Loose Bodies Research Articles

Structural model and capacity determination of underground reservoir in goaf: a case study of Shendong mining area in China

The large-scale extraction of coal resources in the western mining areas of China has resulted in a significant loss of water resources, which is a challenge for coordinating resource extraction with ecological preservation in the mining areas. Although underground reservoir technology can effectively solve this problem, measuring the storage capacity of underground reservoirs through engineering experiments is costly and time-consuming. Currently, there is a lack of accurate, reliable, and low-cost theoretical calculation solutions, which greatly restricts the promotion and application of underground reservoir technology. The theoretical calculation methods for underground reservoir capacity were studied based on parameters from the Shendong mining area in China. A water storage structure model for coal mine underground water reservoirs was established, taking into account the settlement boundaries of the bedrock and loose layers in shallow coal seams, based on the key layer theory and the spatial structure model of the mining roof. The mathematical expression for the load on the coal-rock mass in the goaf was derived considering the rock breaking characteristics of the mining roof. The model determined the range of each water storage area, including the zone of loose body, zone of gradual load, and the compacted zone, based on the strength of the water storage capacity. The key parameters for calculating the water storage capacity were determined using a modified model for shallow thick loose layers and thin bedrock movement. Finally, a calculation method for the storage capacity was obtained. Based on the real data from the 22,615 working face of a mine in the Shendong mining area, the water storage capacity of the underground reservoir in the goaf was jointly calculated using FLAC3D, Surfer 12.0 and the proposed calculation method. The calculated water storage capacity was approximately 1.0191 million m3. Although this result was 2.20% smaller than the on-site water pumping experiment data, it still verifies the feasibility of the above calculation method for determining the water storage capacity of underground water reservoirs.

In Vitro Evaluation of Lateral Femur Condyle Free Chondral Fragment Swelling after Soaking in Normal Saline.

After traumatic knee injuries, chondral fragments can avulse off bone with the progeny fragment becoming a loose body. The loose fragment may be larger than expected when trying to surgically repair the fragment back to its original site. The purpose of this study was to determine whether a loose chondral fragment from the lateral femur condyle would increase in size and weight after soaking in normal saline (NS) for 14 days. Twelve 6-mm OAT (osteoarticular transfer) plugs were harvested from 6 cadaver knees on the lateral femoral condyle to simulate a chondral fragment. The chondral fragments were then placed inside an airtight specimen container with NS (0.9% sodium chloride) and were measured over 14 days. After 14 days, the chondral fragments showed no increase in diameter as they measured an average of 5.567 ± 0.448 mm on Day 1 and 5.702 ± 0.253 mm on Day 14 (P = 0.183). The chondral fragments showed an increase in mass from an average of 0.058 ± 0.012 g on Day 1 to 0.073 ± 0.012 g on Day 14 (P < 0.001) and an increase in thickness from an average of 2.038 ± 0.346 mm on Day 1 to 2.229 ± 0.297 mm on Day 14 (P = 0.033). Chondral fragments in NS increase in mass and thickness over time, but do not change in diameter. When surgeons are evaluating loose chondral fragments for fixation, they should consider that these fragments may appear thicker than the recipient location.

A spaced retraining schedule with 2-day interval improves the acquisition and retention of simulation-based basic arthroscopic skills.

To compare the effect of three differently spaced retraining schedules (1-day, 2-day, and 1-week intervals) on the acquisition of basic arthroscopic skills and skill retention after 3months. Thirty orthopaedic residents without arthroscopic experience were enrolled in a double-blind, randomised, parallel-controlled trial. Spaced retaining schedules were divided into massed training and retraining phases. Participants were required to obtain perfect scores in all tasks on the simulator in the massed training phase, followed by a pretest to evaluate the training effect. During the retraining phase, participants were randomly assigned to Groups A (1-day interval), B (2-day interval) or C (1-week interval). A posttest was used to evaluate the effect of different retraining patterns. Follow-up evaluations were conducted at 1week, 1month and 3months after the completion of spaced retraining schedules to measure skill retention. One-way ANOVA and paired-sample t tests were used for statistical analysis. Significant between-group differences in diagnostic arthroscopy (137.0 ± 24.8 vs. 140.1 ± 21.3 vs. 175.3 ± 27.4s, P(A-C) = 0.005, P(B-C) = 0.010) and loose body removal (193.1 ± 33.9 vs. 182.0 ± 32.1 vs. 228.7 ± 42.9s, P(B-C) = 0.025) completion times were observed. No significant differences were found in other posttest metrics. An assessment of skill retention after the 3-month follow-up (Evaluation 3) showed significant differences in diagnostic arthroscopy completion time (202.5 ± 53.3 vs. 172.0 ± 27.2 vs. 225.5 ± 42.1s, P(B-C) = 0.026). No significant differences were found in other Evaluation 3 metrics. The 2-day retraining schedule was the most effective for the acquisition and retention of basic arthroscopic skills and could be integrated into arthroscopic skills curricula. After a 3-month follow-up, residents who followed this schedule showed better skill retention than those who followed the 1-week interval schedule. Level I.

Stronger Magnets, No Improvements in Accuracy: Comparing Efficacy of 3-T Magnetic Resonance Imaging (MRI) vs 1.5-T MRI in Detecting Associated Lesions in Patients with Lateral Ankle Instability

Category: Ankle Arthritis Introduction/Purpose: Patients with lateral ankle instability often have other associated pathologies, including osteochondral lesions of the talus (OLT), peroneus brevis tears, and intra-articular loose bodies. If left untreated, these pathologies can lead to worsening instability, significant ankle pain, and progressive osteoarthritis. Arthroscopy has historically been the gold standard for diagnosing and treating these abnormalities, while magnetic resonance imaging (MRI) can be useful in preoperative evaluation and planning. Our group’s previous research evaluated a subset of the current sample, focusing on MRI diagnostic accuracy of OLTs, demonstrating that 3-T outperformed 1.5-T. Using a larger sample size, the purpose of this study is to assess the efficacy of 3-T MRI and 1.5-T MRI in diagnosing additional pathologies in patients undergoing Broström Gould procedure for lateral ankle instability. Methods: Following institutional review board approval, a database was obtained for all patients at a single institution who underwent a Broström Gould procedure with a concurrent diagnostic arthroscopy of the tibiotalar joint between 1/1/2014- 6/30/2022. Additionally, patients required a pre-operative ankle MRI for inclusion in the study. Patients who did not undergo a preoperative MRI, diagnostic arthroscopy, and Broström Gould procedure were excluded from the study. Additionally, patients with pre-operative MRIs in which the field strength could not be determined were also excluded from analysis. Patient charts were reviewed to determine the field strength of the preoperative MRIs, the efficacy of 3-T and 1.5-T MRIs in correctly identifying the presence or absence of OLTs, peroneus brevis tears, loose bodies, os trigonum, medial malleolus fractures, lateral malleolus fractures, and posterior impingement lesions. Intraoperative diagnostic arthroscopy findings were utilized as a reference standard. Results: One hundred twelve patients met our inclusion criteria of undergoing preoperative MRI with identifiable field strength, Broström Gould procedure, and diagnostic arthroscopy of the tibiotalar joint. The average age was 35.73 ± 21.01 years; 65 (58.0%) patients were female. Fifty-six (50.0%) patients had a preoperative 3-T MRI and 56 patients had a preoperative 1.5-T MRI. There were no differences observed regarding demographic data between groups. Fifty-one OLTs, 12 peroneus brevis tears, 14 loose bodies, two os trigonum, two medial malleolus fractures, two lateral malleolus fractures, and one posterior impingement lesion were identified in our sample (Figure 1A). Three tesla MRI test characteristics did not significantly differ from the test characteristics of 1.5-T MRI (Figures 1B, 1C). Conclusion: The sensitivity, specificity, and overall diagnostic accuracy of 3-T MRI compared against 1.5-T MRI did not significantly differ regarding each imaging modalities’ efficacy in identifying OLTs, peroneus brevis tears, loose bodies, os trigonum, medial and lateral malleolus fractures, and posterior impingement lesions. These findings demonstrate no significant improvement in the diagnostic accuracy of 3-T MRI over 1.5-T MRI in identifying pathologies associated with lateral ankle instability. While many lesions were correctly identified by both modalities, patients will continue to benefit from undergoing intraoperative arthroscopy to determine the most accurate diagnosis regarding their ankle instability.

Arthroscopic loose body removal following anterior-superior hip dislocation due to low-impact trauma—a case report

Arthroscopic loose body removal following anterior-superior hip dislocation due to low-impact trauma—a case report

Weight-Bearing CT with Maximum Ankle Dorsiflexion to Identify Impingement and Tibial Plafond Stress Fracture: A Case Report.

A 25-year-old male pole vaulter presented with several months of right ankle pain. Radiographs showed an anterior tibial osteophyte with a small intra-articular body suggesting impingement. Weight-bearing computed tomography (CT) revealed an associated tibial plafond stress fracture. Subsequent arthroscopy with osteophyte resection and loose body removal significantly improved symptoms, and he gradually resumed training. Stress fractures should always be considered in athletes with ankle pain. A unique aspect of this case was the use of weight-bearing CT in diagnosis and surgical planning. To our knowledge, this is the first described case in which weight-bearing CT was used in this fashion.

Evaluating the utility of post-reduction imaging for simple hip joint dislocations: Is computed tomography always necessary?

IntroductionFollowing closed reduction of hip dislocations, computed tomography (CT) is considered standard of care to identify occult fractures or intra-articular loose bodies that may be missed on X-ray. The purpose of this study was to evaluate the sensitivity of post-reduction X-rays and the usefulness of subsequent post-reduction CT imaging. MethodsAll patients presenting to our hospital system for traumatic hip dislocations from 2013 to 2022 were retrospectively reviewed. Participants were included if they had a simple dislocation of a native hip, underwent closed reduction, and received post-reduction X-ray and CT imaging. A sensitivity analysis was performed for the detection of associated fractures and intraarticular loose bodies by post-reduction X-ray, using CT as a reference standard. ResultsThirty-five subjects with a mean age of 26 years were included. Post-reduction CT revealed 6 fractures and 3 loose bodies, whereas post-reduction X-ray identified 3/6 (50%) fractures and 3/3 (100%) loose bodies. Four cases received operative management, all of which were identified by X-ray. Post-reduction X-ray had a sensitivity of 67% for identifying pathology that was subsequently found on CT, and a sensitivity of 100% for identifying pathology requiring surgery. Of the 13 cases with pre-reduction CT scans, none had new findings identified on post-reduction CT. ConclusionsPost-reduction X-rays are effective in the evaluation of acute pathology associated with closed reduction of traumatic hip dislocations, especially for cases requiring operative management. Our findings suggest that if a fracture or loose body was not identified on post-reduction X-ray, a post-reduction CT added no value in surgical decision-making and was not necessary.

Giant Synovial Chondromatosis of the Shoulder: The Limits of Arthroscopic Treatment and Technical Tips

Synovial chondromatosis (SC) is a rare disease. It is a chondrocytic metaplasia and is characterized by the presence of cartilaginous loose bodies in the involved joint, bursa or tendon sheath, it occurs most often in those aged 30_50 years and 3 times more in males than females, The shoulder is an exceptional location. It causes significant functional disability in young people. The clinical presentation is not specific, and the diagnosis is based on MRI. Confirmation is still anatomopathological. Classically, the mainstay treatment for SC of the shoulder has been open arthrotomy and removal of loose bodies, followed by either complete or partial synovectomy, removing the affected tissue, with recent advances in arthroscopic techniques and methods, arthroscopy becomes the gold standard. We present this case report of a 26-year-old man, who was left-hand dominant, a maintenance technician, amateur football player presented a left shoulder inflammatory pain; ; plain radiography demonstrated multiple calcific densities over the glenohumeral joint , the MRI showed multiple calcified intra-articular loose bodies around the anterior and posterior joint and axillary recess ; At arthroscopy, a large number of loose bodies were observed together with marked synovitis ,it only allowed the removal of small foreign bodies &lt; 1 cm, partial synovectomy was performed with a shaver ; anatomopathological examination confirmed the diagnosis of sc. the extraction of giant fragments &gt;2 cm was impossible so it was subsequently removed by open surgery. This was carried out one month later using a delto-pectoral approach: all foreign bodies &gt; 1 cm were successfully extracted. We report this case report in order to review the role of shoulder arthroscopy and magnetic resonance imaging (MRI) in diagnosis and treatment and to highlight the operative difficulties, technical tips of arthroscopic extraction of giant Synovial chondromatosis of the shoulder.

Retrospective study of synovial chondromatosis of the temporomandibular joint: clinical and histopathologic analysis and the early-stage imaging features

Herein, we aimed to study the clinical, radiographical, and histopathologic features of synovial chondromatosis in the temporomandibular joint (SC in TMJ) and provide references for early diagnosis and treatment prognosis. The medical records and imaging examinations of patients with SC in TMJ, diagnosed using postoperative histopathologic examination, were reviewed and analyzed. Among them, 18 cases who lacked calcified loose bodies on spiral computed tomography or cone beam computed tomography (SCT/CBCT) were selected for further study. Descriptive statistical methods were used to analyze the clinical characteristics of patients. The study included 100 patients with SC in TMJ, who were predominantly female (male to female: 1:3), and were aged from 21 to 77 years (median, 47). Radiopaque calcified lesions on SCT/CBCT were missing in 18 cases, but cartilaginous nodules were observed during surgery. The cases lacking calcification had a relatively shorter disease course, suggesting they were in the early stages of SC. In the early stage of SC, although calcified loose bodies cannot be detected on SCT/CBCT, attention should be paid to the widening of the posterior superior joint space and sclerosis or slight erosion of the joint fossa. Magnetic resonance imaging would be helpful to detect the early-stage SC in TMJ.

Evolution law and transformation mechanism of force chains in the flow of photoelastic particles under a flexible barrier

The essence of large deformation flow in loose geological bodies lies in the breaking and rebuilding of force chains at the microscopic scale. Therefore, it is crucial to investigate force chains during particle flow processes. This study focuses on particle flow during the ore drawing process, develops a photoelastic experiment model, investigates the evolution law of force chains, reveals the transformation mechanism of strong and weak force chains, and provides insights for removing particle blockage in mining engineering. The results show that strong force chains are primarily located on both sides of the model, with fewer numbers, and extend toward the side boundaries in a direction close to 70°. Weak force chains are predominantly distributed in the middle section of the model, with numerous and uniformly developed directions. In addition, under the effects of self-organization and hetero-organization, the particles' sliding and rolling cause the buckling of force chains and the rearrangement of particles, resulting in the transformation between strong and weak force chains and accelerating the particles' flow. The research results deepen the understanding of the granular material large deformation flow-slip problem and provide a reference for similar engineering analyses.

Localised tenosynovial giant cell tumour of the infrapatellar fat pad mimicking an intra-articular loose body – A case report

Tenosynovial giant cell tumour is a benign lesion which presence in the infrapatellar fat pad is uncommon. Herein, we report a unique case of a young female patient who presented with a loose body sensation at the knee. Surgery revealed a localized swelling in the infrapatellar fat pad which was treated with an open excisional biopsy of the mass. Diagnosis of giant cell tumour is confirmed by histopathological examination.

KNEE ARTHROSCOPY: SHOULD KNEE ARTHROSCOPY SIMULATION BE PART OF THE TRAINING CURRICULUM IN THE UK?

AbstractIntroductionKnee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons.MethodsAt a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centering and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies, and meniscectomy. Pre and post-experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement.ResultsComparing pre and post-experience questionnaires significant improvements in levels of confidence were noted in the following domains: naming arthroscopic instruments, port positioning and insertion, recognising normal anatomy arthroscopically, holding and using arthroscopic instruments and assisting in a live theatre setting (p&lt;0.05). Significant improvements were noted in time taken to complete, distance covered in metres and roughness of instruments used on the simulated exercises on repeat performance (p&lt;0.05).ConclusionWith only five sessions under senior guidance, using a simulator such as the ARTHRO Mentor, significant improvements in both levels of confidence and skill can be developed even among individuals with no prior experience.

X-RAY IDENTIFIED LIPO-HAEMARTHROSIS IN THE ACUTELY INJURED KNEE IS A POOR PREDICTOR OF THE PRESENCE OF INTRA-ARTICULAR FRACTURE OR THE NEED FOR URGENT SURGERY

AbstractIntroductionA lipohaemarthrosis seen on Horizontal beam lateral X-ray in acute knee injury is often considered predictive of an intra-articular fracture requiring further urgent imaging.MethodologyWe retrospectively searched a five-year X-ray database for the term “lipohaemarthrosis”. We excluded cases if the report concluded “no lipohaemarthrosis” or “lipohaemarthrosis” AND “fracture”. All remaining cases were reviewed by an Orthopaedic Consultant with a special interest in knee injuries (AD) blinded to the report. X-rays were excluded if a fracture was seen, established osteoarthritic change was present, a pre-existing arthroplasty present or no lipohaemarthrosis present. Remaining cases were then studied for any subsequent Radiological or Orthopaedic surgical procedures.Results136 cases were identified and reviewed by an Orthopaedic Consultant. 31 were excluded for no lipohaemarthrosis (n= 11), for degenerative change (n=9), for fracture (n=4), for existing arthroplasty (n=4) and for data errors (n=3). The remaining 105 patients had a mean age of 32, and range 5–90 years. 66 patients underwent further imaging in the form of MRI scan (n=47), CT Scan (n=9) repeat x-rays (n=9) and ultrasound (n=1). 27 fractures were identified.Surgery was performed in 12 cases (11%). Two (2%) urgently (One ACL reconstruction plus meniscus repair, one for ORIF of tibial plateau fracture). Ten (10%) had elective surgery (6 for ACL reconstruction, 2 for ACL reconstruction plus meniscus repair, 2 for loose body removal.ConclusionThe presence of a lipohaemarthrosis on x-ray following acute knee injury was a poor predictor of intra-articular fracture (26%) or need for urgent surgery (2%).

Diagnosis and management of temporomandibular joint synovial chondromatosis: A systematic review

The aim of this study was to systematically review the diagnosis and management of temporomandibular joint synovial chondromatosis (TMJ-SC). Using a systematic study design based on the PRISMA guideline, the researchers implemented and analyzed a cohort of relevant publications indexed by PubMed, Embase, Medline, and LILACS between January 1990 and December 2022. The outcomes of interest were demographics of the primary studies, and Clinical, radiological, and therapeutic data associated with TMJ-SC. The study samples included 8 studies presenting 121 TMJ-SC cases (73.6% female; 100% unilateral; 53.7% left-sided; mean age, 43.3 ± SD 5,80 [range, 21–81]. Non-specific symptoms were mostly reported, including TMJ pain, noise and local inflammation, and/or malocclusion. Radiographically, loose bodies, masses with low-signal foci, and calcification were common charateristics. Until now, there has been no internationally accepted consensus on diagnosis and management of TMJ-SC. Arthroscopic surgery should be performed on masses confined to the superior TMJ space, while open arthroplasty is indicated in cases with the extra-articular extension. A combination of both treatment methods may be necessary, when the lesion locates extending beyond the medial groove of the condyle.

Arthroscopically assisted internal fixation for treatment of acute ankle fracture: A systematic review and meta-analysis of comparative studies.

Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult intra-articular lesions, and treatment of traumatic intra-articular pathologies. The aim of this systematic review and meta-analysis was to provide evidence on whether ARIF is an alternative treatment protocol for ankle fractures. The PubMed, Embase, and Cochrane Library databases were searched independently by two investigators from the inception dates to October 9, 2022, for comparative studies. The risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials and the methodological index for non-randomized studies (MINORS) were used for assessing the methodological quality. Outcomes were evaluated in terms of the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, post-operative complications, arthroscopic findings, Visual Analogue Scale (VAS) score, and operation time. Cochrane Review Manager Software 5.4 was used to perform the statistical analysis. A total of 10 trials involving 755 patients were included in this meta-analysis. The results revealed that ARIF for ankle fractures was superior regarding functional outcomes and VAS scores when compared with open reduction and internal fixation (ORIF). No significant difference was noted in the post-operative complication rate and the operation time between the ARIF and ORIF groups. A high incidence of chondral or osteochondral lesions (OCLs), ligamentous injuries, and loose bodies with ankle fractures was found by ankle arthroscopy. ARIF for ankle fractures might be beneficial to offer superior functional outcomes and VAS score than ORIF. Orthopedic surgeons should take a high incidence of OCLs and ligamentous injuries into consideration for the treatment of acute ankle fractures. We believe that with the increase in surgical experience, the occurrence of post-operative complications and the extension of operation time will no longer be a potential concern for surgeons.

Arthroscopic management of recurrent synovial chondromatosis of the hip: a case report.

Here the authors report a case of eighteen years lady with recurrent hip synovial chondromatosis who was treated previously with hip arthrotomy and loose bodies removal and now she underwent arthroscopic loose bodies removal with partial synovectomy. In comparison to arthrotomy of the hip, arthroscopic management is a minimally invasive surgery that is associated with decreased postoperative pain, earlier improvement in range of motion, a shorter course of rehabilitation, and overall lower morbidity. Thus, the authors recommend arthroscopic removal of the loose bodies and partial synovectomy for the management of synovial chondromatosis of the hip.

Role of Ultrasonography in The Diagnosis of Knee Joint Lesions

Introduction: Ultrasound can provide clinically useful information on a wide range of pathologic conditions affecting components of the knee joint, including the tendons, ligaments, muscles, synovial space, articular cartilage, nerves and surrounding soft tissues. The advantages of ultrasound include low cost, portability, real-time assessment, and facilitated side-by-side comparisons. The aim of the study was to study the various pathological conditions of painful knee joint by using ultrasound for early diagnosis and prompt therapeutic approach and to evaluate the osteoarthritic changes in the painful knee joint by ultrasound. Materials and Methods: This is a prospective observational study conducted in the Department of Radiology and Orthopedics&amp; trauma surgery, National Medical College &amp; teaching hospital, Birgunj, Parsa, Nepal for the 6 months duration, patients presented with knee joint pathology including swelling, and pain.Patients included in this study was above 20 years with unilateral (single) knee joint pain. With ethical clearance from the Institutional Review Committee of National Medical College and after obtaining the informed consent of the patient, prospective observational study was conducted. All ultrasound assessments were performed using the same machine with a 9 MHz linear transducer of GE Logiq P7 USG machine. A30–45-degree flexion of the knees was standardized by using the same wedge for all ultrasound assessments. Results: This study included 40 symptomatic patients with knee joints pain included in this study. In 40 patients 19 were females (47.5%) and 21 males (52.5%), with ages ranged from 20 to 70 years. Ultrasound findings showed joint effusions in 25 (62.5 %) as most common finding in painful knees,synovial thickening in 17 (42.5 %) knees, Synovitis in 14 (35.0%) and tendinopathy seen in only 1 (2.5%) knee joint pain. Osteoarthritis such as narrow joint space in 4 (10%) knees, marginal osteophytes in 4 (10%) knees, loose bodies in 3 (7.5%) knees, Baker’s cyst in 1 (2.5%) knee. Most common involved age group is 51-60 years with 17 cases followed by 41-50 years in 11 cases. Conclusion: Ultrasound is a simple and reproducible technique for the assessment of knee joint effusion, synovial changes and osteoarthritis related changes.

Synovial chondromatosis of the temporomandibular joint

When cartilage-like tissue is present in the synovial membrane of joints, it is known as synovial chondromatosis (SC). The main cause is believed to be the metaplasia of embryonal mesenchymal tissue in the synovial membrane. The metaplastic foci grow within the joint space and can detach from the synovial wall, forming free-floating bodies. While SC is more commonly associated with trauma in the temporomandibular joint (TMJ), the exact relationship between trauma and SC remains unclear. Improved diagnostic techniques, such as CT and MRI, have led to increased recognition of SC in the TMJ. Gender differences in the prevalence of TMJ SC have been observed, with women being more affected. Diagnosis involves imaging techniques like X-rays, CT scans, MRIs, and surgical removal of loose bodies is the preferred treatment. Arthroscopy is recommended for small, isolated loose bodies, while open surgery may be necessary for complete removal. Long-term follow-up is essential to monitor for recurrence. Histopathological findings reveal a mixture of cartilage and bone, with ossification and calcification present.

Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum.

Osteochondritis dissecans of the capitellum is debilitating and is a potentially sports career-ending injury in a young and athletic population. Osteochondritis dissecans typically occurs in patients between the ages of 10 and 24 years, and boys are more commonly affected than girls. Conventional radiographs have low diagnostic accuracy, and magnetic resonance imaging (with or without contrast) or computed tomography may aid in accurate diagnosis. The primary indication for non-operative treatment is the presence of an intact cartilage cap on magnetic resonance imaging, indicating a "stable lesion." However, if operative treatment is necessary, various surgical procedures are available when operative treatment for an osteochondritis dissecans of the capitellum is considered, including open or arthroscopic removal of loose bodies, with or without microfracturing, fragment fixation, osteochondral autograft transplantation, and osteochondral allograft transplantation. The decision-making process for selecting the appropriate treatment considers factors such as the patient's characteristics, functional limitations, and lesion morphology.

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

Background: High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are well-recognized treatments to address varus and valgus malalignment, respectively, in the setting of symptomatic unicompartmental arthritis of the tibiofemoral joint. The existing literature is limited in its ability to characterize complications after HTO or DFO procedures. Purpose: The objective of this study was to determine the rate of early (≤90 days) postoperative complications and associated variables from the 15-year experience of a single academic institution. Study Design: Case series; Level of evidence, 4. Methods: Patients treated at a single academic institution between 2008 and 2022 who underwent HTO or DFO procedures were identified. All patients with minimum 90-day follow-up were considered for inclusion in the study. Exclusion criteria were inadequate follow-up, unavailable medical records, age <14 years, and revision osteotomy. Patient demographic characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. All intraoperative complications were recorded. Results: A total of 243 knees in 232 patients met eligibility and were included in the final analysis. Three intraoperative complications (1.2%) involving fracture extension of the osteotomy occurred. There were 127 early postoperative complications (121 surgical, 6 medical) in 102 knees (68 with HTO and 34 with DFO). Medical complications included pulmonary embolus in 3 patients (1.2%), urinary tract infection in 2 patients (0.8%), and postoperative ileus requiring prolonged hospitalization in 1 patient (0.4%). The most common complications were stiffness requiring a non–standard of care intervention (17.7%), superficial wound infection or wound dehiscence (13.2%), and hemarthrosis or effusion requiring aspiration (6.6%). The rate of deep infection requiring irrigation and debridement was 4.1%. Variables associated with early postoperative complications included smoking (odds ratio [OR], 3.05; 95% CI, 1.34-6.94; P = .008), concomitant chondroplasty and/or loose body removal (OR, 2.55; 95% CI, 1.50-4.33; P = .001), and concomitant ligament reconstruction (OR, 3.97; 95% CI, 1.37-11.53; P = .011). Conclusion: These 15-year data revealed a low rate of intraoperative complications (1.2%) and a relatively high rate of early (≤90 days) postoperative complications (42.0%) after an HTO or DFO procedure. Surgeons should be aware of the increased postoperative complications associated with smoking, concomitant chondroplasty, and concomitant ligament reconstruction and should use this information to counsel patients regarding appropriate expectations in the postoperative period.