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Objectives: To identify an optimal pediatric musculoskeletal ultrasound (MSUS) protocol for the detection of knee arthritis in patients with juvenile idiopathic arthritis (JIA) including a comparison with existing protocols. Secondary aims were to correlate MSUS-identified B-Mode (BM) and Power Doppler-Mode (PD) synovitis with clinical findings. Methods: Consecutive JIA patients with confirmed knee arthritis after clinical examination underwent a thorough MSUS study protocol which included views identified and consented by the Pediatric Rheumatology european Society (PReS) Imaging Working Party for the detection of synovitis. In total eight views including measurement of the suprapatellar recess were included. Scoring of synovitis followed the pediatric OMERACT criteria (BM and PD severity grading 0 to 3). Interobserver reliability of BM and PD was tested before study begin. Previously published MSUS protocols for knee synovitis were also identified from the literature and their scan protocols compared to identify differences in sensitivity for synovitis according to the number and specific type of views included. Finally, a clinically applicable MSUS protocol for knee synovitis could be proposed. Results: In 114 patients with clinically active knee inflammation, BM positivity (grading ≥ 1) was most frequently detected in the suprapatellar longitudinal and transverse scans performed in any positioning (frequency 97–99% in suprapatellar longitudinal in 30° or neutral respectively). PD positivity was however higher in these views performed in 30° flexion compared to neutral. Intrasynovial PD positivity (grading ≥ 1) was most frequently detected in the lateral parapatellar (69%, sensitivity 0.68, specificity 0.98), medial parapatellar (frequency 67%, sensitivity 0.67, specificity 1.0), the longitudinal lateral (68%, sensitivity 0.67, specificity 0.98) and suprapatellar transverse in 30° (frequency 64%, sensitivity 0.64, specificity 1.0). A combination of five views was the most sensitive for BM and PD synovitis. The suprapatellar recess size was analyzed by age and gender. For each group, the recess was wider in knees with arthritis than without (p < 0.001). Interobserver reliability of BM and PD positivity showed 85% agreement, with kappa 0.74 (very good). Three published studies with knee synovitis MSUS protocols were identified, which included a range of 1–3 views. Evaluation of the sensitivity of positive PD findings of each of these protocols reached a range of 53–83%; the highest sensitivity (91%) was achieved with the 5 views as identified by this study. These five views were therefore combined to form the Pediatric Internationally agreed Ultrasound (PIUS) knee protocol. Conclusion: BM and PD positivity reliably correlated with the identification of pathological findings in knees of patients with JIA. From an internationally agreed protocol of eight images, a combination of five showed the greatest sensitivity for synovitis. This protocol, termed 'PIUS-Knee' performed well when compared to existing protocols. Key messages: • Synovitis detected using B-Mode and Doppler-Mode Musculoskeletal Ultrasound (MSUS) correlated strongly with clinical examination findings. • A combination of five specific MSUS views achieved the most sensitive B-Mode and Doppler-Mode protocol for knee synovitis. • This optimized knee examination ultrasound protocol termed PIUS-Knee (Pediatric Internationally Agreed Ultrasound) has high sensitivity for detecting intrasynovial hypervascularity. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) knee is one of the most common chronic degenerative conditions that imposes clinical and economic burdens on individuals and societies worldwide. Previous studies showed vitamin D levels correlated positively with lean muscle mass and grip strength, implying that vitamin D supplementation may improve muscle health in knee OA subjects. This randomized controlled trial (RCT) aims to compare the effects of vitamin D supplementation on knee muscle strength, physical function, pain, and sarcopenia status in patients with end-stage knee OA. Patients and outcome assessors will be blinded to group allocation. Fifty-six end-stage knee OA patients with vitamin D insufficiency fulfilling our inclusion criteria will be invited to participate in this study. Patients will be randomly assigned to take vitamin D supplementation (4,000 IU capsule daily) or placebo for six months. Measurements will be taken at baseline, three and six-month after the commencement of the vitamin D supplement, and 6-month after the interventional period. The primary outcome includes the isometric quadriceps and hamstring muscle strength measured by a hand-held dynamometer. Secondary outcomes include pain, performance-based and self-reported physical function and sarcopenia status. The success of this study will provide scientific evidence of whether the relatively cheap and well-tolerated vitamin D supplement can improve quadriceps muscle strength, physical function, pain symptoms, and sarcopenia status of this increasingly large population for end-stage knee OA patients. The study has great clinical significance given Hong Kong's lengthy and growing waiting list for complete knee replacement procedures. Trial registration: The trial was registered on clinicaltrials.gov (NCT05981534) on 31st July 2023. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate a technique for treating pediatric popliteal cysts with a triple-channel knee arthroscopic approach, hypothesizing that this technique exhibits favorable clinical outcomes with reduced recurrence rates. Methods: A retrospective analysis was conducted on the clinical data of 14 patients with symptomatic pediatric popliteal cysts admitted to the joint surgery center using an arthroscopic minimally invasive technique from December 2017 to December 2020. Arthroscopy was employed for adequate enlargement of the posterior medial flap opening between the cyst and the joint cavity and to completely resect the cyst wall. The popliteal cyst recurrence was assessed through Magnetic Resonance Imaging(MRI) at 3 and 12 months post-surgery, and the Rauschning and Lindgren scores were recorded to evaluate the clinical prognosis. Results: A total of 14 children completed the follow-up, including 8 boys and 6 girls, with a mean age of 9.9 ± 1.1 years (5–12 years); 5 cases in the left knee and 9 cases in the right knee; the mean operative time was 19.2 ± 2.7 min (10–25 min); and the mean follow-up time was 15.1 ± 2.4 months (12–24 months). There was no intraoperative vascular or nerve injury and no incisional exudate infection. Postoperatively, posterior knee symptoms disappeared in the children, Rauschning and Lindgren scores significantly improved, and no recurrence signs were observed on MRI. Conclusions: This study determined that the arthroscopic three-channel minimally invasive technique is effective and safe for treating popliteal cysts in children, making it worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionA combination of hamstring stretching and strengthening exercises may benefit patients with knee osteoarthritis by promoting pain relief and disability improvement.The current study aimed to compare the effects of lateral hamstring strengthening and medial hamstring stretching with general hamstring stretching and general hamstring strengthening on pain, disability, and quality of life in patients with primary knee osteoarthritis and varus deformity.Forty patients with knee osteoarthritis were randomly assigned to two groups: a general hamstring strengthening group (14 women, 6 men) and a selective hamstring strengthening group (16 women, 4 men). In the general hamstring strengthening group, participants performed hamstring stretching and strengthening exercises broadly. In contrast, the selective hamstring strengthening group specifically targeted lateral hamstring strengthening and medial hamstring stretching. The treatment program was conducted three times a week for 4 weeks. Pain and disability levels were evaluated before and after treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), quality of life was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire, and physical activity levels were determined using the Tegner activity scale.Both groups demonstrated significant improvement in all outcomes except for the quality of life subscale of the KOOS questionnaire (p = .98) in the general hamstring strengthening group. However, the selective hamstring strengthening group exhibited greater improvements in symptoms (p = .02, effect size (d) = 0.92) and pain subscales (p = .01, d = 0.80) according to the KOOS questionnaire. Additionally, the pain subscale (p = .02, d = 0.79) of the OAKHQOL questionnaire exhibited greater improvements in the selective hamstring strengthening group. Tegner activity scale scores significantly improved in both groups.Strengthening the lateral hamstring and stretching the medial hamstring muscles seem to be beneficial for reducing pain in patients with primary knee osteoarthritis and varus deformity. Attention to stabilization in frontal and horizontal planes in the knee joint might be better than simply evaluating the joint in the sagittal plane. [ABSTRACT FROM AUTHOR]

• fMRI bilateral motor control task was used to evaluate longitudinal changes in brain activity. • Neuromuscular training induced movement adaptations in MC and HxSRC groups. • MCs demonstrate increased cerebellar activity associated with improved frontal plane ROM. • HxSRCs demonstrate increased somatosensory activity associated with improved frontal plane ROM. Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC. [ABSTRACT FROM AUTHOR]

Two new species of oribatid mites (Oribatida)—Hermannobates neotropicus sp. nov. (Hermanniellidae) and Mucrobates venezuelaensissp. nov. (Scheloribatidae)—are described, based on materials collected from sweep sample in the cloud forest in Western Venezuela. The genus Mucrobates is recorded in the Venezuelan fauna for the first time. Hermannobates neotropicus sp. nov. differs from the closely related species, H. intermedius Călugăr, 1990, by length and morphology of the bothridial seta. Mucrobates venezuelaensis sp. nov. differs from the closely related species, M. cayoaguaensis Ermilov & Kontschán, 2021, by the body size, the length of the bothridial and exobothridial setae, the presence of the pedotectum II, keel-shaped ridge and seta v’ on the leg genu II, and the location of the adanal seta ad1. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based on high-quality research are lacking. Several factors should be considered and discussed with the patient before deciding on the best treatment method. These include patient characteristics and expectations, concomitant injuries, and clinical evaluation, with laxity or/and instability being one of the most essential parameters examined. This should eventually lead to an individualized approach for each patient to ensure the best possible outcome. This review aims to delve into all parameters that are related to ACL rupture and guide physicians in choosing the most appropriate treatment method for each patient. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) rupture is a frequent injury among athletes, particularly women. Various techniques have shown effectiveness, but their impact on laxity and clinical outcomes varies. This study aims to compare the rupture rates of patellar tendon (PT) reconstruction versus hamstring reconstruction (HR) combined with anterolateral ligament reconstruction (ALLR) in young women. The secondary objectives include comparing functional ACL-RSI and subjective IKDC scores, as well as the Tegner scale, between these two groups. The hypothesis is that adding ALLR to HR will result in rupture rates and functional scores similar to those of PT reconstruction. Methods: Between 2015 and 2019, 96 patients were treated at two facilities, with 70 having an average follow-up of 44 ± 14.5 months: 35 underwent PT reconstruction, and 35 had HR combined with ALLR. Patients were re-evaluated remotely after at least 2 years using a standardised questionnaire and assessing subjective IKDC, ACL-RSI, and Tegner scores. Results: Rupture rates were 5.7% in both groups. The mean subjective IKDC score was 81% for the HR + ALLR group versus 80.8% for the PT group (p = 0.09). The mean ACL-RSI score was 66% for HR + ALLR versus 68% for PT (p = 0.78). The HR + ALLR group lost an average of 0.4 points on the Tegner scale postoperatively, while the PT group lost an average of 0.77 points (p = 0.09). Conclusions: Hamstring surgery combined with anterolateral surgery provides subjective results, as assessed by patients using subjective scales and questionnaires, that are as good as those obtained with PT surgery in young women. Notwithstanding, the results are not corroborated by clinical or radiological examination. [ABSTRACT FROM AUTHOR]

This study investigates the impact of quadriceps fatigue on lower limb biomechanics during the landing phase of a single-leg vertical jump (SLJ) in 25 amateur male basketball players from Ningbo University. Fatigue was induced through single-leg knee flexion and extension exercises until task failure. Kinematic and dynamic data were collected pre-fatigue (PRF) and post-fatigue (POF) using the Vicon motion capture system and the AMTI force platform and analyzed using an OpenSim musculoskeletal model. Paired sample t-tests revealed significant changes in knee and hip biomechanics under different fatigue conditions, with knee joint angle (p < 0.001), velocity (p = 0.006), moment (p = 0.006), and power (p = 0.036) showing significant alterations. Hip joint angle (p = 0.002), moment (p = 0.033), and power (p < 0.001) also exhibited significant changes. Muscle activation and joint power were significantly higher in the POF condition, while joint stiffness was lower. These findings suggest that quadriceps fatigue leads to biomechanical adjustments in the knee and hip joints, which may increase the risk of injury despite aiding in landing stability. [ABSTRACT FROM AUTHOR]

Understanding the athlete's movements and the restrictions incurred by protective equipment is crucial for improving the equipment and subsequently, the athlete's performance. The task of equipment improvement is especially challenging in sports including advanced manoeuvres such as ice hockey and requires a holistic approach guiding the researcher's attention toward the right variables. The purposes of this study were (a) to quantify the effects of protective equipment in ice hockey on player's performance and (b) to identify the restrictions incurred by it. Twenty male hockey players performed four different drills with and without protective equipment while their performance was quantified. A neural network accompanied by layer-wise relevance propagation was applied to the 3D kinematic data to identify variables and time points that were most relevant for the neural network to distinguish between the equipment and no equipment condition, and therefore presumable result from restrictions incurred by the protective equipment. The study indicated that wearing the protective equipment, significantly reduced performance. Further, using the 3D kinematics, an artificial neural network could accurately distinguish between the movements performed with and without the equipment. The variables contributing the most to distinguishing between the equipment conditions were related to the upper extremities and movements in the sagittal plane. The presented methodology consisting of artificial neural networks and layer-wise relevance propagation contributed to insights without prior knowledge of how and to which extent joint angles are affected in complex maneuvers in ice hockey in the presence of protective equipment. It was shown that changes to the equipment should support the flexion movements of the knee and hip and should allow players to keep their upper extremities closer to the torso. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The risk factors for the degeneration of the patellofemoral joint (PFJ) have not been adequately and thoroughly studied. This study aimed to analyze the population distribution characteristics of patients with patellofemoral osteoarthritis (PFOA) and assess the correlation between PFOA and radiological parameters, including patella morphology, PFJ congruity, and patellar alignment. Moreover, the risk factors across various demographic groups were further analyzed.A retrospective analysis was conducted to examine the population distribution characteristics of PFOA patients from September 2020 to September 2023. Radiological parameters of the PFJ were measured from the anteroposterior and lateral views of knee joint as well as axial view of patella using X‐ray imaging and the PACS imaging system at the First Affiliated Hospital of Kunming Medical University. These parameters included patella morphology (patella type, width, thickness, and Wiberg index), PFJ congruity (patella height, Wiberg angle, sulcus angle, and lateral patella angle), and patellofemoral alignment (patella tilt angle, displacement, and lateral patellofemoral angle). PFOA severity was classified according to the Iwano PFJ radiological classification, and its correlation with the aforementioned parameters was examined. Additionally, risk factors for PFOA across different populations were further evaluated.The study included 1080 patients according to the inclusion and exclusion criteria. Age, female gender, overweight or obesity, and manual workers were significantly associated with PFOA. Moreover, type III patella (OR = 3.03, p < 0.05), greater patella width (OR = 1.12, p = 0.01), sulcus angle (OR = 1.04, p < 0.01), patella tilt angle (OR = 1.13, p < 0.01), and patella displacement (OR = 1.22, p < 0.01) as well as smaller patella thickness (OR = 0.87, p < 0.01), Insall–Salvati index (OR = 0.24, p = 0.04), and lateral patellofemoral angle (OR = 0.93, p = 0.02) were identified as risk factors for PFOA. Furthermore, greater patella thickness (OR = 1.17, p < 0.05) and smaller patella displacement (OR = 0.79, p < 0.01) correlated with higher Kujala patellofemoral scores. Discrepancies in risk factors across different populations were also observed.Older age, female gender, obesity, manual workers, and specific aberrations in patellofemoral parameters are predictive factors for PFOA. Additionally, greater patella thickness and smaller patella displacement were associated with increased severity of clinical symptoms. Thus, more attention should be paid to the discrepancies that exist in different populations. [ABSTRACT FROM AUTHOR]

Objective: Despite long simulation times, recently developed finite element analysis (FEA) models of knee joints have demonstrated their suitability for predicting individual risk of onset and progression of knee osteoarthritis. Therefore, the objective of this study was to assess the feasibility of machine learning (ML) to replicate outcomes obtained from FEA when simulating mechanical responses and predicting cartilage degeneration within the knee joint. Design: Two ML models based on the Gaussian Process Regression (GPR) algorithms were developed. The first model (GPR1) utilized age, weight, and anatomical joint dimensions as predictor variables to predict tissue mechanical responses and cartilage degeneration based on FEA data. The second model (GPR2) utilized age, weight, height, and gender to predict anatomical joint dimensions, which were then used as inputs in the GPR1 model. Finally, the GPR1 and combined GPR1+GPR2 models were used to investigate the importance of clinical imaging when making personalized predictions for knees from healthy subjects with no history of knee injuries. Results: In the GPR1 model, R2 of 0.9 was exceeded for most of the predicted mechanical parameters. The GPR2 model was able to predict knee shape with R2 of 0.67–0.9. Both GPR1 and combined GPR1+GPR2 models offered equally good performances (AUC = 0.73–0.74) in classifying patients at high risk for the onset and development of knee osteoarthritis. Conclusions: In the future, real-time and easy-to-use GPR models may provide a rapid technology to evaluate mechanical responses within the knee for researchers or clinicians who have no former knowledge of FEA. [ABSTRACT FROM AUTHOR]

The positive effects of whole-body vibration exercise in rehabilitation, sport, fitness and preventive medicine have led to a proliferation of vibrating platforms. However, discrepancies have been claimed between the manufacturers' vibration parameters and the vibration applied by the platforms. In addition, the dimensions, materials and motors used in their manufacture mean that each platform behaves differently. These factors can influence their transmission to the human body and, consequently, their effects. Thus, measured vibration parameters were recommended to report the vibration parameters as accurately as possible. Therefore, the present study aimed to determine the feasibility of a large vibration platform. Measurements of vibration parameters and their transmission were added. These parameters were measured using six accelerometers (platform, ankle, knee, hip, third lumbar vertebra, and head) throughout five postures (toe-standing, erect, high squat, deep squat, and lunge) and three vibration frequencies (20 Hz, 25 Hz, and 30 Hz). On the platform, peak accelerations of 1 ± 0.2 g, displacements of 1 ± 0.1 mm at 20 Hz and 25 Hz and 0.6 mm at 30 Hz, and a frequency from the setting of +0.5 Hz were obtained. In the human body, peak accelerations can exceed 2 g, and these transmissibility amplifications were found at the ankles and knees. However, at the hip, accelerations plummet and transmissibility attenuation occurs all the way to the head. The signal purity was highly satisfactory, although at the hip and third lumbar vertebra when adopting the toe-standing and lunge, some less satisfactory results were found—especially at 20 Hz and 30 Hz. Present data indicate that the long vibration platform can be used for exercise and health in a safe way, although its specific behaviours have to be taken into account in order to optimise its applicability. [ABSTRACT FROM AUTHOR]

Research shows that treadmill shock-absorbing devices can reduce the impact of ground reaction forces on the knee and ankle joints during running. Most existing treadmills use fixed or passive shock absorption, meaning their shock-absorbing systems do not actively adjust to changes in ground reaction forces (GRFs). Methods: This study establishes a mathematical model integrating human motion biomechanics and treadmill running surfaces, analyzing the relationships between various parameters affecting the system. Ultimately, an optimal shock-absorbing treadmill control system is designed, utilizing a microcontroller as the main control unit, airbags for shock absorption, and a widely used foot pressure testing system. Objective: The goal is to more effectively prevent running injuries caused by excessive foot pressure. Compared to conventional shock absorption systems, this design features an active multilevel adjustment function with higher precision in regulation. Results: The experimental results demonstrate that the ground reaction force (GRF) generated by the optimal shock-absorbing treadmill control system is reduced by up to 10% compared to that of a conventional shock-absorbing treadmill. Conclusions: This leads to a smaller impact force on the knees due to foot pressure, resulting in better injury prevention outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Information and Communications Technology (ICT) advancements and high customer expectations are boosting the use of digital transformation and tech tools in business processes in a competitive environment. This trend enhances business effectiveness and efficiency but also introduces technostress as a new workplace stress factor. Technostress, defined as stress induced by using ICT in the workplace, has become increasingly prevalent in modern work environments, especially in sectors such as banking, due to digital transformation. As technology use intensifies, it raises concerns about potential adverse psychological and physiological effects on employees, particularly in relation to burnout. From a physiological perspective, musculoskeletal disorders (MSDs) are quite common among employees who use ICT for extended periods. MSDs can play a significant moderating role in the relationship between technostress and burnout. In this context, this study aimed to examine the moderating role of MSDs in the effect of technostress on burnout. Methods: This quantitative study surveyed a convenience sample of 220 bank employees, drawing on COR theory, the JD-R model, the P-E fit approach, and transactional stress theory. Data were analyzed using Structural Equation Modeling with SmartPLS 4.0 software, enabling examination of relationships between variables derived from these frameworks. Results: The results reveal that technostress increases bank employees' burnout experience. Additionally, bank employees with MSDs experience higher burnout levels than those without MSDs. Conclusions: The study's findings provide valuable insights into managing workplace stress, addressing mental health problems, and promoting employee well-being in the digital age. These results have potential implications for academic understanding and practical applications in sustainable management. [ABSTRACT FROM AUTHOR]

Background: In Italy, knee osteoarthritis (KOA) accounts for over 5 million prevalent cases and requires long-term multidisciplinary management. The most frequent KOA symptom is pain. The aim of the survey is to provide a national overview of the current management of moderate-to-severe pain associated with KOA from both clinicians' and patients' perspectives. Methods: An exploratory qualitative survey was conducted in Italy between July and October 2023. The survey participants were members of four national scientific societies and two patient associations who were invited to participate via email and given an online questionnaire. Questions included a mix of single and multiple responses and scalar items. Results: In total, 1473 clinicians and 150 patients with KOA completed the questionnaire. Patients rated knee pain as both the most burdensome symptom and the most frequent reason for treatment dissatisfaction and seeking consultation. One in two patients declared that they were unsatisfied/little satisfied with the current prescribed analgesic treatments. The clinicians surveyed preferentially prescribed intra-articular hyaluronic acid, oral non-steroidal anti-inflammatory drugs/paracetamol, non-pharmacological intervention, and intra-articular corticosteroids. The clinicians' selection of analgesic therapy often failed to adequately meet patients' expectations for pain relief. Conclusions: Our findings highlight the current unmet needs of patients with KOA in Italy and call for new approaches to effectively optimize the management of KOA-associated pain. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study investigated factors influencing the prevalence of musculoskeletal disorders (MSDs) resulting from agricultural work, utilizing the 2020 and 2022 occupational disease survey data collected by the Rural Development Administration. The combined data from these years indicated a 6.02% prevalence of MSDs, reflecting a significant class imbalance in the binary response variables. This imbalance could lead to classifiers overlooking rare events, potentially inflating accuracy assessments. Methods: We evaluated five distinct models to compare their performance using both original and synthetic data and assessing the models' performance based on synthetic data generation. In the multivariate logistic model, we focused on the main effects of the covariates as there were no statistically significant second-order interactions. Results: Focusing on the random over-sampling examples (ROSE) method, gender, age, and pesticide use were particularly impactful. The odds of experiencing MSDs were 1.29 times higher for females than males. The odds increased with age: 2.66 times higher for those aged 50–59, 4.60 times higher for those aged 60–69, and 7.16 times higher for those aged 70 or older, compared to those under 50. Pesticide use was associated with 1.26 times higher odds of developing MSDs. Among body part usage variables, all except wrists and knees were significant. Farmers who frequently used their necks, arms, and waist showed 1.27, 1.11, and 1.23 times higher odds of developing MSDs, respectively. Conclusions: The accuracy of the raw method was high, but the ROSE method outperformed it for precision and F1 score, and both methods showed similar AUC. [ABSTRACT FROM AUTHOR]

This trial examined the effectiveness of the popliteal plexus block (PPB) and tibial nerve block (TNB) for early rehabilitation after total knee arthroplasty (TKA). We allocated 136 participants to receive PPB or TNB with 0.25% levobupivacaine 10 mL in a randomized, double-masked manner. The primary outcome was achieving rehabilitation goals with a non-inferiority 9-hour margin, including adequate pain relief, knee flexion angles over 90 degrees, and enabling ambulatory rehabilitation. The time to reach rehabilitation goals showed non-inferiority with 49.7 ± 10.5 h for TNB and 47.4 ± 9.7 h for PPB, whose mean difference (PPB - TNB) was − 2.3 h (95% CI -5.8 to 1.2 h; P < 0.001). PPB showed higher dorsal and plantar percentage of maximum voluntary isometric contraction (dorsal, PPB 87.7% ± 11.4% vs. TNB 74.0% ± 16.5%: P < 0.001; plantar, PPB 90.9% ± 10.3% vs. TNB 72.1% ± 16.0%; P < 0.001) at six hours after nerve block. No significant differences between the two groups emerged in pain scores, knee range of motion, additional analgesic requirements, success in the straight leg raise, and adverse events. PPB exhibited non-inferiority to TNB in achieving postoperative rehabilitation goals and had superiority in preserving foot motor strength after TKA. (200) [ABSTRACT FROM AUTHOR]

This study develops explainable artificial intelligence for predicting safe balance using hospital data, including clinical, neurophysiological, and diffusion tensor imaging properties. Retrospective data from 92 first-time stroke patients from January 2016 to June 2023 was analysed. The dependent variables were independent mobility scores, i.e., Berg Balance Scales with 0 (45 or below) vs. 1 (above 45) measured after three and six months, respectively. Twenty-nine predictors were included. Random forest variable importance was employed for identifying significant predictors of the Berg Balance Scale and testing its associations with the predictors, including Berg Balance Scale after one month and corticospinal tract diffusion tensor imaging properties. Shapley Additive Explanation values were calculated to analyse the directions of these associations. The random forest registered a higher or similar area under the curve compared to logistic regression, i.e., 91% vs. 87% (Berg Balance Scale after three months), 92% vs. 92% (Berg Balance Scale after six months). Based on random forest variable importance values and rankings: (1) Berg Balance Scale after three months has strong associations with Berg Balance Scale after one month, Fugl-Meyer assessment scale, ipsilesional corticospinal tract fractional anisotropy, fractional anisotropy laterality index and age; (2) Berg Balance Scale after six months has strong relationships with Fugl-Meyer assessment scale, Berg Balance Scale after one month, ankle plantar flexion muscle strength, knee extension muscle strength and hip flexion muscle strength. These associations were positive in the SHAP summary plots. Including Berg Balance Scale after one month, Fugl-Meyer assessment scale or ipsilesional corticospinal tract fractional anisotropy in the random forest will increase the probability of Berg Balance Scale after three months being above 45 by 0.11, 0.08, or 0.08. In conclusion, safe balance after stroke strongly correlates with its initial motor function, Fugl-Meyer assessment scale, and ipsilesional corticospinal tract fractional anisotropy. Diffusion tensor imaging information aids in developing explainable artificial intelligence for predicting safe balance after stroke. [ABSTRACT FROM AUTHOR]

ABSTRACT Estimation of the knee joint strength by maximum voluntary isometric contraction (MVIC) is a common practice to assess strength, coordination, safety to return to work or engage in sports after an injury, and to evaluate the efficacy of treatment modalities and rehabilitation strategies. In this study, we utilize a previously validated coupled finite element‐musculoskeletal model of the lower extremity to explore the sensitivity of output measures (posterior cruciate ligament [PCL]/muscle/contact forces and passive moments) in knee MVIC flexion exercises at seated position. To do so, at three knee flexion angles (KFA), input measures (resistance moment and contribution moments of quadriceps and gastrocnemii) were varied at four levels each using the Taguchi design of experiment. Our findings reveal significant increases in PCL forces with KFA (p < 0.01), net MVIC moment (p < 0.01), and resistance moment of quadriceps (p < 0.01). In contrast, they drop at larger activity in gastrocnemii (p < 0.01). Tibiofemoral (TF) contact forces increase with the net MVIC moment (p < 0.01). The passive knee flexion moment, while highly dependent on the location at which computed, also increases with the net MVIC moment (p < 0.01). Changes in KFA, MVIC moment, and proportions thereof carried by quadriceps and/or gastrocnemii substantially affect biomechanics of the joint. Compared with level walking and stair ascent, slightly larger contact forces/stresses and much greater PCL forces are computed. This study improves our understanding of the knee joint behavior during MVIC in effective evaluation and rehabilitation interventions. Besides, it emphasizes the importance of positioning the joint center in model studies. [ABSTRACT FROM AUTHOR]

Background: Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA. Methods: Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed. Results: Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (−2.7° to 0.8°, −2.2° to 4.3°, and −5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495). Conclusions: Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of evidence Unicondylar arthroplasty was performed using robotic medial unicompartmental knee arthroplasty (R‐mUKA) and gap‐balancing instrumentation. Our hypothesis was that robotic unicondylar knee arthroplasty accurately restores component positioning and lower limb alignment when compared to preoperative planning with actual implantation throughout the range of knee motion due to proper knee balancing.Data were collected prospectively and were analysed for patients undergoing RM‐UKA. A cemented UKA was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded of the native knee, with the trial components in place and finally after component implantation. A spacer according to the femorotibial gap was introduced and the alignment was measured. The position of the final component was planned based on three‐dimensional computed tomography images before making the bone cuts. The positioning of the femoral and tibial components was analysed in all three planes.A total of 52 patients were included (mean age 66.3 ± 6.7 years; 34 males, 18 females). The difference in femoral component position after planning and final implantation was 0.04° ± 0.58° more valgus in the coronal plane (p = 0.326) and 0.6° ± 1.4° more flexion relative to the sagittal plane (p = 0.034). The tibial component was placed in the coronal plane in 0.3° ± 0.8° of more varus (p = 0.113) and in the sagittal plane in 0.6° ± 1.2° of more posterior tibial slope (p = 0.001). Lower limb alignment of the native knee in extension was 5.8° ± 2.6° of varus and changed to 3° ± 2.1° varus after UKA (p ≤ 0.01).R‐mUKA helps to achieve the target of alignment and component position without any significant differences to the planning. Ligament balancing causes non‐significant changes in component position. It allows optimal component position even for off‐the‐shelf implants respecting the patient's specific anatomy.II [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) is a common degenerative and progressive joint disorder that negatively influences patients' quality of life. Intra-articular therapies, such as hyaluronic acid (HA) and platelet-rich plasma (PRP), have garnered attention for their potential to manage osteoarthritis OA symptoms effectively. This systematic review aims to identify the effectiveness and safety of HA and PRP treatment modalities in treating KOA. Methods: A literature search was conducted across MEDLINE (PubMed), Web of Science Core Collection, and Science Direct Collection Elsevier. Twenty-three randomized controlled trials, cohort studies, and observational studies were included in the review. The selection criteria focused on studies published in English within the last 10 years, involving subjects with KOA treated with intra-articular injections of HA or PRP and reporting on pain, function, or overall treatment efficacy outcomes. Results: The analysis showed that both HA and PRP significantly improve functionality and reduce pain in KOA patients. High molecular weight HA consistently reduced pain and improved joint mobility in various studies. PRP had better long-term outcomes when combined with HA, leading to greater pain reduction and functional improvement. Both therapies had generally favorable safety profiles, with only minor adverse events reported. However, there were potential biases identified across the studies, such as selection, performance, detection, and reporting biases, which impacted the reliability of the results. Conclusions: Intra-articular treatments with HA and PRP show promise in managing knee osteoarthritis, with personalized treatment plans and further research needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Effective rehabilitation following total knee arthroplasty (TKA) is crucial for enhancing both range of motion (ROM) and functional outcomes. While robotics has demonstrated its potential in various medical contexts, the evidence on its application in TKA rehabilitation is still scarce. The marsi active knee (MAK), a robotic device that has already proven to be safe and beneficial in people with neurological disease, has been tested to facilitate the rehabilitation of TKA patients. Objective: This study aims to evaluate the safety, patient satisfaction, and clinical impact of integrating the MAK into an early rehabilitation regimen for TKA patients. Methods: The intervention comprised 14 one‐hour sessions administered thrice a week, utilizing the MAK within 48 h post‐TKA surgery. The rehabilitation sessions incorporated exercises involving passive mobilizations, sit‐to‐stand transitions, and gait training. Comprehensive data encompassing safety parameters, patient satisfaction, and clinical outcomes were meticulously collected and analyzed. Results: Six participants successfully completed the rehabilitation protocol with the MAK device. Notably, no significant adverse events were documented. Application of the device corresponded to perceptible reductions in self‐reported pain levels. Vital signs remained within minimal variance pre‐ and post‐rehabilitation. Participants proficiently engaged in all assisted exercises facilitated by the device, culminating in a high overall satisfaction rating of 4.6 ± 0.5 out of 5. Conclusion: The findings indicate that the MAK device exhibits a commendable level of safety while obtaining considerable patient satisfaction during the early rehabilitation phase following TKA, suggesting this device may be a reliable adjunct to TKA protocols. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis (OA) is a highly prevalent and debilitating condition with significant emotional and economic impacts. Current treatment options may only provide temporary pain relief and are not regenerative, thus the progression of knee OA is not deterred and total knee arthroplasty is inevitable. Injection therapies with orthobiologics possess regenerative potential and are an emerging treatment option. We present a prospective study aimed at examining patients with knee OA who had received an autologous platelet concentrate fluid (APCF) injection produced through a fluid volume reducer. Methods: This was an observational review of the results following an APCF injection in a cohort of patients at a single site. Patients were included in the study if they were diagnosed with K/L grade 2–3 knee OA and treated with an APCF knee injection. Patients were excluded if they had obtained an orthobiologic injection in the three months prior to study enrollment or if baseline data were unavailable. Knee score and function score were used to assess patients at the baseline and post-injection follow-ups. Results: Improvements for knee score were statistically significant for the follow-ups at three months, six months, one year, and three years. Function score improved, with statistically significant changes for the three month and three year follow-ups. Conclusions: Our study demonstrates that there is some utility in using APCF injection for knee OA, with improvements that may be sustained up to three years in some patients. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is an orthopedic procedure performed on patients with severe knee pain and advanced knee conditions, such as osteoarthritis and rheumatoid arthritis, in order to restore joint function. Despite the procedure's high success rates, persistent postoperative pain (PPP) remains a significant complication, affecting a substantial proportion of patients. Identifying predictors of PPP is crucial for improving patient outcomes and satisfaction. Methods: A retrospective analytic study was conducted, reviewing the medical records of patients who underwent unilateral or bilateral TKA at King Abdulaziz Medical City. The data collection focused on demographics, comorbidities, clinical presentations, surgical details, and postoperative outcomes. Data were analyzed using JMP software. A p-value of less than 0.05 was considered statistically significant. Results: This study included 838 patients, predominantly female (71.5%), with an average age of 65.4 years. Osteoarthritis was the primary reason for surgery (98.3%). The mean preoperative pain score was 3.4, and the average pain duration prior to surgery was 6.2 years. We identified dyslipidemia as a significant predictor of PPP (OR 1.40, p = 0.042), while we found younger age to be a significant predictor (OR 0.979, 95% CI 0.967–0.991, p = 0.001). Other factors such as gender, diabetes, hypertension, cardiovascular disease, anxiety disorder, mood disorder, tobacco use, chronic kidney disease, chronic lung disease, and BMI were not significant predictors of PPP. Conclusion: This study identifies younger age and dyslipidemia as significant predictors of persistent postoperative pain and improved outcomes following total knee arthroplasty Further research is needed to validate these results in diverse populations and settings, with the objective should be to refine preoperative counseling and postoperative pain management protocols. [ABSTRACT FROM AUTHOR]

High tibial osteotomy (HTO) is the established surgical treatment option for advanced knee osteoarthritis (OA) of the medial compartment, and various treatment options are being investigated continuously to improve the long-term follow-up clinical outcomes after HTO. Stem cell therapy for the regeneration of osteoarthritic cartilage defects has recently been investigated. Nevertheless, little is known about the concomitant use of stem cell therapy in HTO to treat medial compartmental OA of the knee. Representative comparative studies on stem cell therapy combined with HTO were examined in this review. The clinical outcomes improved after stem cell therapy combined with HTO, but there was limited evidence of better clinical outcomes compared to HTO without stem cell therapy. In cartilage regeneration, regardless of the cell type used, cell concentrates or culture-expanded mesenchymal stem cells allow significant cartilage regeneration. On the other hand, there is a report about the difference in cartilage repair based on cell type. Therefore, medium- and long-term follow-up evidence would be required for continued concomitant use of stem cell therapy in HTO to treat knee OA. [ABSTRACT FROM AUTHOR]

Purpose: To compare the differences between men and women who receive primary osteochondral allograft transplantation of the knee with regard to preoperative disease presentation, failures and reoperations. Methods: A retrospective review of patients ≥18 years old who underwent primary osteochondral allograft transplantation between 2002 and 2020 by a single surgeon with a minimum of 2‐year follow‐up was performed. Demographic, preoperative, intraoperative and postoperative data were collected for all included patients. Patients were then assigned to two groups, either male or female, based on their reported sex. Statistical analysis was performed to assess sex‐related differences in baseline characteristics, comparative survival analysis for determining survival probabilities, and regression analysis for determining variables associated with subsequent reoperation or failure. Results: Among the 437 patients that were identified, 337 patients (77.1% follow‐up, 161 men, 176 women) with a minimum of 2‐year follow‐up were included in our study. The mean age of included patients was 31.3 ± 9.9 years (range, 18.0–55.9), with a BMI of 26.7 ± 4.4 (range, 19.0–39.0) and a mean follow‐up of 5.6 ± 2.6 years (range, 2.0–16.3). Male patients had significantly higher body mass index (BMI) (p ≤ 0.01), were more likely to have lesions on the medial femoral condyle (p = 0.041), and had larger lesions at the medial femoral condyle (p ≤ 0.01) and lateral femoral condyle (p ≤ 0.01). 36.8% of patients experienced subsequent reoperation (59 male, 65 female). Mean time to reoperation was 3.5 ± 2.8 years (range, 0.4–16.3 years) in males and 2.1 ± 1.9 years (range, 0.1–13.5 years) in females. No significant difference was found between the two groups with regard to reoperation rates (n.s.) or survivability free from reoperation (n.s.), but females were found to undergo reoperation sooner (p = 0.028). Sixty‐three (18.7%) patients experienced subsequent graft failure (36 male, 27 female). No significant difference was found between the two groups in terms of failure rates, time to failure, survivability free from failure, or mode of failure (n.s. for all). Conclusions: Despite several differences in baseline demographics and intraoperative variables, no significant differences were found between men and women receiving primary osteochondral allograft transplantation of the knee with regard to failure or reoperation, with the exception that women underwent reoperation sooner. Study Design: Retrospective Comparative Cohort Study. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injury is a concerning problem in the paediatric population, impacting joint health and longevity. Moreover, ACL injury hampers physical activity, which is important for children's social network and general well‐being. Recent data demonstrates a rise in paediatric ACL reconstructions, affecting both girls and boys. However, it is unclear whether this rise reflects a higher injury rate or a more proactive approach towards surgery, as information on nonoperated patients is lacking. Regarding gender differences, increasing evidence implies that girls engaged in pivoting sports experience a higher incidence of ACL injuries and reinjuries compared to boys. Furthermore, data suggest that girls have inferior outcomes and lower return‐to‐sport rates than boys. The social context in which girls compete in sports is likely a significant contributing factor to the risk of serious knee injuries. Lack of attention and insufficient data on gender‐based differences in ACL injuries, outcomes and evidence‐based treatment guidelines highlight the need for further research on this topic. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess how gender might affect the clinical outcome and survival of meniscal allograft transplantation (MAT). Methods: A total of 358 patients (23.2% women, 76.8% men) were treated with fresh‐frozen nonirradiated allografts implantated arthroscopically using a single‐ or double‐tunnel technique without bone plugs and peripheral suture to the capsule with 'all‐inside' stitches. Results: Patients were evaluated at baseline and 2‐year follow‐up with the Lysholm score, visual analogue scale (VAS) pain, the Knee Osteoarthritis Outcome Score (KOOS) subscales and Tegner score. Women presented higher body mass index (p < 0.0005), poorer baseline VAS (p = 0.012), Lysholm score (p = 0.005), KOOS symptom (p = 0.034) and KOOS pain (p = 0.030), Tegner score (preinjury and basal, p < 0.0001 and p = 0.002, respectively), a lower number of previous (p = 0.039) and concurrent (p = 0.001) anterior cruciate ligament reconstructions and a higher number of concurrent procedures (p = 0.032) and distal femoral osteotomies (p = 0.024). Worse results were documented in women at 2 years, with lower Lysholm score (p = 0.024) and Tegner score (p = 0.007) and a lower clinical survival rate (p = 0.03) (67.5% vs. 82.2%) in the overall patient cohort. However, the matched‐pair analysis only confirmed a lower Tegner score value at 2 years (p = 0.016), while underlying the interplay of sex, age and concomitant cartilage lesions in determining the clinical outcome. The analysis of this large series of patients affected by postmeniscectomy syndrome and treated with MAT revealed gender differences. Conclusion: While both genders benefited from a significant improvement, the female population presents more often with older age, concomitant cartilage lesions and a lower activity level, all factors contributing towards a lower clinical success after MAT. Level of Evidence: Level III, comparative study. [ABSTRACT FROM AUTHOR]

Purpose: Regenerative techniques for articular cartilage lesions demonstrated heterogeneous clinical results. Several factors may influence the outcome, with sex being one of the most debated. This study aimed at quantifying the long‐term influence of sex on the clinical outcome obtained with a regenerative procedure for knee chondral lesions. Methods: Matrix‐assisted autologous chondrocyte transplantation (MACT) was used to treat 235 knees which were prospectively evaluated with the International Knee Documentation Committee (IKDC), EuroQol visual analogue scale, and Tegner scores at 14‐year mean follow‐up. A multilevel analysis was performed with the IKDC subjective scores standardised according to the age/sex category of each patient and/or the selection of a match‐paired subgroup to compare homogeneous men and women patients. Results: At 14 years, men and women showed a failure rate of 10.7% and 28.8%, respectively (p < 0.0005). An overall improvement was observed in both sexes. Women had more patellar lesions and men more condylar lesions (p = 0.001), and the latter also presented a higher preinjury activity level (p < 0.0005). Men had significantly higher IKDC subjective scores at all follow‐ups (at 14 years: 77.2 ± 18.9 vs. 62.8 ± 23.1; p < 0.0005). However, the analysis of homogeneous match‐paired populations of men and women, with standardised IKDC subjective scores, showed no differences between men and women (at 14 years: −1.6 ± 1.7 vs. −1.9 ± 1.6). Conclusion: Men and women treated with MACT for knee chondral lesions presented a significant improvement and stable long‐term results. When both sexes are compared with homogeneous match‐paired groups, they have similar results over time. However, women present more often unfavourable lesion patterns, which proved more challenging in terms of long‐term outcome after MACT. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

The aim of the study is to investigate the association of cardiorespiratory fitness (CRF) and muscular strength indicators with gray matter volume (GMV) and to study whether fitness‐related regions of GMV are associated to executive function (EF) in cognitively normal older adults. Ninety‐one cognitively normal older adults (71.69 ± 3.91 years; 57.14% females) participated in this study from the AGUEDA trial. CRF was measured by a 2‐km walking test and a 6‐min walking test. Muscular strength was measured by handgrip, biceps curl, squats, and isokinetic strength tests. T1‐weigthed images were obtained through a magnetic resonance scan. GMV was determined by voxel‐based morphometric analysis. Standardized EF tests were performed. CRF did not show any positive association with GMV. Handgrip strength was positively associated with GMV (p < 0.001) in nine regions (β from 0.6 to 0.8 and k from 106 to 1927) and knee extension strength in three regions (β from 0.4 to 0.5 and k from 76 to 2776). Squats strength was negatively associated with GMV (p < 0.001) in two regions (β = −0.3, k = 1102 and k = 152) and the 2‐km walking test in one region (β = −0.4, k = 99). Only handgrip strength‐related GMV was associated with cognitive flexibility (p = 0.039, β = 0.215) and spatial working memory (p < 0.03, β 0.247–0.317), but not with EF score (p > 0.05). Muscular strength, but no CRF, may be positively related to GMV in cortical and subcortical regions, with implications for specific cognitive domains rather than the overall EF score. Specifically, handgrip strength was the indicator most associated with higher GMV, while squats strength and CRF were negatively related to GMV. ClinicalTrials.gov identifier: NCT05186090. [ABSTRACT FROM AUTHOR]

Background: Many adolescents experience knee pain, and only some undergo detailed imaging. In this population, the prevalence of abnormalities and normal variants on magnetic resonance imaging (MRI) scans is unknown. Purpose: To investigate the prevalence of abnormalities and normal variants of the knee on MRI scans and their relationship with participant characteristics in the general young adolescent population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was part of an open population-based cohort study that focuses on health, growth, and development from fetal life until adulthood. Between 2017 and 2020, adolescents aged 12 to 15 years underwent MRI of both knees. These MRI scans were assessed in a standardized way for abnormalities and normal variants to determine their prevalence. Logistic regression was used to analyze the presence of abnormalities and normal variants in relation to sex, height, weight, body mass index–standard deviation (BMI-SD), and ethnicity. Results: A total of 1910 participants (median age, 13.5 years; interquartile range, 13.4-13.7 years; 52% girls) were included in this study. Of them, 370 (19.4%) participants had at least 1 abnormality or normal variant. Bone marrow edema around the knee was the most prevalent finding, affecting 140 (7.3%) participants. In 107 (5.6%) participants, nonossifying fibromas were found. A total of 43 (2.3%) participants had characteristics of Osgood-Schlatter disease, 16 (0.8%) showed characteristics of Sinding-Larsen-Johansson syndrome, and osteochondritis dissecans was found in 13 (0.7%) participants. Variants such as discoid menisci were found in 40 (2.1%) participants and a bipartite patella in 21 (1.1%) participants. There were multiple associations between abnormalities or variants and participant characteristics, including bone marrow edema being more often present in boys (odds ratio [OR], 2.44; 95% CI, 1.69-3.52) and those with a lower BMI-SD (OR, 0.85; 95% CI, 0.73-0.98). Osgood-Schlatter and osteochondritis dissecans were more often present in boys (OR, 4.21 [95% CI, 2.01-8.85] and OR, 13.18 [95% CI, 1.71-101.58], respectively). Discoid menisci were associated with a non-Western ethnicity (OR, 2.06; 95% CI, 1.07-3.96) and higher BMI-SD (OR, 2.34; 95% CI, 1.76-3.11). Conclusion: Abnormalities and normal variants on MRI scans of the knees are common in adolescents. Physicians who are involved in the treatment of adolescents with knee pain need to be aware of this prevalence so that these children will not be overtreated or misdiagnosed. [ABSTRACT FROM AUTHOR]

Background: Despite being recognized as a safe procedure with minimal reported complications, injecting autologous bone marrow aspirate concentrate (BMAC) as an adjuvant to arthroscopic partial meniscectomy (APM) for symptomatic patients with meniscal tears and concomitant knee osteoarthritis (OA) has not been studied in randomized controlled trials. Purpose: To compare patient-reported outcome measure (PROM) scores and radiographic outcomes in symptomatic patients with meniscal tears and concomitant mild knee OA who underwent APM with and without an autologous BMAC injection administered at the time of surgery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Enrolled patients aged ≥18 years determined to have a symptomatic meniscal tear with concomitant mild knee OA suitable for APM and meeting inclusion and exclusion criteria were randomized into 2 groups: BMAC and control (no BMAC). The primary endpoint of the study was the International Knee Documentation Committee (IKDC) score at 1 year postoperatively. Secondary endpoints included radiographic outcomes (Kellgren-Lawrence grade) at 1 year postoperatively and various PROM scores, including those for the IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale, and Veterans RAND 12-Item Health Survey, at 3 months, 6 months, 1 year, and 2 years after meniscectomy. Results: Of the 95 enrolled patients, 83 (87.4%) were included for final analysis. No significant differences were found between the groups with regard to patient characteristics, intraoperative variables, concomitant procedures, preoperative PROM scores, or preoperative radiographic findings. At 1 year postoperatively, the BMAC group failed to demonstrate significantly better IKDC scores (P =.687) or radiographic outcomes (P >.05 for all radiographic measures) compared with the control group. Secondary PROM scores also did not significantly differ between the groups (P >.05 for all PROMs). However, there were higher achievement rates of the minimal clinically important difference for the KOOS Sport (100.0% vs 80.0%, respectively; P =.023) and KOOS Symptoms (92.3% vs 68.0%, respectively; P =.038) at 1 year postoperatively in the BMAC group than in the control group. All PROMs, excluding the VR-12 mental score, showed significant improvements compared with baseline at all postoperative time points for both the BMAC and control groups. Conclusion: The addition of an autologous BMAC injection during APM did not result in significant changes in IKDC scores or radiographic outcomes at the 1-year postoperative mark. Secondary PROM scores were generally comparable between the 2 groups, but there was higher minimal clinically important difference achievement for the KOOS Sport and KOOS Symptoms at 1 year postoperatively in the BMAC group. In patients with symptoms consistent with a meniscal tear who had concomitant mild OA, the addition of BMAC to arthroscopic debridement did not affect the outcome. Registration: NCT02582489 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Background: The Knee Numeric-Entity Evaluation Score (KNEES-ACL) is a 41-item condition-specific patient-reported outcome measure (PROM) that was developed for patients with an anterior cruciate ligament (ACL) deficiency and patients after ACL reconstruction. This measure is intended to be used for longitudinal clinical studies. The KNEES-ACL has demonstrated face and content validity and superior responsiveness compared with other PROMs commonly used in patients with an ACL injury. However, this PROM was developed in Danish and has not been appropriately translated and culturally adapted into North American English. Purpose: To translate and culturally adapt the KNEES-ACL from Danish to North American English. Study Design: Cross-sectional study. Methods: Translation from Danish to English and cultural adaptation to a North American context were performed according to the dual panel method. First, the Danish KNEES-ACL was translated by a bilingual panel, which provided multiple English wording options for each item. Second, an English lay panel focus group was formed to determine the wording for each item that best reflected everyday spoken language. Finally, individual think-aloud cognitive interviews were conducted with patients after an ACL injury to evaluate the relevance, comprehensiveness, and comprehensibility of the PROM content and questions. Repeated modifications and testing were performed until a final English version of the KNEES-ACL was constructed. Results: Participants in the lay panel focus group were able to reach unanimous decisions for each of the 41 items. Further changes to 17 items were made after 8 think-aloud interviews with patients with ACL injuries at various time points to ensure that items were relevant and being interpreted consistently among different types of patients. The final KNEES-ACL consisted of 6 domains: Problems with Daily Activities, Mental Impact, Stability, Strength and Control, Pain, and Sport and Physical Activity. Conclusion: The English KNEES-ACL for patients with ACL injuries has undergone appropriate translation and cultural adaptation using established dual panel and cognitive interviewing methods in the population of interest. The psychometric properties of the English KNEES-ACL will likely mirror those established with the Danish version. However, direct validation of the psychometric properties of the English version would be beneficial before widespread use. [ABSTRACT FROM AUTHOR]

Background: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. Purpose: To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigné–Postel score, and overall patient satisfaction score. Results: The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P =.918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P =.336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. Conclusion: Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment. [ABSTRACT FROM AUTHOR]

Knee arthroplasty technique is constantly evolving and the opportunity for surgeons to practice new techniques is currently highly dependent on the availability of cadaveric specimens requiring certified facilities. The high cost, limited supply, and heterogeneity of cadaveric specimens has increased the demand for synthetic training models, which are currently limited by a lack of biomechanical fidelity. Here, we aimed to design, manufacture, and experimentally validate a synthetic knee surgical training model which reproduces the flexion dependent varus‐valgus (VV) and anterior‐posterior (AP) mechanics of cadaveric knees, while maintaining anatomic accuracy. A probabilistic finite element modeling approach was employed to design physical models to exhibit passive cadaveric VV and AP mechanics. Seven synthetic models were manufactured and tested in a six‐degree‐of‐freedom hexapod robot. Overall, the synthetic models exhibited cadaver‐like VV and AP mechanics across a wide range of flexion angles with little variation between models. In the extended position, two models showed increased valgus rotation (<0.5°), and three models showed increased posterior tibial translation (<1.7 mm) when compared to the 95% confidence interval (CI) of cadaveric measurements. At full flexion, all models showed VV and AP mechanics within the 95% CI of cadaveric measurements. Given the repeatable mechanics exhibited, the knee models developed in this study can be used to reduce the current reliance on cadaveric specimens in surgical training. [ABSTRACT FROM AUTHOR]

Objective • To study the application value of Ilizarov bone handling technology in the treatment of tibial bone defect caused by osteomyelitis segmental resection. Methods • 78 patients with tibial bone defects after osteomyelitis segmental resection admitted to our hospital from January 2018 to August 2019 were retrospectively analyzed and assigned to the Ilizarov bone handling group (38 cases) and the fibular segmental transplantation group (40 cases). The perioperative indexes between the groups were compared (external fixation time, complete weight- bearing time, and intraoperative bleeding volume). The ankle function and knee function of patients were assessed before and 6 months after treatment and the occurrence of postoperative complications were counted. Results • The external fixation time and full weight- bearing time in the Ilizarov bone handling group were significantly shorter than those in the fibular segment transplantation group, and the intraoperative bleeding was less, with statistically significant differences (P < .05). Compared to the pre-treatment period, Baird’s scores and HHS scores of the patients in both groups increased significantly after 6 months of treatment, and both scores in the Ilizarov bone handling group were significantly higher than those in the fibular segment transplantation group, and the differences were statistically significant (P < .05). The postoperative complication statistics showed that the complication rate of the Ilizarov bone handling group was significantly lower than that of the fibular segment transplantation group (P < .05). Conclusion • The Ilizarov bone transfer technique is less invasive than the fibular bone grafting technique used in the treatment of patients with osteomyelitis segmental resection-induced tibial bone defects, with the former having the advantages of less traumatization, faster recovery of the patients, better recovery of knee and ankle functions, and fewer complications, which is of high value for clinical application. [ABSTRACT FROM AUTHOR]

Background: X‐ray radiography is a widely used imaging technique worldwide, and its image quality directly affects diagnostic accuracy. Therefore, X‐ray image quality control (QC) is essential. However, subjectively assessing image quality is inefficient and inconsistent, especially when large amounts of image data are being evaluated. Thus, subjective assessment cannot meet current QC needs. Purpose: To meet current QC needs and improve the efficiency of image quality assessment, a complete set of quality assessment criteria must be established and implemented using artificial intelligence (AI) technology. Therefore, we proposed a multi‐criteria AI system for automatically assessing the image quality of knee radiographs. Methods: A knee radiograph QC knowledge graph containing 16 "acquisition technique" labels representing 16 image quality defects and five "clarity" labels representing five grades of clarity were developed. Ten radiographic technologists conducted three rounds of QC based on this graph. The single‐person QC results were denoted as QC1 and QC2, and the multi‐person QC results were denoted as QC3. Each technologist labeled each image only once. The ResNet model structure was then used to simultaneously perform classification (detection of image quality defects) and regression (output of a clarity score) tasks to construct an image QC system. The QC3 results, comprising 4324 anteroposterior and lateral knee radiographs, were used for model training (70% of the images), validation (10%), and testing (20%). The 865 test set data were used to evaluate the effectiveness of the AI model, and an AI QC result, QC4, was automatically generated by the model after training. Finally, using a double‐blind method, the senior QC expert reviewed the final QC results of the test set with reference to the results QC3 and QC4 and used them as a reference standard to evaluate the performance of the model. The precision and mean absolute error (MAE) were used to evaluate the quality of all the labels in relation to the reference standard. Results: For the 16 "acquisition technique" features, QC4 exhibited the highest weighted average precision (98.42% ± 0.81%), followed by QC3 (91.39% ± 1.35%), QC2 (87.84% ± 1.68%), and QC1 (87.35% ± 1.71%). For the image clarity features, the MAEs between QC1, QC2, QC3, and QC4 and the reference standard were 0.508 ± 0.021, 0.475 ± 0.019, 0.237 ± 0.016, and 0.303 ± 0.018, respectively. Conclusions: The experimental results show that our automated quality assessment system performed well in classifying the acquisition technique used for knee radiographs. The image clarity quality evaluation accuracy of the model must be further improved but is generally close to that of radiographic technologists. Intelligent QC methods using knowledge graphs and convolutional neural networks have the potential for clinical applications. [ABSTRACT FROM AUTHOR]

Few studies have reported on the validity of a sensor-based lower-limb kinematics evaluation during the timed up and go (TUG) test. This study aimed to determine the validity of a wearable gait sensor system for measuring lower-limb kinematics during the TUG test. Ten young healthy participants were enrolled, and lower-limb kinematics during the TUG test were assessed using a wearable gait sensor system and a standard optical motion analysis system. The angular velocities of the hip, knee, and ankle joints in sit-to-stand and turn-to-sit phases were significantly correlated between the two motion analysis systems (R = 0.612–0.937). The peak angles and ranges of motion of hip, knee, and ankle joints in the walking-out and walking-in phases were also correlated in both systems (R = 0.528–0.924). These results indicate that the wearable gait sensor system is useful for evaluating lower-limb kinematics not only during gait, but also during the TUG test. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the impact of aging on neuromuscular fatigue and recovery. Ten young (23.08 ± 1.43 years) and older (61.19 ± 1.80 years) males performed an intermittent maximal isometric exercise with the knee extensors followed by 27 min of recovery. Maximal voluntary contraction (MVC), total work (W′), voluntary activation (VA), potentiated resting twitch (Ptw), and electromyography (EMG) were recorded and then analyzed. Peripheral and central fatigue following exercise were lower in old compared to young (− 29.99% vs. − 42.68% and − 14.55 vs. − 20.02%; P < 0.05, respectively). Despite old performing 50% less work, RMS/Mmax reduction was similar between old and young (− 26.46% vs. − 29.93%; P > 0.05, respectively). During the recovery period, our results showed that recovery of the MVC was impaired for old (14.93% for old vs. 30.66% for young) and still incomplete until 27 min.VA increased significantly compared to post exercise after 1 min only for young (P = 0.001), potentially affecting the recovery pattern of MVC during the early phase due to their significant correlation (r2 = 0.58, P = 0.01). Peripheral fatigue recovery was also lower for old (11.18% vs. 18.72%; P < 0.001), and both groups failed to recover their baseline value (both P < 0.005). The lower peripheral and central fatigue observed in elderly following exercise appears for the first instance as a fatigue resistance. However, the delayed neuromuscular recovery reveals instead a reduced fatigue tolerance reflecting age-related alteration within contractile properties and/or within central nervous system. [ABSTRACT FROM AUTHOR]

Background: The ergonomic advantages and potential challenges that robotic surgery poses to the well-being of surgeons are mainly unexplored. The most recent surgical robot introduced on the European market is the Hugo™ RAS System by Medtronic. This study aims to evaluate the ergonomic benefits of the Hugo™ RAS System, which is available in our training laboratory, CeMIT (Center for Medical Innovation and Technology Cologne). Methods and procedures: Using the previously established Cologne Ergonomic Measurement Setup for Robotic Surgery (CEMRobSurg), we measured three parameters related to ergonomic posture from subjects with different levels of surgical expertise (laypeople, medical students, surgical residents, and expert robotic surgeons). The heart rate was measured continuously using a polar band. The noise level was measured while using the Hugo™ RAS System, and automated photographs using our locally developed methodology were captured of the participant every 2 s to assess body posture. The ergonomic measurements were conducted while the subject performed the same standardized robotic training exercises (Peg Board, Rope Walk, and Ring Walk). Results: A total of 53 participants were enrolled in this study. The average noise level during all measurements was 54.87 dB. The highest stress level was measured in surgical residents with a sympathetic nervous system index (SNS index) of 1.15 (min − 1.43, max 3.56). The lowest stress level was measured in robotic experts with an SNS index of 0.23 (min − 0.18, max 0.91). We observed a risk-prone positioning of the neck and elbow in medical students (mean 39.6° and 129.48°, respectively). Robotic experts showed a risk positioning in the knee and hip region (mean 107.89° and 90.31°, respectively). Conclusion: This is the first study to analyze and objectify the ergonomic posture of medical students, surgical trainees, surgeons, and laypeople using the open console, modular Hugo™ RAS System. Our findings offer recommendations for operating surgeons and allow for a comparative analysis between the different robotic systems. Further evaluations in real-time operative scenarios will follow. [ABSTRACT FROM AUTHOR]

Objectives: Sarcopenia is prevalent in middle to old age. We aimed to investigate the association between muscle strength and the incident knee osteoarthritis (OA). Methods: 12,043 participants were collected from the China Health and Retirement Longitudinal Study. The effects of sarcopenic obesity (defined by obesity in combination with possible sarcopenia) on knee OA onset were calculated using Poisson regression models. Mediation analysis was fit to estimate mediating proportion of muscle strength on the association between obesity and incident knee OA. Results: The study all enrolled 12,043 participants with 2,008 progressed to knee OA. Poisson analyses demonstrated causal association of general obesity (RR:1.23, 95% CI: 1.08 to 1.39) and abdominal obesity (RR:1.23, 95% CI: 1.11 to 1.35) with knee OA onset. For the risk of incident knee OA, participants with the highest level of normalized grip strength had a decreased risk of incident knee OA by 0.33 (RR:0.67, 95% CI: 0.60 to 0.75) times compared to the control group, and chair-rising time was associated with increased risk of incident knee OA by 0.65 (RR:1.65, 95% CI: 1.17 to 2.33) times. Sensitivity analysis identified similar results. Participants with sarcopenic obesity were about 2 times risk of incident knee OA than reference group. Normalized grip strength and chair-rising time mediated the association between obesity and incidence of knee OA. Conclusions: Sarcopenic obesity is correlated with an increased risk of knee OA. Muscle strength recovery may alleviate the risk of incident knee OA in middle to old age with obesity. [ABSTRACT FROM AUTHOR]

Aims: Limited knee range-of-motion (ROM) is common following total knee arthroplasty (TKA). It is associated with functional limitations and patient dissatisfaction. Regular knee ROM assessment is important but accurate testing traditionally requires timely access to trained healthcare professionals. Although accelerometer-based smartphone goniometry has shown to provide reliable and valid joint angles, current evidence of its use still positions healthcare providers as end users instead of patients themselves. Therefore, to maximize the impact of smartphone goniometry on post-TKA care, our study aimed to examine the feasibility, reliability, and validity of patients' self-measurement of knee ROM using an accelerometer-based smartphone goniometry application. Methods: Patients were given standard instructions with a practice trial before the actual measurements. Passive knee flexion and extension ROM was measured on 2 sessions in 30 patients with TKA using 4 block-randomized methods: (i) smartphone self-assessment, (ii) long-arm goniometry by physiotherapist, (iii) smartphone assessment by physiotherapist, and (iv) extendable-arm goniometry by physiotherapist with placement adjudication. Feasibility was assessed by the number of participants who could independently perform the self-measurement. To assess intra- and inter-session reliability, we computed intraclass correlation coefficients (ICCs) from random-effects models. To assess intra- and inter-session agreement, we computed mean absolute differences (MADs) and minimum detectable change (MDC). To assess concurrent validity, we designated extendable-arm goniometry as the "gold standard" and compared other methods against it using ICCs and MADs. Results: All patients were able to comprehend and execute the assessment. 87% (n = 26) found the application easy to administer. Smartphone goniometry by patients showed excellent intra- and inter-session reliability (ICCs>0.97) and minimum variability (MAD = 0.9°-3.9°; MDC95 = 3.1°–9.0°). Smartphone or long-arm goniometry by physiotherapists did not outperform patients' self-assessment (ICC = 0.96–0.99, MAD = 0.7°-3.1°; MDC95 = 2.2°-8.0°). Compared against extendable-arm goniometry, smartphone goniometry by patients measured knee flexion and extension ROM with a MAD of 4.5° (ICC, 0.97) and 2.2° (ICC = 0.98), respectively. Conclusion: Our study demonstrates that smartphone goniometry is feasible, reliable and accurate, and can be used with confidence in the self-assessment of knee ROM post-TKA. Future studies should further explore its utility in telemonitored rehabilitation, and its possible integration into mobile health applications to enhance accessibility to care following TKA. [ABSTRACT FROM AUTHOR]

The golf swing has been associated with mechanical injury risk factors at many joints. One swing, the Minimalist Golf Swing, was hypothesised to reduce lumbar spine, lead hip, and lead knee ranges of motion and peak net joint moments, while affecting swing performance, compared to golfers' existing swings. Existing and MGS swings of 15 golfers with handicaps ranging from +2 to −20 were compared. During MGS downswing, golfers had 18.3% less lumbar spine transverse plane ROM, 40.7 and 41.8% less lead hip sagittal and frontal plane ROM, and 39.2% less lead knee sagittal plane ROM. MGS reduced lead hip extensor, abductor, and internal rotator moments by 17.8, 19.7 and 43%, while lead knee extensor, abductor, adductor and external rotator moments were reduced by 24.1, 26.6, 37 and 68.8% respectively. With MGS, club approach was 2° shallower, path 4° more in-to-out and speed 2 m/s slower. MGS reduced certain joint ROM and moments that are linked to injury risk factors, while influencing club impact factors with varying effect. Most golf injuries are from overuse, so reduced loads per cycle with MGS may extend the healthy life of joints, and permit golfers to play injury-free for more years. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the technical advantages and clinical outcomes of lateral unicompartmental knee arthroplasty (LUKA) through the medial parapatellar approach. Methods: From August 2022 to June 2024, 104 patients who underwent LUKA via the medial parapatellar approach were enrolled. The operation time, hospital stays, surgical complications and follow-up period were collected. Pre- and postoperative Range of movement (ROM), Oxford knee score (OKS) and Hospital for special surgery knee score (HSS) were recorded and further investigated by paired-samples t-test analysis. Results: Primary demographic data of the retrospective case series collected include gender (30 males and 74 females), age (63.1 ± 8.37 years, range 49–84 years), operation time (86 ± 17 min, range 52–135 min), hospital stays (4.0 ± 1.1 days, range 3–8 days) and follow-up period (9.9 ± 5.7 months, range 1–23 months). There was a significant improvement in ROM (P < 0.001), OKS (P < 0.001) and HSS (P < 0.001) compared to preoperative values. Patient satisfaction at 1-month postoperative follow-up was up to 95%. The incidence of deep venous thrombosis was 16.3%. There was no incidence of postoperative infection. Conclusion: The medial parapatellar approach is a understandable, easy to master and credible surgical approach for LUKA, showing a striking improvement in clinical outcomes without adverse events in the short-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Osteochondritis dissecans (OCD) can lead to detrimental effects in the affected joints. Osteochondral autologous transplantation (OAT) allows to restore the articular surface with an autologous osteochondral unit. While short-term results are documented, there is a lack of long-term data. Aim of this study was to analyze the long-term clinical results of single-plug OAT for the treatment of knee OCD. Methods: Twenty patients (14 men, 6 women) were treated with single plug-OAT. Mean age was 23.6 ± 9.9 years and BMI was 23.3 ± 3.6 kg/m2. Lesion size was 2.3 ± 1.6 cm2 and defects included 14 medial femoral condyles (MFC) and 6 lateral femoral condyles (LFC). Patients were followed up prospectively at baseline, 24 months, 60 months, and at minimum ten years (12.6 ± 2.0 years) using the IKDC subjective score and through an overall judgment on treatment satisfaction. The activity level was evaluated with the Tegner score and adverse events and failures were also recorded. Factors influencing the clinical outcomes, including age, sex, BMI, lesions size, and lesion location were also investigated. Results: No severe adverse events and no surgical failures were reported and 85.0% of patients were satisfied at a minimum ten year follow-up. Subjective IKDC showed a significant and stable improvement at all follow-ups, passing from 45.3 ± 16.5 at baseline to 73.7 ± 16.6 at 24 months (p < 0.0005), to 72.9 ± 16.6 at 60 months (p < 0.0005), and to 74.1 ± 20.8 at long-term follow-up (p < 0.0005). Patients with OCD lesions localized on the LFC obtained lower results compared to those with MFC lesions at two years and five years (p = 0.034 and p = 0.023). The highest long-term scores were obtained in patients with lesion size lower than 2 cm2 (89.1 ± 8.8) compared to patients with lesion size between 2 and 4 cm2 (69.2 ± 15.7), and patients with lesion size larger than 4 cm2 (63.8 ± 34.6). Conclusions: OAT is a suitable technique to treat knee OCD in young patients and offers a high patient satisfaction and a significant improvement in terms of clinical subjective scores, with results remaining stable over time, although without reaching the pre-injury activity level. No severe adverse events and no surgical failures have been documented confirming OAT as a valid treatment option, although the best long-term results for lesions smaller than 2 cm2 and for MFC lesions should be considered when choosing this procedure to address knee OCD lesions. Highlights: Single-plug OAT for knee OCD provided good clinical outcome over time with no failures. Despite the good symptoms and functional improvement, a limited activity level was recovered. The lesion size remains a concern for single-plug OAT, with better results with smaller lesions. Lesion site can influence the final outcome offered by this technique, with better results for MFC. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the factors affecting patient-reported outcomes after bicruciate-stabilized total knee arthroplasty (BCS TKA) in patients. Methods: We retrospectively examined 122 knees with primary varus knee osteoarthritis that underwent BCS TKA. This study analyzed preoperative, intraoperative, and postoperative predictors of patient satisfaction and persistent postsurgical pain following BCS TKA at 1 year after surgery. We evaluated persistent postsurgical pain using Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale and patient satisfaction using a visual analog scale. Results: The univariate analysis showed a significant negative correlation between the KOOS pain subscale and three factors: the preoperative central sensitization inventory (CSI) score, medial joint laxity at 90° flexion, and acute postsurgical pain. Patient satisfaction was significantly positively correlated with lateral joint laxity at 90° flexion and postoperative extension angle. Acute postsurgical pain had a significant negative correlation with patient satisfaction. The multiple regression analysis revealed preoperative CSI score and medial joint laxity at 90° flexion influenced patients' KOOS pain subscale responses. Only lateral joint laxity at 90° flexion had an impact on patient satisfaction. Conclusions: The acquisition of adequate soft tissue balance according to the concept of BCS TKA and preoperative central sensitization syndrome affects the clinical outcomes in BCS TKA. [ABSTRACT FROM AUTHOR]

A bone bruise is generated by a bony collision that could occur when the anterior cruciate ligament (ACL) is injured, and its pattern reflects the injury mechanism and skeletal maturity. Thus, the bone bruise pattern is useful to predict a subject-specific injury mechanism, although the sensitivity and/or effect of the material property and the knee position at injury is still unclear. The objective of the present study was to determine the effect of the material property and knee position on the bone bruise pattern in skeletally mature and immature subjects using finite element analysis. Finite element models were created from a magnetic resonance (MR) image in the sagittal plane of a skeletally mature (25 y. o.) and immature (9 y. o.) male subject. The femur and tibia were collided at 2 m/s to simulate the impact trauma and determine the maximum principal stress. The analysis was performed at 15, 30, and 45 deg of knee flexion, and neutral, 10 mm anterior and posterior translated position at each knee flexion angle. Although high stress was distributed toward the metaphysis area in the mature model, the stress did not cross the growth plate in the immature model. The size of the stress area was larger in the mature model than those in the immature model. The location of the stress area changed depending on the joint position. Young's modulus of cartilage and trabecular bone also affected the location of the stress area. The Young's modulus for the cartilage affected peak stress during impact, while the size of the stress area had almost no change. These results indicate that the bone bruise pattern is strongly associated with subject-specific parameters. In addition, the bone bruise pattern was affected not only by knee position but also by tissue qualities. In conclusion, although the bone bruise distribution was generally called footprint of the injury, the combined evaluation of the quality of the structure and the bone bruise distribution is necessary for properly diagnosing tissue injury based on the MR imaging. [ABSTRACT FROM AUTHOR]

Understanding the biomechanical impact of injuries and reconstruction of the anterior cruciate ligament (ACL) is vital for improving surgical treatments that restore normal knee function. The purpose of this study was to develop a technique that enables parametric analysis of the effect of the ACL reconstruction (ACLR) in cadaver knees, by replacing its contributions with that of a specimen-specific virtual ACLR that can be enabled, disabled, or modified. Twelve ACLR reconstructed knees were mounted onto a motion simulator. In situ ACLR graft forces were measured using superposition, and these data were used to design specimen-specific virtual ACLRs that would yield the same ligament force-elongation behaviors. Tests were then repeated using the virtual ACLR in place of the real ACLR and following that in ACL deficient knee by disabling the virtual ACLR. In comparison to the ACL deficient state, the virtual ACLRs were able to restore knee stability to the same extent as real ACLRs. The average differences between the anterior tibial translation (ATT) of the virtual ACLR versus the real ACLR were +1.6 ± 0.9 mm (p = 0.4), +2.1 ± 0.4 mm (p = 0.4), and +1.0 ± 0.9 mm (p = 0.4) during Anterior drawer, Lachman and Pivot-shift tests, respectively, which is small in comparison to the full ATT range of motion (ROM) of these knees. Therefore, we conclude that a virtual ACLR can be used in place of real ACLR during biomechanical testing of cadaveric knees. This capability opens the door for future studies that can leverage parameterization of the ACLR for surgical design optimization. [ABSTRACT FROM AUTHOR]