Left Knee Research Articles

Adipose-Derived Stromal Vascular Fraction in Treatment of Osteoarthritis: Experimental Study

Background Osteoarthritis OA is the commonest musculoskeletal disabling disease in adults. Most of the current available treatments provide only symptomatic relief. Adipose derivedstromal vascular fraction SVF has been recently introduced as potential regenerative therapy for OA. Objective We aimed to study the therapeutic role of adipose – derived SVF in OA. Materials and Methods This work included 42 female Wister rats for induction of osteoarthritis and 6 male Wistar rats acting as donors for the extraction of SVF from adipose tissue which yielded 106 cells/ml. Osteoarthritis was induced by intra-articular injection of collagenase type II in the right knee joint of all female rats and the left knee was considered as healthy controls. Rats were divided into three groups, healthy control Group (group I), induced osteoarthritis control group (Group II) which received no treatment and SVF treatment group (Group III). Group II and III were subdivided into 2 subgroups; IIa, IIb and IIIa, IIIb which were euthanized after 1 and 2 months of OA induction respectively. Modified Manikin score (MS) was used to assess cartilage degeneration. Image Analysis was used to assess chondrocyte count, articular cartilage thickness and optical density in slides stained with Hematoxylin and Eosin and Safranin-O-stain. Results It was observed that MS scored highest in Group II compared to Group III and Group I (P < 0.001). After 1 month, MS in Group IIa and Group IIIa was (10.75 ± 0.50 and 2.50 ± 0.53, P < 0.001). Similarly at 2 months MS was (8.50 ± 0.58, 0.50 ± 0.53, P < 0.001). Also, morphometric analysis revealed Group II contained least chondrocyte cellular count compared to Group III and Group I (P < 0.001). After 2 months, articular cartilage thickness was least in Group II compared to Group IIIb and highest in Group I (P < 0.001). Also, optical density OD measurement using imaging in slides stained with Safranin revealed OD was highest in Group I, followed by Group III and least in Group II (P < 0.001). Conclusion Adipose derived SVF represents potential regenerative therapy for OA. It decreased development of degenerative changes at early stages of induced osteoarthritis in rats and promoted regeneration with increased cartilage thickness and proteoglycan content at later stage.

Factor VIII Level in the Potential Female Carrier Mothers of Patients with Hemophilia A and Its Impact on Joint Health

Background Hemophilia A is an X-linked bleeding disorder. The characteristic bleeding phenotype in patients with severe hemophilia is recurrent spontaneous hemarthrosis with development of hemophilic arthropathy. Heterozygous female carriers with factor VIII (FVIII) activity level lower than 40% may be at risk for bleeding that is usually comparable to that seen in males with mild hemophilia. Aim of the Work To assess factor VIII level in mothers of known patients of hemophilia A correlating it with the frequency of clinically and radiologically documented arthropathy. Patients and Methods A cross sectional study included 40 mothers of patient with hemophilia A during the period from September 2020 to September 2021. Studied participants were subjected to detailed analysis of bleeding history, six major joints range of motion (ROM) examination, functional independence score in hemophilia (FISH), FVIII level one stage assessment and magnetic resonant imaging (MRI) of the reported affected joints. Results Mean age of mothers is 42.25 ± 7.74 years. Eleven mothers (27.5%) had no bleeding symptoms, 16 (40%) had one bleeding symptoms and 13 (32.5%) had two or more bleeding symptoms. As regard joint pain, 13 (32.5%) had severe pain, 3 (7.5%) had ankle pain and 2 (5%) had elbow pain with a mean pain score of 2.55±3.32, and 7 (17.5%) had bilateral pain. Mean FVIII activity was 43.33 IU (± 22.79), ranging from FVIII (0 < 30 IU) in 13 (32.5%), FVIII (30 <60) in 18 (45.0%) and FVIII ≥ 60 IU in 9 (22.5%) among the studied participants. Knees were the most affected joints with decreased mean ROM (±SD) in right and left knees of (123.25 (±12.06) and 120.00 (±15.81)) respectively. The median MRI scores were studied was 5 (2.6%) with median osteochondral changes of 4 (2.5%) and median soft tissue changes of 1 (0-1), their median FISH score of 8 (8-9). By comparing groups at the level of factor VIII, there was no significant difference according to anthropometric bleeding parameters, pain, and MRI score. None of participants needed hospital admission, factor VIII replacement or packed red cells replacement. Conclusion Potential female hemophilia A carriers are at risk of spontaneous bleeding which may entail bleeding in the joints, causing early joint damage. They showed reduced overall joint ROM and structural osteochondral changes in MRI joint examination which mandates further studies about early detection of potential female hemophilia carriers for the possible need of early medical intervention.

Effects of left thigh blood flow restriction exercise on muscle strength and golf performance in amateur golfers.

This study aimed to investigate the effect of lower-extremity strengthening exercise (LSE) with and without blood flow restriction (BFR) on the left thigh on golf performance. Eighteen amateur golfers with more than 1 year of golf experience participated in the study and were randomly divided into two groups: LSE+BFR group (LSE with BFR on the left thigh, n=9) and LSE group (LSE without BFR, n=9). The LSEs consisted of squats, lunges, and standing leg curls. All exercises were performed 3 times a week for 6 weeks. Changes in thigh muscle strength, plantar foot pressure (weight transfer), and golf performance, such as club head speed, ball speed, and carry distance were measured before and after the exercise program. Right knee extension (P<0.001) and left knee extension and flexion (P<0.001) strength were higher in the LSE+BFR group than in the LSE group. The changes in plantar foot pressure confirmed that smooth weight transfer appeared in E1 (event 1) (address) (P<0.05) of the LSE+BFR group, which confirmed that the carry distance (P<0.05) of the LSE+BFR group improved after the exercise program. The results of this study showed that BFR muscle strengthening exercise are more effective than basic simple muscle strengthening exercise in improving golf performance through muscle strength and weight transfer improvement.

Low-frequency whole-body vibration can enhance cartilage degradation with slight changes in subchondral bone in mice with knee osteoarthritis and does not have any morphologic effect on normal joints.

To evaluate the effects of low frequency whole-body vibration (WBV) on degeneration of articular cartilage and subchondral bone in mice with destabilization of the medial meniscus (DMM)induced osteoarthritis(OA) and mice with normal knee. Ten-week-old C57BL/6J male mice received DMM on right knees, while the left knees performed sham operation. There were six groups: DMM, SHAM DMM, DMM+WBV,SHAM DMM+WBV, DMM+ NON-WBV and SHAM DMM+NON-WBV. After four weeks, the knees were harvested from the DMM and SHAM DMM group. The remaining groups were treated with WBV (10 Hz) or NON-WBV. Four weeks later, the knees were harvested. Genes, containing Aggrecan(Acan) and CollagenⅡ(Col2a1), Matrix Metalloproteinases 3 and 13(MMP3,13), TNFα and IL6, were measured and staining was also performed. OA was graded with OARSI scores, and tibial plateaubone volume to tissue volume ratio(BV/TV), bone surface area to bone volume ratio (BS/BV), trabecular number(Tb.N) and trabecular thickness separation(TS) between groups were analyzed. Increased OARSI scores and cartilage degradation were observed after WBV. BV/TV, Tb.N and TS were not significant between the groups. Significant reductions were observed in MMP3, MMP13, Col2a1, Acan, TNFα and IL6 in the DMM+WBV compared to SHAM DMM+WBV group. BV/TV, BS/BV, Tb.N, TS and OARSI scores were not significantly changed in the left knees. IL6 expression in the SHAM DMM+WBV group was significantly increased compared with the SHAM DMM+ NON-WBV group, while Col2a1, Acan and MMP13 expression decreased. WBV accelerated cartilage degeneration and caused slight changes in subchondral bone in a DMM-induced OA model. WBV had no morphologic effect on normal joints.

Lipoma Arborescens Might Be an Unusual Cause of Knee Pain in Adolescents: A Case Report

Lipoma arborescens (LA) is a rare benign soft tissue tumor characterised by a hyperproliferation of villi and fat cells in the joint synovium. It is most frequently localized in the knee as reported here. This is a case report of a 16-year-old adolescent, affected by type I diabetes mellitus, who reported left knee pain and functional limitation to medical attention. She performed a physical examination, MRI and biopsy using an arthroscopic approach, leading to the LA diagnosis and classification. The LA has been thus treated with an arthroscopic synovectomy, which is the treatment of choice for LA, characterized by a low recurrence rate.

E34 Coexisting sickle cell disease and autoimmune diseases among Nigerian children

Abstract Introduction Patients with sickle cell disease (SCD) do have a defective activation of the alternate complement pathway which increases their risk of having infections. This is thought to predispose to autoimmune disease (AID) in them. However, there is paucity of data on coexisting AID and SCD in children which may be due to under diagnosis as a result of overlapping symptoms of the two disease conditions. Objectives To highlight the clinical features, diagnostic challenge and importance of early recognition and treatment of autoimmune diseases in children with sickle cell disease. Methods Retrospective review of records of four children with sickle cell disease who were diagnosed with autoimmune diseases at the paediatric Rheumatology Clinic of Lagos State University Teaching Hospital (LASUTH) between May 2018 to February 2023. Results Case 1 15 –year –old girl known haemoglobin SC patient of haematology unit who was referred to rheumatology unit with history of worsening jaundice, abdominal swelling, headache, constitutional symptoms, left knee pain, and two episodes of blood transfusion within two months. Initally being managed for hyperhaemolytic and vaso-occlusive crisis but later referred to rheumatology unit on suspicion of autoimmune disease due to recurrent anaemia, and five episodes of blood transfusion within two months. ESR was 65 mm/h, ANA of 1:2560, positive anti-smith antibodies, elevated urine protein creatinine ratio (UPCR), low C3 and C4 and positive direct coomb’s test. Diagnosis was juvenile systemic lupus erythematosus (JSLE). She had pulse methylprednisolone, oral prednisolone, hydroxychloroquine and mycophenolate mofetil. She has improved clinically and being followed up in clinic. Case 2 10-year-old girl, known sickle cell anaemia patient who had unproductive cough of one-month duration and chest radiograph findings of bronchiectatic and fibrotic changes in the right upper/middle lobes with reduction in lung volume. Gene xpert was negative for tuberculosis but chest CT showed honeycombing in the right upper lobe implying Interstitial lung disease. Further investigations showed ESR of 5, ANA of 1:1280, borderline anti-dsDNA, positive anti-SM/RNP, normal urinalysis, normal renal function and restrictive lung disease on spirometry. She is being managed as a case connective tissue disorder with associated Interstitial Lung Disease. She is presently on mycophenolate mofetil and being followed up in clinic. Case 3 11-year-old female living with sickle cell anaemia who presented with inflammatory arthritis of the small joints of the hands, elbows and knees of nine-month duration, sclerodactyly, contractures of the PIP of the fingers, narrowing of oral aperture, generalized hypopigmented macules and abnormal nailfold capillaroscopy. ANA was 1:640, positive anti-Scl 70, negative anti-centromere, ESR of 130 mm/h, thrombocytosis, severe restriction on spirometry and features of interstitial lung disease on HRCT of the chest. She commenced mycophenolate mofetil, prednisolone and nifedipine. She later had 2 doses of rituximab due to slow clinical improvement and is being followed up. Case 4 13-year-old female with sickle cell anaemia who presented with recurrent fever &amp; severe haemolytic anaemia requiring frequent blood transfusions (13 pints of blood over 6 months!!!). Initial diagnosis was septicaemia, and autoimmune haemolytic anaemia. Following rheumatology review, ANA was 1:640, positive anti-DsDNA, negative anti-Smith antibodies, ESR of &amp;gt; 150mm/h, elevated UPCR and pancytopaenia. She was later diagnosed with Lupus nephritis. She had Mycophenolate mofetil, prednisolone and hydroxychloroquine. She died of acute lupus flare 4 weeks after discharge from the hospital. Conclusions Physicians should have high index of suspicion for possible association of sickle-cell disease and autoimmune diseases so as not to delay definitive diagnosis and initiation of appropriate treatment.

E69 Localised intraarticular pigmented villonodular synovitis in an adolescent patient: a case-based review of the literature

Abstract Introduction Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive subtype of tenosynovial giant cell tumours that affect the synovium of the joints and tendons, occurring either focally or diffusely associated with the deposition of hemosiderin into the involved joint(s) and soft tissues. Although PVNS is historically considered an inflammatory process, recent evidence suggests the possibility of a neoplastic transformation. In addition, despite being typically found as a monoarticular knee disorder, other large and small joints can also be affected. The disease is rarely reported in African children, with most reported cases not histologically confirmed. We, therefore, present the first histologically proven case of localised intraarticular PVNS in an African teenager who presented with unilateral left knee swelling and pain. Method/Setting We report the case of a 16-year-old male teenager who presented to the rheumatology clinic with a nine-month history of non-traumatic anterior left knee swelling and pain that increased over time with associated difficulty walking and standing without aid. After clinical examination and relevant investigations, Magnetic Resonant Imaging (MRI) was done to confirm our suspicion of PVNS. Findings/Treatment Examination revealed a tender, swollen knee with a fluctuant palpable infrapatellar mass. Knee arthrocentesis yielded about 200mls of non-clotted hemorrhagic effusions. The patient had an open synovectomy following MRI, which was highly suggestive of pigmented villonodular synovitis with extensive suprapatellar bursitis. Specific histological findings (below) further confirmed the diagnosis. He commenced early physiotherapy, and symptoms resolved without recurrence of swelling eleven months after surgery. Conclusion This case highlights the visual presentation of an uncommon joint disorder and suggests it is considered a differential diagnosis of non-traumatic monoarticular pain and swelling in our rheumatology clinic set-up and among teenagers in whom juvenile rheumatoid arthritis would have been the first differential. Key words: Pigmented villonodular synovitis, Synovectomy, Multinucleated giant cells Contribution statement: AA conceived the idea to write the case report, draft the first manuscript, and manage the patient. YA, HO and AF edited the manuscript, while AIL interpreted the histological findings. All the authors approved the final version of the manuscript. Disclosure statement: None declared. Ethics and patient consent: This case report adheres to the Helsinki declaration, and the patient’s parents gave written consent to publish the details of the information. Additional information: Any institution did not fund this publication. Acknowledgements: We thank Dr Isaac Akanbi and Dr Bukar for interpreting the MRI and performing the surgery.

Using a Xenogeneic Acellular Dermal Matrix Membrane to Enhance the Reparability of Bone Marrow Mesenchymal Stem Cells for Cartilage Injury.

Due to its avascular organization and low mitotic ability, articular cartilage possesses limited intrinsic regenerative capabilities. The aim of this study is to achieve one-step cartilage repair in situ via combining bone marrow stem cells (BMSCs) with a xenogeneic Acellular dermal matrix (ADM) membrane. The ADM membranes were harvested from Sprague-Dawley (SD) rats through standard decellularization procedures. The characterization of the scaffolds was measured, including the morphology and physical properties of the ADM membrane. The in vitro experiments included the cell distribution, chondrogenic matrix quantification, and viability evaluation of the scaffolds. Adult male New Zealand white rabbits were used for the in vivo evaluation. Isolated microfracture was performed in the control (MF group) in the left knee and the tested ADM group was included as an experimental group when an ADM scaffold was implanted through matching with the defect after microfracture in the right knee. At 6, 12, and 24 weeks post-surgery, the rabbits were sacrificed for further research. The ADM could adsorb water and had excellent porosity. The bone marrow stem cells (BMSCs) grew well when seeded on the ADM scaffold, demonstrating a characteristic spindle-shaped morphology. The ADM group exhibited an excellent proliferative capacity as well as the cartilaginous matrix and collagen production of the BMSCs. In the rabbit model, the ADM group showed earlier filling, more hyaline-like neo-tissue formation, and better interfacial integration between the defects and normal cartilage compared with the microfracture (MF) group at 6, 12, and 24 weeks post-surgery. In addition, neither intra-articular inflammation nor a rejection reaction was observed after the implantation of the ADM scaffold. This study provides a promising biomaterial-based strategy for cartilage repair and is worth further investigation in large animal models.

Ultrasonographic assessment of knee joint in patients with diabetes mellitus: comparison of sonographic changes in distal femoral cartilage and tendon structures with non-diabetics patients.

The aim of this study was to evaluate the adverse effects of diabetes mellitus on the knee joint by using ultrasonography. One hundred and two subjects with diabetes for 5 years and more were compared prospectively with 93 age and sex-matched healthy subjects. Individuals in both groups were aged between 40-55, had a body mass index below 30 kg/m2, and had no knee joint complaints. Femoral cartilage thickness, cartilage surface, quadriceps and patellar tendon thickness in both knees were assessed by ultrasonography using a 5-12 mHz linear transducer. According to ultrasonographic findings, thin and irregular femoral cartilage was more common in diabetic patients than in healthy controls (p<0.05). Diabetic patients had thinner quadriceps tendons compared to the control group (p<0.001). No statistically significant difference was recorded in patellar tendon thickness (right knee p=0.697, left knee p=0.639). The presence of effusion in the suprapatellar recess of the right knee was more common in diabetics than non-diabetics (p=0.006). Irregularity and thinning of the distal femoral cartilage in diabetics may indicate cartilage degeneration. In addition, the decrease in the thickness of the quadriceps tendon may lead to instability and adversely affect the knee joint. These sonographic findings may indicate early knee joint degeneration, so ultrasonography may help determine the possible risk of osteoarthritis in diabetic patients.

Intervention of Refractory Arthrofibrosis After Anterior Cruciate Ligament Reconstruction: A Case Report.

Although nonsurgical and surgical management of knee arthrofibrosis has been reported in the literature, there is little information on the effect of procedural treatment modalities of refractory arthrofibrosis on clinical outcomes. The purpose of this case report is to describe the intervention of refractory knee arthrofibrosis after anterior cruciate ligament reconstruction and investigate long-term clinical outcomes after procedural intervention. A 27-year-old male presented with decreased range of motion (ROM), patellar mobility, strength, and knee joint function following anterior cruciate ligament reconstruction of his left knee. After failed conservative management, the patient underwent manipulation under anesthesia (MUA) to release scar tissue. Following MUA, the emphasis of comprehensive physiotherapy was on decreasing inflammation, relieving pain, and maintaining patellar mobility while increasing knee joint ROM and strength. Knee ROM, patellofemoral motion, gait, and quadriceps recruitment were measured 3, 6, 12, and 24months after MUA. At 2-year follow-up after MUA, the patient continued to present with decreased ROM and quadriceps strength compared to the contralateral knee, but had returned to a running program and reported knee joint dysfunction no longer interfered with his daily activities. This case report demonstrates signs and symptoms that could indicate knee arthrofibrosis and introduces procedural intervention for refractory arthrofibrosis after anterior cruciate ligament reconstruction.

A 78-year-old Man Presented with Knee Pain and Recurrent Fever

&lt;p&gt;發燒為常見臨床症狀，本案例是一位78歲末期腎臟疾病接受長期血液透析治療男性，近一個月曾發生永久性透析導管感染合併金黃色葡萄球菌菌血症，此次因左膝關節疼痛就醫，理學檢查發現關節發熱腫脹，診斷感染性關節炎入院治療， 關節液及血液培養顯示金黃色葡萄球菌，在抗生素治療及行左膝切除關節成形術後仍反覆發燒， 經由專科護理師完整病史收集、全身理學檢查、實驗室檢驗結果，排除導管感染及心內膜炎等相關鑑別診斷，電腦斷層血管攝影顯示囊狀主動脈合併周圍積液確診為感染性動脈瘤。因年紀大合併多種慢性共病（塵肺症、慢性阻塞性肺病及末期腎臟疾病等），在家屬考量動脈瘤切除、結紮及血管重建手術利弊後決定採保守治療（6週Piperacillin-Tazobactam和Vancomycin抗生素靜脈注射療程），發燒及低血壓狀況改善，且血液培養亦未發現新的感染。臨床上，當病人主訴反覆發燒合併金黃色葡萄球菌菌血症時，根據我們的案例及文獻回顧，應強調以焦點式理學檢查積極探查可能的轉移性感染（包括：導管感染、軟組織感染、感染性關節炎、心內膜炎及感染性動脈瘤等），輔以影像學檢查。以此案例提升專科護理師於類似複雜案例時的照顧能力，利於醫療團隊即早確定診斷及介入治療，以降低延遲治療對於脆弱老年病人帶來負面影響。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Fever is a common symptom in clinical practice. A 78-year-old male with end-stage kidney disease (ESKD) who underwent hemodialysis was admitted due to left knee pain. Upon physical examination, there were signs of joint heat, swelling, and tenderness in addition to febrile state, suggesting a diag&amp;shy;nosis of septic arthritis. Staphylococcus aureus (SA) was later identified in both the synovial fluid and blood culture. However, the patient experienced recurrent fever despite receiving appropriate antimi&amp;shy;crobial treatment and undergoing left knee resectional arthroplasty. To rule out other potential diagno&amp;shy;ses related to SA bacteremia, a thorough evaluation involving medical history, physical examination, and laboratory tests was conducted. The computed tomography angiography revealed the presence of a saccular aortic aneurysm with perianeurysmal fluid collection, confirming a diagnosis of mycotic an&amp;shy;eurysm. The patient and his family carefully considered the advantages and disadvantages of surgical options, such as aneurysm excision, ligation, or vessel reconstruction. Under the considerations of the age and underlying comorbidities such as pneumoconiosis, chronic obstructive pulmonary disease, and ESKD, conservative treatment was performed (a 6-week course of intravenous piperacillin-tazobactam and vancomycin). The fever and hypotension gradually subsided, and there was no evidence of blood&amp;shy;stream infection. Based on our case and extensive literature reviews, it is crucial to actively evaluate metastatic complications, including infective endocarditis, catheter infection, septic arthritis, and my&amp;shy;cotic aneurysm, among patients who present with persistent fever and concurrent SA bacteremia. This case aims to enhance the abilities of nurse practitioners in conducting comprehensive assessments, providing vital information to the medical team, facilitating accurate diagnoses, timely interventions, and ultimately reducing the adverse impact of delayed treatment in vulnerable older adults.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Genicular Nerve Radiofrequency Ablation Before and After Magnetic Resonance Imaging Anatomical Mapping: Case Study

Background: Chronic knee pain is a significant cause of morbidity for which radiofrequency ablation (RFA) of genicular nerves (GN) may be considered. However, treatment effectiveness depends on accurate placement of RFA probes, and there remains uncertainty on GN anatomical location. Case Report: A 21-year-old man presented with 2 months of severe knee pain following a canoe trip. Hoffa’s fat impingement was diagnosed with magnetic resonance imaging (MRI), and a subsequent fat pad injection was unsuccessful. After GN blocks, RFA provided 90% relief for 4 weeks. At this time, RFA was performed with probe placement determined by the patient’s MRI-mapped GN neurovascular bundle location. At 8 weeks, the patient continues to have 100% left knee pain relief. Conclusion: This case suggests that MRI-mapped GNs may assist in planning genicular RFA to improve probe and nerve apposition. Key words: Genicular nerve, magnetic resonance imaging, radiofrequency ablation

Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report

BackgroundKnee arthroplasty is an orthopedic surgical procedure in which a damaged joint is replaced with an artificial one. It is estimated that 1–2% of knee arthroplasties will encounter infection over their lifetime. Although α-hemolytic Streptococcus species play an important role in prosthetic joint infection, they are less common than staphylococcal species.Case presentationIn this report, a 50-year-old Iranian woman was diagnosed with prosthetic knee joint infection based on clinical, radiological, and laboratory findings. She was diabetic and had undergone a left total knee arthroplasty, which, 18 months after the surgery, presented pain, erythema, and edema in that knee. The primary culture of knee aspirate was positive for α-hemolytic Streptococcus species, but following antibiotic medication, culture was negative. The primary antibiotic regime was vancomycin and meropenem, which was changed to cefepime for the management of the infection based on the results of antimicrobial susceptibility testing.ConclusionsThis report indicated the clinical presentation and management of the patient with prosthetic joint infection in which the patient recovered without any severe complications or surgical intervention.

Race and Sex Disparities in Lower Extremity Total Joint Arthroplasty: A Retrospective Database Study.

Total joint arthroplasty (TJA) is successful in improving health-related quality of life. However, outcomes vary in the literature due to modifiable and non-modifiable factors. Modifiable factors consist of body mass index (BMI), nutrition, and tobacco use. Non-modifiable risk factors include age, race, sex, and socioeconomic status. Prior literature has focused on racial disparities in terms of the utilization of lower extremity arthroplasty. The purpose of this study is to determine the effect of race and sex on the in-hospital complication rate, length of stay, and charges associated with primary TJA. This retrospective cohort utilized complex survey data from the National Inpatient Sample (NIS) between 2016 and 2019. The use of the International Classification of Disease-10 Procedure Codes (ICD-10 PCS) for right hip, left hip, right knee, and left knee TJA yielded a preliminary total of 2,660,280 patients. The exclusion criteria were bilateral arthroplasty and concomitant unilateral hip and knee arthritis. Major complications were defined as acute myocardial infarction, cardiac arrest, pulmonary embolism, adult respiratory distress syndrome, stroke, shock, and septicemia. Odds ratio (OR) and beta coefficients were adjusted for age, sex, primary payer, hospital region, hospital teaching status, and year. Total charges were adjusted for inflation using the Consumer Price Index data reported by the US Bureau of Labor Statistics. A total of 2,589,510 patients met our inclusion criteria; 87.6%, 5.9%, 4.8%, 1.4%, and 0.3% of people were 'White', 'Black', 'Hispanic', 'Asian, or Pacific Islander', and 'Native American', as defined by the National (Nationwide) Inpatient Sample (NIS) Variable 'RACE'. Black individuals experienced a significantly greater major complication rate compared to White individuals (0.87% vs. 0.74%, OR 1.25, p-value = 0.0004). Black and Hispanic individuals experienced a significantly greater minor complication rate compared to White individuals (6.39% vs. 4.12%, odds ratio (OR) 1.61, p-value < 0.0001; 4.68% vs. 4.12%, OR 1.17, p-value < 0.0001). Black, Hispanic, Asian or Pacific Islander, and Native American individuals stayed, on average, 0.33, 0.19, 0.19, and 0.25 days longer than White individuals (2.78, 2.54, 2.55, 2.56 vs. 2.37 days, p<0.0001). None of these statistically significant differences exceeded the established minimal clinically important difference of two days. Black, Hispanic, and Asian or Pacific Islander patients were charged $5,751, $18,656, and $12,119 more than White patients ($72,122, $85,027, $78,490, and $59,297 vs. $66,371, p ≤ 0.0165). Native American patients were charged $7,074 less than White patients ($59,297 vs. $66,371, p < 0.0001). Black and Hispanic TJA patients may have higher complication rates than White TJA patients. The differences in length of stay between race groups may not affect outcomes. Hispanic patients received significantly more charges than White patients, and Native American patients received significantly fewer charges than White patients after controlling for non-modifiable risk factors. Addressing the charge disparities may reduce the total national cost burden associated with TJA. The present study highlights the need for further studies on healthcare outcomes related to race and sex.

Autologous Osteochondral Grafts for Knee Osteochondral Diseases Result in Good Patient-Reported Outcomes in Patients Older Than 60 Years

This study aims to examine the clinical autologous osteochondral grafts (AOG) outcomes for knee osteochondral diseases at operative ages >60 years, and to determine whether patients are able to sit straight in Japanese style after AOG. All patients who underwent AOG for knee osteochondral diseases between November 2001 and April 2018 were retrospectively identified. The inclusion criteria were AOG only without osteotomy, operative ages between 60 and 79 years, >2 years of follow-up, and involved femorotibial angle between 169° and 179° (normal alignment). Patients who underwent osteotomy to improve knee alignment and patients with inflammatory diseases such as rheumatoid arthritis were excluded. The patients' knee symptoms and their clinical outcome were evaluated according to the criteria of the knee scoring system of the Japanese Orthopedic Association (JOA), International Knee Documentation Committee (IKDC) subjective score, and the ability of straight sitting in Japanese style. This study enrolled 57 cases and 60 knee joints during the study period. The follow-up ratio was 85.1%. Moreover, 14 men and 43 women and 29 right and 31 left knee joints were included in this study. The mean operative age and mean follow-up period were 67.8 years (range 60-76 years) and 81.1 months (range 24-167 months), respectively. In addition, the study involved 30 cases and 32 knee joints (60s group), and 27 cases and 28 knee joints (70s group). Moreover, 34 cases and 36 knee joints had osteonecrosis (ON group), and 23 cases and 24 knee joints had cartilage injury (CI group). The IKDC subjective and JOA scores in both the 60s and 70s groups showed significant differences: 2 years after AOG ＞at the follow-up period, ＞at the preoperative period. The scores in both the CI and ON groups showed similar significant differences. Furthermore, 8.3% and 53.5% of the patients could sit straight in Japanese style at the preoperative period and 2 years after AOG, respectively. Even if the patient's operative age was >60 years, the AOG only for their knee osteochondral diseases had good clinical outcomes, including the ability to sit straight in Japanese style. IV, Therapeutic case series Key words: autologous osteochondral grafts, aged patients, clinical outcome, knee joint, straight sitting in Japanese style.

Comparison of allogeneic mesenchymal stem cells therapeutic potentials in rabbits' cartilage defects: Μacroscopic and histological outcomes

Mesenchymal stem cells are safe and effective for treating joint injuries. However, the most suitable cell source remains controversial. This randomized controlled, double-blind study aimed to evaluate the potentials of rabbit allogeneic bone marrow- (BMSCs), adipose- (ASCs) and synovial membrane- (SDSCs) derived stem cells encapsulated in fibrin glue (FG) in vivo. The therapeutic properties of fibrin glue in critical-sized osteochondral defects (ODs) were also investigated. A 3 × 3 mm-sized OD was created in the femoral patellar groove on both knees of New Zealand rabbits, except from the left knees of the control group in which the OD was 2 × 3mm. The rabbits were randomly divided into four groups (right/left knee): 3 × 3 mm / 2 × 3 mm-sized OD control group, FG/FG with ASCs group, FG/FG with BMSCs group, FG/FG with SDSCs group. The International Cartilage Repair Society (ICRS) and the O'Driscoll scales were used to evaluate tissue characteristics after 12 weeks.FG promoted the production of reparative tissue with superior macroscopic features. Allogeneic MSCs combined with FG improved the macroscopic and histological scores more than the FG groups. The tissue in the SDSCs group was macroscopically and histologically better than the ASCs and BMSCs groups. The ICRS score differed among the SDSCs and the ASCs groups, while the empty critical-sized ODs were filled with inferior tissue compared to smaller ones.The preclinical feasibility of stem cells for OD regeneration in rabbits and the osteochondrogenic superiority of SDSCs was demonstrated. Additional tests and extended studies are required to reassure the long-term safety of these findings.

An isolated rupture of the anterolateral ligament of the knee: A case report.

The anterolateral ligament (ALL) is a controversial ligament in the knee that may play a significant role in knee stability. It is difficult to identify on magnetic resonance imaging (MRI) imaging and is often injured in conjunction with other ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament. This is a unique case of an isolated ALL tear in a 48-year-old woman who presented with severe left knee pain, swelling, and inability to bear weight during a yoga session. Physical examination showed swelling and tenderness at the lateral aspect of the femoral condyle, with increased pain on varus stress testing. Radiographs revealed normal osseous structures with the absence of traumatic bone lesions. MRI revealed an intact meniscus, cruciate, and collateral ligaments, but a rupture of the ALL at its femoral origin. Diagnosis of isolated ALL rupture of the left knee was made, and the patient was treated conservatively with icing, rest, and non-steroidal anti-inflammatory drugs. Physiotherapy was started 2 weeks post-injury, and return to sports was allowed at the sixth week. Upon last follow-up, the patient had excellent functional outcomes and was satisfied with the treatment. Physical examination showed a stable knee with negative Lachman and pivot shift tests. To the best of the authors' knowledge, this is the first case of isolated ALL rupture to be reported. The paper highlights the rarity of isolated ALL injuries and the difficulty in diagnosing them. Conservative treatment can be successful for isolated ALL injuries, with physiotherapy playing an essential role in rehabilitation.In conclusion, isolated ALL injuries are rare and can be challenging to diagnose. Conservative treatment with physiotherapy can lead to successful outcomes. Further research is needed to understand the role of the ALL in knee stability and to determine optimal treatment options.

Anatomical Variations in the Posterior Tibial Slope in the North Indian Population: A Hospital-Based Study.

The measurement of the posterior tibial slope (PTS) angle is crucial for various knee surgeries such as total knee replacement, high tibial osteotomy, and anterior cruciate ligament reconstruction. This hospital-based study aimed to determine the average PTS angle in the knee joints of the North Indian population and provided valuable data to aid knee surgeries in this region. An analysis of 200 plain X-ray films, specifically the true lateral view of both knees in 20-degree flexion, was conducted on participants who exhibited skeletal maturity with no arthritis, tumours, or previous knee surgeries. The PTS measurements were performed manually. The data were analyzed statistically by matching them with variables such as gender, age, laterality, and body mass index (BMI). The study revealed the following findings for the posterior tibial slope in a section of the North Indian population: there was no significant laterality difference (right knee: 12.76±2.35°, left knee: 12.55±2.46°); no notable sexual dimorphism (males: right knee - 12.79±2.65°, left knee - 12.25±2.65°, females: right knee - 12.73±2.11°, left knee - 12.77±2.30°). However, as age advanced, there were significant differences observed (PTS: 14.27±1.28° and 13.84±1.80° in the 18-40 years age group, 11.36±1.76° and 11.31±1.97° in the 41-60 years age group, 10.32±2.82° and 10.56±3.04° in the >60 years age group for the right and left knee, respectively). No significant correlation was found with BMI (PTS: 13.12±3.13° and 12.59±3.14° for BMI <25, 12.88±2.15° and 12.80±2.34° for BMI 25-30, 12.00±2.09° and 11.66±2.99° for BMI >30 in the right and left knee, respectively). The study demonstrated significant variations in the posterior tibial slope based on age, emphasizing the need for individualized treatment in knee surgeries. The research provided valuable insights into normal PTS values specific to the North Indian population, offering regional data to inform knee surgery procedures.

Popliteal Vein Aneurysm: A Rare Cause of Knee Pain in a Young Male

Popliteal venous aneurysms are a rare disease of uncertain etiology that can present with serious complications, such as deep-vein thrombosis and pulmonary embolism. Ultrasound, computed tomography, and magnetic resonance imaging can be used as diagnostic tools for this condition. Early surgical repair in the form of tangential aneurysmectomy and lateral venorrhaphy of both symptomatic and asymptomatic popliteal venous aneurysms is advised since they are associated with an ill-defined possibility of pulmonary embolism and mortality, if left untreated. Herein, we present a case report of a popliteal vein aneurysm in a previously healthy 26-year-old male, presenting with pain in left knee, increased during physical activities and was successfully managed surgically.

Pressure sore at an unusual site: the bilateral knee - a case report.

The authors reported a case of a 66-year-old male, last seen 5 days ago by his son, who was found on the floor (with the knee on the ground) and was brought to the hospital. The patient had no history of mobility issue. On initial assessment his vitals were unstable but Glasgow Coma Scale 15/15 and CT head and ECG were unremarkable. On knee examination, there was bilateral grazing and bruising diagnosed as grade 3 and grade 4 pressure sore in the right and left knee, respectively. The pressure ulcer was managed adhering to the principles to remove all pressure, keep the ulcer clean, prevent further injury, and regular dressing by tissue viability nurses. On 17 March 2023, the patient was discharged from the hospital to a care home after his condition improved. A comprehensive review of the medical literature found no other reports of pressure sore at knee. A few published articles showed pressure sore as a complication of prone positioning. It is postulated that fall and long-term lie on the knees have developed this pressure ulcer. The Clinicians should be vigilant to check for pressure ulcers especially in all the bony prominences in any patients having an unwitnessed fall.