Medial Joint Surface Research Articles

A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation

To introduce a new fluoroscopic method for assessing the quality of medial and lateral joint surface reduction during internal fixation of patellar fractures and to summarize the clinical outcomes of patients treated using this method. A retrospective analysis was conducted on the clinical data of 52 patients with patellar fractures treated between January 2018 and January 2022 who met the inclusion criteria. There were 27 male and 25 female patients, aged 21-75 years, with an average age of 62 years. The types of patellar fractures included 9 transverse fractures, 37 comminuted fractures, and 6 longitudinal fractures. According to the AO/Orthopaedic Trauma Association (AO-OTA)-2018 fracture classification, there were 21 cases of type 34A, 6 cases of type 34B, and 25 cases of type 34C. The time from injury to operation ranged from 1 to 5 days, with an average of 2.3 days. Treatments included internal fixation with hollow screws or hollow screw tension bands, with or without anchor repair. During operation, the medial and lateral joint surfaces of the patella were observed using the tangential fluoroscopic method to assess the smoothness of reduction of the median ridge, lateral joint surface, medial joint surface, and lateral joint edge. Patients were followed up regularly, and X-ray films were taken to observe fracture healing. Knee joint range of motion, Böstman score, and Lysholm score were used to evaluate functional recovery. The tangential fluoroscopic method for the medial and lateral joint surfaces of the patella during operation showed satisfactory reduction of the joint surfaces and good positioning of the implants. All patients were followed up 12-16 months, with an average of 13.4 months. During the follow-up, fracture displacement occurred in 1 case and titanium cable breakage in 1 case. All patella fractures healed successfully, with a healing time of 8-16 weeks (mean, 11.4 weeks). At last follow-up, knee joint range of motion ranged from 120° to 140°, with an average of 136°. The Böstman score ranged from 20 to 30, with an average of 28, yielding excellent results in 45 cases and good results in 7 cases. The Lysholm score ranged from 88 to 100, with an average of 93, yielding excellent results in 40 cases and good results in 12 cases. The intraoperative application of the tangential fluoroscopic method for the medial and lateral joint surfaces of the patella can quickly determine the fluoroscopic plane of the patella, accurately assess the quality of fracture reduction and the position of internal fixator, thereby improving effectiveness.

Sex determination from human patella in a Polish medieval sample.

This study aimed to address whether the anthropometric features of the patella can be used to determine the sex of the individuals on the basis of the skeletal remains and to set limit values for anthropometric measurements and indicators of the patella in relation to each sex. 71 patellas (32 female and 39 male) from the Middle Ages from Wroclaw, Poland, were analyzed. The measurements (the greatest height, width, thickness, width of the lateral and medial joint surface and the height of these joint surfaces) and ratios were calculated (height to width, height to thickness as well as width to height of lateral and medial joint surfaces) and tested according to sexual dimorphism. The best parameter in terms of discriminatory assessment was the patella's highest height, which made it possible to classify the sex in 46.5% of cases. However, an index of the sum of the height, width and thickness measurements seems to be even better for differentiating between the sexes, making it possible to correctly classify the sex in 49.3% of cases. Due to some limitations of this study and the need of population-specific standard, it is recommend to employ the patella in sex determination only in cases of fragmented human remains and when no other method can be applied. Further investigation of possible factors influencing the variability of its size and shape should be explored in larger and geographically more diverse samples, and this could contribute to forensic, clinical, anatomical, and anthropological studies in this body part.

Chipping corrective osteotomy for reconstruction of malunion with angular deformity of the lower extremity: Technical tips and preliminary clinical results.

Significant functional disturbance, deformity, and malalignment may occasionally develop after healing of a fracture, especially one involving the lower extremities. This study sought to provide preliminary evidence of the effectiveness of chipping corrective osteotomy (CCO), which does not require autologous bone grafting, for treating malunion with lower extremity angular deformity. We retrospectively reviewed clinical and radiologic results of 6 male patients (median age 48.5 years) treated with CCO for femoral and tibial malunion (4 femurs, 4 tibias) with angular deformity in the coronal plane. In performing CCO, we applied a temporary external fixator to correct the deformity; definitive fixation was performed using a locking plate. Time to consolidation after the surgery was recorded. The Mikulicz line was evaluated before surgery and at final follow-up in each patient to confirm a change in alignment of the affected lower extremity. We measured the score taken as the ratio of the distance between the medial tibial joint surface and the Mikulicz line to the width of the tibial plateau. Median follow-up duration was 34 months. Bone healing was achieved by a median of 3.5 months postoperatively. Correction of the mechanical axis in the affected lower extremity was achieved in all 6 patients. Median score by the length from the tibial medial joint surface to the Mikulicz line to the tibial plateau width was 7.7% preoperatively and 25.7% at final follow-up. These preliminary findings suggest that CCO is potentially useful for treating malunion with lower extremity angular deformity. Further evaluation in a larger series is needed to clarify the usefulness of CCO in correction of angular malunion.

Micromorphology and topography of tarsal joint capsule's vascular elements in cats and dogs.

Both cats and dogs belong to animals with the same type of limb support but have different nature of movement. Despite belonging to digitigrade animals, cats and dogs have a different nature of motion. While moving, the medial joint surface in cats and lateral surface in dogs carry the larger pressure. The aim of the study was to compare the similar surfaces of the cat's and dog's tarsal joint capsule and to detect differences in its histostructure and vascularisation. For the study, we used the capsule of the tarsal joint of five cats and five dogs dissected with accordance to anatomical surfaces. Sections of the capsule joint were stained with haematoxylin-eosin. The sections were examined with a microscope at magnification ×250 and ×400. The statistical analysis of the results was done using Student's t test. During the research, a difference in histostructure and vascularisation of tarsal joint capsule in cats and dogs on respective surfaces were found. The medial surface of the tarsal joint capsule was the most saturated with hemomicrocirculatory bed structures in cats, whereas this was the lateral surface in dogs. The most active metabolic processes also take place in these areas of the joint capsule, which is important to know when prescribing therapeutic procedures and determining an optimal surgical access.

Aplicação do laser 808nm na dor articular crônica de ratos Wistar

Durante o processo inflamatório, alguns tipos de células predominam e estão envolvidos com a produção de dor. O laser de baixa potência mostra-se útil no controle de mediadores inflamatórios, mas a ampla divergência nos parâmetros dosimétricos, conduz a variações nos resultados positivos. O objetivo deste estudo foi analisar o uso do laser 808nm, na dor articular crônica e edema de ratos Wistar submetidos a sinovite. Foram utilizados 10 ratos Wistar, divididos em dois grupos: GC - indução de sinovite em joelho direito e tratamento placebo; GT - indução de sinovite e irradiado com laser 10J/cm². Para a produção de sinovite foram injetados 100µl de formalina a 5%, no espaço articular tibiofemoral direito. A avaliação da dor ocorreu pelo tempo de elevação da pata (TEP). No 10º dia após a indução de sinovite, iniciou-se o tratamento com laser sobre a face articular medial do joelho, procedimento mantido no decorrer de 10 dias. Os resultados mostraram que o laser apresentou efeitos analgésicos, visto que, para o grupo tratado, houve redução significativa nos valores de TEP, indicando redução da dor, quando comparados os valores pós-tratamento com os pré-tratamento, o que não ocorreu para o grupo que recebeu tratamento placebo; para o edema, o laser também mostrou redução significativa do mesmo. Concluiu-se que o laser 808nm, com 10J/cm², é eficaz na redução da dor articular crônica e edema, em animais submetidos a sinovite experimental.

Evaluation of cartilage defect at medial femoral condyle in early osteoarthritis of the knee

The purpose of this study was to evaluate cartilage defect at medial femoral condyle on MRI in early osteoarthritis and to compare with early osteoarthritis with meniscal tear without clear cartilage defect. Twelve patients with medial pain of the knee and cartilage defect without meniscal tear by MRI were studied for cartilage defect. There were two males and 10 females with cartilage defect, and they were between 42 and 61 years of age (average, 51.6). Fifteen patients with medial pain of the knee and meniscal tear and without clear cartilage defect had been studied as meniscal tear cases. There were five males and 10 females with meniscal tear, and they were between 45 and 61 years of age (average 54.5). In both groups, knee injuries by trauma and Kellgren radiographic grade III and IV osteoarthritis were excluded. We compared cartilage defect cases and meniscal tear cases by gender, age, medial meniscus displacement ratio from the edge of the tibial medial joint surface, femorotibial angle (FTA) and Mikulicz line. We measured medial meniscus displacement ratio by the proportion of medial meniscus lesion protruding from the edge of tibial medial joint surface to all the medial meniscus width on MRI. For the evaluation of Mikulicz line, we measured the score by the length from tibial medial joint surface to Mikulicz line to tibial plateau width. chi(2) Test was used for gender, and Mann-Whitney U test was used for age, medial meniscus displacement ratio, FTA and Mikulicz line. Statistically significant difference was not observed between cartilage defect cases and meniscal tear cases for age and gender. Medial meniscus displacement ratio was 13+/-12.3% in cartilage defect cases and 50.4+/-20.1% in meniscal tear cases. Medial meniscus displacement ratio in cartilage defect cases was significantly smaller than in meniscal tear cases (P=.0001). FTA was 174.9+/-2.2 degrees in cartilage defect cases and 178.3+/-4.8 degrees in meniscal tear cases. FTA in cartilage defect cases was significantly smaller than in meniscal tear cases (P=.00390). The score by the length from tibial medial joint surface to Mikulicz line to tibial plateau width was 35.8+/-11.8% in cartilage defect cases and 21.7+/-15.8% in meniscal tear cases. Mikulicz line in cartilage defect cases passes more laterally than in meniscal tear cases significantly (P=.0264). In this study, we reported cartilage defect cases at medial femoral condyle in the early osteoarthritis of the knee. We think that these cases were different from early osteoarthritis with meniscal tear in alignment of lower limb and onset mechanism. It is necessary to evaluate meniscus and cartilage in MRI when we diagnose middle-aged patients with medial pain of the knee and without remarkable changes of X-ray.

Remodeling of Articular Step-Offs

One of the major unresolved questions in trauma repair concerns the degree of step-off that can be accepted in a joint surface. In answer to this question, a new rabbit model of femoral step-off was developed. Osteoarthrotic changes in cartilage and bone and the failure of repair responses were seen at 20 weeks in the presence of a 3-mm wide sagittal defect displaced 5 mm from the joint surface and spanning the anteroposterior extent of the medial femoral condyle. This study examined the effects of a similar defect, displaced 2 mm from the joint surface, to determine whether the development of osteoarthrosis is dependent on the size of the step-off. Defects were created in 18 New Zealand white rabbits. In a second group, the medial joint surface was osteotomized, but was not displaced. In contrast to th first study, cartilaginous and bony repair resulted in closure of the surgical defect and restoration of femoral congruity. Histologic and biochemical parameters did not differ significantly between groups. The results indicate that cartilage and bone possess the ability to remodel small articular step-offs and to restore joint congruity. Furthermore, the combined data suggest that the development of osteoarthrosis requires significant articular incongruity.

変形性膝関節症に対するけい骨粗面下骨切り術の治療経験

High tibial osteotomies, both the wedge or dome type, are common in the treatment of osteoarthritis of the knee joint. However there is still some controversy remaining over whether the proximal fragment is too small to achieve a stable union using this technique.We performed proximal low tibial osteotomy (PLTO) to resolve the above. This technique offers the following advantages:(1) By using an equilateral triangular wedge osteotomy, the lateral cortical line is also adapted, and therefore a stable shape is maintained.(2) Using the May plate, rigid fixation is obtained.(3) Early rehabilitation is able to be carried out.We report on nine cases (11 knees), 2 male and 7 female, whose ages ranged from 52 to 72 years (mean 63.5) who were operated on using the PLTO technique from April 1990 to October 1992. The follow-up interval was from 6 to 32 months (mean 63.5). The JOA score was used for the clinical evaluation, and for the radiological evaluation, mechanical axis (MA), femorotibial angle (FTA) and condylar plateau angle (CPA) were measured.Good clinical and radiological results were obtained. On average the JOA score improved from 60 to 85 points, MA improved from 108.6% to 45%, FTA from 185° to 169° and CPA from 6.3° to 2.3°.We concluded that proximal low tibial osteotomy (PLTO) was a useful technique especially for treating the moderate osteoarthritic knee joint in which the mechanical axis passes within the medial joint surface.

Change in subchondral mineralization after reconstruction of the anterior cruciate ligament of the sheep

The cruciate ligaments are generally regarded as regulators of the joint kinematics, but also increasingly as a "Sensory organ" regulating the periarticular musculature, which influences the position of the contact surfaces and the direction and magnitude of the resultant forces. Indirectly, therefore, they influence the long-term stress distribution, which is itself reflected in the distribution of the subchondral mineralisation. An experimental investigation was therefore undertaken to see whether, in terms of this distribution, the distribution of the stress alters postoperatively, since this could be regarded as an early cause of degenerative change. We examined the distribution of the subchondral mineralisation of six tibiae from six adult Merino sheep 1 year after anterior cruciate ligament reconstruction with patellar tendon. The contralateral tibia we used as controls. Maximum subchondral mineralisation of both the medial and the lateral joint surfaces in all the control joints was found to be central. In the treated knees, however, the medial joint surface maxima were found to have been displaced towards the dorsomedial edge of the surface in every case. If the density pattern on the control side is accepted as the expression of a normal stress distribution, the distribution patterns on the treated side must indicate a pathologic distribution of stress. Reconstruction of the anterior cruciate ligament is therefore--at least in the animal model--not able to prevent the development of a pathologic stress distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

The Mechanics of Treatment of the Osteoarthritic Knee with a Wedged Insole

The mechanism of the static effects of the wedged insole for the medial osteoarthritic knee was studied in ten women. They stood with one leg on the wedged sole board, and the change of the position of the line through the center of gravity, the femorotibial angle, the tibiocalcaneal angle, and the spatial position of the whole lower limb were investigated using load transducers and roentgenograms. When the subjects stood on the wedged sole board, the line through the center of gravity and femorotibial angle did not change. The change in the spatial positions of the lower limb (p less than 0.02), i.e., the mechanical axis of the lower limb near an upright position, and the change of the calcaneus to valgus direction in the subtalar joint (p less than 0.01) were observed. These changes were considered from two-dimensional analysis to reduce the excessive loading on the medial joint surface and the excessive tensile force of the lateral side. The wedged insole thus proved effective for the conservative treatment of the medial compartment osteoarthritic knee.