Tibial Condyle Research Articles

Efektivitas Larutan Dekalsifikasi pada Os tibia Domba Garut (Ovis aries) (THE EFFECTIVENESS OF DECALCIFYING SOLUTIONS ON THE TIBIAL OF GARUT SHEEP (OVIS ARIES))

Bone is a tissue that has a density of extracellular matrix structures and composed by organic and inorganic components. Decalcification is a stage that plays an important role in bone histology using various types of solutions. The sample used in this study was lateral condyle from tibia of three garut sheeps (Ovis aries) which had been fixed with 10% Neutral Buffered Formalin (NBF) for 24 hours. Sample were cut into pieces ranging from 1 cm x 1 cm x 1 cm in size, the decalcification using three solutions; 10% nitric acid, 10% EDTA (pH 7.4) and 10% EDTA (pH 7.4) + TBD-1®. The aim of this study was to evaluate the effectiveness of three solutions for the decalcification process of lateral tibial condyle of garut sheep. Observation parameter in this study includes: duration of decalcification, sectioning process of ribboning formation, structural integrity and absorption of hematoxylin-eosin (HE) staining. The results shows that 10% EDTA (pH 7.4) solution provides a long duration of decalcification which is ease sectioning process ribboning, the best structural integrity of lateral tibial condyle. In hematoxylin-eosin (HE) staining shows that 10% nitric acid solution does not absorb the optimum color, opposite in 10% EDTA and 10% EDTA + TBD-1® solution, the color intensity between hematoxylin and eosin in the tissue shows the best results. Based on these results, it can be concluded that the 10% EDTA (pH 7.4) is the best decalcification solution for lateral condyle from tibial of garut sheeps.

Anatomical and Clinical Rationale for Posterolateral Transfibular Approach for Internal Fixation of the Posterolateral Column of the Tibial Plateau

Purpose of the study — to provide an anatomical rationale and evaluate the clinical application of posterolateral surgical approach with osteotomy of the fibular head for internal fixation of the posterior aspect of the lateral tibial condyle. Material and Methods. Anatomical topography research was performed on 14 lower limbs of 8 fresh cadavers. In the first series of research L-shaped plate was fixed on the posterolateral surface of lateral tibial condyle from the examined approach, then preparation was performed and measuring of distances from various parts of the plates to the common peroneal nerve and anterior tibial artery. In the second series the authors prepared histological topograms by transverse sectioning of plastinated specimens from the knee joint area after implantation of L-shaped buttress plates. Prospective observation clinical study included 20 patients who underwent internal fixation with L-shaped buttress plate from the examined approach for fracture of the posterolateral column of the tibial plateau, type 41В by AO classification. KSS and Lysholm scales were used to evaluate treatment outcomes at days 7–10 and in 1, 3, 6 and 9 months postoperatively. Data of the anatomical and clinical research was compared. Results. Compliance with the technique of posterolateral transfibular surgical approach allows to avoid risk of injury to the common peroneal nerve and anterior tibial arthery which on the specimen were always located safely away from implanted plates. All 20 clinical cases demonstrated good visualization of bone fragments and articular surface of the tibial plateau which ensured reliable reduction and fixation by L-shaped buttress plate. KSS excellent and good outcome scores amounted to 50% and 45%, respectively, while satisfactory score was reported in 5% of cases; Lysholm scale demonstrated 55% of excellent outcomes, 45% of good outcomes, and 5% of satisfactory outcomes. Safety of the approach was verified: no injuries to large blood vessels or iatrogenic neuropathies were reported as well as no large hematomas or infectious complications of the surgical wound in early postoperative period. Conclusion. Results of the present study proved the feasibility and safety of the posterolateral transfibular surgical approach for internal fixation procedures in patients with intraarticular fractures of posterolateral column of the tibial plateau.

Genetic mapping of distal femoral, stifle, and tibial radiographic morphology in dogs with cranial cruciate ligament disease.

Cranial cruciate ligament disease (CCLD) is a complex trait. Ten measurements were made on orthogonal distal pelvic limb radiographs of 161 pure and mixed breed dogs with, and 55 without, cranial cruciate partial or complete ligament rupture. Dogs with CCLD had significantly smaller infrapatellar fat pad width, higher average tibial plateau angle, and were heavier than control dogs. The first PC weightings captured the overall size of the dog’s stifle and PC2 weightings reflected an increasing tibial plateau angle coupled with a smaller fat pad width. Of these dogs, 175 were genotyped, and 144,509 polymorphisms were used in a genome-wide association study with both a mixed linear and a multi-locus model. For both models, significant (pgenome <3.46×10−7 for the mixed and< 6.9x10-8 for the multilocus model) associations were found for PC1, tibial diaphyseal length and width, fat pad base length, and femoral and tibial condyle width at LCORL, a known body size-regulating locus. Other body size loci with significant associations were growth hormone 1 (GH1), which was associated with the length of the fat pad base and the width of the tibial diaphysis, and a region on CFAX near IRS4 and ACSL4 in the multilocus model. The tibial plateau angle was associated significantly with a locus on CFA10 in the linear mixed model with nearest candidate genes BET1 and MYH9 and on CFA08 near candidate genes WDHD1 and GCH1. MYH9 has a major role in osteoclastogenesis. Our study indicated that tibial plateau slope is associated with CCLD and a compressed infrapatellar fat pad, a surrogate for stifle osteoarthritis. Because of the association between tibial plateau slope and CCLD, and pending independent validation, these candidate genes for tibial plateau slope may be tested in breeds susceptible to CCLD before they develop disease or are bred.

Can marathon running improve knee damage of middle-aged adults? A prospective cohort study

ObjectivesTo evaluate the short-term impact of long-distance running on knee joints using MRI.Methods82 healthy adults participating in their first marathon underwent 3T (Tesla) MRI of both knees 6 months before...

Does Intra-Articular Platelet Rich Plasma Injection Improve Meniscal Repair Outcomes?

Background: Meniscal tear surgeries have many long term sequelae. Intra-articular platelet rich plasma injection is thought to stimulate repair and increase meniscal function. Objectives: To assess the effect of 6-monthly intra-articular injection of platelet rich plasma (PRP) on the pain assessment and functional status of knee joint undergone meniscal repair. Methods: A randomized controlled trial was carried out on thirty patients who had undergone arthroscopic meniscal repair and presented with persistent pain within 4 months after surgery. Half of the patients were randomly intra-articularly injected with 5 mL PRP at 1 month intervals for 6 injections and the other half were not injected and taken as a control group. Clinical examination, visual analogue scale (VAS), knee injury and osteoarthritis outcome score (KOOS) score and Doppler ultrasonography were performed before and after PRP treatment. Results: After 6 months, in the PRP injected group, there was a significant improvement in VAS score (1 (1 - 3)) and KOOS score (86.2 ± 4) compared to baseline values (9 (7 - 10) and 62 ± 9.8 respectively; P < 0.001) as well as significant decrease in the percentage of degeneration of medial femoral condyle (MFC), lateral femoral condyle (LFC), medial tibial condyle (MTC), lateral tibial condyle (LTC) measured by Doppler Ultrasonography (US), (6.16 ± 3.33 and 9.07 ± 3.66, respectively; P = 0.031). Conclusions: This study showed that intra-articular PRP injection following meniscal repair can be effective in reducing pain, improving knee function, and slowing the rate of cartilage degeneration that accounts for early osteoarthritis.

Morphological variants of pes anserinus in South India

Background. It was described that variations exist in the pes anserinus tendons. In this study, our aim was to observe the variations of the pes anserinus in South Indians. Methods. We examined 53 embalmed human adult lower extremities. The pes anserinus was macroscopically observed for the morphological variants after dissecting the tendons which inserted at the antero medial surface of proximal tibia. Results. The pes anserinus was formed by 3 tendons, gracilis, semitendinosus and sarto-rius in 48 lower limbs (90.6%). It was observed that, 41 (77.4%) had convergent type, 7 (13.2%) had early convergence and 5 lower limbs (9.4%) were having divergent pattern of pes anserinus morphology.Semimembranosus muscle was taking in the formation of pes anserinus in 3 lower limbs (5.7%). The pes anserinus was inserting into the fascia cruris and not tibia in 8 specimens (15.1%). However in 10 cases (18.9%), the insertion was both at the tibia and fascia cruris.The insertion was only at fascia cruris and not in tibia in 15.1% cases. The semitendinosus was giving an extra slip, which was attaching to the medial condyle of tibia in 7 cases (13.2%). It was giving slip to medial collateral ligament in 2 cases (3.8%) and ligamentum patellae in 1 case (1.9%).Conclusion. We believe that this information about morphological variants of pes anser-inus is helpful to the plastic and orthopaedic surgeons. Preoperative radiological exam-ination of pes anserinus may be helpful to the operating surgeons to avoid the subsequent difficulties during the procedures like transplant surgeries and graft harvesting during reconstructive surgeries.

Saphenous Artery Perforator Flaps in Minipigs: Anatomical Study and a New Experimental Model

This study describes the anatomy of the saphenous artery (SA) perforators in minipigs and the development of a new animal model. First, the anatomic characteristics of the SA and perforators in minipigs were examined after latex-lead oxide perfusion. Subsequently, the right hind limbs of 10 minipigs were used to generate capillary perforator flaps (group A; utilizing the SA and 5.5 cm of deep fascia above the knee), while all perforators of the left hind limbs were reserved (group B). Four additional minipigs were used to evaluate SA perforator flaps with capillary perforators plus sarcolemma and a small amount of muscle (group C). Preoperative and postoperative CTA of both hind limbs confirmed that all perforators were ligated in groups A and C. The average length of the SA was 14.86 ± 0.76 mm. The diameters of the SA at initiation, the medial tibial condyle, and the medial malleolus were 1.73 ± 0.15 mm, 1.50 ± 0.12 mm, and 1.30 ± 0.13 mm, respectively. There were 7.09 ± 1.16 perforators per hind limb, with an average diameter of 0.40 ± 0.13 mm (range, 0.10–0.78 mm), and the majority (96.2%) had a diameter >0.2 mm. The survival rates of the flaps in groups A, B, and C were 32 ± 39%, 100%, and 60.2 ± 17%, respectively. The position of the SA in minipigs is constant, its diameter is relatively large, and it has many perforators, allowing it to be used as a reliable model of perforator flaps, including capillary perforator flaps.

The anterolateral ligament of the knee and the lateral meniscotibial ligament – Anatomical phantom versus constant structure within the anterolateral complex

BackgroundConcerning the ongoing controversy about the existence and nature of the anterolateral ligament (ALL) of the knee joint, we reinvestigated the formation of the anterolateral part of its fibrous capsule in anatomic specimens. Furthermore, we wanted to clarify if the lateral meniscus has established a constant anchoring to the lateral tibial condyle via a lateral meniscotibial ligament (lmtl). MethodsForty paired embalmed lower extremities taken from 20 human body donors (15 men and five women) underwent exact macroscopic dissection. For the detailed evaluation of the lmtl, additionally 12 specially dissected joint specimens were used. In two of these specimens, the lmtl underwent further histological examination. ResultsIn all specimens, the anterolateral part of the knee joint fibrous capsule was established by the iliotibial tract and the anterior arm of the aponeurosis of the biceps femoris muscle. According to their close connection and the fact that the anterolateral part of the fibrous capsule is exclusively assembled by these two aponeuroses, they do not leave any space for a distinct ALL connecting the lateral femoral epicondyle and the lateral tibial condyle.The constantly present lmtl was identified as a flat, rectangular bundle of collagen and also elastic fibers reinforcing the inner aspect of the fibrous capsule. Following an oblique direction, it connected the lateral face of the lateral meniscus with the superolateral margin of the lateral tibial condyle. The lmtl measured, on average, 17.1mm in longitudinal and 13mm in anteroposterior direction. ConclusionOur results show that there is no evidence for the existence of an ALL in human knee joints. It is represented either by the iliotibial tract or – most likely – by the anterior arm of the short head of the biceps femoris muscle. On the other hand, the lmtl was found to be a constantly present structure.

Morphologic difference and size mismatch in the medial and lateral tibial condyles exist with respect to gender for unicompartmental knee arthroplasty in the Korean population.

The purpose of this study was to characterize the geometry of the proximal tibia in both genders in the Korean population. Anthropometric data on the medial and lateral tibial condyles of the osteoarthritic knees of 149 males and 814 females were obtained using three-dimensional magnetic resonance imaging. In the medial and lateral proximal tibial condyles, the anteroposterior (AP) dimension, widest dimension (WD) at defined points, and condylar aspect ratio were evaluated. These measurements were compared with similar dimensions of the tibial components from five commonly used unicompartmental knee arthroplasty (UKA) designs in Korea. Both the AP dimension and WD in the medial and lateral tibial condyles of the male patients were significantly greater than those of the female patients (P < 0.05). In addition, the AP dimension and WD were greater in the medial than in the lateral tibial condyle (P < 0.05). There was WD overhang in three and two prostheses in the medial and lateral tibial condyles, respectively. A decrease in the condylar aspect ratio with an increasing AP dimension was found in the medial and lateral tibial condyles for both the male and female patients. Smaller medial and lateral tibial condylar dimensions are more frequent in Korean women than in Korean men. This study highlights the finding that conventional UKA designs lead to size mismatch in the Korean population and may indicate an important guideline on proper gender-specific UKA tibial prostheses with different WD/AP dimension aspect ratios. In addition, this study suggests that the shape of the medial tibial plateau is different to that of the lateral plateau, which can lead to a mediolateral overhang for medial UKA in an attempt to optimize the AP coverage. III.

Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency

Objectives: Kneeling stress radiographs are commonly used to evaluate posterior cruciate ligament (PCL) laxity. Patients, however, report significant pain, and reproducibility is challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement (PTD). Weighted gravity stress radiographs may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. Hypothesis: weighted gravity radiographs will be more comfortable and produce similar PTD measurements when compared to the kneeling technique. Methods: Patients 18-70 years old with non-operatively or &gt;6 months post-operatively treated PCL injuries (isolated or multi-ligamentous) were recruited from two academic level one trauma centers to undergo bilateral PCL stress radiographs. Exclusions: open/bilateral injuries, fractures. Patients underwent PCL stress radiographs by two randomly ordered methods. Kneeling stress views: patients knelt on padded scales (separate for each knee) with the padding distal to the tibial tubercle. Patients were verbally encouraged to place equal weight on both knees (scale outputs not visible to the patient). A digital radiography plate was placed between the legs to acquire bilateral lateral radiographs. Weighted gravity stress views: Patients lay supine with their hip and knee at 90°with the heel supported. A 20 lb weight was placed on the anterior tibia just distal to the tibial tubercle. A lateral radiograph was taken and then repeated on the contralateral leg. Images were anonymized and uploaded to PACS for measurement. Outcomes: side to side difference (SSD) in translation of the posterior tibial condyles relative to the posterior femoral condyles (primary outcome); patient-reported VAS knee pain (100 mm) during the radiographs; time required to acquire the images; patient preference for technique. Statistics: sample size = 31 patients to detect a 2 mm difference (α=0.05, power 80%, SD = 2.8 mm [Jung, 2006]). Paired t-tests were used to compare the SSD between the kneeling and weighted gravity methods, VAS pain, and time to complete the radiographs. Results: 40 patients (77.5% male, 34.5 ± 12.8yrs old, 65% left knee) were recruited. 42.5% had undergone PCL reconstruction. There was no difference between the two radiographic methods in the mean SSD (kneeling = 6.29 ± 4.58 mm, gravity = 6.82 ± 4.60 mm, p= 0.61). There was no difference in the total time required to perform the radiographs (kneeling = 307.3 s ± 140.5 s, gravity = 318.7 s ± 151.1 s, p= 0.73) or the number of radiographs taken to obtain acceptable images (kneeling = 3.6 ± 1.6, gravity = 3.7 ± 1.7, p= 0.73). The amount of weight placed on each knee during the kneeling views differed slightly but was not significant (affected = 21.5 ± 11.3 kg, unaffected = 26.1 ± 12.1 kg, p= 0.09). There was significantly less knee pain reported for the gravity views (kneeling = 31.8 ± 26.6, gravity = 4.0 ± 12.0, p &lt; 0.0001). 94.6% of patients preferred the gravity method. Conclusion: Weighted gravity PCL stress radiographs should be considered for use in clinical practice as they produce similar posterior tibial translation values to the kneeling technique, do not rely on patient weightbearing, and provide significantly better patient comfort.

Establishment of experimental model for saphenous artery perforator flap in mini pig

Objective To investigate the anatomy characteristics of saphenous artery(SA) and its perforator vessels in mini pig, and to provide a new perforator flap animal model. Methods Between May, 2018 and August, 2018, 6 7-months-old mini pigs weight 25 kilograms were sacrificed by blooding under general anesthesia. The bilateral external iliac arteries were injected with a mixture of latex-lead oxide mixture and underwent CT-scanning to provide 3-dimensional reconstruction. The origin, diameter, courses and distribution of the SA and perforators of both hind limbs were observed. Results One of the hind limbs was abandoned due to the leakage of perfusion fluid. The other 11 hind limbs were available. The femoral artery passed through the medial femoral muscle and sartorius muscle in the middle of thigh, and run between the medial femoral muscle and gracilis muscle above the knee. Below the knee, it run on the surface of the medial leg muscles. A number of small branches were distributed in the tarsal joint and calcaneus at the medial malleolus, and there were abundant communicating branches with the posterior tibial artery. The average length of SA was (14.86±0.76) mm. The outer diameters of SA at initiative, medial tibial condyle and medial malleolus were(1.73±0.15) mm, (1.50±0.12) mm and (1.30±0.13) mm, respectively. There were a total of 79 perforators which were identified, with a mean of (7.09±1.16) perforators per hind limbs. And the average outer diameter was 0.10-0.78 (0.40±0.13) mm. Conclusion The SA constantly exist with good outer diameter. The number of perforator is abundant. SA can be used as a reliable animal model for studying and training of perforator flap. Key words: Saphenous artery; Perforator flap; Mini pig; Animal model

Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design — a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years’ follow-up

Background and purpose — Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients?Patients and methods — 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1–5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs).Results — The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse.Interpretation — The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.

Age-related morphometric changes of the tidemark in the ovine stifle.

Though the ovine stifle is commonly used to study osteoarthritis, there is limited information about the age-related morphometric changes of the tidemark. The objective of this study was to document the number of tidemarks in the stifle of research sheep without clinical signs of osteoarthritis and of various ages (n=80). Articular cartilage of the medial and lateral tibial condyles and of the medial and lateral femoral condyles was assessed by histology: (a) to count the number of tidemark; and (b) to assess the OARSI (Osteoarthritis Research Society International) score for structural changes of cartilage. The number of tidemarks varied between anatomical regions, respectively, from 4.2 in the medial femoral condyle to 5.0 in the lateral tibial condyle. The axial part showed a significant higher number of tidemarks than the abaxial part, for all regions except the medial tibial condyle. Whilst the tidemark count strongly correlated with age (Spearman's correlation coefficient=0.70; 95% confidence interval (95% CI): 0.67-0.73; p<0.0001), the OARSI score was weakly correlated with age in our cohort of sheep (Spearman's correlation coefficient=0.25; 95% CI: 0.19-0.30; p<0.0001). Interestingly, no tidemark was seen in the three animals aged 6months. Our data indicate that the number of tidemarks increases with age and vary with anatomical region. The regional variation also revealed a higher number of tidemarks in the tibia than in the femur. This could be attributed to the local variation in cartilage response to strain and to the difference in chondrocyte biology and density.

Effect of Fibular Height and Lateral Tibial Condylar Geometry on Lateral Cortical Hinge Fracture in Open Wedge High Tibial Osteotomy

To evaluate whether the fibular position and lateral proximal tibial geometry affect the osteotomy configuration and lateral hinge fracture (LHF) during open wedge high tibial osteotomy (OWHTO). From March 2014 to January 2016, patients who underwent OWHTO for isolated medial compartment osteoarthritis of the knee were retrospectively reviewed. To identify whether the fibular position and lateral proximal tibial geometry affect the osteotomy configuration, the fibular height, fibular anteroposterior position, lateral tibial condylar width, and lateral tibial condylar slope were evaluated on plain radiograph or computed tomography (CT). Thereafter, the correlation of these parameters with the thickness of the proximal fragment around the osteotomy end and LHFs was determined. A total of 123 OWHTOs including 30 LHFs (24.3%) were evaluated. High fibular head and small tibial condylar width and slope were related to thin thickness of the proximal tibial fragment, particularly on the posterior side (fibular height, P= .005; condylar width, P= .002; condylar slope, P= .01). The fibular height was shorter in the LHF group than in the non-LHF group on both plain radiography and CT (fibular height [plain radiography], 18.3 ± 1.6 vs 20.2 ± 2.1mm; P < .001; fibular height [CT], 17.4 ± 1.1 vs 19.6 ± 2.0mm; P < .001). The lateral tibial condylar width and slope were also smaller in the LHF group compared with the non-LHF group (tibial condylar width, 21.2 ± 4.9 vs 23.4 ± 4.5mm; P= .023; tibial condylar slope, 37.7 ± 6.6 vs 41.3 ± 7.6mm; P= .027). The fibular position and lateral proximal tibial geometry affect the osteotomy configuration and LHFs. A highly positioned fibula was related to a small lateral tibial condyle, which induced a thin proximal fragment. This finding was related to a higher risk of LHFs. Therefore, understanding the fibular height and lateral proximal tibial geometry may be helpful for the prediction of the osteotomy configuration and development of LHFs. Level III, case-control study.

Comparative Morphological Studies of the Stifle Menisci in Donkeys, Goats and Dogs

AbstractThe present work aims to provide more anatomical information on the stifle joint of the investigated species using computed tomography with gross anatomical cross-sections. The current work analyzed the stifle joint of the pelvic limbs of 12 adult donkeys, goats and dogs of both genders. The medial condyle of the femur was larger than the lateral one in the donkey, while it was smaller and lower than the lateral one in the goat and in the dog. The unsuitable femoral and tibial condyles were adapted by the presence of menisci. In the donkey, the medial meniscus was crescentic in shape, but it was semicircular in the goat, while in the dog, the medial and lateral menisci were C-shaped. In the donkey, the medial meniscus was larger than the lateral one, but in the goat and in the dog, the lateral meniscus was the largest, and more concave and thicker. The lateral meniscus was semicircular in the donkey, but it was shaped like an elongated kidney in the goat. In the goat and in the dog, the central border of two menisci was thin, concave and notched centrally. The meniscal ligaments included cranial and caudal ligaments of the medial and lateral menisci, and meniscofemoral ligament of the lateral meniscus. In the dog, the cranial ligament of the medial meniscus was absent, and the medial meniscus had no bony attachment to the tibia but it attached to the transverse intermeniscal ligament, which connected the cranial horn of the medial meniscus with the cranial ligament of the lateral meniscus. The meniscofemoral ligament connected the caudal pole of the lateral meniscus with the intercondyloid fossa of the femur.

Gait Mechanics and T1ρ MRI of Tibiofemoral Cartilage 6 Months after ACL Reconstruction.

Aberrant walking biomechanics after anterior cruciate ligament reconstruction (ACLR) are hypothesized to be associated with deleterious changes in knee cartilage. T1ρ magnetic resonance imaging (MRI) is sensitive to decreased proteoglycan density of cartilage. Our purpose was to determine associations between T1ρ MRI interlimb ratios (ILR) and walking biomechanics 6 months after ACLR. Walking biomechanics (peak vertical ground reaction force (vGRF), vGRF loading rate, knee extension moment, knee abduction moment) were extracted from the first 50% of stance phase in 29 individuals with unilateral ACLR. T1ρ MRI ILR (ACLR limb/uninjured limb) was calculated for regions of interest in both medial and lateral femoral (LFC) and medial and lateral tibial condyles. Separate, stepwise linear regressions were used to determine associations between biomechanical outcomes and T1ρ MRI ILR after accounting for walking speed and meniscal/chondral injury (P ≤ 0.05). Lesser peak vGRF in the ACLR limb was associated with greater T1ρ MRI ILR for the LFC (posterior ΔR = 0.14, P = 0.05; central ΔR = 0.15, P = 0.05) and medial femoral condyle (central ΔR = 0.24, P = 0.01). Lesser peak vGRF loading rate in the ACLR limb (ΔR = 0.21, P = 0.02) and the uninjured limb (ΔR = 0.27, P = 0.01) was associated with greater T1ρ MRI ILR for the anterior LFC. Lesser knee abduction moment for the injured limb was associated with greater T1ρ MRI ILR for the anterior LFC (ΔR = 0.16, P = 0.04) as well as the posterior medial tibial condyle (ΔR = 0.13, P = 0.04). Associations between outcomes related to lesser mechanical loading during walking and greater T1ρ MRI ILR were found 6 months after ACLR. Although preliminary, our results suggest that underloading of the ACLR limb at 6 months after ACLR may be associated with lesser proteoglycan density in the ACLR limb compared with the uninjured limb.

Morphometric Analysis of Proximal End of the Tibia

Abstract Background Total knee arthroplasty and unicompartmental knee arthroplasty are frequently done procedures for the treatment of various forms of arthritis and knee injuries. The knee prosthesis, which is used for these procedures, requires adequate sizing specific to the population. Morphometric parameters of upper end of the tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Information regarding morphometry of upper end of the tibia is important as it provides reliable method of assessing knee deformity. This article assesses different morphometric parameters of condylar and intercondylar surface of the tibia and to compile the results, analyze, and formulate a baseline data for future studies with relevance to Indian population. Materials and Methods The study group comprised of 60 adult human dry and processed tibia of both sides which are grossly normal and complete, obtained from the Department of Anatomy, Himalayan Institute of Medical Sciences. Morphometric measurements of the medial condyle, lateral condyle, and intercondylar area of tibia were recorded with vernier calipers with a least count of 0.01 mm. The dimensions were summarized as mean ± standard deviation. A p-value of &lt; 0.05 was considered significant. Result Mediolateral and anteroposterior length were 66.33 and 42.52 mm, respectively. Conclusion Anatomical profile of tibial condyle for Indians is smaller, hence highlighting the need for sizing of prosthesis specific to the population in question.

Restoring Condylar Width: Radiographic Relationship Between the Lateral Tibial Plateau and Lateral Femoral Condyle in Normal Adult Knees.

We hypothesized that a constant radiographic relationship exists between the lateral tibial and femoral condyles and that no side-to-side variation exists. We reviewed anteroposterior x-rays of 217 uninjured adults ages 18-65, Included 109 unilateral and 108 bilateral radiographs with no or minimal osteoarthrosis (Kellgren-Lawrence grades 0-1). The perpendicular distance between the lateral-most margins of the tibial plateau articular surface (A) and the lateral femoral epicondyle (B) and the lateral femoral condyle articular surface (C) was measured in millimeters (mm). Medial and lateral measurements to point (A) were recorded as (-) and (+), respectively. First, the average of measured distances in all unilateral knees and randomly selected either right or left knees from the bilateral group (n = 217) was calculated. Comparison was made between both sexes. Next, A-B and A-C distances were compared between right and left knees in the bilateral group (n = 108) to find any significant difference (2-tailed t test, alpha = 0.05). The average A-B distance was 0.60 ± 2.40 mm (-4.82 to +6.49 mm). The mean A-C distance was -3.96 ± 2.07 mm (-8.51 to +3.98 mm). No significant difference was found between A-B and A-C distances between males (0.40 ± 2.62 mm and -3.91 ± 2.05 mm) and females (0.70 ± 2.28 mm and -3.99 ± 2.09 mm). Similarly, no significant difference was found between A-B and A-C distances between right (1.08 ± 2.31 mm and -3.90 ± 1.73 mm) and left knees (0.90 ± 2.38 mm and -4.31 ± 1.7 mm). Concordance coefficient for interobserver and intraobserver reliability showed substantial agreement. In conclusion, this study provided a "normal" range for the relationship of the proximal lateral tibial plateau relative to the lateral femoral condyle. The lateral femoral epicondyle is generally aligned with the lateral tibial articular margin. The relationship between the lateral tibial plateau, lateral femoral epicondylar surface, and lateral femoral articular surface is constant from side to side. This technique is reproducible in the setting of fracture, and templating off of the contralateral uninjured knee may be beneficial in tibial plateau fracture surgery.

Functional outcome of 59 patients of bicondylar tibial plateau fractures treated with internal vs external fixation: Selection criteria

Background: The purpose of this prospective study was to evaluate the Functional results of Internal versus External fixation of bicondylar tibial plateau fractures decided on specific selection criteria.Materials and Methods: Fifty nine patients with tibial condyle fractures (Schatzker type V and VI) were recruited in the study between Nov 2013 and Dec 2015 at our tertiary care hospital in Bengaluru, India. Open reduction and internal fixation with Dual Buttress plates, Buttress plate and CC screws was done in 38 patients (closed, Type I & II open with good skin conditions). Hybrid External fixation was done in 21 patients (closed, Type I & II open with bad skin conditions, Impending compartment syndrome). They were followed up at six weeks, six months and twelve months and was evaluated for the functional outcomes by Hospital for special surgery knee scoring system (HSS). Result: 86% of our patients had good to Excellent results according to HSS score. The outcomes between both modes of fixation were not significantly different at 1 year follow up. There was no difference in total arc of knee motion. Mean range of knee flexion in internal fixation was 115.79 + 21.290, External fixation was 115.24 + 13.370. Average HSS Score at final follow up for internal fixation was 78.87 + 10.94 and external fixation was 78.71 + 9.05. 2 patients needed flap surgery due to wound complications, 3 patients experienced infection following internal fixation compared to external fixator. 1 patient experienced non union following external fixation.Conclusion: Both methods of fixation in Bicondylar tibial plateau fractures gives a favourable functional outcome provided selection criteria is followed strictly. Level of Evidence: Level 3.

Is There A Relationship Between Three-Dimensionally Measured Baker's Cyst Volume and Knee Pathologies?

Baker's cyst (BC) is also known as popliteal cyst. To evaluate its effect on intra-articular pathology, it is important to have the exact volume of the cyst. As BC may change its shape due to mass effect of the surrounding anatomic structures, it is difficult to measure the exact volume of BC. This study examined the relationship between three-dimensionally measured BC volume and symptomatic intra-articular knee pathologies. The magnetic resonance (MR) images of 45 patients with symptomatic knees were retrospectively examined.The BC volumes were measured via volumetric analysis. The joint effusion was examined in the sagittal plane in T2-proton density-weighted images. The medial plicae were assessed in accordance with the modified Sakakibara classification. Using the MR images, the meniscuses were classified in accordance with the meniscus rupture classification of Stoller et al. The cartilaginous lesions were analyzed using an MR grading system.In this study, correlations between the following measures were analyzed: BC volume and effusion level, medial plica presence, medial femoral condyle, medial tibial condyle, lateral femoral condyle and lateral tibial condyle cartilage degeneration, and medial meniscus anterior horn, medial meniscus posterior horn, lateral meniscus anterior and posterior horn ruptures. Cartilage degeneration, medial plicae, increase in intra-articular effusion, and increase in the BC volume were found to be statistically significant (p<0.01). Cartilage degeneration, medial plicae, and increase in intra-articular effusion may increase the BC volume. We believe that this study may contribute to clinicians in understanding the relationship between BC volume changes and pathologies causing intra-articular knee symptoms.