Rosenberg View Research Articles

Posterior cruciate ligament injury is influenced by intercondylar shape and size of tibial eminence.

Little is known about the risk factors that predispose to a rupture of the posterior cruciate ligament (PCL). Identifying risk factors is the first step in trying to prevent a rupture of the PCL from occurring. The morphology of the knee in patients who rupture their PCL may differ from that of control patients. The purpose of this study was to identify any variations in bone morphology that are related to a PCL. We compared the anteroposterior (AP), lateral, and Rosenberg view radiographs of 94 patients with a ruptured PCL to a control group of 168 patients matched by age, sex, and body mass index (BMI), but with an intact PCL after a knee injury. Statistical shape modelling software was used to assess the shape of the knee and determine any difference in anatomical landmarks. We found shape variants on the AP and Rosenberg view radiographs to be significantly different between patients who tore their PCL and those with an intact PCL after a knee injury. Overall, patients who ruptured their PCL have smaller intercondylar notches and smaller tibial eminences than control patients. This study shows that differences in the shape of the knee are associated with the presence of a PCL rupture after injury. A smaller and more sharply angled intercondylar notch and a more flattened tibial eminence are related to PCL rupture. This suggests that the morphology of the knee is a risk factor for sustaining a PCL rupture. Cite this article: Bone Joint J 2019;101-B:1058-1062.

Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy.

To determine the classification scheme for osteoarthritis severity grading that most closely correlates with postoperative clinical outcomes and to identify the positive and negative prognostic factors for medial open-wedge high-tibial osteotomy (OWHTO). Seventy-nine consecutive patients with primary varus osteoarthritis were treated using OWHTO. Arthritic grading was determined by arthroscopic assessment according to the modified Outerbridge classification and by radiographic classification according to the Kellgren-Lawrence (KL) grading scale on standing anteroposterior (AP) and 45° posteroanterior (PA) flexion weight-bearing radiography. Clinical outcome was assessed using the Oxford Knee Score (OKS), which was evaluated both preoperatively and at the postoperative 2-year follow-up after OWHTO. Multivariate regression analyses were used to explore and quantify the influence of baseline patient demographics, variables related to arthroscopic and radiological grades of arthritis, as well as postoperative alignment changes on the OKS. At the 2-year follow-up, the mean OKS had improved from 20 ± 4 to 39 ± 5 points (p < 0.001). The average mechanical femorotibial and mechanical medial proximal tibial angle (MPTA) changed from 6.9°±3.4° to valgus 2.7° ± 2.8° and from 85.6°±2.4° to 92.9°±3.7° (all p < 0.001). The osteoarthritis severity grade based on the KL scale was 2.4 ± 0.9 on standing AP radiography, 2.8 ± 0.9 on 45° PA flexion weight-bearing radiography (p = 0.003), and 3.4 ± 0.7 according to the modified Outerbridge classification. In the multivariate analyses, the KL grade on 45° PA flexion weight-bearing radiography (p = 0.01) and postoperative MPTA (p = 0.01) showed significant negative correlations with postoperative OKS at the 2-year follow-up. The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest significant negative correlation with postoperative OKS after the OWHTO procedure using three different common OA classification schemes, which should be considered to determine the surgical indication of HTO. The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest correlation with high-tibial osteotomy-surgical indications and the counselling of patients with advanced osteoarthritis. IV.

Delayed Rehabilitation After Lateral Meniscal Allograft Transplantation Can Reduce Graft Extrusion Compared With Standard Rehabilitation

Background: Meniscal extrusion prevention would be important for restoring normal knee kinematics, even though the effect of graft extrusion after meniscal allograft transplantation (MAT) has not been clearly identified. Hypothesis: When compared with standard rehabilitation protocols, delayed rehabilitation after lateral MAT could reduce graft extrusion. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 53 patients who underwent lateral MAT with the keyhole technique from June 2011 to March 2015 were included. Graft extrusion and lateral compartment articular cartilage loss on magnetic resonance imaging, joint space width (JSW) on weightbearing radiographs, and clinical outcomes (including subjective scores and functional tests) of 25 patients who underwent standard rehabilitation (group S) after lateral MAT were compared with those of 28 patients who underwent delayed rehabilitation (group D), which included immobilization during the first 3 weeks and use of unloading braces for 9 weeks. Results: Mean ± SD follow-up times for groups S and D were 25.7 ± 6.4 and 24.5 ± 7.1 months, respectively. Although the postoperative clinical outcomes did not differ between the groups, graft extrusion (3.2 ± 1.5 mm vs 1.8 ± 1.6 mm) and relative percentage of extrusion (32.2% ± 14.6% vs 17.3% ± 16.6%) were greater in group S than in group D (P < .001 for both). The percentage of patients with graft extrusion (≥3 mm) was 52% in group S and 21.4% in group D. JSWs on Rosenberg view decreased by 0.1 mm in group S but increased by 0.3 mm in group D (P = .035). Kellgren-Lawrence grade and modified Outerbridge grade progressed by 44% and 44% among patients in group S and by 17.9% and 21.4% among patients in group D, respectively. There were significant correlations between the coronal graft extrusion and postoperative JSWs on full extension (–0.452) and Rosenberg (–0.410) views, Kellgren-Lawrence grade (0.727), and modified Outerbridge grade (0.732) on magnetic resonance imaging (P < .001 for all). Conclusion: Compared with standard rehabilitation, delayed rehabilitation showed less coronal graft extrusion and joint space narrowing on weightbearing and reduced the progression of arthrosis, although the rehabilitation protocols showed no differences in clinical outcomes.

Using the Anatomical Axis as an Alternative to the Mechanical Axis to Assess Knee Alignment

The treatment of knee osteoarthritis and the preparation for total knee arthroplasty require repetitive imaging to guide preoperative planning and operative technique. Full-length standing anteroposterior images are the gold standard in assessing the alignment of the limb via the measurement of the mechanical axis of the knee. The anatomical axis can be obtained from a more limited image of the knee, and as such is less expensive and exposes the patient to less ionizing radiation. The objective of this cross-sectional prospective study was to examine the extent to which the anatomical axis measured on a fixed-flexed posteroanterior (Rosenberg view) radiograph correlates with the mechanical axis. The data of 209 total knee arthroplasty radiographs were analyzed to compare the preoperative correlation between the mechanical and anatomical axis. The anatomical axis correlated with the mechanical axis when it was measured from both the standing full-length anteroposterior radiograph and from a fixed-flexed posteroanterior radiograph. Using an angle of offset found from linear regression, these correlations become closer. Body mass index and Kellgren-Lawrence grade were not found to have a significant effect. It is the conclusion of this study that the anatomical axis, as measured from a limited knee radiography, may serve as a plausible estimate of the mechanical axis when done with a neutral angle of offset, and that offset angle depends on gender and the imaging technique used to determine the anatomical axis.

Long-term outcomes of medial CMI implant versus partial medial meniscectomy in patients with concomitant ACL reconstruction

To compare the clinical, objective and radiographic long-term results of patients with anterior cruciate ligament (ACL) lesion and partial medial meniscus defects, treated with ACL reconstruction and partial medial meniscectomy or medial CMI implant. Seventeen patients treated with combined ACL reconstruction and medial CMI and 17 patients treated with ACL reconstruction and partial medial meniscectomy were evaluated with mean follow-up 9.6 years with Lysholm, Tegner, objective and subjective International Knee Documentation Committee scores, and VAS for pain. Arthrometric evaluation was performed with KT 2000. Weigh-bearing radiographs, antero-posterior and Rosenberg view, were also performed and evaluated with Kellgren-Lawrence score, Ahlback score and joint space narrowing. Pre-operative demographic parameters and clinical scores between patients treated with CMI and partial medial meniscectomy revealed no significant differences. A significant improvement of all the clinical scores was detected in both groups from pre-operative status to final follow-up. No significant difference between groups were found for clinical and radiographic scores; however, the chronic subgroup of patients treated with CMI showed a significantly lower level of post-operative knee pain compared to patients treated with partial medial meniscectomy and the acute subgroup of medial CMI showed better arthrometric scores. Good long-term clinical results in terms of stability, subjective outcomes and objective evaluation were reported both for medial CMI implant and partial medial meniscectomy, combined with ACL reconstruction for the treatment of partial medial meniscus tears combined with ACL lesions. Chronic meniscal tears treated with medial CMI reported lower levels of post-operative pain compared to meniscectomy, while acute lesions treated with medial CMI showed less knee laxity. Therefore, the use of the collagen meniscus implant in the case of anterior knee instability with a meniscal defect appears justified and able to improve clinical outcomes in the long term. Retrospective comparative study, Level III.

Correlation between Femoral Tunnel Location in Three-Dimensional Computed Tomography and Femoral Tunnel Angle in Plain Radiographs after Single-Bundle Anterior Cruciate Reconstruction

Purpose: The purpose of this study is to determine correlation between femoral tunnel angle in the coronal plane on a simple radiograph and femoral tunnel location in the sagittal plane on three-dimensional computed tomography (3D-CT). Materials and Methods: The subjects included 42 patients who underwent 3D-CT after the operation out of 70 cases of anterior cruciate ligament reconstruction using quadriceps tendon-patelllar bone autograft from April, 2009 to June, 2011. Measurement of the femoral tunnel angle was based on the anatomical axis of the femur in antero-posterior (AP) and Rosenberg views; femoral tunnel location was described as a proportional percentage on the medial surface of the lateral femoral condyle in the 3D-CT image; then the correlation between femoral tunnel angle and femoral tunnel location was analyzed retrospectively. Results: Femoral tunnel angle was 41.5±6.8 (range: 29.7−53.9) on AP radiographs, and 34.9±6.9 (range: 23.8−46.5) on Rosenberg views. The femoral tunnel was located 36.9%±11.3% from posterior, and 38.1%±6.5% from proximal on the 3D-CT image. On plain AP radiographs, femoral tunnel angle and femoral tunnel location showed negative correlation (p<0.001, rho=-0.498), and, in comparison with Rosenberg view, they showed negative correlation (p=0.006, rho=-0.416). Twenty three patients (53.5%) had femoral tunnel in the anatomical location. Their femoral tunnel angle on AP radiographs was 43.3±6.1, while the femoral tunnel angle of patients who had femoral tunnel in non-anatomical locations was 38.4±6.4 (p=0.004). In the Rosenberg picture, similar difference was observed between the two groups (p=0.012). Conclusion: On AP radiographs and Rosenberg views, femoral tunnel angle showed significant correlation with the femoral tunnel location on the 3D-CT image, and the group who had femoral tunnel location in the anatomical range showed a relatively higher femoral tunnel angle.

Knee shape might predict clinical outcome after an anterior cruciate ligament rupture

We have investigated whether shape of the knee can predict the clinical outcome of patients after an anterior cruciate ligament rupture. We used statistical shape modelling to measure the shape of the knee joint of 182 prospectively followed patients on lateral and Rosenberg view radiographs of the knee after a rupture of the anterior cruciate ligament. Subsequently, we associated knee shape with the International Knee Documentation Committee subjective score at two years follow-up. The mean age of patients was 31 years (21 to 51), the majority were male (n = 121) and treated operatively (n = 135). We found two modes (shape variations) that were significantly associated with the subjective score at two years: one for the operatively treated group (p = 0.002) and one for the non-operatively treated group (p = 0.003). Operatively treated patients who had higher subjective scores had a smaller intercondylar notch and a smaller width of the intercondylar eminence. Non-operatively treated patients who scored higher on the subjective score had a more pyramidal intercondylar notch as opposed to one that was more dome-shaped. We conclude that the shape of the femoral notch and the intercondylar eminence is predictive of clinical outcome two years after a rupture of the anterior cruciate ligament.

The Nature of Supreme Court Power. By Matthew E. K. Hall. New York: Cambridge Univ. Press, 2011. 262 pp. $94.00 cloth. - Merely Judgment: Ignoring, Evading, and Trumping the Supreme Court. By Martin J. Sweet. Charlottesville and London: Univ. of Virginia Press, 2010. 240 pp. $35.00 cloth.

The Nature of Supreme Court Power. By Matthew E. K. Hall. New York: Cambridge Univ. Press, 2011. 262 pp. $94.00 cloth.Merely Judgment: Ignoring, Evading, and Trumping Supreme Court. By Martin J. Sweet. Charlottesville and London: Univ. of Virginia Press, 2010. 240 pp. $35.00 clothMatthew E. K. Hall's The Nature of Supreme Court Power and Martin J. Sweet's Merely Judgment are impressive books considerably advance our knowledge about implementation and impact of Supreme Court decisions. Hall frames his study as a direct response to Gerald Rosenberg's thesis Court (and generally) 'can almost never be effective producers of significant social reform' (xiii; 160, quoting Rosenberg 2008: 422). Moreover, Hall argues, Rosenberg's view is emblematic of decided weight of scholarly authority on nature of Court's power. The Court is generally seen as a highly constrained and weak institution (13-15). By contrast, Hall finds that Court possesses remarkable power to alter behavior of [other] actors in a wide range of policy (160). Sweet wants to make a different argument. He claims political institutions enjoy considerable discretion in deciding whether and how to follow Court, because they can often defang would be plaintiffs (5). Obviously, both authors cannot be right. As is often case, as between Hall and Sweet, different theoretical approaches play a part in competing interpretations. Notwithstanding different approaches in play here, it seems to me for most part, Hall is right, and Sweet is wrong, although Sweet's study is well done and informative in many ways.Like Rosenberg, Hall is committed to social scientific positivism. Through an objective case selection method (27, and Appendix I), he pinpoints no less than 57 important cases decided between 1954 and 2006, which he then groups into 27 issue areas for purposes of impact analysis. Hall's conception of power, like Rosenberg's, is one-dimensional: 'A power relation, actual or potential, is an actual or potential relation between preferences of an actor regarding an outcome and outcome itself ' (7, quoting Nagel 1975). Hall's study, notwithstanding its incredible scope, is limited to seeking to observe whether Court changes behavior of other actors in cases in which it actually attempts to do so by striking down laws.The question is Under what conditions is Court powerful? (14). The independent variables are twofold: (1) the context of a decision, and (2) degree of popular opposition to a decision. The first of these brings us to Hall's great insight. Vast research demonstrates lower are generally faithful and reliable implementers of Court decisions (16). By institutional Hall means the distinction between Supreme Court rulings can and cannot be implemented by lower courts (5). He calls issues for which lower are primary in implementation process issues, and issues for which they are not issues. He codes every case as either vertical or lateral. For popular opinion, Hall relies exclusively on public opinion data. This elegant model thus yields a two-by-two framework for inquiry. Hall hypothesizes only very strong popular opposition in a lateral issue can defeat Court when it intends to alter behavior, and it follows Court can prevail over public opposition (even very strong opposition) in vertical cases, but not lateral ones. It then remains for Hall to specify relevant intended outcomes of Court's decisions, and to find good data can show us whether actors changed their behavior in response to them. Hall is well aware his analysis is shot through with interpretation and judgment calls. To his credit, he does not try to standardize his measures across cases, but rather clearly lays out his thinking about what research and information is available, which indicators or measures make most sense in a given context, and so on. …

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature.

Rosenberg versus 20/10 Views in Osteoarthritic Knees

It has become a common practice to obtain weight-bearing radiographs for the assessment of early-stage osteoarthritis of the knee, and weight bearing with the knee in full extension has been the most common method. Other methods for evaluating knee joint space using weight-bearing radiography include the Rosenberg and 20/10 views. Eighty consecutive patients with knee pain were evaluated with standing Rosenberg and standing 20/10 views as part of their radiographic evaluation. The joint space for the right and left knee of each patient was measured. There was no statistically significant difference between the measurements for the 20/10 or Rosenberg views in left or right knees. We found no indication to additionally include 20/10 views in routine examinations of osteoarthritic knees when Rosenberg views had been obtained.

Prospective comparative study between two different fixation techniques in meniscal allograft transplantation

To compare the functional and radiographic results between two different horn fixation techniques for meniscal allograft transplant. This is a prospective study of 88 meniscal allograft transplants with a mean 5-year follow-up. Forty transplants were performed on the medial compartment and 48 on the lateral compartment. The same surgeon performed all surgeries. Thirty-three grafts were fixed only with sutures (Group A) and 55 only with bony fixation (Group B). Both groups were comparable in terms of age, laterality, time since meniscectomy and preoperative functional and radiographic status. Functional assessment was done with Lysholm and Tegner scores and the Visual Analogical Scale for pain. Joint space narrowing was evaluated in the Rosenberg view. There was a significant improvement in Lysholm, Tegner and VAS scores without differences between Group A and Group B (n.s.). Radiographic evaluation did not show any joint space narrowing (n.s.). No differences in the comparison of all the variables of the two compartments were found. There were complications in 33.3 % of patients in Group A that including 7 graft tears (21.4 %) and in which there was an allograft failure rate of 9 %. Group B showed complications in 16.4 % of the patients and included 4 graft tears (7.3 %, n.s.) with an allograft failure rate of 3.6 %. Meniscal allograft transplantation with either technique provided good functional and radiographic results at mid-term follow-up. Both graft fixation methods showed no differences relative to functional and radiographic results. There was a considerably higher rate of complications in transplantations performed with the only-suture technique than those with bony fixation, although the difference was not statistically significant with the numbers available. The results suggest that similar functional results should be expected whether the meniscal graft includes bone plugs or not. However, graft tears seem to happen more frequently if the MAT is performed without bony fixation. Prospective comparative study, Level II.

Reliability of Early Postoperative Radiographic Assessment of Tunnel Placement After Anterior Cruciate Ligament Reconstruction

To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories.

Characteristic shape of the lateral femoral condyle in patients with osteochondritis dissecans accompanied by a discoid lateral meniscus

BackgroundThere are various indirect signs of a discoid lateral meniscus in radiographs, for example lateral joint space widening, hypoplasia of the LFC, etc. There has, however, been no previous report of the characteristic shape of the lateral femoral condyle (LFC) in patients with osteochondritis dissecans (OCD) accompanied by a discoid lateral meniscus. The purpose of this study was to evaluate the characteristic shape of the LFC in patients with OCD accompanied by a discoid lateral meniscus, and sex differences associated with the shape of the LFC in those patients. MethodsThis study included 29 males (31 knees) and 29 females (32 knees) of average age 17.7years. There were 15 knees in 15 patients that were accompanied by OCD of the LFC (9 males, 9 knees; 6 females, 6 knees; average age 14.9years; OCD group). There were 48 knees in 43 patients that were not accompanied by OCD of the LFC (20 males, 22 knees; 23 females, 26 knees; average age 17.6years; non-OCD group). Standardized Rosenberg view radiographs of the knee were obtained for all patients. We evaluated the shape of LFC using the Rosenberg view and measured the condylar prominence ratio of the medial and lateral condyles adjacent to the intercondylar notch, in accordance with Ha’s procedure. ResultsThe OCD group had a significantly larger prominence ratio than the non-OCD group. The prominence ratio for males was significantly larger than that for females. ConclusionWe clearly demonstrated that the prominence ratio in the OCD group was significantly larger than that in the non-OCD group, indicating that the shape of the LFC and OCD in the LFC may be associated with the development of these lesions.

Comparison between Rosenberg view and the standing A-P view in knee extension

Comparison between Rosenberg view and the standing A-P view in knee extension

Open-wedge high tibial osteotomy: comparison between manual and computer-assisted techniques

The purpose of our study was to compare clinical and radiological results of two groups of patients treated for medial compartment osteoarthritis of the knee with either conventional or computer-assisted open-wedge high tibial osteotomy (HTO). Goals of surgical treatment were a correction of the mechanical axis between 2° and 6° of valgus and a modification of posterior tibial slope between -2° and +2°. Twenty-four patients (27 knees) affected by varus knee deformity and operated with HTO were prospectively followed-up. They were randomly divided in two groups, A (11 patients, conventional treatment) and B (13 patients, navigated treatment). The American Knee Society Score and the Modified Cincinnati Rating System Questionnaire were used for clinical assessment. All patients were radiologically evaluated with a comparative lower limb weight-bearing digital radiograph, a standard digital anteroposterior, a latero-lateral radiograph of the knee, and a Rosenberg view. Patients were followed-up at a mean of 39months. Clinical evaluation showed no statistical difference (n.s.) between the two groups. Radiological results showed an 86% reproducibility in achieving a mechanical axis of 182°-186° in group B compared to a 23% in group A (p=0.0392); furthermore, in group B, we achieved a modification of posterior tibial slope between -2° and +2° in 100% of patients, while in group A, this goal was achieved only in 24% of cases (p=0.0021). High tibial osteotomy with navigator is more accurate and reproducible in the correction of the deformity compared to standard technique. Therapeutic study, Level II.

Meniscal Allograft Transplantation Without Bone Blocks: A 5- to 8-Year Follow-Up of 33 Patients

The purpose of this study was to evaluate the functional and radiographic results on a midterm basis, as well as complications, in an initial series of meniscal allograft transplantations performed with suture fixation without any bone block. A series of 33 meniscal allograft transplantations were performed at our institution from January 2001 to October 2003. Inclusion criteria were patients with compartmental joint line pain due to a previous meniscectomy. There were 24 men and 9 women with a mean age of 38.8 years (range, 21 to 54 years). The functional outcomes were evaluated by use of Lysholm and Tegner scores at a mean and minimum follow-up of 6.5 years and 5 years, respectively. A visual analog scale for pain was also used. Radiographic assessment included joint space narrowing on the Rosenberg view and magnetic resonance imaging evaluation. The Lysholm and Tegner scores significantly improved from 65.4 to 88.6 (P < .001) and from 3.1 to 5.5 (P < .001), respectively, after surgery. The visual analog scale score significantly dropped from 6.4 to 1.5 (P < .001). The radiographic evaluation did not show any joint space narrowing (P = .38). Meniscal extrusion was a constant finding, averaging 36.3% of total meniscal size. According to the Van Arkel criteria, the survival rate was 87.8% at 6.5 years. The rate of complications was 33%. This study suggests that this procedure provides significant pain relief and functional improvement in selected symptomatic individuals on a midterm basis. However, there was a high rate of complications (33%) and revision surgery. Level IV, therapeutic case series.

Relationship between Meniscal Extrusion and various Clinical Findings after Meniscus Allograft Transplantation

Background Meniscus allograft transplantation (MAT) is useful for meniscus-deficient knees. Although meniscal extrusion is common after MAT, there is no consensus regarding the criteria for normal meniscal extrusion or the relationship between clinical and radiologic results. Hypothesis Meniscal extrusion after MAT results in poor clinical, radiologic, and arthroscopic outcomes. Study Design Case series; Level of evidence, 4. Methods Thirty-six of 60 patients undergoing MAT from September 2002 to June 2007 who were available for follow-up evaluation for more than 2 years were evaluated. The study population (31 men, 5 women) consisted of 15 and 21 cases of medial and lateral meniscus transplant, respectively. Knee status was evaluated by Lysholm score, plain radiography, and magnetic resonance imaging preoperatively and postoperatively. Second-look examinations were performed in 18 cases. Results Mean follow-up was 31.4 months (range, 24-36). Lysholm knee score increased significantly (mean, 88.2; range, 70-100) on final visit versus the preoperative value (mean, 61.2; range, 26-83; P < .001). Joint-space narrowing was 0.08 mm (range, —2.58 to 1.92) in extension AP and —0.09 mm (range, —2.3 to 1.8) in Rosenberg view. Kellgren-Lawrence arthrosis grade did not change in 28 knees (77.8%) and progressed by 1 grade in 8 knees. Meniscal extrusion extent was 3.87 ± 1.94 mm and relative percentage extrusion was 42.1% ± 17.7%. Seven cases (19.4%) showed minor extrusion (<3 mm), 27 (75%) showed major extrusion (>3 mm), and 2 (5.6%) showed no extrusion. Further degeneration was absent in 28 knees (77.8%) on magnetic resonance imaging. In second-look arthroscopic examinations at an average of 26.3 months, 11 of 18 (63.6%) cases showed no progression of cartilage degeneration. There was no significant correlation between meniscal extrusion and other parameters. Conclusion This study indicated that MAT can improve the clinical status of the meniscectomized knee. Although meniscal extrusion occurred after surgery in most cases, there was no significant correlation with various clinical, radiologic, or arthroscopic outcomes. Further studies are required to evaluate long-term effects of meniscal extrusion.

Assessment of correlation between knee notch width index and the three-dimensional notch volume

This study was done to determine whether there is a correlation between the notch volume and the notch width index (NWI) as measured on the three most frequently used radiographic views: the Holmblad 45°, Holmblad 70°, and Rosenberg view. The notch volume of 20 cadaveric knees was measured using Computed Tomography (CT). The Holmblad 45°, Holmblad 70°, and Rosenberg notch view radiographs were digitally re-created from the CT scans for each specimen, and the NWI was measured by two observers. The Pearson correlation coefficient between the NWI and notch volume was calculated, as well as between the three views. An independent t test was performed to determine the difference in NWI and notch volume between male and female specimens. The reliability for each view was also determined. There was no correlation between the NWI as measured on the Holmblad 45°, Holmblad 70°, or Rosenberg view and the notch volume. All three radiographic views proved reliable, but showed only a moderate correlation with each other. Men had larger notch volumes than women, but there was no difference in NWI. A knee with a small intercondylar notch is often considered an increased risk for ACL rupture. The NWI is a frequently used two-dimensional method to determine notch size. However, in the present study, this index was not positively correlated with the overall volume of the notch. Based on the results of the current study, the authors would advice to use caution when using notch view radiographs in a clinical setting to predict risk of ACL rupture.

The Russian Roots of Nazism: White Émigrés and the Making of National Socialism, 1917-1945 (review)

Reviewed by: The Russian Roots of Nazism: White Émigrés and the Making of National Socialism, 1917–1945 Oleg Budnitskii Michael Kellogg , The Russian Roots of Nazism: White Émigrés and the Making of National Socialism, 1917–1945. 327 pp. Cambridge: Cambridge University Press, 2005. ISBN 0521845122. $80.00; eBook $64.00. Michael Kellogg's book examines the contribution of Russian émigrés to the formation of Nazi ideology as well as the cooperation of far-right Russian émigrés in Germany with the Nazis. The author pays special attention to the Russian–German society Aufbau (Reconstruction), with which Adolf Hitler collaborated between 1920 and 1923. Chapter 4 is dedicated to Aufbau (109–35), but other parts of the book also touch on the subject. Among the leading figures of Aufbau were the Baltic German émigrés Max Scheubner-Richter, Arno Schickedanz, Alfred Rosenberg, and Otto von Kursell; the Russian émigrés General Vladimir Viktorovich Biskupskii, Fedor Viktorovich Vinberg, Petr Nikolaevich Shabel´skii-Bork, and Sergei Vladimirovich Taboritskii; and the "Ukrainian Cossack" Ivan Poltavets-Ostranitsa. The distinct contribution of Russian émigrés to the formation of the Nazi ideology has been noted before by investigators. Usually mentioned have been German familiarity with The Protocols of the Elders of Zion and the conception of Bolshevism as the brainchild of Jewry (7–9).1 Unlike his predecessors, Kellogg goes much further, writing of the "Russian roots of Nazism" and stressing that early National Socialism was based on a synthesis of German and Russian right-radical tendencies and ideologies. Kellogg draws a parallel between the ideas of Arthur Schopenhauer, Richard Wagner, and Houston Stewart Chamberlain, who argued that Germans should resist Jewish materialism, and the predictions of the Russian mystical writer Fedor Mikhailovich Dostoevskii and the philosopher Vladimir Sergeevich [End Page 190] Solov´ev, who foresaw a battle between Russia and world Jewry, with Russia embodying Christ and Jewry the Antichrist (11–12). Based on new archival materials and periodicals from 1919–23 that are now bibliographic rarities, Kellogg's book is the most detailed investigation of the phenomenon of cooperation between German and Russian rightists during the troubled period following the Great War. In Kellogg's estimation it was precisely the influence of Aufbau that to a considerable degree defined the antisemitism and anti-Bolshevism of Hitler, which in turn led to the risky invasion of the Soviet Union in 1941 and facilitated the "Final Solution of the Jewish Question." Even the fateful decision to direct a significant portion of German forces for the occupation of Ukraine instead of concentrating on the advance on Moscow in the summer and fall of 1941 was, in the author's opinion, a reflection of the influence of the ideas of Aufbau (16–17, 261–62). Kellogg came to these conclusions based on his study of materials at the Center for the Preservation of Historical Documentary Collections in Moscow (Tsentr khraneniia istoriko-dokumental´nykh kollektsii [TsKhIDK], now part of the Russian State Military Archive), for many years closed to researchers. Kellogg investigated materials of the Secret Intelligence Office of the Weimar Republic, the Gestapo, and French and Polish intelligence (10–11). Several personal collections were deposited in the former TsKhIDK, among them the diary of Walter Nikolai, chief of German intelligence during World War I, who worked thereafter with Aufbau and the Nationalsozialistische Deutsche Arbeiterpartei (NSDAP); and the fond of the well-known völkish publicist Ludwig Mueller von Hausen. It was precisely to the latter that Shabel´skii-Bork gave a copy of the Protocols with his own commentaries, introducing the text into German antisemitic discourse (11). Kellogg also employed materials of the State Archive of the Russian Federation, the Russian State Archive of Socio-Political History (the former Central Party Archive of the Communist Party of the Soviet Union [CPSU] Central Committee), and several German archives. Rosenberg's views, as Kellogg puts it, formed under the simultaneous influence of Germanic mythology (the works of Schopenhauer and Chamberlain, whom he read enthusiastically in his youth) and of Russian literature, in particular Dostoevskii. Here he has in mind, of course, the latter's antisemitic "publicistic" works. "Later on," the author concludes, "Rosenberg helped in the formation...

Radiographic Measurements of the Intercondylar Notch: Are They Accurate?

The purpose of this study was to evaluate the accuracy of radiographic measurements of the intercondylar notch. Radiographs of 10 cadaveric knees were obtained via the 3 methods reported in the literature (Holmblad 45 degree, Holmblad 70 degree, and Rosenberg views), after removal of the patella and surrounding soft tissues. The anterior outlet of the intercondylar notch of each knee was then outlined with barium paste, and radiography was repeated. A total of 1,770 radiographs were obtained for the 10 knees. Six measurements of the anterior outlet of the intercondylar notch were made from each radiograph and corrected for magnification. Finally, the notch width index was calculated. Caliper measurements were subsequently made of each knee to compare the size of the anterior outlet of the notch with the radiographic measurements with and without barium. There were statistically significant differences in caliper measurements compared with all but one radiographic measurement obtained from the Holmblad 45 degree, Holmblad 70 degree, and Rosenberg views. The radiographs taken with barium outlining the intercondylar notch clearly showed the inability to accurately identify the anterior outlet on radiographs. Even under optimal conditions, correcting for technique, projection, and magnification, most of the radiographic measurements of the anterior outlet of the intercondylar notch were inaccurate. The notch width index calculated from the Holmblad 70 degree view appears to be the only accurate radiographic measurement. This controlled laboratory study shows that clinicians should use caution when basing conclusions on radiographic measurements of the intercondylar notch.