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Objective: To identify, summarise and critically assess economic evaluation studies on sports injury prevention strategies.Design: Systematic review.Data Sources: PubMed, SportDiscuss.Eligibility Criteria For Selecting Studies: The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Economic analyses published since 2010 were checked for inclusion. The methodological quality of the studies was assessed using the Oxford Level of Evidence for economic and decision analysis; underlying randomised controlled trials (RCTs) were rated according to the Physiotherapy Evidence Database (PEDro) Scale, and risk of bias was assessed using the Revised Cochrane risk-of-bias tool.Results: Ten studies fulfilled the inclusion criteria. The quality assessment revealed limited data quality. For trial-based analysis, underlying RCTs were of good quality and had a low risk of bias. Prevention concepts for general injury reduction showed effectiveness and cost savings. Regarding specific injury types, the analysis of the studies showed that the best data are available for ankle, hamstring and anterior cruciate ligament injuries. Measures using specific training interventions were the predominant form of prevention concepts; studies investigating these concepts showed cost-effectiveness with total cost savings between €24.82 and €462 per athlete.Conclusion: Injury prevention strategies that were studied are cost-effective. However, estimates and outcomes vary throughout the included studies, and precluded pooling of existing data. Knowledge about the cost-effectiveness of evaluated prevention measures will help improve the acceptance and application of prevention initiatives. [ABSTRACT FROM AUTHOR]

Background: The use of morphometric implants in total knee arthroplasty (TKA) has shown better early clinical outcomes compared to conventional implants. The primary objective of this study is to evaluate the functional outcome and the implant survivorship of a morphometric TKA at a minimum of 5 years of follow-up.Methods: From May 2012 to June 2015, all patients undergoing primary TKA with a single design of morphometric posterior-stabilized prosthesis (Persona; Zimmer) in a prospective observational single-center study were evaluated. The Knee Society Scoring System (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were completed preoperatively, 1, 3, and 5 years postoperatively. Kaplan-Meier was used to calculate survivorship of the implants. The average follow-up was 75 months.Results: In total, 237 TKAs were performed in 235 patients with a mean age of 73 years (49-90). The KSS Knee Score increased from 44.7 (13-64) preoperatively to 93.6 (71-100), the KSS Function Score from 45.8 (17-69) to 92.2 (51-98), and the KSS Satisfaction Score from 26.6 (16-51) to 41 (35-55) at 5 years of follow-up. Similarly, for the KOOS score, a significant improvement of all the subscales was observed at 5 years of follow-up. Implant survival without reoperation at 5 years of follow up was 98.72% (95% confidence interval 0.95-1.00).Conclusion: This is the first study demonstrating that significant improvements of the functional scores with good survivorship can be achieved at a minimum of 5 years of follow-up with TKA using morphometric implants. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper was to report the results presented in the session "Does practice of meniscus surgery change over time?" of the 2021 MENISCUS webinar held online on January 30th 2021. Method: During the 2021 MENISCUS webinar, an evaluation of meniscus surgery practices was performed by analyzing: (1) The presentation of the results of a survey conducted among ESSKA members and assessing their current practices in the field of meniscus surgery, (2) Four reports by national experts analyzing the trends in Arthroscopic Partial Meniscectomy (APM) and meniscus repair procedures in their respective countries (France, Belgium, Germany and Japan). Results: (1) ESSKA Survey: Among the 461 respondents, 75% of surgeons claimed to perform more meniscus repairs and 85% less APM than 5 years ago. In ACL-associated meniscus injuries, a majority of surgeons (60%) indicated to perform a meniscal resection in less than 25% of cases. 25% declared to perform meniscus repair in ACL-associated meniscus injuries in less than 25% of cases and 37% in more than 50% of cases. Half of the respondents repair medial or lateral root tears in less than 25% of cases. Less than 20% of respondents were not familiar with the ESSKA consensus. (2) National trends: In France, between 2005 and 2017, the APM rate decreased by 21.4%, while the repair rate increased by 320%. In Belgium, between 2007 and 2017, the APM rate decreased by 28.6%. In Germany, between 2010 and 2017 the number of APM decreased by 30%, while the number of repair procedures increased by 55%. Finally, in Japan, between 2011 and 2016, the APM ratio (APM/meniscus procedures) decreased by 16% from 91 to 75% while the repair ratio increased from 9 to 25%. Conclusion: The 2021 ESSKA members' survey as well as statistics from 4 specifically examined countries (Belgium, France, Germany and Japan) suggest there has been a significant shift over the last years in the surgical management of meniscal lesions towards less APM and more conservative treatments. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to identify the epidemiological characteristics of litigation following arthroscopic procedures, performed in private practice and public hospitals in France. The secondary objective was to establish a risk profile for medical malpractice lawsuits after arthroscopic surgery. Methods: All court decisions related to arthroscopic surgery between 1994 and 2020 were collected and reviewed cases from the two main French legal databases (Legifrance and Doctrine). Data were retrospectively collected and included: gender, joint and defendant's specialty involved, reason behind the lawsuit, initial indication and the type of arthroscopic procedure performed. The final verdicts as well as the indemnity awarded to the plaintiff (if any) were recorded. Results: One-hundred eighty cases met the inclusion criteria of the study and were analyzed: 58 cases were before administrative courts and 122 were before civil courts. An orthopaedic surgeon was involved alone or in solidum in 45.6% of cases (82/180), followed by anesthesiologists in 5.6% (10/180). The private surgery center or public hospital were implicated in 63.9% (115/180) of cases. The 2 most common joints involved in litigation following arthroscopic surgery were the knee (82.2%, n = 148) and the shoulder (11.1%, n = 20). The main reasons behind the lawsuit were related to postoperative infection in 78/180 cases and to a musculoskeletal complication in 45/180 cases (25%). A failure to inform was also reported in 34/180 cases (18.9%). Of the 180 cases, 122 cases (67.8%) resulted in a verdict for the plaintiff. The average indemnity award for the plaintiff was 77.984 euros [2.282–1.117.667]. A verdict for the plaintiff was significantly associated with postoperative infection or a wrong-side surgery, while technical error and musculoskeletal complications were more significantly likely to result in a verdict in favor of the defendant (p = 0.003). Conclusion: This study evaluated and mapped lawsuits following after arthroscopic surgery in France over a period of more than 20 years. The main joint involved in lawsuits was knee. The main causes of lawsuits following arthroscopic surgery were related to postoperative infection, musculoskeletal complications and failure to inform. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype. Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip–knee–ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype. Results: The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment. Conclusion: Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus. Level of clinical evidence: III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: Defining a Minimal Clinically Important Difference (MCID) value for Patient-Reported Outcome Measures (PROMs) is crucial for determining the effectiveness of a procedure and calculating the sample size for trial planning. The purpose of this study was to determine the MCID of several PROMs (Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and the SF-12) in patients who underwent medial opening-wedge High-Tibial Osteotomy (owHTO) with Patient-Specific Cutting Guides (PSCGs), using anchor-based methods. Methods: Patients undergoing isolated medial owHTO with PSCGs between January 2013 and January 2017 were enrolled in this single-center, prospective, observational study. Three outcome scores were collected pre-operatively and at the 2 years follow-up evaluation: KOOS, KSS and SF-12. The MCIDs were calculated using anchor-based method: at 2 years postoperatively: "Compared with before surgery, how would you rate operated joint now?" The responses were recorded using a five-point scale. Patients who answered "about the same" or "somewhat worse" were classified into the no change group, while those who answered "somewhat better" were classified into the minimal change group. A receiver operating characteristic (ROC) curve was used to define the cutoff point that best discriminated between the minimal change and no change groups for each PROMs Results: 196 patients were included, 75 (somewhat better) and 24 patients (about the same and somewhat worse) were, respectively, assigned to the "no change" and "minimal change" groups. There was no significant difference between the two groups in terms of baseline characteristics and postoperative complications. At 24 months follow-up all the PROMs (KOOS, KSS and SF-12) were significantly better for the "minimal change" group compared to the "no change" group. MCID was 15.4 for KOOS pain, 15.1 for KOOS symptoms, 17 for KOOS ADL, 11.2 for KOOS sports/recreation, 16.5 for KOOS QQL, 3 for KSS symptoms, 5.6 for KSS activity, 7.2 for SF-12 physical component and 6.3 for PCS mental component. Conclusion: This study determined the MCIDs of common used PROMs in patients undergoing owHTO. Level of evidence: Prospective Cohort Study, Level II [ABSTRACT FROM AUTHOR]

The suspensory mechanism of the posterior horn of the lateral meniscus (PHLM) is an anatomically complex structure including the popliteomeniscal fascicles, the meniscotibial posterior root attachment and the meniscofemoral ligaments. Damage to one or several of these structures – either through knee trauma or congenital abnormalities—can result in an instability of the PHLM that may lead to lateral knee pain, locking sensations or lack of rotational control of the knee (e.g. after anterior cruciate ligament injuries). The diagnosis of PHLM instability is complex due to the lack of reliable clinical tests and imaging signs. Direct visual dynamic inspection via arthroscopy thus remains the gold standard. However, arthroscopic probing of the PHLM is not always reliable and the precise quantification of the amount of subluxation of the PHLM can be difficult. Therefore, the main objective of this report was to describe a quick and easy arthroscopic screening test called "the aspiration test" in order to help surgeons to detect PHLM instability. During the exploration of the lateral tibiofemoral compartment with the knee kept in the figure of 4 position, the arthroscope is placed in the antero-lateral portal and directed towards the lateral tibiofemoral compartment. The aspiration test is then performed by activating the aspiration of the 4-mm shaver when located in the intercondylar notch. In case of a PHLM instability, an excessive displacement of the PHLM is observed. After repair, a second aspiration test allows to verify that the PHLM has been stabilized. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the functional outcomes and implant survivorship at a minimum of 5 years of follow-up of several reconstruction techniques with or without metaphyseal cone and stems of variable length.Methods: A retrospective comparative matched analysis was performed from 2 prospectively collected databases. Only patients who underwent revision total knee arthroplasty procedures for aseptic causes using a single design of rotating hinge knee with a minimum of 5 years of follow-up were analyzed. Patients were separated into 3 groups: trabecular metal (TM) cones + short cemented stems (TM + short stem [SS]), TM cones + long uncemented stems (TM + long stem [LS]), and no cone (NC) + long uncemented stems (NC + LS). A matching process based on age (±5 years) was realized.Results: About 99 patients were included; 33 in the TM + SS group, 33 in the TM + LS group, and 33 in the NC + LS group. The mean time of follow-up was 9.3 years. A significant difference of the improvement of subscale pain, symptom, activities of daily living, quality of life of the Knee Injury and Osteoarthritis Outcome score and knee, function of the Knee Society Score was observed in favor of TM + SS group compared with the 2 other groups. At 8 years of survivorship, the components free of revision for any cause were 90.9% for the TM + SS group, 84.9% for the TM + LS group, and 90.6% for the NC + LS group.Conclusion: The use of a short cemented tibial stem combined with a TM cone in revision total knee arthroplasty offers identical survival rate with better functional outcome compared with the use of a long uncemented stem associated with TM cones or metallic augments at a minimum of 5 years of follow-up. [ABSTRACT FROM AUTHOR]

Purpose: A recent study reported that positioning a K-wire to intersect the cutting plane at the theoretical lateral hinge location increases the lateral hinge's resistance to fracture during the opening of opening wedge high tibial osteotomy (OWHTO). The purpose of this study was to evaluate the clinical relevance of the use of this K-wire and its benefits in terms of lateral hinge protection during OWHTO in daily practice.Methods: A retrospective comparative study identified 206 patients who underwent OWHTO from January 2014 to December 2017. Among these patients, 71 had an additional K-wire (HK + group), whereas 135 did not (HK- group). The subjects meeting the inclusion criteria were included in a matched pairing process, which identified 60 patients in the HK + group and 60 patients in the HK- group. Mean follow-up time was 2.3 ± 1.0 years (range 2-4.2). Radiographic outcomes were evaluated with intraoperative and postoperative fluoroscopic imaging and with CT imaging at 6 weeks post OWHTO surgery. The knee osteoarthritis outcomes score (KOOS) was used and time needed to return to work and any kind of sports was collected.Results: Thirty six patients (30%) were found to have a LHF. Among these patients, 26 (72%) did not have an additional K-wire positioned at their theoretical lateral hinge location (HK- group) during the procedure. LHF rate for patients without additional K-wire group (HK-) was 43.3%, whereas it was 16.7% for the patients with an additional K-wire (HK +) [Odd ratio 3.8 95% CI 1.6-8.3; p = 0.005]. The mean time to return to work, return to any kind of sports, and bone union was significantly shorter for HK + group (p < 0.05).Conclusion: This study demonstrated that during OWHTO, positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location reduced the number of intraoperative lateral hinge fractures.Level Of Evidence: III retrospective case-control study. [ABSTRACT FROM AUTHOR]

Purpose: Patient-specific cutting guides (PSCGs) have been advocated to improve the accuracy of deformity correction in opening-wedge high-tibial osteotomies (HTO). It was hypothesized that PSCGs for HTO would have a short learning curve. Therefore, the goals of this study were to determine the surgeons learning curve for PSCGs used for opening-wedge HTO assessing: the operating time, surgeons comfort levels, number of fluoroscopic images, accuracy of post-operative limb alignment and functional outcomes.Methods: This prospective cohort study included 71 consecutive opening-wedge HTO with PSCGs performed by three different surgeons with different experiences. The operating time, the surgeon's anxiety levels evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), the number of fluoroscopic images was systematically and prospectively collected. The accuracy of the postoperative alignment was defined by the difference between the preoperative targeted correction and the final post-operative correction both measured on standardized CT-scans using the same protocol (ΔHKA, ΔMPTA, ΔPPTA). Functional outcomes were evaluated at 1 year using the different sub-scores of the KOOS. Cumulative summation (CUSUM) analyses were used to assess learning curves.Results: The use of PSCGs in HTO surgery was associated with a learning curve of 10 cases to optimize operative time (mean operative time 26.3 min ± 8.8), 8 cases to lessen surgeon anxiety levels, and 9 cases to decrease the number of fluoroscopic images to an average of 4.3 ± 1.2. Cumulative PSCGs experience did not affect accuracy of post-operative limb alignment with a mean: ΔHKA = 1.0° ± 1.0°, ΔMPTA = 0.5° ± 0.6° and ΔPPTA = 0.4° ± 0.8°. No significant difference was observed between the three surgeons for these three parameters. There was no statistical correlation between the number of procedures performed and the patient's functional outcomes.Conclusion: The use of PSCGs requires a short learning curve to optimize operating time, reduce the use of fluoroscopy and lessen surgeon's anxiety levels. Additionally, this learning phase does not affect the accuracy of the postoperative correction and the functional results at 1 year.Level Of Evidence: II: prospective observational study. [ABSTRACT FROM AUTHOR]

Purpose: To compare the biomechanical properties of human semitendinosus graft presoaked with or without vancomycin under a load to failure tensile test.Methods: Thirty semitendinosus grafts harvested during anterior cruciate ligament reconstruction were included. These were dissected equally into 2 halves and subsequently randomly allocated to a vancomycin group and to a control group. A digital caliper was used to precisely measure each samples thickness, length, and width. For the vancomycin group, samples were presoaked in a solution of 5 mg/mL vancomycin for a duration of 10 minutes and the control group samples were presoaked in a physiological serum equally for 10 minutes. Mechanical testing was performed on a universal testing machine (Instron 5566-A) after a preconditioning of 10 cycles of 1 mm extension and a progression of 10 mm/min to failure for each sample. The stress-strain curve was obtained to determine the elastic modulus (Young's modulus), the ultimate tensile stress, the ultimate tensile elongation (UTE) before failure and the elasticity limit.Results: For the control group, the average Young's modulus value was 4.8 ± 0.8, the average UTS was 25.2 ± 5.2 MPa, the average percentage of UTE was 78 ± 17%, and the average elasticity limit value was 17.3 ± 5.3 MPa. For the vancomycin group, the average Young's modulus value was 4.7 ± 0.9, the average ultimate tensile stress was 24.1 ± 6.1 MPa, the average percentage of UTE was 82 ± 14%, and the average elasticity limit value was 18.5 ± 5.9 MPa. No significant difference was observed between the 2 groups for all investigated parameters.Conclusions: Presoaking of human semitendinosus graft with vancomycin does not alter its biomechanical properties.Clinical Relevance: This study demonstrates that vancomycin presoaking used to prevent post-anterior cruciate ligament reconstruction septic arthritis does not affect immediate biomechanical properties of semitendinosus tendons. [ABSTRACT FROM AUTHOR]

Purpose: In cases where the femur or tibia exhibits abnormal mechanical angulation due to degenerative changes or fracture, the contralateral leg is often used to complete preoperative templating. The aim of this study was to determine the degree of asymmetry between knee joints in healthy individuals and to determine whether it is affected by differing demographic parameters.Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 233 patients (102 males, 131 women; mean age 61.2 ± 15.2 years, mean body mass index 24.9 ± 4.4 kg/m2) The hip-knee angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior proximal tibial angle (ppta) and posterior distal femoral angle (PDFA) were then calculated for each patient. Results were then analysed to calculate femoral symmetry based on absolute differences (AD) and percentage asymmetry (%AS) using a previously validated method.Results: Our results do not demonstrate any considerable asymmetry (percentage of asymmetry > 2%) for all the anatomical parameters analysed: HKA (mean AD = 1.5°; mean AS % = 0.8, n.s), MPTA (AD = 1.1°; AS % = 1.3, n.s), PPTA (AD = 1.4°; AS % = 1.0, n.s), LDFA (AD = 1.2 mm; AS % = 1.4, n.s) and PDFA (AD = 0.9°; AS % = 1.0, n.s). Gender and ethnicity were not associated with significantly higher AD asymmetry. A significant correlation of AD asymmetry was observed between BMI and HKA, BMI and MPTA, and between patients' age and the MPTA.Conclusion: This data demonstrate that there is a non-statistically significant mechanical angle asymmetry between the two lower limbs. In cases where contralateral templating is used, such asymmetry will induce minimal (if any) clinical differences.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Despite the use of a locking plate a 30% incidence of lateral hinge fracture after Open-Wedge High Tibial Ostetomy was described in the literature. A finite element model was used to analyze if the presence of a hinge-securing screw in the osteotomy area, using Patient Specific Cutting Guides with a locking plate, decreases the stresses within the lateral hinge during compression and torsion. A 3D model of a tibial sawbone was used to simulate an opening wedge of 10°. To apply loads on the tibial plateau, two supports were modelled on each tibial plateau to simulate the femoral condyles forces. A two second model with a hinge-stabilizing was defined with two different screws (diameter 2 mm and 4 mm). Two cases of static charges were considered 1) compression test (2500 N) 2) Torsion test (along the tibial mechanical axis). During compression simulation, 17% of the total surface of lateral hinge was stressed between 41-50Mpa without hinge-securing screw while the amount of surface under stress between 41 and 50 MPa dropped significantly under screw stabilization (1% for the 2 mm and 3% for the 4 mm). During torsion stress simulation a decrease of the value of the maximal stress in the lateral hinge was also observed with the addition of a hinge-securing screw (37 MPa without screw, 27Mpa with a 2 mm screw and 25 Mpa with a 4 mm screw). Positioning a screw intersecting the cutting plane at the theoretical lateral hinge location associated with a locking plate reduces lateral hinge stress in both compression and torsion. Those findings need to be confirmed by further specimens' mechanical testing. • A 3D model of a left tibial was used to simulate a high tibial osteotomy with an opening wedge of 10°. • Analogously a second model with a hinge-stabilizing screw inserted at the hinge point was created. • The two models were tested using finite element analysis in both Compression and Torsion Settings. • The screw stabilized model exhibited reduced lateral hinge stress in both compression and torsion. • A 4 mm screw was superior to a 2 mm in terms of hinge stabilization. [ABSTRACT FROM AUTHOR]

Articular traumatic bone loss is a severe condition with heterogeneous outcomes, often necessitating complex technical solutions and posing challenges in managing both bone and cartilage loss. Thus, some surgeons have used a technique of osteochondral autograft using a rib to fix an articular bone loss to manage both of these tissue losses. We present the case of a 25-years-old patient, who had a complex open elbow injury. He presented an association of a terrible triad of the elbow injury with an open traumatic bone loss of the capitulum humeri and unfixable lesion of the lateral collateral ligament complex of the elbow. We initially managed these lesions with an external fixator for 2 months followed by a reconstruction of the capitulum humeri using a costal osteochondral autograft. Unfortunately, the patient was lost to follow-up after the 1 month post-operative consultation but he had some encouraging results. In this case report, we describe our technique using an osteochondral autograft to address complex bone and cartilaginous losses, thereby expanding the treatment options available to trauma surgeons. This case report shows that a reconstruction of the capitellum humeri for a traumatic bone loss with an osteochondral autograft using the eighth rib can be easily performed. More generally, this technique could even help to manage complex traumatic substance loss of both bone and cartilage in other locations. • An articular traumatic bone loss is a complex lesion which combine the management difficulties of the bone and the cartilaginous loss. • We present the case of a patient, who had an open traumatic bone loss of the capitulum humeri reconstructed using a costal osteochondral autograft. • In this case report, we describe the technique we used so that it can be considered in other locations. [ABSTRACT FROM AUTHOR]

Background: During medial unicompartmental knee arthroplasty (UKA), tibial tray implantation requires compromise between bone coverage and rotational position. It was hypothesized that morphometric tibial tray (MTT) would improve implant positioning and subsequently clinical outcomes as compared to symmetric tibial tray (STT).Methods: A total of 106 patients who underwent medial UKA in our department between January 2017 and March 2018 were included matched on gender and age (53 in each group). Inclusion criteria were symptomatic medial femorotibial osteoarthritis, functional anterior cruciate ligament, primary arthritis, or osteonecrosis. Rotation of the tibial implant, tibial bone coverage, medial and posterior overhang were assessed with a postoperative computed tomography scan. The Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score Short Form (KOOS SF), and the quality of life score EuroQoL 5-Dimensions 3-Levels (EQ5D3L) were assessed at a minimum of 1-year follow-up.Results: Implants of the STT group exhibited more external rotation (6.3° ± 4.02° vs 4.6° ± 3.59°; P = .04), and medial and posterior overhang >3 mm (35% vs 0% and 22% vs 0%; P < .0001) but no difference for tibial bone coverage (97.3% ± 11.35% vs 94.7% ± 10.89%; P = .23). Global KSS (188.6 ± 6.6 vs 175.2 ± 31.7; P < .01), KOOS SF (16.9 ± 6.1 vs 22.5 ± 11.8; P < .003), and EQ5D3L (1 ± 0.1 vs 0.9 ± 0.2; P < .001) were higher in MTT group. According to the multivariate analysis, MTT had a positive independent effect on the KSS, KOOS SF, and EQ5D3L.Conclusion: The use of an MTT in medial UKA allowed better implant positioning when decreasing the rate of overhang; superior short-term clinical outcomes were found as compared to STT. [ABSTRACT FROM AUTHOR]

Summary: Plant ‐specific lysin‐motif receptor‐like kinases (LysM‐RLKs) are implicated in the perception of N‐acetyl glucosamine‐containing compounds, some of which are important signal molecules in plant−microbe interactions. Among these, both lipo‐chitooligosaccharides (LCOs) and chitooligosaccharides (COs) are proposed as arbuscular mycorrhizal (AM) fungal symbiotic signals. COs can also activate plant defence, although there are scarce data about CO production by pathogens, especially nonfungal pathogens.We tested Medicago truncatula mutants in the LysM‐RLK MtLYK9 for their abilities to interact with the AM fungus Rhizophagus irregularis and the oomycete pathogen Aphanomyces euteiches. This prompted us to analyse whether A. euteiches can produce COs.Compared with wild‐type plants, Mtlyk9 mutants had fewer infection events and were less colonised by the AM fungus. By contrast, Mtlyk9 mutants were more heavily infected by A. euteiches and showed more disease symptoms. Aphanomyces euteiches was also shown to produce short COs, mainly CO II, but also CO III and CO IV, and traces of CO V, both ex planta and in planta.MtLYK9 thus has a dual role in plant immunity and the AM symbiosis, which raises questions about the functioning and the ancestral origins of such a receptor protein. [ABSTRACT FROM AUTHOR]