Loose Bodies Research Articles

Rescuing the knee: arthroscopic extraction of a long-neglected glass fragment: a case report

The knee joint frequently encounters penetrating injuries and has ample space to harbor foreign objects. While foreign bodies in the knee joint are unusual, especially those not originating from surgical procedures, extensive literature exists on the extraction of loose bodies and metallic objects from this articulation. However, documentation on uncommon intruders remains scarce. This case study delves into the experience of a 22-year-old male who suffered persistent pain due to a neglected foreign object in his knee joint. After its removal, a complete resolution of symptoms was achieved. It highlights the importance of prompt arthroscopic intervention for optimal outcomes. Here we present a unique case involving a 22-year-old male who underwent arthroscopic retrieval of a neglected glass fragment from his knee joint. The patient sought medical attention five months after the initial injury due to sudden and severe pain onset. Arthroscopy stands as the favored minimally invasive method for extracting foreign bodies from the knee joint, especially from its deeper and less accessible regions. Utilizing pre-operative radiological imaging enhances understanding of the anatomical placement, facilitates surgical orientation, and reduces operation time. A keen sense of suspicion and thorough history-taking are crucial in achieving an accurate diagnosis.

Real-time monitoring of urban roadway health: Utilizing GPR techniques for the early detection and classification of subsurface cavity diseases

The effectiveness of ground penetrating radar (GPR) in identifying and categorizing diseases that occur underground beneath the surfaces of urban roads is investigated in this study. Both 2D and 3D forward modeling use simulation with the GprMax program to show the response characteristics of common cavity illnesses, which facilitates interpretation in practical situations. The cavity morphology classification accuracy is improved to 90.5% by using convolutional neural networks (CNNs), specifically transfer learning with AlexNet. This method outperforms existing approaches even with minimal data. Four primary types are identified from an analysis of 1965 subsurface cavity data: hollow bodies, empty bodies, loose bodies, and water-rich bodies. These categories are important for evaluating road risks such as voids and subsidence. However, it is still difficult to interpret picture features linked to cavity diseases accurately because of a variety of elements, such as anthropogenic, environmental, and geological influences. However, the accurate interpretation and recognition of image features related to cavity diseases remain challenging. Moreover, there are various factors involved in the formation of underground diseases and cavities, including geological and environmental factors, physical and chemical properties of the geotechnical materials, anthropogenic engineering activity and social population or commercial effects.

Femoral head and acetabular necrosis combined with hip subluxation in people with HIV: a case report and literature review

IntroductionHIV is widely prevalent in all regions of the world. The use of antiretroviral drugs has dramatically reduced the mortality rate of HIV-related diseases, but correspondingly increased the incidence of chronic complications in HIV-positive people. Related studies have found that the incidence of osteonecrosis of the femoral head is higher in HIV-positive people, but the co-occurrence of femoral head necrosis, acetabular necrosis and hip joint dislocation in HIV-positive patients is rare.MethodsWe report a 50-year-old man with a 15-month history of progressively worsening right hip pain with movement restriction. According to the CT findings of the other hospital, the patient was admitted to the hospital with femoral head necrosis. After the admission, the relevant X-ray, CT and MRI examinations showed that the right femoral head collapsed and deformed, with the surrounding bone sclerosis, bone fragments, loose body of the joint, right hip subluxation, acetabular marginal osteogeny, and local microcystic degeneration. The left femoral head was in good shape, and cystic degeneration can be seen under the articular surface. The patient was finally diagnosed with femoral head necrosis and acetabular necrosis combined with hip subluxation.ResultsThe pain of the patient was significantly relieved after the operation, and the patient was discharged from the hospital one week after the start of treatment to continue rehabilitation training. During the follow-up one month after the operation, the self-reported pain disappeared completely, and the limitation of activity was significantly improved.

Neuromechanisms of simulation-based arthroscopic skills assessment: a fNIRS study.

The neural mechanisms underlying differences in the performance of simulated arthroscopic skills across various skill levels remain unclear. Our primary objective is to investigate the learning mechanisms of simulated arthroscopic skills using functional near-infrared spectroscopy (fNIRS). We recruited 27 participants, divided into three groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). Participants completed seven arthroscopic tasks on a simulator, including diagnostic navigation, triangulation, grasping stars, diagnostic exploration, meniscectomy, synovial membrane cleaning, and loose body removal. All tasks were videotaped and assessed via the simulator system and the Arthroscopic Surgical Skill Evaluation Tool (ASSET), while cortical activation data were collected using fNIRS. Simulator scores and ASSET scores were analyzed to identify different level of performance of all participants. Brain region activation and functional connectivity (FC) of different types of participants were analyzed from fNIRS data. Both the expert and intermediate groups scored significantly higher than the novice group (p < 0.001). There were significant differences in ASSET scores between experts and intermediates, experts and novices, and intermediates and novices (p = 0.0047, p < 0.0001, p < 0.0001), with the trend being experts > intermediates > novices. The intermediate group exhibited significantly greater activation in the left primary motor cortex (LPMC) and left prefrontal cortex (LPFC) compared to the novice group (p = 0.0152, p = 0.0021). Compared to experts, the intermediate group demonstrated significantly increased FC between the presupplementary motor area (preSMA) and the right prefrontal cortex (RPFC; p < 0.001). Additionally, the intermediate group showed significantly increased FC between the preSMA and LPFC, RPFC and LPFC, and LPMC and LPFC compared to novices (p = 0.0077, p = 0.0285, p = 0.0446). Cortical activation and functional connectivity reveal varying levels of activation intensity in the PFC, PMC, and preSMA among novices, intermediates, and experts. The intermediate group exhibited the highest activation intensity.

Hybrid Fixation for Large Unstable Juvenile Osteochondritis Dissecans Lesions: Midterm Results in Adolescent Patients With Completely or Partially Salvageable Progeny Fragment.

This study aimed to describe the midterm clinical and radiographic outcomes of a hybrid fixation technique (HFT) combining interfragmentary compression with screws and biological support provided by the osteochondral autograft transplantation system (OATS) for treating large unstable juvenile osteochondritis dissecans (JOCD) lesions involving the knee in patients aged ≤18 years. Thirteen patients (15 knees, 9 males) with unstable JOCD lesions in the knee underwent treatment. HFT was indicated for lesions that had a completely salvageable (N=10) or partially salvageable progeny fragment (N=5). Patients were evaluated at a minimum follow-up of 1 year. The mean age of the patients was 15.3 years (range, 11 to 18y), with 10 lesions involving the medial femoral condyle and 5 involving the lateral femoral condyle. The mean lesion area were 397.7mm2. The outcome measures included the Pedi-IKDC and Tegner activity scales. Radiographic evaluation consisted of assessing osteochondral graft integration using the MOCART score on MRI and determining the degree of osteoarthritis using the Kellgren-Lawrence system (KL). At a mean follow-up of 51 months (range, 12 to 143mo), the mean Pedi-IKDC and Tegner activity scale were 90.1±7.2 and 94.7±6.7 points, respectively. Patients with unilateral lesions resumed sports activities on average after 7.7 months (range, 6 to 12mo). All patients exhibited progeny fragment integration on MRI, with a mean MOCART score of 85±6.5 (range, 75 to 95). Radiographs indicated grade 1 KL joint space in 13 knees and grade 2 in 2 knees. At the last follow-up, 12 patients were asymptomatic, whereas 1 patient experienced occasional mild discomfort during intense physical activity. Six patients required additional surgery for hardware removal, and 1 patient underwent intra-articular loose body removal. The hybrid fixation technique showed promising outcomes in terms of fragment healing and midterm results for unstable JOCD lesions. These findings suggest that HFT can be considered a valid treatment option for large unstable lesions involving the femoral condyles of the knee in adolescents. Therapeutic study (level of evidence IV).

Osteoarthritis of Proximal Radioulnar Joint: Computed Tomography-Based Assessment and Associations with Clinical Findings.

Although many studies have focused on the degenerative changes of the ulnohumeral and radiohumeral joints in osteoarthritis (OA) of the elbow, the proximal radioulnar joint (PRUJ), which facilitates the pronation and supination motions of the forearm, has not been comprehensively evaluated. To assess the prevalence of PRUJ OA in patients diagnosed with OA of the elbow using computed tomography (CT) images and to establish an association between the CT findings and clinical manifestations. Cross-sectional study; Level of evidence, 3. Between 2010 and 2022, a total of 85 consecutive patients who were scheduled to undergo osteocapsular arthroplasty for OA of the elbow and had undergone preoperative CT imaging were included in the study. As a control group, 85 patients who underwent CT scans of the elbow for reasons other than OA of the elbow were selected and matched to patients in the OA group. CT findings of OA in the PRUJ, including osteophytes, joint space narrowing, subchondral cysts, and loose bodies, were evaluated. Inter- and intraobserver agreement analyses for CT findings were performed. The relationship between the CT findings of OA in the PRUJ and OA of the elbow classification systems (Broberg-Morrey, Hasting-Rettig, and Kwak) as well as clinical manifestations (range of motion [ROM], Mayo Elbow Performance Score, and visual analog scale for pain) were evaluated. Patients in the OA group showed osteophytes in the radial notch (81.2%), osteophytes in the radial head (45.9%), joint space narrowing (54.1%), loose bodies (25.9%), and subchondral cysts (23.5%) involving the PRUJ. Both the interobserver (κ = 0.866) and intraobserver agreements (κ = 0.933) for CT findings of PRUJ OA were almost perfect. The CT findings of PRUJ OA were associated with the severity of OA of the elbow in Cochran-Armitage Trend analysis (with Brogberg-Morray, r = -2.624, P = .011; with Hasting-Rettig, r = -3.421, P = .002; with Kwak, r = -2.266, P = .032). The presence of radial notch osteophytes restricted ROM in the flexion-extension arc and pronation-supination arc (P = .009 and P < .001, respectively). PRUJ OA could be identified using CT imaging and showed radial notch osteophytes, joint space narrowing, loose bodies within the joint space, and subchondral cysts. PRUJ OA was related to overall OA of the elbow and may contribute to reduced ROM in the elbow joint. Therefore, preoperative evaluation of PRUJ OA can aid in the surgical planning of osteocapsular arthroplasty for OA of the elbow.

Rectal endoscopic full-thickness resection of peritoneal loose body.

Rectal endoscopic full-thickness resection of peritoneal loose body.

Clinical guidance based on MRI for the management of temporomandibular joint synovial chondromatosis: One institution's experience

The aim of this retrospective observational study was to introduce a comprehensive MRI evaluation criterion for the clinical management of synovial chondromatosis of the temporomandibular joint (TMJ-SC). Patients received different treatments according to the MRI evaluation system: bone erosion, extent, articular disc condition, location, maturity, and size of loose body. At least a 2-year follow-up was completed to assess tumor recurrence, visual analogue scale score for pain (VAS) and maximum interincisal opening (MIO). Of the 195 patients included for TMJ-SC, 34 received arthroscopy and 161 received open surgery. Among the patients with significant extent of SC, 32 received temporary resection of the condylar neck or zygomatic arch and 2 received treatment combined with ear, nose and throat(ENT). 28 received articular disc reconstruction and 56 received disc repositioning. Patients showed good recovery of joint function with only two cases of tumor recurrence at an average follow-up of 75.1 months after surgery. The MIO had improved from 30.2 mm to 40.0 mm(P < 0.0001) and VAS had decreased from 5.1 to 0.78(P < 0.0001).The preoperative MRI evaluation principles has been effective in selecting appropriate surgical options.

Hip Arthroscopy After Total Hip Arthroplasty Is Rare (0.04%) and May be Contralateral

PurposeThe purpose of this study was to determine the patient demographics and incidence of hip arthroscopy after total hip arthroplasty using the PearlDiver database. MethodsThis is a retrospective study of patients undergoing total hip arthroplasty and arthroscopic hip surgery. The PearlDiver Claims Database was queried using CPT codes for records from 2010-2021. Inclusion criteria were presence of a hip arthroplasty CPT code, followed by a hip arthroscopy CPT code. Additional data collected included age, gender, and time between surgeries. A sub-analysis for ICD9/10 codes was completed to estimate association with iliopsoas tendinitis. ResultsQuery of the database showed that 314 patients had a hip arthroscopy code after a hip arthroplasty code. 0.04% of patientswho underwent arthroplasty subsequently underwent arthroscopy. 63.4% were female. Mean age was 58.2 ± 12.2 years at time of arthroscopy. 214 (72.3%) patients had a CPT code for synovectomy, 56 (18.9%) for loose body removal, and 44 (15.3%) for diagnostic arthroscopy. The mean time from arthroplasty code to arthroscopy code was 2.5 ± 2.0 years. 105 patients (33.4%) also had an ICD 10 diagnosis code for iliopsoas tendinitis and 116 (36.9.0%) had the ICD 9 code for enthesopathy of hip. ConclusionIn this limited study, we found that hip arthroscopy after hip arthroplasty is uncommon but occurs more frequently in female patients, is undertaken in a broad age range of patients, and is often associated with a diagnosis of iliopsoas or hip tendinitis. Level of Evidence: Level IV, Retrospective Case Series

EVALUATION OF CLINICAL RESULTS OF SURGICAL RESECTION OF SYNOVIAL OSTEOCHONDROMATOSIS IN THE SHOULDER: A RETROSPECTIVE STUDY

Synovial osteochondromatosis of the shoulder is a rare condition and its details remains unclear. Aim of this study was to evaluate the clinical results of surgical resection and histopathological characteristic of SOC of the shoulder. Ten shoulders with SOC were retrospectively assessed for demographic characteristic, history of trauma, presence of osteochondral loose bodies, inferior humeral osteophytes and acromial spurs. Visual analog scores for pain and functional scores using Constant scores were compared pre and post operatively. Resected lesions were histo-pathologically differentiated between primary and secondary SOC. The average age of patients was 39.8+/- 15.7 year; four female and six patients was male in our study. Average duration of symptoms was 11.5+/-8.11 months. Three shoulders has osteochondral lesion in subacromial space (30%) and seven in glenohumeral joint (70%). Five shoulders (71%) show inferior humeral osteophytes out of seven shoulders with lesion in glenohumeral joint. All three shoulder (100%) with SOC in the subacromial space had spur formation. One shoulder have primary SOC while other nine had secondary SOC. Average Visual analog scale pain score graded from 0 (no pain) to 100 mm( maximal pain) was 47.5+/-11.32 mm. The Constant score was improved from preoperative score 51.6+/-8.34 points to postoperative score 78.7+/-11.62. No case show recurrence of new loose bodies, acromial spur and inferior humeral osteophytes. Our study showed that resection of SOC successfully relieved the pain and clinical symptoms. Primary SOC is less common than secondary SOC and histopathological identification is needed to differentiate between both types. Thus further investigations required to determine long term prognosis SOC in the shoulder. KEYWORDS: osteochondromatosis, shoulder joint, synovium

Synovial chondromatosis of the shoulder: A rare case report

Synovial chondromatosis is a monarticular svnovial proliferative disease in which cartilaginous or osteocartilaginous metaplasia occurs within the synovial membrane of joints, bursae or tendon sheaths. The disease has been classified into three phases. 1: Early: with svnovial chondrometaplasia but no loose bodies; 2: Transitional: with active svynovial disease and loose bodies; 3: Late: With loose bodies but no synovial disease.Cartilaginous metaplasia from joint, tendo, or bursal synovial lining differentiates this entity from loose bodies arising from degenerative arthritis, osteochondritis dissecans. and osteochondral fractures. A 54 Year Hindu male presented to the orthopaedic OPD with complains of pain and swelling in left shoulder which was insidous in onset, gradually progressive in nature and not relieved by medications. Patient also complained of clicking noise during shoulder movements which was insidous in onset and gradually progressive in nature. Synovial chondromatosis is a synovial lesion seen generally in adults with a male predominance. It occurs most commonly in the knee, unsually also occuring at the hand, wrist, elbow and shoulder. It can lead to mechanical symptoms, decreased range of motion and effusion. Histopath shows nodules of moderately cellular hyaline cartilage. D/D can include Myositis Ossificans, Synovial Chondrosarcoma and Synoval Sarcoma. Treatment is usually observation if asymptomatic. It symptomatic, then arthroscopic or open synovectomy can be done, arthroscopy increases chances of recurrence.

A rare case of giant peritoneal loose body: A case report

Peritoneal loose bodies (PLBs) are uncommon abdominal lesions, typically asymptomatic and discovered incidentally during surgery. Giant PLBs, exceeding 5 cm in size, are even rarer and can present with clinical symptoms mimicking other abdominal pathologies. We present a 57-year-old male with a giant PLB presenting as intermittent abdominal pain, distention, and rectal bleeding. Imaging studies suggested colo-colic intussusception due to a colonic lipoma. The patient underwent an exploratory laparotomy revealing a segment of the descending colon containing multiple lipomas, one causing intussusception. In addition, a separate giant PLB 6 × 5.5 cm with central calcification was identified. A segmental colectomy with primary anastomosis and resection of the PLB was performed. The patient recovered well and reported complete resolution of symptoms at follow-up. Pathology confirmed a benign lipoma and a giant PLB. This case highlights the potential for giant PLBs to cause clinical symptoms and emphasizes the importance of including them in the differential diagnosis of abdominal complaints, even in the absence of a classic presentation. Exploratory laparotomy remains a definitive approach for diagnosis and management in such cases.

Longitudinal Assessment of Clinical Outcomes After Arthroscopic Treatment for Hip Synovial Chondromatosis and the Effect of Residual Loose Bodies: Minimum 4-Year and 8-Year Follow-up

Background: Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited. Purpose: To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan. Results: A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with P < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with P > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS (P = .045) and iHOT-12 (P = .037) scores but a comparable survival (P > .05) at long-term follow-up compared with those who did not have loose bodies. Conclusion: Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.

Poster 244: Magnetic Resonance Imaging versus Diagnostic Arthroscopy to Identify Intraarticular Pathology Associated with Patellar Instability: A High Rate of Discordant Findings Altering Surgical Treatment

Objectives: While uncommon, acute traumatic patellar dislocations can lead to recurrent symptoms of patellar instability in 15% to 45% of patients. Patellar stability is an interplay of bony and soft tissue restraints as well as anatomic factors, however, a mainstay of treatment remains reconstruction of the medial patellofemoral ligament (MPFL). Instability events can lead to intra-articular derangements of the knee, both in the acute and chronic patellar instability setting. These findings may not always be appropriately identified on magnetic resonance imaging (MRI). The incidence of these “surprise” injuries have not been previously reported. The purpose of this study is to determine the rates of coexisting intra-articular pathology in patients with patellar instability requiring MPFL reconstruction and elucidate any discordance between preoperative MRI findings and diagnostic arthroscopy findings. Methods: All patients undergoing MPFL reconstruction at a single institution between 2010 and 2023 were identified and preoperative MRI reports, defined as the most recent MRI report to the date of surgery with no interval traumatic events, were queried. Records without full MRI reports as read by a radiologist or cases in which a diagnostic arthroscopy was not conducted were excluded. MRI findings were discordant from arthroscopic findings if a lesion identified on diagnostic arthroscopy was not present in the full MRI report. Procedures that were undertaken because of these missed pathologies on MRI were recorded. Results: A total of 640 patients were identified during the study period, and 507 complete records were ultimately included. Preoperative MRI identified patellar osteochondral lesions or cartilage fissures in 333 patients (66%), loose bodies in 119 patients (24%), lateral femoral condyle osteochondral lesions or fissures in 97 patients (19%) and meniscus tears in 47 patients (9%). Among these patients, 172 (34%) had a diagnosis at the time of arthroscopy which was not identified on the preoperative MRI. These arthroscopic findings resulted in 75 loose body removals, 74 patellar shaving chondroplasties, 16 partial meniscectomies, 3 microfractures, 3 osteochondral lesion open reduction internal fixation, and 2 meniscal repairs which would have been missed without diagnostic arthroscopy due to discordant MRI findings. Conclusions: Over one-third of patients at a single institution who underwent diagnostic arthroscopy in the setting of patellar instability surgery had pathology identified which required surgical intervention that was not reported on a preoperative MRI. A comparison of MRI and diagnostic arthroscopy has been extensively reported on for other knee pathologies including ACL tear and lateral meniscal tear; however, there has been no similar investigation of the reliability of MRI for identification of concomitant pathology in the setting of patellar instability to date. The findings of this study highlight the importance of diagnostic arthroscopy in the treatment of patellar instability, the frequency with which this altered treatment, and the high preponderance of discordant MRI findings.

Paper 49: Osteochondral Allograft Transplantation for Capitellar Osteochondritis Dissecans: Excellent Patient Reported Outcomes Scores and High Return to Sports

Objectives: Unstable osteochondritis dissecans of the capitellum (OCD-C) is treated surgically, most commonly with loose body removal and marrow stimulation. This treatment has historically been associated with suboptimal return to high-demand upper extremity sports (baseball and gymnastics) and persistent elbow pain. Fresh osteochondral allograft transplantation (OAlloT) is an alternative treatment which restores subchondral bone and articular cartilage without donor site morbidity associated with autograft harvest. The purpose of this study was to evaluate the outcomes of osteochondral allograft transplantation in pediatric patients with unstable OCD-C 10mm or greater in size. Methods: A single-center prospective study was performed of consecutive pediatric patients, less than 19 years of age, with unstable OCD-C 10mm or greater in size treated with primary fresh OCAlloT using pre-cut 10mm, 12mm, or 16mm cores. Imaging, including radiographs and MRI were obtained preoperatively to assess OCD size and characteristics, as well as postoperatively to assess incorporation of the OCA. Patient reported outcome scores (PROs), including sport data, were obtained preoperatively and annually following surgery. Minimum follow-up duration was 2 years. Results: 26 elbows in 24 patients, mean age 13.4 years (11.3 – 17.1 years) met inclusion. The most common primary sport was gymnastics in 11 elbows (42%), baseball/softball in 7 elbows (27%), and cheer in 3 elbow (12%). The majority of patients (88%) played at a competitive level. Median symptom duration prior to presentation was 3 months. The most common presenting symptoms were pain (85%) and mechanical symptoms (81%). Sixteen elbows (62%) presented with a &gt;5° loss of elbow extension compared to the contralateral side. The capitellar physis was open in 23 elbows (88%). OCD location was central in 17 elbows (65%) and far lateral in 9 elbow (35%). Mean MRI size of the OCD was 11 mm in coronal width, 12 mm in sagittal length, and 6 mm in depth. Twelve elbows (48%) had a loose body on MRI. The majority of elbows (22, 85%) were treated with a single allograft plug, while 4 elbows had two allograft plugs transplanted. Median OCA size was 12 mm. There were no infections nor arthrofibrosis. Two elbows (8%) had a secondary surgery, both underwent partial synovectomy and chondroplasty at 14- and 16-months following the primary surgery. Postoperative MRIs were obtained in 15 elbows (58%) and had a mean BOGIE (Boston Osteochondral Graft Incorporation in the Elbow) score of 11, thus documenting a high degree of incorporation. Mean follow-up duration was 40 months (range 25 – 60 months). All patients had preoperative, 1-year, and 2-year PROs (Table 1). 21 elbows (81%) had returned to sports at 1-year postoperatively9, and all but 1 patient had returned to sports by 2 years following surgery. Forty-five percent of gymnasts returned to gymnastics, while the remaining pursued different sports. Five of 6 baseball players (83%) returned to baseball. Conclusions: OCAlloT as a treatment for OCD-C is a procedure associated with low rates of complications, excellent graft incorporation, high elbow function and patient satisfaction, and overall high rates of return to sports at 2-years. Return to sports, particularly among gymnasts was less than 50% in this series, which we attribute to a combination of factors, including loss of training and competition time at a critical time for an elite gymnast as well as physician counseling on alternative sports with less stress on the elbow. Continued patient follow-up is ongoing and will be critical to the assessment of this treatment on the mid- and long-term outcomes in these young athletes. [Figure: see text]

Clinical Outcomes and Survivorship of Lateral Unicompartmental Knee Arthroplasty: A Large Single Surgeon Cohort

BackgroundLateral unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated lateral compartment osteoarthritis. However, due to the rarity of the procedure, long-term outcomes and survivorship are poorly understood. We report the clinical and radiographic outcomes after lateral UKA. MethodsWe retrospectively reviewed a consecutive series of patients who underwent lateral UKA by a single fellowship-trained arthroplasty surgeon from 2001 to 2021 with a minimum 2 year follow up. There were 161 knees in 153 patients (average age 69 years) that met inclusion criteria, with a mean follow up of 10.0 years (range 0.05 to 22.2). All patients underwent the procedure via a minimally invasive lateral parapatellar approach with a fixed-bearing implant. Patient demographics, complications, radiographic findings, patient-reported outcomes, and the need for revision surgery were evaluated. Survivorship was defined with the end point as revision of components. ResultsThere were 8 patients (5.0%) who underwent conversion to total knee arthroplasty for lateral UKA implant failure or progression of arthritis. There were 3 patients (1.9%) who underwent ipsilateral medial UKA due to medial compartment arthritis progression with preserved mechanical alignment and patellofemoral joint. There were 8 additional procedures that did not require implant changes, including 5 irrigation and debridements for acute periprosthetic joint infection (3.1%), 2 wound closures for dehiscence (1.3%), and one loose body removal (0.6%). ConclusionsLateral UKA showed a survivorship rate of 98.0% at 5 years, 96.0% at 10 years, and 94.5% at 15 years. When including patients who underwent additional surgery for the progression of arthritis, survivorship was 97.4% at 5 years, 95.4% at 10 years, and 91.3% at 15 years. Lateral UKA should be seen as a durable treatment option for isolated lateral compartment osteoarthritis.

Predictive Modeling for Functional Outcomes After All-Inside Arthroscopic Anterior Talofibular Ligament Repair of Chronic Ankle Instability.

Arthroscopic anterior talofibular ligament repair (AATFLR) is a surgical strategy to treat chronic ankle instability (CAI) patients. This study identified risk factors that influenced the functional outcomes of AATFLR for CAI and developed prognostic nomogram for predicting functional outcomes in future AATFLR cases. Patients undergoing AATFLR from January 2016 to June 2022 with at least 10 months of follow-up were included in the study. The Karlsson Ankle Functional Score (KAFS) was evaluated preoperatively and at last follow-up visit. A total of 15 potential predictors including age, sex, body mass index, side affected, time from injury to surgery, sports-related injury, osteophyte, loose bodies, distal tibiofibular syndesmosis, ATFL avulsion fracture, Outerbridge classification of osteochondral lesions, postoperative immobilization method, ambulation time, walking time, and follow-up time, were recorded. We first used univariate binary logistic regression analysis to select the potential significant prognostic features, which were then subjected to the least absolute shrinkage and selection operator (LASSO) regression algorithm for final feature selection. A nomogram based on the regression model was developed to estimate the functional outcomes of patients. Models were validated internally using bootstrapping and externally by calculating their performance on a validation cohort. Overall, 200 ankles fit inclusion criteria. Of these 200, a total of 185 (92.5%) ankles were eligible and divided into development (n = 121) and validation (n = 64) cohorts. Four predictors were ultimately included in the prognostic nomogram model: age, sex, sports-related injury, and postoperative immobilization method. We found in our cohort that the significant predictors of poorer functional outcomes of AATFLR were postoperative immobilization with lower-leg cast, female sex, non-sports-related ankle sprain, and increasing age. Prognostic nomograms were created.

Migration and cooling characteristics of low-temperature gaseous CO2 in high-temperature loose coal

To investigate the extinguishing effect of low-temperature gaseous CO2 on coal spontaneous combustion, a similar simulation experiment was designed and conducted to test its migration and cooling characteristics in high-temperature loose coal. During the injection of low-temperature gaseous CO2, the temperature along the central axis of the release port decreases rapidly. The size of the cooling range and the diffusion rate of the cooling area are inversely proportional to the distance from the center axis and directly proportional to the injection time. The injection time plays a dominant role in the cooling effect of the high temperature coal, followed by the injection position. Gaseous CO2 diffuses inside the loose coal body rapidly, filling the vicinity of the release port within 5s and the container within 30s. The average diffusion velocity of CO2 within the loose coal is 0.051 m/s. The results of this study provide a theoretical basis for the application of low-temperature carbon dioxide to combat coal fire disasters.

Secondary Epiploic Appendagitis – Report of Three Cases with CT Findings

ABSTRACT Epiploic appendages are the fat-containing peritoneal pouches usually seen in the anti-mesenteric border, adjacent to the large bowel loop. The major components are adipose tissue and vessels. The exact functions are not understood. Epiploic appendagitis (EA) is an inflammatory process, primarily may be due to torsion or vascular occlusion or may be secondarily related to other inflammatory processes. Symptoms vary from mild abdominal pain to severe variety, depending on the underlying cause. Primary EA is a benign self-limiting condition and does not require any surgical intervention, whereas secondary cause of inflammation needs management of underlying pathology. Proper diagnosis plays a vital role in appropriate management. Cross-sectional study like computed tomography (CT) is the ideal choice of imaging. On CT, epiploic appendigitis appears as round to oval fat-attenuating lesions with hyperattenuating peripheral rim, usually abutting the adjacent large bowel. Chronic inflammation shows peripheral calcification, may detach, and appears as intra-abdominal loose body. We describe three cases of secondary EA with CT imaging features, which will guide the clinician in proper management, avoiding unwarranted surgery or hospitalization.

Extended Interportal Capsulotomy for Hip Arthroscopy, a Single-Center Clinical Experience.

Background and Objectives: The number of hip arthroscopy procedures is on the rise worldwide, and awareness regarding proper management of the hip capsule has increased. No capsulotomy shape is agreed upon as a standard approach, with literature supporting both isolated interportal and T-shaped capsulotomies. The aim of this retrospective cohort study is to report the clinical results of a standardized extended interportal capsulotomy (EIPC) during hip arthroscopy. Materials and Methods: Patients operated on between 2017 and 2020 with a hip arthroscopy were eligible. The inclusion criteria were ages 18-60 years, failed non-operative treatment, and at least a 2-year follow-up. Exclusion criteria were bilateral femoroacetabular impingement syndrome (FAS) cases or labral lesions, ipsilateral knee injury, history of ipsilateral hip surgery, and significant spine lesions. Data regarding demographic characteristics such as age, gender, operation date, BMI, but also Beighton score, presence of postoperative pudendal nerve damage, and revision for any reason were gathered from patients' records. All patients were evaluated preoperatively with a visual analog scale (VAS), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score (mHHS). Results: Of the 97 patients operated on with a hip arthroscopy between the defined dates, only 90 patients were included. The mean age was 37.9 ± 9.8, and 58.9% of patients were male. The most frequent surgical indication was an isolated FAS lesion (73.3%), followed by FAS associated with a labral tear (12.2%), an isolated labrum tear (10.0%), synovitis (3.3%), and a loose body (1.1%). The mean follow-up for the study cohort was 39.3 months. The majority of the patients had uneventful surgeries (76.7%), while there were three cases of sciatic nerve neuropraxia and 12 cases of pudendal nerve neuropraxia. Two patients underwent revision surgery during the study period. Comparison between preoperative and postoperative clinical scores showed a significant improvement with a final mHHS mean value of 67.7 ± 18.2, an HOOS value of 74.1 ± 13.2, and a low VAS score of 1.3 ± 1.2. Conclusions: A hip arthroscopy procedure with a standardized and unrepaired, extended interportal capsulotomy is a safe procedure with satisfactory mid-term results and high overall patient satisfaction. At a minimum of 2 years and a mean of 39.2 months, patients showed improved clinical scores and a low revision rate.