Radiographic Measurements Research Articles

Association between deformity angular distance ratio and neurological risk in patients undergoing three-column osteotomy.

Postoperative neurological deficits are a significant concern for surgeons during spinal deformity correction surgery. Preoperative identification of high-risk patients can help ensure that appropriate measures are taken to minimize the risk of neurological deficits during these procedures. Previous studies have shown that patients with large Cobb angles or deformity angular ratios (DARs) are at higher risk for postoperative neurological deficits. However, some curves with similar Cobb angles and DARs may exhibit significantly different risks of neurological deficits during surgery. Existing methods for evaluating the degree of deformity cannot fully or accurately reflect the degree of spinal deformity. The aim of this study was to determine whether the deformity angular distance ratio (DADR) can reliably assess the neurological risks of patients undergoing three-column osteotomy (3CO). A consecutive series of 266 patients with a deformity apex at T1-L1 who underwent 3CO at a single academic center from December 2010 to January 2024 were included in the study. Preoperative radiograph measurements were used to calculate DAR and DADR. Binary logistic regression was used to model the relationship between DADR and postoperative neurological deficits. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess the performance of the model. The 266 patients had a median (IQR) age of 48.0 (30.0-60.0) years, with 128 (48.1%) females and 138 (51.9%) males. The incidence of postoperative neurological deficits was 11.3% in this series of patients. Among patients undergoing 3CO, sagittal DADR (OR 1.086, 95% CI 1.045-1.129; p < 0.001) and total DADR (OR 1.080, 95% CI 1.046-1.116; p < 0.001) were associated with an increased incidence of postoperative neurological deficits. A total DADR > 30.4 or a sagittal DADR > 26.4 were associated with a 30% incidence of postoperative neurological deficits, which increased to 50% when the total DADR reached 41.4 or the sagittal DADR exceeded 36.6. The overall predictive performances of sagittal DADR (AUC 0.781) and total DADR (AUC 0.799) for postoperative neurological deficits were comparable and considered to be good. In patients undergoing 3CO for severe spinal deformities, the DADR can be used to quantify the severity of the deformity, which is strongly correlated with the risk of postoperative neurological deficits. Patients with a total DADR > 30.4 or a sagittal DADR > 26.4 are at much higher risk for developing new neurological deficits after surgery.

Study of the TOFPET2c ASIC in time-of-flight detection of x-rays for scatter rejection in medical imaging applications

Objective.Integrating time-of-flight (ToF) measurements in radiography and computed tomography (CT) enables an approach for scatter rejection in imaging systems that eliminates the need for anti-scatter grids, potentially increasing system sensitivity and image quality. However, present hardware dedicated to the time-correlated measurement of x-rays is limited to a single pixel physically too large for the desired spatial resolution. A switch to highly integrated electronics and detectors is needed to progress towards detector arrays capable of acquiring images, while offering a timing resolution below 300 ps FWHM to achieve scatter rejection comparable to current anti-scatter grids.Approach.Using off-the-shelf scintillators, photodetectors and readouts designed for ToF positron emission tomography (PET) provides a preliminary evaluation of available highly integrated readout systems supporting detector arrays for ToF scatter rejection. The TOFPET2c ASIC from PETSys offers an established development platform necessary for fast and reliable results, with no known limitation regarding time-correlated detection of medical imaging x-rays (20-140 keV).Main results.Reliable photon detection down to 31 keV was achieved, reaching energy resolutions from 23% to 92% FWHM throughout the desired energy range. Optimal detector timing resolution (DTR) from 250 ps FWHM at 130 keV to 678 ps FWHM at 30 keV was reached. Strong time walk effects were observed, showing a time shift of 642 ps up to 1740 ps between events spanning the energies used in x-ray medical imaging.Significance.The TOFPET2c ASIC has shown its potential for ToF scatter rejection, but meets the time resolution requirement of 300 ps FWHM only for limited energies (110-140 keV). This significant timing degradation observed at lower energies limits the use of the TOFPET2c ASIC for ToF scatter rejection, but offers significant advancements regarding the understanding of the phenomenon arising from the time-correlated detection of medical imaging x-rays.

Improving predictability of post-operative knee joint line obliquity in high tibial osteotomy: A new radiographic parameter correcting for foot position.

Joint line obliquity is crucial for the long-term success of a high tibial osteotomy (HTO), particularly when large corrections are made. The relationship between the size of correction and changes in joint line obliquity (KJLO) is complex, often leading to the preference for a double-level osteotomy to manage significant post-operative obliquity. We aim to improve the prediction of knee joint line orientation changes and correction size by examining the influence of foot position. The goal is to develop a linear model to predict post-operative KJLO, which could assist in determining whether a single- or double-level osteotomy is necessary to prevent excessive post-operative joint line obliquity. A retrospective radiographic analysis was conducted on patients who underwent HTO surgery between April 2016 and April 2017. Ninety-one patients were randomly selected for radiographic measurements on long-leg radiographs pre- and 3-month post-operative. A novel radiographic parameter was introduced to realign the foot of the operated side to the midline. The foot position relative to the midline was assessed by determining the angle formed when rotating the natural foot position onto the midline using the centre of the hip as a rotation point. The angle obtained by subtracting this from the KJLO results in a corrected KJLO for midline foot position (aKJLO). Predictive model of differences between pre- and post-operative values of MPTA (ΔMPTA [medial proximal tibial angle]) and KJLO (ΔKJLO) was less predictive (0.185 [p < 0.001]) than ΔMPTA and ΔKJLO corrected for foot position, namely ΔaKJLO (0.688 [p < 0.001]). Adding more parameters did not significantly improve the linear model's predictions. Predictability of aKJLO could be significantly enhanced. With this new parameter, inter- and intra-variability of foot position is bypassed. A safe MPTA position of 91° can be presumed; however, inter-individual variability in limb adaptation following correction remains uncertain. Level IV.

Assessment of stifle effusion-synovitis as a predictor for canine cruciate disease

Objective: To objectively quantify stifle effusion-synovitis in dogs with confirmed cranial cruciate ligament (CrCL) disease, with or without meniscal pathology, through radiographic assessment by investigating an association between severity of effusion-synovitis and cruciate and meniscal disease, and to establish a standardised quantitative radiographic measurement screening tool to predict severity of cruciate and meniscal injury. Methods: A total of 100 diseased stifles met the inclusion criteria and were assigned to either partial CrCL tear (PT), complete CrCL tear (CT), partial CrCL tear with meniscal pathology (PTM) or complete CrCL tear with meniscal pathology (CTM) groups. Quantitative measurement assessment was then performed to evaluate the percentage of cranial effusion-synovitis (CrES), caudal effusion-synovitis (CdES) and cranial fat pad compression. Three surgeons conducted a blinded review of 15 mediolateral stifle radiographs and were instructed to subjectively and quantitatively predict the degree of cruciate and meniscal pathology. Results: A significant difference of CrES between CT and PT groups (P=0.0173) and CTM and PT (P=0.0169) groups was identified. A significant difference in CdES between PT and CT groups (P=0.0015), PT and CTM groups (P=0.0041) and CTM and CT (P=0.0005) groups was identified. Quantitative measurement demonstrated improved sensitivity, specificity and agreement when compared to subjective assessment. Clinical significance: The results of this study propose that a quantitative radiographic measuring tool for predicting the severity of cruciate and meniscal disease may improve diagnosis of stifle pathology in a clinical setting and aid in pre-operative clinician decision making compared to subjective classification schemes.

Robotic Assistance in Simultaneous Bilateral Medial Unicompartmental Knee Arthroplasty: A Retrospective Cohort Study of 126 Knees Demonstrating Enhanced Radiographic Accuracy and Comparable Safety to Conventional Methods.

One-stage bilateral unicompartmental knee arthroplasty (BUKA) is a promising option for patients with bilateral medial knee osteoarthritis. This study aims to compare the safety, early clinical and functional outcomes, and radiological results of conventional vs robotic-assisted medial BUKA. A retrospective cohort study was conducted involving patients who underwent medial BUKA as a single-stage procedure between April 2016 and January 2022. The study included both conventional (36 procedures) and robotic-assisted techniques (90 procedures) with a minimum follow-up of 6months. Conventional procedures were performed either simultaneously by two surgical teams or sequentially by one team. Robotic procedures were exclusively performed sequentially by a single team. Data on surgical outcomes, patient-reported outcome measures (International Knee Society score), and radiographic measurements were collected. Among the 63 patients analyzed, robotic-assisted procedures took significantly longer (115 ± 22 minutes) compared to conventional approaches (86.9 ± 12 minutes; P < .0001). No significant differences were observed in complications, length of hospital stay, rehospitalizations, patient-reported outcome measures, or overall clinical outcomes. However, radiographic analysis showed superior joint line restoration in the robotic group (-0.2 ± 0.7 mm vs-1.4 ± 1.35 mm, P= .03) and better tibial implant varus control (0.3° ± 0.6 vs 1° ± 1.8 degrees, P= .03). While robotic-assisted BUKA resulted in longer operative times, clinical outcomes were comparable. Radiographic findings indicated improved implant positioning, suggesting potential benefits in implantation accuracy that warrant further research. IV.

Automated Web Tool Measurement of Total Hip Arthroplasty Acetabular Component Inclination and Anteversion Angles.

Periprosthetic hip dislocation after total hip arthroplasty is a devastating postoperative complication. It is often associated with suboptimal orientation of the acetabular component, characterized by the acetabular abduction and anteversion angles obtained from anteroposterior pelvic radiographs. We introduce a novel automated web tool to streamline the subjective and lengthy process of this manual measurement and compare it to manual human measurements. One board-certified orthopaedic surgeon used the web tool to make automatic measurements of anteroposterior radiographs of 97 patients who underwent unilateral hip arthroplasty. Manual and web tool measurements included abduction angle and calculated anteversion angle by Liaw's method. Differences between manual and web tool measurements were compared with a paired t-test and Bland-Altman analysis. There were no statistically significant differences between the average of manual measurements as compared to the web tool measurement in abduction angle (43.29 ± 7.05 vs 43.00+ 6.22, P= .85), anteversion angle (20.43 ± 7.62 vs 20.82 ± 7.37, P= .52), and ratio of the minor axis of the acetabular cup circumference in the AP radiograph to the total length of the acetabular head (0.42 ± 0.15 vs 0.44 ± 0.15, P= .18). The mean difference of average for abduction angle, anteversion angle, and ratio between the short axis of the transverse ellipse to the total length of the acetabular cup were-0.28, 0.39, and 0.02, respectively. Bland-Altman analysis for all 3 measurements displayed negligible systemic bias with random scattering. Automated measurements obtained with a novel web tool are in strong agreement with the manually obtained ground truth measurements. The web tool helps to eliminate interobserver differences that arise with manual annotation. The web tool has the potential to streamline acetabular measurements with enhanced accuracy.

The Prevalence of Congenital Cervical Stenosis Differs based on Race.

Congenital cervical stenosis (CCS) is a rare condition involving a narrowed spinal canal due to developmental anomalies. CCS heightens the risk of neurologic deficits and acute spinal cord injury post-trauma, influencing return-to-play decisions for contact athletes. Additionally, CCS patients are prone to cervical myelopathy as degenerative changes progress with age. Limited evidence-based literature exists addressing the epidemiology of CCS, including the effects of race. To investigate the anatomical differences and prevalence of CCS as it pertains to race and ethnicity. Single center retrospective cross-sectional study. A total of 343 patients with cervicalgia between the years of 1999-2023. Radiographic measurements of anatomical parameters were collected and CCS was defined as a sagittal canal diameter (SCD) of less than 10 mm at 2 or more vertebral levels (C3-7) at the pedicle. We screened 5395 cervical MRIs from a single institution. Exclusion criteria included patients under 18 and over 50 years, prior cervical spine surgery, congenital fusions, spinal malignancy, or active smoking history. For each patient, axial measurements were taken at each level, including coronal vertebral body length, anteroposterior vertebral body length, pedicle width, pedicle length, laminar length, anteroposterior lateral mass length, posterior canal distance, apex-to-vertebral body, lamina-disc angle (LDA), lamina-pedicle angle, and anteroposterior spinal cord diameter. CCS prevalence varied significantly among ethnic groups; Black (39.3%), Asian (33.6%), and Hispanic (22%) patients demonstrated significantly higher CCS rates than White patients (7.5%) [x2 (3, N=343) = 30.04, p <0.05)]. Blacks and Asians showed consistently smaller SCDs at all pedicle levels compared to Whites, who had the largest SCDs overall (p<0.001). Average SCDs were 11.4 mm (White), 10.4 mm (Black), 10.5 mm (Asian), and 11 mm (Hispanic). Additionally, LDAs were larger in Asians, Blacks, and Hispanics compared to Whites, leading to a significantly decreased cross-sectional canal area (p<0.001). Our study indicates a statistically significant correlation between race/ethnicity and CCS prevalence. Black and Asian patients had the highest CCS rates, smallest SCDs, and largest LDAs. These anatomical differences may predispose these subjects to the development of cervical myelopathy compared to those with normal spinal canal diameters. Increased knowledge base of the epidemiology of this condition may lead to personalized clinical management and possibly early intervention to prevent spinal cord injuries in these patients.

Predictive Factors for Failed Nonsurgical Management of Long Bone Metastasis and Myeloma.

Understanding the risk factors for failing nonsurgical management of metastatic bone disease is necessary to determine those patients who will benefit from prophylactic stabilization; however, standard predictive models do not include several clinically relevant factors. The primary and secondary objectives of this study were to evaluate comprehensive patient- and disease-related factors as potential predictors of failure of radiation therapy alone for long bone lesions and overall survival in metastatic disease and myeloma. All patients who underwent radiation therapy for long bone metastases at our tertiary care institution from May 2011 to February 2020 were retrospectively reviewed. Of 475 lesions, we excluded those with prophylactic fixation or fracture before radiation therapy, and those <0.5 cm on plain radiographs. Outcomes of the 186 lesions were classified as no progression, progression requiring prophylactic fixation, or progression to pathologic fracture. Blinded radiograph review was done by two orthopaedic oncology surgeons and two musculoskeletal radiologists. Demographic, socioeconomic, lesion, cancer severity, and patient-specific risk factors were identified, and potential predictors were analyzed using backwards stepwise regression. Following radiation therapy, 8.6% lesions underwent prophylactic fixation and 14.0% fractured. Prophylactic fixation was associated with Mirels' score (OR = 1.98, P = 0.025), lesion cortical involvement (OR = 16.96, P = 0.010), and younger patient age (OR = 0.93, P = 0.024). Fracture was associated with lesion cortical involvement (OR = 10.16, P = 0.003) and "low risk" histology (OR = 9.01, P = 0.057). Orthopaedic treatment (either prophylactic surgery or pathologic fracture management) was associated with Mirels' score (OR = 1.62, P = 0.015), lesion cortical involvement (OR = 8.94, P = 0.002), humerus location (OR = 4.19, P = 0.042), and Medicare (OR = 4.12, P = 0.062) or private insurance (OR = 5.69, P = 0.022) compared with Medicaid. ECOG score (OR = 1.28, P = 0.003) was found to be a risk factor for increased mortality after radiotherapy, while "low risk" histology (OR = 0.51, P = 0.029), mixed lesion type (OR = 0.34, P = 0.006), and increased body mass index (OR = 0.95, P = 0.001) were protective factors. Radiograph measurements of cortical involvement were the most clinically relevant for determination of metastatic lesion fracture risk; however, predictors of local failure not addressed in Mirels' score should be considered in clinical decisions about prophylactic fixation. Surgery may be underperformed for histologies commonly considered to be "low risk" for local progression after radiation therapy.

How Do Different Image Modules Impact the Accuracy of Working Length Measurements in Digital Periapical Radiography? An In Vitro Study

Background/Objectives: This study aims to evaluate the accuracy of digital dental radiography in determining working length in root canal treatment via various image modules. Methods: A total of 40 intact single-rooted, single-canal human premolar teeth were examined. Following meticulous cleaning, the teeth were placed in a maxillary premolar socket within a dry human skull. X-ray images were systematically captured via a Carestream RVG digital sensor under standardized conditions. The digital images are processed under five distinct image modules: 1. original module, 2. autoenhancement module, 3. autoenhancement+negative module, 4. negative module, 5. colored module. Three calibrated observers determined the working length of each digital radiograph after the specified image modules were applied. The agreement between the actual working length and the lengths determined by the observers was evaluated via Pearson correlation analysis. A significance level of 0.05 was set for the statistical tests. Results: A high level of intra- and interobserver agreement, with a strong correlation between the actual measurements and all image module groups, was obtained (p &lt; 0.001). The original image module group demonstrated the highest compatibility (ICC = 0.940, r = 0.912), whereas the colored image module group exhibited the lowest compatibility (ICC = 0.924, r = 0.879) with the actual measurement. Conclusions: This study demonstrates the accuracy of digital radiography in determining working length through the application of various image modules, with the original image module exhibiting the closest alignment to actual working lengths. These findings support the continued use and further development of computer-based image processing tools to optimize clinical outcomes in root canal therapy.

Thickness of Subcutaneous Fat as a Proxy for BMI in Non-ambulatory Patients With Neuromuscular Scoliosis Undergoing Posterior Spinal Fusion

Background: Posterior spinal fusion in neuromuscular scoliosis patients carries a significant risk of postoperative surgical site infection (SSI). Body mass index has been associated with increased risk of surgical site infections, but it is difficult to obtain an accurate height of non-ambulatory children with severe neuromuscular scoliosis. Subcutaneous fat thickness has been associated with increased rates of surgical site infections in other surgeries; however, current literature has not elucidated a relationship between subcutaneous fat thickness and surgical site infections in this patient population. Methods: A retrospective chart review analyzed non-ambulatory patients with neuromuscular scoliosis who underwent posterior spinal fusion. Patients were stratified into 3 groups (underweight, normal weight, and overweight/obese) based on BMI-for-age percentiles. Subcutaneous fat thickness was measured in both the sagittal and coronal planes at 24 landmarks. Comparisons of categorical data were analyzed using χ2 tests. Logistic regression analysis was used to isolate independent factors associated with surgical site infections. Results: A total of 109 patients were analyzed. Thirty-four patients were underweight, 55 patients were normal weight, and 20 were overweight/obese. Twelve patients developed surgical site infections, with only 1 of them requiring an unplanned return to the operating room. Patients in the overweight/obese category had an increased risk of surgical site infection when compared with those in the normal weight and underweight categories (P=0.027). Of the 24 measurements taken, subcutaneous fat thickness to total distance from skin ratios at L2 spinous process (P=0.031), L3 spinous process (P=0.42), and averages of L2, L3, and L4 ratios (P=0.028) were all found to be associated with increased risk of surgical site infection. Conclusion: In this study population of patients with neuromuscular scoliosis who underwent posterior spinal fusion, increased BMI was associated with increased risk of SSI. Furthermore, 3 radiographic measurements of subcutaneous fat thickness associated with a higher risk of surgical site infections were identified. This knowledge could contribute to devising preoperative strategies to mitigate surgical risk and postoperative complications. Level of Evidence: Level III—a retrospective study

What does the patients' perception of alignment tell us about alignment targets in total knee arthroplasty?

Knee alignment significantly impacts the outcome of total knee arthroplasty (TKA). Understanding patient perceptions of their knee alignment in relation to objective measurements is essential to ensure optimal surgical outcomes and to meet patients' expectations. This study reports patients' perception of pre- and postoperative knee alignment in relation to radiographic alignment measurements. The study included 141 patients with primary osteoarthritis of the knee (mean age: 65.4 years, BMI: 30.8). Patients categorized their knee alignment before and after surgery using a picture-based rating scale: very bow-legged (> 10° varus), bow-legged (2.1-10° varus), straight (2° varus to 2° valgus), knock-kneed (2.1-10° valgus), and very knock-kneed (> 10° valgus). Hip-to-ankle films were performed to compared actual knee alignment with patients' assessments retrospectively. Preoperatively, 15.1% of patients with severe varus, 55.6% with varus, and 86.7% with neutral alignment perceived their knees as straight. None of the patients with valgus or severe valgus alignment considered their knees as straight. Overall, 40.2% of patients with radiographic varus alignment classified their knees as straight, while nobody with valgus alignment did. Postoperatively patients with preoperative varus considered their knees as straight with an average of 1.8 ± 1.7deg. mechanical varus alignment, while patients with preoperative valgus alignment considered their knees straight with an average of 0.4 ± 0.9deg. mechanical valgus alignment. Patients predominantly desire a straight knee postoperatively, however, most patients tend to perceive some varus alignment as straight. This is most common in patients with up to 5 degrees of varus deformity and suggests that a restricted or inverse kinematic alignment with up to 5 degrees of varus can meet the expectations of most patients. In contrast, patients with valgus deformity are sensitive to any remaining valgus deformity and leaving the knees in more than 2deg. of valgus will unlikely satisfy the patients' overall desire for a straight knee after surgery.

Which Lenke type curve is most appropriate for vertebral body tethering in adolescent idiopathic scoliosis?

Clinical trials have studied the effects of curve magnitude and flexibility, age, and skeletal immaturity on the outcomes of VBT. No studies have assessed the effect of Lenke curve type on the outcomes of VBT. This study compares outcomes in patients who underwent VBT with Lenke type 1, 3, 5, and 6 curves. Single center retrospective review of patients undergoing mini-open thoracoscopic-assisted two row vertebral body tethering (2RVBT) for the correction of AIS with a minimum 2-year follow-up were included. Patients were grouped by Lenke type, which yielded 4 groups; types 1, 3, 5, or 6. Analysis included preoperative demographic parameters, as well as radiographic and clinical outcome measures. 156 2RVBT (Lenke 1, N = 61; Lenke 3, N = 35; Lenke 5, N = 37; Lenke 6, N = 23) patients met inclusion criteria. The mean preoperative apex Cobb angle in the Lenke type 1, 3, 5, and 6 groups were 50.2 ± 9.1, 50.5 ± 10.1, 45.0 ± 8.6, and 49.0 ± 10.8, respectively. This corrected to 21.2 ± 10.2, 19.2 ± 8.5, 13.6 ± 7.2, 18.5 ± 8.3 in Lenke type 1, 3, 5, and 6 groups, respectively, demonstrating that Lenke type 5 saw greatest correction following 2RVBT. With regards to revision recommendation following tether breakage, Lenke type 3 curves were most frequently indicated for fusion, whereas Lenke type 1 curves were most frequently not indicated for revision surgery. Lenke type 5 curves are the most amenable to correction via 2RVBT, as evident by their lower post-operative apex Cobb angles and lowest rate of recommendation for revision to posterior spinal fusion.

Development of a 3D cephalometric index to grade severity of dentofacial deformity in patients with juvenile idiopathic arthritis

This investigation aimed to develop a radiographic 3D cephalometric index to grade severity of dentofacial deformity in patients with juvenile idiopathic arthritis (JIA), and to perform a validation against expert evaluations. Data were collected from a population-based Nordic JIA cohort of 240 patients that received a cone-beam computed tomography (CBCT) scan approximately 17 years after onset of JIA. The cohort was randomized into two groups: A baseline group for establishing the index (n = 210) and a test group (n = 30). The standardized index generation process led to the inclusion of six radiographic outcome measures, each representing different facets of dentofacial deformities. Specific severity scores were established for three domains; dentofacial asymmetry (0–8), vertical deviation (0–8), and sagittal deviation (0–8). An overall dentofacial deformity index score was computed by aggregating the scores from the six variables, with the total score ranging from 0 to 24. The validity of the index was assessed by comparing the index score with expert evaluations. Based on the generated index, 10 patients exhibited severe deformities. Reliable agreement between data-generated index scores and expert assessments was found. A 3D radiographic dentofacial deformity index was generated and tested. This index can support an objective assessment of the severity of dentofacial deformities related to JIA in a clinical setting and future research.

Treatment of antebrachial deformities secondary to premature closure of the distal radial physis using circular external skeletal fixation and distraction osteogenesis in skeletally immature dogs.

To report clinical outcomes of skeletally immature dogs with antebrachial deformities secondary to premature closure of the distal radial physis (PCDRP) treated with angular corrections and distraction osteogenesis using circular external skeletal fixation (CESF). Retrospective multi-institutional case series. A total of 12 client-owned dogs with premature distal radial physeal closure. Medical records from four hospitals between 2009 and 2022 were reviewed. Preoperative and final radiographic measurements of limb alignment and osteoarthritis were compared. Long-term outcomes were obtained using an owner questionnaire. Mean ± SD age and bodyweight were 7.5 ± 1.7 months and 12.8 ± 11.1 kg. Distal radial corrective osteotomies and distraction osteogenesis were performed in all dogs. Mean ± SD time between surgery and fixator removal was 78 ± 20 days. Uncomplicated osseous union was documented in 9/12 dogs. Final mean affected limb anatomic lateral distal radial angle (aLDRA) of 85.6° was higher than preoperative values 71.6° and within reported normal ranges. A total of 10 of 12 dogs had mild non-progressive elbow osteoarthritis at final follow up, including two dogs with mild residual elbow incongruity. Major complications occurred in two dogs and included permanent carpal flexor contracture and radial fracture through a pin tract. Minor complications including persistent loss of carpal extension, radioulnar synostosis, and pin tract drainage occurred in 10/12 dogs. Owner questionnaires were obtained from 8/12 dogs and all reported good to excellent function. Angular correction and lengthening using CESF can achieve target alignment and improved clinical function with moderate complications in growing dogs with PCDRP. Distraction osteogenesis and angular corrections can be considered as a treatment option for PCDRP in skeletally immature dogs.

Comparison of long-term clinical and radiologic outcomes of AperFix and fixed loop device fixation in anterior cruciate ligament reconstruction: A retrospective study.

Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups (P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used (P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups (P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.

Functional alignment in robotic-assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short-term outcomes.

Functional alignment (FA) in total knee arthroplasty (TKA) prioritizes soft tissue balancing and anatomical restoration without systematic correction to neutral alignment. Most studies have focused on varus deformity, with little evidence available about FA in valgus deformity. The hypothesis of the present study was that FA in robotic-assisted TKA for valgus deformity would demonstrate correction of the coronal alignment and yield satisfactory short-term outcomes. This retrospective study included 58 patients with valgus coronal alignment (hip-knee-angle [HKA] ≥ 183°) who underwent robotic-assisted TKA using the FA technique with a minimum of 1-year follow-up. Outcomes were assessed through the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and radiographic measurements of alignment and phenotypes. Complication and revision rates were also analyzed. The cohort included 39 females and 19 males with a median age of 70. Post-operatively, 86.2% of cases achieved coronal alignment within the safe zone (HKA 177-183°). Significant improvements were observed in KSS (part 1: 69.5-95, part 2: 65-94, p < 0.001), while OKS and FJS exhibited optimal outcomes. Two complications were recorded: one aseptic loosening (1.7%) and one early infection (1.7%). Kaplan-Meier survival analysis indicated favourable implant survivorship at a median follow-up of 18 months. FA in image-based robotic TKA is a safe and effective approach for patients with valgus deformity. This procedure resulted in a modest correction of the coronal alignment, where no soft tissue releases were needed. The majority of the cases fell within the target coronal alignment boundaries by only accommodating the individual laxities, suggesting the aim of FA to restore each knee's pre-pathological alignment. Level IV.

Characterization and variability of PROMIS-10 scores with physical therapy in knee osteoarthritis: A retrospective review.

Knee osteoarthritis (OA) and its impairments affect patients' physical and mental health. Radiographically severe knee OA is believed to respond less to conservative treatments including physical therapy (PT) but has not been compared specifically with Patient-Reported Outcomes Measurement Information System (PROMIS)-10. To correlate baseline PROMIS-10 physical and mental health scores in patients undergoing PT for knee OA, subgrouped by radiographic severity (Kellgren-Lawrence [KL] grade and number of knee compartments involved). Additionally, to describe the relationship between radiographic severity of knee OA and the change in PROMIS-10 scores post-PT. Retrospective review. Outpatient musculoskeletal clinics at an orthopedic specialty hospital. One hundred nine patients (age ≥ 18 years) who presented for evaluation of knee OA from April 1, 2019 to August 1, 2021, had baseline radiographs, underwent PT, and completed PROMIS-10 at baseline and follow-up. PT. PROMIS-10 physical and mental health scores. Participants were 60% female; average age was 66.6 ± 10.0 years. Baseline PROMIS-10 physical and mental health scores averaged 44.4 ± 7.2 and 52.8 ± 9.0. Post-PT PROMIS-10 physical and mental health scores averaged 44.7 ± 6.7 and 52.6 ± 8.7. Physical health scores improved in 39% of patients; mental health scores improved in 36% of patients (no statistical significance). There was no relationship between post-PT PROMIS-10 scores and radiographic severity of knee OA. Females exhibited osteoarthritic changes in all compartments in 72% of cases compared to 55% of males (p = .020). Females demonstrated a higher predisposition for lateral compartment involvement (83% vs. 64%; p = .021) and a higher proportion of severe OA, radiographically, with a KL grade 3-4 (92% vs. 80%; p = .051). More than one third of patients with knee OA reported improved physical and mental health post-PT. The degree of benefit did not relate to radiographic severity. Although OA is characterized by radiographic measurements, there are variables beyond the radiographic imaging that may affect patient outcomes.

Guided Personalized Surgery (GPS) in Posterostabilized Total Knee Replacement: A Radiological Study.

Background: Surgical accuracy in total knee replacement (TKR) may vary with the surgeon, the patient preoperative deformity, and the guiding system to perform the procedure. Navigation systems attempt to increase the intraoperative information the surgeon requires to make the appropriate decisions, sometimes associating cumbersome procedures and unclear effectiveness to place the implant more precisely than conventional instruments. Methods: We conducted a retrospective case-control study with prospective data collection of radiographic measurements (alignment, joint line and patellar height) in a sample of 100 consecutive patients receiving TKR Optetrak Logic PS, either with standard surgical technique with Trulion Instrumentation (n = 59) or with the Guided Personalized Surgery (GPS) system (n = 41). Results: The GPS group improved the alignment of the mechanical Lateral Distal Femoral Angle (mLDFA) in 1.6° compared to the control (p = 0.003), but not evident in the mechanical Medial Proximal Tibial Angle (mMPTA) (p = 0.132). The GPS system achieved a normal patellar height in 98% of cases, according to the Blackburne-Peel Index (BP), compared to 71% in the control group (p = 0.002). This was obtained in the femoral side, as measured in the Epicondylar Ratio (ER) (p = 0.004). A lower dispersion of postoperative measurements was observed in the GPS group in comparison with the control, being statistically significant in mMPTA (p = 0.000), CD-Index (p = 0.011), IS-Index (p = 0.002), mIS-Index (p = 0.008), BP-Index (p = 0.011), and ER (p = 0.004). Conclusions: Better post-surgical restoration of joint line and patellar height is observed in surgeries performed with the GPS system, as well as a tendency to more accurate mechanical alignment and lower inter-patient variability, suggesting higher reproducibility.

Comparison of clinical and radiological outcomes of three-column lumbar osteotomies with and without interbody cages for adult spinal deformity.

Correcting sagittal malalignment in adult spinal deformity (ASD) is a challenging task, often requiring complex surgical interventions like pedicle subtraction osteotomies (PSOs). Different types of three-column osteotomies (3COs), including Schwab 3, Schwab 4, Schwab 4 with interbody cages, and the "sandwich" technique, aim to optimize alignment and fusion outcomes. The role of interbody cages in enhancing fusion and segmental correction remains unclear. This study aimed to compare outcomes among these 4 3CO techniques, evaluating the impact of cage use at the osteotomy site on postoperative radiographic imaging and clinical outcomes. This is a multicenter retrospective study utilizing data from a prospective multicenter database of patients undergoing complex ASD surgery. Ninety-seven patients who underwent 1 of 4 3CO techniques for thoracolumbar ASD correction with at least 2 years of follow-up were included. The sample consisted of 29 patients who underwent Schwab 3 osteotomy, 20 Schwab 4, 28 Schwab 4 with interbody cages, and 20 who underwent "sandwich" osteotomy. The Scoliosis Research Society-22 revised (SRS22r) questionnaire evaluating pain, activity, appearance, mental health, and satisfaction was used to evaluate patient reported outcomes and radiographic measures including segmental lordosis and fusion rates determined by 3 blinded reviewers were used to evaluate physiologic outcomes. This study analyzed demographic data, radiographic outcomes, patient-reported outcomes, complications, and fusion rates over a 2-year follow-up period. Fusion status was determined via serial radiographs and evaluated independently by 3 blinded reviewers. Univariate and multivariate statistical analyses were performed to assess differences among the groups and the impact of interbody cage use on outcomes. Patients undergoing "sandwich" osteotomy exhibited worse preoperative leg pain scores and lower SRS22r activity (p=.015), appearance (p=.007), and mental health domain scores (p=.0015). No differences in complications were found among groups (p>.05). Patients who underwent osteotomy with a cage were more likely to have had previous spine fusion (91.7% vs. 71.4%, p=.010). Additionally, these patients had lower preoperative SRS22r mental domain (2.9±1 vs. 3.5±1, p=.009), satisfaction (2.3±1 vs. 2.7±1.2, p=.034), and SRS22r total scores (2.3±0.6 vs. 2.6±0.6, p=.0026) but demonstrated the greatest improvement in the mental health domain (0.9±0.7 vs. 0.3±0.9, p=.002). Cage use was associated with a larger mean change in segmental lordosis at the osteotomy site (32.9±9.6 vs. 28.7±9.5, p=.038). Fusion rates were significantly higher in the cage group (79.2% vs. 55.1%, p=.0012). Regression analysis identified cage use as an independent predictor for fusion (odds ratio, 3.338; 95% confidence interval, 1.108-10.054, p=.032). Interbody cage use at the osteotomy site during 3COs for ASD correction was associated with improved fusion rates and greater segmental lordosis without increasing complication rates. Incorporating cages may provide enhanced alignment and fusion outcomes in complex ASD surgeries.

Ilio-femoral impingement angle: a new radiographic measurement.

Hip dislocations after total hip arthroplasty (THA) are a debilitating complication, often occurring in deep flexion. Current 3D modelling allows for simulating the flexion angle at which bone-on-bone impingement occurs, but it is resource-intensive and not widely available for routine clinical use. Therefore, we propose the ilio-femoral impingement angle (IFIa) as a novel, simple radiographic measure to help identify patients at higher risk for dislocation using standard radiographs. A radiographic study was performed on 117 consecutive patients who underwent preoperative planning for THA with 3D remodelling from 2021 to 2022 at a single institution. The flexion angle was recorded at which the femur impingement on the pelvis was identified from the 3D model. This was compared to the angle subtended between a vertical line, the centre of the femoral head and a line rotated upwards to the first point of contact with the ipsilateral ilium. This angle was named the ilio-femoral impingement angle (IFIa). The mean IFIa was 142.29° ± 11.49°, and it demonstrated a strong correlation with the 3D impingement angle (r = 0.69, p < 0.05). The inter-rater reliability of the IFIa measurement was high, with an ICC of 0.87, confirming the consistency of this novel radiographic measure. This study demonstrates that the novel radiographic measurement of the IFIa represented the deep flexion impingement angle of the femur on the ilium. The IFIa may be used as simple and cost-effective alternative measurement to model impingement during flexion.