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Abstract Subchondral insufficiency fracture of the knee (SIFK) causes acute knee pain in adults and often requires surgical management. Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are the two most common surgical treatments for SIFK. While both UKA and TKA have their advantages, there is no consensus for SIFK localized on the medial compartment. We hypothesized that patients with SIFK treated with UKA would show superior patient-reported outcomes compared to those who underwent TKA. A total of 90 patients with SIFK located medially were included in the TKA (n = 45) and UKA (n = 45) groups. Size of SIFK lesions were measured on MR images. Patient reported outcomes in the form of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital Special Surgery (HSS) scores, and Knee Society Scores (KSS) were assessed preoperatively, postoperative 6, 12 months, and at the final follow-up. There were no differences in the size of the SIFK lesion between two groups. At 6 months, WOMAC score was better in the UKA group than the TKA group (p

Abstract Knee cartilage is in an aqueous environment filled with synovial fluid consisting of water, various nutrients, and ions to maintain chondrocyte homeostasis. Aquaporins (AQPs) are water channel proteins that play an important role in water exchange in cells, and AQP1, -3, and -4 are known to be expressed predominantly in cartilage. We evaluated the changes in AQP expression in chondrocytes from human knee articular cartilage in patients of different ages and identified the key factor(s) that mediate age-induced alteration in AQP expression. The mRNA and protein expression of AQP1, -3 and -4 were significantly decreased in fibrocartilage compared to hyaline cartilage and in articular cartilage from older osteoarthritis patients compared to that from young patients. Gene and protein expression of AQP1, -3 and -4 were altered during the chondrogenic differentiation of C3H10T1/2 cells. The causative factors for age-associated decrease in AQP included H2O2, TNFα, and HMGB1 for AQP1, -3, and -4, respectively. In particular, the protective effect of AQP4 reduction following HMGB1 neutralization was noteworthy. The identification of other potent molecules that regulate AQP expression represents a promising therapeutic approach to suppress cartilage degeneration during aging.

Abstract Background Only limited data are available regarding postural stability between anterior cruciate ligament (ACL)-injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups. Methods Ninety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anterior–posterior stability index (APSI), and medial–lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device. Results In the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p > 0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0 ± 0.8 vs. 1.6 ± 0.5, p = 0.001; APSI: 1.5 ± 0.6 vs. 1.3 ± 0.5, p = 0.023), but not the MLSI (p > 0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p > 0.05). There was no significant difference in the knee muscle strength between the two groups (p > 0.05). All postural stability showed no significant correlation with knee muscle strength (p > 0.05). Conclusion Dynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear. Level of evidence: Level III

Background Many studies exist about remnant preservation in anterior cruciate ligament (ACL) reconstruction. However, concern remains for development of a cyclops lesion during remnant preservation. To prevent this, a tensioning method has been suggested. Current study evaluated the clinical and radiologic results of remnant preservation in ACL reconstruction with tensioning compared to classical ACL reconstruction. Methods From January 2016 to June 2017, ACL reconstruction patients who underwent magnetic resonance imaging (MRI) 2 years postoperatively were enrolled. For comparison, all participants were divided in two groups: remnant preservation with tensioning (group R) and controls (group C). Clinically, Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), Lysholm scores, and incidence of symptomatic cyclops lesions were evaluated. Radiologically, signal-to-noise quotient (SNQ) and size of the synovium on MRI as well as anterior instability in Telos stress radiographs were evaluated. Results A total of 64 patients were enrolled (42 in group R and 22 in group C). The IKDC score in group R (70) was better than that in group C (62; p < 0.05). One patient in group R had a cyclops lesion with clinical symptoms and arthroscopic excision was recommended. Radiologically, the SNQ, synovium area, and anterior instability on Telos radiography showed no difference between the two groups. Conclusion Remnant preservation with tensioning is a good option for ACL reconstruction without the development of a cyclops lesion.

Muscle atrophy is defined as the progressive degeneration or shrinkage of myocytes and is triggered by factors such as aging, cancer, injury, inflammation, and immobilization. Considering the total amount of body iron stores and its crucial role in skeletal muscle, myocytes may have their own iron regulation mechanism. Although the detrimental effects of iron overload or iron deficiency on muscle function have been studied, the molecular mechanism of iron-dependent muscle atrophy has not been elucidated. Using human muscle tissues and in the mouse rotator cuff tear model, we confirmed an association between injury-induced iron depletion in myocytes and muscle atrophy. In differentiated C2C12 myotubes, the effects of iron deficiency on myocytes and the molecular mechanism of muscle atrophy by iron deficiency were evaluated. Our study revealed that the lower iron concentration in injured muscle was associated with the upregulation of ferroportin, an iron exporter that transports iron out of cells. Ferroportin expression was increased by hypoxia-inducible factor 1α (HIF1α), which is activated by muscle injury, and its expression is controlled by HIF1 inhibitor treatment. Iron deprivation caused myocyte loss and a marked depletion of mitochondrial membrane potential leading to muscle atrophy, together with increased levels of myostatin, the upstream regulator of atrogin1 and muscle RING-finger protein-1 (MuRF1). Myostatin expression under iron deficiency was mediated by an orphan nuclear receptor, dosage-sensitive sex reversal-adrenal hypoplasia congenita critical region on the X chromosome (DAX1).

BACKGROUND: Mixed use of T1- or T2-weighted magnetic resonance imaging (MRI) in histographic analysis has impeded cross-reference of studies on fatty degeneration of muscles in patients with back pain. OBJECTIVE: The current study aimed to establish the measurement reliability of histographic analysis for normal and painful paraspinal muscles between T1- and T2-weighted MRI. METHODS: T1- and T2-weighted MRI at the L4-5 level were performed in 31 patients with unilateral back pain. Two raters conducted the histographic analysis on 2 separate occasions. Multifidus, erector spinae, and psoas major muscles were assessed on both normal and painful sides. RESULTS: Intra- and interrater reliability of the parameters were generally excellent for both T1- (intrarater: 0.83 ± 0.13 and interrater: 0.93 ± 0.08) and T2-weighted images (intrarater: 0.93 ± 0.12 and interrater: 0.92 ± 0.12). Histogram width was fair to good for both kinds of image. Intraclass correlation coefficients were similar between painful and normal sides. CONCLUSIONS: The evidence that most histographic analysis parameters had excellent reliability for both T1- and T2- weighted images allows for cross-reference of the results between the two kinds of image. Moreover, the results of this study support the availability of histographic analysis for assessment of fatty degeneration in patients with back pain. [ABSTRACT FROM AUTHOR]

Background: Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction can be a serious complication, and there is controversy over how to prevent it. This study aimed to suggest surgical approaches to prevent TW using an allo-Achilles tendon graft, and then to evaluate TW after these surgical tips were applied. Materials and Methods: Sixty two patients underwent ACL reconstruction with an allo-Achilles tendon graft. Four surgical approaches were used: Making a tibial tunnel by bone impaction, intraarticular reamer application, bone portion application for the femoral tunnel, and an additional bone plug application for the tibial tunnel. After more than 1-year, followup radiographs including anteroposterior and lateral views were taken in 29 patients encompassing thirty knees. The diameter of the tunnels at postoperation day 1 (POD1) and at followup was measured and compared. Results: In 18 knees (60%), there were no visible femoral tunnel margins on the radiographs at POD1 or followup. In the other 12 cases, which had visible femoral tunnel margins on followup radiographs, the mean femoral tunnel diameter was 8.6 mm. In the tibial tunnel, the mean diameters did not increase on all three levels (proximal, middle, and distal), and there was no statistically significant difference between the diameters at POD1 and followup. Conclusion: The suggested tips for surgery involving an allo-Achilles tendon graft can effectively prevent TW after ACL reconstruction according to this case series. These surgical tips can prevent TW. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy. Materials and Methods: Ten patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed. Results: The average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5±4.2 mm) was significantly greater than that of the contralateral knees (7.7±3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides. Conclusions: During the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle. [ABSTRACT FROM AUTHOR]

Background: Post-laminectomy syndrome is a common cause of dissatisfaction after endoscopic interlaminar approach. Our aim was to evaluate the efficacy and safety of our two newly designed instruments for laminotomy, a dural protector attached to the scope and a knot pusher for water-tight suturing of the incidental dural tears. Material and Methods: This was a multicenter evaluation. Efficacy was quantified as the pre-to-postoperative improvement in pain (visual analog scale), disability (Oswestry Disability Index), patient satisfaction (modified MacNab score), and length of hospital stay. Safety was quantified by the incidence and location of dural tears, rate of revision, and radiological outcomes. Outcomes were evaluated between the control (before instrument development) and experimental (after instrument development) groups. Results: There was a significant improvement in leg pain in the experimental group (p = 0.03), with greater patient satisfaction in the control group (p < 0.01). There was no incidence of dural tears in the area of the traversing and exiting nerve roots in the experimental group. Water-tightness of sutures was confirmed radiologically. Conclusion: The novel dural protector and the knot pusher for water-tight sutures improved the efficacy and safety of decompression and discectomy; however, a prolonged operative time was a drawback.