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Background: The correction of lower limb deformity should be performed at the site of deformity to maintain knee joint orientation. However, the effectiveness of open-wedge high tibial osteotomy (OWHTO) for treatment of medial osteoarthritis in varus malalignment without definite tibial varus deformity has not been confirmed. Purpose/Hypothesis: This study aimed to compare the clinical and radiologic outcomes after OWHTO in patients without tibial varus deformity versus patients with tibial varus deformity after matching for confounding factors. We hypothesized that these outcomes would be inferior in patients without tibial varus deformity. Study Design: Cohort study; Level of evidence, 3. Methods: The outcomes of 133 OWHTO operations for medial osteoarthritis in 107 patients were retrospectively reviewed after follow-up for >2 years. The patients were divided into group 1 (tibia with varus deformity, preoperative medial proximal tibial angle [MPTA] Results: After propensity score matching, 32 patients were selected for each group. The mechanical hip-knee-ankle angle was corrected without significant difference from a mean ± SD varus angle of 8.0°± 3.3° to valgus angle of −3.2°± 2.5° in group 1 and from varus 8.0°± 3.6° to valgus −3.9°± 1.7° in group 2. The preoperative joint line obliquity was greater in group 2 as compared with group 1 (2.2°± 2.2° vs −0.4°± 1.8°, P < .001). With a similar 10° correction angle, the postoperative MPTA and joint line obliquity were 96.6°± 2.5° and 5.3°± 2.3°, respectively, in group 2, which were greater than 94.0°± 2.6° and 3.5°± 1.8°, respectively, in group 1 (both P < .001). The changes in joint space width and mechanical hip-knee-ankle angle were not significantly different between the groups over the follow-up period. At the last follow-up, the postoperative KSS objective score and WOMAC pain score in terms of symptom improvement were not significantly different between groups ( P = .092 and .068). However, the postoperative KSS and WOMAC functional scores were significantly worse in group 2 than in group 1 (77.3 ± 14.1 vs 84.4 ± 11.6, P = .044; 10.3 ± 9.2 vs 5.6 ± 7.2, P = .001). In group 1, 96.9% and 100% of patients showed improvements of >10 points in the KSS functional score and 15 points in the WOMAC functional score based on MCID or minimally important change. Meanwhile, 65.6% and 81.3% of patients in group 2, which were significantly lower than those of group 1, were improved beyond the MCID or minimally important change ( P = .001 and .024, respectively). Conclusion: In varus malalignment, the knee joint line was more oblique in patients without tibial varus deformity after OWHTO pre- and postoperatively. The clinical outcomes in terms of functional scores were inferior in patients without tibial varus deformity. However, the radiologic outcomes and symptomatic improvement after OWHTO were comparable regardless of the preoperative tibial varus deformity on midterm follow-up.

Air-stable ambipolar organic field-effect transistors (OFETs) are fabricated from the active layers of π-conjugated polymer and elastomer composites. Compared to the p-channel dominant charge transport behavior of pure donor–acceptor-type copolymer semiconductors, the polymer composites exhibited superior ambipolar charge transport characteristics with well-balanced and high electron and hole mobilities, both of more than 1.0 cm2/Vs. Moreover, these OFETs exhibited significantly improved air stabilities, particularly in the n-channel regime, which is because the encapsulation effect of the nanofibril conjugated polymers surrounded by the elastomer matrix efficiently suppressed electron trapping. At the optimal composition, spinodal decomposition of the constituent polymers is induced, forming fibrillar network structures during the solution casting and thermal annealing processes. These anisotropic polymer aggregates embedded in the elastomer matrix are induced to align in a direction parallel to the channel by directional printing techniques, such as off-centered spin coating and bar coating. This strategy of controlling the semiconductor film morphology is beneficial for the fabrication of high-performance and air-stable complementary-like electronic circuits. Furthermore, the embedded nanofibril morphology in a deformable elastomer can be widely used to realize stretchable optoelectronic devices.

Background: Whether lateral hinge fracture (LHF) after open-wedge high tibial osteotomy (OWHTO) is associated with the change in tibial posterior slope (PS) has not been determined. Risk factors for PS increase are still unknown. Hypothesis: There will be no difference in patient characteristics and radiographic factors when stratified by change in tibial PS (ΔPS). Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of 148 patients who underwent OWHTO with locking-plate fixation from 2010 to 2016. Included were those with a minimum 2-year follow-up and true lateral radiographs before and at 1 year after surgery. ΔPS was defined as a difference between preoperative and 1-year postoperative PS, with positive values indicating PS increase. ΔPS was classified into Results: There were 79 (53.4%) patients with ΔPS Conclusion: LHF type and correction angle were associated with ΔPS after OWHTO, and unstable LHF and large correction angle were risk factors for PS increase. There was no significant difference in clinical outcomes according to ΔPS.

Purpose To compare the differences with respect to clinical and graft survivorship and patient-reported outcomes (PROs) between lateral (LMAT) and medial (MMAT) meniscus allograft transplantation. Methods Patients having a primary MAT between 1998 and 2016 were enrolled. The inclusion criteria were (1) patients who had a minimum 2-year follow-up and (2) patients who had magnetic resonance imaging (MRI) >2 years after surgery. Knees with localized grade 4 articular cartilage lesions >3 cm2 at the time of MAT were excluded. Clinical failure was defined as follows: modified Lysholm score 50% of the graft, meniscectomy to the meniscocapsular junction zone, conversion to revision MAT, or realignment osteotomy or arthroplasty. Graft failure was defined as follows: tears involving >50% of the graft or unhealed peripheral rim observed on MRI. Kaplan–Meier survival analysis with log-rank test was used to compare survivorship between LMAT and MMAT. Patient-reported outcomes were compared based on the Hospital for Special Surgery, modified Lysholm, and International Knee Documentation Committee subjective scores collected preoperatively and at the final follow-up. Results A total of 299 knees (249 LMAT, 50 MMAT, mean age 33.0 ± 9.8 years) were included. Twenty clinical [2 MMAT (4.0%), 18 LMAT (7.2%)] and 24 graft [2 MMAT (4.0%), 22 LMAT (8.8%)] failures were identified. The mean clinical follow-up period was 63.1 ± 43.1 months (range 2 to 248), and MRI follow-up period was 62.6 ± 43.8 months (range 2 to 248). No significant differences in clinical and graft survivorship were found between the LMAT and MMAT groups (P = .481, P = .271, respectively). PROs preoperatively and at last follow-up also showed no significant difference between the groups. Conclusion No significant differences in clinical survivorship, graft survivorship, and PROs were found between the LMAT and MMAT groups. Level of evidence Level III, retrospective comparative study.

Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction, the residual rotational instability of knee joints remains a major concern. The anterolateral ligament (ALL) has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint. Numerous studies investigated the anatomy, function, and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability. However, controversies regarding its existence, prevalence, and femoral and tibial insertions need to be addressed. According to a recent consensus, ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint, with some anatomic variations. The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies. Generally, ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy's tubercle below the lateral tibial plateau.

Background Femoral coronal bowing (FCB) has been reported to be a risk factor for mechanical malalignment after total knee arthroplasty (TKA). However, the effects of FCB on the long-term survivorship (when postoperative mechanical alignment (MA) is neutral after TKA) have not been determined. Hypothesis The effects of FCB on the cumulative survivorship after TKA may be significantly smaller compared with those of MA. Patients and methods Consecutive 328 knees of 211 patients (10 males, 201 females) who underwent TKA between 1995 and 2009 (mean age of 64.2 ± 6.7 years at the time of TKA, mean follow-up period of 11.9 ± 2.5 years) were retrospectively evaluated. FCB and MA were evaluated using preoperative and immediate postoperative whole-leg anteroposterior radiographs, respectively. The patients were grouped according to FCB and postoperative MA, which included group A (FCB ≤ 5°, MA ≤ 3°), B (FCB > 5°, MA ≤ 3°), C (FCB > 5°, MA > 3°), and D (FCB ≤ 5°, MA > 3°). Primary end-point was defined as aseptic mechanical failures requiring revision TKA. Survivorship was assessed using the Kaplan-Meier method and compared using log-rank tests. Factors associated with the risk of aseptic mechanical failures were analyzed by Cox regression analysis. Preoperative and final follow-up clinical outcomes were assessed using Hospital for Special Surgery (HSS) scores. Results Group A, B, C, and D included 190, 73, 40, and 25 knees, respectively. The 10-year survivorship was similar between group A and B (96.3 ± 1.4% vs. 98.6 ± 1.4%; p = 0.733) and group C and D (87.3 ± 5.3 vs. 87.6 ± 6.7%; p = 0.974); however, it was significantly higher in group B than in group C (p = 0.036) and in group A than in group D (p = 0.005). Age (OR = 0.991; 95% CI 0.906–1.085; p = 0.002) and MA > 3° (OR = 3.645; 95% CI 1.744–7.604; p = 0.001) were associated with the risk of aseptic mechanical failures. The mean preoperative and final HSS scores in the four groups were not significantly different. Discussion Marked FCB was not associated with long-term survivorship for knees with neutral alignment after TKA. However, non-neutral postoperative alignment reduced long-term survivorship for knees with marked FCB. Level of evidence III, Retrospective comparative cohort study.

Background: Long-term outcomes after lateral meniscal allograft transplantation (MAT) are not completely understood. Purpose/Hypothesis: We investigated changes in meniscal extrusion in the coronal and sagittal planes using magnetic resonance imaging (MRI) after lateral MAT through long-term follow-up. We hypothesized that meniscal extrusion would progress during follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients subjected to lateral MAT were followed up by MRI evaluation in both planes at 1, 4 to 6, and >8 years after MAT. Meniscal extrusion and entire meniscal widths in the coronal plane and anterior (ACMD) and posterior (PCMD) cartilage meniscal distances in the sagittal plane were measured, and values were compared at each time point. Clinical outcomes were evaluated using the Lysholm score. Results: A total of 27 lateral MATs were included with a mean MRI follow-up period of 10.3 years (range, 8.1-15.3 years). The mean absolute meniscal extrusion (coronal plane) was not significantly different at each time point. However, the relative value differed (0.27 ± 0.04 at 1 year; 0.33 ± 0.06 at >8 years after MAT) owing to entire meniscal width reduction. There was no difference in the mean absolute value of the ACMD in the sagittal plane. However, relative values differed (0.21 ± 0.01 at 1 year; 0.27 ± 0.06 at >8 years) owing to entire meniscal width reduction. Absolute and relative values of the PCMD remained unaffected at each time point. The Lysholm score increased after surgery but did not differ postoperatively. Conclusion: During the long-term follow-up of extrusion after lateral MAT using MRI, absolute extrusion remained unchanged across all planes. Relative extrusion in the coronal plane and of the ACMD in the sagittal plane significantly increased, with no differences in the PCMD on follow-up. Clinical outcomes after surgery improved compared with those before surgery and were maintained throughout the long-term follow-up period.

This study aimed at determining whether overcorrection after open wedge high tibial osteotomy (OWHTO) would be predicted by the magnitude of preoperative medial and lateral coronal soft tissue laxity around the knee joint.Overall, 68 knees of 62 patients who underwent OWHTO for primary medial osteoarthritis were retrospectively reviewed. The mechanical hip-knee-ankle (HKA) axis, weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), joint line obliquity, coronal subluxation, and joint line convergence angle (JLCA) were measured on full-weight-bearing long-standing HKA radiographs preoperatively and at 1 year postoperatively. The varus valgus stress angle was measured on preoperative radiographs. The correction amount due to soft tissue factors was calculated as the difference between the WBL ratio on postoperative 1-year radiographs and that on virtually corrected preoperative radiographs with the same amount of MPTA at 1 year postoperatively. The patients were grouped according to the presence or absence of a ≥ 10% overcorrection of WBL ratio (overcorrection or expected correction). Multiple logistic regression analysis was performed to identify the preoperative risk factors of overcorrection.The average WBL ratio was corrected from 19.0 ± 13.5% preoperatively to 61.6 ± 9.1% postoperatively (P 0.001). The average MPTA changed from 85.1 ± 1.7° preoperatively to 93.6 ± 2.6° postoperatively, resulting in an average tibia correction angle of 8.6 ± 3.1°. The average estimated correction from soft tissue factors was 5.8 ± 7.4% of the WBL ratio. Soft tissue correction of the WBL ratio 10% was confirmed in 17 patients (28%). The preoperative JLCA and valgus stress angle were significantly greater in the overcorrection group than in the expected correction group: 5.0 ± 1.7° vs. 3.4 ± 1.9° (P = 0.003) and 2.4 ± 1.0° vs. 1.3 ± 1.2° (P = 0.002), respectively. Among the radiologic parameters, the presence of both ≥ 4° JLCA and ≥ 1.5° valgus stress angle was the only significant risk factor for overcorrection from soft tissue factors (P = 0.006; odds ratio, 30.2).The magnitude of both medial and lateral coronal soft tissue laxity was a predictor of overcorrection from soft tissue factors after OWHTO. Overcorrection was more likely to occur in cases with both ≥ 4° JLCA and ≥ 1.5° valgus stress angle.III.

Purpose To evaluate the incidence and degree of shrinkage of transplanted fresh-frozen meniscal allografts in a long-term period of >8 years and to investigate whether the shrinkage of allograft progresses and is associated with inferior clinical and radiologic outcomes after meniscal allograft transplantation (MAT) in the long term. Methods Twenty-two knees were reviewed in 20 patients (mean age, 31.41 ± 9.11 years) who underwent isolated lateral MAT. All patients were followed with magnetic resonance imaging (MRI) for at least 8 years (mean, 11.78 ± 3.10 years). The allograft widths of the anterior horn, mid-body, and posterior horn at 1 and >8 years postoperatively were measured by using MRI. To estimate the degree of shrinkage, the relative changes in widths during intervals were calculated. Patients were categorized into 4 groups according to shrinkage degree: minimal ( 50%). The joint space width was measured on the weightbearing radiographs to evaluate the radiologic outcome. The Lysholm score was used to evaluate the clinical outcome. Results The relative change in the width of the anterior horn, mid-body, and posterior horn, compared with that 1 year postoperatively, was 82.7% (95% confidence interval 77.4%-87.5%), 75.9% (70.7%-81.0%), and 85.0% (81.4%-88.5%), respectively. The shrinkage degree was greater at the mid-body than at the anterior and posterior horns. About 70% of allografts showed ≥10% shrinkage of the posterior horn. Meniscal shrinkage did not show significant correlation with clinical and radiologic outcome. Conclusions At long-term follow-up (>8 years), shrinkage of transplanted fresh-frozen meniscal allografts progressed at 1 year postoperative. On average, the shrinkage was mild and more prominent in the mid-body than in the anterior or posterior horn. In this study, it could not be concluded that the shrinkage of allografts was significantly associated with inferior clinical and radiologic outcomes in the long term. Level of Evidence Level IV, therapeutic case series.

To evaluate the effect of age itself on the joint survivorship after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus tears (DMTs).Patients undergoing APM for DMTs during 1999-2010 were retrospectively reviewed. The inclusion criteria were as follows: (1) DMTs identified on preoperative MRI scans, (2) no definite history of trauma, and (3) follow-up duration more than 5 years. In evaluation of the joint survivorship, the endpoint was defined as conversion to arthroplasty (or realignment osteotomy) or progression to Kellgren-Lawrence grade 4. The study population was divided into older and younger groups by a cutoff age at which the difference in the joint survival rates was maximized, using a time-dependent receiver operating characteristic (ROC) curve. The two groups were then matched based on propensity scores. The joint survival rates were compared between the groups using Kaplan-Meier analysis, before and after propensity score matching (PSM).A total of 633 knees were included. The cutoff age was calculated as 60 years. Before PSM, 239 knees were allocated to the older group (≥ 60 years) and 394 knees to the younger group ( 60 years). A significant difference in the joint survival rates was noted between the groups (log-rank test, p 0.001). After PSM, 183 knees remained in each group. The difference in the survival rates was no more statistically significant (n.s.). The latest Lysholm scores of the older and the younger groups before PSM were 72.2 ± 20.8 and 79.9 ± 19.6, respectively (p 0.001); however, the scores after PSM were 73.2 ± 20.3 and 77.4 ± 20.5, respectively (n.s.).Joint survivorship after APM was affected by other factors associated with the aging process, such as cartilage status and meniscal tear pattern, rather than age itself. Advanced age should not be the only reason for precluding APM in treatment of DMTs. APM is a viable option when treating DMTs in elderly patients if adopted with caution. According to this study, a surgeon should assess the age-related factors when he considers APM in elderly patients.III.

Background: Magnetic resonance imaging (MRI) is an effective tool for objective evaluation after meniscal allograft transplant (MAT). Little is known about the association between MRI features of allograft and clinical outcomes. Purpose/Hypothesis: To assess the degree and location of signal intensity (SI) as well as the morphology of allografts on MRI after MAT and evaluate the association between clinical outcomes and MRI features in the midterm period. It was hypothesized that a high SI accompanied by a deformed allograft in specific locations on MRI would be associated with inferior clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent MAT with fresh-frozen allografts and had >3 years of follow-up with 3.0-T MRI scans. Allograft status was assessed by SI on MRI as grade 0 (normal), grade 1 (globular increased SI not adjacent to the articular surface), grade 2 (linear SI within the meniscus), or grade 3 (increased SI extended to the articular surface). Allograft morphology was assessed by the presence of distorted contours. Clinical outcomes were evaluated using the Lysholm score. The association between clinical outcomes and MRI findings was assessed by multiple linear regression analysis. Results: A total of 138 patients (156 MAT procedures: 132 lateral, 24 medial) with a mean follow-up period of 55.4 ± 19.9 months (range, 36-110 months) were enrolled in this study. Grade 3 SI was observed in the posterior meniscus root and posterior third of the allograft in 39 (25%) and 62 (39.7%) MATs, respectively. Among the 62 MATs with grade 3 SI in the posterior third of the allograft, 34 (54.8%) were accompanied by distorted allograft contour. The presence of grade 3 SI with distorted contour in the posterior third of the allograft was significantly associated with inferior outcomes (β = –6.5 [95% CI, –12.5 to –0.5]; P < .035), as was the presence of grade 3 SI in the posterior meniscus root (β = –5.5 [95% CI, –10.5 to –0.4]; P < .034). Conclusion: On MRI evaluation in the midterm period after MAT, grade 3 SIs of the meniscal allograft were observed in about a third of the cases, and the association with clinical outcomes was dependent on the specific location and morphology of the allograft on MRI.

This study aimed to evaluate graft survivorship according to the size and location of chondral defects and its effect on clinical outcomes after meniscal allograft transplantation (MAT). It was hypothesized that large chondral defects would be associated with inferior outcomes. Patients who underwent lateral MAT with fresh-frozen allografts between 2007 and 2016 were retrospectively reviewed. The inclusion criteria were patients with femoral or tibial chondral defects (International Cartilage Repair Society grade 4) who were followed up more than 2 years with 3.0-T magnetic resonance imaging (MRI) scans. Maximal lesion diameter and location were assessed on MRI. The patients were divided into two groups, with chondral defects of

Background: Analyzing the current trends in meniscal allograft transplant (MAT) is important. However, no recent descriptive epidemiological study based on a national registry database has been reported. Purpose: To assess serial trends in the incidence of MAT in the Republic of Korea between 2010 and 2018, stratified by age and sex. Study Design: Descriptive epidemiology study. Methods: The number of MAT procedures between 2010 and 2018 was assessed using the Korean National Health Insurance claims database. We used code N0825 for isolated MAT and code N0820 for MAT combined with other procedures, such as ligament reconstruction, realignment surgery, and cartilage procedures. The incidence of MAT was calculated using the general population data of the Republic of Korea, and Poisson log-linear regression analysis was used to assess statistical serial trends. Results: A total of 369 patients underwent MAT in 2010 and 774 in 2018, with an increase of 47.6%. The incidence of MAT per 100,000 person-years in the Republic of Korea increased significantly during the period studied, from 0.75 in 2010 to 1.50 in 2018 (annual relative risk = 1.09; 95% CI, 1.08-1.10; P < .001), whereas the rate of MAT combined with other procedures increased from 5.1% in 2014 to 16.0% in 2018. MAT was mostly performed in men in their early 20s. Most MAT procedures were performed in the summer and winter, with distinct seasonal variances. Conclusion: In the Republic of Korea, the incidence of MAT in 2018 was 1.50 per 100,000 person-years, with an average annual increase of 10% since 2010. MAT was mostly performed in men in their early 20s, and the rate of MAT combined with other procedures has increased since 2014.

To evaluate the effect of joint line obliquity of the knee on intrasubstance degeneration of isolated medial meniscus horizontal cleavage tear (HCT) in young patients.Sixty knees of 50 patients aged 40 years (mean age, 33.3 ± 5.5 years old), who underwent arthroscopic partial meniscectomy (APM) for HCT, were retrospectively reviewed. The radiologic parameters of alignment, including mechanical hip-knee-ankle (mHKA) angle, posterior tibial slope, and joint line obliquity, were measured on preoperative long-standing whole-leg radiographs. The patients were classified into two groups, simple horizontal type (type 1) and complicated type (type 2), according to the presence of diffuse intrasubstance degeneration of the meniscus on preoperative magnetic resonance imaging. The risk factors for intrasubstance degeneration of HCT were analyzed using multiple logistic regression analysis. Medial joint space width (JSW) on weight-bearing 45° flexion posteroanterior radiographs and the mHKA were measured to evaluate the radiographic outcomes. The clinical outcomes were evaluated using the modified Lysholm score. Among patients followed-up for 5 years, the clinical and radiologic outcomes were compared between the two groups.The joint line obliquity was significantly greater in the type 2 group than in the type 1 group (2.9 ± 1.3 vs. 0.9 ± 1.4, P 0.001), and a significant risk factor for diffuse intrasubstance degeneration (P 0.001; odds ratio, 2.88; 95% confidence interval, 1.27-6.54). The relative changes in the JSW in the type 2 group were greater than those in the type 1 group during the mean follow-up period of 7.9 ± 2.5 years (26% vs 10%, P = 0.045). The modified Lysholm score was not significantly different between the two groups (n.s).The diffuse intrasubstance degeneration of medial meniscus HCTs in young patients is associated with increased joint line obliquity of the knee joints. The radiologic outcomes after APM were inferior in the patients with diffuse intrasubstance degeneration. However, the clinical outcomes were not different during the mid-term follow-up.Level III.

Background: Knee joint-line orientation is altered after open-wedge high tibial osteotomy (OWHTO), and excessive joint-line obliquity (JLO) can adversely affect outcomes. Little is known regarding preoperative prediction of postoperative knee JLO. Purpose/Hypothesis: The purpose of this study was to assess the correlation between the amount of lower limb adduction and changes in knee JLO after OWHTO. The hypothesis was that postoperative knee JLO could be predicted using the amount of lower limb adduction after OWHTO. Study Design: Case series; Level of evidence, 4. Methods: The records of 67 patients (77 knees) who underwent OWHTO for medial compartment osteoarthritis were retrospectively reviewed. The mechanical hip-knee-ankle (HKA) axis, lateral distal femoral angle, medial proximal tibial angle (MPTA), knee JLO, ankle JLO, and joint-line convergence angle were measured on standing whole-leg plain radiographs preoperatively and at 1 year postoperatively. The limb adduction angle was defined as the angle between the native weightbearing line (WBL) and the planned WBL on preoperative standing whole-leg plain radiographs. The predicted knee JLO was calculated as the sum of the preoperative knee JLO and the limb adduction angle. Multivariable linear regression analysis was used to identify the preoperative radiologic factors associated with the postoperative knee JLO. The agreement between postoperative and predicted values was determined using intraclass correlation coefficients (ICCs). Results: The estimated limb adduction angle was 4.2° ± 1.3°, and the predicted knee JLO was 4.9° ± 3.0°. The actual postoperative knee JLO was 4.5° ± 2.4°, which was a significant increase from 0.7° ± 2.4° preoperatively ( P < .001). Excellent agreement was found between the predicted knee JLO and postoperative knee JLO (ICC = 0.928; P < .001). Limb adduction angle and changes in preoperative MPTA were significantly associated with changes in knee JLO ( P < .001). On multivariable linear regression analysis, preoperative knee JLO and limb adduction angle were significantly associated with postoperative knee JLO ( P < .001; R 2 = 0.83). Conclusion: Changes in knee JLO after OWHTO were associated with adduction of the lower limb after OWHTO. During preoperative planning, postoperative knee JLO can be predicted as the sum of the preoperative knee JLO and the limb adduction angle between the preoperative WBL and planned WBL.

To compare the serial changes in radiographic outcomes in terms of the mechanical axis (MA) angle and medial joint space width (JSW) between medial meniscus posterior root tear (MM PRT) and non-root tear (MM NRT) after arthroscopic partial meniscectomy (APM).Patients who underwent APM for degenerative MM PRT or MM NRT from January 1999 to July 2012 were retrospectively reviewed. One hundred ten patients each in the MM PRT group and the MM NRT group, who were matched through propensity score matching (adjusting for confounding factors such as age, sex, body mass index, anatomic axis, cartilage state of the medial compartment, and follow-up period), were included in the study. The MA angle on weightbearing whole-leg radiographs and the medial JSW on weightbearing 45° flexion posteroanterior radiographs were measured to evaluate the radiographic outcomes. The serial changes were compared between radiographs taken before surgery, at postoperative 3 to 5 years, and at postoperative 5 years to the last follow-up. The linear mixed model was used to compare the changes in radiographic outcomes during the follow-up period between groups.The 2 groups were balanced with standardized mean differences of0.2 after propensity score matching. Both the MM PRT and NRT groups showed increased varus alignment after surgery. However, there was no significant difference in the change in the MA angle during the follow-up period between groups (P = .182). The medial JSW also showed progression of joint space narrowing after surgery in both groups; however, there was no significant difference in the change in medial JSW during the follow-up period between groups (P = .270).The radiographic outcomes after partial meniscectomy in terms of the MA angle and medial JSW show comparable results between degenerative MM PRT and NRT after proper matching of confounding factors.Level III, retrospective comparative study.

No comparative studies of outcomes between degenerative medial meniscus posterior root tear (MM PRT) and non-root tear (NRT) have been conducted. This study aimed to compare joint survival and clinical outcome between MM PRT and MM NRT after partial meniscectomy with proper control of confounding factors. One hundred and ten patients each in MM PRT and MM NRT groups who underwent arthroscopic partial meniscectomy were retrospectively evaluated through propensity score matching. Joint survival was assessed on the basis of surgical and radiographic failures. Clinical outcomes were assessed using the Lysholm score. The confounding variables were well balanced between the groups, with standardized mean differences of

Herein, we demonstrate the preparation of a scalable bar-coated nanocomposite organic-inorganic hybrid film and developed robust barrier films for general purpose packaging. Using combinatory printing of polymers and nanocomposites by bar coating, a facile and effective barrier film fabrication method was developed. Based on a preliminary survey with several material combinations, a rationalized two-fold nanocomposite film was fabricated. The number of layers in the barrier film significantly modified oxygen barrier performance such that, for the 1 wt% ethylene vinyl alcohol (EVOH) intercalated film, the oxygen transmission rate (OTR) of the 5-layer sample was reduced to 31.69% of the OTR of the 3-layer sample (112.8 vs. 35.75 cc/(m² · day)). In addition, fine tuning the amount of EVOH polymer enabled further improvement of oxygen barrier performance. Intercalation of 2 wt% EVOH resulted an OTR improvement from 35.75 in the 1 wt% sample to 11.90 cc/(m² ·day), which is a 4.25-fold enhancement. Overall barrier characteristics proved that our approach could be used for large-area deposited, oxygen resistant, general purpose packaging applications.

Background: Meniscal allograft transplantation (MAT) is a widely performed surgical technique used to reconstruct meniscal deficiencies after meniscectomy. However, the long-term effects of extrusion on clinical and radiologic outcomes are unclear. Hypothesis: In long-term follow-up, extrusion after MAT would show poorer outcomes than nonextrusion and would lead to faster progression of arthritic changes. Study Design: Cohort study; Level of evidence, 3. Methods: Forty-five MAT cases (lateral, n = 36; medial meniscal, n = 9) with a minimum 8-year follow-up period were selected. The mean follow-up period was 12.3 years (range, 8.0-19.6 years). Data were collected on patients’ sex, age, surgical side, and mechanical axis deviation. Patients were categorized into 2 groups: extrusion (≥3 mm) and nonextrusion (8 years postoperative). Differences of the measured and relative JSW values between the groups and differences at different time points were analyzed. The Lysholm score was used to evaluate clinical function. Results: Mean ± SD extrusion was 3.07 ± 0.82 mm. The extrusion and nonextrusion groups were composed of 19 (42.2%) and 26 (57.8%) patients, respectively. Analysis of JSW showed a difference in relative JSW between the groups at >8 years ( P = .017). At the point of transition from 4 to 6 years to >8 years, the differences in absolute JSW values were −1.25 ± 0.78 mm (extrusion group) and −0.58 ± 0.66 mm (nonextrusion group; P < .001). Relative JSW values also differed between groups (extrusion group, −0.22 ± 0.13; nonextrusion group, −0.04 ± 0.18; P < .001). No differences were observed in the Lysholm scores between the groups at each time point. Conclusion: Long-term follow-up after MAT revealed a greater decrease in JSW in the extrusion group than in the nonextrusion group. However, no significant differences in clinical outcomes were observed.

Background Femoral coronal bowing (FCB) has been reported to be a risk factor for mechanical malalignment after total knee arthroplasty (TKA). However, the effects of FCB on the long-term survivorship (when postoperative mechanical alignment (MA) is neutral after TKA) have not been determined. Hypothesis The effects of FCB on the cumulative survivorship after TKA may be significantly smaller compared with those of MA. Patients and methods Consecutive 328 knees of 211 patients (10 males, 201 females) who underwent TKA between 1995 and 2009 (mean age of 64.2 ± 6.7 years at the time of TKA, mean follow-up period of 11.9 ± 2.5 years) were retrospectively evaluated. FCB and MA were evaluated using preoperative and immediate postoperative whole-leg anteroposterior radiographs, respectively. The patients were grouped according to FCB and postoperative MA, which included group A (FCB ≤ 5°, MA ≤ 3°), B (FCB > 5°, MA ≤ 3°), C (FCB > 5°, MA > 3°), and D (FCB ≤ 5°, MA > 3°). Primary end-point was defined as aseptic mechanical failures requiring revision TKA. Survivorship was assessed using the Kaplan–Meier method and compared using log-rank tests. Factors associated with the risk of aseptic mechanical failures were analyzed by Cox regression analysis. Preoperative and final follow-up clinical outcomes were assessed using Hospital for Special Surgery (HSS) scores. Results Group A, B, C, and D included 190, 73, 40, and 25 knees, respectively. The 10-year survivorship was similar between group A and B (96.3 ± 1.4 vs. 98.6 ± 1.4%; p = 0.733) and group C and D (87.3 ± 5.3 vs. 87.6 ± 6.7%; p = 0.974); however, it was significantly higher in group B than in group C (p = 0.036) and in group A than in group D (p = 0.005). Age (OR = 0.991; 95% CI 0.906–1.085; p = 0.002) and MA > 3° (OR = 3.645; 95% CI 1.744–7.604; p = 0.001) were associated with the risk of aseptic mechanical failures. The mean preoperative and final HSS scores in the four groups were not significantly different. Discussion Marked FCB was not associated with long-term survivorship for knees with neutral alignment after TKA. However, non-neutral postoperative alignment reduced long-term survivorship for knees with marked FCB. Level of evidence III, Retrospective comparative cohort study.

Many soft-electronic applications, such as internet of things (IoTs) and wearable smart devices, must be operated at extremely low power because of their limited power sources. Here, we report the fabrication and performance of ultralow operating-voltage organic-inorganic hybrid thin-film transistors (TFTs) and their complementary-like circuits using solid-state-electrolyte gate insulators (SEGIs). The high specific capacitance of SEGIs, which is of the order of a few μF·cm−2, enables the supply of enough power to fully turn on TFT devices with operating voltages below ±2 V. For low-cost printable electronic circuitries, n-type amorphous metal-oxide semiconductors and p-type polythiophene-based π-conjugated organic molecules are sequentially deposited via solution processes, and their corresponding p- and n-channel TFT performances exhibit relatively well-balanced ambipolar charge-transport, with high hole and electron mobilities of more than 1 cm2 V−1 s−1. The ambipolar hybrid TFTs based on bi-layered organic and inorganic hetero-interfaces are then used to construct complementary-like inverters with very low operation bias (

Aims To examine the effects of longitudinal changes in fat mass or lean body mass on risk of Type 2 diabetes in Korean adults. Methods Participants included 18 687 Korean adults (aged 20–79 years) who underwent routine medical check-ups in 2007–2008 and again in 2011–2012 with a mean (range) of 4.3 (3.0–5.7) years interval. Total fat, fat-free, and soft fat-free masses were determined using bioelectrical impedance. Results A total of 692 subjects (3.7%) developed Type 2 diabetes during follow-up. Those who developed diabetes had a greater increase in percent body fat (2.9 ± 3.0 vs 2.6 ± 3.2 percentage points, P = 0.043), as well as greater decreases in percent fat-free mass (−3.0 ± 3.3 vs −2.7 ± 3.3 percentage points, P = 0.008) and percent soft fat-free mass (−2.8 ± 3.1 vs −2.4 ± 3.1 percentage points, P = 0.003) compared with those who did not develop diabetes. In multiple logistic regression analysis, an increase in total fat mass of > 10% was associated with an increased odds ratio for diabetes (1.29, 1.05–1.60), and a decreased total fat mass was associated with lower odds ratio (0.75, 0.58–0.96). A loss of total fat-free mass of > 5% (odds ratio 1.08, 0.90–1.30) or an increase in total fat-free mass (odds ratio 0.96, 0.71–1.28) was not significantly associated with the risk of diabetes after adjustments for baseline waist circumference and glucose levels. Conclusions These results show that changes in total body fat mass, but not lean body mass, are associated with development of Type 2 diabetes, independently of baseline measures of general or central obesity.

Controversies still exist regarding the relative contributions of insulin resistance and β-cell dysfunction to the pathogenesis of Type 2 diabetes in different populations. We examined the associations of baseline insulin resistance and β-cell function indices with the development of Type 2 diabetes in Koreans.We analysed the clinical and laboratory data of 17 878 Korean adults (age 20-79 years) who underwent routine medical examinations with a median interval of 3.5 years (range 2.5-4.7 years). Using the homeostasis model assessment, insulin resistance (HOMA-IR) and β-cell function (HOMA-%B) indices at baseline were assessed.Those who developed diabetes (n = 732, 4.1%) had significantly higher fasting serum insulin level (53.4 ± 31.2 vs. 41.4 ± 23.4 pmol/l) and HOMA-IR (2.38 ± 1.45 vs. 1.65 ± 1.02) and lower HOMA-%B (74 ± 47 vs. 85 ± 48) at baseline (P0.001 for all). Both high HOMA-IR and low HOMA-%B were independently associated with an increased odds ratio of incident Type 2 diabetes. Among the participants who developed diabetes, 29% demonstrated predominant β-cell dysfunction (HOMA-%B25th percentile) and 51% had predominant insulin resistance (HOMA-IR75th percentile). When we divided the participants according to the median BMI of the whole population (23.7 kg/m²), 49% of participants in the low BMI group demonstrated predominant β-cell dysfunction and 26% had predominant insulin resistance, whilst 21% in the high BMI group demonstrated mainly β-cell dysfunction and 60% had mainly insulin resistance.In individuals with low BMI, β-cell dysfunction is the predominant defect, whereas insulin resistance is the predominant pathogenetic factor in individuals with high BMI in the development of Type 2 diabetes in Koreans.

Aims The optimal anthropometric measure of obesity or body fat distribution that best predicts the risk of Type 2 diabetes in Asians is unclear. Moreover, it has not been determined whether BMI modifies the effect of body fat distribution on diabetes risk in Asians. Methods We analysed the anthropometric and laboratory data of 7658 non-diabetic Korean adults (5061 men and 2597 women, aged 20–79 years) who underwent routine medical check-ups at 5-year intervals. BMI, waist circumference, waist-to-height ratio, and bioelectrical impedance (to calculate fat mass and per cent body fat) were measured at baseline. Results Of the 7658 participants, 278 subjects (3.6%) developed diabetes over 5 years. Each of the anthropometric measures of general obesity (BMI, fat mass, per cent body fat) and central body fat distribution (waist circumference and waist-to-height ratio) was a good predictor of Type 2 diabetes. However, when the areas under the receiver-operating characteristic curves were compared, BMI (0.697; 95% CI, 0.669–0.725), waist circumference (0.709, 0.682–0.736) and waist-to-height ratio (0.718, 0.692–0.743) were better predictors of diabetes risk than fat mass (0.672, 0.643–0.700) or per cent body fat (0.657, 0.628–0.686). In the low- (

The frequency and temperature dependence of the complex dielectric constant of Bi4-xLaxTi3O12 (BLT, x=0.9) ferroelectric thin film was studied in the frequency range of 10-1∼106 Hz and the temperature range of 298∼673 K. A low frequency dielectric dispersion (LFDD) was found. A model was proposed to account for this observed phenomena. The complex dielectric constant data obtained in the measured frequency and temperature ranges have been found to fit very well to the dielectric dispersion relation: e*=e∞+iσ/e0ω+[B(iω)n-1]/e0. The knee in the log of the electrical conductivity versus the reciprocal temperature curve occurs at Tc. The activation energies associated with charge conduction are Ea,II=0.73 eV below Tc and Ea,I=0.95 eV above Tc. The occurrence of an anomaly in both the n and e∞ parameters near Tc indicates a coupling between charge carries and phonons.

The electrical properties of a single crystal of KTiOPO4 was studied by impedance spectroscopy methods in the temperature range –100 to 100 °C. The complex resistivity decreases rapidly with increasing temperature, and resistivity dispersion begins at a temperature of TS=-80 °C. The complex resistivity was fitted to the superposition of two Cole-Cole-type relaxations. The low frequency relaxation is associated with the electrode/crystal surface, while the high frequency relaxation is interpreted as resulting from ion migration in the bulk. It is believed that high frequency relaxation is related to ionic hopping conduction, which arises mainly from the jumping of K+ ions. The activation energies associated with hopping conduction are Ea∼0.21 eV above TS and Ea∼0.11 eV below TS .

Aims Although hyperphagia is a common manifestation of diabetes mellitus, data on food craving in patients with diabetes are limited. This study compared food craving in patients with Type 2 diabetes mellitus and a control group without diabetes. Methods A total of 210 subjects (105 with Type 2 diabetes and 105 age-, sex- and BMI-matched control subjects) participated in two food craving surveys. The surveys were as follows: the General Food Cravings Questionnaire—Trait, which assesses the general trait of food craving; and the Food Cravings Questionnaire—State, which assesses the state of food craving or current desire for high-carbohydrate or high-fat foods in response to pictures of food. Follow-up Food Cravings Questionnaire—State surveys were administered approximately 3 months later to the subjects with diabetes. Survey results were analysed to assess relationships between food craving and glycaemic control. Results The General Food Cravings Questionnaire—Trait scores in the group with Type 2 diabetes and the control group were not significantly different. The group with Type 2 diabetes had higher carbohydrate craving scores, but lower fat craving scores, than the control group. Carbohydrate craving scores in subjects with diabetes were positively correlated with HbA1c. In follow-up surveys, carbohydrate craving scores declined in patients with improved glycaemic control. Conclusions The surveys showed that patients with Type 2 diabetes had higher carbohydrate cravings and lower fat cravings than the age-, sex- and BMI-matched control group. Carbohydrate craving in patients with diabetes was associated with poor glycaemic control.

Aims To investigate whether fatty liver per se is an independent risk factor of incident type 2 diabetes mellitus (T2DM) in Koreans. Methods We examined the clinical and laboratory data of 5372 non-diabetic participants (3670 men and 1702 women; age 46.8 ± 8.4 years, range 20–79 years) who underwent voluntary medical check-ups in 2000 and follow-up examinations in 2005. Results Two hundred and thirty-three participants (4.3%) developed T2DM after 5 years. Univariate analysis showed that the development of diabetes was associated with: male sex; family history of diabetes; smoking; older age; higher body mass index (BMI), systolic and diastolic blood pressure, fasting plasma glucose (FPG), hepatic enzymes, total cholesterol and triglycerides; lower HDL cholesterol; and the presence of fatty liver on ultrasonography at baseline. In multiple logistic regression models, after adjusting for age, sex and alcohol consumption, patients with fatty liver were at significantly higher risk of developing T2DM compared to those without fatty liver [relative risk (RR) 3.92, 95% confidence interval (CI) 2.89–5.31]. After further adjustment for smoking, BMI, triglycerides, HDL cholesterol, FPG, alanine aminotransferase and ultrasonographer, fatty liver remained significantly associated with the development of T2DM (RR 1.51, 95% CI 1.04–2.20). Patients with moderate to severe fatty liver had higher risk ratios than patients with mild fatty liver. Exclusion of frequent drinkers did not attenuate the association. Conclusions Fatty liver on ultrasonography is associated with the development of T2DM, independently of classical risk factors, in Korean adults.

A new needle-type sample cell was designed and produced to investigate the correlation between blood glucose and electrical parameters using an impedance analyzer. The characteristics of the measurement cells were optimized to give high sensitivity. High sensitivity complex dielectric constant measurements were obtained by calibration with several known fluids. It was observed that the values of the real (epsilon') and the imaginary (epsilon") dielectric constant increase with decreasing glucose contents in the water/glucose system, and that the value of epsilon' in hamster tail changes according to the variation in blood glucose. It is likely that there is a correlation between blood glucose and the value of epsilon', the electrical parameter.