-
Orthopaedic Journal of Sports Medicine Jun 2024Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and...
BACKGROUND
Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure.
PURPOSE/HYPOTHESIS
The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles.
STUDY DESIGN
Descriptive laboratory study.
METHODS
A total of 27 artificial right tibias (3 per subgroup) were allocated to 9 experimental groups based on the inclination of the socket tunnels (55°, 60°, and 65°) created for simulating medial and lateral MAT and ACLR. Five standardized socket tunnels were created for each tibia using arthroscopic guides: one for the ACL tibial insertion and one for each meniscus root insertion. CT scans were performed for all specimens and sequentially processed using computer software to produce 3D models for quantitative assessment of socket-tunnel overlap risk. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney tests.
RESULTS
No subgroup consistently presented significantly safer distances than other subgroups for all distances measured. Three cases (11%) and 24 cases (~90%) of tunnel overlap occurred between the ACL tunnel and tunnels for medial and lateral MAT, respectively. Most socket-tunnel overlap (25 of 27; 92.6%) occurred between sockets at depths ranging between 6.3 and 10 mm from the articular surface. For ACLR and posterior root of the lateral meniscus setting, the guide set at 65° increased socket-tunnel distances.
CONCLUSION
When combined ACLR and MAT using socket tunnels for graft fixation is performed, the highest risk for tibial socket-tunnel overlap involves the ACLR tibial socket and the lateral meniscus anterior root socket at a depth of 6 to 10 mm from the tibial articular surface.
CLINICAL RELEVANCE
Setting tibial guides at 65° to the tibial articular surface with the tunnel entry point anteromedial and socket aperture location within the designated anatomic "footprint" will minimize the risk for socket-tunnel overlap.
PubMed: 38845611
DOI: 10.1177/23259671241246277 -
BMC Musculoskeletal Disorders Jun 2024Fractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with...
INTRODUCTION
Fractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw.
MATERIALS AND METHODS
Eight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions.
RESULTS
Amidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension.
CONCLUSIONS
Sufficient space was available for the screw started from the dorsal approach despite the wrist positions.
Topics: Humans; Scaphoid Bone; Male; Adult; Wrist Joint; Female; Tomography, X-Ray Computed; Bone Screws; Young Adult; Range of Motion, Articular; Pronation; Biomechanical Phenomena
PubMed: 38844912
DOI: 10.1186/s12891-024-07561-4 -
Arthroscopy : the Journal of... Jun 2024To compare the sagittal position of the tibial tubercle in relation the trochlea groove in patients with and without trochlear dysplasia (TD).
PURPOSE
To compare the sagittal position of the tibial tubercle in relation the trochlea groove in patients with and without trochlear dysplasia (TD).
METHODS
All patients between January 2017 and December 2020 with high-grade TD (Dejour type B, C and D) who underwent patellar stabilizing surgery for patellar instability at a single institution were included in the current study. Patients without preoperative magnetic resonance imaging (MRI), any prior osteotomy on the affected lower extremity or cruciate ligament insufficiency were excluded. Patients who underwent knee arthroscopy for meniscal repair/debridement without any signs of TD or any of the above-mentioned criteria served as control group. Preoperative magnetic-resonance imaging (MRI) was retrospectively assessed to compare common patellofemoral anatomic parameters including patellar angle, patellar tilt, patella morphology according to Wiberg, Caton-Deschamps index (CDI), PF index, trochlear sulcus angle, sulcus depth, lateral inclination angle of the trochlea, tibiofemoral rotation, TTTG and sTTTG distance, between both groups. The sTTTG is measured as the distance between the nadir point of the cartilaginous trochlear groove and the most anterior point of the tibial tubercle on an axial MRI. Independent predictors for the sTTTG were assessed for patients with TD.
RESULTS
Patients with high-grade TD (n=82) showed an increased patellar tilt, CDI, trochlear sulcus angle, lateral tibiofemoral rotation angle, TTTG and sTTTG (9.16 ± 4.47 mm vs. 2.66 ± 4.21 mm) compared to the control group (n=83) (p<0.001). Patellar angle, PF index, sulcus depth and lateral inclination angle of the trochlear were significantly decreased in the TD group (p<0.001). The sTTTG was similar in all TD groups (n.s.). Among patients with TD, both tibiofemoral rotation and patellar height were independent predictors of the sTTTG (p<0.05).
CONCLUSION
Patients with high-grade TD show not only abnormal values in common patellofemoral instability risk factors, but also a significantly increased sTTTG compared to patients without TD.
LEVEL OF EVIDENCE
Retrospective case comparative study, III.
PubMed: 38844015
DOI: 10.1016/j.arthro.2024.05.023 -
Heliyon Jun 2024This study investigates the MRI features of knee gouty arthritis (KGA), examines its relationship with the extent of tissue involvement, and assesses whether risk...
OBJECTIVE
This study investigates the MRI features of knee gouty arthritis (KGA), examines its relationship with the extent of tissue involvement, and assesses whether risk factors can predict KGA.
MATERIALS AND METHODS
Patients diagnosed with KGA underwent MRI examinations, and two independent observers retrospectively analyzed data from 44 patients (49 knees). These patients were divided into mild and severe groups based on tissue involvement observed during arthroscopy. MRI features were summarized, and the intraclass correlation coefficient evaluated interobserver reproducibility. Single-factor analysis compared clinical indicators and MRI features between groups, while Cramer's V coefficient assessed correlations. Multivariate logistic regression identified predictors of tissue involvement extent, and a ROC curve evaluated diagnostic performance.
RESULTS
Among 49 knees, 18 had mild and 31 had severe tissue involvement. Key MRI features included ligament sketch-like changes, meniscal urate deposition, irregularly serrated cartilage changes, low-signal signs within joint effusion, synovial proliferation, Hoffa's fat pad synovitis, gouty tophi, bone erosion, and bone marrow edema. The interobserver reliability of the MRI features was good. Significant differences (P < 0.05) were observed between the groups for anterior cruciate ligament (ACL) sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi. ACL sketch-like changes (r = 0.309), Hoffa's fat pad synovitis (r = 0.309), and gouty tophi (r = 0.408) were positively correlated with the extent of tissue involvement (P < 0.05). ACL sketch-like changes (OR = 9.019, 95 % CI: 1.364-61.880), Hoffa's fat pad synovitis (OR = 6.472, 95 % CI: 1.041-40.229), and gouty tophi (OR = 5.972, 95 % CI: 1.218-29.276) were identified as independent predictors of tissue involvement extent (P < 0.05). The area under the ROC curve was 0.862, with a sensitivity of 67.70 %, specificity of 94.40 %, and accuracy of 79.14 %.
CONCLUSION
This comprehensive analysis of MRI features identifies ligament sketch-like changes, meniscal urate deposition, and low-signal signs within joint effusion as characteristic MRI manifestations of KGA. Irregular cartilage changes are valuable for differential diagnosis in young and middle-aged patients. ACL sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi correlate with tissue involvement severity and are critical in predicting and assessing the extent of tissue involvement in KGA.
PubMed: 38841465
DOI: 10.1016/j.heliyon.2024.e31888 -
Journal of Clinical Imaging Science 2024Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical...
Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical entities treated by orthopedic surgeons with arthroscopic surgery. Preoperatively, magnetic resonance imaging (MRI) is now standard in confirming knee pathology, particularly detecting pathology less evident with history and physical examination alone. The radiologist's MRI interpretation becomes essential in evaluating intra-articular knee structures. Typically, the radiologist that interprets the MRI does not have the opportunity to view the same pathology arthroscopically. Thus, the purpose of this article is to illustratively reconcile what the orthopedic surgeon sees arthroscopically with what the radiologist sees on magnetic resonance imaging when viewing the same pathology. Correlating virtual and actual images can help better understand pathology, resulting in more accurate MRI interpretations. In this article, we present and review a series of MR and correlating arthroscopic images of ACL tears, meniscal tears, chondral lesions, and intra-articular masses and cysts. Short teaching points are included to highlight the importance of radiological signs and pathological MRI appearance with significant clinical and arthroscopic findings.
PubMed: 38841313
DOI: 10.25259/JCIS_98_2023 -
SA Journal of Radiology 2024This report describes a rare case in which double calcifications of the acetabular labrum and rectus femoris occurred concomitantly in a middle-aged female patient who...
UNLABELLED
This report describes a rare case in which double calcifications of the acetabular labrum and rectus femoris occurred concomitantly in a middle-aged female patient who was treated successfully with surgical intervention via hip arthroscopy.
CONTRIBUTION
This case highlights the existence of various types of calcifications around the acetabulum, with a proposed new classification system for acetabular and periacetabular rim ossifications.
PubMed: 38840829
DOI: 10.4102/sajr.v28i1.2874 -
Foot & Ankle Orthopaedics Apr 2024
Reduction of the Posterior Malleolar Component of Trimalleolar Fractures Using Dry Arthroscopic Visualization and Manipulation by Working Through the Medial Malleolus Fracture.
PubMed: 38840787
DOI: 10.1177/24730114241258098 -
World Journal of Orthopedics May 2024Congenital absence of the menisci is a rare anatomical variation characterized by the absence or underdevelopment of one or both menisci in the knee joint. The menisci...
BACKGROUND
Congenital absence of the menisci is a rare anatomical variation characterized by the absence or underdevelopment of one or both menisci in the knee joint. The menisci are crucial in load distribution, joint stability, and shock absorption. Understanding the clinical presentation, diagnosis, and management of this condition is important for optimal patient care.
CASE SUMMARY
A 27-year-old male with a long-standing history of knee pain underwent diagnostic arthroscopy, revealing a congenital absence of the meniscus. The patient's clinical findings, imaging results, surgical procedures, and pertinent images are detailed. This case presents a unique aspect with the congenital absence of the meniscus, contributing valuable insights to the literature on rare anatomical anomalies.
CONCLUSION
This case of congenital absence of the menisci highlights the diagnostic challenges posed by rare anomalies. The diagnostic arthroscopy played a crucial role in identifying the absence of the meniscus and providing an explanation for the patient's persistent knee pain. The case underscores the importance of individualized treatment approaches, including physical therapy, for optimal management of rare meniscal anomalies. Further research is warranted to explore effective management strategies for the aforementioned cases and to expand our knowledge of these rare conditions.
PubMed: 38835691
DOI: 10.5312/wjo.v15.i5.477 -
Arthroscopy Techniques May 2024Isolated posterior shoulder instability accounts for approximately 10% of shoulder instability cases. Patients may present after an acute trauma or with insidious onset...
Isolated posterior shoulder instability accounts for approximately 10% of shoulder instability cases. Patients may present after an acute trauma or with insidious onset and associated posterior shoulder pain. Knotless and all-suture anchor devices have become increasing popular and are often used in arthroscopic shoulder instability cases to avoid knot stacks and allow for the ability to re-tension the fixation. This technical note describes our technique for 2-portal posterior labral repair using knotless all-suture anchors with the patient in the lateral decubitus position.
PubMed: 38835471
DOI: 10.1016/j.eats.2024.102928 -
Arthroscopy Techniques May 2024Meniscus allograft transplantation (MAT) is a technically challenging procedure. Bone plugs, slot techniques, and all-soft-tissue fixation techniques have been described...
Meniscus allograft transplantation (MAT) is a technically challenging procedure. Bone plugs, slot techniques, and all-soft-tissue fixation techniques have been described in the past. Each technique comes with advantages and disadvantages. Native menisci have circumferential collagen fibers to help resist hoop stress during loading cycles. Although hoop stress resistance is a known function of the menisci, its recreation in MAT has only been targeted indirectly through anatomic root placement. The authors describe the use of a high-tensile suture tape (i.e. InternalBrace) to promote centralization by directly mitigating hoop stresses through recreation of peripheral meniscus tensioning in MAT.
PubMed: 38835470
DOI: 10.1016/j.eats.2024.102954