Tibial Condyle Research Articles

Evaluating the Mechanical Axis for Detection of Posterior Tibial Slope Malalignment in ACL-Deficient Knees on Lateral Radiographs.

Distal tibial deformities are not assessed using the proximal anatomical axis (PAA) to determine the posterior tibial slope (PTS). Therefore, it seems advantageous to measure PTS on full-length lateral tibial radiographs using the mechanical axis (MA). To (1) compare the PTS measurements using the MA and the PAA and (2) determine whether using the PAA fails to detect a certain number of significantly elevated PTS values compared with using the MA. Cohort study (Diagnosis); Level of evidence, 3. Full-length lateral tibial radiographs of 218 consecutive cases were reviewed. Radiographs were checked for malrotation. Therefore, the distance between the posterior tibial condyles was measured in millimeters. Patients with a difference of ≥7 mm between the posterior tibial condyles were excluded, leaving 196 cases for the final statistical analysis. The PTS was measured using the MA and the PAA. Differences between these 2 techniques were analyzed. The sensitivity and specificity of the PAA as a screening method for pathological PTS were calculated, with the MA as the standard for comparison. Four subgroups were formed, all with PAA <12° and different lower limits for the MA: group 1, MA ≥10°; group 2, MA ≥10.5°; group 3, MA ≥11°; and group 4, MA ≥11.5°. Radiographs with ≥7 mm between the posterior tibial condyles showed an increased inconsistency between the PTS measurement with the MA and the PAA. In the group with a distance of <7 mm between the posterior tibial condyles (n = 196), the mean PTS measured with the MA was 9.4°± 3.8° (range, 0.4° to 21.9°), and the mean PTS was 10.5°± 3.5° (range, 1.7° to 20.9°) according to the PAA. The mean difference in PTS between the PAA and the MA was 1.1°± 1.2° (range, -2.4° to 4.1°; P < .001). Group 1 had a sensitivity of 73% and specificity of 98%; group 2, sensitivity of 84% and specificity of 97%; group 3, sensitivity of 87% and specificity of 93%; and group 4, sensitivity of 95% and specificity of 89%. Measuring the PTS using the MA was advantageous, as the measurement with the PAA did not correctly identify all cases with sagittal alignment changes. The proportion of patients with pathologically increased PTS not identified with the proximal anatomical measurement, reflected by the sensitivity, depended on the threshold value defined for the MA. Lateral radiographs, showing an increased distance between the posterior tibial condyles, indicated malrotation of the tibia leading to measurement inaccuracy.

T2 Mapping of Articular Cartilage of the Adult Knee Joint: Changes in the Relaxation Time and Thickness of Knee Cartilage with Age among Normal Adult Patients in 3 Tesla MRI

Abstract Background Degenerative joint disease, such as osteoarthritis, is characterized by the breakdown of cartilage in the joints, resulting in a decreased range of motion and stiffness. The T2 mapping approach is a very useful tool for detecting early osteoarthritis. The main goal of the study was to assess the variations in the relaxation time and articular cartilage thickness of knee cartilage across different age groups among healthy adults using the T2 mapping technique in 3 Tesla magnetic resonance imaging. Methods A total of 42 measurements were taken from each individual's knee cartilage and were confirmed to have no cartilage damage. The relaxation time was calculated from T2 maps using 21 circular regions of interest and the articular cartilage thickness was measured using 21 linear measurements from a self-created fusion image. The thickness was measured in the same regions where the relaxation time was measured. Overall, 2,142 measurements (1,071 circular regions of interest from T2 maps and 1,071 linear measurements from fusion images) were taken from 51 participants. Results The majority of the variables of T2 relaxation time show a positive linear correlation with age groups. As age increases, cartilage relaxation time increases, which may be connected to an increase in cartilage degeneration. However, half of the variables associated with knee cartilage thickness show a negative linear correlation with age group. As age increases, the thickness of the cartilage starts to decrease. T2 relaxation times of the middle lateral tibial condyle, middle superior patella, and central inferior patella differ significantly between healthy males and females (p &lt; 0.05). The cartilage thickness of the posterior lateral tibial condyle, middle medial patella, central superior patella, central middle patella, and lateral middle patella varied significantly between healthy males and females (p &lt; 0.05). Conclusion Using an additional T2 articular cartilage mapping sequence to a routine sequence in the knee joint can reveal age-related changes in relaxation time and cartilage thickness in knee cartilage. The T2 mapping technique also can help detect early changes in osteoarthritis, track progression, and plan treatment.

Relationship Between the Sagittal and Coronary Alignment of the Tibiofemoral Joint and the Medial Meniscus Extrusion in Knee Osteoarthritis.

Background/Objectives: This study aims to clarify the reproducibility, validity, and accuracy of tibial external-rotation alignment evaluation using ultrasound imaging and to investigate the relationship between medial meniscus extrusion (MME) and tibiofemoral alignment in both the sagittal and coronal planes in knee osteoarthritis (OA). Methods: Study 1 included 10 healthy participants. The tibial external-rotation angle was calculated using MRI. In the ultrasound imaging evaluation, the differences in the distance from the most posterior points of the tibial and femoral condyles to the skin were calculated as the medial and lateral condyle gaps, respectively. The mediolateral (ML) gap was calculated by subtracting the lateral condyle gap from the medial condyle gap. Study 2 included 63 patients with unilateral OA and 16 healthy controls. MME was compared according to the severity of OA, the degree of tibial rotation, and the presence or absence of a tibial posterior shift. Results: Ultrasound imaging examinations showed high intra- and inter-rater reliabilities (0.786-0.979). The ML gap significantly affected the tibial external-rotation angle, determined using MRI. The ML gap of ultrasound imaging was significantly correlated with the ML gap of MRI. MME was significantly higher in the Early OA group than in the Control group. There was no significant difference in MME based on the tibial rotation degree. The group with a tibial posterior shift exhibited significantly more MME than that without a posterior shift. Conclusions: Ultrasound imaging is useful for evaluating knee alignment. MME was found to be associated with the tibial posterior shift.

Functional Outcomes of Robotic-Assisted Total Knee Arthroplasty in Severe Varus Deformities of the Knee in the Indian Population.

Correction of severe coronal plane deformities while performing a total knee arthroplasty (TKA) is challenging. The use of functional alignment (FA) strategy along with image-based robotic technology during TKA makes it possible to restore a patient's constitutional alignment with minimal or no soft tissue release. The present study aims to report the functional outcomes of robotic-assisted TKA in Indian patients with severe varus deformity. This retrospective study included 82 primary TKA performed by a single senior arthroplasty surgeon from January 2022 to December 2022. The Visual Analogue Score for Pain (VAS-P) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) were used to assess functional outcomes. A comparison between mild and severe varus deformities was done using Student's t-test. The mean age was 66.35 ± 9.21 years. There were 79 (96.34%) knees with a mean preoperative varus hip-knee-ankleangle (HKA)of 12.85° ± 6.03° (range = 177°-148°). Postoperative limb alignment was achieved in the range of HKA 174° to 180°, with mean HKA being 175.78° ± 1.35°. The VAS-P improved significantly from a mean of 7.87 ± 0.81 preoperatively to 1.96 ± 1.43 at 18 months. KOOS-JR improved from 41.22 ± 7.6 preoperatively to 88.44 ± 8.23 at 18 months. A total of 73(89.02%) cases achieved the minimal clinically important difference (MCID) for VAS-P and 77(93.9%) cases achieved the MCID for KOOS-JR in our study. Functional outcomes were comparable among the mild (<10°) and severe (>10°) varus deformity cases at 18 months follow-up (p-value > 0.05). There was a significant difference in bone resection from the medial tibial and medial distal femoral condyle (p-value < 0.05) with less bone resected in the severe varus group. The amount of bone resected from the lateral tibial, distal lateral femoral, andposterior femoral condyles was comparable among the two groups (p-value > 0.05). FA was more bone conserving even in severe varus-deformed knees when compared to mechanical alignment (MA). The use of FA with robotic assistance to correct severe varus deformities in TKA showed a significant reduction in VAS-P scores and an improvement in KOOS-JR scores. The functional outcomes were comparable with TKA in mild varus deformities. FA helps in preserving bone from the lateral tibial condyle and distal femur.

Anatomy of the saphenous nerve, its branches within the adductor canal, and its relationship with clinical implications during ACL reconstruction

Purpose: The saphenous nerve lies in close proximity to the hamstrings and is at risk of injury during autologous grafting. This study aims to describe the potential risk of surgical injury to the saphenous branches during a classic HT harvesting with a stripper and to evaluate the efficacity of the diffusion of methylene blue infiltration into the adductor canal from a single retrograde injection from the hamstring tendon (HT) harvesting site. Methods: Eighteen frozen cadaveric lower limbs from nine cadavers were selected for surgical dissection. The study was divided into two separate procedures: 1) Surgical dissection and detailed anatomic description of the saphenous nerve and its branches was performed. 2) Methylene blue infiltration was performed from the harvesting site of the hamstring tendons followed by dissection to evaluate the diffusion of methylene blue to the saphenous nerve and its branches. Results: The direct visualization of the sartorial branch of the saphenous nerve (SBSN) was reproducible during HT harvesting, minimizing the risk of its iatrogenic damage. Additionally, nine limbs were infiltrated with 20cc of methylene blue prior to dissection. The dissemination limits of the nine cadavers included the saphenous nerve and its two main branches, whether the division was in the adductor canal or downstream at the adductor hiatus, in all cases (100%). The upper limit of diffusion was located at an average of 17 cm from the medial tibial condyle, at the level of the fascia between the vastus medialis and the adductor longus muscle. The femoral vascular bundle, the saphenous nerve and the medial aspect of the vastus medialis were stained with methylene blue in all cases. Conclusion: Direct visualization of the SBSN branch of the saphenous nerve, close to the HT expansions, must be recognized and appreciated to limit iatrogenic injury. Also, infiltration of the adductor canal via the hamstring donor site during autologous HT harvesting leads to diffusion to the saphenous nerve and its main branches which can be utilized intraoperatively with local anesthetic for reliable post operative pain control. Level of Evidence: Level IV. Keywords: ACL reconstruction, analgesia, FNB, postoperative pain, saphenous nerve, cadaver

Clinical evaluation of closed tibial condyle fracture managed by ILIZAROV fixator: A prospective study

Clinical evaluation of closed tibial condyle fracture managed by ILIZAROV fixator: A prospective study

Effect of changes in the centre of rotation after hip arthroplasty on knee joint function

Introduction: A common complication after hip arthroplasty is pain and inflammation in other large joints, especially the knee joint. Displacement of the centre of rotation of the femoral head after endoprosthetics can change the redistribution of force vectors acting on the femur, change its tilt and pressure on the surface of the knee joint. Objective: The investigation of the effect of displacement of the centre of rotation of the hip joint after arthroplasty on the knee joint.Methods: Using SolidWorks software and the SimulationXpress tool, a 3D model of the lower limb was created that reproduced the interaction between the components of the musculoskeletal system.Results: As a result, it was found that the displacement of the centre of rotation of the hip joint medially and laterally from the anatomical position leads to a significant increase in pressure on the corresponding tibial condyles. The increase in load is linear and increases from a minimum value of 1.77 N⋅m in anatomical position to 123.79 N⋅m with a medial displacement of up to 8 mm.Conclusions: This study indicates the need for proper restoration of the centre of rotation of the hip joint after implantation and the possible consequences of changes in knee joint loads. The data may be useful for specialists working in the field of implantology and the development of hip prosthesis systems

Revision arthrodesis in a failed knee arthrodesis for a giant cell tumor excision of distal femur: a case report

Giant cell tumor is a benign tumor with locally aggressive behaviour. It is common in 20–40 years of age group. Common location of the tumor includes distal end of femur, proximal end of tibia. It is slightly more common in females than males. We present a case of forty-four years-old lady with a persistent swelling over her left knee and was diagnosed with a distal femur giant cell tumor. After a wide excision, dual free fibula grafting and arthrodesis of the knee with a long nail was performed. However, she experienced pain and progressive deformity three years after surgery. X-rays revealed the failure of union of the free fibula graft to the residual femur and the breakage of the nail at that site. A revision arthrodesis was performed with removal of implant and stabilizing the non-united ends with dual plating with bone grafting from lateral tibial condyle and bone graft substitutes. She was discharged with left side non weight bearing mobilization with walker support and was started on full weight-bearing mobilization after one year with satisfactory union on X-rays.

Bankart knee. Operative treatment of posterior part of lateral tibial condyle fracture with concomitant avulsion injury of anterior cruciate ligament (ACL). Technique and case report

Fractures of the posterolateral part of the tibial plateau (PLTP) are rare and complex fractures among other orthopedic entities. This case report describes a 54-year-old male who suffered a twisting injury of the left knee in a scooter crash. As a result, impaction fracture and displacement of the posterolateral margin of the tibial plateau were diagnosed with concomitant avulsion of the intercondylar eminence of the tibia and medial tibial condyle cleft fracture. The treatment comprised reduction of the medial tibial condyle (MTC) cleft fracture with one cancellous screw, arthroscopic bone-suture of the intercondylar eminence, and reduction of compressed PLTP with fixation of the displaced fragment on a distal radius T-plate working as a “buttress” rather than firm stabilizer. The operative technique of PLTP impaction fracture reduction is described in an instructional manner.

Radiographic and Functional Outcome of Depressed Tibial Plateau Fractures Treated with Raft Plate with Bone Graft – A Prospective Study

Tibial plateau fractures are the fractures that involve the articular surface of the tibial condyles. The Schatzker and OA classifications are the most commonly used to classify these fractures. The Schatzker classification system is a widely recognized method used by orthopedic surgeons to categorize tibial plateau fractures into six distinct types. This classification helps in assessing the initial injury, planning the appropriate management strategy, and predicting the prognosis. Each type represents a different pattern of fracture, which can guide treatment decisions and expectations for recovery. These fractures typically result from the external(valgus) or internal(varus) forces on the knee with axial loading. In younger individuals, tibial plateau fractures are most commonly caused by road traffic accidents due to the high-energy impact. However, in elderly patients with osteopenic bone, even a simple fall can lead to these fractures because their bones are more fragile and susceptible to injury. The tibial plateau fractures are intra-articular fractures of the knee joint and are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. Surgery is the preferred modality of treatment for these fractures, along with bone void fillers to address bone defects caused by the injury. At present, there is no consensus on the optimal method of fixation or the void filling to treat such fractures. Techniques of operative management of tibial plateau fractures have become more successful in achieving and maintaining reduction of the fracture. Still, avoiding malalignment of the limb has been shown to be at least as important as articular congruity to long-term joint viability.

Chiba osteotomy (Tibial condylar valgus osteotomy) for a large tibial varus deformity: Technical note

Chiba osteotomy is an effective technique for advanced knee osteoarthritis (KOA). The principle of the osteotomy is to correct both varus deformity and intra-articular joint congruity through an L-shaped osteotomy from the medial tibial condyle to the lateral intercondylar eminence. Previous studies have demonstrated that Chiba osteotomy is an effective method for alignment correction surgery for severe knee osteoarthritis. However, these reports slightly differ from the original concept of Chiba osteotomy. This report describes the pre-operative planning and surgical technique of Chiba osteotomy for patients with large tibial varus deformity, focusing on the management of early knee osteoarthritis following conditions such as post-traumatic Blount disease and “Pagoda” like proximal tibia varus deformities, as originally described. Level of evidenceIV

Digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy for the treatment of tibial plateau fracture.

Current treatments do not support direct exposure of fracture fragments, resulting in the inability to directly observe the articular surface during surgery for accurate reduction and firm fixation. The aim of the study was to explore the treatment effect of digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy on tibial plateau fracture involving the lateral posterior condyle collapse. 41 patients with tibial plateau fracture involving the lateral posterior condyle collapse were recruited in the trial. All patients underwent Computed Tomography (CT) scanning before operation. After operation, fracture reduction was evaluated using Rasmussen score and function of knee joint was assessed using hospital for special surgery (HSS) score. 41 patients were followed-up 6-26 months (mean, 15.2 months). Fracture reduction was good after operation, with an average of 13.3 weeks of fracture healing without serious complications. The excellent and good rate was 97.6%. The joint movement degree was -5∘∼0∘∼135∘ with an average of 125.5∘. Digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy was effectively for treating tibial plateau fracture involving the lateral posterior condyle collapse.

Poster 361: Changes in Anterior Tibial Translation Are Not Associated with Degradation in Weightbearing Cartilage of the Knee Following Anterior Cruciate Ligament Reconstruction

Objectives: Anterior cruciate ligament (ACL) injury is a frequent knee injury that commonly results in post-traumatic osteoarthritis (PTOA). ACL injury has been shown to increase the risk of osteoarthritis (OA) over eightfold within 11 years following injury. While the development of OA is well documented, the mechanism by which this accelerated cartilage degradation occurs is not well understood. The ACL is crucial in providing anterior-posterior and rotational stability of the tibia relative to the femur. Our previous work has demonstrated that ACLR does not restore pathologic anterior tibial translation (ATT) in the lateral or medial tibiofemoral compartment to levels present in uninjured knee. Increased static ATT, specifically the lateral tibial plateau on static magnetic resonance imaging (MRI) in ACL-deficient knees is associated with rotary instability. However’ how ATT relates to clinical outcomes, specifically the development of PTOA, has not been well studied. The objective of this study was two-fold. (1) Compare T2 relaxation times of cartilage in injured knees [a measure of water content and collagen organization of articular cartilage that indicates early cartilage breakdown] 6 months after ACL reconstruction (ACLR); (2) investigate whether greater ATT associates with longer (worse) T2 relaxation times in the lateral and medial compartment. We hypothesized that T2 relaxation times would increase (worsen) from before to 6-months post-operatively, and would be positively correlated with greater amounts of ATT. Methods: Twenty-nine participants between the ages of 15 and 35 were enrolled within one month of ACL injury but prior to ACLR. Individuals older than 35 were excluded due to possible baseline cartilage degeneration. Other exclusion criteria included previous injury or surgery to either knee, acute chondral lesions, concomitate Grade III tear to other ligaments of the knee, or open growth plates requiring altered ACLR technique. Bilateral knee quantitative MRI data were acquired on a 3-Tesla Phillips Ingenia MRI scanner T2 relaxation maps were generated by using multi-echo MRI data at each signal to fit the signal equation using Levenberg-Marquardt nonlinear least squares algorithm ( Si = the signal at echo time TEi, and S0 = signal at TE = 0) within Interactive Data Language (Harris Geospatial Solutions Inc.). Cartilage segmentation was manually segmented using ITK-SNAP software (Figure 1) The medial and lateral tibial (MTC, LTC) and femoral (MFC, LFC) condyles were divided into three weightbearing regions of interest (ROI) related to the meniscal horns in the sagittal plane (figure 1). Accuracy of segmentation and ROI boundaries were confirmed by a bord-certified, fellowship-Trained musculoskeletal radiologist. ATT was measured on MRI using the validated method described by Iwaki et al. A midsagittal point was identified halfway between the posterior cruciate ligament (PCL) insertion and the lateral edge of the LTC was identified on sagittal MRI. At the midsagittal point, a vertical line was drawn off the posterior cortex of the tibia, perpendicular to the plateau. A best-fit circle was then drawn over the posterior LFC and a second line perpendicular to the LTC was drawn off the posterior margin of the best fit circle. The distance between the two vertical lines was used to calculate ATT. Paired t tests were used to determine if T2 relaxation times differed in the injured limb from before to 6 months after ACLR. Pearson correlations were used to determine the relationship in each weightbearing ROI between 1) change in ATT and percent change in T2 relaxation times from before to 6 months after ACLR, and 2) between-limb difference in ATT before ACLR and percent change in T2 relaxation time. Results: Demographic data including age, sex, race, and pre-injury cutting and pivoting sport participation are presented in Table 1. Twenty-six (89.7%) individuals participated in level one activities (i.e. basketball, soccer) prior to injury. T2 relaxation times increased (worsened) in all weightbearing ROIs from before to 6 months after ACLR except the posterior weightbearing region in the LFC (p=0.296) and the central weightbearing region in the LTC (0.470). Neither the postoperative change in ATT nor the difference in ATT between injured and uninjured limbs before ACLR were significantly correlated with increase in T2 relaxation times (Table 3). Conclusions: The results of this study support our hypothesis that T2 relaxation times would be significantly longer, representing cartilage degradation, after ACLR, even at an early time point of 6 months post-operatively. However, greater ATT in ACL-injured knees remaining at 6 months after ACLR as well as relative to the uninjured limb before ACLR was not correlated with changes in T2 relaxation times in the weightbearing cartilage of the femur and tibia. Future work is needed to identify possible dynamic changes in cartilage loading related to early OA development following ACL injury and reconstruction.

Saurodesmus robertsoni Seeley 1891-The oldest Scottish cynodont.

Predating Darwin's theory of evolution, the holotype of Saurodesmus robertsoni is a long-standing enigma. Found at the beginning of 1840s, the specimen is a damaged stylopodial bone over decades variably assigned to turtles, archosaurs, parareptiles, or synapsids, and currently nearly forgotten. We redescribe and re-assess that curious specimen as a femur and consider Saurodesmus robertsoni as a valid taxon of a derived cynodont (?Tritylodontidae). It shares with probainognathians more derived than Prozostrodon a mainly medially oriented lesser trochanter and with the clade reuniting tritylodontids, brasilodontids, and mammaliaforms (but excluding tritheledontids) the presence of a projected femoral head, offset from the long axis of the femoral shaft; a thin, plate-like greater trochanter; a distinct dorsal eminence proximal to the medial (tibial) condyle located close to the level of the long axis of the femoral shaft and almost in the middle of the width of the distal expansion; and a pocket-like fossa proximally to the medial (tibial) condyle. Saurodesmus robertsoni is most similar to tritylodontids, sharing at least with some forms: the relative mediolateral expansion of the proximal and distal regions of the femur, the general shape and development of the greater trochanter, the presence of a faint intertrochanteric crest separating the shallow intertrochanteric and adductor fossae, and the general outline of the distal region as observed dorsally and distally. This makes Saurodesmus robertsoni the first Triassic cynodont from Scotland and, possibly, one of the earliest representatives of tritylodontids and one of the latest non-mammaliaform cynodonts worldwide. Moreover, it highlights the need for revisiting historical problematic specimens, the identification of which could have been previously hampered by the lack of adequate comparative materials in the past.

Gerdy's tubercle as a novel anatomical landmark for the proximal tibial cut in total knee arthroplasty.

This study aimed to explore the use of Gerdy's tubercle (GT) as an innovative and dependable anatomical landmark for the proximal tibial cut in total knee arthroplasty (TKA) in cases with extensive knee degeneration. One hundred dry tibia bones and 10 formalin-fixed cadaveric knee specimens of both sexes were examined. A Zimmer NexGen tibial cutting guide and a Mitutoyo digital caliper were utilized to align the guide with the tibia's mechanical axis. The procedure was replicated on cadaver knees using a standardized medial parapatellar arthrotomy approach. Measurements included the distance from GT superior border to the resection line and the length of the tibia. A radiological study involving magnetic resonance imaging examinations of 48 patients, which were evaluated focusing on the upper border of GT and the least degenerated segment of the posterolateral part of the lateral tibial condyle, was conducted. Anatomical measurements of GT and proximal tibial areas in 110 specimens showed slight but consistent variations with cadaver measurements. Magnetic resonance imaging analysis of 48 patients revealed notable sex differences in the distance between the superior border of GT and the tibia's posterolateral surface. There was also a significant negative correlation between the distance from GT to the posterolateral corner and cartilage thickness. Proper alignment in TKA is crucial for success, but identifying an extra-articular landmark for horizontal tibial resection remains challenging, particularly in severely arthritic knees. This study introduces GT as a novel anatomical landmark for TKA, offering a more reliable reference for achieving desired joint levels in knees with significant degenerative changes.

Early experience with the use of Cissus quadrangularis and Dalbergia sissoo therapy on bone marrow edema and knee pain associated with degenerative medial compartment knee osteoarthritis

Background: Bone marrow edema (BME) refers to the accumulation of excess fluid in the bone marrow, often indicative of injury or inflammation. Some studies suggest that incorporating plant-based therapies, rich in anti-inflammatory compounds and nutrients, may contribute to alleviating BME and promoting overall bone health. Aims and Objective: The study aims to evaluate the effect of Cissus quadrangularis and Dalbergia sissoo therapy on BME and knee pain associated with degenerative medial compartment knee osteoarthritis (OA). Materials and Methods: This retrospective study examined seven individuals with medial tibial condyle BME associated with medial compartment OA. These patients were treated with initial 10 days of non-steroidal anti-inflammatory drugs along with once-a-day tablet containing C. quadrangularis (500 mg) and D. sissoo (400 mg). Visual analogue scores (VAS) and Oxford knee score (OKS) were noted at the beginning of the therapy and at 12 weeks of completion of therapy. Before treatment, BME (percentage of the medial tibial condyle) and presence/absence of subtle subchondral fracture were diagnosed with T2-weighted magnetic resonance imaging (MRI) images, and subsequently, its resolution was confirmed with a repeat MRI scan at 12 weeks. Results: At the end of 12 weeks of therapy, there was a statistically significant improvement in the mean VAS score (baseline 8.14±0.90 improved to 2.00±0.58 at 12 weeks, [P&lt;0.0001]), OKS (baseline 25.71±1.80 improved to 36.57±1.51 at 12 weeks, [P=0.0001]), and there was statistically significant decrease in mean BME (baseline 37.86±10.35% decreased to 14.29±4.50% at the end of 12 weeks, [P=0.0001]). Conclusion: Our early experience shows that the combination therapy of C. quadrangularis + D. sissoo is effective in relief of pain, improvement in knee function, and resolution of BME associated with medial compartment knee OA. This combination is safe, effective, and well-tolerated by patients’ population.

Impacts of Segond Fractures on Anterior Cruciate Ligament Reconstruction Outcomes.

Segond fractures, characterized by avulsion injuries at the lateral tibial condyle's anterolateral structure (ALS) attachment, often coincide with anterior cruciate ligament (ACL) injuries, potentially leading to knee instability. However, the influence of Segond fractures on knee stability after ACL reconstruction remains uncertain. Despite documented ALS reconstructions, there is a lack of consensus regarding the assessment of ALS failure and the criteria for surgical interventions. This study aimed to determine if Segond fracture presence impacts ACL reconstruction outcomes, utilizing patient-reported subjective assessments and healthcare providers' objective evaluations. This retrospective study encompassed 639 patients (328 males, 311 females; mean age 26.9 years) who underwent ACL reconstruction, with a follow-up of at least one year. Subjects were divided into two groups: Segond fractures diagnosed through radiographic findings (Group S+, n = 17) and no Segond fractures (Group S-, n = 622). Clinical evaluation included the 36-item Short Form Survey (SF-36), Lysholm score, visual analog scale (VAS) for knee pain, knee injury and osteoarthritis outcome score (KOOS), and knee instability assessment via Telos SE (Telos Japan, Tokyo, Japan). Statistical comparisons were performed between the two groups. At the final follow-up, all SF-36 subscales improved in all eight subscales compared to before surgery, reaching national standard scores; no significant inter-group differences were evident. Lysholm scores were 93.0 ± 12.1 (Group S+) and 91.7 ± 10.9 (Group S-) (P = 0.62), VAS for knee pain was 10.0 ± 18.0 (Group S+) and 11.9 ± 16.9 (Group S-) (P = 0.62), total KOOS was 89.0 ± 17.4 (Group S+) and 90.7 ± 9.9 (Group S-) (P = 0.39), and anterior tibial translation differences were 2.8 ± 3.0 mm (Group S+) and 2.7 ± 2.9 mm (Group S-) (P = 0.73). All these values represent postoperative measurements. No significant discrepancies existed between groups across evaluation methods. This study's results suggest that Segond fractures have minimal impact on clinical ACL reconstruction outcomes, as assessed through both patient-reported subjective evaluations and objective healthcare provider evaluations. Segond fractures' significance in postoperative outcomes questions the necessity of ALS reconstruction.

Osteonecrosis of the Knee: The Unintended Consequence of Steroid Abuse.

The anti-inflammatory and immunosuppressive properties of steroids allow their use in a wide variety of rheumatological diseases, asthma, inflammatory bowel disease, cancer therapy, and severe viral infections. Though life-saving or organ-saving, long-term clinical use leads to a vast array of complications. Osteoporosis is the most common orthopedic side effect of steroid abuse, while osteonecrosis is a rare occurrence. The risk of osteonecrosis appears to be dose and duration dependent, but several patient factors also play a major role and usually affect the femoral head followed by the knee joint. The long-term effects of steroids must be explained to all patients on therapy, but this risk is missed in individuals who abuse steroids for recreational or performance-enhancing purposes. We describe a male, aged 29 years, who presented with dull aching bilateral knee pain of 2-years' duration after a long-term steroid abuse for weight and muscle mass gain. Radiological and magnetic resonance imaging studies confirmed osteonecrosis of femoral and tibial condyles and secondary degenerative arthritis of the knee joint. Prompt suspicion, early diagnosis, and intervention in osteonecrosis of knee joints, and termination of steroids may reverse the pathology and prevent progression of disease.

A new injection method for identifying the subpopliteal recess of the knee.

The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin-containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty-two formalin-fixed cadavers (34 knees), two N-vinyl-pyrrolidone (NVP)-fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1-3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.

Postoperative Decrease in Bone Marrow Lesion Associated With Better Clinical Outcomes Following Medial Open-Wedge High Tibial Osteotomy

PurposeThe aim of the current study was to assess serial changes of preoperative bone marrow lesion(BML) following medial open-wedge high tibial osteotomy(MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures(PROMs) till the 2 years follow-up. Factors related to the postoperative changes in BML were also evaluated. MethodsCurrent study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment(≥5°) and minimum 2-year follow-up. Serial MRIs at preoperative and postoperative 3, 6, 18, and 24 months were performed and the extent of BML was evaluated consecutively using two validated methods. Clinically, preoperative and postoperative PROMs and their achievement of minimal clinically important difference(MCID) values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed. ResultsOf 26 patients, 21(80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17(81.0%) and 18(85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved MCID was 84.6% for total WOMAC scores and 80.8%, 76.9%, and 84.6% for KOOS symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction(2°–5° valgus) was a significant factor for decreased BML following MOWHTO. ConclusionPreoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML.