Radiographic Analysis Research Articles

Reliability of the Biomechanical Assessment of the Sagittal Lumbar Spine and Pelvis on Radiographs Used in Clinical Practice: A Systematic Review of the Literature.

Background: Biomechanical analysis of the sagittal alignment of the lumbar spine and pelvis on radiographs is common in clinical practices including chiropractic, physical therapy, scoliosis-related thoraco-lumbo-sacral orthosis (TLSO) management, orthopedics, and neurosurgery. Of specific interest is the assessment of pelvic morphology and the relationship between angle of pelvic incidence, sacral slope, and lumbar lordosis to pain, disability, and clinical treatment of spine conditions. The current state of the literature on the reliability of common methods quantifying these parameters on radiographs is limited. Methods: The objective of this systematic review is to identify and review the available studies on the reliability of different methods of biomechanical analysis of sagittal lumbo-pelvic parameters used in clinical practice. Our review followed the recommendations of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The design of this systematic review was registered with PROSPERO (CRD42023379873). Results: The search strategy yielded a total of 2387 articles. A total of 1539 articles were screened after deduplication and exclusion by automation tools, leaving 473 full-text articles that were retrieved. After exclusion, 64 articles met the inclusion criteria. The preponderance of the evidence showed good to excellent reliability for biomechanical assessment of sagittal lumbo-pelvic spine alignment. Conclusions: The results of this systematic review of the literature show that sagittal radiographic analysis of spinal biomechanics and alignment of the human lumbo-pelvic spine is a reliable tool for aiding diagnosis and management in clinical settings.

The Optimal Variation Range of Posterior Condylar Offset Associated with Positive Clinical Outcomes of Primary Total Knee Arthroplasty: A Retrospective Analysis.

Posterior condylar offset (PCO) and anterior condylar offset (ACO) exert an influence on the sagittal alignment in total knee arthroplasty (TKA). However, there is no common consensus that the variation range of posterior condylar offset (PCO) is associated with patient-reported outcome measures (PROMs) and the optimum variation range of PCO. This study aims to investigate the correlation between PCO and the PROMs of primary TKA for osteoarthritis (OA) and find out the optimal variation range of the PCO. In this study, we performed a radiographic analysis of 106 patients (112 knees) with primary TKA. Patients were divided into two cohorts (A and B) according to the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Correlations between the sagittal parameter and WOMAC were investigated using univariate and multivariate analysis. The receiver operating characteristic (ROC) curve was used to establish the cut-off value for the optimal variation range. We then further investigated how different variation range affects the WOMAC subscale score and forgotten-joint-score-12 (FJS-12). Univariate analysis revealed a correlation between the variation range of PCO (p < 0.01), ACO (p < 0.01) and PROMs. Multivariate analysis showed that only PCO was associated with PROMs. In the ROC graph, the cut-off value of the variation range of PCO is 2.85 mm (AUC = 0.66, Youden index = 0.26). The WOMAC functional ability score of the group outside the PCO variation range of 2.85 mm significantly increased compared to the group within the range. In this study, PCO variation was significantly associated with clinical outcomes in TKA and the optimal PCO variation range was within 2.85 mm. Maintaining the PCO variation within 2.85 mm could enhance functional recovery and patient satisfaction.

Effect of Preoperative Coronal Plane Alignment on Actual Versus Predicted Alignment Using Patient Specific Instrumentation in Total Ankle Replacement

Alignment in total ankle replacement is important for success and implant survival. Recently there has been the introduction and adoption of patient specific instrumentation for implantation in total ankle replacement. Current literature does not evaluate the effect of preoperative deformity on accuracy of patient specific instrumentation. A retrospective radiographic analysis was performed on 97 consecutive patients receiving total ankle replacement with patient specific instrumentation to assess the accuracy and reproducibility of the instrumentation. Subgroup analysis evaluated the effect of preoperative deformity. All surgeries were performed by fellowship trained foot and ankle surgeons without industry ties to the implants used. Preoperative and postoperative films were compared to plans based on computerized tomography scans to assess how closely the plan would be implemented in patients. Overall postoperative coronal plane alignment was within 2° of predicted in 87.6% (85 patients). Similarly, overall postoperative sagittal plane alignment was within 2° of predicted in 88.7% (86 patients). Tibial implant size was accurately predicted in 81.4% (79 patients), and talus implant size was correct in 75.3% (73 patients). Patients with preoperative varus deformity had a higher difference between predicted and actual postoperative alignment compared to valgus deformity (1.1° compared to 0.3°, p=0.02). A higher average procedure time was found in varus patients, and more adjunctive procedures were needed in patients with varus or valgus deformity, but these were not significant, p>0.5. Surgeons can expect a high degree of accuracy when using patient specific instrumentation overall, but less accurate in varus deformity.

Influence of cranium orientation on cervical sagittal alignment during radiographic examination: a radiographic analysis

BACKGROUND CONTEXTDuring the radiographic examination, the cranium orientation varies not only individually but also within the same subject, in different imaging sessions. Knowing how changes in the orientation of the cranium influences cervical sagittal alignment during the radiographic examination of the cervical spine can aid clinicians in the accurate evaluation for cervical sagittal alignment in clinical practice. PURPOSETo radiographically examine the influence of cranium orientation on cervical sagittal alignment during radiographic examination in an asymptomatic cohort. STUDY DESIGNA prospective radiographic study. PATIENT SAMPLEEighty asymptomatic volunteers (mean age, 40.4 years; 50.0% male) were enrolled. OUTCOME MEASURESCervical sagittal parameters including the regional slope (C1 slope, C2 slope, C5 slope, C7 slope, and T1 slope), Cobb angle (O–C1 angle, C1–C2 angle, C2–C5 angle, C5–C7 angle, and C7–T1 angle), and cranial/cervical offset (sella turcica tilt [ST tilt] and C2 tilt). METHODSIn all participants, standing lateral radiographs of the cervical spine were taken in three forward-gazing positions: anteverted-cranium (AC) position; neutral-cranium (NC) position; and retroverted-cranium (RC) position. Cervical sagittal parameters, including the regional slope, Cobb angle, and cranial/cervical offset, in these three positions were statistically compared. RESULTSThe C1 and C2 slopes were anteverted and retroverted in the AC and RC positions, respectively, compared to those in the NC position. The C5 slope, C7 slope, and T1 slope were constant among the three positions. In O–C2 and C2–C5, statistically significant differences in the regional Cobb angles were identified among the three positions; however, there were no significant differences in the C5–C7 or C7–T1 segments. Cranial and cervical offsets of ST tilt and C2 tilt increased and decreased when the cranium was anteverted and retroverted, respectively. CONCLUSIONSThe current study suggests that the adjustment of the cranium orientation when taking cervical spine radiographs is mainly controlled at the upper cervical spine of the O–C2 segment in an asymptomatic cohort. On radiograph, alignment in the upper cervical segment of O–C2 changes; accordingly, the middle cervical segment of C2–C5 can change during the adjustment of cranium orientation. However, alignment in the lower cervical segment of C5–C7 and the cervicothoracic junction of C7–T1 remains constant. Further, cranial/cervical offset increases and decreases when the cranium is anteverted and retroverted, respectively. Our results can help the accurate evaluation of cervical sagittal alignment on plain radiographs in clinical practice.

PARAMETERS ASSOCIATED WITH ERUPTION OUTCOMES AND IMPACTION OF PERMANENT MAXILLARY CANINES AFTER SECONDARY ALVEOLAR BONE GRAFTING IN PATIENTS WITH CLEFT LIP AND PALATE

A cleft lip and palate (CLP) is the most prevalent anomaly affecting craniofacial structures. Alveolar bone grafting is essential for patients with CLP to ensure the proper alignment of the maxillary segments and to create a bony foundation for the permanent maxillary canines (PMC) to erupt. To reduce the risk of PMC impaction, secondary alveolar bone grafting (SABG) is usually performed in patients aged 8–12 years when the development of the canine root is 1/4 to 1/2 the expected length. The aim of this systematic literature review is to access the parameters associated with eruption outcomes and impaction of PMC after SABG in patients with CLP. A comprehensive literature search was carried out following PRISMA guidelines in the MEDLINE (PubMed) and EMBASE (ScienceDirect) electronic databases, using the combinations of the following Medical Subject Heading (MeSH) terms: (impacted canines) AND (alveolar bone grafting) [MeSH term] AND (cleft lip) [MeSH term] AND (cleft palate) [MeSH term]. A total of 276 articles were identified, of which 4 studies met the eligibility criteria. Based on the studies reviewed, the most reliable parameters to determine the risk of canine impaction through the analysis of panoramic radiographs are the angulation and vertical position of PMC. A greater risk of PMC impaction on the cleft side after SABG is associated with an increased canine angulation and a more pronounced displacement in the vertical direction.

Structural bone grafting with reverse shoulder arthroplasty for osteoarthritis with severe glenoid bone loss: outcomes using a long post

Severe posterior glenoid bone loss with glenohumeral osteoarthritis with an intact rotator cuff can be managed with reverse shoulder arthroplasty but requires lateralization and version correction to avoid potential complications, such as instability, notching and implant failure. Angled bone grafting with humeral head autograft can provide durable glenoid bone stock, but results have been mixed. The purpose of this study was to evaluate patient-reported and objective outcomes as well as complication and failure rates for patients who underwent angled humeral head autografting for severe retroversion. All patients who underwent a primary reverse shoulder arthroplasty with angled humeral head autograft and Stryker Tornier long central postbaseplate for severe glenoid bone loss in the setting of glenohumeral osteoarthritis with an intact rotator cuff at our institution between November 2018 and February of 2022 were identified. Individuals with a primary diagnosis of osteoarthritis and preoperative glenoid retroversion of ≥30° were included. Patients undergoing revision procedures, planned 2-stage arthroplasty were excluded. Differences in pre- and postoperative range of motion, as well as patient-reported outcomes were assessed. Intraoperative complications, postoperative complications, and re-operation rates were analyzed. A total of 24 shoulders in 23 patients (61% male), with a mean age of 65.6years were included. Average preoperative retroversion was 37.4° (range: 30°-51°). Mean follow-up was 2.9years (range: 2-4.3years). Significant improvements were found in flexion, abduction, and external rotation. Patient-reported subjective outcomes were excellent, with average American Shoulder and Elbow Surgeons score of 93.6 and average Subjective Shoulder Value score of 93.8%. Sixteen (67%) shoulders received postoperative computed tomography scans and all were found to have incorporated. Complications included one shoulder hematoma requiring incision and drainage without revision, and a post-traumatic fracture of the inferior glenoid screw at 11months, requiring revision reverse shoulder arthroplasty with bone grafting. No atraumatic catastrophic failures occurred due to component loosening. This study suggests that using angled humeral head bone grafting is a good solution for version correction in extreme posterior glenoid bone loss. Significant improvements are reported in range of motion, pain, and subjective functional scores, with excellent graft incorporation rates and a low complication profile at early follow-up. Further work should focus on gathering higher levels of evidence, detailed radiographic analyses, and exploring humeral head bone grafting for other indications.

Clinical outcomes and survival rates of a uncemented modular revision stem system in hip arthroplasty: a 10-year single-institution study on a frail population

IntroductionThe increasing prevalence of primary hip arthroplasty has led to a parallel rise in revision cases. Femoral revision often entails compromised bone integrity, requiring consideration of various solutions for optimal reconstructive options. Despite technological advancements, there is limited evidence on the clinical outcomes of the latest modular revision stems. This study aimed to evaluate the clinical outcomes and survival rates of next generation uncemented modular revision stem in patients undergoing hip revision surgery.Materials and methodsThis retrospective single-center study assessed the survival and failure causes of a specific uncemented modular stem in 48 patients undergoing hip revision surgery between 2012 and 2022. Data included preoperative parameters, surgical details, and postoperative outcomes measured through clinical and radiographic assessments. Forty-eight patients (25 males, 23 females; mean age 72 years) were included, with a mean Charlson Comorbidity Index of 5. Preoperative diagnoses varied, with periprosthetic joint infection (PJI) being the most common (45.8%), followed by periprosthetic fractures (27.1%). Partial revisions occurred in 60.4%, total revisions in 39.6%. According to Paprosky classification of femoral bone loss, type II and III were the most represented, respectively 35.4% and 50%.ResultsAt a mean follow-up of 4.6 years, stem survival was 92.5%. Complications (20%) included dislocation, PJI, fracture, and loosening; the overall reoperation rate was 12.5%. The SF-12 physical score was 43.6, while the mental score was 51.1. The HOOS score was 71.8, and the HHS score was 71.4. Radiographic analysis identified nonprogressive osteolysis in 15.1% of patients.ConclusionsThis study on this uncemented modular revision stem demonstrated favorable outcomes in an elder fragile population with moderate to severe femoral bone loss. The implant’s modularity provides versatility in addressing various defects, without any implant breakage observed during the study period. Literature comparison highlighted similar outcomes despite sample size differences. The promising results warrant continued investigation into the long-term survivorship of this modular stem system.

Investigating the effects of pelagic trawling on the welfare of Atlantic herring (Clupea harengus)

The effects of pelagic trawling on the health and welfare of Atlantic herring (Clupea harengus L.) were investigated on a refrigerated seawater vessel operating in the North Sea. A total of 495 Atlantic herring (Clupea harengus L.) were sampled during five hauls from two fishing trips in September 2021 and 2022. For assessments of consciousness and mortality, a Reflex Action Mortality Predictor test (i.e. RAMP-test) was used on herring collected following trawling and pumping. Inspections for external and internal damage or wounds were performed via morphological welfare indicators and analyses of photos and radiographs. In addition, blood samples were taken and analysed for haematological indicators of stress. Following trawling and pumping, only 5% of the investigated herring showed signs of external wounds associated with the morphological indicators of welfare, and no internal damage was observed in the radiographic inspections. However, 96% of the assessed herring scored 0 on all three reflexes included in the RAMP-test and were therefore judged dead. On average, herring lost 95% of their scales, while 95% of herring had a very high degree of ruptured red blood cells (i.e. haemolysis). Extensive scale loss results in a deterioration of the skin's protective barrier function, which in turn impairs the osmoregulatory capacity of the herring. This was evident by elevated levels of plasma osmolality and circulating chloride concentrations, which could also likely explain the high occurrence of haemolysis in captured herring. Extended trawling time and larger catch size proved to be two important factors to consider, as the former led to increased plasma levels of osmolality, whereas the latter was associated with elevated plasma levels of lactate and cortisol. In conclusion, the high mortality appears to be influenced by a combination of factors such as severe stress, loss of osmoregulatory ability, crowding density within the trawl, and extended trawling times. This study provides important information on the welfare of wild Atlantic herring caught using pelagic trawls and highlights areas where improvements can be made to safeguard the welfare of fish captured in pelagic fisheries in the future.

Odontogenic Maxillary Sinusitis: A clinical case report

underdiagnosed due to its nonspecific clinical presentation, which overlaps with other types of rhinosinusitis. The etiopathogenesis involves a complex interplay of factors including iatrogenic causes, periodontal infections, and traumatic events, leading to a persistent inflammatory response in the maxillary sinus. This report details a clinical case involving a 19-year-old male patient presenting with exacerbated sinusitis symptoms linked to a carious upper right first molar. Clinical manifestations included blurred vision, facial pain, and nasal regurgitation of liquids. Radiographic analysis revealed a radiolucent area indicative of sinus involvement, confirming the diagnosis of OMS.Surgical intervention comprised the extraction of the infected molar and the debridement of the maxillary sinus, followed by the application of Bichat’s fat pad to repair the resulting oroantral communication. This technique demonstrated effective closure of the defect, promoting tissue healing and reducing postoperative complications. The postoperative regimen included antibiotics, anti-inflammatories, and antihistamines, which facilitated recovery. This case underscores the necessity of a multidisciplinary approach in the diagnosis and management of OMS, integrating dental and surgical expertise to optimize patient outcomes. Imaging plays a crucial role in the diagnostic process, enabling precise identification of odontogenic lesions and their extent. The successful use of Bichat’s fat pad highlights its utility in oral-maxillofacial surgery for managing oroantral fistulas. This report contributes to the growing body of evidence supporting the importance of tailored surgical and medical strategies in managing complex cases of odontogenic maxillary sinusitis.

Early Functional Outcomes and Complications of Tibial and/or Peroneal Sesamoidectomy Utilizing a Burr Through a Medial Approach.

Sesamoid pathology can lead to significant pain and disability both with activities of daily living and high-impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain, but complications were reported. A proposed alternative medial approach using a burr may provide many advantages compared with traditional approaches. This study presents patient outcomes and complications for this technique. This was a retrospective chart review of patients undergoing sesamoidectomy (tibial, peroneal, or both) using a burr through a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Twenty-seven patients (29 feet) were included. The mean age was 38.4 years followed up for a mean of 30.9 months. VR-12 physical component improved from 35.98 ± 7.86 to 51.34 ± 8.01 (P < .001), FAAM ADL and sport improved from 58.33 ± 16.61 to 83.27 ± 18.28 (P < .001) and 26.37 ± 20.31 to 63.75 ± 29.74 (P < .001), respectively. Patient satisfaction with the treatment was 80.59% ± 27.06%. The overall complication rate was 11 (37.9%) whereas the overall reoperation rate was 4 (13.7%) of 29 feet. Complications included 1 arthrofibrosis, 1 flexor hallucis longus subacute rupture, and 1 asymptomatic hallux valgus. There were no sesamoid excision revisions. Sesamoidectomy using a medial approach with a burr provided significantly improved short-term functional outcomes, 80% patient satisfaction rate, with a relatively acceptable complications rate including 20% persistent pain. The medial approach is familiar to orthopaedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar scar while avoiding disruption of the plantar plate, flexor hallucis brevis tendon, and ligamentous structures attached to the sesamoids. Larger studies with long-term follow-up from other centers are needed.

Rheological and osteogenic effect of Agaricus blazei Murill polysaccharides on composite hydrogels based on HPMC/graphene oxide – A preliminary study

This study aimed to prepare and preliminarily characterize the potential bone restorative effect of composite hydrogels based on hydroxypropylmethylcellulose (HPMC), graphene oxide (GO), and polysaccharides from Agaricus blazei Murill mushroom (PAb). The chemical composition and morphology of the biomaterials were analyzed using FTIR, XRD, SEM, and EDS. Rheological tests were conducted on the hydrogels to assess their flow properties for in vivo application and product stability. Cytotoxicity assays were performed using the GO (1 – 100 µg mL–1) against human neutrophils. Additionally, an in vivo tooth extraction test was carried out by applying HPMC hydrogels containing GO and PAb directly into the alveoli to enhance oral bone restoration. The rheological behavior of the hydrogels followed the Ostwald de Waele model (R² > 0.99), with flow index (n) values below 1.0, indicating a pseudoplastic behavior. Furthermore, the consistency index (k) values increased with the addition of GO and PAb, suggesting a more complex structure, and altered flow behavior at lower shear rates. In the MTT assay, GO exhibited low cytotoxicity towards human neutrophils, maintaining cell viability above 95.0 % even at high concentrations. For the in vivo study, a bisphosphonate-induced osteonecrosis model was used to assess bone tissue healing through macroscopic and radiographic analyses. A significant improvement was observed in the reduction of bone tissue loss in rats treated with the hydrogels compared to the negative control (ZA group). These findings indicate that composite hydrogels containing HMPC/GO/PAb have the potential to be used as biomaterials for mitigating bone loss.

Distribution, morphology, and natural history observations of the Colombian weasel, Neogale felipei

ABSTRACT The Colombian weasel, Neogale felipei, is a rare carnivoran known only from nine localities, eight in Colombia and one in Ecuador. Recent records have expanded our understanding of the distribution and threats that this mammal faces, but the species is still among the rarest Neotropical carnivores. Here, we present an update to the distribution of N. felipei based on a recent record obtained in the Cordillera Occidental (Western Cordillera) of Colombia, and information on internal and external morphology using noninvasive technique such as X-rays of museum preserved specimens. We also documented the presence of lice, Neotrichodectes minutus, which is the first documented ectoparasite of the species. With the new records, the species is currently known from 12 localities (11 in Colombia and one in Ecuador). We also present the first radiographic analyses for N. felipei and the obtained vertebral formula (49 total vertebrae) fits into the range reported for the species and other mustelids. Considering that the Colombian weasel is one of the rarest carnivores of the Neotropics, our work represents a noteworthy contribution to several aspects of the anatomy, distribution, and natural history of this rare carnivoran.

Improving the radiographic image analysis of the classic metaphyseal lesion via conditional diffusion models

The classic metaphyseal lesion (CML) is a unique fracture highly specific for infant abuse. This fracture is often subtle in radiographic appearance and commonly occurs in the distal tibia. The development of an automated model that can accurately identify distal tibial radiographs with CMLs is important to assist radiologists in detecting these fractures. However, building such a model typically requires a large and diverse training dataset. To address this problem, we propose a novel diffusion model for data augmentation called masked conditional diffusion model (MaC-DM). In contrast to previous generative models, our approach produces a wide range of realistic-appearing synthetic images of distal tibial radiographs along with their associated segmentation masks. MaC-DM achieves this by incorporating weighted segmentation masks of the distal tibias and CML fracture sites as image conditions for guidance. The augmented images produced by MaC-DM significantly enhance the performance of various commonly used classification models, accurately distinguishing normal distal tibial radiographs from those with CMLs. Additionally, it substantially improves the performance of different segmentation models, accurately labeling areas of the CMLs on distal tibial radiographs. Furthermore, MaC-DM can control the size of the CML fracture in the augmented images.

Two-stage corrective operation for the treatment of pes cavovarus in patients with spina bifida.

Pes cavovarus has an estimated incidence of 8%-17% in patients with spina bifida (SB). The majority of the current literature on surgical treatment of cavovarus feet in children and adolescents includes a variety of diagnoses. There are currently no case series describing a treatment algorithm for deformity correction in this specific patient population. The authors of this study present the results of a retrospective case series performed to assess the radiographic outcomes of two-stage corrective surgery in patients with SB. To assess the radiographic outcomes of a staged operation consisting of radical plantar release followed by osteotomy for pes cavovarus in patients with SB. Retrospective chart review was performed on patients with SB with a diagnosis of pes cavovarus at a freestanding children's hospital who underwent surgical correction of the deformity. Patients were excluded for lack of two-stage corrective operation, nonambulatory status, lack of at least six months follow-up, and age > 18 years at the time of surgery. This resulted in a cohort of 19 patients. Radiographic analysis was performed on 11 feet that had a complete series of preoperative and postoperative weightbearing X-rays. Preoperative and postoperative radiographic outcome measurements were compared using a two-sample t-test. Significant changes between the preoperative and postoperative measurements were seen in Meary's angle, the anteroposterior talo-first metatarsal (AP TMT1) angle, and the talonavicular coverage. Mean values of Meary's angle were 17.9 ± 13.1 preoperatively and 4.7 ± 10.3 postoperatively (P = 0.016). Mean AP TMT1 angle was 20.6 ± 15.1 preoperatively and 9.3 ± 5.5 postoperatively (P = 0.011). Mean talonavicular coverage values were -10.3 ± 9.6 preoperatively and -3.8 ± 10.1 postoperatively (P = 0.025). The two-stage corrective procedure demonstrated efficacy in correcting cavovarus deformity in patients with SB. Providers should strongly consider employing the staged surgical algorithm presented in this manuscript for management of these patients.

Investigating the anti-inflammatory and immune-modulatory effects of “Gola” guava fruit and leaf extract in alleviating papain-induced knee osteoarthritis

IntroductionThis present research was designed to investigate the anti-inflammatory and immune-modulatory effects of a 50% hydroethanolic extract of “Gola” guava fruit (GF50%) and guava leaf (GL50%) against papain-induced knee osteoarthritis (KOA).MethodsSixty Sprague–Dawley rats were divided into five groups (10 rats/ group): T0 (negative control), T1 (positive control), T2 (200 mg/kg GF50%), T3 (400 mg/kg GF50%), T4 (200 mg/kg GL50%), and T5 (400 mg/kg GL50%). Physical parameters were evaluated throughout the trial, while biochemical, histopathological, and radiographic analyses were performed at 0, 15, and 30 days. The histopathological and radiographic analyses were evaluated using the Osteoarthritis Research Society International (OARSI) score and Kellgren–Lawrence (KL) classification systems, respectively.Results and discussionThe T1 group demonstrated a significant increase in knee diameter, confirming successful OA induction. The T5 group maintained a significantly lower body weight at day 30, and the T3 group exhibited the highest weight gain. The high dose of GL50% (400 mg/ kg) effectively reduced knee inflammation and significantly downregulated myeloperoxidase (MPO), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). In contrast, it significantly (p &amp;lt; 0.001) upregulated the serum and knee capsule tissue superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). In addition, histopathological and X-ray examinations also confirmed the chondroprotective potential of GL50% extract against OA. Consequently, 400 mg/kg GL50% exhibited anti-inflammatory and chondroprotective potential by lowering oxidative stress and pro-inflammatory cytokines and elevating antioxidant status. These findings could provide a theoretical basis for understanding the mechanism and potential medicinal value of guava fruit and leaf in treating KOA.

How to be sure of a complete removal of Essure® implant? A radiological study of Essure® microinserts

PurposeLaparoscopic cornuectomy, one of the most performed surgical techniques to remove Essure® implants, is associated with a risk of fragmentation of the device. We aimed to assess the diagnostic accuracy of the intraoperative radiograph of the removed Essure® microinserts compared with intraoperative inspection of the device. Study designIn this French retrospective cohort study including 66 patients, two experienced gynecologists and two residents evaluated the intraoperative radiograph in a blind manner. Diagnostic accuracy was calculated for each observer. ResultsThe global sensitivity and specificity for intraoperative radiograph to detect a residual fragment for both senior gynecologists and residents were, respectively 87.5 % (±3.3) and 80.0 % (+/12.2). Pooled positive (PPV) and negative predictive values (NPV) for intraoperative radiograph were respectively 99.2 % (±0.5) and 21.6 % (±6.4). There was a statistically significant difference in intraoperative radiograph analysis between senior gynecologists and residents (sensitivity: 91.4 %±0.8 vs 79.6 %±1.5, p = 0.02; specificity: 100% vs 50.0 %, p < 0.0001; PPV: 100 % vs 98.0 % ±0.1, p = 0.0007; NPV: 26.8 % ±1.8 vs 7.2 % ±0.5, p = 0.009).Sensitivity and specificity of the intraoperative inspection of the removal specimen was respectively 95.3 % and 100 % (PPV and NPV were, respectively 100 and 40 %).There were no statistically significant differences in diagnostic accuracy between intraoperative radiographs analysis and intraoperative inspection of the device for the senior gynecologists. ConclusionsIntraoperative radiograph of the removed Essure® implants analysis is a difficult skill needing specific training. Postoperative pelvic X-ray is still recommended in clinical practice after laparoscopic cornuectomy.

Rate of graft retear is higher in over-the-top superior capsular reconstruction for massive posterosuperior rotator cuff tears with subscapularis tear.

To compare side-to-side superior capsular reconstruction (SCR) with over-the-top SCR in terms of functional outcomes, pain relief and allograft survival rates. Patients who had undergone arthroscopic dermal allograft SCR for massive irreparable rotator cuff tears and clinical follow-up for ≥2 years were recruited. All patients underwent postoperative assessment with routine radiographic analysis for acromiohumeral distances, ultrasound imaging 1 and 3 months after SCR and magnetic resonance imaging (MRI) at least 12 months after SCR. The outcome measures were visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant and Single Assessment Numeric Evaluation (SANE) scores. SCR was performed in 56 patients including side-to-side SCR in 32 and over-the-top SCR in 24. Postoperative MRI showed that the grafts were intact in 46 patients (82.1%; 26 who underwent side-to-side SCR and 20 who underwent over-the-top SCR). The proportion of nonhealing grafts in the over-the-top group was significantly higher with concomitant subscapularis tears (60% vs. 5.3%; p = 0.02). VAS scores and functional outcomes improved postoperatively in both groups and postoperative VAS (1.4 vs. 1.7; n.s.), Constant (74.8 vs. 76.0; n.s.), mean ASES (87.4 vs. 89.1; n.s.) and mean SANE (81.7 vs. 84.3; n.s.) scores did not differ significantly. For massive rotator cuff tears, over-the-top and side-to-side SCR achieve similar pain relief and functional improvement, and the rate of healing allografts is high. However, over-the-top SCR is not recommended for massive posterosuperior rotator cuff tears with repairable subscapularis tendon tears due to a higher nonhealing rate. Level III.

Progression of arthritis after four-corner fusion in patients with calcium pyrophosphate deposition disease: a case series of eleven patients

Aim: The purpose of this study is to evaluate outcomes and radiographic progression of wrist arthritis after four-corner fusion (4CF) in patients with evidence of calcium pyrophosphate deposition disease (CPPD). The insights derived from this study are expected to improve the understanding of 4CF outcomes in the presence of CPPD, guiding clinical decisions, and management strategies. Methods: 11 patients with prior 4CF and evidence of CPPD were available for prospective follow-up and imaging, with a mean follow-up time of 5 years. Range of motion measurements, radiographs, and outcome data were collected at the follow-up visit and prior data and imaging were reviewed retrospectively. The chronological progression of arthritis was evaluated on standard three-view wrist radiographs using the Larsen scale. Results: All participants (11/11) deemed their wrist fusion a success, with an average satisfaction score of 8.8 out of 10.73% (8/11) patients were able to return to their original occupation after the procedure. The mean flexion of the affected wrist preoperatively was 43 degrees (SD: ±12 degrees) and 41 degrees (SD: ±7 degrees) at the final follow-up. The mean extension of the affected wrist was 35 degrees (SD: ±8 degrees) preoperatively and 40 degrees (SD: ±12 degrees) at the final follow-up. Radiographic analysis showed that 82% (9/11) of patients displayed progression of arthritis as per the Larsen scale by the final follow-up. All patients that showed radiographic progression had involvement of the radiolunate (RL) articulation, which is classically persevered in non-inflammatory wrist arthritis. Conclusions: Scaphoid excision with 4CF is a promising surgical option for managing CPPD-related wrist arthritis, offering significant functional improvements, motion preservation, and high patient satisfaction. However, it does not halt radiographic progression of arthritis for the majority of patients at a mean prospective long-term follow-up of 5 years.

Radiographs demonstrate poor accuracy for evaluation of postoperative osseous integration of osteochondral allografts in the knee

PurposeTo evaluate the interrater reliability and accuracy of radiographs in assessing healing of osteochondral allografts (OCA) in the knee compared to computed tomography (CT) imaging. MethodsA retrospective review patients who underwent OCA transplantation of the knee was conducted. Postoperatively, knee radiographs were obtained at three and six months, and CT scans were obtained at six months. Three board-eligible orthopaedic surgeons independently graded postoperative radiographs, utilizing the grading scale established by Oladeji et al 2017, and the CT scans utilizing the grading scale established by Gelber et al 2021. Their consensus measurements served as a comparative gold standard. ResultsAmong 44 prospectively imaged grafts, 13 (29.5%) had radiographs at three months and 28 (63.6%) had radiographs available for evaluation at six months. Assessment of radiographic integration demonstrated low reliability (ICC: -0.02 to 0.14). On CT scan, this improved to fair reliability (k=0.29, p<0.001). However, Spearman rho between CT and XR grading demonstrated poor correlation (ρ = -0.23, p=0.04). Among six-month postoperative radiographs, accuracy of cyst identification was negatively correlated to greater degree of cystic changes from 90.9% (30/33 correct; no cystic changes) to 19.4% (7/36 correct; small cystic changes) and 33.3% (5/15 correct; large cystic changes). Overall true positive cyst detection rates on radiographs were 27.8% to 46.7%. ConclusionRadiographs demonstrate poor interrater reliability and accuracy in evaluation of healing after OCA transplantation of the knee. Notably, there was a high rate of missed cystic changes on radiographic analysis, as well as poor correlation of integration assessment with CT scan findings.

Assessment of Pelvic Tilt in Anteroposterior Radiographs by Area Ratio Based on Deep Learning.

Diagnostics. Based on deep learning semantic segmentation model, we sought to assess pelvic tilt by area ratio of the lesser pelvic and the obturator foramen in anteroposterior (AP) radiographs. Pelvic tilt is a critical factor in hip and spinal surgery, commonly evaluated by medical professionals through sagittal pelvic radiographs. The inherent pelvic asymmetry, as well as potential obstructions from clothing and musculature in roentgenography, may result in ghosting and blurring artifacts, thereby complicating precise measurement. PT directly affects the area ratio of the lesser pelvis to the obturator foramen in AP radiographs. An exponential regression analysis of simulated radiographs from ten male and ten female pelvises in specific tilt positions derived a formula correlating this area ratio with PT. Two blinded investigators evaluated this formula using 161 simulated AP pelvic radiographs. A deep learning semantic segmentation model was then fine-tuned to automatically calculate the area ratio, enabling intelligent PT evaluation. This model and the regression function were integrated for automated PT measurement and tested on a dataset of 231 clinical cases. We observed no disparity between men and women in the aforementioned area ratio. The test results from two blinded investigators analyzing 161 simulated radiographs revealed a mean absolute error of 0.19° (SD ±4.71°), with a correlation coefficient between them reaching 0.96. In addition, the mean absolute error obtained from testing 231 clinical AP radiographs using the fine-tuned semantic segmentation model mentioned earlier is -0.58° (SD ±5.97°). We found that using deep learning neural networks enabled a more accurate and robust automatic measurement of PT through the area ratio of the lesser pelvis and obturator foramen.