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We aimed to establish a selective and sequential medial release technique using multiple needle puncturing (MNP) with a spacer block in situ in severe varus deformity during total knee arthroplasty (TKA) and to investigate its efficacy and safety. A total of 128 patients with a varus angle >15° were included. Patients were classified according to the tightness of extension and flexion (group 1, no tightness; group 2, extension; group 3, flexion; group 4, extension and flexion). When medial tightness was found on extension, the posterior clearing procedure, including release of the posterior capsule, posterior oblique ligament, and semimembranosus, was performed sequentially. When medial tightness was found on flexion, MNP using an 18-gauge needle with a spacer block in situ was performed at the anterior portion of the superficial MCL (aMCL). Clinical and radiological evaluations including stress radiographs were performed. Among 128 knees, 110 required medial release (posterior clearing procedure only in 44 [34.3%], MNP with a spacer block in situ at aMCL only in 38 [29.7%], posterior clearing procedure and MNP in 28 [21.9%]). The mediolateral gap imbalances on extension and/or flexion were significantly improved (p

Mesenchymal stem cells (MSCs) have gained popularity for articular cartilage repair. However, efficacy of intra-articular MSCs in osteoarthritis remains unclear. In the setting of a meta-analysis of randomized controlled trials (RCTs), we aimed to investigate the efficacy of intra-articular MSCs on clinical outcomes and cartilage repair in patients with knee osteoarthritis. PubMed, EMBASE, Cochrane Library, CINAHL, and Scopus were searched from inception to March 31, 2017. This study included RCTs using cell population containing MSCs for treatment of knee osteoarthritis. The quality was assessed by Cochrane Collaboration`s risk of bias tool. For meta-analysis, data on clinical outcomes measured by visual analog scale (VAS), Lysholm score, WOMAC and data on cartilage repair measured by MOCART and WORMS were extracted. In studies with several cell concentrations, outcomes of recommended concentration were used mainly to ensure robustness. A total of five RCTs (220 patients) were included. Two studies were deemed to have low risk of bias. In pooled analysis, there was significant difference in VAS score (mean difference [MD], − 9.2; 95% CI: − 17.21, − 1.20) and Lysholm score (MD, 8.70; 95% CI 0.06, 17.34), but not WOMAC (MD, − 7.44; 95% CI − 20.38, 5.50). In cumulative functional analysis using Lysholm score and WOMAC in recommended concentration, there was a significant improvement (standard mean difference [SMD], 0.53; 95% CI 0.13, 0.94) after treatment. In cartilage repair assessed by MRI, there was no significant difference (SMD, 0.53; 95% CI− 0.28, 1.34). This meta-analysis demonstrated that intra-articular MSCs have a limited evidence in pain relief and functional improvement in knee osteoarthritis. While MSCs may result in favorable clinical outcomes with a recommended concentration, use of concomitant treatment should be considered. In addition, current evidence does not support the use of intra-articular MSCs for improving cartilage repair in knee osteoarthritis. Systematic review of Level-II studies.

Factors for graft failure after trans-tibial (TT) ACL reconstruction, including anterolateral ligament (ALL) injury and degree of synovialization, remain unclear. This study is to evaluate the risk factors for graft failures after TT ACL reconstruction including ALL injury and synovialization. A total 391 patients who underwent primary TT ACL reconstruction were included. Failure was defined as greater than grade 2 laxity on the Lachman or pivot shift tests or 5 mm of anterior translation on stress radiograph. After applying inclusion/exclusion criteria, 31 patients with failure were categorized as group 1 and 89 patients without failure were categorized as group 2. Chi-square test and Cox proportional hazard analyses were performed. Preoperatively, 64 patients had ALL injuries (53.3%), 58 had medial meniscal (MM) tears (48.3%), and 62 had lateral meniscal (LM) tears (51.6%). Ninety-three patients (77.5%) had acute injuries and 27 had chronic injuries as per 6-weeks duration. Significant risk factors for failure were LM tear (hazard ratio [HR], 4.018; 95% confidence interval [CI] 1.677–9.629; p = 0.002), chronicity (HR, 6.812; 95% CI 2.758–16.824; p = 0.000), presence of ALL injury (HR, 3.655; 95% CI 1.442–9.265; p = 0.006), and poor synovialization (HR, 3.134; 95% CI 1.298–7.566; p = 0.011) in Cox proportional hazard analysis. If combined MM and LM tears were found, an increased risk of failure was also identified (combined tears: HR, 3.951; 95% CI 1.754–8.901; p = 0.001/preoperative high-grade laxity: HR, 4.546; 95% CI 1.875–11.02; p = 0.001). Chronic ACL injuries, meniscus tear, preoperative ALL injuries, preoperative high-grade laxity and poor synovialization are significant risk factors. Therefore, these factors should be carefully assessed and properly treated in TT ACL reconstruction. IV, retrospective cohort study.

To evaluate the incidence and risk factors of postoperative hyperextension after mobile-bearing total knee arthroplasty (TKA) and its clinical outcomes. This retrospective case–control study included 387 knees of primary TKA patients after a 5-year follow-up. The clinical outcomes and radiographs including posterior condylar offset (PCO), femur and tibial slope angle and its discrepancy were evaluated. The patients were divided into two groups (group 1: non-hyperextension, group 2: hyperextension). An extension greater than 5° measured using a goniometer at the final follow-up was defined as hyperextension. Logistic and linear regression analyses were performed. Overall, 43 knees (11.1%) with hyperextension were observed at the last follow-up. There was no significant difference between groups in terms of the clinical outcomes although the functional scores were worse in group 2. There was no significant difference in the postoperative radiologic evaluation except for a change in PCO (group 1 vs. group 2; − 0.2 mm ± 3.8 vs. − 2.4 mm ± 3.0, p = 0.003), distal femoral resection slope angle (− 9.1° ± 2.1 vs. − 12.1° ± 1.7, p

To evaluate cartilage healing using second-look arthroscopic examination in tibia plateau fracture patients who have undergone open reduction and internal fixation with a submeniscal approach technique.Between January 2007 and January 2010, we used second-look arthroscopy during 18-24-month follow-up of 20 patients with Schatzkar type II tibial plateau fractures who had undergone open reduction and internal fixation with a submeniscal approach technique. We classified patients according to step-off, knee range of motion, and Knee Society Score, and compared the results with those obtained by arthroscopy.Radiologically, 16 cases (80 %) were reduced within 2 mm of step-off. In 11 of these cases, according to the Outerbridge classification, we checked for chondromalacia from grade II to III. We observed 2 mm of step-off in four cases, and each had chondromalacia of at least grade III. The Knee Society Score was associated with chondromalacia grade (p0.05).Even in patients with normal joint range of motion and good clinical and radiological results, the actual condition of the articular cartilage varied significantly. Therefore, more long-term and regular follow-up is needed for proximal plateau fractures.

To our knowledge, the simultaneous coronal fractures of the hamate, capitate, and trapezoid have not been previously reported in the literature. There were few reports about coronal fractures of the hamate caused only by axial loading to the ulnar column. We report 43-year-old man who presented with painful swelling on the dorso-ulnar side of the wrist after striking a wall with his right clenched fist. The computed tomography scan demonstrated coronal fractures through the hamate, capitate, and trapezoid. We performed closed reduction and fixation with a percutaneous compression screw. At the last follow-up, the patient was able to return to sports activities without any symptoms.

Currently, several potential advantages lead to minimally invasive total hip arthroplasty which become popular with orthopaedic community. However, there is little comparative study on minimally invasive techniques especially through anterior approach. This investigation aimed to evaluate the efficacy of minimally invasive modified Watson-Jones approach and to compare short-term clinical results with minimally invasive modified Hardinge approach.A consecutive series of 92 patients managed with minimally invasive total hip arthroplasty (47 with use of a modified Watson-Jones approach and 45 with use of a modified Hardinge approach) by one surgeon at one hospital were studied. All patients received the same design of cementless acetabular cup and femoral component. Data analysis included patient demographics, pre-operative diagnosis, surgical duration, intra-operative blood loss, type of anesthesia and length of hospital stay. Radiographic analysis included cup inclination angle, femoral stem alignment and leg length discrepancy.No significant differences were noticed with regard to the average surgical time, intra-operative blood loss and length of hospital stay in both groups. The average femoral component alignment and the average post-operative abduction angle of the acetabular cup were in acceptable ranges in both groups. However, the prevalence of femoral stem varus outlier was significantly high in minimally invasive modified Watson-Jones approach group.The higher prevalence of varus stem outlier in minimally invasive modified Watson-Jones approach must be considered to minimize femoral stem malalignment.