RESUMO
INTRODUCTION: Anterior knee pain is a major problem following Bone-patellar-tendon-bone graft (BPTB) use in anterior cruciate ligament (ACL) reconstruction. We hypothesized that filling the donor defect sites with bone-graft substitute would reduce the anterior knee symptoms in ACL reconstruction surgeries. MATERIAL AND METHODS: Patients operated for ACL-deficient knee between March 2012 and August 2013 using BPTB graft were divided into two treatment groups. The patellar and tibial donor-site bony defects were filled-up with Hydroxyapatite-Bioglass (HAP:BG) blocks in the study group (n = 15) and no filler was used in the control group (n = 16). At 2 years, the clinical improvement was assessed using International Knee Documentation Committee (IKDC) score and donor-site morbidity was assessed by questionnaires and specific tests related to anterior knee pain symptoms. RESULTS: Donor-site tenderness was present in 40% patients in the study group and 37.5% patients in the control group (p = 0.59). Pain upon kneeling was present in 33.3% patients in the study group and 37.5% patients in the control group (p = 0.55). Walking in kneeling position elicited pain in 40% patients in the study group and 43.8% in the control group (p = 0.56). The mean visual analogue score for knee pain was 3.0 in the study group and 3.13 in the control group, with no statistically significant difference (p = 0.68). Unlike control group, where a persistent bony depression defect was observed at donor sites, no such defects were observed in the study group. CONCLUSION: Filling the defects of donor sites with HAP:BG blocks do not reduce the anterior knee symptoms in patients with ACL reconstruction using autogenous BPTB graft.
RESUMO
STUDY DESIGN: Description of a novel application. OBJECTIVE: Proposal of a new system for content-based image retrieval (CBIR) of scoliosis images for the retrieval of clinically similar images to a query image on the basis of automatically derived features. BACKGROUND: Variability exists in the selection of strategic vertebrae, measurement of Cobb angle, and assignment of a curve type in a classification scheme for scoliosis images. Besides, many classification schemes are in use today, creating ambiguity in selecting a particular classification scheme. METHODS: A rule-based algorithm for strategic vertebrae selection and Cobb angle measurement was developed. A set of automatically derived features necessary for indexing the scoliosis image for CBIR was formulated. A hybrid CBIR system is proposed in which scoliosis features and treatment procedure along with preoperative and postoperative images are integrated. The system was evaluated using 30 curves on standing anteroposterior scoliosis images. The measurement was carried out by 3 independent observers who measured twice at an interval of 7 days. RESULTS: The average difference in Cobb angle was 2.0 degrees with a standard deviation of 3.0 degrees. High values for the correlation coefficient were obtained for both interobserver and intraobserver assessment, proving the repeatability of the system. The CBIR system was validated by query-by-example test method and the system could retrieve correct sets of clinically matching images in the increasing order of distance. CONCLUSIONS: The newly developed system is an accurate and reliable system for search and retrieval of scoliosis images. On querying with a new image, the therapeutic strategy for surgical planning can be assigned on the basis of the outcome assessment of the most similar images retrieved, thereby reducing the importance of any classification scheme.
