The reliability of the patellotrochlear index on magnetic resonance imaging for measuring patellofemoral height.

BACKGROUND: The purpose of this study was to determine the inter- and intra-observer reliability of the patellotrochlear index (PTI) on magnetic resonance images (MRI) in patients with patellofemoral pain. The correlation between the PTI measured on MRI and the modified Insall-Salvati (MIS) ratio measured on radiographs was also assessed. METHODS: The PTI was assessed on MRI images and the MIS ratio on radiographs of 66 knees of 62 patients. Assessment was performed by two orthopaedic surgeons, one orthopaedic surgery registrar, two radiologists and one radiology registrar. Correlation coefficients, standard errors of measurement and limits of agreement were calculated for the PTI. To assess the association between the PTI and the MIS ratio, the Pearson's correlation coefficient was calculated. RESULTS: The PTI showed good interobserver reliability (intraclass correlation coefficient (ICC) 0.79; 95% confidence interval (CI) 0.73-0.85) and excellent intra-observer reliability (ICC 0.90; 95% CI 0.89-0.91). The standard error of measurement was 0.05 and limits of agreement with the mean ± 0.09. A very weak and not significant correlation was found between the PTI and the MIS (r = 0.02; P = 0.77). CONCLUSIONS: The PTI showed good interobserver reliability and excellent intra-observer reliability. In order to conclude which measurement method of assessing patellar height is truly the most reliable, future studies should investigate agreement parameters (standard error of measurement, limits of agreement) besides solely correlation coefficients. We found a very weak correlation between the PTI and the MIS which suggests that at least one index has poor validity. Future validity studies on indices to assess patellar height are necessary.

Parvimonas micra Spondylodiscitis: A Case Report and Systematic Review of the Literature.

INTRODUCTION: Treatment and risk factors for Parvimonas micra spinal infections are scarcely researched. This study reports a case and presents a systematic review of the literature to provide evidence-based ground for diagnosis and treatment of P. micra spinal infections. CASE REPORT: This is a case of a 78-year-old male with severe back and leg pain. Advanced imaging demonstrated the destruction of L2-L3 with an extensive fluid collection in the remaining intervertebral space, paravertebral myositis, and multiple abscesses. A decompression of L2 and L3 and a posterior spondylodesis from T12 to L5 was performed. Intraoperative cultures showed P. micra. The postoperative treatment consisted of intravenous penicillin for 2 weeks and subsequent oral clindamycin for 4 weeks. At 1-year follow-up, the patient was in good health and reported only occasional back pain. CONCLUSIONS: A total of 15 additional cases of P. micraspinal infections were identified. The antibiotic treatment showed a great variety in the treated patients. Nevertheless, the outcome of these patients was good concerning relapse of the infection and pain. Spinal infections caused by P. micra are rare, but can be successfully treated according to the guidelines for spinal infection.

No differences between fixed- and mobile-bearing total knee arthroplasty.

PURPOSE: For years, numerous studies have been performed to determine whether mobile-bearing total knee arthroplasty (MB-TKA) or fixed-bearing total knee arthroplasty (FB-TKA) is the preferential design in total knee arthroplasty. Reviews and meta-analyses on this subject have focused on a relatively small number of randomised controlled trials, possibly missing important results of smaller studies. The goal of this review was to provide a comprehensive overview of all literature comparing MB-TKA and FB-TKA in the treatment of osteoarthritis of the knee. METHODS: An extensive literature search was performed in the PubMed database. All studies that compared MB-TKA with FB-TKA and looked at one of four theorised advantages (insert wear, signs of loosening, survival rate of the prosthesis and clinical outcome) were included. RESULTS: The initial search yielded 258 articles, of which 127 were included after the first screening. The included studies consisted of 9 meta-analyses, 3 systematic reviews, 48 RCT's, 44 comparative studies, 10 reviews and 13 studies that examined patients who received bilateral TKA (one MB-TKA and one FB-TKA). Combining the results of all studies showed that almost all studies found no difference between MB-TKA and FB-TKA. CONCLUSIONS: Even when examining all different types of studies on MB-TKA and FB-TKA, the results of this review showed no difference in insert wear, risk of loosening, survivorship or clinical outcome. In daily practice, the choice between MB-TKA and FB-TKA should be based on the experience and judgment of the surgeon, since no clear differences are observed in the scientific literature. LEVEL OF EVIDENCE: III.

Gel-type autologous chondrocyte implantation for cartilage repair in patients with prior ACL reconstruction: A retrospective two year follow-up.

PURPOSE: To describe the early patient-reported outcomes of articular cartilage repair in patients with pain due to grade III or IV articular cartilage defects after prior anterior cruciate ligament (ACL) reconstruction. METHODS: Nineteen patients underwent a gel-type autologous chondrocyte implantation (GACI) procedure after ACL reconstruction. Median timeframe between ACL reconstruction and GACI procedure was 52 months (range 16 to 369). The average age at chondrocyte implantation was 35 (standard deviation (SD) eight) years and average cumulative articular cartilage defect size was nine (SD four) square centimeter. Outcome was assessed prior to the GACI procedure and two years after GACI using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Two year post-GACI scores showed a statistically significant improvement of IKDC (13, SD 22, p=.02) and KOOS quality of life (18, SD 27, p=.01) compared to the pre-GACI scores. The other KOOS domains did improve, but not statistically significant. Seven (37%) patients underwent reoperation after the GACI. CONCLUSION: Patients with prior ACL reconstruction and suffering from ongoing pain associated with cartilage defects can benefit from cartilage repair with GACI.

The relationship between overweight and obesity, and sick leave: a systematic review.

OBJECTIVE: To investigate the relationship between overweight and obesity and sick leave. DESIGN: Systematic, qualitative review. LITERATURE SEARCH: A search in diverse databases was performed. Studies were considered as relevant if they were longitudinal in design and investigated the relationship between overweight and obesity and sick leave. DATA EXTRACTION: The methodological quality of the studies was evaluated with a quality criteria list. To draw conclusions, a best-evidence synthesis was applied. RESULTS: Thirteen studies were included. Four out of seven found overweight to be a predictor of long-term sick leave, whereas the remaining three showed a positive trend, but did not observe significance. Of the five studies investigating the relationship between overweight and short-term sick leave, inconsistent results were shown. Seven out of eight studies investigating the relationship with long-term sick leave found obesity as a significant predictor of long-term sick leave. In contrast, there were inconsistent results between the five studies examining the relationship between obesity and short spells of sick leave. CONCLUSIONS: Although this review found inconclusive evidence for a relationship between overweight and sick leave, a clear trend was discerned in that overweight was a predictor of especially long spells (>7 days) of sick leave. As regards obesity, there was strong evidence for a positive relationship with sick leave because of the consistent finding that obesity was a significant predictor of long-term sick leave.