The Prevalence, Zone, and Type of the Meniscus Tear in Patients with Anterior Cruciate Ligament (ACL) Injury; Does Delayed ACL Reconstruction Affects the Meniscal Injury?

BACKGROUND: Meniscus tear is a common finding in patients with anterior cruciate ligament (ACL) injury and may affect the natural history of the injury and the outcomes of treatment. In the current study, the characteristics of meniscus tears in patients who underwent arthroscopic ACL reconstruction were investigated. METHODS: The hospital records of 1022 patients were reviewed. The measured variables included the presence of meniscus tear, ramp and root injury, the zone of injury based on the Cooper classification, and the type of tear. The ACL tears with delay more than 3 months for ACLR were recorded as chronic injuries. RESULTS: The incidence of meniscus tear was 44.4%; among whom, bucket-handle injury was the most common type (30.4%) and the ramp lesion was found in 20.5%. The meniscus was repaired in 56.6%. The incidence of medial meniscus injury was significantly higher in chronic ACL tears and vice versa (P<0.001). The incidence of ramp lesion (9.1% Vs 20.5%) and root tear (1.3% Vs 2.9%) were significantly higher in the chronic and acute tears, respectively (P<0.001). CONCLUSION: Delay more than 3 months in ACLR was associated with the increased incidence of meniscal injury, specially the medial meniscus, and ramp lesion. It seems that early ACLR may be more helpful for the patients.

Which Route of Tranexamic Acid Administration is More Effective to Reduce Blood Loss Following Total Knee Arthroplasty?

BACKGROUND: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty. METHODS: One hundred twenty 120 patients were scheduled to undergo primary total knee arthroplasty. Patients were randomly allocated to three equal groups: IV tranexamic acid (500 mg), topical tranexamic acid (3 g in 100 mL normal saline) and the control. In the topical group, half of the volume was used to irrigate the joint and the other half was injected intra-articularly. The volume of blood loss, hemoglobin (Hb) level at 24 hours postoperative, and rate of transfusion was compared between groups. RESULTS: The blood loss and Hb level were significantly greater and lower in the control group, respectively (P=0.031). Also, the rate of transfusion was significantly greater in the control group (P=0.013). However, IV and topical groups did not differ significantly in terms of measured variables. No patient experienced a thromboembolic event in our study. CONCLUSION: Tranexamic acid is a useful antifibrinolytic drug to reduce postoperative blood loss, Hb drop, and rate of blood transfusion in patients undergoing total knee arthroplasty. The route of tranexamic acid administration did not affect the efficacy and safety.

Treatment of Humeral Shaft Fractures: Minimally Invasive Plate Osteosynthesis Versus Open Reduction and Internal Fixation.

BACKGROUND: The optimal technique for operative fixation of humeral shaft fractures remains controversial and warrants research. OBJECTIVES: The purpose of the current study was to compare the functional and clinical outcomes of conventional open reduction and internal fixation (ORIF) with minimally invasive plate osteosynthesis (MIPO) in patients with fractures in two-third distal humeral shaft. PATIENTS AND METHODS: In the current prospective case-control study, 65 patients with humeral shaft fractures were treated using ORIF (33 patients) or MIPO (32 patients). Time of surgery, time of union, incidence of varus deformity and complications were compared between the two groups. Also, the university of California-Los Angeles (UCLA) shoulder rating scale and Mayo Elbow performance score (MEPS) were used to compare the functional outcomes between the two groups. RESULTS: The median of union time was shorter in the MIPO group (4 months versus 5 months). The time of surgery and functional outcomes based on the UCLA and MEPS scores were the same. The incidence of varus deformity was more than 5° and was higher and the incidence of nonunion, infection and iatrogenic radial nerve injury were lower in the MIPO group; however, the differences were not significant. CONCLUSIONS: Due to the shorter union time, to some extent less complication rate and comparable functional and clinical results, the authors recommend to use the MIPO technique in treating the mid-distal humeral shaft fracture.

Diagnostic Efficacy of UBI Scan in Musculoskeletal Infections.

BACKGROUND: Limited recent studies have demonstrated that 99mTc-UBI scan can be a helpful method in precise diagnosis of infection. In the current study, we aimed to investigate the diagnostic efficacy of 99mTc-UBI scan in detection of musculoskeletal infections. METHODS: Fifty patients with suspected musculoskeletal infections (painful THA, TKA, implant and nonunion) were enrolled in this study. After injection of 99mTc-Ubiquicidin 29-41, up to 30 minutes, dynamic imaging was performed every 1 minute. Whole body anterior and posterior images were acquired at 60 and 120 min (5 min/frame). A polygonal region of interest (ROI) was drawn manually around the area of increased accumulation of tracer (lesion) and anatomically similar area on the contralateral side (background) and the lesion to background ratio (LBR) was calculated. Then, patients underwent surgical procedures to assess infection by tissue sampling and histopathologic studies as gold standard. The receiver operating characteristics (ROC) analysis was performed to find a cut-off value for LBR and determining the diagnostic efficacy of UBI scan in musculoskeletal infections. RESULTS: Histopathologic studies revealed infection in 38 patients. The mean LBR was significantly higher in infected patients (2.05 ± 0.41 vs. 1.52 ± 0.22; P < 0.001). ROC analysis showed that a cut-off point of 1.74 for LBR will have 94.7% sensitivity, 83.3% specificity and 92% accuracy for diagnosis of musculoskeletal infections. CONCLUSION: UBI scan is a useful diagnostic tool for evaluation of patients with suspected musculoskeletal infection. However, UBI imaging has some limitations which result in some incorrect diagnoses. It is important to interpret the results of the scan with regard to the clinical findings.

Arthroscopic Meniscal Repair: "Modified Outside-In Technique".

BACKGROUND: Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named "modified outside-in technique" aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with meniscal injuries by our new technique were evaluated. METHODS: The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients' satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months. RESULTS: Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients' satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. CONCLUSIONS: The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.

Temporary paraplegia resulting from Gorham's disease involving the third lumbar vertebra and proximal femur: a five-year follow-up and review of the literature.

Gorham's disease is a rare musculoskeletal disease of unknown etiology characterized by progressive osteolysis and massive bone destruction. Here, we report an extremely rare case of Gorham's disease involving two far sites in the lumbar spine and trochanteric region, gradually resulting in paraplegia. The patient underwent cord decompression and chemotherapy, and resumed her normal life; she was followed up for nearly five years.

Modified retro-tubercle opening-wedge versus conventional high tibial osteotomy.

Despite the fact that common surgical techniques for the treatment of genu varum usually correct the malalignment in the affected knee, these methods have significant complications and cause problems in the long term. Retro-tubercle opening-wedge high tibial osteotomy is among the newer techniques for the treatment of genu varum. The goal of this study was to compare the results of retro-tubercle opening-wedge high tibial osteotomy with those of medial opening-wedge osteotomy. In a randomized, controlled trial, 72 patients with varus knees who were scheduled for surgery were assigned into either the retro-tubercle opening-wedge high tibial osteotomy (n=34) or medial opening-wedge osteotomy groups (n=38). Groups were matched for age and sex. The position of the patella was compared with respect to the tuberosity and the upper tibial slope pre- and postoperatively. Patients were followed for an average of 13 months (range, 10-21 months). In the retro-tubercle opening-wedge high tibial osteotomy group, the length of the patellar tendon did not significantly differ pre- and postoperatively (P≥.5); however, in the medial opening-wedge osteotomy group, a statistically significant shortening was noted in patellar tendon postoperatively (P≤.05). Similarly, the tibial plateau inclination showed a statistically significant difference postoperatively in the medial opening-wedge osteotomy group, while the difference in the retro-tubercle opening-wedge high tibial osteotomy group did not reach statistical significance.