Radiographic Grading Research Articles

Relationship between osteoarthritis findings in knee radiography and meniscus lesion in magnetic resonance imaging in symptomatic knee pain cases

Aim: Knee osteoarthritis is a very common joint disease in the community. However, some meniscus lesions are asymptomatic. Studies show that a significant number of individuals with knee pain without radiographic osteoarthritis findings show meniscus injury on magnetic resonance imaging (MRI). Our study aimed to evaluate the relationship between meniscus lesions and the presence of radiographic knee osteoarthritis in individuals over 50 years of age with knee pain complaints. Methods: Radiographic and MRI results of two hundred and forty patients who applied to our hospital with the complaint of knee pain between August 2018 and January 2020 were analyzed. Radiographic grading for knee osteoarthritis was performed using the Kellgren Lawrence scale. Classification of meniscus lesions in MRI was made as per the criteria defined by the British Knee Meniscus Surgery Association. Intergroup results were evaluated statistically. Results: Osteoarthritis was detected in 110 (45.8%) of 240 knee radiographs. In 78.3% of all cases, meniscus lesions were detected in 96.4% of those with osteoarthritis and 63% of those without osteoarthritis. In patients with osteoarthritis, the prevalence of surgically targeted and possible target lesions was found to be significantly higher than those with no arthritis findings. Conclusions: According to our study results, meniscus lesions were found quite common in individuals with knee pain, especially those with osteoarthritis. Particularly in patients with radiographic osteoarthritis findings, surgical targets and possible target meniscus lesions were more common than those without osteoarthritis findings. Therefore, MRI, in addition to direct radiography, should not be overlooked when determining treatment.

What factors are associated with perceived disease onset in patients with hip and knee osteoarthritis?

IntroductionNewly symptomatic osteoarthritis (OA) is often misinterpreted as new pathology or injury, which is associated with pain intensity and incapability. MethodsAdult patients with hip and knee OA completed measures of catastrophic thinking, depression, capability, symptom duration, and perceived injury. ResultsSymptom duration was associated with OA grade and symptoms of depression. Perceived injury was common (31%) and associated with men and knee arthritis. Capability was associated with misinterpretation of symptoms and the work status ‘other,’ but not radiographic severity. ConclusionsMisinterpretation of OA symptoms is common and has a greater influence on capability than radiographic grade of pathophysiology.

Outcomes of oblique supramalleolar osteotomy without fibular osteotomy for congruent- and incongruent-type medial ankle arthritis

BackgroundAlthough high talar tilt and ankle mortise incongruence are risk factors for supramalleolar osteotomy (SMO), no study on lateral talofibular joint congruence exists. We aimed to evaluate the outcomes of oblique SMO without fibular osteotomy for medial ankle arthritis and compare them according to the lateral talofibular joint congruity. MethodsForty-eight ankles were retrospectively reviewed and divided according to preoperative talofibular joint congruity (congruent, 22 [45.8%] vs. incongruent, 26 [54.2%]). ResultsThe mean VAS score, AOFAS score, and modified Takakura stage were significantly improved. No significant differences were noted in clinical outcomes, but the mean postoperative tibiotalar angle and difference between the upper and lower talofibular gaps were significantly different in both groups (p = 0.004 and p = 0.009, respectively). The mean Takakura stage at 1 and 2 years after surgery was higher in the incongruent group (p = 0.013, p = 0.012). ConclusionThis procedure was effective against early- to mid-stage medial ankle arthritis. Radiographic arthritic grade changed according to the talofibular joint congruity.

Long-Term fate of the upper urinary tract and ITS association with continence in exstrophy patients

Scarce data is available in literature about the upper urinary tract outcomes of patients with Exstrophy-Epispadias Complex (EEC). After bladder closure during childhood, EEC bladders can become hostile to the upper tracts after bladder by exposing them to high pressures, leading to hydronephrosis (HN) and kidney damage. Similarly, vesicoureteral reflux (VUR) may be present and increase the likelihood for pyelonephritis. We sought to assess long-term upper urinary tract outcomes by evaluating renal function, HN and VUR; and to assess if upper urinary tract outcomes are associated with continence status. A retrospective review of EEC patients having ≥1 surger(y) (ies) at our institution from 1990 until 2019 was performed. Renal function was assessed by evaluating last available estimated glomerular filtration rate (eGFR) and creatinine values. HN was assessed on ultrasound and classified according to the SFU-classification. Patients with recurrent febrile urinary tract infections (UTI) or pyelonephritis underwent a voiding-cystourethrogram (VCUG) assessing VUR, graded following the 'International system of radiographic grading of VUR'. Descriptive and comparative statistical analysis were performed to assess if upper tract outcomes are associated with continence status. Forty-eight patients (75% male) had a median (IQR) follow-up of 18 (10-21) years. The table shows upper tract outcomes for the entire group and stratified by continence status. The median creatinine was 0.6 (0.2-0.9) mg/dL and median eGFR was 108 (72-160) mL/min/1.73m [2]. In two patients (4.2%), HN (SFU-grade 2) was detected. Thirty-six patients (75%) underwent VCUG, revealing high-grade VUR (stage IV-V) in 8 patients (17%) and low-grade VUR (stage I-III) in 7 patients (15%). Continence was associated with a higher need for VCUG (p=0.02) and a higher presence of VUR (p=0.03). Renal function in EEC patients and non-EEC patients is comparable when age matched. Only 6% had low-grade HN which was asymptomatic. 17% had high-grade VUR, which is little compared to literature (40-70%). However, results in literature are described in patients with a 'one-stage' bladder closure, whereas some of our patients had a 'two-stage' procedure. A one-stage procedure creates higher bladder pressures resulting in higher VUR-rates. Statistical analysis has showed that continence is associated with a higher prevalence of recurrent febrile UTI's or pyelonephritis and of VUR. No statistically differences were found between continent and incontinent patients concerning creatinine and eGFR value (p=0.52 and p=0.29), nor in the prevalence of hydronephrosis (p=0.36). However, results of this study suggest that continent patients may portend a higher risk of upper tract deterioration with recurrent febrile UTI's and pyelonephritis due to VUR. Close monitoring of the upper tract status is therefore as important as focus on continence. Large-scale prospective studies defining renal function as well as pyelonephritis rates are needed to optimize the management of the upper tracts in EEC patients.

Outcomes of Joint Preservation Surgery in Valgus Ankle Arthritis Without Deltoid Ligament Insufficiency.

To date, information about the role of proximal alignment correction in treating nontraumatic valgus ankle arthritis is limited. This study aimed to report outcomes of realignment surgery, including supramalleolar correction in valgus arthritic ankles without evidence of deltoid ligament insufficiency. Thirteen patients (13 ankles) who underwent joint preservation surgery for valgus ankle arthritis without evidence of deltoid ligament insufficiency were reviewed. Medial opening wedge supramalleolar osteotomy (n = 11) and varization supramalleolar dome osteotomy (n = 2) were performed to realign the hip-knee-ankle-hindfoot axis. Concomitant hindfoot correction was accompanied with either medial displacement calcaneal osteotomy (n = 8) or subtalar arthrodesis (n = 5). Pain, functional outcome (Foot Function Index [FFI]), radiographic arthritis grade (grades 0-4), 9 plain radiographic parameters, and 2 weightbearing computed tomography parameters were evaluated pre- and postoperatively. All patients completed a minimum 2-year follow-up. Preoperatively, 10 ankles (77%) demonstrated a varus tibial plafond, and 3 ankles (23%) demonstrated a valgus or neutral tibial plafond. Postoperatively, radiographic arthritis grade improved in all except 1 patient, and the mean talar tilt angle improved from 5.5 to 1.7 degrees. The mean pain score (visual analog scale) decreased significantly from 7.3 to 2.5 (P < .05), and the mean FFI improved significantly from 57.7 to 18.6 (P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. This study demonstrated a possible relationship between lower limb malalignment and valgus ankle arthritis. Realignment surgery, including supramalleolar osteotomies, which straightens the mechanical axis and decreases the slope of the tibial plafond, may be a reasonable approach in joint preservation of valgus ankle arthritis without deltoid ligament insufficiency. Level IV, case series.

A simple inclusion criteria combination increases the rate of cartilage loss in patients with knee osteoarthritis

ObjectivesSelection of patients with KL radiographic grade 2 and 3 is widely used in clinical trials, but this approach could have some limitations. The purpose of this study performed on OsteoArthritis Initiative (OAI) data is to assess whether adding OARSI-JSN to KL grading could select a population with increased rate of cartilage loss. Indeed, KL is not compartment-specific and not uniformly graded amongst expert readers. OARSI-JSN is another established, compartment-specific grading scale that specifically captures the joint space narrowing from radiographs. Design1019 knee radiographs data from the progression cohort of the OAI public database were used. Cartilage loss measured with magnetic resonance imaging was evaluated using change over 1 year from baseline in cartilage thickness in the central Medial Tibio-Femoral Compartment (cMTFC) in the KL2-3 and KL2-3+JSN1-2 populations. ResultsThe mean cMTFC cartilage loss over one year was −0.135 ​± ​0.29 ​mm (median ​= ​−0.095 ​mm) in the KL2-3 population and −0.176 ​± ​0.29 ​mm (median ​= ​−0.140 ​mm) in the KL2-3 +JSN1-2 population. ConclusionsOARSI-JSN appears to be an effective inclusion criterion to be considered in combination with the KL grade in future clinical trials testing the structural efficacy of DMOADs in a time window of 1-year as it contributes to identify knees in whom the disease progresses rapidly.

Biochemical Characteristics and Clinical Result of Bone Marrow–Derived Fibrin Clot for Repair of Isolated Meniscal Injury in the Avascular Zone

To characterize bone marrow aspirate-derived fibrin clot (BMA clot) and evaluate the clinical result of meniscal repair with a BMA clot for isolated meniscal injury in the avascular zone. Blood counts of total leukocytes, platelets, and concentrations of basic fibroblast growth factor (bFGF), transforming growth factor β (TGF-β), and stromal cell-derived factor 1 (SDF-1) were analyzed with BMA, peripheral blood (PB), BMA clot, and PB clot from 5 patients treated for meniscal repair. In addition, a retrospective analysis of 30 patients with isolated avascular meniscal injuries who underwent repair with a BMA clot was performed to assess rate failure. Avascular meniscal injury was identified as horizontal tear, radial tear, and flap tear. Clinical failure was defined as the presence of 1 or more of Barrett's criteria. Anatomic failure was defined as the existence of equivalent signal intensity to intra-articular fluid along the repair area on follow-up magnetic resonance imaging (MRI). Patients' demographic and clinical data were compared between the overall failure group and the success group. The bFGF, TGF-β, and SDF-1 levels of BMA clots were more highly concentrated compared with PB clots. The Lysholm scores and meniscal status evaluated by MRI were significantly improved from preoperatively to postoperatively (both P < .001). The Kellgren-Lawrence grading of knee radiographs did not significantly differ pre- and postoperatively (P= .140). Rates of clinical failure, anatomic failure, and retear were 10%, 6.7%, and 3.3%, respectively. The demographic characteristics and surgical and postoperative status did not significantly differ between the overall failure group and the success group. BMA clots had increased levels of cytokines compared to PB clots. The retrospective analysis revealed that the rates of clinical failure and anatomic failure after meniscal repair with a BMA clot for isolated avascular meniscal injury were 10% and 6.7%, respectively. Level IV, case series.

Improvement in some Ames-ISSG cervical deformity classification modifier grades may correlate with clinical improvement

This retrospective cohort study describes adult cervical deformity(ACD) patients with Ames-ACD classification at baseline(BL) and 1-year post-operatively and assesses the relationship of improvement in Ames modifiers with clinical outcomes. Patients ≥ 18yrs with BL and post-op(1-year) radiographs were included. Patients were categorized with Ames classification by primary deformity descriptors (C = cervical; CT = cervicothoracic junction; T = thoracic; S = coronal) and alignment/myelopathy modifiers(C2-C7 Sagittal Vertical Axis[cSVA], T1 Slope-Cervical Lordosis[TS-CL], Horizontal Gaze[Horiz], mJOA). Univariate analysis evaluated demographics, clinical intervention, and Ames deformity descriptor. Patients were evaluated for radiographic improvement by Ames classification and reaching Minimal Clinically Important Differences(MCID) for mJOA, Neck Disability Index(NDI), and EuroQuol-5D(EQ5D). A total of 73 patients were categorized: C = 41(56.2%), CT = 18(24.7%), T = 9(12.3%), S = 5(6.8%). By Ames modifier 1-year improvement, 13(17.8%) improved in mJOA, 26(35.6%) in cSVA grade, 19(26.0%) in Horiz, and 15(20.5%) in TS-CL. The overall proportion of patients without severe Ames modifier grades at 1-year was as follows: 100% cSVA, 27.4% TS-CL, 67.1% Horiz, 69.9% mJOA. 1-year post-operatively, severe myelopathy(mJOA = 3) prevalence differed between Ames-ACD descriptors (C = 26.3%, CT = 15.4%, T = 0.0%, S = 0.0%, p = 0.033). Improvement in mJOA modifier correlated with reaching 1-year NDI MCID in the overall cohort (r = 0.354,p = 0.002). For C descriptors, cSVA improvement correlated with reaching 1-year NDI MCID (r = 0.387,p = 0.016). Improvement in more than one radiographic Ames modifier correlated with reaching 1-year mJOA MCID (r = 0.344,p = 0.003) and with reaching more than one MCID for mJOA, NDI, and EQ-5D (r = 0.272,p = 0.020). In conclusion, improvements in radiographic Ames modifier grades correlated with improvement in 1-year postoperative clinical outcomes. Although limited in scope, this analysis suggests the Ames-ACD classification may describe cervical deformity patients’ alignment and outcomes at 1-year.

EVALUATION OF CHONDROPROTECTIVE EFFECTS OF INTRA ARTICULAR PIROXICAM IN POST-TRAUMATIC OSTEOARTHRITIS MODEL OF RAT

Objective: To evaluate the chondroprotective effect of piroxicam in post-traumatic osteoarthritis model of rat.&#x0D; Study Design: Laboratory based experimental study.&#x0D; Place and Duration of Study: Pharmacology department, Army Medical College, Rawalpindi, from Apr to Jun 2019.&#x0D; Methodology: Project included sixteen rats of Sprague Dawley breed. Osteoarthritis was induced in anesthetized rats by surgical removal of medial meniscus and anterior cruciate ligament resection. After that rats were randomly allocated in two groups with eight rats in each group. Rats of group I were positive control that received 0.2 ml saline intra articularly once weekly for four weeks. Meanwhile rats of group II (treatment group) received 50 µl piroxicam intra articularly once weekly for four weeks. One week after the drug intervention, radiograph of the right knee joint of all rats were taken. Animals were then sacrificed with inhaled chloroform and part of proximal tibia was obtained for histopathological analysis.&#x0D; Results: Comparison of radiographs of both groups depicted a significant p-value of &lt;0.01. Meanwhile mean histopathological score of control group and treatment group were 11.50 ± 1.195 and 6.50 ± 1.195 respectively with a p-value of &lt;0.01.&#x0D; Conclusion: Intra articular administration of piroxicam in post-traumatic Osteoarthritis model of rats resulted in improvement in radiographic grades and histopathology scores.

P107 Can a computer sense the symptoms of osteoarthritis from a radiograph? Initial findings from a pilot, AI approach to osteoarthritis assessment

Abstract Background/Aims Osteoarthritis is the most common joint disease and is associated with substantial morbidity for the affected individual and a significant financial burden for the health system at large. There is a marked discrepancy between the extent of osteoarthritis observed via plain radiography and the magnitude of clinical symptoms. For this reason we aimed to investigate whether, using an artificial intelligence approach, we could train an algorithm to diagnose osteoarthritis and if we were able to find correlations between clinical symptoms and radiographic images. Methods Anterior-posterior and lateral radiographic images of the knees and hips were ascertained from members of the Hertfordshire Cohort Study (HCS, a group of community-dwelling older adults in the UK) and were merged with anterior-posterior knee X-rays obtained from Mendeley (a repository of open-access images). The HCS contributed 1,445 images, which were equally split into training and testing sets, and the Mendeley cohort provided 2,889 training and 828 testing radiographs. The radiographic images were passed through a detection network in order to identify the region of interest (the knee or hip joint), thereby streamlining the necessary information in the image. Next, a classification network was trained with the goal of differentiating the Kellgren and Lawrence (KL) grade for each joint. Finally, the clinical symptoms and radiographic grading was subject to pairwise correlation, using Spearman rank-order correlation. Results The HCS sample included 222 males and 221 females with a mean age of 76 years (SD 2.6). In terms of detection of the join, an average accuracy of 99% was achieved. The classification task utilised alternative evaluation metrics, with the best network achieving 58% accuracy, 63% average precision and 61% average recall in the KL grading task. Superior results were obtained with knee joints than hips. However, when using the dichotomous outcomes of ‘osteoarthritis’ (defined by a KL ≥ 2) or ‘no osteoarthritis’, the results significantly improved, obtaining an accuracy of 81.2%. Significant correlations were observed between the majority of pain symptoms and the radiograph images, with the strongest correlations seen at the knees with; pain going up or down stairs (rho 0.30), pain standing upright (rho 0.30), pain walking on hard surface (rho 0.28), pain walking on uneven surface (rho 0.31) and pain standing from chair (rho -0.30). Conclusion To conclude, in this pilot study, we have trained an algorithm, to diagnose osteoarthritis of the knees and hips with limited accuracy. We have also demonstrated moderate correlations with some specific pain symptoms. It will be interesting to see whether these initial findings are replicated as we expand this project into other cohorts. Disclosure N.R. Fuggle: None. D. Pinto Pereira: None. E.M. Dennison: None. C. Cooper: None. S. Mahmoodi: None.

Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study.

Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. Prospective case series. Level 4. A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale (P = 0.03) and WOMAC (P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months (P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. This research supports the use of autologous PRP injections for symptomatic DMLs.

Treatment Efficacy with a Novel Hyaluronic Acid-Based Hydrogel for Osteoarthritis of the Knee

Background: Prior trials investigating the treatment of symptomatic osteoarthritis (OA) with hyaluronic-acid-derived products injections have provided optimistic results. The study was directed to assess the effectiveness of an innovative hyaluronic-acid-based hydrogel (Hymovis®) in the treatment of symptomatic knee OA. Methods: A prospective, single-center, clinical trial was performed. Thirty-five patients with degenerative knee OA were included. Inclusion criteria were: age between 45–80, radiographic Kellgren grade II or III osteoarthritis, minimum 35 mm score on the Visual Analogue Scale (VAS), pain for at least 6 months and agreement to participate in the study. Patients received two injections at a one-week interval. The evaluator assessed the patients using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and VAS. Evaluation was performed before, at 2 and 6 months after the injections. Results: A significant improvement on the WOMAC Index pain subscale was observed at 6 months after the injection. At two months, pain subscale score decreased from 10.34 to 9.34. At six months, a significant decrement in pain parameters compared to baseline was observed (from 10.34 to 7.72; p = 0.0004). Median points on VAS significantly ameliorated after 6 months (from 74.2 to 57.3 cm; p < 0.0001). Regarding physical function, a statistically significant difference compared to baseline was observed at the end of the study (from 29.74 to 25.18; p = 0.0025). WOMAC Index stiffness component did not differ from baseline at any time during follow-up. Conclusions: Pain relief installed with a delayed on-set but had a prolonged duration. The novel hyaluronic acid-based hydrogel (Hymovis®) had effective results, particularly after six months post-injections and offers a therapeutic advancement in the treatment of moderate to severe osteoarthritis.

Quantitative Three-dimensional Assessment of Knee Joint Space Width from Weight-bearing CT.

Background Imaging of structural disease in osteoarthritis has traditionally relied on MRI and radiography. Joint space mapping (JSM) can be used to quantitatively map joint space width (JSW) in three dimensions from CT images. Purpose To demonstrate the reproducibility, repeatability, and feasibility of JSM of the knee using weight-bearing CT images. Materials and Methods Two convenience samples of weight-bearing CT images of left and right knees with radiographic Kellgren-Lawrence grades (KLGs) less than or equal to 2 were acquired from 2014 to 2018 and were analyzed retrospectively with JSM to deliver three-dimensional JSW maps. For reproducibility, images of three sets of knees were used for novice training, and then the JSM output was compared against an expert's assessment. JSM was also performed on 2-week follow-up images in the second cohort, yielding three-dimensional JSW difference maps for repeatability. Statistical parametric mapping was performed on all knee imaging data (KLG, 0-4) to show the feasibility of a surface-based analysis in three dimensions. Results Reproducibility (in 20 individuals; mean age, 58 years ± 7 [standard deviation]; mean body mass index, 28 kg/m2 ± 6; 14 women) and repeatability (in nine individuals; mean age, 53 years ± 6; mean body mass index, 26 kg/m2 ± 4; seven women) reached their lowest performance at a smallest detectable difference less than ±0.1 mm in the central medial tibiofemoral joint space for individuals without radiographically demonstrated disease. The average root mean square coefficient of variation was less than 5% across all groups. Statistical parametric mapping (33 individuals; mean age, 57 years ± 7; mean body mass index, 27 kg/m2 ± 6; 23 women) showed that the central-to-posterior medial joint space was significantly narrower by 0.5 mm for each incremental increase in the KLG (threshold P < .05). One knee (KLG, 2) demonstrated a baseline versus 24-month change in its three-dimensional JSW distribution that was beyond the smallest detectable difference across the lateral joint space. Conclusion Joint space mapping of the knee using weight-bearing CT images is feasible, demonstrating a relationship between the three-dimensional joint space width distribution and structural joint disease. It is reliably learned by novice users, can be personalized for disease phenotypes, and can be used to achieve a smallest detectable difference that is at least 50% smaller than that reported to be achieved at the highest performance level in radiography. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Roemer in this issue.

The clinical radiographic incidence of post-traumatic osteoarthritis 10 years after anterior cruciate ligament reconstruction: data from the moon nested cohort

Purpose: The incidence of post-traumatic osteoarthritis (PTOA) using clinical radiographic grading criteria at 10 years after anterior cruciate ligament reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients. Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis changes (joint space narrowing [JSN] and osteophyte formation) between the ACL reconstructed and contralateral knees at 10 years.

Automated morphological phenotyping to characterize knee osteoarthritis progression

Automated morphological phenotyping to characterize knee osteoarthritis progression

The Clinical Radiographic Incidence of Posttraumatic Osteoarthritis 10 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON Nested Cohort

Background: The incidence of posttraumatic osteoarthritis (PTOA) based on clinical radiographic grading criteria at 10 years after anterior cruciate ligament (ACL) reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients. Hypothesis: Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis (OA) changes (joint space narrowing and osteophyte formation) between ACL-reconstructed and contralateral knees at 10 years. Study Design: Case series; Level of evidence, 4. Methods: The first 146 patients in an ongoing nested cohort study of the Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort presented for a minimum 10-year follow-up. Included patients had a sports-related ACL injury, were aged <33 years at the time of ACLR, had no history of ipsilateral or contralateral knee surgery, and did not undergo revision ACLR before follow-up. Bilateral knee metatarsophalangeal view radiographs were obtained and graded according to International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by 2 blinded reviewers. The incidence and severity of ipsilateral and contralateral radiographic OA were determined among patients without a contralateral ACL injury before 10-year follow-up (N = 133). Results: Interrater reliability was substantial for the IKDC (Gwet Agreement Coefficient [AC] 1 = 0.71), moderate for the KL (0.48), and almost perfect for the OARSI (0.84) grading systems. Among patients with a contralateral radiographically normal knee, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The maximum side-to-side difference in the OARSI osteophyte grade in the medial or lateral compartment was 0 in 65% of patients, 1 in 20%, and ≥2 in 15%. The maximum side-to-side difference in the OARSI joint space narrowing grade was 0 in 77% of patients, 1 in 19%, and ≥2 in 4%. Conclusion: In young active patients, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The mean difference in the degree of osteophyte formation (≤1 grade in 85%) and joint space narrowing (≤1 grade in 96%) between the ACL-reconstructed and contralateral knees was small. Registration: NCT02717559 (ClinicalTrials.gov identifier)

Rhizarthrosis Bilateral – Trapeziectomy Versus Arthroplasty with Dual Mobility Prosthesis: Case Report

Background: The trapeziometacarpal joint is the second joint affected by osteoarthritis in the hand. The symptoms and clinical presentation are characterized by pain, limited range of motion, muscle weakness with loss of strength, bone deformities and disability. The symptomatology often is not related to the radiographic grade of osteoarthrosis. Therefore, in addition to the radiographic stage of the disease, the treatment is influenced by multiple variables such as age, functional requirement, symptoms and stability of the joint. Objective: There are several options of surgical treatments. Although trapeziectomy and its technical variation is the gold standard for treatment, prosthesis replacement can be used with good results. This case report discusses the case of a 70-year-old male who presents bilateral trapeziometacarpal osteoarthrosis treated with two different techniques with different timelines. Methods: The patient underwent a trapeziectomy on the right hand and arthroplasty with implant on the left. In both TMC the stage of the disease was grade III according to the Eaton Litter classification and the results were evaluated according to clinical and radiographic criteria. The NPRS pain scale and the Quick Dash functional scale were used in subsequent checks. The mean follow-up was 12 months. Conclusion: There were no significantly different results with respect to pain, activities of daily living, mobility or strength. No complications were observed. The patient is satisfied with the treatment having found a better and earlier resumption of daily activity of the left hand treated with prosthesis replacement.

The Fate of Morbidly Obese Patients With Joint Pain: A Retrospective Study of Patient Outcomes

BackgroundThe number of obese patients seeking a total joint arthroplasty (TJA) continues to increase. Weight loss is often recommended to treat joint pain and reduce risks associated with TJA. We sought to determine the effectiveness of an orthopedic surgeon’s recommendation to lose weight. MethodsWe identified morbidly obese (body mass index (BMI) 40-49.9 kg/m2) and super obese (BMI ≥50 kg/m2) patients with hip or knee osteoarthritis. Patients with less than 3-month follow-up were excluded. Patient characteristics (age, gender, BMI, comorbidities), disease characteristics (joint affected, radiographic osteoarthritis grading), and treatments were recorded. Clinically meaningful weight loss was defined as weight loss greater than 5%. ResultsTwo hundred thirty morbid and 50 super obese patients were identified. Super obese patients were more likely to be referred to weight management (52.0% vs 21.7%, P < .001) and were less likely to receive TJA (20.0% vs 41.7%, P = .004). Each 1 kg/m2 increase in BMI decreased the odds of TJA by 10.9% (odds ratio = 0.891, 95% confidence interval: 0.833-0.953, P = .001). Forty (23.0%) of the nonoperatively treated patients achieved clinically meaningful weight loss, and 19 (17.9%) patients who underwent TJA lost weight before surgery. After surgery, the number of patients who achieved a clinically meaningful weight loss grew to 32 (30.2%). ConclusionIn morbid and super obese patients, increasing BMI reduces the likelihood that a patient will receive TJA, and when counseled by their orthopedic surgeon, few patients participate in weight-loss programs or are otherwise able to lose weight. Weight loss is an inconsistently modifiable risk factor for joint replacement surgery.

IF NEEDED TO BE SURGICALLY INTERVENED UPON, IN THE PAEDIATRIC DIAPHYSEAL FRACTURES, WHICH IS THE BETTER AMONG THE AVAILABLE FIXATION DEVICES-A CASE SERIES CONSIDERATION.

Humeral fractures, in the paediatric age group, have two peaks of incidence. It has a high incidence in babies below three years of age, and again also in children, above 10 years of age. The objective of our study, was to compare the most popular operative techniques for handling humeral diaphyseal fractures, in the paediatric age group, such as Plate Osteosynthesis (Locking Compression Plate), Elastic Stable Intramedullary Nailing System (ESIS), and the External Fixation devices (EF). This prospective study was conducted at Chettinad Hospital and Research Institute (CH&amp;RI), Kelambakkam, from July 2017 to June 2020. A total of 15 patients were a part of this study, of which, 8 were males and 7 were females. The functional outcomes were assessed using the DASH, the Borberg and Morrey scoring system and the radiographic assessment was done using Stan's Radiographic Grading system, in all the three methods of treatment. The Follow up period was for a minimum of twelve months. The Broberg and Morrey Score points were 88.4 (74-95) for LCP, 80.67 for ESIS (70- 91) and 83.87 (80-87) for EF (p value&gt;0.05). In the DASH score, the average was 19.2 in the LCP group, 21.17 and 21.10, respectively, in the ESIS and EF groups. Stan's Radiographic Grading showed Grade 2 to 3 fracture union status, in all the xation modalities of our study. The prudence of the surgeon, his surgical experience, the age of the patient, the geometry of the fracture and the nature of the humeral diaphyseal fracture, all needs to be carefully weighed, analyzed and on a case-to-case basis, the decision has to be taken, regarding which xation device is best suited for that very particular fracture. All the three modalities have been showcased to highlight their pros and cons, not with-standing the fact that, all the three modalities have faired superiorly in giving good to excellent result outcomes.

Mini-anterior approach for surgical reduction of developmental dysplasia of the hip: a case series

Background: Our hypothesis was that the mini-anterior approach gives adequate exposure with satisfactory result in patients with developmental dysplasia of the hip. Methods: Twenty-three hips in 20 patients who had developmental dysplasia of the hip (18 girls and two boys) underwent surgical reduction using the mini-anterior approach. The incision extended from a point about 1 cm below and medial to the anterior iliac superior spine obliquely to a point about 1 cm lateral to the femoral pulsation. The average patient age at the time of surgery was 15 mo. Results: Clinical results were evaluated according to the modified McKay criteria and the cosmetic appearance of the wound. Excellent wound cosmetic appearance was present in all patients. Twenty-two hips (95.7%) were rated clinically as excellent to good, whereas only one hip was rated as fair. According to radiographic Severin grading, 20 hips (86.4%) were rated as excellent to good and only three hips (13.6%) were rated as fair. Conclusions: The mini-anterior approach can be used safely in patients with dysplasia of the hip who are younger than 20 mo with adequate exposure and minimal soft-tissue dissection. Level of Evidence: Level IV.