive.Objective. The aim of the study. Nowadays, relevant issue is to investigate the effects of various types of pathogenetic therapy on the state of the osteoarticular system in patients with severe and mild phenotypes of MPS I to prevent further progression of joint pathology.Methods. The study included 46 patients diagnosed with “mucopolysaccharidosis type I”. 35 children had severe phenotype (Hurler syndrome) and 11 — with mild phenotypes (Hurler-Scheie and Scheie syndromes). The onset age of clinical manifestations in osteoarticular system, the state of large and small joints, and the presence of cervical stenosis according to the therapy were evaluated in these patients.Results. The osteoarticular system pathology can be usually revealed in all patients with MPS I, in both mild and severe phenotypes. The contractures of shoulder, ulnar, wrist, and small hand joints have been revealed in most patients with Hurler syndrome, regardless of the administered therapy. Hip joints pathology was observed in children who was administered with: enzyme replacement therapy (ERT) — in 46.7% of cases, hematopoietic stem cell transplantation (HSCT) in combination with ERT — in 34.4% of cases. Patients with Hurler syndrome administered with HSCT in combination with ERT had cervical stenosis statistically significantly more rarely (p = 0.018) compared to patients treated with ERT only. Patients with Hurler syndrome who were on ERT had statistically significantly lower growth rates than patients after HSCT in combination with ERT. Lesions in ulnar, wrist, knee and small hand joints were the most common in children with mild phenotypes (in 90% of cases).Conclusion. Combined therapy (HSCT and ERT) in patients with Hurler syndrome reduces severe manifestations in osteoarticular system, including children with a pathogenic nucleotide variant c.208C&gt;T in a homozygous state.

Association Between CRP/Albumin Ratio and Long-Term Mortality in Patients With cHronIc Limb-Threatening Ischemia Undergoing EndovaScular Therapy Below The Knee: The ACHILES-BTK Registry

Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall, and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI. A total of 172 patients who underwent endovascular treatment (EVT) for below the knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into 2 groups according to mortality. A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 [1.46 - 7.86] vs. 9.75 [4.5 - 17.71], P < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis. CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.