Are Two- and Three-Dimensional Computed Tomographic Scan Measurements of Tibial Tubercle-Trochlear Groove Distance Equivalent? A Comparative Study.

Background: Accurate planning for patellar instability correction is important in obtaining good post-operative outcome. The main challenge in the current two-dimensional (2-D) computed tomographic (CT) scans method is the difficulty in choosing reliable bony landmarks. This study aimed to compare the reliabilities between the 2-D and three-dimensional (3-D) methods of measuring tibial tubercle-trochlear groove (TT-TG) distance. We hypothesize that the proposed 3-D method will result in measurements with narrower error margin, providing higher reliability and accuracy. Materials and Methods: We traced CT scans of 106 knees with no patellofemoral pathology from 59 subjects from the database system and converted all 2-D images into 3-D models to determine the values for each parameter. We compared the intra- and interobserver reliability of each method using intraclass correlation (ICC) and Bland-Altman method. Results: The values of TT-TG measured by 2-D and 3-D methods were 16.1 ± 4.6 mm and 16.2 ± 4.2 mm, respectively. The ICC values of both methods were comparable (95% limits of agreement between the same observer: - 3.3 to 3.8 mm versus - 2.4 to 2.7 mm and different observers: - 4.3 to 4.9 mm versus - 3.9 to 2.7 mm), with 3-D method results in narrower limits of agreement. Conclusion: TT-TG measurement is reliable using the 2-D method without using advanced radiographic software. The 3-D method of measuring TT-TG provides measurement with narrower variation when compared with the 2-D method. However, both TT-TG distances' measurement methods in the current study were comparable as the variations are not significant.

Typical response of CD14++CD16- monocyte to knee synovial derived mediators as a key target to overcome the onset and progression of osteoarthritis.

Objective: Synovitis with increased infiltration of immune cells is observed in osteoarthritis (OA). Given the inflammatory condition of synovitis, we explored the protein profile of OA synovium (OAS) and its effect on circulating monocytes activation, migration, and functional commitments. Methods: Knee-synovium was acquired from end-stage OA (N = 8) and trauma patients (Trauma baseline control: TBC; N = 8) for characterization using H&E histology, IHC (iNOS), LCMS-QTOF, and MALDI-imaging. Response of peripheral blood monocytes to OAS conditioned-media (OACM) was observed using transwell (n = 6). The migrated cells were captured in SEM, quantified using phase-contrast microphotographs, and their activation receptors (CCR2, CXCR2, CX3CR1, and CD11b), pro-inflammatory genes, and phagocytic potential were studied using flow cytometry, gene expression array/qPCR, and latex beads (LB) phagocytosis assay, respectively. Results: The Venn diagram displayed 119 typical proteins in OAS, while 55 proteins in TBCS. The STRING protein network analysis indicated distinctive links between proteins and gene ontology (GO) and revealed proteins associated with leukocyte-mediated immunity in OAS as compared to TBC. The MALDI-imaging showed typical localized proteins at 2234.97, 2522.61, 2627.21, 3329.50, and 3539.69 m/z and IHC confirmed pro-inflammatory iNOS expression in OA synovium. CD14++CD16- classical monocytes significantly migrated in OACM and expressed CCR2, CXCR2, and CD11b receptors, TNFRSF11A, MAPK1, S100A8, HSPB1, ITGAL, NFATC1, IL13RA1, CD93, IL-1ß, TNF-α, and MYD88 genes and increased LB uptake as compared to SFM. Conclusion: Our findings suggest that the differential protein profile of OA synovium and the classical monocytes migrated, activated, and functionally committed in response to these mediators could be of therapeutic advantage.

Biomechanical comparison of new Achilles tendon rupture repair technique the "Giftbox" versus the Krackow technique in New Zealand white rabbits: An experimental animal study.

INTRODUCTION: To compare the strength between the Achilles tendons repaired with the "Giftbox" and the Krackow techniques in New Zealand white rabbits post six weeks of tendon healing. MATERIALS AND METHODS: Eight rabbits were randomized into Giftbox and Krackow groups. Tenotomy was performed on the Achilles tendon of one side of the lower limb and repaired with the respective techniques. The contralateral limb served as control. Subjects were euthanized six weeks post-operative, and both repaired and control Achilles tendons were harvested for biomechanical tensile test. RESULTS: The means of maximum load to rupture and tenacity in the Giftbox group (156.89 ± 38.49 N and 159.98 ± 39.25 gf/tex) were significantly different than Krackow's (103.55 ± 27.48 N and 104.91 ± 26.96 gf/tex, both p = 0.043). CONCLUSION: The tendons repaired with Giftbox technique were biomechanically stronger than those repaired with Krackow technique after six weeks of tendon healing.

A Biomechanical and Ease of Learning Comparison Study of Arthroscopic Sliding Knots.

INTRODUCTION: This study aims to compare the biomechanical properties and ease of learning and tying of our novel knot (UM Knot) with other commonly used arthroscopic sliding knots. MATERIALS AND METHODS: The Duncan, HU, SMC, Pretzel, Nicky's and square knots were selected for comparisons with UM knot. All knots were prepared with size 2 HiFi® suture by a single experienced surgeon and tested with cyclic loading and load to failure tests. The ease of learning was assessed objectively by recording the time to learn the first correct knot and the total number of knots completed in 5 min by surgeons and trainees. RESULTS: The UM knot average failure load is significantly superior to the HU knot (p < 0.05) and comparable to Duncan, SMC, Pretzel and Nicky's knots. According to the ease of learning assessment, UM, Duncan, SMC, Pretzel and Nicky's knots took statistically less time to learn than the HU knot. Although not significant, the failure count due to slippage is fewer in UM knot compared with other knots. CONCLUSIONS: This study showed that UM knot is among the easiest knot to learn and tie, along with Duncan, SMC, Pretzel and Nicky's knots. Their biomechanical properties are comparable and their loads to failure were superior to the HU knot.

Evaluating the risk of popliteal artery injury in the all-inside meniscus repair based on the location of posterior meniscal lesions.

The 'all-inside' meniscus repair is extremely useful technique in addressing tears at the far posterior horn of meniscus. However, this procedure may place the popliteal neurovascular bundle at risk of injury. The purpose of this study was to evaluate the risk of popliteal artery injury by the trajectory of anchor delivery instruments inserted through standard knee arthroscopic portals for the repair of the far posterior horn of meniscus tears. Standard arthroscopic portals were marked on five human cadaveric knees which were subsequently disarticulated. Axial photographs were taken after marking the 5 10, and 15 mm points from the meniscal root on the posterior horns of the menisci. The unsafe zones for meniscus repair at each of these points were identified on the photographs of knees by first drawing two lines from the edges of the popliteal artery and crossing at the respective points at the posterior horns. The points at which these lines meet a circular protractor applied to the center of each meniscus in the knee photograph were recorded as a range. The range signifies the unsafe zone for each respective point on the posterior horn of meniscus. The anterolateral arthroscopic portal fell within the unsafe zone of the 5 mm point on the posterior horn of lateral meniscus in three of the five knees and within the unsafe zone of the 10 mm point on the posterior horn of lateral meniscus in another two knees. A cautious approach should be practiced during the repair of tears located at these two points. None of the other points' unsafe zones (lateral 15 mm, medial 5 mm, 10 mm and 15 mm points) coincided with the ipsilateral portal sites. Level of evidence 5 (Human cadaveric study).

Crossing Suture Technique for the Osteochondral Fractures Repair of Patella.

Osteochondral fracture of the patella is a common concomitant injury of the knee, especially in lateral patellar instability, and the importance of early stable fixation with minimal complication and early mobilization should be emphasized. Screws and Kirschner wires both absorbable and nonabsorbable have been the common mode of fixation of these fractures. Nevertheless, these fixation techniques require larger osteochondral fragments and are associated with cartilage abrasion, hardware prominence, synovitis, and foreign body reaction. In contrast, suture fixation can adequately stabilize smaller osteochondral fragments without comminution and prevent some of the possible complications of other techniques of fixation. We created 4 holes in a rectangular pattern on the patella oriented perpendicular to its anteroposterior surface. We used readily available, and affordable, no. 2 Ultrabraid sutures inserted into the holes and looped around the osteochondral fragment, compressing it to the patella. The technique is very simple and is relatively easy to learn. It provides secure fixation and allows early mobilization. And it spares the knee from subsequent surgical procedure for removal of metallic implants.

Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study.

INTRODUCTION: We conducted a study to elucidate the correlation between the anatomy of the shoulder joint with the development of rotator cuff tear (RCT) and glenohumeral osteoarthritis (GHOA) by using acromioglenoid angle (AGA). MATERIALS AND METHODS: The AGA is a new measured angle formed between the line from midglenoid to lateral end of the acromion with the line parallel to the glenoid surface. The AGA was measured in a group of 85 shoulders with RCT, 49 with GHOA and 103 non-RCT/GHOA control shoulders. The AGA was compared with other radiological parameters, such as, the critical shoulder angle (CSA), the acromion index (AI) and the acromiohumeral interval (AHI). Correlational and regression analysis were performed using SPSS 20. RESULTS: The mean AGA was 50.9° (45.2-56.5°) in the control group, 53.3° (47.6-59.1°) in RCT group and 45.5° (37.7-53.2°) in OA group. Among patients with AGA > 51.5°, 61% were in the RCT group and among patients with AGA < 44.5°, 56% were in OA group. Pearson correlation analysis had shown significant correlation between AGA and CSA ( r = 0.925, p < 0.001). It was also significant of AHI in RCT group with mean 6.6 mm (4.7-8.5 mm) and significant AI in OA group with mean 0.68 (0.57-0.78) with p value < 0.001 respectively. CONCLUSION: The AGA method of measurement is an excellent predictive parameter for diagnosing RCT and GHOA.

Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.

A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures.