Lateral Femoral Condyle Research Articles

Case Report: Isolated osteochondral fracture of the weight-bearing lateral femoral condyle

Introduction Osteochondral fractures (OCF)s of the femoral condyle are rare in pediatric patients but can have significant implications if missed or left untreated. Surgical fixation is often recommended, particularly in young, to restore joint congruency and function. Case report We report the case of a 14-year-old boy who presented with isolated weight-bearing OCF of the lateral femoral condyle following a sports injury. Magnetic resonance imaging (MRI) revealed a 30.4 mm osteochondral fragment confirmed by arthroscopy but unsuitable for percutaneous management due to its size and location. Open reduction and internal fixation were performed using headless compression screws, a technique reserved for those cases where based on sufficient detached fragment bone to facilitate secure fixation and bone-to-bone healing. Conclusion This case underscores the importance of prompt diagnosis and individualized treatment to prevent long-term joint damage, contributing valuable insights into the management of pediatric femoral osteochondral fractures.

Hypoplasia of the Lateral Femoral Condyle is Not Associated with Valgus Knee Alignment.

Valgus lower limb alignment has anecdotally been associated with lateral femoral condyle (LFC) hypoplasia. However, limited scientific evidence exists to substantiate this doctrine. This study aimed to investigate the association between coronal plane alignment (CPA) and bony distal femoral geometry. Routine preoperative computed tomography (CT) scans and full-length weight-bearing radiographs were analyzed for patients undergoing primary total knee arthroplasty, and standardized measurements of bony distal femoral geometry were recorded. Ratios between lateral to medial structure measurements were used to adjust for size differences between patients. Patients were grouped by CPA and sex with statistical analysis performed to determine any significant groupwise differences for each measurement/ratio. There were 156 patients included, with 83 women (53.2%) and 73 men (46.8%). There were 100 patients (64.1%) who demonstrated varus (women n = 49; men n = 51) and 56 patients (35.9%) who had valgus alignment. No significant differences were observed between groups in age, body mass index, race, or laterality of the imaged knee. Linear regression modeling demonstrated no significant groupwise differences in lateral/medial condyle antero-posterior (AP) distance or lateral/medial posterior condyle offset ratios in relation to CPA and sex, or in lateral/medial condyle diameter ratio in relation to CPA alone. Valgus alignment was associated with significantly reduced lateral/medial epicondyle to posterior condyle distance ratio, lateral/medial femoral column length ratios, and increased lateral femoral AP condyle distance to trans-condylar width. No statistically significant differences exist across most standardized measurements of lateral distal femoral geometry in relation to CPA. Contrary to conventional thought, patients who had valgus alignment did not demonstrate reduced bony AP diameter of the LFC. Perceived LFC hypoplasia in patients who have valgus alignment may be attributable to differences in cartilage wear of the LFC, relative shortening of the lateral femoral column, or a relative posterior position of the lateral epicondyle resulting in an internally rotated appearance of the distal femur in the axial plane relative to the TEA.

Management of Habitual Patellar Dislocation in Pediatrics

Habitual patellar dislocation occurs when the knee is bent and returns to its usual position when straightened. Habitual patella dislocation is 13.5 per 100,000 in children under 13 and 147.7 per 100,000 in children 14–18. This review aims to present a comprehensive and complete literature on the management of habitual dislocation of the patella so that appropriate therapy can be obtained. A complete literature review was used in this investigation. Source search databases are PubMed, Science Direct, and Google Scholar. The literature study shows that habitual patellar dislocation in children is infrequent. Stability requires bone and connective tissue that match the patellofemoral joint. Patella alta, torsional, angular, trochlear dysplasia, muscular anomalies, ligamentous laxity, or ligament damage can produce lateral patellar habitual instability. The quadriceps muscle drags laterally to the limb's mechanical axis. Clinical children with recurrent patellar dislocation may experience a sudden dislocation that "disappeared somewhere." If this condition returns, patients frequently develop unusual knee edema and inflammation. MRI, CT, and plain radiography can diagnose this condition. A CT scan can detect trochlear dysplasia. Joint effusion, osteochondral lesions, medial retinaculum tears, and medial patella and lateral femoral condyle cartilaginous discolorations can be seen by MRI. Conservative or surgical treatment of habitual patellar dislocation depends on the deformity and its effects.

Evaluation of the Femoral Condyle Radius of Curvature at the Chondral Surface Shows Significant Correlation With the Anterior-Posterior Length.

Accurate donor-recipient matching of the femoral condyle radius of curvature (ROC) in osteochondral allograft (OCA) transplantation may aid in minimizing articular surface incongruities. Matching linear femorotibial dimensions, such as the femoral condyle anterior-posterior length (APL), femoral condyle width (lateral-medial length, LML), femoral hemicondyle width (HCW), and tibial plateau width (TPW), can provide similar results if they correlate well with ROC. This study investigates the relationship between femorotibial dimensions and ROC at the cartilage surface using magnetic resonance imaging (MRI). Deidentified MRI images of 63 patients (35 men, 33 ± 10 years old, and 28 women, 27 ± 8 years old) were analyzed. Axial images were used for APL, LML, and TPW (TPW-Ax) measurements, while coronal images were used for HCW and TPW (TPW-Cor) measurements. Cartilage was segmented in true sagittal images at the medial femoral condyle (MFC) and lateral femoral condyle (LFC) to calculate their specific cartilage surface ROCs. Linear regression models were used to determine the relationship between the femorotibial dimensions and ROC. Cartilage ROC was significantly correlated with all the linear femorotibial dimensions at the MFC (P < 0.01, R2 = 0.78, 0.69, 0.67, 0.59, and 0.37 for ROC correlations with APL, LML, TPW-Ax, TPW-Cor, and HCW, respectively), and the LFC (P < 0.01, R2 = 0.81, 0.61, 0.56, 0.54, and 0.41 for ROC correlations with APL, LML, TPW-Ax, TPW-Cor, and HCW, respectively). The APL was the most predictive femorotibial dimension of the cartilage surface ROC. Donor-recipient APL matching in OCA transplantation may provide a similar level of matching to that achievable by direct ROC measurements. The APL matching may help reduce cartilage incongruities, particularly for patients with large osteochondral lesions, in which the ROC measurement cannot be accurately determined.

Osteochondral Fractures in Adolescents With First-time Patellar Dislocation: Three-dimensional Characterization and Association With Radiographic Features.

Consequences of osteochondral fractures associated with patellar dislocation can be severe for younger patients. Precise 3-dimensional characterization of fracture location, size, frequency, and radiographic associations remain undefined in this population. (1) To define the topographic characteristics of osteochondral fractures in pediatric and adolescent patients with first-time patellar dislocations and (2) to determine the relationship between these characteristics and radiographic and patient factors. Cross-sectional study; Level of evidence, 3. A retrospective observational study was conducted between 2015 and 2023 of consecutive patients aged <18 years undergoing surgical intervention for displaced osteochondral fractures in the setting of first-time patellar dislocation. Three-dimensional location and relative injury frequency were quantified with heat map analysis. Subgroup analysis of intraoperative osteochondral fracture size and location was conducted using chi-square testing and an independent t test at an alpha of .05. The study cohort included 82 knees (80 patients) with first-time patellar dislocation and osteochondral fracture. A total of 97 osteochondral fractures were identified, with the lateral femur as the most common fracture site at 55% (n = 53), as compared with 43% (n = 42) for the patella and 2% (n = 2) for the lateral trochlea. Patellar osteochondral fractures were significantly larger than femoral lesions (mean ± SD, 258 ± 168 mm2 vs 126 ± 109 mm2; P < .001) and more amenable to fixation than femoral osteochondral fractures (fixation, 57.1% [n = 24] vs 15.1% [n = 8]; P < .001). Patellar and femoral osteochondral fractures were >100 mm2 in 78.6% (n = 33) and 32.1% (n = 17) of lesions, respectively. Patellar mean fracture size was significantly larger in the group with a tibial tubercle-trochlear groove distance <20 mm (P = .018). The mean osteochondral fracture size of the lateral femoral condyle was significantly larger in the open physis group as compared with the closed physis group (P = .027). We found that the most common site for osteochondral fracture was the femur, although patellar osteochondral fractures were significantly larger. Factors that affect anatomic structure and ligamentous laxity appear to contribute to patterns of osteochondral fractures.

High Detection Rate of Posterolateral Tibial Plateau Fractures and Poor Functional Outcomes in Type IIIB Impaction Fractures After Anterior Cruciate Ligament Rupture and Reconstruction.

The incidence of anterior cruciate ligament (ACL) ruptures has been increasing annually. However, clinical surgeons have overlooked the impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with ACL ruptures. The purpose of the present study was to report the detection rate of the posterolateral tibial plateau impaction fractures in patients with ACL ruptures, and to evaluate the functional outcomes of patients following ACL reconstruction (ACLR) without treatment of the tibial fractures at a 2-year postoperative follow-up. Four hundred eighty-eight patients treated for ACL ruptures between January 2016 and June 2020 were retrospectively reviewed, and the posterolateral tibial plateau impaction fractures were classified based on MRI assessment. The detection rate of the posterolateral tibial plateau impaction fractures was calculated, and the functional outcomes (SF-12 Mental Component Summaries, SF-12 Physical Component Summaries, Tegner, Lysholm, IKDC, and KOOS) were evaluated at a 2-year postoperative follow-up. The detection rate of posterolateral tibial plateau impaction fractures was 41.6% among ACL ruptures. Of these, 285 cases (58.4%) had no fractures, 98 cases (20.1%) had type I impaction fractures, 41 cases (8.4%) had type IIA impaction fractures, 15 cases (3.1%) had type IIB impaction fractures, 22 cases (4.5%) had type IIIA impaction fractures, and 27 cases (5.5%) had type IIIB impaction fractures. Patients with type IIIA or IIIB impaction fractures showed an increased detection rate of contact mechanism compared to the other subgroups. Significant differences in Tegner (postoperation) and KOOS (QOL) were found between no fracture and type IIIB impaction fractures in patients following ACLR. The detection rate of posterolateral tibial plateau impaction fractures in patients with ACL ruptures was high. Patients with type IIIB impaction fractures following ACLR had poor functional outcomes.

Correlation of Increased Lateral Tibial Slope With Baseline Tibial Position in Intact Knees and Side-to-Side Anterior Tibial Translation for Knees With ACL Tears.

Anterior cruciate ligament (ACL) stress techniques-including single-leg stress radiographs, Telos, and KT-1000 arthrometer-are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on magnetic resonance imaging is not conclusive or for judging if additional treatments, such as anterolateral complex augmentation, may be necessary. The purpose of this study was to evaluate the effect of increasing posterior tibial slope (PTS) on baseline tibial position (BTP) and side-to-side differences (SSD) in ATT. A secondary purpose was to perform a subgroup analysis of SSD in ATT for patients with a PTS of ≥12° versus <12°, as well as for acute (<6 weeks from injury) versus chronic (≥6 weeks from injury or ACL graft tear) ACL tears. It was hypothesized that the BTP in normal intact knees would increase linearly with the PTS and there would be an increased SSD in ATT when comparing ACL-injured and ACL-intact knees. Case-control study; Level of evidence, 3. Bilateral ACL stress radiographs were assessed from patients with primary ACL and ACL graft tears between March 2023 and March 2024. Bilateral stress views were obtained by single-leg full-length lateral weightbearing radiograph in 20° of knee flexion. The BTP and ATT were measured using a perpendicular line drawn between the posterior position of the lateral femoral condyle and the lateral tibial plateau. PTS measurements were assessed by the anatomic tibial axis. Statistical analysis using linear regression-r > 0.6 was considered strong, r between 0.4 and 0.6 moderate, and r < 0.4 weak-and t tests were used to compare the PTS with BTP and SSD in ATT. A total of 72 patients were analyzed using ACL stress radiographs. The results found a significant positive correlation between increased PTS and increased BTP for the ACL-intact knees (P < .001; r = 0.476). A significant increase was found in the SSD in ATT of 1.73 mm with a positive correlation between increased PTS and increased SSD in ATT of ACL-deficient knees (P < .001; r = 0.397). A subgroup analysis reported significant increases in SSD in ATT for both ACL-injured knees with a PTS ≥12° (P = .008) and for chronic ACL tears (P < .001) and no significant differences in SSD in ATT for ACL-injured knees with a PTS of <12° (P = .650) and for acute ACL tears (P = .745). This study found a significant positive correlation between PTS and the BTP in ACL-intact knees and for the SSD in ATT between ACL-injured and ACL-intact knees. Moreover, the SSD in ATT was significantly increased for ACL-injured knees with a PTS of ≥12° and for chronic ACL tears. No significant difference in SSD in ATT was found for ACL-injured knees with a PTS of <12° and for acute ACL tears.

Functional Recovery and Clinical Outcome After Internal Fixation Using Osteochondral Autologous Transplantation for Osteochondritis Dissecans of the Knee.

Functional recovery and return to sports after fixation of osteochondritis dissecans (OCD) lesions of the knee with osteochondral autologous transplantation (OAT) have not been well investigated. To retrospectively evaluate the functional recovery and clinical outcomes after internal fixation with OAT for knee OCD. Case series; Level of evidence, 4. A consecutive series of patients who underwent OAT for OCD lesions between 2010 and 2020 were initially enrolled in the study. Patients with adult-onset OCD and those who underwent fragment removal and/or mosaicplasty were excluded. Lysholm score, Tegner activity scale, return-to-sports rate (at the practice/training and preinjury levels), and time to return were evaluated. Clinical factors influencing postoperative functional recovery were analyzed. Included were 24 patients (26 knees); there were 23 male and 1 female patients, with a mean age of 14.7 years. The mean follow-up period was 27.6 months. A total of 17 lesions were located in the medial femoral condyle and 9 in the lateral femoral condyle. The mean Tegner score was 7.0 preoperatively and 6.5 postoperatively, with no significant difference. The return-to-sports rate was 96.2% at the practice/training level and 84.6% at the preinjury level, with an average return time of 5.1 months and 9.6 months, respectively. In a subgroup analysis of knees that returned to preinjury level (n = 22) by lesion location, there was a significant difference between knees with lesions in the lateral femoral condyle (12.9 months) versus the medial femoral condyle (8.1 months) (P = .02). The rate of return to preinjury level after primary surgery was significantly higher than after revision surgery after failed drilling (P = .02). Return-to-sports rates and clinical outcomes were favorable after fixation with OAT in patients with knee OCD. A shorter time to return to sports was observed in knees with medial lesions compared with lateral lesions. Furthermore, the rate of return to sports at the preinjury level was significantly higher after primary surgery than after revision surgery after drilling.

Morphological changes to the intercondylar space in different stages of osteoarthritis - a retrospective cross-sectional study.

The intercondylar space is defined as the topographic area walled by the intercondylar notch (IN) and encasing the central ligaments of the knee joint. As the anterior cruciate ligament (ACL) is not only impinged against the roof but also against the lateral wall of the IN, information concerning changes to the IN during the progression of osteoarthritis could be potentially relevant in predicting the future risk for ACL-rupture and -degeneration and ensure preventive measures as early as possible. Therefore, the purpose of this study was to evaluate the influence of osteoarthritis on osseous notch morphology. Image data was retrieved from the Osteoarthritis Initiative. Patients were subdivided into five groups according to the severity of osteoarthritis following the Kellgren and Lawrence classification. 415 patients were selected randomly to ensure equally large groups. Osseous structures were measured in coronal and axial planes in MRI. At the level of the popliteal groove and on the level of the joint line, the width of the lateral and medial femoral condyle, the notch width (NW) as well as the total width of the distal femur were measured. The notch width index (NWI) as ratio between the NW and the total width of the distal femur was calculated. Three shapes (A-shape, Inverse-U-shape and Ω-shape) of the IN were differentiated. The morphology of the IN is directly influenced by the development of osteoarthritis. Especially the Ω-shape is characteristic for more severe cases of osteoarthritis (p<0.001). Measurements were also significantly influenced by the imaging plane and the level of measurements (both p<0.001). The results of this study reflect significant changes to the intercondylar space in increasing grades of osteoarthritis. Additionally, the recommendation on the location of measurements of the IN should be revised, as especially the measurements on the level of the joint line in coronal plane MRI are a more reliable and objective indicator for the diagnosis of IN stenosis and therefore of changes to the intercondylar space, which always influences the health of the ligaments housed. At the level of the popliteal groove a NWI<0.25 and NW<19mm and at the level of the joint line a NWI<0.17 and a NW<14mm should be interpreted as severe notch stenosis and a definitive risk factor for ACL rupture.

Osteochondral Fracture of the Posterior Aspect of Lateral Femoral Condyle Presumably Caused by Tibia Pushing Up Against the Femur—A Case Report

Osteochondral Fracture of the Posterior Aspect of Lateral Femoral Condyle Presumably Caused by Tibia Pushing Up Against the Femur—A Case Report

Mechanism and Prevention of Acute Knee Joint Injury During Exercise

Anatomically, the knee joint is the most complex joint in the human body. It consists of the medial and lateral condyles of the femur, the medial and lateral condyles of the tibia, and the patella. From the perspective of kinematics, the knee joint is one of the most critical joints to complete various actions in the human movement. Due to these two characteristics, it has also become a high incidence of sports injuries. Especially in sports activities, sports knee injury is extremely common, so it must be paid attention to, especially professional athletes, denying that it may affect the careers. This study mainly analyzes the common sports injuries of the knee joint and their mechanisms, and discusses the common sports injuries of the knee joint, as well as the mechanism of the knee joint injury and how to prevent the knee joint injury from three aspects, so as to prevent the small problems and help the development of sports.

The Vascular Anatomy and Harvesting of the Lateral Femoral Condyle Flap in Pigs.

Clinically, there has been increasing employment of the lateral femoral condyle flap. The objective of this study was to explore the vascular anatomy of the lateral femoral condyle in pigs and to explore the feasibility of using pigs as an animal model of the lateral femoral condyle flap. A total of 20 fresh cadaveric hindlimbs of 4-week-old hybrid pigs were used in this study. The origination, course, and branches of the nourishing vessels of the lateral femoral condyle were observed in 15 specimens. The primary parameters included the variability in the anatomy of the vessels and the length and outer diameter of the vessels. Surgical procedures for the lateral femoral condyle flap were conducted on five specimens. The primary nourishing arteries of the lateral femoral condyle in pigs were the first superolateral geniculate artery, which was observed in all 15 specimens and had a diameter and length of 1.99 ± 0.44 mm and 2.27 ± 0.46 cm, respectively, as measured at their origination. The operation was performed in the lateral position. A 10-cm skin incision was made from the lower edge of the patella to the posterior lateral side of the distal femur. After blunt dissection of the intermuscular septum between the biceps femoris and vastus lateralis, the whole course of the first superolateral geniculate artery was exposed. The vascular anatomy of the lateral femoral condyle in pigs and that of humans exhibited great similarities. The harvesting of the lateral femoral condyle flap in pigs was as easy as that in humans. Pigs could serve as a suitable animal model for the lateral femoral condyle flap.

Characteristics of the femoral tunnel of anatomical and isometric single bundle anterior cruciate ligament reconstruction: a modeling analysis based on quadrant method and anatomical landmarks

PurposeTo investigate the anatomical features of the femoral tunnel in anatomical and isometric single-bundle ACL reconstruction.MethodThirty-two 3-dimensional knee models were reconstructed based on CT scan (average age: 26.5 ± 6.7 years, 18 males and 14 females, 17 left and 15 right). Multiple anatomical landmarks were identified. Virtual femoral tunnels were created at the deep and high portion of ACL footprint, close to the lateral intercondylar ridge to achieve best anatomy and isometry, simulating an anteromedial portal reconstruction. Anatomical features of the femoral tunnels were analyzed. The position of the femoral tunnel was quantified by the distance to anatomical landmarks and using quadrant methods. The spatial angles, length and outer opening of the femoral tunnels were also evaluated.ResultsAcceptable tunnels were created in all models. The center of femoral tunnel was slightly higher than the apex of deep cartilage, near the deep one-third point across the shallow-deep dimension of the lateral femoral condyle. Using the quadrant method, the tunnel was located at 28.4% ± 2.2% and 22.2% ± 3.6%, parallel and perpendicular to the Blumensaat line, respectively. The spatial angles of the tunnel were 40°, 33.5° ± 4.1° and 38.2° ± 4.4° on the sagittal, transverse, and coronal planes, respectively. The average tunnel length was 34.8 mm ± 3.8 mm. The outer opening of the tunnels was located at the posterior one-third of the femoral metaphysis.ConclusionThe anatomical and isometric positioning of the femoral tunnel can be achieved through anteromedial portal with satisfied tunnel characteristics. The apex of deep cartilage may be used as an anatomical reference for tunnel positioning. When drilled at appropriate orientation, favorable tunnel length, integrity and position of the outer opening can be obtained.

Which Osteochondritis Dissecans Lesions Will Heal Nonoperatively? An Application of Machine Learning to the ROCK Prospective Cohort

Background: There are limited evidence-based guidelines to predict which osteochondritis dissecans (OCD) lesions will heal with nonoperative treatment. Purpose: To train a set of classification algorithms to predict nonoperative OCD healing while identifying new clinically meaningful predictors. Study Design: Case-control study; Level of evidence, 3. Methods: Patients with OCD of the knee with open physes undergoing nonoperative management were prospectively queried from the Research on OCD of the Knee (ROCK) cohort ( https://kneeocd.org ) in April 2022. Patients were included if they met the study criteria for nonoperative treatment success or failure. Nonoperative treatment success was defined as complete healing on magnetic resonance imaging (MRI) and total return to sports participation. Failure was defined as the crossover from nonoperative management to surgery at any point at or beyond the 3-month follow-up. If a patient did not meet one of these criteria, they were not included. Normalized lesion size, lesion location, patient characteristics, and symptoms were used as clinically relevant predictors. Results: A total of 64 patients were included, of whom 24 (37.5%) patients successfully healed with nonoperative management. Multivariate logistic regression revealed that a 1% increase in normalized lesion width was associated with an increase in the likelihood of nonoperative failure (odds ratio [OR], 1.41 [95% CI, 1.17-1.81]; P &lt; .01). By contrast, lesions in the posterior sagittal zone (OR, 0.08 [95% CI, 0.009-0.43]; P &lt; .01) or the medial-most coronal zone (for lesions of the medial femoral) and lateral-most coronal zone (for lesions of the lateral femoral condyle) on MRI (OR, 0.05 [95% CI, 0.004-0.44]; P &lt; .01) were associated with a decrease in the likelihood of nonoperative treatment failure. Support vector machines had a cross-validated area under the receiver operating characteristic curve of 0.89 and a classification accuracy of 83.3%. Conclusion: Lesion location in the posterior aspect of the condyle on sagittal MRI and lesion location in the medial-most or lateral-most locations on coronal MRI were identified as statistically significant predictors of increased nonoperative treatment success on multivariate analysis. Machine learning models can predict which OCD lesions will heal with nonoperative management with superior accuracy compared with previously published models.

Patient-Specific Implant for Anatomic Restoration of Lateral Femoral Condyle Contour After Impaction Fracture Associated With an ACL Tear

Impaction fractures of lateral femoral condyle (LFC-IF) are challenging entities following anterior cruciate ligament tears. Anatomic reduction and restoration of the native LFC curvature is crucial in their treatment, because if they are neglected, it may potentially lead to incongruence in the lateral knee compartment with subsequent cartilage deterioration or damage to other intra-articular structures. Previously established operative techniques seem to achieve these milestones, yet there is still a potential risk of cartilage breakage or nonanatomical reduction. The presented technique addresses those weak points by the use of patient-specific implants, which provides the opportunity to closely restore the anatomical LFC curvature with minimal risk of osteochondral fracture of the LFC-IF site.

Osteochondral Lesion of the Lateral Femoral Condyle Following Patellar Dislocation – Treatment of a Rare Injury in Adolescents: A Case Study

Introduction: Osteochondral injuries of the knee are increasingly common among active adolescents, often resulting from acute trauma, repetitive microtrauma, or conditions like osteochondritis dissecans. Patellar dislocation is a frequent cause of osteochondral lesions (OCL). Studies indicate that a significant percentage of patients with patellar dislocation exhibit OCLs, particularly in the anterior lateral femoral condyle and medial portion of the patella. Case presentation: A case study of a 15-year-old female athlete illustrates the clinical presentation and management of such injuries. After sustaining a knee injury during a football match, she experienced significant pain and swelling, with imaging revealing an osteochondral defect in the lateral gutter. Surgical intervention confirmed the presence of a larger deffect and involved stabilizing the osteochondral fragment and repairing the surrounding cartilage. Postoperative management included a period of non-weight-bearing followed by gradual rehabilitation. Follow-up MRIs showed complete integration of the cartilage defect, and the patient successfully returned to football practice six months post-surgery. Conclusion: This case highlights the importance of early recognition and appropriate treatment of osteochondral injuries in adolescents. Surgical techniques, including chondral fixation, can be effective, particularly in skeletally immature patients, facilitating a successful return to athletic activities. Early intervention is crucial for preserving joint function and ensuring optimal recovery outcomes.

Associated Reconstruction Technique for the Posterolateral Corner and the Anterior Cruciate Ligament with Double Femoral Tunnel

Objectives The constant study evolution of the structures and biomechanical functioning of the posterolateral complex (PLC) of the knee show that this structure plays an extremely important role in joint stability, especially when associated with injury to the anterior cruciate ligament (ACL). Failure to detect the PLC lesion causes posterolateral rotational instability in the knee, generating an overload on the reconstructed ACL, increasing its potential for failure. Surgical treatment is the gold standard for patients with combined injuries of the PLC and ACL. However, despite the numerous reconstruction techniques described, the best technique is still controversial. This study presents a less invasive technique with fewer bone tunnels, lower cost and less surgical complexity, using four bone tunnels with a single tunnel for the ACL and lateral collateral ligament (LCL) in the lateral femoral condyle and only 04 interference screws for the anatomical reconstruction of the ACL / PLC and restoration of stability of the injured knee. Surgical technique Patient in supine position. A graft is prepared with 2 semitendinosus tendons (1 from each knee) and 1 gracilis tendon (from the knee with ligament injury). The tendons must be at least 24 cm long. The graft is prepared in quadruple for the ACL (gracilis tendon duplicated and 2 simple semitendinosus tendons) and double for the PLC (continuation of the 2 simple semitendinosus tendons). An incision is made on the lateral aspect of the knee over the lateral epicondyle, towards the head of the fibula, approximately 12cm long. The femoral insertion site of the lateral collateral ligament (LCL) is identified slightly proximal and posterior to the femoral epicondyle. The unique femoral tunnel for the ACL and LCL is performed using the outside-in technique. The guidewire must be inserted in the origin of the LCL anatomical point at the external lateral cortex towards the origin of the ACL anatomical on the medial wall of the lateral fêmur condyle. The fibular head tunnel is performed, positioned from anterolateral to posteromedial, approximately 0.5 cm below the tip of the fibular head. The fourth and last tunnel is performed l at the popliteal tendon femoral insertion. It should be directed anteriorly and proximally to avoid confluence with the ACL tunnel. The graft is passed through the tibial tunnel towards the femoral tunnel. Both semitendinosus legs exit the LCL insertion at the lateral aspect of the femur. Graft fixation at the femoral tunnel lateral cortex is performed with an interference screw. The graft is tensioned at its tibial exit with knee flexed at 20° and fixed with an interference screw, reconstructing the ACL. For PLC reconstruction, the two semitendinosus legs are passed under the iliotibial tract through the fibular head tunnel from anterolateral to posteromedial. The graft is tensioned with knee at 30° of flexion and valgus and fixed with an interference screw at the fibular tunnel, reconstructing the LCL. The remaining portion of the graft is passed below the iliotibial tract and LCL, being inserted into the femoral tunnel corresponding to the insertion of the popliteal tendon. The graft is then tensioned with knee flexed at 60° and valgus and fixed with an interference screw. Conclusion We believe that the described technique for ACL reconstruction associated with PLC injury is able to restore knee stability through a minimally invasive, reproducible and less technically challenging approach, with a lower learning curve than those currently available.

Association Between Tibiofemoral Bone Shape Features and Retears After Anterior Cruciate Ligament Reconstruction.

A retear after anterior cruciate ligament (ACL) reconstruction remains a common and devastating complication. Knee bone morphology is associated with the risk of ACL injuries, ACL retears, and osteoarthritis, and a combination of tools that derive bone shape from clinical imaging, such as magnetic resonance imaging (MRI) and statistical shape modeling, could identify patients at risk of developing these joint conditions. To identify bone shape features before primary ACL reconstruction in patients with an eventual retear compared to those with a known intact ACL graft. Case-control study; Level of evidence, 3. Bone was automatically segmented on 2-dimensional proton density-weighted MRI of the knee in patients at the time of the initial ACL injury using deep convolutional neural networks. Patients with a subsequent retear after reconstruction within 3 years (22 femurs, 19 tibias) were compared with those with an intact ACL graft at 3 years (20 femurs, 22 tibias) using statistical shape modeling to identify preoperative bone shape features predictive of a retear after ACL reconstruction. Statistical shape modeling revealed 2 specific bone shape features (modes) in the femur and 1 mode in the tibia that demonstrated significant differences at the time of the initial injury in patients with subsequent retears. In the femur, a narrower intercondylar notch width, a widened medial condylar width, an increased femoral condylar offset ratio, increased surface area along the lateral femoral condyle relative to the medial condyle, and a more prominent trochlear sulcus at the time of the initial injury were associated with retears after ACL reconstruction. In the tibia, a diminished ACL facet prominence, a squared lateral and medial tibial plateaus, and a broader and flattened tibial spine at the time of the initial injury were associated with retears after ACL reconstruction. Using the automatic bone segmentation pipeline on preoperative MRI, the authors identified bone shape features associated with a retear after ACL reconstruction. The use of this pipeline enables large-scale studies of bone shape on MRI and could predict patients at risk of ACL retears to alter treatment decisions.

Medial center of rotation and 90-degree lateral laxity improve patient-reported outcomes in posterior cruciate retaining total knee arthroplasty

ObjectivesPhysiologic knee kinematics is crucial for successful total knee arthroplasty (TKA) but are often not replicated. Using a medial stabilizing technique (MST) minimizes bone resection but results in lateral laxity. This study aimed to investigate the effects of lateral laxity on knee kinematics and symptoms after TKA. MethodsMobile-bearing cruciate-retaining MST-TKA was performed on 40 knees using a navigation system. In the kinematic analysis, the anteroposterior (AP) translations of the medial femoral condyle (MFC) and lateral femoral condyle (LFC), femoral rotation angles, and medial and lateral component gaps were recorded every 0.1 ​s. These data were extracted from the software from 0° to 120° flexion in 10° increments. Kinematics was classified as the medial center of rotation (MCR) or non-MCR between 0° to 90° of flexion. Lateral laxity was calculated by subtracting the medial component gap from the lateral component gap. The final follow-up Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated. The relationships between the pre- and post-operative kinematics and between postoperative lateral laxity and kinematics were assessed using Spearman's correlation coefficients. Finally, the correlation between postoperative lateral laxity and KOOS symptoms was evaluated using linear regression analysis. ResultsPreoperative kinematics, including AP translation of the MFC and LFC and femoral rotation, correlated with postoperative kinematics (all P ​< ​0.001). Additionally, postoperative lateral laxity correlated with postoperative AP translation of the MFC, LFC, and femoral rotation (all P ​< ​0.001). Furthermore, the receiver operating characteristic analysis indicated a cutoff value of 0.9 ​mm on postoperative lateral laxity at 90° flexion for postoperative MCR (P ​< ​0.001). Postoperative lateral laxity at 90° flexion was significantly correlated with KOOS symptoms (β ​= ​0.465, P ​= ​0.025). ConclusionPreoperative kinematics and postoperative lateral laxity correlated with postoperative kinematics after MST-TKA. Postoperative lateral laxity greater than 0.9 ​mm at 90° flexion was associated with physiological kinematic motion, leading to fewer knee symptoms in the PROMs. The key to successful TKA was considered to be keeping the asymmetric gap balance with physiological lateral laxity, rather than the conventional symmetrical gap balance. Level of Evidence Level IIIRetrospective study.

Normal Dimensions of Lateral Femoral Condyle in Pakistani Population

Background: The medial condyle is wider and having larger surface area for articulation than lateral femoral condyle however anteroposteriorly lateral femoral condyle is larger. The aim of this study was to find normal dimensions of lateral femoral condyle in Pakistani population. Methods: This Cross-sectional descriptive study, carried out from September 2023 to May 2024 in Radiology department of Peshawar General Hospital, Peshawar with sample size of 385. Non probability convenience sampling technique was used. All healthy adult, intact femur with clear features were included and scanned through magnetic resonance imaging. Data analysis was done through SPSS version 22, descriptive analysis was done and association was assessed by applying independent sample t-test and ANOVA. P-value ≤ 0.05 considered statistically significant. Results: About 54% (n=149) male participants and 60% (n=67) of females had right knee measurements, whereas 46% (n=125) males and 40% (n=44) females had measurements of their left knee. There was no significant relationship between gender and the measured side (p=0.169). Age and size of the lateral femoral condyle were shown to be significantly correlated (p=0.027). Males exhibited greater femoral condyle dimensions, notch widths, and heights compared to females (p&lt;0.001). Furthermore, ANOVA showed statistically significant variations in parameters of lateral femoral condyle, notch width, and height with age (p&lt;0.001). Conclusions: This study demonstrates that the femoral condyles parameters depend on several variables and differ by gender and region. Considering this study, accurate tunnel in lateral femoral condyle can be made for anterior cruciate ligament graft in ACL injury.