Lateral Tibial Plateau Research Articles

Posterior tibial slope of the knee measured on X-rays in a Turkish population.

Posterior tibial inclination of the knee joint should be considered during anterior cruciate ligament reconstruction and total knee replacement surgery. This inclination is called the posterior tibial slope (PTS) angle. The PTS differs among populations and the aim of this study was to determine the mean PTS in a Turkish population. PTS was measured retrospectively on lateral knee X-rays (n = 1024). The angle between the line connecting the anterior and posterior points of the lateral tibial plateau and the tibial longitudinal axis was taken as the PTS angle. Intra- and inter-observer agreement regarding the measurements on 20 X-rays were checked. The mean PTS angle for the entire cohort was 8.36 ± 3.3° (range: 2.1-18.7°); it was 8.57 ± 3.4° (range: 2.3-17.4°) in men and 8.16 ± 3.2° (range: 2.1-18.7°) in women. Although no significant correlation was detected between PTS and age, PTS was higher in men than in women. The increasing number of total knee replacement surgeries has increased the need for studies on implant mismatch. In this study, reference PTS values were determined for a Turkish population. It may be beneficial to use patient-specific implants in some cases.

Presence of magnetic resonance imaging verified soft tissue injuries did not significantly affect the patient-reported outcome 12 months following a lateral tibial plateau fracture: A 12-month prospective cohort study of 56 patients

BackgroundSoft tissue injuries following lateral tibial plateau fracture affect more than half of patients. Regardless of the type of soft tissue injured, it is still unclear how different treatment strategies influence postoperative outcome. The aim of this study was to report the 12-month Knee Injury and Osteoarthritis Outcome Score (KOOS5) of patients with surgically managed lateral tibial plateau fractures divided into groups with and without conservatively managed magnetic resonance imaging (MRI)-verified soft tissue injuries. MethodsProspective cohort study. Patients treated surgically following a lateral tibial plateau fracture (AO-41B) between December 2013 and November 2016 were included. Soft tissue injuries were evaluated with preoperative MRI scans. The primary outcome score was the 12-month KOOS5 score divided into groups with and without soft tissue injuries. ResultsA total of 56 patients were included. Average patient age was 56 years (range 22–86). Thirty-three patients (59%) were female. Fifty percent of patients presented with MRI-verified soft tissue injuries. At 12 months postoperatively, the mean KOOS5 score for patients with soft tissue injuries was 53.5 (95% confidence interval (CI): 44.8–62.1) and the KOOS5 score for patients without soft tissue injuries was 59.6 (95% CI: 50.7–68.6). No significant difference in the KOOS5 score between patients with and without soft tissue injuries was observed (P = .31). ConclusionsAt 12-month follow-up the presence of MRI-verified soft tissue injuries did not significantly affect the patient-reported KOOS5 score. More research is needed to investigate the effects of surgical vs. non-surgical treatment strategies of associated soft tissue injuries following lateral tibial plateau fractures.

Giant Cell Tumor Masquerading as Lateral Meniscus Injury: A Case Report

Giant cell tumor (GCT) is a benign bone tumor with aggressive characteristics and capacity to metastasize. They are more common in the third decade of life and demonstrate a preference for being located in the epiphyseal region of long bones. They have a high local recurrence rate, which depends on the type of treatment and initial tumor presentation. Early detection of GCT is possible with proper clinical assessment and radiograph. However, due to its rarity, physicians may have neglected the possibility of bone tumor as one of the differential diagnosis for cases referred as “soft tissue injury”.We report a case of a 22-year-old lady who presented with seven-month-history of right knee pain, lateral joint line tenderness and positive McMurray test and initially treated as right lateral meniscus injury. However, the knee pain worsened over time and became persistent despite starting on physiotherapy and home-based-exercises. Upon subsequent visit two months later, she presented with tender bony swelling over the lateral tibial plateau and radiological examination revealed a lytic lesion over her proximal right tibia. Magnetic resonance imaging and histopathology testing confirmed the diagnosis of Giant cell tumor. This case report aims to increase the awareness of possible bone tumors in soft tissue injury cases and highlight the importance of detailed reassessment and reviewing diagnosis during each follow up.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 148-151

Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction \u2013 a biomechanical study

BackgroundLateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view.MethodsSeven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured.ResultsWe successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004).ConclusionsBased on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously.

Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

Background: Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures. Purpose: The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears. The secondary objective was to investigate the association between impaction fractures and concomitant meniscal and ligamentous injuries. Study Design: Case series; Level of evidence 4. Methods: Patients with available magnetic resonance imaging (MRI) scans who were treated for primary ACL tear by a single surgeon were identified. MRI scans were reviewed with denotation of posterolateral tibial and femoral condylar contusions and displaced impaction fractures. Measurements of the lateral tibial plateau were taken in all patients with displaced lateral tibial plateau fractures and in a subset of control patients without tibial plateau fracture present to characterize the size and location of the bony lesion. Associations of impaction fractures with concomitant meniscal or ligamentous injuries were evaluated through use of chi-square testing. Results: There were 825 knees identified with available MRI scans. Lateral tibial plateau bone bruising was present in 634 knees (76.8%), and lateral femoral condyle bone bruising was present in 407 knees (49.3%). Posterolateral tibial plateau impaction fractures were present in 407 knees (49.3%), and lateral femoral condylar impaction fractures were present in 214 knees (25.9%). Patients with posterolateral tibial plateau impaction fractures were older than patients without these fractures (42.6 vs 32.7 years; P < .001), whereas patients with lateral femoral condylar impaction fractures were younger (23.8 vs 32.7 years; P < .001). There were 71 knees (8.6%) with a posterolateral tibial plateau impaction fracture with greater than 10% loss of lateral tibial plateau depth, and this group had an increased incidence of lateral meniscus posterior root tears (22.1% vs 12.0%; P = .02). Conclusion: Posterolateral tibial plateau impaction fractures occurred with a high incidence (49.3%) in patients with primary ACL tears and demonstrated an increased association with lateral meniscus posterior horn root tears as their size increased. Lateral femoral condylar impaction fractures occurred in 25.9% of patients with primary ACL tears and entailed an increased incidence of lateral meniscal tears and medial meniscal ramp lesions.

Predictive validity of radiographic signs of complete discoid lateral meniscus in children using machine learning techniques.

The diagnostic utility of radiographic signs of complete discoid lateral meniscus remains controversial. This study aimed to investigate the diagnostic accuracy and determine which sign is most reliably detects the presence of a complete discoid lateral meniscus in children. A total of 141 knees (age 7-16) with complete discoid lateral meniscus and 141 age- and sex-matched knees with normal meniscus were included. The following radiographic signs were evaluated: lateral joint (LJ) space, fibular head (FH) height, lateral tibial spine (LTS) height, lateral tibial plateau (LTP) obliquity, lateral femoral condyle (LFC) squaring, LTP cupping, LFC notching, and prominence ratio of the femoral condyle. Prediction models were constructed using logistic regressions, decision trees, and random forest analyses. Receiver operating characteristic curves and area under the curve (AUC) were estimated to compare the diagnostic accuracy of the radiographic signs and model fit. The random forest model yielded the best diagnostic accuracy (AUC: 0.909), with 86.5% sensitivity and 82.2% specificity. LJ space height, FH height, and prominence ratio showed statistically large AUC compared with LTS height and LTP obliquity (P < .05 in all). The cut-off values for diagnosing discoid meniscus to be <12.55 mm for FH height, <0.804 for prominence ratio, and >6.6 mm for LJ space height when using the random forest model. On the basis of the results of this study, in clinical practice, LJ space height, FH height and prominence ratio could be easily used as supplementary tools for complete discoid lateral meniscus in children.

Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

Background: Impaction fractures of the posterolateral tibial plateau commonly occur in the setting of anterior cruciate ligament (ACL) tears, with considerable variability found in fracture size and morphologic features. Purpose: The primary objective was to characterize different morphologic variants of posterolateral tibial plateau impaction fractures. The secondary objective was to investigate the association between these impaction fracture variants and concomitant meniscal and ligamentous injuries. Study Design: Cross-sectional study; Level of evidence 3. Methods: Patients treated for primary ACL tears and having magnetic resonance imaging available were included in this study, and magnetic resonance images were reviewed with denotation of displaced posterolateral tibial impaction fractures. A classification system was created based on morphologic variants of impaction fractures; associations were evaluated through use of independent chi-square testing. Results: There were 825 knees meeting the inclusion criteria, with displaced posterolateral tibial plateau impaction fractures present in 407 knees (49.3%). We observed 3 distinct morphologic variants of lateral tibial plateau impaction fractures: (I) posterior cortical buckle not involving the articular surface; (II) posterior impaction fracture involving the articular surface, with subtypes based on (A) tibial plateau depth bone loss <10% and (B) bone loss >10%; and (III) displaced osteochondral fragment, with subtypes for (A) shear or (B) depressed fragment. Type IIIA impaction fractures were associated with an increased incidence of lateral meniscus posterior root tears (33.3% vs 12.4%; P = .009) and an increased incidence of lateral meniscal tears (83.3% vs 56.7%; P = .024) compared with all knees without type IIIA impaction fracture. An increased incidence of medial collateral ligament (MCL) tears was noted in patients with type IIIA impaction fractures compared with those who had no fracture or had another fracture type (61.1% vs 20.1%; P < .001). Type IIIB impaction fractures were associated with an increased incidence of lateral meniscal tears (80.0% vs 56.2%; P = .005). Conclusion: A high prevalence of displaced posterolateral tibial plateau impaction fractures occur in the setting of ACL tears, and they can be classified into distinct morphologic subtypes. Posterolateral tibial plateau impaction fractures with displaced depressed or shear fragments were both associated with an increased incidence of lateral meniscal tears, whereas impaction fractures with a shear fragment were associated with an increased incidence of lateral meniscus posterior root tears and MCL tears.

Combined posterior cruciate ligament and chronic posterolateral corner deficiency in varus knee, two-stage reconstruction

Background Conservative management of chronic posterolateral corner (PLC) knee injuries had a bad repetition and often followed by poor outcomes. In patients who had associated posterior cruciate ligament [PCL] and chronic PLC knee injuries with varus knee deformity, failure to correct the mechanical axis by correcting varus was usually followed by failure of the posterolateral knee repair or reconstruction. Aim of the study To assess prospectively the results of treatment of associated PCL and chronic PLC injury in the varus knee, with a two-stage procedure. Initial high tibial medial opening wedge osteotomy was followed by PCL reconstruction. Methods This study included 10 patients who had associated PCL and chronic PLC deficiency in varus knee who were treated by two-stage surgical technique, first stage was high tibial medial opening wedge osteotomy to align the mechanical axis and correct varus deformity, then PCL ligament reconstruction in the second stage. Results According to the International Knee Documentation Committee, the 10 patients included in the study [100%] were graded as grade C (abnormal) or D (sever abnormal) preoperatively, while 8 of the 10 patients [80%] were graded as grade A (normal) or B (nearly normal), and 2 patients [20%] were rated as abnormal grade C at final follow-up scoring. Statistically significant improvement was achieved. Radiologically, the average mechanical axis that preoperatively passed within the medial tibial plateau with varus deformity ranged between 10 and 15° in our cases, while the mechanical axis postoperatively passed through the mid of tibial plateau or slightly within the lateral tibial plateau with full correction of the deformity with valgus angle ranged from 5 to 10°. The preoperative posterior tibial sagittal slope angle was average 7.8°, which became 10.5° in the last follow-up visit. Conclusion Two-stage reconstruction of the knee in cases who had PLC injuries associated with varus knee, starting by proximal tibial medial opening wedge osteotomy followed by reconstruction of PCL, is a valuable technique and had good results.

Plate-screw and screw-washer stability in a Schatzker type-I lateral tibial plateau fracture: a comparative biomechanical study.

The aim of this study was to evaluate the biomechanical role of both a non-locking two-hole small fragment dynamic compression plate with 3.5-mm screws and a 4.5-mm cortical screw with a washer applied to a Schatzker type-I tibial plateau fracture. Sixteen right synthetic tibiae were used to create an anterolateral shear tibial plateau fracture (Schatzker type-I fracture). Eight models were fixed with a small fragment non-locked straight dynamic compression plate with one 3.5-mm bicortical screw (plate-screw construction) and eight models were fixed with a 4.5-mm cortical screw and a washer (screw-washer construction), both inserted at 1.0 mm distal to the apex of the fracture. Specimens were tested up to the onset of yielding at a constant strain rate of 5.0-mm/min. Stiffness ranged from 311.83 N/mm to 199.54 N/mm, with a mean + SD of 260.32 + 33.8 N/mm in the plate-screw construction, and from 290.34 N/mm to 99.16 N/mm, with a mean + SD of 220.46 + 63.12 N/mm in screw-washer construction. There was no significant difference (p=0.172). Use of a two-hole small-fragment non-locked plate with one 3.5-mm cortical screw or a 4.5-mm cortical screw with a washer applied at 1.0 mm distal to the apex of the fracture as buttressing present similar stiffness in terms of preventing axial displacement in synthetic tibiae models tested up to the onset of yielding.

An imaging study of tibial plateau fractures combined with avulsion fracture of medial femoral condyle

Objective To explore the cross classification of tibial plateau fractures combined with avulsion fracture of medial femoral condyle. Methods The 16 patients were retrospectively analysed as an observation group who had been treated at Department of Lower Limbs, Sichuan Orthopaedic Hospital for tibial plateau fracture and avulsion fracture of the medial condyle of the same femur from January 2015 to December 2018. They were 9 males and 7 females, aged from 27 to 78 years (average, 51.5 years). By the Schatzker classification, there were 2 cases of type Ⅰ, 8 cases of type Ⅱ, 3 cases of type Ⅲ and one case of type Ⅳ; by the cross classification, there were 10 cases of type Ⅰe, one case of type Ⅱe and 2 cases of type Ⅲe and 3 cases of type Ⅰv. The 332 patients were included as a control group who had been treated at the same department for simple tibial plateau fracture from January 2010 to December 2015. The imaging data of the 2 groups were compared to find out the charateristics of cross type distribution; the widened distance of the lateral tibial plateau, collapse depth of the tibial plateau, separation of avulsion fracture of medial femoral condyle, maximum clearance of the medial knee and eversion angle of the tibial plateau were investigated in the patients with cross types e and Ⅰv in the observation group. Results In the observation group, the widened distance of the lateral tibial plateau averaged 7.18 mm, the collapse depth of the tibial plateau 8.74 mm, the separation of avulsion fracture of medial femoral condyle 3.44 mm, the maximum clearance of the medial knee 7.77 mm, and the eversion angle of the tibial plateau 87.03°. There was a significant difference in the cross type distribution of tibial plateau fractures between the 2 groups (P=0.002). In the observation group, the average widened distance of the lateral tibial platea for the 13 type e patients (8.49±4.26 mm)was significantly larger than that for the 3 type Ⅰv patients (1.51±2.11 mm) (t=2.706, P=0.017). Conclusion The cross classification of tibial plateau fractures with avulsion fracture of mediall condyle of the same femur may result mainly in types e and type Ⅰv. The widened distance of lateral tibial plateau helps distinction between types e and type Ⅰv. Key words: Tibial fractures; Femoral fractures; Classification; Radiology

A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees.

The trochlear dysplastic femur has a specific morphotype previously characterised by not only dysplastic features of the trochlea but also by specific features of the notch and posterior femur. In this study the morphology of the tibia and patella was investigated to gain further insight in the complete geometrical complexity of the trochlear dysplastic knee. Arthro-CT scan-based 3D models of 20 trochlear dysplastic and 20 normal knees were uniformly scaled and landmarks and landmark-based reference planes were created to quantify a series of morphometric characteristics of the tibia and patella. In the mediolateral direction, the 3D-analysis revealed a 3% smaller medial tibial plateau (30.4 ± 1.6mm vs 31.5 ± 1.6mm), a 3% smaller overall width of the tibial plateau (73.6 ± 2.0mm vs 75.7 ± 2.0mm), a 16% smaller medial facet (17.3 ± 2.2mm vs 20.1 ± 1.3mm) and a 4% smaller overall width of the patella (41.7 ± 2.5mm vs 43.4 ± 2.3mm) in trochlear dysplastic knees. In the anteroposterior direction, the lateral tibial plateau of trochlear dysplastic knees was 5% larger (37.2 ± 2.3mm vs 35.5 ± 3.1mm). A correlation test between the width of the femur and the width of the tibia revealed that trochlear dysplastic knees show less correspondence between the femur and tibia compared to normal knees. Significant differences in the morphology of the tibial plateau and patella were detected between trochlear dysplastic and normal knees. Both in the trochlear dysplastic tibial plateau and patella a narrower medial compartment leads to a significant smaller overall mediolateral width. These findings are important for the understanding of knee biomechanics and the design of total knee arthroplasty components. III.

WITHDRAWN: Limited value of MRI in the preoperative assessment of lateral-compartment cartilage in potential candidates for medial unicompartmental knee arthroplasty

Abstract Background Intact lateral-compartment cartilage is a requirement for the long-term success of medial unicompartmental knee arthroplasty (UKA). The value of MRI to rule out lateral-compartment cartilage lesions (OARSI ≥ grade 2) in potential candidates for medial UKA was prospectively evaluated. Methods One-hundred consecutive knees undergoing total knee arthroplasty for varus osteoarthritis (OA) were included. Knees with lateral-compartment OA (Kellgren-Lawrence > grade 2) were excluded, leaving 84 knees for final assessment. On MRI, lateral-compartment cartilage was assessed using a validated score. In corresponding locations, cartilage was histologically assessed using the OARSI system. Results The prevalence of histologically intact (OARSI grade 0/1) cartilage was: distal lateral femur: 71/84 (85%); lateral tibia plateau: 22/84 (26%). The sensitivity of MRI to rule out advanced cartilage lesions (OARSI ≥ grade 2) was 77% (17/22) for the lateral tibia plateau. The precision of MRI to correctly identify intact cartilage (OARSI grade 0/1) on the lateral tibia plateau was 38% (17/45). For the distal lateral femur, MRI was able to rule out OARSI ≥ grade 2 cartilage lesions in 85% (60/71) with high precision (60/62 (97%)). Conclusion MRI does not have a high accuracy of ruling out patients with more advanced (ORASI ≥ grade 2) cartilage damage on the lateral tibia plateau. MRI can reliably rule out advanced histologic cartilage lesions on the distal lateral femur, however, advanced cartilage lesions are rare in varus OA of the knee. The current study does not support the routine use of MRI to rule out lateral-compartment cartilage damage.

Reduction in tibiofemoral conformity in lateral unicompartmental knee arthroplasty is more representative of normal knee kinematics.

AimsCommonly performed unicompartmental knee arthroplasty (UKA) is not designed for the lateral compartment. Additionally, the anatomical medial and lateral tibial plateaus have asymmetrical geometries, with a slightly dished medial plateau and a convex lateral plateau. Therefore, this study aims to investigate the native knee kinematics with respect to the tibial insert design corresponding to the lateral femoral component.MethodsSubject-specific finite element models were developed with tibiofemoral (TF) and patellofemoral joints for one female and four male subjects. Three different TF conformity designs were applied. Flat, convex, and conforming tibial insert designs were applied to the identical femoral component. A deep knee bend was considered as the loading condition, and the kinematic preservation in the native knee was investigated.ResultsThe convex design, the femoral rollback, and internal rotation were similar to those of the native knee. However, the conforming design showed a significantly decreased femoral rollback and internal rotation compared with that of the native knee (p < 0.05). The flat design showed a significant difference in the femoral rollback; however, there was no difference in the tibial internal rotation compared with that of the native knee.ConclusionThe geometry of the surface of the lateral tibial plateau determined the ability to restore the rotational kinematics of the native knee. Surgeons and implant designers should consider the geometry of the anatomical lateral tibial plateau as an important factor in the restoration of native knee kinematics after lateral UKA.Cite this article: Bone Joint Res 2019;8:593–600.

Surgical Treatment of Lateral Tibial Plateau Fractures Involving the Posterolateral Column.

ObjectiveTo summarize the indications and the clinical effects of a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach in the treatment of fractures of the lateral tibial plateau involving the posterolateral column.MethodsEleven patients with lateral tibial plateau fractures were included in the present study. The fractures were Schatzker type II or lateral platform fractures involving posterolateral column. The anterolateral combined posterolateral approach (lateral + posterolateral locking plate fixation) was applied in 7 patients and 4 patients underwent transfibular neck osteotomy (lateral + posterolateral locking plate fixation + 1/4 tubular plate edge fixation, fibular osteotomy with Kirschner wire tension band fixation, and hollow nail fixation for upper tibiofibular joint). All cases were followed up for 12–24 months, with an average follow‐up of 17.5 ± 5.0 months. At the last followup, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the knee function evaluation criteria of the Hospital for Special Surgery (HSS). The Lachman test and the pivot‐shift test were used to evaluate the anterior and posterior and rotational stability of the knee joint. The range of knee motion was recorded.ResultsBone healing was achieved in all patients with fractures treated with a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach. At the last follow‐up, both the Lachman test and the pivot‐shift test results were negative. All patients had complete knee extension. For the combined anterolateral and posterolateral approach, the knee flexion angle was 110°–130°, with an average of 122.86° ± 7.56°. For the transfibular neck osteotomy approach, the knee flexion angle was 115°–130°, with an average of 120.00° ± 7.07°. For the patients in which the combined anterolateral and posterolateral approach was used, the Rasmussen score was 12–18 points, with an average of 16.00 ± 2.56 points. The results were excellent in 4 cases and good in 3 cases; therefore, 100% of results were excellent or good. For patients in which the transfibular neck osteotomy approach was used, the Rasmussen score was 10–18 points, with an average of 15.25 ± 3.77 points. The results were excellent in 2 cases, good in 1 case, and acceptable in 1 case; therefore, 75% of results were excellent or good. The HSS score for the combined anterolateral and posterolateral approach was 76–98 points, with an average of 88.43 ± 7.55 points. The results were excellent in 5 cases and good in 2 cases; therefore, 100% of results were excellent or good. The HSS score for the transfibular neck osteotomy approach was 74–96 points, with an average of 87.25 ± 9.43 points. The results were excellent in 3 cases and good in 1 case; therefore, 100% of results were excellent or good. There were no significant differences in operation time, surgical blood loss, fracture healing time, postoperative imaging score, and knee function evaluation between the two approaches. One patient who underwent transfibular neck osteotomy had a 3‐mm step that gradually appeared, but no significant abnormalities were found in the width of the platform and the lower limb force line. One patient in whom the combined anterolateral and posterolateral approach was used showed numbness in the common peroneal nerve. No common peroneal nerve injury occurred through the transfibular neck osteotomy approach.ConclusionsThe anterolateral combined posterolateral approach and the transfibular neck osteotomy approach are effective in the surgical treatment of lateral tibial plateau fractures involving the posterolateral column. However, the transfibular neck osteotomy approach is more suitable for the posterolateral plateau articular surface damaged with bone separation and displacement, deep collapse, cases involving a large range of the posterolateral column, especially fractures of the lateral tibial plateau in the upper tibiofibular syndesmosis area of the line connecting the anterior and posterior margin of the fibular head to the midpoint of the plateau.

Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction.

Background:Increased posterior tibial slope has been identified as a possible risk factor for injury to the anterior cruciate ligament (ACL) and has also been shown to be associated with ACL reconstruction graft failure. It is currently unknown whether increased posterior tibial slope is an additional risk factor for further injury in the context of revision ACL reconstruction.Purpose:To determine the relationship between posterior tibial slope and further ACL injury in patients who have already undergone revision ACL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 330 eligible patients who had undergone revision ACL reconstruction between January 2007 and December 2015 were identified from a clinical database. The slope of the medial and lateral tibial plateaus was measured on perioperative lateral radiographs by 2 fellowship-trained orthopaedic surgeons using a digital software application. The number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) was determined at a minimum follow-up of 2 years (range, 2-8 years). Tibial slope measurements were compared between patients who sustained further ACL injury to either knee and those who did not.Results:There were 50 patients who sustained a third ACL injury: 24 of these injuries were to the knee that underwent revision ACL reconstruction, and 26 were to the contralateral knee. Medial and lateral slope values were significantly greater for the third-injury group compared with the no–third injury group (medial, 7.5° vs 6.3° [P = .01]; lateral, 13.6° vs 11.9° [P = .001]).Conclusion:Increased posterior tibial slope, as measured from lateral knee radiographs, was associated with increased risk of graft rupture and contralateral ACL injury after revision ACL reconstruction. This is consistent with the concept that increased posterior slope, particularly of the lateral tibial plateau, is an important risk factor for recurrent ACL injury.

Facteurs radiologiques et IRM de bilatéralité devant une lésion symptomatique sur ménisque discoïde latéral

BackgroundThe incidence of bilateral discoid lateral meniscus (DLM) is as high as 73 to 85%, and associated contralateral meniscus tears ranged from 4 to 33% in symptomatic surgical DLM. The goal of the study was analyzing the factors that predict contralateral presence and tearing of DLM in patients who underwent surgery for symptomatic DLM. Our hypothesis was that there is a significant correlation between operative DLM properties and the incidence of bilateral DLM with associated contralateral meniscus tears. These properties include tear patterns, younger patient age, and characteristic X-ray findings. Patients and methodsThis prospective study included 76 patients who underwent arthroscopic surgery for symptomatic DLM. The contralateral knees were evaluated with X-ray and MRI. Based on the MRI findings, DLM was categorized into three types, and tear patterns were analyzed. The characteristic X-ray findings were evaluated as follows: (1) high fibular head, (2) squared-off appearance of the lateral femoral condyle, (3) cupping of the lateral tibial plateau, (4) widened femorotibial joint space, (5) hypoplasia of the lateral intercondylar spine, (6) notching of the LFC. The number of characteristic X-ray findings (0/1/more than 2) was noted. Binary logistic analysis was performed to find the factors that predict the presence and tear of contralateral DLM. ResultsMRI of contralateral knees revealed 43 cases (57%) of complete DLM, 25 cases (33%) of incomplete DLM, and 8 cases (11%) of normal meniscus. Meniscus tears were found in 29 cases (38%) in the contralateral knee. X-ray of the contralateral knee revealed that 27 patients (36%) had one and 24 patients (32%) had two or more characteristic X-ray findings. On logistic regression analysis, the associations between contralateral knee meniscal tear and the presence of one or more than two characteristic X-ray findings were statistically significant (OR: 16.5, p=0.028; OR: 264.0, p=0.000, respectively). DiscussionThe number of characteristic X-ray findings in the contralateral knee is a significant predictive factor for contralateral DLM type and/or tear. Symptomatic DLM patients with characteristic X-ray findings should be carefully evaluated for contralateral DLM and meniscal tears. Level of evidenceIII, prospective diagnostic study of consecutive patients.

Clinical Outcome of Lateral Extraarticular Augmentation Procedure for Anterior Cruciate Ligament Reconstruction: Systematic Review of Recent 5-year Studies

Objectives:Anterolateral rotational instability contributes to the persistent significant failure rate after anterior cruciate ligament reconstruction (ACLR) and suggests an inability of the intra-articular graft to normalize knee kinematics. Therefore, there has been a renewed interest in lateral-based soft tissue reconstructive techniques as augmentation of ACLR. Previous reviews regarding this topic have been published, yet the emergence of new findings should be considered to decide the best treatment. The aim of this study is to systematically review evidence of lateral extraarticular augmentation procedure (LEAP) for ACLR in the past 5 years.Methods:Literature research was performed using the PubMed/MEDLINE database for English-language studies pertaining anterolateral or lateral extraarticular procedure for ACLR. This systematic review was conducted based on PRISMA guideline. Inclusion criteria were patients who underwent ACL reconstruction with a combination of intraarticular and extraarticular procedure as augmentation. We excluded studies using isolated extraarticular procedure and studies on cadavers. The primary outcome assessed was subjective and objective clinical outcome.Results:After assessing full text and applying inclusion and exclusion criteria, six articles from 2015-2018 were found to be eligible, with 360 patients undergoing ACLR and LEAP. Level of evidence for the articles were II (n=2), III (n=2), and IV (n=2). The basic data of the studies were as follows: patients age was 16-48 years old; weight was 48-95 kg. Time from injury to surgery is more than 3 months, with one study included only patients with more than 12 months of injury. The procedure is in general indicated for strenuous sporting activities, while excluding collateral ligaments injury. Grafts were taken from gracilis tendon with only 1 study used semitendinosus. After a follow-up ranging from 2-24 years, both subjective (IKDC, Lysholm, Tegner, KOOS, and VAS) and objective (pivot shift test, KT-1000 arthrometer, and laxity tests) functional outcome was found to be satisfying. Two studies found no statistically significant difference with isolated ACLR, while one study favoured the use of LEAP. Most studies agreed that less ACL graft failure was found with LEAP. The complication was minimal, consisting of superficial wound infection.Discussion:Compared to acute ACL injuries, chronic injuries have higher anterolateral laxity. This instability is due to an anterior asymmetrical translation of the lateral tibial plateau. When there is injury or insufficiency of anterolateral structures, either by acute injury that does not heal properly or by the loosening resulting from an untreated ACL injury, it is more complicated to restore normal knee kinematics. It was found that by adding lateral extra-articular procedure to ACL reconstruction, internal rotation of the tibia at 30° of knee flexion can be reduced more significantly compared with either single-bundle or anatomic double-bundle reconstruction. However, three studies with less than 12 months period from injury to surgery concluded that LEAP did not give statistically significant difference in terms of functional outcome. Only one comparison study with more than 12 months of injury favored LEAP, indicating that more chronic injuries might benefit more from this procedure. Despite the differing results of functional outcome among studies, there is a common understanding that LEAP gives significantly better results in terms of pivot-shift test. Two previous systematic reviews agreed that combined procedure of ACLR and LEAP resulted in improvement of pivot-shift, without any statistically significant difference in terms of subjective outcome measures with ACLR alone. An ACL reconstruction alone did not restore stability with the pivot-shift as well as an ACL reconstruction and an extra-articular procedure. Nonetheless, to avoid potential overconstraint, it is best not to perform an extra-articular procedure at the time of ACL reconstruction if there is no evidence of ALL injury.Conclusion:This systematic review presents the update from the last 5-year literature of LEAP for ACLR with sufficient quality of evidence. The different results in terms of functional outcome might be influenced by, among many others, the duration between injury to surgery. More chronic ACL injuries might benefit more from LEAP. The quality of evidence in studies presented herein can still be improved in terms of methodology, number of samples, and duration of follow-up period. This study is expected to provide a platform for future studies in this field.

Anterior cruciate ligament transection of rabbits alters composition, structure and biomechanics of articular cartilage and chondrocyte deformation 2 weeks post-surgery in a site-specific manner

Anterior cruciate ligament (ACL) injury often leads to post-traumatic osteoarthritis (OA) and articular cartilage degradation, changing biomechanics of the tissue and chondrocytes, and altering the fixed charged density (FCD) and collagen network. However, changes in these properties are not known at a very early time point after ACL rupture, but recognizing early changes might be crucial for successful intervention. We investigated the effects of ACL transection (ACLT) in rabbits on the site-specific biomechanical properties of articular cartilage and chondrocytes, FCD content and collagen network organization, two weeks post-surgery.Unilateral ACLT was performed in eight rabbits, and femoral condyles, tibial plateaus, femoral grooves and patellae were harvested from experimental and contralateral knee joints. An intact control group was used as a reference. We analyzed chondrocyte morphology under pre- and static loading, cartilage biomechanical properties, FCD content and collagen fibril orientation.ACLT caused FCD loss in the lateral and medial femoral condyle, lateral tibial plateau, femoral groove and patellar cartilage (p < 0.05). Minor changes in the collagen orientation occurred in the femoral groove and lateral and medial femoral condyle cartilage (p < 0.05). Cartilage stiffness was reduced in the lateral and medial femoral condyles, and chondrocyte biomechanics was altered in the lateral femoral condyle and patellar cartilage (p < 0.05).We observed loss of FCD from articular cartilage two weeks after ACLT at several joint locations. These changes may have led to decreased cartilage stiffness and altered cell deformation behavior, especially in the femoral condyles.

Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRI and X-ray

BackgroundThe incidence of bilateral discoid lateral meniscus (DLM) is as high as 73 to 85%, and associated contralateral meniscus tears ranged from 4 to 33% in symptomatic surgical DLM. The goal of the study was analyzing the factors that predict contralateral presence and tearing of DLM in patients who underwent surgery for symptomatic DLM. Our hypothesis was that there is a significant correlation between operative DLM properties and the incidence of bilateral DLM with associated contralateral meniscus tears. These properties include tear patterns, younger patient age, and characteristic X-ray findings. Patients and MethodsThis prospective study included 76 patients who underwent arthroscopic surgery for symptomatic DLM. The contralateral knees were evaluated with X-ray and MRI. Based on the MRI findings, DLM was categorized into three types, and tear patterns were analyzed. The characteristic X-ray findings were evaluated as follows: (1) high fibular head, (2) squared-off appearance of the lateral femoral condyle, (3) cupping of the lateral tibial plateau, (4) widened femorotibial joint space, (5) hypoplasia of the lateral intercondylar spine, (6) notching of the LFC. The number of characteristic X-ray findings (0/1/more than 2) was noted. Binary logistic analysis was performed to find the factors that predict the presence and tear of contralateral DLM. ResultsMRI of contralateral knees revealed 43 cases (57%) of complete DLM, 25 cases (33%) of incomplete DLM, and 8 cases (11%) of normal meniscus. Meniscus tears were found in 29 cases (38%) in the contralateral knee. X-ray of the contralateral knee revealed that 27 patients (36%) had one and 24 patients (32%) had two or more characteristic X-ray findings. On logistic regression analysis, the associations between contralateral knee meniscal tear and the presence of one or more than two characteristic X-ray findings were statistically significant (OR: 16.5, p=0.028; OR: 264.0, p=0.000, respectively). DiscussionThe number of characteristic X-ray findings in the contralateral knee is a significant predictive factor for contralateral DLM type and/or tear. Symptomatic DLM patients with characteristic X-ray findings should be carefully evaluated for contralateral DLM and meniscal tears. Level of evidenceIII, prospective diagnostic study of consecutive patients.

Increased lateral meniscal slope is associated with greater incidence of lateral bone contusions in noncontact ACL injury.

(1) To investigate whether an increased lateral meniscal slope measured on magnetic resonance image (MRI) would be associated with greater risk of bone contusions in noncontact anterior cruciate ligament injury, and (2) to measure the relationship between the occurrence of bone contusions and associated findings observed in ACL deficient knees such as cartilage damage, anterolateral complex injury and concomitant meniscal tears. Patients who underwent ACL reconstruction surgery between 2013 and 2018 were retrospectively reviewed. Sixty-three patients were included in the study group (ACL + bone contusions group), 56 participants were in the control group (isolated ACL group). The presence and severity of bone contusions were determined from preoperative MRIs. The lateral meniscal slope and lateral posterior tibial slope were measured on the MRIs in a blinded fashion. The predictors of lateral bone contusions including age, sex, body mass index, lateral meniscal slope and lateral posterior tibial slope were examined by multivariable logistic regression. Associated findings including concomitant meniscal lesions, intra-articular cartilage damage and anterolateral complex injury, which were also calculated bymultivariable logistic regression. The mean lateral meniscal slope in the study group was 6.5° ± 3.5°, which was significantly larger than that in the control group (3.8° ± 2.7°;P < 0.01). In addition, increased lateral meniscal slope was significantly associated with lateral bone contusions in noncontact ACL injury (Lateral femoral condyle (LFC): AOR 16.5; 95% CI 5.40-50.20; P < 0.01; Lateral tibial plateau (LTP): AOR 31.8; 95% CI 8.68-116.7; P < 0.01). However, lateral posterior tibial slope was not significantly associated with bone contusions. Moreover, the presence of lateral bone contusions was associated with concomitant lateral meniscal tears (OR 12.4; 95% CI 3.30-46.30) and cartilage damage (OR 2.9; 95% CI 1.04-8.18). An increased lateral meniscal slope was associated with increased risk of lateral bone contusions in noncontact ACL injury. In addition, the presence of lateral bone contusions was associated with intra-articular cartilage damage, anterolateral complex injury and concomitant meniscal tears. Hence, additional information was provided for counseling patients who have increased LMS on the greater risk of knee rotational instability and identify patients undergoing ACL reconstruction who may benefit from extra-articular tenodesis. IV.