Sonographic Characterization of the Pericruciate Fat Pad with the Use of Compression Elastography-A Cross-Sectional Study among Healthy and Post-Injured Patients.

Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them with cases of post-traumatic injuries. Methods: Conducted as a retrospective cross-sectional study (n = 110 knees each) following STROBE guidelines, it employed grayscale ultrasound with echogenicity measurement, compression elastography with elasticity measurement, and Color Doppler for blood flow assessment. Results: PCFP showed a homogenic and hyperechoic echostructure. The echogenicity of the PCFP was higher than that of the posterior cruciate ligament (PCL) (p < 0.001, z-score = 8.97) and of the medial head of gastrocnemius (MHG) (p = 0.007, z-score = 2.72) in healthy knees, but lower than subcutaneous fat (SCF) (p < 0.001, z-score = -6.52). Post-injury/surgery, PCFP echogenicity surpassed other structures (p < 0.001; z-score for PCL 12.2; for MHG 11.65 and for SCF 12.36) and notably exceeded the control group (p < 0.001, z-score = 8.78). PCFP elasticity was lower than MHG and SCF in both groups, with significantly reduced elasticity in post-traumatic knees (ratio SCF/PCFP 15.52 ± 17.87 in case group vs. 2.26 ± 2.4 in control group; p < 0.001; z-score = 9.65). Blood flow was detected in 71% of healthy PCFPs with three main patterns. Conclusions: The main findings, indicating increased echogenicity and reduced elasticity of PCFP post-trauma, potentially related to fat pad fibrosis, suggest potential applications of echogenicity and elasticity measurements in detecting and monitoring diverse knee pathologies. The description of vascularity variations supplying the PCFP adds additional value to the study by emphasizing the clinically important role of PCFP as a bridge for the middle genicular artery on its way to the inside of the knee joint.

Observational Study of Self-Reported Offshore Sailing-Related Injuries in a Wide Range of Amateur and Professional Sailors.

INTRODUCTION: Offshore sailing yields injury risk. Unfortunately, many studies are restricted to a specific geographic location, regatta, or class of sailboat or to only professional sailors. Therefore, the primary aim of this study was to gather a large database of sailing-related injuries with demographic, injury, and voyage characteristics. METHODS: An observational study of self-reported offshore sailing-related injuries was performed using an internet-based, multiple-choice survey distributed on social media. Data were analyzed statistically with the use of the Shapiro-Wilk test, Mann-Whitney U test, and χ2 test. RESULTS: Five hundred sixty-eight people completed the survey, 217 women and 351 men, with a mean age of 36.26 y (SD=13.69 y). Among reported 793 cruises, 141 resulted in injury (18%). The most frequent injury types were contusion (40%) and skin lesions and lacerations (20%); the most frequent locations were hand (28%) and foot and ankle (18%), and the most frequent mechanisms were tripping/falling (33%), being hit by an object (19%), and using ropes (19%). Sex, age, and sailing experience were not injury risk factors, while higher number of offshore days was (P=0.0004). None of the analyzed voyage characteristics (purpose, ship's class, position on the ship, ship's length overall, type of rigging, and harness wearing) were injury risk factors. Sailors perceived the following as risk factors: inattention/distraction (34%), difficult weather conditions (22%), and fatigue/lack of sleep (14%). CONCLUSIONS: Approximately 1 in 5 cruises resulted in an injury, occurring regardless of demographic, injury, and voyage characteristics. The multifactorial nature of injuries poses a challenge in implementing safety measures. The authors hope that this study may aid in that cause.

Bone marrow lesions in the knee are associated with meniscal lesions and cartilage pathologies according to the six-letter system.

PURPOSE: This study aims to find a correlation between bone marrow lesions (BMLs) in knee MRI and pathologies of joint structures. In addition, according to the six-letter system classification, the authors analyzed a potential association between the area affected by BMLs and the specific type of joint lesion. METHODS: The authors screened all the knee MRIs performed in the investigation center between 2017 and 2018 to identify the presence of BMLs. The lesions were then categorized following the "six-letter system". The authors searched the presence of associated meniscal, chondral or ligamentous lesions. Finally, the authors researched a correlation between the lesion type described by the six-letter system classification and the associated lesions. RESULTS: MRI exams of 4000 patients were studied, identifying 666 BMLs. The associated lesions were collected for all patients, resulting in an overall prevalence of related lesions in almost 90% of patients. The authors found a statistical significance for type TLD (Tibia-Lateral-Articular) and ACL rupture. The study suggests a strong positive correlation between type E (Edge) and meniscal fracture or extrusion. CONCLUSION: BMLs in the knee are associated in 90% of cases with a radiological sign of related injury to the joint structures. The six-letter system of BMLs type TLD can be considered a sign of ACL rupture and type E as a high suspicious sign for meniscal extrusion. Those very typical BML patterns can help the clinician in the diagnosis of ACL tears and meniscal extrusion. Furthermore, the presence of a BML must be, for the clinician, a high suspicious sign of joint-related injuries. LEVEL OF EVIDENCE: Level 1.

Assessment of the deformation model of the proximal tibia in the course of degenerative disease: analysis of the 3-dimensional mathematical model.

Background: The high tibial osteotomy (HTO) is an effective knee-saving procedure, which relieves arthritis symptoms and prolongs the life of the knee joint. This procedure requires detailed preoperative planning. Usually, the contralateral side is used as a template for this purpose. Some intra-operative complications made us thinking how exactly the degenerative disease alter the epiphysis if the tibia. Our study aimed to assess morphological differences between healthy knees and degenerative knees using a three-dimensional mathematical model. Methods: Twenty-three computed tomography (CT) examinations were collected out of 237 individuals screened for inclusion/exclusion. The inclusion criteria were: age between 40 and 69 years, degenerative knees with visible varus deformation, and signs of radiological osteoarthritis (OA) in the knee joint (such as joint space narrowing, subchondral sclerosis, subchondral cyst formation, and osteophytes. The average age of the included patients was 56.2 years. Nine men's and 14 women's knee joints were used for the calculation and comparisons. Results: Female varus knees showed much more significant variability in tibial plateau dimensions according to sides of the body than male ones. These differences were statistically significant (P=0.03). In comparison between the basal bone and bones with OA, variability in 3D dimensions was statistically significant only for lateral condyles in males' right knees (P=0.025). Compared to the degenerative knees to the most average, healthy knees, there were significant differences in the measured surface area of males' right knees for both condyles: for the medial P=0.0046, for lateral P=0.005. Male varus knees had a statistically more considerable (P=0.028) surface area for all measured condyles. Angles of inclination differ significantly between knees with OA and healthy knees in the male population for the medial condyle plateau in the left knees. The female population for the lateral condyle in left knees and the medial condyle in right knees. Conclusions: The proximal tibial plateau deformation showed high variability in the two-dimensional and three-dimensional analysis in the designed mathematical models. This finding must be considered during preoperative planning.

Validation of a new topographic classification of bone marrow lesions in the knee: the six-letter system.

PURPOSE: The aim of this study was to propose and validate a new six-item topographical classification of knee bone marrow lesions in coronal MRI images, to provide an easy-to-use aid to describe their location in a more reproducible and accurate way. METHODS: This study was conducted in four phases. The first was to do a literature search for methods of describing bone marrow lesions in MRI of the knee. The second was creation of a six-area topographic classification of bone marrow lesions in coronal MRI of the knee. The third phase was selection of cases with bone marrow lesions on knee MRI performed in a single hospital between January of 2017 and December of 2018. The fourth phase was categorization of the bone marrow lesions' location according to the new proposed classification by three independent examiners, two orthopedic surgeons and one radiologist. Patient's demographic data and associated lesions were collected. The inter-observer and intra-observer reliability of the proposed classification was then calculated. RESULTS: MRI examination of 4000 patients were studied and in 520 patients a total of 666 bone marrow lesions were identified and their location classified using the new system. The inter-observer and intra-observer reliability analysis found a Fleiss' Kappa value of 0.96 (0.95-0.97) and 0.97 (0.96-0.97), respectively, confirming the high reproducibility of the proposed classification. CONCLUSIONS: The proposed six-location classification of bone marrow lesions is highly reproducible and can help researchers develop studies and share information in a more accurate and reliable way. The correct classification of bone marrow lesions can lead to a more accurate description of this pathology and help clinicians to propose appropriate therapies for this group of patients. LEVEL OF EVIDENCE: V.

Talus Fracture Accompanied by Irreducible Dislocation of Talar Trochlea - Treatment Strategy.

A talus fracture accompanied by trochlear dislocation is an ever-present therapeutic problem as it requires immediate surgery since any delay may result in necrosis of soft tissues and the talus, which, consequently, leads to permanent disability. Of crucial importance in the treatment of such injury is accurate analysis of fracture morphology, immediate institution of treatment and minimally invasive surgery allowing early movement of the affected limb. We operated on a male patient after a high-energy injury using a low-invasive method we had modified, which allowed for early kinesiotherapy. The functional outcome of the procedure was very good.

The impact of having siblings - analysis of "hygiene theory" of chronic diseases in patients with type 1 diabetes in population of the Lódz region Hygiene theory and type 1 diabetes.

INTRODUCTION: In the recent years there has been a significant increase in the incidence of the type 1 diabetes mellitus. Therefore, numerous studies are underway to evaluate the possible factors underlying this trend. Some studies suggest that better sanitary conditions and lack of contact with microorganisms might be important, thus increasing the risk of disease in firstborns. Moreover, siblings could play an important role in the transmission of pathogens, which, by stimulating the immune system, may prevent the development of atopic and autoimmune diseases including such as type 1 diabetes. Current data, however, are still inconclusive. PURPOSE: The aim of the study was to evaluate the effect of having siblings on the incidence of type 1 diabetes among children and adults. MATERIALS AND METHODS: A group of 469 patients with type 1 diabetes was selected. The study population was composed of 245 adults and 224 youth patients. Information from Outpatient Diabetologic Departments database was gathered. Data such as age at the diagnosis of diabetes, sex of siblings, number and birth order were analyzed. RESULTS: In the studied population, 4.5% were only children, and 30.3% patients came from large families. In the group of type 1 diabetic patients 39.7% were firstborns and this proportion was comparable to the group of healthy subject. The highest proportion of firstborns was noted in the group that was diagnosed after 18 years of age (45,1%) compared to the group that was diagnosed between 10 and 14 (29,1%) (p<0.05). Type 1 diabetic patients that were not firstborns much more often had older siblings of the opposite sex than the same sex. CONCLUSIONS: he firstborns in the population of type 1 diabetes from the Lódz region did not outnumber the healthy subjects. Significantly higher proportion of firstborns in the group that was diagnosed after 18 years of age compared to the group that was diagnosed between 10 an 14 years was noted.