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Evidence supports direct referral for imaging by physical therapists. Accuracy and self-efficacy for imaging decisions have not been investigated in entry-level doctor of physical therapy (DPT) students. The purpose of this study was to understand the relationship between entry-level DPT instruction and accuracy and self-efficacy for imaging referral due to acute knee trauma. A second purpose was to identify relationships between accuracy and self-efficacy. An online survey was sent via e-mail to program directors in accredited DPT programs in the United States with an invitation to forward the survey to DPT students. The survey captured demographic information and included five questions that assessed the respondent's ability to apply the Ottawa Knee Rules (OKR). Self-efficacy was assessed using the Physiotherapist Student Self-Efficacy (PSE) questionnaire, a self-rated 5-point Likert scaled tool. Of 240 surveys, DPT students who completed imaging coursework had greater accuracy and higher self-efficacy (68.0% correct (95% CI, 63.6–72.5), PSE = 3.67, P <.001) compared to students who had not (45.8% correct (95% CI, 40.8–50.7), PSE = 2.67, P <.001). Conclusion: Accuracy by DPT students who completed imaging coursework was significantly improved and comparable to values from autonomous providers. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is a common surgical procedure for end-stage knee osteoarthritis. However, conventional alignment techniques may lead to postoperative dissatisfaction in up to 20% of cases. Kinematic alignment (KA) has emerged as a new philosophy to restore the native joint line and achieve more natural kinematics. Preserving the posterior tibial slope (PTS) and posterior cruciate ligament (PCL) is crucial to maintaining the pre-arthritic joint line and improving knee kinematics. This study aimed to assess the prevalence of postoperative PTS changes and their impact on functional outcomes and range of motion. A retrospective single-center study was conducted on patients who underwent KA-TKA with PCL preservation. The preoperative and postoperative PTS were measured on lateral knee radiographs using the tibial proximal anatomic axis method. Patient-reported outcome measures (PROMs) were collected pre- and postoperatively up to a two-year follow-up. Of the 95 included patients, 62.1% achieved an anatomically similar PTS (within 3° from the preoperative value), while 37.9% experienced noticeable PTS changes. However, no significant associations existed between PTS changes and compromised PROMs (WOMAC, 22.2 and 23.1; FJS, 66.6 and 67.3), ROM (118.5° and 119.4°), or patient satisfaction. No postoperative complications requiring reoperation or component revisions were observed. Preserving or modifying the native PTS during KA-TKA could be confidently undertaken without compromising functional outcomes or patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: Intra‐articular (IA) mineralization may contribute to osteoarthritis (OA) structural progression. We studied the association of IA mineralization on knee computed tomography (CT) with cartilage damage worsening on knee magnetic resonance imaging (MRI), with a focus on location‐ and tissue‐specific effects. Methods: Participants from the Multicenter Osteoarthritis Study with knee CT and MRI scans were included. Presence of IA mineralization on CT was defined as a Boston University Calcium Knee Score >0 anywhere in the knee. Cartilage worsening on MRI was defined as any increase in the MRI OA Knee Score, including incident damage. We evaluated the association of whole‐knee, compartment‐specific (ie, medial or lateral), and subregion‐specific (ie, location‐matched) IA mineralization at baseline with cartilage worsening at two years' follow‐up in the corresponding locations using binomial regression with generalized estimating equations, adjusting for age, sex, and body mass index (BMI). Results: We included 1,673 participants (mean age 60 years, 56% female, mean BMI 29). Nine percent had any IA mineralization in the knee, and 47.4% had any cartilage worsening on follow‐up. Mineralization of any tissue in the knee, regardless of location, was not associated with MRI cartilage worsening. However, cartilage mineralization was associated with 1.39 (95% confidence interval 1.04–1.88) times higher risk of cartilage worsening in the same compartment, with similar results in subregion‐specific analysis. Conclusion: CT‐detected IA mineralization in the cartilage was associated with higher risk of MRI cartilage worsening in the same compartment and subregion over two years. These findings suggest potential localized, tissue‐specific effects of IA mineralization on cartilage pathology in knee OA. [ABSTRACT FROM AUTHOR]

Background: A recent study has reported that the radiographic measurement of posterior tibial slope (PTS) is larger in male pediatric patients with tibial spine fractures (TSF) than in controls. However, they found no difference in PTS between female patients and controls. Purpose: (1) To identify whether PTS is larger in female pediatric patients with TSF than in female controls and (2) to validate the relationship between PTS and pediatric TSF in male patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: After an a priori power analysis, 84 pediatric patients with TSF (50 female patients and 34 male patients) and 84 age- and sex-matched controls were enrolled in this study. Demographic information, including sex, age, and race, was recorded. Skeletal maturity was determined based on the stage of epiphyseal union on knee radiographs. PTS was defined as the angle between a line perpendicular to the longitudinal axis of the tibia and the posterior inclination of the medial tibial plateau on standard knee lateral radiographs. Results: The mean age when the TSF occurred was 11.2 ± 2.7 years for female patients and 12.9 ± 2.5 years for male patients. There was no significant difference in skeletal maturity between female patients and female controls or between male patients and male controls. The mean PTS was not significantly different between female patients (8.8°± 2.8°) and female controls (8.3°± 3.1°) (P =.366) or between male patients (9.0°± 2.8°) and male controls (9.3°± 2.6°) (P =.675). Those with a PTS >1 SD (2.9°) above the mean (8.8°) had no greater odds (1.0 [95% CI, 0.4-2.5]; P ≥.999) of having a TSF than others. Conclusion: PTS was not found to be a risk factor for pediatric TSF in female or male patients in this study. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is a successful procedure in treatment of degenerative disease of the knee, and optimal component placement is essential for long-term implant survival. The purpose of this study was to compare the accuracy of the accelerometer-based KneeAlign 2 (KA2) navigation system against conventional methods for accurate positioning of the femoral and tibial components in TKA in a Chinese population. Methods: A total of 123 (37 conventional and 86 KA2) cases of elective primary TKA were reviewed. Hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and anatomical lateral distal femoral angle (aLDFA) were measured from hip-to-ankle EOS radiographs. Accuracy of conventional alignment and KA2 navigation system was assessed by measuring the difference between intraoperative goal and postoperative radiographic measurements of the components for each respective case. Results: There was no significant difference between conventional alignment methods and KA2 navigation in achieving a neutral mechanical alignment of the lower limb. KA2 navigation was significantly more accurate than conventional alignment methods for optimal positioning of the tibial component in both the coronal and sagittal plane, while no significant difference between the two groups was appreciated in the positioning of the femoral component in the coronal plane. Conclusions: TKA using the accelerometer-based KA2 system was found to offer a high degree of accuracy in component alignment, and in particular, significantly improved tibial component alignment in comparison with conventional alignment methods in a Chinese population. However, no significant improvements were observed in neutral mechanical axis of the lower limb alignment and femoral component placement in the coronal plane. [ABSTRACT FROM AUTHOR]

Background: Data are limited regarding the surgical technique or outcomes of double-level osteotomy (DLO) combining medial closing-wedge distal femoral osteotomy and medial closing-wedge high tibial osteotomy in patients with moderate-to-severe valgus deformity. Purpose/Hypothesis: To describe the surgical technique and assess the short-term outcomes and surgical accuracy of DLO in patients with a moderate or severe valgus deformity. It was hypothesized that this technique would result in good clinical outcomes with precise deformity correction. Study Design: Case series; Level of evidence, 4. Methods: Eight patients (mean age, 44.2 ± 10.9 years) with a moderate or severe valgus knee treated with DLO (9 knees; mechanical tibiofemoral angle [mTFA], 10.3°± 3.5°) were included. The mean follow-up was 25.1 ± 11.1 months. Preoperative to postoperative changes in radiographic parameters (mTFA, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle) and clinical scores (Hospital for Special Surgery score, Oxford Knee Score, Lysholm score) were assessed. Surgical accuracy was calculated by subtracting the achieved postoperative correction from the preoperatively planned targeted correction. Results: The mTFA changed significantly from 10.3°± 3.5° preoperatively to –1.8°± 3.4° postoperatively (P <.001); the mechanical lateral distal femoral angle and mechanical medial proximal tibial angle changed significantly by 5.1°± 2.7° and 5.9°± 2.2°, respectively (P <.001 for both); and the posterior distal femoral angle decreased significantly from 85.9°± 3.1° to 84.2°± 2.4° (P <.01). There was no significant difference between pre- and postoperative joint line convergence angles (3.3°± 2.3° to 2.6°± 2.1°). The accuracy of the correction was high: the mTFA achieved postoperatively differed from the mTFA planned preoperatively by a mean of 2.7°± 1.9° (range, 0.6°-6.6°). Significant pre- to postoperative improvement was seen for all outcome scores (Hospital for Special Surgery, from 67 ± 11 to 93 ± 4; Oxford Knee Score, from 29 ± 7 to 43 ± 3; Lysholm, from 41 ± 24 to 89 ± 8; P <.001 for all). Conclusion: High surgical accuracy was achieved, and patients who underwent varus DLO for valgus knees showed improved knee function at short-term follow-up. Varus DLO can be a surgical option to restore the optimal alignment and joint line obliquity in patients with moderate or severe valgus malalignment. [ABSTRACT FROM AUTHOR]

Background: Several approaches to surgical techniques and graft types exist in posterolateral corner (PLC) reconstruction. The literature lacks knowledge regarding outcomes after autograft versus allograft reconstruction for PLC injuries. Purpose: To comprehensively review the current literature on PLC reconstruction and compare outcomes between autograft and allograft tissues. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Scopus online databases were searched with the terms "PLC,""posterolateral knee,""posterolateral corner," and "reconstruction" in varying combinations. Patient characteristics, graft type, graft failure, surgical techniques, functional outcome scores, and varus laxity on stress radiographs were reviewed and compared between PLC reconstruction with autografts versus allografts. Results: Included were 22 studies comprising 33 cohorts: 16 autografts (n = 280 knees) and 17 allografts (336 knees). There were 69 isolated PLC reconstructions (58 allografts and 11 autografts) and 493 multiligament reconstructions (269 autografts and 224 allografts). There was no difference in the mean patient age (30.5 vs 33.5 years, respectively; P =.11) or mean follow-up (39.5 vs 37.7 months, respectively; P =.68) between the autograft and allograft groups. There was no evidence to suggest a difference in graft failures between graft types (pooled mean autograft vs allograft: 0.44 vs 0.41 failures; P =.95). There was a significant difference in the mean postoperative Lysholm scores for autografts versus allografts (89.6 vs 85.5, respectively; P =.04). There was no difference between the cohorts in preoperative or postoperative International Knee Documentation Committee (IKDC) scores or postoperative varus laxity. Conclusion: Our review and meta-analysis indicated no significant differences in graft failure rates or objective outcomes after PLC reconstruction based on graft type alone. There was a significant difference in postoperative Lysholm scores in favor of the autograft group and no significant difference in IKDC subjective scores. [ABSTRACT FROM AUTHOR]

Background: Increased posterior tibial slope (PTS) has been identified as a risk factor for failure after anterior cruciate ligament (ACL) reconstruction. Correction of PTS may improve outcomes after revision ACL reconstruction. There are conflicting reports demonstrating the measurement of the PTS on standard short knee (SSK) radiographs versus full-length lateral (FLL) radiographs including the entire tibia. Purpose/Hypothesis: To compare PTS measurements between SSK and FLL radiographs in patients who failed primary ACL reconstruction. It was hypothesized that there would be high variability between the SSK and FLL radiographic measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The medial and lateral PTS were measured on the SSK and FLL radiographs of 33 patients with failed primary ACL reconstructions. All measurements were performed by 2 trained independent observers (A.A.M., J.S.), and inter- and intraobserver reliability were calculated using the intraclass correlation coefficient (ICC). Measurements recorded by the observer with the higher intraobserver ICC were used for comparison of the PTS on SSK versus FLL radiographs. Results: Both the inter- and the intraobserver reliability values of the PTS measurements were excellent. There was a significant difference in mean PTS on the medial plateau as measured on the SSK and FLL radiographs (11.2°± 5.3° vs 12.5°± 4.6°; P =.03), with the FLL radiographs demonstrating higher PTS. There was also a significant difference in the mean PTS on the lateral plateau as measured on SSK versus FLL radiographs (10.7°± 4.3° vs 12.2°± 4°, respectively; P =.01), with the FLL radiographs demonstrating higher PTS. Notably, 66.67% of the absolute measurements for PTS on the medial plateau differed by ≥2°, with variability as high as 8.5°. Conclusion: Results indicated that FLL and SSK radiographs are not interchangeable measurements for PTS associated with failed ACL reconstruction. Because FLL radiographs demonstrate less variability than SSK radiographs, we recommend obtaining them to evaluate these complex patients. [ABSTRACT FROM AUTHOR]

Background: The patellar height index is important; however, the measurement procedures are time-consuming and prone to significant variability among and within observers. We developed a deep learning-based automatic measurement system for the patellar height and evaluated its performance and generalization ability to accurately measure the patellar height index. Methods: We developed a dataset containing 3,923 lateral knee X-ray images. Notably, all X-ray images were from three tertiary level A hospitals, and 2,341 cases were included in the analysis after screening. By manually labeling key points, the model was trained using the residual network (ResNet) and high-resolution network (HRNet) for human pose estimation architectures to measure the patellar height index. Various data enhancement techniques were used to enhance the robustness of the model. The root mean square error (RMSE), object keypoint similarity (OKS), and percentage of correct keypoint (PCK) metrics were used to evaluate the training results. In addition, we used the intraclass correlation coefficient (ICC) to assess the consistency between manual and automatic measurements. Results: The HRNet model performed excellently in keypoint detection tasks by comparing different deep learning models. Furthermore, the pose_hrnet_w48 model was particularly outstanding in the RMSE, OKS, and PCK metrics, and the Insall–Salvati index (ISI) automatically calculated by this model was also highly consistent with the manual measurements (intraclass correlation coefficient [ICC], 0.809–0.885). This evidence demonstrates the accuracy and generalizability of this deep learning system in practical applications. Conclusion: We successfully developed a deep learning-based automatic measurement system for the patellar height. The system demonstrated accuracy comparable to that of experienced radiologists and a strong generalizability across different datasets. It provides an essential tool for assessing and treating knee diseases early and monitoring and rehabilitation after knee surgery. Due to the potential bias in the selection of datasets in this study, different datasets should be examined in the future to optimize the model so that it can be reliably applied in clinical practice. Trial registration: The study was registered at the Medical Research Registration and Filing Information System (medicalresearch.org.cn) MR-61-23-013065. Date of registration: May 04, 2023 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the biomechanical characteristics of grafts from three different anterior cruciate ligament (ACL) reconstructive surgeries and to determine which method is better at restoring knee joint stability. Methods: A 31-year-old female volunteer was enrolled in the study. According to the magnetic resonance imaging of her left knee, a three-dimensional model consisting of the distal femur, proximal tibia and fibula, ACL, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament was established. Then, the ACL was removed from the original model to simulate the knee joint after ACL rupture. Based on the knee joint model without the ACL, single-bundle ACL reconstruction, double-bundle ACL reconstruction, and flat-tunnel ACL reconstruction were performed. The cross-sectional diameters of the grafts were equally set as 6 mm in the three groups. The bone tissues had a Young's modulus of 17 GPa and a Poisson's ratio of 0.36. The ligaments and grafts had a Young's modulus of 390 MPa and a Poisson's ratio of 0.4. Six probes were placed in an ACL or a graft to obtain the values of the equivalent stress, maximum principal stress, and maximum shear stress. After pulling the proximal tibia with a forward force of 134 N, the distance that the tibia moved and the stress distribution in the ACL or the graft, reflected by 30 mechanical values, were measured. Results: The anterior tibial translation values were similar among the three groups, with the double-bundle ACL reconstruction group performing the best, followed closely by the patellar tendon ACL reconstruction group. In terms of stress distribution, 13 out of 30 mechanical values indicated that the grafts reconstructed by flat bone tunnels had better performance than the grafts in the other groups, while 12 out of 30 showed comparable outcomes, and 5 out of 30 had worse outcomes. Conclusion: Compared with traditional single-bundle and double-bundle ACL reconstructions, flat-tunnel ACL reconstruction has advantages in terms of stress dispersion. Additionally, flat-tunnel ACL reconstruction falls between traditional double-bundle and single-bundle ACL reconstructions in terms of restoring knee joint stability and is superior to single-bundle ACL reconstruction. [ABSTRACT FROM AUTHOR]

Patients with total knee arthroplasty occasionally develop postoperative abnormalities such as posttraumatic knee stiffness and arthrofibrosis, which may affect activities of daily living. However, there are no clear assessment methods or interventions for knee stiffness. Musculoskeletal ultrasound imaging enables real-time evaluation of mobility and flexibility of tissues. The purpose of this case report was to describe the use of musculoskeletal ultrasound imaging for evaluating the optimal location and methods of passive manipulation. The patient was an 82-year-old woman who had undergone total knee arthroplasty. She was unable to climb stairs due to limited knee flexion. Based on the results of musculoskeletal ultrasound imaging assessment, we hypothesized that the knee flexion limitation was caused by decreased sliding movement of the suprapatellar pouch. Hence, we performed passive manipulation on the tissue with decreased sliding under musculoskeletal ultrasound guidance. The patient's knee flexion angle increased from 90° to 110° within 1 week of intervention, and her gait speed improved from 16.48 to 13.2 s per 10 m. Furthermore, after the intervention, she was able to climb 10 steps using a handrail. Ultrasound imaging is important because it allows the examination of tissues with mobility changes such as in arthrofibrosis. Our work highlights the use of musculoskeletal ultrasound imaging for identifying the target region for therapy and for providing guidance during passive manipulation. [ABSTRACT FROM AUTHOR]

Introduction: Injuries of the anterior cruciate ligament (ACL) are commonly found in the general population, both among adult and pediatric patients, and their incidence has been increasing in recent years. Most of the late literature agrees that surgical reconstruction of the ACL is effective in improving long-term outcomes in pediatric patients, while others in the past have pleaded for non-surgical management. Purpose/Hypothesis: Our study aims to verify if ACL reconstruction (ACLR) using transphyseal technique in skeletally immature patients will provide angular deviations or growth restrictions. Study Design: Retrospective cohort study; Level of evidence 4. Methods: We perfomed a retrospective study to verify if transphyseal ACLR in children with less than or equal to 2 years of remaining growth leads to either limb length discrepancies or axis deviations. Results: Most patients who were treated using transphyseal technique showed significant improvements in their functional scores. There were statistically significant differences in lateral distal femoral angles (LDFA) and medial proximal tibial angles (MPTA), with no clinical impact. There was no significant limb length discrepancy (LLD) during the 2-year follow-up. Conclusions: Transphyseal ACLR is safe among children who have less than or equal to 2 years of remaining growth and brings no risk of axis deviations or limb length discrepancy. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) tears are prevalent orthopedic sports injuries and are difficult to precisely classify. Previous works have demonstrated the ability of deep learning (DL) to provide support for clinicians in ACL tear classification scenarios, but it requires a large quantity of labeled samples and incurs a high computational expense. This study aims to overcome the challenges brought by small and imbalanced data and achieve fast and accurate ACL tear classification based on magnetic resonance imaging (MRI) of the knee. We propose a lightweight attentive graph neural network (GNN) with a conditional random field (CRF), named the ACGNN, to classify ACL ruptures in knee MR images. A metric-based meta-learning strategy is introduced to conduct independent testing through multiple node classification tasks. We design a lightweight feature embedding network using a feature-based knowledge distillation method to extract features from the given images. Then, GNN layers are used to find the dependencies between samples and complete the classification process. The CRF is incorporated into each GNN layer to refine the affinities. To mitigate oversmoothing and overfitting issues, we apply self-boosting attention, node attention, and memory attention for graph initialization, node updating, and correlation across graph layers, respectively. Experiments demonstrated that our model provided excellent performance on both oblique coronal data and sagittal data with accuracies of 92.94% and 91.92%, respectively. Notably, our proposed method exhibited comparable performance to that of orthopedic surgeons during an internal clinical validation. This work shows the potential of our method to advance ACL diagnosis and facilitates the development of computer-aided diagnosis methods for use in clinical practice. [ABSTRACT FROM AUTHOR]

The anti-inflammatory and immunosuppressive properties of steroids allow their use in a wide variety of rheumatological diseases, asthma, inflammatory bowel disease, cancer therapy, and severe viral infections. Though life-saving or organ-saving, long-term clinical use leads to a vast array of complications. Osteoporosis is the most common orthopedic side effect of steroid abuse, while osteonecrosis is a rare occurrence. The risk of osteonecrosis appears to be dose and duration dependent, but several patient factors also play a major role and usually affect the femoral head followed by the knee joint. The long-term effects of steroids must be explained to all patients on therapy, but this risk is missed in individuals who abuse steroids for recreational or performance-enhancing purposes. We describe a male, aged 29 years, who presented with dull aching bilateral knee pain of 2-years' duration after a long-term steroid abuse for weight and muscle mass gain. Radiological and magnetic resonance imaging studies confirmed osteonecrosis of femoral and tibial condyles and secondary degenerative arthritis of the knee joint. Prompt suspicion, early diagnosis, and intervention in osteonecrosis of knee joints, and termination of steroids may reverse the pathology and prevent progression of disease. [ABSTRACT FROM AUTHOR]

Background: Multiple joint arthritis patterns require a comprehensive understanding to optimize patient management. This study aimed to present a patient cohort that deviated from known definitions of coxitis knee (CK), identifying and characterizing this atypical group. Methods: Patients undergoing both total hip arthroplasty and total knee arthroplasty between January 2008 and December 2018 were retrospectively reviewed. The patients were classified into a typical coxitis knee group (classic, long leg arthropathy, and windswept deformity) and an atypical coxitis knee group. Leg-length discrepancy, body mass index (BMI), and radiographic parameters of the groups were compared and analyzed. Results: A total of 31 patients were allocated to the typical coxitis knee group (n = 10), and atypical coxitis knee group (n = 21). In the atypical group, 27 hips were involved, of which 21 had acetabular dysplasia, 5 exhibited subchondral insufficiency fracture-like changes, and only 1 had classic osteoarthritis. Among the 27 knees undergoing total knee arthroplasty, 26 showed varus alignment, 1 was within the normal range, and none was valgus. Acetabular dysplasia involved ipsilateral (n = 1), contralateral (n = 14), and bilateral (n = 6) hips, showing atypical coxitis knee. Patients with acetabular dysplasia were more likely to exhibit atypical CK. Conclusion: Most patients in the cohort displayed acetabular dysplasia and contralateral varus knees, constituting a pattern referred to as acetabular dysplasia-associated gonarthritis. Identifying this novel subtype may have important clinical implications for regions with high risk factors, where acetabular dysplasia and constitutional genu varum are prevalent. [ABSTRACT FROM AUTHOR]

There have been several described imaging findings that correlate with anterior cruciate ligament (ACL) injuries. The investigators in this study observed a higher frequency of posterior translation of the lateral meniscus beyond the posterior border of the tibial plateau in patients with ACL tears. The purpose of this study was to assess the frequency and degree of posterior lateral meniscal overhang (LMO) of the lateral meniscus in patients with ACL tears compared to uninjured controls. Magnetic resonance imaging (MRI) was analyzed in 117 knees with ACL tears and compared to a control group of 89 knees without injury. Lateral meniscus diameter, LMO, knee flexion angle, and lateral tibial plateau diameter were measured and compared between the two groups. Exclusion criteria included displaced and macerated lateral meniscus tears, multi-ligamentous knee injuries, and periarticular fractures. Difference in mean lateral meniscal overhang between ACL injured and control groups was tested using a paired T-test (alpha = 0.01). Assumptions for normality and variance were tested prior to analysis. In patients with ACL tears, average LMO was significantly greater compared to the control group (0.95 mm vs. 0.08 mm; p < 0.001). Additionally, measurable LMO was found in 42.7 % of patients with ACL tears compared to 4.5 % uninjured knees (p < 0.001). Patients with ACL injury show higher incidence of LMO compared to uninjured controls. Future studies are necessary to better understand its clinical significance. [ABSTRACT FROM AUTHOR]

Background: Traumatic knee injuries are widespread, especially among young adults; when a clinical exam suspects the diagnosis, it is evaluated by magnetic resonance imaging (MRI) and confirmed by arthroscopy. MRI is non-invasive and saves patients from potential general anesthesia and surgical site infection complications. We aim to assess the precision of ligamentous and meniscal injuries by MRI compared to the gold standard knee arthroscopy. Methods: We performed a crosssectional observational study at An-Najah University Hospital (NNUH). Patients who underwent knee arthroscopic surgery and had preoperative MRIs were included in this study. The magnetic resonance and intraoperative findings during arthroscopy were recovered from patients' records and compared for sensitivity and specificity. Results: 107 patients were included in our research. Their MRI and arthroscopy findings were compared using a cross-tabulation test. MRI sensitivity to detect anterior cruciate ligament and medial meniscal tears was 57.1% and 86%, respectively. However, the specificity of the lateral meniscal tear was 89.6%. Furthermore, concerning the type of tear, the sensitivity of MRI to diagnose a full-thickness tear was 66.7%. For the specificity of partial tears, it was measured as 94.2%. Conclusion: For assessing ligamentous knee tears, MRI may be a reliable, accurate, and less invasive option. It can be reliably employed as the first-line investigation; however, the gold standard investigation is arthroscopy. MRI is less invasive, has a major adjuvant rule that helps the surgeon avoid lengthy knee exploration of the knee during arthroscopy by focusing on preoperative MRI findings, and could be considered standard routine imaging for a patient scheduled for arthroscopy. [ABSTRACT FROM AUTHOR]

Background: India has a higher prevalence of about 20-24%.of people suffering from osteoarthiritis. Due to the load effect, forces between two and three times body weight are transmitted across the knee joint during a normal stride, which accounts for the higher risk of OA.A Qualitative Analysis of Decision-Making for Total Knee Replacement in Patients with Osteoarthritis. A cutting-edge wearable sensor system called Fitknees delivers a complex arrangement of motion sensors that are carefully placed on the lower limb. These sensors outline thorough kinematic data that include gait analysis, muscle strength, knee range of motion, and balance metrics. Objective: Utilizing individualised measurements, using wearable sensors and AI tool to assess preoperative evaluations and postoperative rehabilitation programs. Results: camping between affected and unaffected side with the normative data provided by the AI.Conclusion: advancement in the medical technologies have made it easier for medial professionals to detect and early diagnose the diseases. Plan a better treatment plan with the aid of artificial intelligence to achieve better results. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association of leisure‐time sitting with radiographic incidence and progression of knee osteoarthritis (OA) over 2 years, and to determine whether worktime sitting modifies this association. Methods: We included adults with or at high risk for knee OA who enroled in the Osteoarthritis Initiative (OAI). Participants reported leisure‐time sitting (≤4 vs. >4 h/day) and worktime sitting (frequent vs. infrequent) at enrolment, and had bilateral knee radiographs at enrolment and 2 years later. Our outcome, radiographic knee OA incidence/progression (yes/no), was defined as any increase in Kellgren‐Lawrence grade over 2 years. We examined the association of leisure‐time sitting (≤4 vs. >4 h/day) with risk of radiographic knee OA incidence/progression using binary linear regression, adjusting for potential confounders. We stratified by worktime sitting (frequent vs. infrequent) and repeated our analysis. Results: We included 4254 adults (mean age 61 years; 58% women; mean body mass index 29 kg/m2) who contributed a total of 8127 knees. Adults with >4 h/day of leisure‐time sitting had 25% higher risk (adjusted risk ratio [RR] 1.25, 95% confidence interval [95% CI] 1.08–1.50) for radiographic knee OA incidence/progression compared with adults with ≤4 h/day of leisure‐time sitting (referent group). Importantly, this association was intensified (RR 1.60, 95% CI 1.19–2.33) among adults with frequent worktime sitting, but was attenuated (RR 1.11, 95% CI 0.89–1.39) among adults with infrequent worktime sitting. Conclusions: Higher leisure‐time sitting (>4 h/day) may be associated with greater risk for radiographic knee OA incidence/progression over 2 years. Furthermore, this association was intensified among adults who also reported frequent worktime sitting. [ABSTRACT FROM AUTHOR]

Background: This study aims to implement and assess the inter- and intra-reliability of a modernized radiolucency assessment system; the Radiolucency In cemented Stemmed Knee (RISK) arthroplasty classification. Furthermore, we assessed the distribution of regions affected by radiolucency in patients undergoing stemmed cemented total knee arthroplasty. Methods: Stemmed total knee arthroplasty cases over 7-year period at a single institution were retrospectively identified and reviewed. The RISK classification system identifies five zones in the femur and five zones in the tibia in both the anteroposterior (AP) and lateral planes. Post-operative and follow-up radiographs were scored for radiolucency by four blinded reviewers at two distinct time points four weeks apart. Reliability was assessed using the kappa statistic. A heat map was generated to demonstrate the reported regions of radiolucency. Results: 29 cases (63 radiographs) of stemmed total knee arthroplasty were examined radiographically using the RISK classification system. Intra-reliability (0.83) and Inter-reliability (0.80) scores were both consistent with a strong level of agreement using the kappa scoring system. Radiolucency was more commonly associated with the tibial component (76.6%) compared to the femoral component (23.3%), and the tibial anterior–posterior (AP) region 1 (medial plateau) was the most affected (14.9%). Conclusion: The RISK classification system is a reliable assessment tool for evaluating radiolucency around stemmed total knee arthroplasty using defined zones on both AP and lateral radiographs. Zones of radiolucency identified in this study may be relevant to implant survival and corresponded well with zones of fixation, which may help inform future research. [ABSTRACT FROM AUTHOR]

Objective: Intra‐articular (IA) calcium crystal deposition is common in knee osteoarthritis (OA), but of unclear significance. It is possible that low‐grade, crystal‐related inflammation may contribute to knee pain. We examined the longitudinal relation of computed tomography (CT)–detected IA mineralization to the development of knee pain. Methods: We used data from the National Institutes of Health–funded longitudinal Multicenter Osteoarthritis Study. Participants had knee radiographs and bilateral knee CTs at baseline, and pain assessments every 8 months for 2 years. CT images were scored using the Boston University Calcium Knee Score. We longitudinally examined the relation of CT‐detected IA mineralization to the risk of frequent knee pain (FKP), intermittent or constant knee pain worsening, and pain severity worsening using generalized linear mixed‐effects models. Results: We included 2,093 participants (mean age 61 years, 57% women, mean body mass index 28.8 kg/m2). Overall, 10.2% of knees had IA mineralization. The presence of any IA mineralization in the cartilage was associated with 2.0 times higher odds of having FKP (95% confidence interval [CI] 1.38–2.78) and 1.86 times more frequent intermittent or constant pain (95% CI 1.20–2.78), with similar results seen for the presence of any IA mineralization in the meniscus or joint capsule. A higher burden of IA mineralization anywhere within the knee was associated with a higher odds of all pain outcomes (odds ratio ranged from 2.14 to 2.21). Conclusion: CT‐detected IA mineralization was associated with risk of having more frequent, persistent, and worsening knee pain over 2 years. Targeting IA mineralization may have therapeutic potential for pain improvement in knee OA. [ABSTRACT FROM AUTHOR]

Background: Biomechanical studies have shown that an increased medial posterior tibial slope (MPTS) may affect anteroposterior knee laxity and tibial shear forces, ultimately increasing the risk for graft failure after anterior cruciate ligament (ACL) reconstruction. Previous clinical studies have, however, reported inconclusive results. Purpose: The purpose of this study was to evaluate the relationship between the MPTS and graft failure as well as functional outcomes after anatomic primary isolated ACL reconstruction using a hamstring tendon autograft. It was hypothesized that an increased MPTS would be associated with a higher ACL graft failure rate. Furthermore, a higher MPTS would negatively correlate with functional outcomes in patients without ACL graft failure. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients who underwent isolated primary ACL reconstruction with an anteromedial portal drilling technique between January 2011 and December 2019 were retrospectively reviewed. The MPTS was measured on preoperative lateral knee radiographs. At a minimum of 24 months postoperatively, the ACL graft failure rate and patient-reported outcome measures (PROM; International Knee Documentation Committee subjective knee form, Lysholm score, Tegner Activity Scale, visual analog scale for pain and subjective instability) were evaluated. Differences in the MPTS between patients with and without ACL graft failure as well as the frequency of graft failure between those with an MPTS <12° and those with an MPTS ≥12° were assessed for statistical significance. Binary logistic regression analysis was performed to stratify the risk of graft failure with the following variables: MPTS, age at surgery, and sex. Correlation analysis was performed to evaluate the relationship between the MPTS and PROM in patients without ACL graft failure. Results: In total, 326 patients were included (median follow-up, 71.0 months [IQR, 49.0-104.0 months]). There was no significant difference in the MPTS between patients with and without graft failure (10.6°± 3.2° vs 11.2°± 2.8°, respectively; P =.264). Additionally, there was no significant difference in the frequency of graft failure between patients with an MPTS <12° and those with an MPTS ≥12° (15.6% vs 16.5%, respectively; P =.835). Binary logistic regression showed that younger age at the time of surgery (odds ratio, 1.069 [95% CI, 1.031-1.109]) was associated with graft failure; sex and MPTS were not associated with graft failure. In patients without ACL graft failure, there was no significant correlation between the MPTS and PROM. Conclusion: In patients who underwent anatomic primary isolated ACL reconstruction, an increased MPTS was not associated with a higher rate of graft failure or inferior functional outcomes. Younger age was a significant nonmodifiable risk factor for ACL graft failure. [ABSTRACT FROM AUTHOR]

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Purpose: To predict whether a patient has osteoporosis/osteopenia using the attenuation of trabecular bone obtained from knee computed tomography (CT) scans. Methods: Retrospective analysis of 273 patients who underwent contemporaneous knee CT scans and dual-energy X-ray absorptiometry (DXA) within 1 year. Volumetric segmentation of the trabecular bone of the distal femur, proximal tibia, patella, and proximal fibula was performed to obtain the bone CT attenuation. The data was randomly split into training/validation (78%) and test (22%) datasets and the performance in the test dataset were evaluated. The predictive properties of the CT attenuation of each bone to predict osteoporosis/osteopenia were assessed. Multivariable support vector machines (SVM) and random forest classifiers (RF) were used to predict osteoporosis/osteopenia. Results: Patients with a mean age (range) of 67.9 (50–87) years, 85% female were evaluated. Seventy-seven (28.2%) of patients had normal bone mineral density (BMD), 140 (51.3%) had osteopenia, and 56 (20.5%) had osteoporosis. The proximal tibia had the best predictive ability of all bones and a CT attenuation threshold of 96.0 Hounsfield Units (HU) had a sensitivity of.791, specificity of.706, and area under the curve (AUC) of.748. The AUC for the SVM with cubic kernel classifier (AUC =.912) was better than the RF classifier (AUC =.683, P <.001) and better than using the CT attenuation threshold of 96.0 HU at the proximal tibia (AUC =.748, P =.025). Conclusions: Opportunistic screening for osteoporosis/osteopenia can be performed using knee CT scans. Multivariable machine learning models are more predictive than the CT attenuation of a single bone. Visual Abstract [ABSTRACT FROM AUTHOR]

Introduction Considerable attention is focused on preoperative templating of radiological images in patients undergoing total knee arthroplasty to obtain optimal alignment and outcome. Several radiological measurements have been described. Purpose In this study, we illustrate a new linear measurement: The linear coronal knee offset (LCKO) that can be used to analyze the coronal configuration on long leg alignment radiographs commonly undertaken during preoperative templating. Methods A retrospective search was performed of our Picture Archiving and Communication System and Radiology Information System to identify 100 lower limbs anteroposterior, weight bearing, long leg alignment view radiographs of patients referred to knee clinics over 1 year with knee pain. Demographic details, clinical indication, standard radiological measurement of the anatomical tibiofemoral angle, and the LCKO were measured and data were analyzed using Student's t -test. In addition, intraclass correlation coefficient was used to analyze for intraclass reliability. Results The average age of patients was 36.3 years (range: 12–80 years) with a male predominance. The LCKO was statistically significant between the three cohorts of patients. The mean LCKO in normal cohorts was 0.24 cm, varus was −0.6 cm, and valgus was 1.72cm. There was good inter and interobserver reliability (Kappa of 0.8 and 0.8, respectively). Conclusion The novel LCKO measurement provides a simpler method in assessing coronal lower limb malalignment and can easily identify a normal, varus, or valgus knee deformity. [ABSTRACT FROM AUTHOR]

Background: There exists some controversy regarding whether patient age is a predictive factor for outcomes after high tibial osteotomy (HTO). Purpose/Hypothesis: The purpose of this study was to evaluate whether patient age affects clinical and radiological outcomes after medial open-wedge HTO (OWHTO) in a large population with a wider age range than previous studies. It was hypothesized that there would be no differences in outcomes when compared across age-groups. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective comparative study was conducted using 344 patients (303 knees) who underwent OWHTO from 2009 to 2018. These patients were divided into 3 groups based on age at the time of surgery: ≥55 years (group Y: 76 knees in 57 patients), 56 to 64 years (group M: 129 knees in 120 patients), and ≤65 years (group O: 139 knees in 126 patients). Clinical and radiological evaluations were performed immediately before surgery and at the final follow-up period, at a mean of 5.1 years (range, 3-11 years). Comparisons among the 3 groups were conducted with 1-way analysis of variance for continuous variables. When a significant result was obtained, a post hoc test with Bonferroni correction was conducted for multiple comparisons. Results: In clinical evaluations, there were no significant differences among the 3 groups either preoperatively or postoperatively concerning the Japanese Orthopaedic Association score, the Lysholm score, or the Knee injury and Osteoarthritis Outcome Score (KOOS), with the exception of the preoperative KOOS Symptoms subscale, which was significantly higher in group Y versus group O (48.9 ± 18.7 vs 58.7 ± 15.4, respectively; P =.011). The Tegner activity score was significantly different among the groups, both preoperatively and postoperatively (P <.001 for both). There was no significant difference in the occurrence of complications or the survival rate at final follow-up among the 3 groups. Conclusion: The study findings suggest that patient age does not affect clinical and radiological outcomes after OWHTO. [ABSTRACT FROM AUTHOR]

Image quality control (QC) is crucial for the accurate diagnosis of knee diseases using radiographs. However, the manual QC process is subjective, labor intensive, and time-consuming. In this study, we aimed to develop an artificial intelligence (AI) model to automate the QC procedure typically performed by clinicians. We proposed an AI-based fully automatic QC model for knee radiographs using high-resolution net (HR-Net) to identify predefined key points in images. We then performed geometric calculations to transform the identified key points into three QC criteria, namely, anteroposterior (AP)/lateral (LAT) overlap ratios and LAT flexion angle. The proposed model was trained and validated using 2212 knee plain radiographs from 1208 patients and an additional 1572 knee radiographs from 753 patients collected from six external centers for further external validation. For the internal validation cohort, the proposed AI model and clinicians showed high intraclass consistency coefficients (ICCs) for AP/LAT fibular head overlap and LAT knee flexion angle of 0.952, 0.895, and 0.993, respectively. For the external validation cohort, the ICCs were also high, with values of 0.934, 0.856, and 0.991, respectively. There were no significant differences between the AI model and clinicians in any of the three QC criteria, and the AI model required significantly less measurement time than clinicians. The experimental results demonstrated that the AI model performed comparably to clinicians and required less time. Therefore, the proposed AI-based model has great potential as a convenient tool for clinical practice by automating the QC procedure for knee radiographs. [ABSTRACT FROM AUTHOR]

Objectives Knee joint distraction (KJD) has been associated with clinical and structural improvement and SF marker changes. The current objective was to analyse radiographic changes after KJD using an automatic artificial intelligence-based measurement method and relate these to clinical outcome and SF markers. Methods Twenty knee osteoarthritis patients were treated with KJD in regular care. Radiographs and WOMAC were collected before and ∼1 year post-treatment. SF was aspirated before, during and after treatment; biomarker levels were assessed by immunoassay. Radiographs were analysed to obtain compartmental minimum and standardized joint space width (JSW), Kellgren–Lawrence (KL) grades, compartmental joint space narrowing (JSN) scores, and osteophytosis and sclerosis scores. Results were analysed for the most affected compartment (MAC) and least affected compartment. Radiographic changes were analysed using the Wilcoxon signed rank test for categorical and paired t -test for continuous variables. Linear regression was used to calculate associations between changes in JSW, WOMAC pain and SF markers. Results Sixteen patients could be evaluated. JSW, KL and JSN improved in around half of the patients, significant only for MAC JSW (P  < 0.05). MAC JSW change was positively associated with WOMAC pain change (P  < 0.04). Greater monocyte chemoattractant protein 1 (MCP-1) and lower TGFβ-1 increases were significantly associated with changes in MAC JSW (P  < 0.05). MCP-1 changes were positively associated with WOMAC pain changes (P  < 0.05). Conclusion Automatic radiographic measurements show improved joint structure in most patients after KJD in regular care. MAC JSW increased significantly and was associated with SF biomarker level changes and even with improvements in pain as experienced by these patients. [ABSTRACT FROM AUTHOR]

Background: An increased tibial slope (TS) has been identified as a risk factor for anterior cruciate ligament (ACL) injury and graft failure after ACL reconstruction. However, different imaging modalities are used to determine the TS, resulting in divergent values. Consequently, no reference values and no consensus on thresholds can be reached, which in turn is mandatory for indicating correction osteotomies when facing outlier TS. Purpose: To determine the mean values of the TS and the incidence of their outliers in large cohorts of patients with ACL-injured and noninjured knees and to determine the feasibility of measuring TS on conventional lateral radiographs (CLRs). Study Design: Cross-sectional study; Level of evidence 3. Methods: TS of ACL-injured knees (n = 1000, group A) and ACL-intact knees (n = 1000, group B) was measured by 3 experienced examiners. Medial TS was measured on CLRs using the technique of Dejour and Bonnin. Patients with radiographs with poor image quality, osteoarthritis, previous osteotomies, or nondigital radiographs were excluded. The intra- and interrater reliability was calculated using the intraclass correlation coefficient. Results: The mean TS was significantly higher in group A than in group B (10.04°± 3° [range, 2°-22°] vs 9.02°± 2.9° [range, 1°-18°], respectively; P <.001). Significantly more participants in group A had TS larger than 12° (≥12°, 32.2% vs 19.8%, P <.001; ≥13°, 20.9% vs 11.1%, P <.001; ≥14°, 13.5% vs 5.7%, P <.001; ≥15°, 8% vs 2.7%, P <.001; ≥16°, 3.7% vs 1.4%, P =.0005), respectively. In contrast, significantly more participatns in group B had TS 8° or less (≤8°, 32.1% vs 42.7%, P <.001; ≤7°, 20% vs 30.9%, P <.001; ≤6°, 12.4% vs 19.8%, P <.001; ≤5°, 6.6% vs 12%, P =.0003; ≤4°, 2.8% vs 5.3%, P =.0045). The intraclass correlation coefficient revealed a good to excellent reliability throughout measurements. Conclusion: Median values for the TS were 9° for uninjured and 10° for ACL-injured knees on CLRs. Notwithstanding its statistical significance, this finding might be negligible in clinical practice. However, a significantly larger number of outliers were found in the ACL-injured group exceeding a TS of 12° and demonstrating an incremental proportion with increasing TS, serving as a potential threshold for correction osteotomy. Furthermore, CLRs in the largest cohort to date exhibited high reproducibility, proving the feasibility of CLRs as a routine measurement for TS. [ABSTRACT FROM AUTHOR]

Purpose: This case–control study aimed to assess the influence of BMI and PTS on subsequent ACL injury affecting either ACL graft or the native ACL of the contralateral knee after primary ACL reconstruction. Methods: A retrospective case–control study was performed using a cohort of patients who underwent arthroscopic ACL reconstruction between 2010 and 2020 using the same surgical procedure: Hamstring tendon autograft. The study group (group I) included all the patients (n = 94) during this period who sustained a subsequent ACL injury. The control group (group II) consisted of 94 patients randomly selected (matched Group I in terms of sex, age, and ACL graft) who did not sustain any further ACL injury. PTS was measured by two blinded surgeons on lateral knee view radiographs of the operated knee after primary ACL. BMI in kg/m2 was measured during the preoperative anesthesia consultation. Exclusion criteria were: non-true or rotated lateral knee radiographs of the operated knee post-ACLR, associated knee ligament injury requiring surgical management, iterative knee surgeries, open growth plate, and related fracture. Results: The mean posterior tibial slope in group I was 7.5° ± 2.9, and 7.2° ± 2.0 in group II. A PTS angle cutoff was set at 10 degrees. The rate of patients showing a PTS ≥ 10° was significantly higher in group I compared to group II (p < 0.01). Patients with PTS ≥ 10° were 5.7 times more likely to sustain a subsequent ACL injury, (OR: 5.7 95% CI[1.858–17.486]). The Average BMI in group I was 24.5 ± 3.7 kg.m−2 compared to group II which was 23.3 ± 3.0 kg.m−2. There were no significant differences in any of the four BMI categories between both groups (p value 0.289). A series of BMI cut-offs were also analyzed at 23 to30 kg/m2, and there was no significant difference between both groups. Conclusions: A posterior tibial slope equal to or above 10 degrees measured on lateral knee radiographs was associated with 5.7 times higher risk of ACL graft rupture or contralateral native ACL injury; however, BMI was not. [ABSTRACT FROM AUTHOR]

Background: Tibial deflexion osteotomy (TDO) is sometimes indicated for revision anterior cruciate ligament (ACL) reconstruction in knees with posterior tibial slope (PTS) ≥12° and aims to decrease PTS to around 5°. When planning TDO, measuring the anterior tibial metaphyseal height (aHt) could help ascertain whether the available metaphyseal bone would be sufficient to create the wedge and leave adequate residual bone. Purpose: To (1) determine whether, compared with knees with normal native PTS (<12°), aHt is greater in knees with excessive native PTS (≥12°), and (2) verify if, aiming to decrease PTS to 5°, supratuberosity TDO in knees with excessive native PTS could be performed without tibial tuberosity osteotomy, leaving a minimum of 15 mm of residual bone for fixation staples or plates. Study Design: Cross-sectional study; Level of evidence, 3. Methods: True lateral radiographs of 350 consecutive patients scheduled for ACL reconstruction were digitized to measure PTS, tibial medial plateau length, tibial anterior and posterior metaphyseal heights and inclinations, and patellar height. Measurements were compared between knees with PTS <12° and those with ≥12°. The wedge height required for supratuberosity TDO was estimated for knees with excessive PTS, aiming for a target PTS of 5°, to determine the proportion of knees that would have residual aHt <15 mm. Results: A total of 326 knees had adequate true lateral radiographs. The mean PTS was 9.8°± 3.1° (range, 1°-20°) and exceeded 12° in 83 (25%) knees. There were no significant differences between knees with normal versus excessive PTS when comparing aHt (30.7 ± 4.5 mm vs 31.6 ± 4.9 mm; P =.270) and medial tibial plateau length (43.1 ± 5.4 mm vs 43.3 ± 5.6 mm; P =.910). Setting the target mPTS at 5° for supratuberosity TDO, the mean residual aHt was 25.0 ± 4.4 mm, and 7 (8%) knees had a residual aHt <20 mm, of which only 1 (1%) had residual aHt <15 mm. Setting the target mPTS at 0°, the mean residual aHt was 21.3 ± 4.2 mm, and 36 (43%) knees had a residual aHt <20 mm, of which only 4 (5%) had residual aHt <15 mm. Conclusion: aHt was not significantly different between knees with normal versus excessive PTS. Estimation of the wedge height required for supratuberosity TDO to reduce excessive PTS to 5° revealed sufficient metaphyseal bone for wedge removal in all knees. Furthermore, 99% of knees would have sufficient residual bone (aHt, ≥15 mm) to accommodate fixation staples or plates, without the need for tibial tuberosity osteotomy. [ABSTRACT FROM AUTHOR]

Objectives: Sagittal plane tibial deformity has been implicated in anterior cruciate ligament ruptures, as most commonly quantified by measurement of the posterior tibial slope (PTS) using lateral knee radiographs as well as full-length lateral tibia radiographs. We propose the measurement of a novel distance between the superior aspect of the tibial tubercle and the tibial plateau (Lateral SupraTubercle Distance (LSTD)) on the lateral knee radiographs. This distance seems to have large variability based on tibial anatomy and no prior correlation has been reported in an ACL or non-ACL cohort. It is possible that this distance may be related to the PTS and supratubercle variances could account for the tibial deformity causing increased PTS. Therefore, this could be used to predict the risk of ACL reconstruction failure. This distance also has implications for tibial osteotomy technique: if this distance is too small, supra-tubercle posterior slope-reducing osteotomy may not be feasible. We also propose the measurement of a novel angle (Lateral SupraTubercle Angle (LSTA)) on the lateral knee radiographs. It is possible that this angle may be related to the PTS and could be used to predict the risk of ACL reconstruction failure as well. Our primary objective was to determine normative data for the LSTD as measured as the distance between the superior aspect of the tibial tubercle and the tibial plateau on a lateral knee radiograph, as well as the LSTA as measured as the angle formed between a line drawn from the distal aspect of the posterior tibial flare of the PCL insertion to the proximal point of the tibial tubercle and a line drawn parallel to the tibial plateau. Our secondary objective was to evaluate the relationship between the LSTD and/or LSTA and PTS on a lateral knee radiograph. Ultimately, we sought to evaluate whether LSTD and/or LSTA may be another tool that could be used preoperatively to determine the risk of rupture after ACL reconstruction. The LSTD can also be used to help plan supra-tubercle versus infra-tubercle tibial osteotomy during slope-correcting surgery. Methods: This was a retrospective cohort study using 2 disparate cohorts of skeletally mature patients. Other criteria included absence of osteoarthritis on radiographs and no history of prior knee surgery. Radiographic requirements included xrays with a centered knee and posterior femoral condyle overlap of less than 5 mm as measured between the medial and lateral femoral condyles. The first cohort included patients with a knee complaint not related to ligament injury who underwent lateral knee radiographs. This cohort was used to establish a normal value for the LSTD and LSTA. Measurements were taken using both the medial and lateral plateaus. The LSTD was defined as the distance along the anterior tibial cortex between a point at the superior aspect of the tibial tubercle and a point tangential to a line drawn parallel to the tibial plateau. The LSTA was defined as the angle between a line drawn from the superior tibial tubercle to the posterior tibial flare of the PCL insertion and a line drawn parallel to the tibial plateau. The second cohort included patients with an ACL tear proven on MRI who underwent lateral knee radiographs. This cohort was used to compare the LSTD and LSTA to the previously established normal value or range of values and establish an association, if any, between the LSTD or LSTA and ACL tear. Results: Measurements were obtained on 100 lateral knee xrays that met inclusion criteria. This included 65 xrays in the control cohort and 35 xrays in the ACL cohort. The mean measurements for LSTA-medial and LSTA-lateral in the control group were 12.2 ± 3.3 and 13.12 ± 3.75, respectively. The mean for PTS-medial and PTS-lateral in the cohort group were 8.14 ± 3.57 and 9.1 ± 3.0, respectively. In the ACL group, the mean measurements for LSTA-medial and LSTA-lateral were 13.7 ± 4.3 and 14.37 ± 4.04, respectively. The means for PTS-medial and PTS-lateral in the ACL group were 8.77 ± 3.74 and 9.23 ± 3.40, respectively. The mean measurements for LSTD-medial and LSTD-lateral in the control group were 26.34 ± 4.27 and 30.15 ± 4.23, respectively. In the ACL group, the mean measurements for LSTD- medial and LSTD-lateral were 27.4 ± 4.05 and 30.71 ± 4.1, respectively. Pearson correlation calculations were performed to evaluate each measurement's ability to predict ACL injury. The Pearson correlations for LSTA (r=0.19) were higher than that of posterior tibial slope (r=0.083). Conclusions: We have established mean values for LSTA-medial and LSTA-lateral as well as mean values for LSTD-medial and LSTA-lateral. Based on our data, we cannot discern for sure that LSTA or posterior tibial slope had significant correlations with ACL injury. However, according to our correlation calculations, the LSTA has stronger correlations than posterior tibial slope. Thus, LTSA could be a better predictor for ACL injury than posterior tibial slope. Further studies with larger cohorts should be performed to further clarify the implications that LTSA has on risk of ACL injury. This novel measurement could be utilized in pre-operative planning to determine whether high-tibial ostoetomy would be beneficial when performed concurrently with ACL reconstruction. Furthermore, future studies could also be performed to evaluate LTSD as it relates to the choice of supra or infra-tubercle osteotomy. [ABSTRACT FROM AUTHOR]

Background: Return to sport is essential information when an athlete contemplates surgical intervention. Young athletes, <30 years of age, may undergo complex cartilage procedures or femoral/tibial osteotomies to successfully treat single-compartment knee osteoarthritis. Unicompartmental knee arthroplasty (UKA) may offer an attractive alternative option to middle-aged/older athletes with timely return to the same sport without a lengthy rehabilitation. Purpose: The purpose of this study was to determine if athletes are able to return to the same level of vigorous and moderate sports after fixed-bearing intramedullary nonrobotic UKA and the specific sports activities that these athletes continued to participate in at a minimum of 5 years. We hypothesized that UKA in the appropriately selected middle-aged/older athlete would yield high return to sport after UKA with high patient satisfaction. We also hypothesized that UKA would allow athletes to return to their sports of choice. Study Design: Cohort study; Level of evidence, 3. Methods: We identified 245 patients who underwent a UKA by a single surgeon between 2003 and 2017. Athletes were included if they participated in vigorous or moderate sports, as defined by the American College of Sports Medicine, and had minimum 5-year follow-up. The primary outcome was return to vigorous or moderate sports after UKA. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living score, KOOS Sport and Recreation score, Lysholm score, Patient Acceptable Symptom State (PASS) analysis, and radiographic analysis. Results: An overall 169 athletes met the inclusion criteria and were evaluated for return to sports. A total of 98% (165/169) returned to vigorous or moderate sports participation. The mean ± SD time to return to sport was 5.2 ± 2.3 months in the 39- to 50-year-old cohort, 5.8 ± 3.2 months in athletes aged 51 to 64 years, and 5.2 ± 3.0 months in athletes aged ≥65 years. A total of 143 athletes had minimum 5-year clinical and radiographic follow-up (mean, 10 years; range, 5-19 years). Maintenance of vigorous and moderate sport was seen in 99% (142/143) of athletes at a mean 10 years. In athletes who participated in vigorous sports, the mean Lysholm score was 85 ± 17, and 83% reached the PASS for KOOS Sport and Recreation. Radiographic analysis revealed no evidence of implant loosening (ie, subsidence, radiolucency) or osteolysis, and limb alignment and posterior slope of the implant were within normal limits. Conclusion: Athletes returned to sport at a mean 5 months after UKA implantation, with 98% (165/169) participating in vigorous or moderate sports. UKA is recommended as an alternative procedure in middle-aged and older athletes with single-compartment osteoarthritis who are contemplating a return to vigorous or moderate sport. [ABSTRACT FROM AUTHOR]

Background: Knee arthroscopy is frequently performed to improve joint function and relieve pain. However, there is no consensus regarding the effect of prior arthroscopy on outcomes following medial opening-wedge high tibial osteotomy (MOWHTO). Purpose: To compare midterm clinical outcomes and survival rates after MOWHTO between patients with and without a history of knee arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled patients who underwent MOWHTO between March 2008 and February 2017 and had ≥4 years of follow-up. Patients who had undergone knee arthroscopy were included in an arthroscopy group, and those who had not were included as controls. After propensity score matching based on age, sex, body mass index, and lesion size, 80 patients in each group were included. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey, and Tegner Activity Scale. Furthermore, survival rates and relevant risk factors that affected joint survivorship were analyzed, wherein conversion to total knee arthroplasty was considered the endpoint. Results: Although the pre- to postoperative improvement in clinical outcomes did not differ significantly between the groups, there were significant between-group differences in final postoperative scores on the KOOS–Activities of Daily Living (arthroscopy vs control, 78.1 ± 10.6 vs 81.0 ± 9.8; P =.031), KOOS–Sport and Recreation (45.4 ± 12.8 vs 48.7 ± 13.5; P =.045), 36-Item Short Form Health Survey Physical Component Summary (65.1 ± 12.7 vs 69.3 ± 11.8; P =.017), and Tegner Activity Scale (4.1 ± 1.1 vs 4.5 ± 1.0; P =.007). The survival rate was 96.8% at a mean follow-up of 8 years, and survival was not associated with a history of arthroscopy (P =.697; log-rank test). Conclusion: Although patients with prior arthroscopy had some inferior patient-reported outcome scores after MOWHTO, the overall clinical improvements were similar in the arthroscopy and control groups. [ABSTRACT FROM AUTHOR]

Background: Increased posterior tibial slope (PTS) is a risk factor for knee pathology. Accurate measurement of PTS is predicated on a quality lateral knee radiograph; however, little is known about how the quality of the radiograph affects the measured PTS. Purposes: To (1) describe a method for measuring malalignment on lateral knee radiographs, (2) assess the effects of malpositioning of the knee on radiographic measures of malalignment, and (3) determine any correlations between malalignment and the measured PTS. Study Design: Descriptive laboratory study. Methods: Using a setup similar to that of a standard radiology suite, 25 sets of radiographs were taken using 5 sawbone models. Each set included a true lateral view and separate malpositioned radiographs at 5°, 10°, and 15° of adduction, abduction, internal rotation, and external rotation. Malalignment for each radiograph was quantified as the anterior-posterior distance (APD) and proximal-distal distance (PDD) between femoral condyles. The medial PTS was measured in duplicate, and the interrater reliability was calculated. Results: The interrater reliability was excellent, with intraclass correlation coefficients of 0.92, 0.91, and 0.96 for the APD, PDD, and PTS, respectively. Malrotation significantly affected the APD (P <.001), with a mean change of 5.6 mm per 5°. Malpositioning in abduction/adduction significantly affected the PDD (P <.001), with a mean change of 5.1 mm per 5°. There was no significant impact of rotation or APD on the PTS. Abduction/adduction did affect the PTS (P <.001) above a threshold of 5° of malpositioning. The PTS decreased as the PDD increased, moving from adduction to abduction (R 2 = 0.5687). Conclusion: The measured PTS was more sensitive to malpositioning by abduction/adduction than by malrotation. Malrotation affected the APD, while abduction/adduction affected the PDD. Thus, the accuracy of the measured PTS was compromised more by poorly aligned distal femoral condyles than it was by poorly aligned posterior femoral condyles. Clinical Relevance: To minimize the effects of malpositioning, we recommend utilizing radiographs with a |PDD| of <5 mm and an |APD| of <15 mm when measuring the PTS. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare variables such as medial posterior tibial slope, lateral posterior tibial slope, medial tibial plateau depth calculated by preoperative MRI, and posterior tibial slope calculated by lateral knee X-ray on randomly selected patients with ACL injuries to a control group of patients without the injury. The secondary aim is to determine the critical value of these parameters and ascertain whether they can be used as a screening tool to identify at-risk individuals. Methods: Study participants included 426 subjects with noncontact knee injuries. Using stratified systematic random sampling, they were randomly divided into two equal groups of sixty, one for patients with ACL tears, and the other for those with ACL that was intact based on clinical and MRI findings. Based on the blinded assessment, MPTS, LPTS, MTPD, and PTS were assessed in MRI and lateral knee X-ray (PTS only), and the results were compared between groups using appropriate statistical models. Results: There were higher MPTS, LPTS, and PTS scores in the ACL tear group when compared to the control group (p < 0.01), while MTPD was lower when compared to the control group (p > 0.05). ROC analysis for predicting ACL tear revealed an area under the curve for MPTS, LPTS, PTS, and MTPD as 0.942, 0.907, 0.967, and 0.878, respectively. The critical angle for MPTS, LTPS, PTS and MTPD was 8.25°,6.75°,8.5° and 2.25 mm, respectively, which has sensitivity of 91.0%, 86.7%, 93.3% and 80%; specificity of 86.7%, 78.3%, 90.0% and 71.7%, respectively. Conclusions: Medial posterior tibial slope, lateral posterior tibial slope, and posterior tibial slope were significantly higher in individuals in the ACL tear group but there was no significant difference in medial tibial plateau depth. MPTS, LPTS, and PTS are better predictors of identifying at-risk individuals predisposed to ACL injury than MTPD. [ABSTRACT FROM AUTHOR]

Background: A coherent measurement approach for sagittal alignment of the distal femur after fracture reduction or distal femur osteotomies is not available. The present study aims to introduce a new method using Blumensaat's line and tangent lines to the femoral cortexes to determine the sagittal alignment of the distal femur. Methods: 113 patients who had true lateral knee radiographs were included. All of the radiographs were evaluated by one fellowship-trained knee surgeon and one radiologist using the PACS system. The Blumensaat's line was determined on the true lateral knee radiographs. Then, three long lines were drawn on the distal third of the femoral shaft. The first line is tangent to the anterior cortex of the femur, the second line is along with the anatomical axis of the femur, and the third line is tangent to the posterior cortex of the femur. The angles between Blumensaat's line and these lines were measured. Intraclass Correlation Coefficient (ICC) was used to measure the strength of inter-and intra-rater agreement. Results: The mean angle between the Blumensaat's line and the anatomical axis of the femur was 35.4 ± 3°. The mean angle between the Blumensaat's line and the line tangent to the anterior femoral cortex and the line tangent to the posterior femoral cortex were 34.5 ± 3° and 35.2 ± 3°, respectively. Excellent inter-and intra-rater reliabilities were observed between the measurements (ICC = 0.96 and ICC = 0.98, respectively). The angle between the Blumensaat's line and the line tangent to the posterior femoral cortex was significantly higher in participants aged < 38 years (p = 0.049). No other significant association was found between the angles and demographic characteristics of the patients. Conclusions: The expected mean angles between the Blumensaat's line and the distal femur were 34.3 to 35.4 degrees. This finding could be useful to determine the normal sagittal alignment of the distal femur. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Background: Discoid lateral meniscus (DLM) has a varied and complex morphology that can be challenging to assess and treat. Preoperative magnetic resonance imaging (MRI) is frequently used for diagnosis and surgical planning; however, it is not known whether surgeons are reliable and accurate in their interpretation of MRI findings when defining the pathomorphology of DLM. Hypothesis: Surgeons experienced in treating DLM are able to reliably interpret DLM pathology using MRI. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Knee MRI scans from 44 patients (45 knees) were selected from a pool of surgically treated patients with DLM. Five reviewers (fellowship-trained pediatric sports medicine surgeons) performed independent review of each MRI scan using the PRiSM Discoid Meniscus Classification. Inter- and intraobserver reliability of the rating factors—primary (width, height, presence of peripheral instability or tear) and secondary (location of instability or tear, tear type)—was assessed using the Fleiss κ coefficient, designed for multiple readers with nominal variables (fair reliability, 0.21-0.40; moderate, 0.41-0.60; substantial, 0.61-0.80; excellent, 0.81-1.00). Reliability is reported as κ (95% CI). Results: Interobserver reliability in assessing most primary and secondary characteristics ranged from substantial (meniscal width) to moderate (peripheral instability, anterior instability, posterior instability, and posterior tear). Intraobserver reliability for most characteristics ranged from substantial (peripheral instability, presence of tear, anterior instability, posterior instability, and posterior tear) to moderate (meniscal width, anterior tear, and tear type). Notable exceptions were presence of tear, anterior tear, and tear type—all with fair interobserver reliability. Height had poor interobserver reliability and fair intraobserver reliability. Conclusion: Orthopaedic surgeons reliably interpret MRI scans using the PRiSM Discoid Meniscus Classification for the majority of DLM characteristics but vary in their assessment of height and presence and type of tear. MRI evaluation may be helpful to diagnose discoid by width and identify the presence of instability: 2 major factors in the decision to proceed with surgery. Arthroscopic evaluation should be used in conjunction with MRI findings for complete DLM diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The outcomes of the constrained condylar knee (CCK) implant used during primary total knee arthroplasty (TKA) in knees with severe varus in patients from low- and middle-income countries (LMICs) such as Iraq are not known. Hence, this study aimed to analyze and report the functional outcome of CCK TKA in patients with severe varus deformities at the end of 5 years in Iraqi patients. Methods: In this prospective study, pre- and post-operative (at the end of 5 years) clinical outcome using Knee Society Score (KSS) and radiological deformity using hip-knee-ankle (HKA) angle was analyzed in 76 CCK TKAs (20 bilateral and 36 unilateral TKAs) performed in 56 patients with severe varus deformity (> 15°). Results: At a mean follow-up of 60.3 months (range 60–68 months), the mean preoperative KSS knee score of 6.6 ± 4.5 improved significantly (p < 0.0001) to 87.2 ± 6.6 and the mean preoperative KSS function score of 7.1 ± 6.4 improved significantly (p < 0.0001) to 70.4 ± 7.8. The function score was good to excellent in 64.3% (36 patients), fair in 28.5% (16 patients), and poor in 7.1% (4 patients) at the end of 5 years. The mean preoperative HKA angle significantly improved (p < 0.001) from 25.5° ± 6° varus (range 17°–37°) to 3° ± 2.5° varus (range 0°–7.5°) at final follow-up. Conclusion: The CCK implant significantly improved pain and function in patients with severe varus deformity at the end of 5 years. The CCK implant is a good option during primary TKA in severe varus knees in patients from LMICs and can help achieve clinical outcomes similar to patients from high-income countries. [ABSTRACT FROM AUTHOR]

Purpose: The outcome of a tibial plateau fracture (TPF) depends on the fracture reduction achieved and the extent of soft-tissue lesions, including lesions in the ligaments, cartilage, and menisci. Sub-optimal treatment can result in poor knee function and osteoarthritis. Preoperative planning is primarily based on conventional X-ray and computed tomography (CT), which are unsuitable for diagnosing soft-tissue lesions. Magnetic resonance imaging (MRI) is not routinely performed. To date, no literature exists that clearly states the indications for preoperative MRI. This systematic review aimed to determine the frequency of soft-tissue lesions in TPFs, the association between fracture type and soft-tissue lesions, and the types of cases for which MRI is indicated. Methods: A systematic review of the literature was based on articles located in PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), supplemented by searching the included articles' reference lists and the ePublication lists of leading orthopedic and trauma journals. Results: A total of 1138 studies were retrieved. Of these, 18 met the eligibility criteria and included a total of 877 patients. The proportion of total soft-tissue lesions was 93.0%. The proportions of soft-tissue lesions were as follows: medial collateral ligament 20.7%, lateral collateral ligament 22.9%, anterior cruciate ligament 36.8%, posterior cruciate ligament 14.8%, lateral meniscus 48.9%, and medial meniscus 24.5%. A weak association was found between increasing frequency of LCL and ACL lesions and an increase in fracture type according to Schatzker's classification. No standard algorithm for MRI scans of TPFs was found. Conclusion: At least one ligament or meniscal lesion is present in 93.0% of TPF cases. More studies with higher levels of evidence are needed to find out in which particular cases MRI adds value. However, MRI is recommended, at least in young patients and cases of high-energy trauma. [ABSTRACT FROM AUTHOR]

The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018–July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor. [ABSTRACT FROM AUTHOR]

Background: Knee kinematic parameters during a drop vertical jump (DVJ) have been demonstrated to be associated with increased risk of noncontact anterior cruciate ligament (ACL) injury. However, standard motion analysis systems are not practical for routine screening. Affordable and practical motion sensor alternatives exist but require further validation in the context of ACL injury risk assessment. Purpose/Hypothesis: To prospectively study DVJ parameters as predictors of noncontact ACL injury in collegiate athletes using an affordable motion capture system (Kinect; Microsoft). We hypothesized that athletes who sustained noncontact ACL injury would have larger initial and peak contact coronal abduction angles and smaller peak flexion angles at the knee during a DVJ. Study Design: Case-control study; Level of evidence, 3. Methods: 102 participants were prospectively recruited from a collegiate varsity sports program. A total of 101 of the 102 athletes (99%) were followed for an entire season for noncontact ACL injury. Each athlete performed 3 DVJs, and the data were recorded using the motion capture system. Initial coronal, peak coronal, and peak sagittal angles of the knee were identified by our software. Results: Five of the 101 athletes sustained a noncontact ACL injury. Peak coronal angles were significantly greater and peak sagittal flexion angles were significantly smaller in ACL-injured athletes (P =.049, P =.049, respectively). Receiver operating characteristic (ROC) analysis demonstrated an area under the curve of 0.88, 0.92, and 0.90 for initial coronal, peak coronal, and peak sagittal angle, respectively. An initial coronal angle cutoff of 2.96° demonstrated 80% sensitivity and 72% specificity, a peak coronal angle cutoff of 6.16° demonstrated 80% sensitivity and 72% specificity, and a peak sagittal flexion cutoff of 93.82° demonstrated 80% sensitivity and 74% specificity on the study cohort. Conclusion: Increased peak coronal angle and decreased peak sagittal angle during a DVJ were significantly associated with increased risk for noncontact ACL injury. Based on ROC analysis, initial coronal angle showed good prognostic ability, whereas peak coronal angle and peak sagittal flexion provided excellent prognostic ability. Affordable motion capture systems show promise as cost-effective and practical options for large-scale ACL injury risk screening. [ABSTRACT FROM AUTHOR]

Background: Despite recent evidence that medial patellofemoral ligament reconstruction (MPFLR) in the skeletally immature patient is both safe and effective, there are limited data evaluating postoperative coronal- and sagittal-plane growth and radiographic patellofemoral parameters in this population. Purpose: The primary purpose was to assess radiographic measures of coronal-plane alignment, longitudinal growth, patellar congruence, and trochlear dysplasia after MPFLR in a skeletally immature population. A secondary purpose was to assess this population compared with a matched cohort with a focus on trochlear dysplasia prevalence and the effect of MPFLR on patellar height. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 28 children with a minimum 1-year follow-up who underwent isolated MPFLR were identified. All patients were skeletally immature, defined as fully open physes on both sides of the knee joint, at the time of surgery. The development of a limb length discrepancy or angular growth abnormalities were assessed on standing hip-to-ankle radiographs, patellar tilt and congruence were measured on the Merchant view of the knee, and the grade of trochlear dysplasia and patellar height were assessed on lateral knee radiographs. A sex- and age-matched group of patients who underwent anterior cruciate ligament reconstruction was formed as a control for patellar height and trochlear dysplasia measurements. Results: The mean patient age was 11.71 ± 2.02 years at the time of surgery with a mean follow-up of 23.54 ± 12.49 months. All but 1 patient in the MPFLR group had preoperative features consistent with trochlear dysplasia. There was no significant difference in limb length or coronal-plane alignment at final follow-up (P =.725 and P >.999, respectively). Both the MPFLR and the anterior cruciate ligament reconstruction groups had a statistically significant decrease in the Caton-Deschamps index between the preoperative and postoperative time points (mean, 0.18 ± 0.20 and 0.11 ± 0.14, respectively; P =.161). Conclusion: MPFLR may be safely performed utilizing an epiphyseal femoral socket in a skeletally immature cohort without affecting normal longitudinal growth or coronal limb alignment. The previously reported effect of MPFLR in reducing patellar height may be related to physiological growth based on similar changes noted in a comparison cohort that did not undergo the procedure. [ABSTRACT FROM AUTHOR]

Objectives: This study uses a practical positional MRI protocol to evaluate tibiofemoral translation and rotation in normal and injured knees. Methods: Following ethics approval, positional knee MRI of both knees was performed at 35° flexion, extension, and hyperextension in 34 normal subjects (mean age 31.1 ± 10 years) and 51 knee injury patients (mean age 36.4 ± 11.5 years, ACL tear n = 23, non-ACL injury n = 28). At each position, tibiofemoral translation and rotation were measured. Results: Normal knees showed 8.1 ± 3.3° external tibial rotation (i.e., compatible with physiological screw home mechanism) in hyperextension. The unaffected knee of ACL tear patients showed increased tibial anterior translation laterally (p = 0.005) and decreased external rotation (p = 0.002) in hyperextension compared to normal knees. ACL-tear knees had increased tibial anterior translation laterally (p < 0.001) and decreased external rotation (p < 0.001) compared to normal knees. Applying normal thresholds, fifteen (65%) of 23 ACL knees had excessive tibial anterior translation laterally while 17 (74%) had limited external rotation. None (0%) of 28 non-ACL-injured knees had excessive tibial anterior translation laterally while 13 (46%) had limited external rotation. Multidirectional malalignment was much more common in ACL-tear knees. Conclusions: Positional MRI shows (a) physiological tibiofemoral movement in normal knees, (b) aberrant tibiofemoral alignment in the unaffected knee of ACL tear patients, and (c) a high frequency of abnormal tibiofemoral malalignment in injured knees which was more frequent, more pronounced, more multidirectional, and of a different pattern in ACL-tear knees than non-ACL-injured knees. Key Points: • Positional MRI shows physiological tibiofemoral translation and rotation in normal knees. • Positional MRI shows a different pattern of tibiofemoral alignment in the unaffected knee of ACL tear patients compared to normal control knees. • Positional MRI shows a high prevalence of abnormal tibiofemoral alignment in injured knees, which is more frequent and pronounced in ACL-tear knees than in ACL-intact injured knees. [ABSTRACT FROM AUTHOR]

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Background: Quantitative magnetic resonance imaging (qMRI) methods were developed to establish the integrity of healing anterior cruciate ligaments (ACLs) and grafts. Whether qMRI variables predict risk of reinjury is unknown. Purpose: To determine if qMRI measures at 6 to 9 months after bridge-enhanced ACL restoration (BEAR) can predict the risk of revision surgery within 2 years of the index procedure. Study Design: Cohort study; Level of evidence, 2. Methods: Originally, 124 patients underwent ACL restoration as part of the BEAR I, BEAR II, and BEAR III prospective trials and had consented to undergo an MRI of the surgical knee 6 to 9 months after surgery. Only 1 participant was lost to follow-up, and 4 did not undergo MRI, leaving a total of 119 patients for this study. qMRI techniques were used to determine the mean cross-sectional area; normalized signal intensity; and a qMRI-based predicted failure load, which was calculated using a prespecified equation based on cross-sectional area and normalized signal intensity. Patient-reported outcomes (International Knee Documentation Committee subjective score), clinical measures (hamstring strength, quadriceps strength, and side-to-side knee laxity), and functional outcomes (single-leg hop) were also measured at 6 to 9 months after surgery. Univariate and multivariable analyses were performed to determine the odds ratios (ORs) for revision surgery based on the qMRI and non-imaging variables. Patient age and medial posterior tibial slope values were included as covariates. Results: In total, 119 patients (97%), with a median age of 17.6 years, underwent MRI between 6 and 9 months postoperatively. Sixteen of 119 patients (13%) required revision ACL surgery. In univariate analyses, higher International Knee Documentation Committee subjective score at 6 to 9 months postoperatively (OR = 1.66 per 10-point increase; P =.035) and lower qMRI-based predicted failure load (OR = 0.66 per 100-N increase; P =.014) were associated with increased risk of revision surgery. In the multivariable model, when adjusted for age and posterior tibial slope, the qMRI-based predicted failure load was the only significant predictor of revision surgery (OR = 0.71 per 100 N; P =.044). Conclusion: Quantitative MRI-based predicted failure load of the healing ACL was a significant predictor of the risk of revision within 2 years after BEAR surgery. The current findings highlight the potential utility of early qMRI in the postoperative management of patients undergoing the BEAR procedure. [ABSTRACT FROM AUTHOR]

Background: Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. Purpose/Hypothesis: The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. Study Design: Descriptive laboratory study. Methods: Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. Results: Mean ACL strain increased with decreasing knee flexion angle (ρ = −0.3; P =.002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, −0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = −0.01; P =.9). Conclusion: ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. Clinical Relevance: These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs. [ABSTRACT FROM AUTHOR]