Lateral meniscal injury without medial meniscal injury indicates the existence of the Segond fracture in ACL-deficient knees.

Background/Objective: The purpose of this study was to find factors indicating the occurrence of the Segond fracture, a specific type of anterolateral ligament injury. Methods: From January 2015 to December 2017, we retrospectively reviewed the medical records of patients diagnosed with acute anterior cruciate ligament (ACL) injury who underwent reconstruction within 90 days of injury. Diagnosis of the Segond fracture was determined either by magnetic resonance imaging or plain radiographs. Factors examined were: age at surgery, sex, body mass index (kg/m2), status of menisci, and activities led to ACL injury. After univariate screening, multivariate logistic regression analyses were performed. Patients were divided into four groups based on the presence of lateral meniscal (LM) and/or medial meniscal (MM) injuries and compared with respect to the occurrence of Segond fractures. Results: A total of 375 patients were included (163 males, 212 females), with mean age 25.8 years old. Among them, 22 of 375 (5.9 %) had a Segond fracture. We identified injured lateral menisci (adjusted odds ratio (aOR), 3.029; 95 % Confidence Interval (CI), 1.206-7.609; P = 0.018), intact medial menisci (aOR, 0.229; 95 % CI, 0.065-0.810; P = 0.022), and higher body mass index (aOR, 1.102; 95 % CI, 1.008-1.205; P = 0.034) as factors indicative of the occurrence of Segond fracture. LM injury without MM injury suggested the existence of a Segond fracture. Conclusion: LM injury without a MM injury indicated the occurrence of a Segond fracture. Higher body mass index also increased the risk for Segond fracture occurrence.

Comparison of joint awareness after medial unicompartmental knee arthroplasty and high tibial osteotomy: a retrospective multicenter study.

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are established treatments for medial compartment osteoarthritis (OA) or osteonecrosis (ON) of the knee joint, and the predominance of either procedure is inconclusive. We compared the awareness of the knee after UKA and HTO using the Forgotten joint score-12 (FJS). MATERIALS AND METHODS: This was a retrospective, multicenter study. Ninety-six knees of 90 patients who received UKA or HTO and were followed-up for at least 1 year were analyzed. Postoperative FJS was compared between the two groups and evaluated for the effect of patient-related factors and clinical outcomes. Multiple linear regression analysis was performed to predict FJS. RESULTS: There was no significant difference in the FJS between the UKA and HTO groups (p = 0.24). FJS did not correlate with any of the patient-related factors. There was a correlation between the FJS and each item of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Lysholm Knee Scoring Scale (LKS). In multiple linear regression analysis, lower BMI, the diagnosis of OA Kellgren-Lawrence (KL) grade ≥ 3, and ON were significant predictors of better FJS. In both groups, FJS was correlated with each item of the KOOS and LKS. Internal consistency in terms of Cronbach's alpha was excellent. CONCLUSIONS: There was no significant difference in FJS between patients who underwent UKA and HTO. Lower BMI, the diagnosis of OA KL grade ≥ 3, and ON were significant predictors of better FJS.

Joint effusion at 6 months is a significant predictor of joint effusion 1 year after anterior cruciate ligament reconstruction.

PURPOSE: This study aimed to assess the risk factors for prolonged joint effusion in patients undergoing double-bundle anterior cruciate ligament reconstruction (ACLR). METHODS: In total, 160 patients who underwent primary ACLR using autograft hamstring between 2015 and 2018 were retrospectively reviewed. Joint effusion was defined as any grade ≥ 2 (range, 0-3) according to the MRI Osteoarthritis Knee Score (MOAKS). Univariate and multivariate logistic regression analyses were performed. RESULTS: The median age of the patients was 25 years (range 14-68 years) at the time of the surgery; there were 89 women and 71 men. At 1 year, 46 (28.8%) patients experienced knee joint effusion, as defined by the MOAKS. Univariate analysis revealed that age, preoperative Kellgren-Lawrence (K-L) grade, and joint effusion at 6 months were significantly associated with joint effusion at 1 year. In the multivariate analysis, joint effusion at 6 months was significantly associated with joint effusion at 1 year (odds ratio, 68.0; 95% confidence interval, 22.1-209.4). No significant difference in the Lysholm scores was observed between patients with and without joint effusion at 1 year (n.s.). CONCLUSIONS: Joint effusion at 6 months was significantly associated with joint effusion 1 year after ACLR. LEVEL OF EVIDENCE: III.

Possible role of MRI-detected osteophytes as a predictive biomarker for development of osteoarthritis of the knee: A study using data from the Osteoarthritis Initiative.

Objective: To elucidate the possible role of MRI-detected osteophytes as a predictive imaging biomarker for knee osteoarthritis (KOA). Design: Subjects (n â€‹= â€‹303) were selected according to the following inclusion criteria from the Osteoarthritis Initiative (OAI) data set: (1) â€‹< â€‹55 years old; (2) Western Ontario and McMaster Universities Arthritis Index pain score of 0; (3) Kellgren-Lawrence (KL) system grade 0 or 1; and (4) Complete MRI data set of the right knee. A pre-OA group (POA) consisted of subjects who developed KL grade 2 or more within 96 months, and a non-OA group (NOA) that remained KL 0 or 1 during that period. Baseline MRIs were assessed for osteophyte formation. Twenty-five locations were examined according to the MOAKS osteophyte score. Osteophytes at each location were assessed in terms of their predictive value for OA development. Results: Thirty-two subjects were POA and 271 were NOA. Age, BMI, and sex did not differ between the two groups. In the POA group, the number of subjects with osteophytes tended to be higher at all 25 sites. Forward stepwise regression analysis revealed five locations - medial patella, lateral intra-condylar notch of the femur, lateral femoral condyle, tibial spine, and lateral posterior condyle - were important for the prediction of KOA development. Having more than two osteophytes at these five locations predicted KOA development with a sensitivity of 0.75 and specificity of 0.79. Conclusions: MRI-detected osteophytes could serve as a predictive biomarker of KOA development within 96 months after detection.

A new anterior total hip arthroplasty reduction technique for patients who require leg lengthening.

BACKGROUND: When performing anterior total hip arthroplasty (THA) for patients who require leg lengthening, surgeons often encounter difficulties during reduction due to soft tissue tightness. The purpose of this study was to introduce a new THA reduction technique for these patients. METHODS: Between October 2018 and September 2019, 545 THAs were performed. In 15 hips (2.8%), reduction was not achieved with a traditional technique. The preoperative diagnosis was Crowe grade II in 4 hips, Crowe grade III in 4 hips, Crowe grade IV in 1 hip, and sequelae of Legg-Calvé-Perthes disease in 6 hips. All procedures were performed using a direct anterior approach. The new reduction technique was to use a lever hooked on the acetabular teardrop as a counter force against the preserved muscles. The lever was connected to the impactor with a wire and the counterforce was transmitted to the impactor. RESULTS: Reduction was achieved in all cases without shortening osteotomy or muscle release. The mean lengthening of the operated limb was 30 mm (range 13-59 mm). Neither sciatic nor femoral nerve palsy were observed. CONCLUSION: We developed a new anterior THA reduction technique for patients who require leg lengthening. When the centre of the femoral head was reduced to the superior edge of the cup with the traditional technique, reduction was safely achieved with this technique.

Acetabular revision using a Kerboull-type reinforcement device through direct anterior approach.

BACKGROUND: The direct anterior approach has gained popularity in total hip arthroplasty (THA) over the past decade. However, there are few reports that describe the use of this approach for cases of complex revision. The purpose of this study was to report the surgical procedure and early clinical results of acetabular revision in the presence of bone defects using a Kerboull-type reinforcement device through the direct anterior approach. METHODS: Eleven patients who had undergone acetabular reconstruction using a Kerboull-type reinforcement device for aseptic or septic loosening bone defects were enrolled. All procedures were performed using the direct anterior approach on a standard operating table. The mean age was 71.8 years, the mean period from initial surgery to revision THA was 14.5 years, and the mean follow-up period was 19.8 months. RESULTS: The Kerboull-type acetabular reinforcement device with cemented cup combined with allogenic femoral head bone grafts was used in all hips. The mean operative time and intraoperative blood loss were 148 min and 743 g, respectively. None of the patients required allogeneic blood transfusion. One patient required revision surgery 11 months postoperatively because of device displacement. No other major or minor orthopedic complications were observed. CONCLUSION: The direct anterior approach allows for less invasive acetabular reconstruction using a Kerboull-type reinforcement device.