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Background: The medial collateral ligament (MCL) is frequently involved in injuries around the knee but is uncommonly treated surgically. There are various techniques to reconstruct the medial side of the knee, which have varying outcomes. Purpose/hypothesis: The purpose of the present systematic review and meta-analysis is to describe the clinical results of surgical management of acute and chronic isolated grade III MCL injury using various functional scores, such as IKDC, Lysholm, and VAS, and to ascertain complication rates associated with these interventions. Methods: A systematic review was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, and two independent authors (L.F and A.M) conducted a comprehensive search across multiple databases (PubMed, Web of Science, and Scopus). They reviewed each article's title and abstract for studies available until April 2024. The search terms used were "((MCL) OR (Medial collateral ligament)) AND (injuries) AND (treatment)". The full texts of the studies were evaluated when eligibility could not be assessed from the title and abstract. Results: The pooled proportion (percentage) of complications from the three studies reporting data on surgery for the MCL acute stage was 15.3% with 95% CI [6.1% to 24.6%]. No complications were reported in studies reporting surgery in the chronic stage. Marked resolution of pain was observed with the mean VAS Score for pain at the final follow-up after surgery for MCL injury in the acute stage was 0.4 with 95% CI [-0.04 to 0.84]. The mean IKDC score at the final follow-up in the three studies reporting data on surgery for the MCL in the acute stage was 79.39 with 95% CI [67.96 to 90.82], and in the chronic stage, was 85 with 95% CI [83.02 to 86.98]. The mean Lysholm Score at the final follow-up after surgery for MCL injury in the chronic stage was 83.04 with 95% CI [75.24 to 94.84], and in the acute stage was 95 with 95% CI [91.76 to 98.24]. Conclusion: This systematic review found that functional outcomes regarding IKDC and LYSHOLM scores were comparable for surgeries performed in acute and chronic MCL tears. There was a marginally increased risk of complication in surgeries performed for acute MCL tears. Compared to the acute phase, a marked resolution of pain was observed at the final follow-up after surgery for MCL injury. Study Design: Systematic review; level of evidence, 4.. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to conduct a comprehensive assessment of MLKI outcome studies in order to ascertain the overall rates of return to sport following MLKI. Methods: A systematic review was conducted based on the PRISMA guidelines. Quality assessment of the systematic review was performed using the MINORS Score. The following search terms were browsed in the title, abstract, and keyword fields: "multiligament knee" or "MLKI" AND "return to sport" or "sports activity" or "athletes" or "sports" or "sportsman". The resulting measures extracted from the studies were the rate of RTS, level of RTS, complications, revision surgery, Tegner, International Knee Documentation Committee (IKDC) Lysholm and anterior cruciate ligament-return to sport after injury (ACL-RSI). Results: A total of 439 patients were included in the study, of whom 383 (87.2%) were male and 56 (22.8%) were female. The mean age at surgery was 28.06 ± 8.93 years. The mean time from injury to surgery was 97.68 ± 127.81 weeks, while the mean follow-up was 42.83 ± 39.22 months. Of 312 patients who completed the follow-up and reported to be sportsmen before surgery, 184 (58.97%) returned to the same or higher pre-injury level, 58 (18.58%) returned to a lower level, while 69 (22.11%) did not return to sports activity. The author analysed the Tegner score in three studies and noted a decrease compared to the pre-injury level (from 7.12 ± 0.8 pre-injury to 4.59 ± 0.57 at the final follow-up; p < 0.001). At the final follow-up, 4 studies analysed IKDC with a mean value of 75.14 ± 9.6, 3 reported a mean Lysholm of 51.81 ± 27.6, and two reported a mean ACL-RSI of 64.82 ± 0.149. Among the 439 patients, a total of 90 (20.5%) complications/re-operations were reported, while a total of 29 (6.6%) failures were recorded. Conclusions: Return to sport after MLKI occurs in approximately 75% of surgically treated patients, though return to high-level sport is about 60% of the patients. Furthermore, one in five patients report complications, while the failure rate is relatively low (< 7%). Level of Evidence: Systematic review of level 4. [ABSTRACT FROM AUTHOR]

Background: Injuries of the superficial medial collateral ligament (sMCL) and anteromedial structures of the knee result in excess valgus rotation and external tibial rotation (ER) as well as tibial translation. Purpose: To evaluate a flat reconstruction of the sMCL and anteromedial structures in restoring knee kinematics in the combined MCL- and anteromedial-deficient knee. Study Design: Controlled laboratory study. Methods: Eight cadaveric knee specimens were tested in a 6 degrees of freedom robotic test setup. Force-controlled clinical laxity tests were performed with 200 N of axial compression in 0°, 30°, 60°, and 90° of flexion: 8 N·m valgus torque, 5 N·m ER torque, 89 N anterior tibial translation (ATT) force, and an anteromedial drawer test consisting of 89 N ATT force under 5 N·m ER torque. After determining the native knee kinematics, we transected the sMCL, followed by the deep medial collateral ligament (dMCL). Subsequently, a flat reconstruction of the sMCL with anteromedial limb, mimicking the function of the anteromedial corner, was performed. Mixed linear models were used for statistical analysis (P <.05). Results: Cutting of the sMCL led to statistically significant increases in laxity regarding valgus rotation, ER, and anteromedial translation in all tested flexion angles (P <.05). ATT was significantly increased in all flexion angles but not at 60° after cutting of the sMCL. A combined instability of the sMCL and dMCL led to further increased knee laxity in all tested kinematics and flexion angles (P <.05). After reconstruction, the knee kinematics were not significantly different from those of the native state. Conclusion: Insufficiency of the sMCL and dMCL led to excess valgus rotation, ER, ATT, and anteromedial tibial translation. A combined flat reconstruction of the sMCL and the anteromedial aspect restored this excess laxity to values not significantly different from those of the native knee. Clinical Relevance: The presented reconstruction might lead to favorable results for patients with MCL and anteromedial injuries with an anteromedial rotatory knee instability. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament and meniscus tears are common among sports injuries. There are different techniques for addressing anterior cruciate ligament and meniscus tears, with distinct indications, advantages, and disadvantages. We present the case of a 23-year-old male who underwent right anterior cruciate ligament reconstruction and posterior horn medial meniscus repair using an all-inside technique via superficial medial collateral ligament (sMCL) pie-crusting. Clinical examination and radiological investigations a few months later identified calcifications on the medial side of the right knee. We diagnosed the patient with heterotopic ossification post-sMCL pie-crusting; no apparent causal factors were present. To our knowledge, there have been no documented instances of heterotopic ossification following sMCL pie-crusting. In conclusion, heterotopic ossification may occur after sMCL pie-crusting; further studies are needed on this subject. [ABSTRACT FROM AUTHOR]

It is important to highlight that in certain specialized industries, humidity detection limit is increasingly stringent. The dynamic range of humidity measurement can be expanded from low relative humidity levels to measurements at the ppm, ppb, or even ppt level. The increasingly tight humidity detection limits, especially in some industries, make this growth all the more important. Two major obstacles prevent the development of high-performance low-humidity sensors based on nanostructured materials: first, the sensor's small water-molecule-absorbing capacity, and second, the restrictions imposed by some harsh environments. As of right now, there are few comprehensive reviews of studies done on trace and low humidity sensors. With any luck, the findings of this research will shed light on how low/trace humidity sensors should be developed, which should speed up the production of high-performance materials and encourage the use of better methods for controlling low humidity. Initially, our attention has been directed toward evaluating the contemporary market outlook and the significance of trace/low humidity sensors, encapsulating the evolutionary trends observed in recent years. We have explored the advancements made and the critical issues requiring attention over the past decade. In conclusion, we have provided a summary and offered insights into the future direction of low and trace humidity sensors. [ABSTRACT FROM AUTHOR]

Introduction and Purpose: This article presents a comprehensive analysis of the risks and benefits associated with downhill skiing. The article elucidates the prevalence and etiology of common injuries, while also delineating the salutary effects of engaging in the sport. Methods: A literature search was conducted using PubMed and Google Scholar, focusing on articles from 2019 to 2024, including observational studies, clinical trials, meta-analyses and systematic reviews. State of Knowledge: Skiing is a globally popular winter sport, attracting millions of enthusiasts each year. The sport's combination of outdoor adventure, social activity, and the allure of winter landscapes contribute to its enduring global popularity. Despite its global popularity, skiing carries a significant risk of injury, with knee injuries, particularly ACL sprains, being the most common, especially among women. Despite these risks, alpine skiing offers significant physical health benefits, including improved cardiorespiratory fitness, muscle strength and mental health, making it a beneficial lifelong sport, particularly for older adults. Conclusion: It is notable that while injuries such as ACL sprains and fractures are prevalent, particularly among beginners and those who engage in risk-taking activities, the sport also offers significant health benefits. Alpine skiing has been demonstrated to enhance cardiorespiratory fitness, muscle strength, and mental well-being, thereby conferring significant benefits that extend throughout the lifespan, despite the potential for injury.

Simple Summary: Bispecific antibodies are a novel type of immune-based therapy used to treat patients with non-Hodgkin's lymphoma. This review article will help define the current treatment landscape of non-Hodgkin's lymphoma and detail ways in which bispecific antibodies fit in the current management paradigm, with special attention paid to diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma. B-cell non-Hodgkin's lymphoma (NHL) refers to a heterogenous group of diseases, all of which have a wide range of treatment strategies and patient outcomes. There have been multiple novel, immune-based therapies approved in NHL in the last decade, including bispecific antibodies (BsAbs) and chimeric antigen receptor therapy (CAR-T). With a host of new therapies, an important next step will be determining how these therapies should be sequenced in contemporary management strategies. This review seeks to offer a framework for the ways in which BsABs can be incorporated into the current management paradigm for NHL, with special attention paid to diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and mantle cell lymphoma (MCL). [ABSTRACT FROM AUTHOR]

The "Unhappy Triad" or "O'Donoghue's Triad" is one of the most severe multiligamentous sports injuries that involves a tear of the ACL, MCL and medial meniscus of the knee. Recovery after surgical treatment is between 6 and 12 months, and many athletes after this injury do not return to their sports activities. Purpose: to follow the functional state of the knee complex in patients after surgical treatment of the "Unhappy Triad", before and after 10 days of kinesitherapy in the moderately protective period. Methodology: 70 patients after surgical treatment of the "Unhappy Triad" were studied, 32 were assigned to a control group (CG) and 38 to an experimental group (EG). In all patients, the treatment of the MCL rupture was conservative (30 days of knee immobilization) with subsequent surgery that included partial meniscectomy and ACL reconstruction using the BPTB method. A traditional model of kinesitherapy was applied in the CG, and in the EG the following were applied: instrumentally assisted soft tissue mobilization - Ergon® IASTM Technique, kinesio tape, post-isometric relaxation, stretching, proprioceptive training, locomotor training, analytical exercises and aquatherapy for 10 days. To monitor changes in the functional state of the knee, a functional scale for complex assessment according to D. Seligson was applied, before and after 10 days of kinesitherapy. Results: the initial average cumulative assessment of the functional state of the damaged knee in CG before kinesitherapy was 4.688, and in EG it was similar – 5.105. The values indicate a severe functional state on the first day of the study. After 10 days of kinesitherapy there was a significant improvement in results in both groups. In absolute values, the functional state of the knee in CG increased by 5.37, and in relative values by 114.67%, in EG it increased by 7.9 or the improvement was by 155.66%. As a result, the final mean cumulative score of patients in the control group was 10.06 and in the experimental group it was 13.05. The testing of the hypotheses for the significance of the differences of the variable in the two groups shows that P>0.05 on the first day of the study, from which it follows that the groups are the same in terms of the studied indicator, and on the tenth day P<0.05, which proves the existence of a statistically significant difference in the average values of the indicator in favor of EG. Conclusions: The applied model of kinesitherapy in the experimental group is more effective and contributes to a more significant complex restoration of the functional state of the knee joint of the patients, compared to the traditional model of kinesitherapy in the control group. [ABSTRACT FROM AUTHOR]

Background: Anteromedial rotatory instability (AMRI) of the knee is a complex and severe condition caused by injury to the anterior cruciate ligament and/or the medial collateral ligament. Clinical studies dealing with AMRI are rare, and objective measurements are nonexistent. Purpose/Hypothesis: The objectives of this study were, first, to quantify anteromedial rotatory knee laxity in healthy individuals using a noninvasive image analysis software and, second, to assess intra- and interrater reliability and equivalence in measuring anteromedial knee translation (AMT). It was hypothesized that AMT could be reliably quantified using a noninvasive image analysis software. Study design: Cohort study; Level of evidence, 3. Methods: This prospective proof-of-concept study included healthy individuals aged 16 to 40 years with no history of knee injury or surgery. Three adhesive surface markers were placed on predefined landmarks on the medial side of the knee. Three independent investigators examined anteromedial rotatory knee laxity with an anterior drawer test in different tibial rotations (neutral tibial rotation, 15° of external tibial rotation, and 15° of internal tibial rotation). The entire examination of each knee was recorded, and AMT including the side-to-side difference (SSD) was assessed using a freely available and validated image analysis software (PIVOT iPad application). Group comparisons were performed using a 1-way analysis of variance with Bonferroni-adjusted post hoc analysis. Intraclass correlation coefficients (ICCs) were calculated to assess inter- and intrarater reliability of AMT measurements. Equivalence of measurements was evaluated using the 2 one-sided t -test procedure. Results: Anteromedial rotatory knee laxity was assessed in 30 knees of 15 participants (53% male) with a mean age of 26.2 ± 3.5 years. In all 3 raters, the highest AMT was observed in neutral tibial rotation (range of means, 2.2-3.0 mm), followed by external tibial rotation (range of means, 2.0-2.4 mm) and internal tibial rotation (range of means, 1.8-2.2 mm; P <.05). Intrarater reliability of AMT (ICC, 0.88-0.96) and SSD (ICC, 0.61-0.96) measurements was good to excellent and moderate to excellent, respectively. However, interrater reliability was poor to moderate for AMT (ICC, 0.44-0.73) and SSD (ICC, 0.12-0.69) measurements. Statistically significant equivalence of AMT and SSD measurements was observed between and within raters for almost all testing conditions. Conclusion: Anteromedial rotatory knee laxity could be quantified using a noninvasive image analysis software, with the highest AMT observed during neutral tibial rotation in uninjured individuals. Reliability and equivalence of measurements were good to excellent within raters and moderate between raters. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to retrospectively analyse the pattern of injury to the medial knee structures in anterior cruciate ligament (ACL) injured patients. It was hypothesised that anteromedial injuries would be more common than posteromedial lesions. Methods: One hundred and twenty subjects aged 18–25 years with a primary ACL injury were included. Patients were excluded if the time between injury and magnetic resonance imaging (MRI) was more than 28 days or if a knee dislocation or fracture was present. The MRIs were analysed with particular emphasis on injuries to the medial knee structures, menisci and bone bruise patterns. Injuries to the ligaments and anteromedial retinaculum (AMR) were graded according to severity, ranging from periligamentous oedema (grade I), partial fibre disruption of less or more than 50% (grade IIa or IIb) to complete tears (grade III). Results: AMR injury was seen in 87 subjects (72.5%) on the coronal plane and in 88 (73.3%) on the axial plane, with grade III lesions observed in 27 (22.5%) and 29 knees (24.2%). Injuries to the superficial medial collateral ligament (sMCL), deep MCL (dMCL) and posterior oblique ligament (POL) were detected in 60 patients (50%), 93 patients (77.5%) and 38 patients (31.6%). However, grade III injuries to the POL were observed in only seven knees (5.8%). Medial meniscus injuries were associated with lesions of the sMCL and AMR (p < 0.05), while lateral meniscus injuries were significantly more common in patients with dMCL rupture (p < 0.05). Conclusion: Data from this study suggest that injuries to the AMR are much more common than posteromedial lesions in subjects with ACL injuries. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Semantic information has started to be used in localization methods to introduce a non-geometric distinction in the environment. However, efficient ways to integrate this information remain a question. We propose an approach for fusing data from different object classes by analyzing the posterior for each object class to improve robustness and accuracy for self-localization. Our system uses the bearing angle to the objects' center and objects' class names as sensor model input to localize the user on a 2D annotated map consisting of objects' class names and center coordinates. Sensor model input is obtained by an object detector on equirectangular images of a 360° field of view camera. As object detection performance varies based on location and object class, different object classes generate different likelihoods. We account for this by using appropriate weights generated by a Gaussian process model trained by using our posterior analysis. Our approach follows a systematic way to fuse data from different object classes and use them as a likelihood function of a Monte Carlo localization (MCL) algorithm. [ABSTRACT FROM AUTHOR]

The term "Unhappy Triad", coined by O'Donoghue, reflects a severe knee injury with rupture of the medial collateral ligament, medial meniscus, and anterior cruciate ligament. The triad is primarily a sports injury, and patients' recovery is 6 to 12 months. Material/Methods: 70 patients with "O'Donoghue's triad" were studied. Total anterior cruciate ligament rupture was reconstructed with patellae ligament autograft; medial meniscus tear was treated with partial meniscectomy; and medial collateral ligament injury was treated conservatively at 1 month before surgery. The aim of the study is to establish the epidemiology of the injury: age and gender distribution, distribution by types of sports in patients with "O'Donoghue's Triad" after arthroscopic treatment. 222 persons were examined in two stages – first, 187 with various soft tissue injuries of the knee, after surgical treatment, including persons with the triad, and second, 70 patients with O'Donoghue's triad. Results: The study shows that among 18-19-year-olds, the triad was found in 4 people; from 20 to 29 in 34, from 30 to 39 in 23, and from 40 to 49 in 9. In terms of gender, there were 62 men (86.11%) and 8 women (13.89%) with the triad injury. "O'Donoghue's Triad" was obtained during sports in 91.52% of cases, the remaining 8.48% in car accidents and household accidents. Conclusions: The results of the study establish and provide coaches, physiotherapists, orthopedists, scientists and educators with up-to-date data on the epidemiology of O'Donoghue's Triad, its incidence, age and sex characteristics and its distribution by sport.

Mantle cell lymphoma (MCL), representing 5% of cases, is an aggressive B-cell non-Hodgkin lymphoma. Rarely, it can spread to other areas. This case illustrates a unique occurrence of MCL involving the appendix, leading to obstructive symptoms. Additionally, its presentation as volvulus added complexity to diagnosis and treatment. A 72-year-old man with a history of MCL came to the ER with right lower quadrant abdominal pain and nausea for 7 days. A computed tomography scan showed a swirling sign, concerning for volvulus. The patient required emergent surgery for exploratory laparotomy. Intraoperatively, the patient was found to have an enlarged appendix measuring 16.5 cm in length and 5 cm in diameter. An appendectomy was performed, and the pathology was confirmed to be MCL. This is a rare case of MCL presenting in the appendix as a volvulus, resulting in obstructive symptoms. This distinctive manifestation posed significant challenges in diagnosis and management. Appreciating such cases is pivotal for accurate diagnosis and effective medical and surgical interventions for this aggressive lymphoma subtype. [ABSTRACT FROM AUTHOR]

Background: Combined injury of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) is a common injury pattern and accounts for 20% of all ligamentous knee injuries. Despite advancements in surgical technique, there is no up-to-date consensus regarding the superiority of nonoperative versus operative management in higher-grade MCL tears of combined ACL-MCL injuries. Purpose: To interpret recent literature on treatment options and to provide an updated evidence-based approach for management of combined ACL-MCL knee injuries. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: We performed a systematic review on outcomes following treatment of concomitant ACL and MCL injuries. A computerized search was conducted in PubMed, Embase.com, and Scopus.com. Authors independently assessed eligible studies and screened titles and abstracts. Articles reporting on patients with concomitant ACL and MCL injuries with or without concomitant procedures were included. Data regarding study design, sample size, patient age and sex, length of follow-up, timing of surgery, indications, surgical methods, concomitant procedures, outcomes, and complications were recorded. Patient-reported outcomes (PROs) and functional outcomes, including Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee scores, Lysholm and Tegner scores, and range of motion, were estimated via meta-analysis and compared statistically by surgical approach. Results: In total, 18 studies were included in the systematic review with level 1 to level 4 evidence, with a total of 1,534 cases, were included in the systematic review. Of these, 16 studies with sufficient statistical reporting including 997 cases with sufficient follow-up were included in meta-analysis. Three different approaches to combined ACL-MCL injuries were identified: ACL reconstruction with (1) nonoperative MCL, (2) MCL repair, and (3) MCL reconstruction. There was no statistical difference between nonoperative versus surgically managed MCL injuries for PROs, range of motion at final follow up, or quadriceps strength. Conclusion: Reconstruction of combined injury in a delayed fashion facilitates return of range of motion and may allow time for low-grade MCL tears to heal. If residual valgus or anteromedial rotatory laxity remains after a period of rehabilitation, then concomitant surgical management of ACL and MCL injuries is warranted. Avulsion MCL injuries and Stener-type lesions may benefit from early repair techniques. [ABSTRACT FROM AUTHOR]

This document is a guideline from the British Society for Haematology on the diagnosis and management of mantle cell lymphoma (MCL). It provides healthcare professionals with clear guidance on how to diagnose and treat patients with MCL. The guideline includes a literature review of relevant studies and recommendations based on the evidence. It covers topics such as pretreatment evaluation, initial clinical assessment, staging, and prognostic models for MCL. The document also includes diagnostic features of MCL and information on frailty assessments and prognostication models. The text discusses the use of different prognostic indices and treatment recommendations for mantle cell lymphoma (MCL). It mentions the use of the Mantle Cell Lymphoma International Prognostic Index (MIPI) and its simplified version (s-MIPI) for risk stratification. It also introduces the biological MIPI (MIPI-B) score, which incorporates Ki-67, and the combined MIPI (MIPI-C) score. The text provides recommendations for clinical assessment, diagnostic tests, and treatment options for MCL patients. It also discusses the use of radiotherapy and observation for early-stage MCL, as well as the use of intensive chemotherapy induction followed by autologous stem cell transplantation (ASCT) for younger patients. The text emphasizes the importance of rituximab maintenance therapy after ASCT. The text discusses various treatment options for mantle cell lymphoma (MCL) based on different patient profiles and disease characteristics. It emphasizes [Extracted from the article]

Purpose: There remains controversy regarding the optimal surgical treatment for acute complete (grade III) posterolateral corner (PLC) injuries. The purpose of this article is to systematically review the contemporary literature regarding surgical options and subsequent outcomes of acute grade III PLC injuries. Methods: A systematic review was performed using the following search terms: posterolateral corner knee, posterolateral knee, posterolateral instability, multi-ligament knee, and knee dislocation. Inclusion criteria consisted of studies with level I–IV evidence, reporting on human patients with acute grade III PLC injuries undergoing operative management within 4 weeks from injury, with subjective and/or objective outcomes (including varus stress examinations or varus stress radiographs) reported at a minimum 2-year follow-up. Two investigators independently performed the search by sequentially screening articles. Accepted definitions of varus stability on examination or stress radiographs and revision surgery were used to determine success and failure of treatment. Results: A total of 12 studies, consisting of 288 patients were included. Ten studies reported primary repair, while reconstruction techniques were reported in seven studies. Overall, 43% (n = 125/288) of injuries involved the PLC, ACL and PCL. Staged reconstruction was reported in 25% (n = 3/12) of studies. The Lysholm score was the most commonly reported outcome measure. An overall failure rate of 12.4% (n = 35/282) was observed. Surgical failure was significantly higher in patients undergoing repair (21.9%; n = 21/96) compared to reconstruction (7.1%; n = 6/84) (p = 0.0058). Return to sport was greater in patients undergoing reconstruction (100%; n = 22/22) compared to repair (94%; n = 48/51) (n.s). The most common post-operative complication was arthrofibrosis requiring manipulation under anesthesia (8.7%; n = 25/288). A total of 3.8% (n = 11/288) of patients underwent revision PLC reconstruction. Conclusion: There remains substantial heterogeneity in the surgical techniques of acute, grade III PLC injuries with an overall failure rate of 12.4%. Failure rates were significantly lower, and return to sport rates higher in patients undergoing PLC reconstruction compared to repair. The most common postoperative complication was arthrofibrosis requiring manipulation under anesthesia. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

IntroductionThe varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release.MethodsCadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed.ResultsA total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm–7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm–26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm–4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm–25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988).DiscussionOur results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.

Resistance to antimalarial drugs leads a global recurrence of malaria, posing a significant challenge to malaria control. This study aimed to assess gene expression and resistance profiles in clinical isolates, and validate the inhibitory effect of MCL compound against PbAP2-I and PbBDP1 genes in vivo. Malaria prevalence rate throughout the clinical study period stood at 12.24%. Blood samples were obtained from 182 malaria outpatients and 30 P. berghei-infected mice treated with varying MCL concentrations. DNA and RNA were extracted. PfAP2-I, PfBDP1, PfMDR1, and PfK13 genes were amplified using Real-time qPCR and sequenced for mutation profiling. Relative gene expression of AP2-I and BDP1 genes in P. falciparum and P. berghei-treated mice was carried out by Reverse-transcription PCR. The data were analyzed using ANOVA at P

Background: Micheliolide (MCL), which is the active metabolite of parthenolide, has demonstrated promising clinical application potential. However, the effects and underlying mechanisms of MCL on atherosclerosis are still unclear. Method: ApoE−/− mice were fed with high fat diet, with or without MCL oral administration, then the plaque area, lipid deposition and collagen content were determined. In vitro, MCL was used to pretreat macrophages combined by ox-LDL, the levels of ferroptosis related proteins, NRF2 activation, mitochondrial function and oxidative stress were detected. Results: MCL administration significantly attenuated atherosclerotic plaque progress, which characteristics with decreased plaque area, less lipid deposition and increased collagen. Compared with HD group, the level of GPX4 and xCT in atherosclerotic root macrophages were increased in MCL group obviously. In vitro experiment demonstrated that MCL increased GPX4 and xCT level, improved mitochondrial function, attenuated oxidative stress and inhibited lipid peroxidation to suppress macrophage ferroptosis induced with ox-LDL. Moreover, MCL inhibited KEAP1/NRF2 complex formation and enhanced NRF2 nucleus translocation, while the protective effect of MCL on macrophage ferroptosis was abolished by NRF2 inhibition. Additionally, molecular docking suggests that MCL may bind to the Arg483 site of KEAP1, which also contributes to KEAP1/NRF2 binding. Furthermore, Transfection Arg483 (KEAP1-R483S) mutant plasmid can abrogate the anti-ferroptosis and anti-oxidative effects of MC in macrophages. KEAP1-R483S mutation also limited the protective effect of MCL on atherosclerosis progress and macrophage ferroptosis in ApoE−/− mice. Conclusion: MCL suppressed atherosclerosis by inhibiting macrophage ferroptosis via activating NRF2 pathway, the related mechanism is through binding to the Arg483 site of KEAP1 competitively.

Background: Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting. Purpose: To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury. Study Design: Controlled laboratory study. Methods: A biomechanical study on 10 cadaveric knees was performed. Valgus load (force moment of 10 N/m) was applied at 0°, 30°, and 60° of flexion, and the resultant rotation was recorded using an optoelectronic motion analysis system. Measurements were repeated for 4 different knee states: intact knee, superficial medial collateral ligament (sMCL) injury, deep medial collateral ligament (dMCL) injury, and posterior oblique ligament (POL) injury. For each state, 4 loading conditions (+ loaded; – unloaded) of the semitendinosus (ST) and gracilis (GRA) tendons were tested: ST+/GRA+, ST+/GRA–, ST–/GRA+, and ST–/GRA–. Results: At 0° of flexion, combined unloading of the ST and GRA (ST–/GRA–) increased valgus laxity on the intact knee compared with the ST+/GRA+ condition (P <.05). For all medial-sided injury states (isolated sMCL; combined sMCL and dMCL; and combined sMCL, dMCL, and POL damage), ST–/GRA– increased valgus laxity at 0° and 30° of flexion versus ST+/GRA+ (P <.05 for all). The absolute value of valgus laxity increased with the severity of medial-sided ligament injury. Isolated ST unloading increased valgus laxity for the intact knee and the MCL-injured knee (combined sMCL and dMCL) at 0° of flexion (P <.05 vs ST+/GRA+). Isolated unloading of the GRA had no effect on valgus knee stability. Conclusion: The medial HS tendons contributed to the stabilization of the knee in valgus, and this was even more important when the medial side was severely affected (POL damage). This stabilizing effect was greater between 0° and 30°, in which the POL is the main valgus stabilizer. Clinical Relevance: When deciding on graft selection for multiligament knee injury reconstruction, the surgeon should be aware of the effect of harvesting the medial HS tendon on valgus laxity. [ABSTRACT FROM AUTHOR]

Non-Hodgkin lymphoma's (NHL) incidence is rising over time, and B cell lymphomas comprise the majority of lymphomas. The phosphoinositide 3-kinase (PI3K)/v-akt murine thymoma viral oncogene homologue 1 (Akt)/mammalian target of the rapamycin (mTOR) signaling pathway plays a critical role in a variety of cellular processes, such as cell proliferation and survival. Its role in lymphomagenesis is confirmed in many different types of B cell lymphomas. This review is mainly focused on the PI3K/v-akt/mTOR pathway-related oncogenic mechanisms in B cell NHLs with an emphasis on common B cell lymphoma types [diffuse large B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL)]. Furthermore, it summarizes the literature regarding the clinical applications of the mTOR inhibitors temsirolimus and everolimus in B cell NHLs, which have been tested in a range of clinical trials enrolling patients with B cell malignancies, either as monotherapy or in combination with other agents or regimens. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to report on the biomechanical durability and strength of an MCL internal brace construct. The null hypothesis is that there will be no difference between this construct and the intact MCL in terms of deflection during fatigue testing and the ultimate failure load. Methods: Eight cadaver knees were used. A grade 3 equivalent MCL tear was created with both the superficial and deep femoral MCL severed. An internal brace was created by placing a cortical button and loop through the center of the femoral MCL origin and secured on the lateral cortex of the distal femur. A FiberTape (Arthrex, Naples, FL) was looped through the cortical button loop and was secured in the center of the tibial insertion of the MCL. After pre-cycling, the specimens underwent 1000 cycles of compressive load between 100 and 300 N, using four point bending testing into direct valgus. Pre and post testing deflection was measured using three dimensional motion data from two sets of reflective markers. A load-to-failure test was then conducted with failure defined as the first significant decrease in the load–displacement curve. Results: The mean increase in deflection between pre- and post-testing was 0.6° (SD ± 0.3°). The mean failure bending moment was 122.4 Nm (SD ± 29 Nm). Conclusion: The internal brace construct employed in this study was able to withstand cyclic fatigue loading and recorded a valgus load to failure similar to that of intact knees. It is important for clinicians who are considering using this commercially available technique to be aware of how the construct performs under cyclic loading compared to the intact MCL. [ABSTRACT FROM AUTHOR]

Purpose: The null hypothesis is that there would be no difference in medial gapping under valgus load between the intact MCL and the ruptured MCL with an internal brace in place. Methods: Eight pairs of cadaver knees were used (16 knees). Alternating sides, one knee from each pair was used for one of two "internal brace" constructs. The constructs involved different methods of fixation for securing FiberTape (Arthrex, Naples, FL) to both the femur and tibia in an effort to brace the MCL. The knees were then subjected to valgus stress by applying 10 N m of torque with the knee at 20 degrees of flexion. The amount of medial joint space opening was measured on radiographs. The stress testing was conducted with three MCL states: intact, grade 2 tear, and grade 3 tear. Results: In the Construct I specimens, gapping increased from 0.7 mm with the MCL intact to 1.1 mm with grade 2 tearing (p < 0.01), and to 1.3 mm with grade 3 tearing (p < 0.01). In the Construct II specimens, gapping increased from 0.7 mm with the MCL intact to 1.0 mm with grade 2 tearing (p < 0.01), and to 1.1 mm with grade 3 tearing (n.s.). Construct I specimens failed primarily at the femoral attachment. All Construct II specimens survived the valgus stress testing. Conclusion: Construct I did not maintain tension. Construct II did maintain tension during application of valgus load, but did not restore valgus opening to the intact state. It is important for clinicians who are considering using this commercially available technique to be aware of how the construct performs under valgus stress testing compared to the intact MCL. [ABSTRACT FROM AUTHOR]

This report describes the identification and management of a Stener-like lesion of the medial collateral ligament of the knee in a 55-year-old woman. Patient underwent magnetic resonance imaging (MRI) following a skiing injury and was found to have a tear of the distal fibers of the superficial medial collateral ligament (MCL) complex, with displacement of the ligament superficial to the tendons inserting at the pes anserinus. Identification of a Stener-like lesion in the setting of MCL injury aids in selecting appropriate management. Prompt surgical intervention is warranted to achieve anatomic healing and prevent long-term valgus instability, chronic pain, and osteoarthritis.

Purpose: Ligament balancing is a prerequisite for good function and survival in total knee arthroplasty (TKA). Various balancing techniques exist, but none have shown superior results. The pie-crusting technique by Bellemans of the medial collateral ligament is commonly utilized; however, it can be difficult to achieve repeatable ligament lengthening with this technique. Therefore, we invented a novel instrument to standardize the pie-crusting technique of the superficial and deep medial collateral ligament (hereafter MCL). The purpose was to examine if pie-crusting with the instrument could produce repeatable ligament lengthening. Methods: The MCL was isolated in 16 human cadaveric knees, and subjected to axial tension. The instrument was composed of a specific grid of holes in rows, used to guide sequential pie-crusting puncturing of the MCL with a Ø1.6 mm end-cutting cannula. Ligament lengthening was measured after each row of punctures. Regression analysis was performed on the results. Results: Mean lengthening ± SD in human cadaveric MCL for puncturing of row 1 in the instrument was 0.06 ± 0.09 mm, 0.06 ± 0.04 mm for row 2, 0.09 ± 0.08 mm for row 3, 0.06 ± 0.05 mm for row 4 and 0.06 ± 0.04 mm for row 5, giving a mean total lengthening of 0.33 ± 0.20 mm. Linear regression revealed that MCLs were repeatably lengthened by 0.07 mm per row when punctured using the instrument. Conclusions: MCLs showed linear lengthening in human cadavers for subsequent use of the instrument. Our instrument shows promising results for repeatable ligament lengthening. [ABSTRACT FROM AUTHOR]

We assessed real-world healthcare resource utilization (HRU) and costs among US patients with relapsed or refractory mantle cell lymphoma (R/R MCL) by line of therapy (LoT). We selected patients from MarketScan® (1/1/2016–12/31/2020): ≥1 claims of MCL-indicated first line (1L) therapies, ≥1 diagnoses of MCL pre-index date (1L initiation date), ≥6-month continuous enrollment pre-index date, second line (2L) therapy initiation, ≥18 years old at 2L, and no clinical trial enrollment. Outcomes included time to next treatment (TTNT), all-cause HRU, and costs. The cohort (N = 142) was 77.5% male, aged 62 years (median). Sixty-six percent and 23% advanced to 3L and 4L+, respectively. Mean (median) TTNT was 9.7 (5.9), 9.3 (5.0), and 6.3 (4.2) months for 2L, 3L, and 4L+, respectively. Mean (median) per patient per month (PPPM) costs were $29,999 ($21,313), $29,352 ($20,033), and $30,633 ($23,662) for 2L, 3L, and 4L+, respectively. Among those who received Bruton tyrosine kinase inhibitors, mean (median) PPPM costs were $24,702 ($17,203), $31,801 ($20,363), and $36,710 ($25,899) for 2L, 3L, and 4L+, respectively. During the period ending in 2020, patients relapsed frequently, incurring high HRU and costs across LoTs. More effective treatments with long-lasting remissions in R/R MCL may reduce healthcare burden. Mantle cell lymphoma is a rare blood cancer of white blood cells. This type of cancer can be hard to treat, even with new treatments. In about 15% to 20% of people, the cancer will not get better or will come back within 2 years of starting treatment. When this happens, there are few good options for treatments that work. Using medical claims data, we looked at healthcare use and costs among US patients with mantle cell lymphoma that came back after treatment or did not respond to treatment. We found 142 patients who met the study criteria. Of these, 77.5% were men with a median age of 62 years. Sixty-six percent got a third of the treatment and 23% got a fourth treatment or more. The time until the next treatment was about 9–10 months for patients who got a second and third treatments.. It was about 6 months for people who got a fourth or more treatment. The average monthly cost of treatment was about $30,000 for those receiving a second or fourth or more treatment. It was slightly less for those who got a third treatment. For those who got Bruton's tyrosine kinase inhibitors, the monthly costs went up with each treatment they needed. Overall, we found that during the study period, patients with mantle cell lymphoma worsened quickly, received multiple treatments, and had high costs of care. Better treatments that work longer are needed. [ABSTRACT FROM AUTHOR]

Despite major progress in mantle cell lymphoma (MCL) therapeutics, MCL remains a deadly disease with a median survival not exceeding four years. No single driver genetic lesion has been described to solely give rise to MCL. The hallmark translocation t(11;14)(q13;q32) requires additional genetic alterations for the malignant transformation. A short list of recurrently mutated genes including ATM, CCND1, UBR5, TP53, BIRC3, NOTCH1, NOTCH2, and TRAF2 recently emerged as contributors to the pathogenesis of MCL. Notably, NOTCH1 and NOTCH2 were found to be mutated in multiple B cell lymphomas, including 5–10% of MCL, with most of these mutations occurring within the PEST domain of the protein. The NOTCH genes play a critical role in the early and late phases of normal B cell differentiation. In MCL, mutations in the PEST domain stabilize NOTCH proteins, rendering them resistant to degradation, which subsequently results in the upregulation of genes involved in angiogenesis, cell cycle progression, and cell migration and adhesion. At the clinical level, mutated NOTCH genes are associated with aggressive features in MCL, such as the blastoid and pleomorphic variants, a shorter response to treatment, and inferior survival. In this article, we explore in detail the role of NOTCH signaling in MCL biology and the ongoing efforts toward targeted therapeutic interventions. [ABSTRACT FROM AUTHOR]

TNF blockade constitutes an effective therapy for inflammatory bowel disease, yet increases the risk for infection, including active tuberculosis. The DECTIN2 family C-type lectin receptors MINCLE, MCL, and DECTIN2 sense mycobacterial ligands and activate myeloid cells. In mice, upregulation of DECTIN2 family C-type lectin receptor after stimulation with Mycobacterium bovis Bacille Calmette-Guérin requires TNF. Here, we investigated whether TNF controls inducible C-type lectin receptor expression in human myeloid cells. Monocyte-derived macrophages were stimulated with Bacille Calmette-Guérin and the TLR4 ligand lipopolysaccharide, and expression of C-type lectin receptor was analyzed. Bacille Calmette-Guérin and lipopolysaccharide strongly upregulated messenger RNA expression of DECTIN2 family C-type lectin receptor but not of DECTIN1. Bacille Calmette-Guérin and lipopolysaccharide also induced robust production of TNF. Recombinant TNF was sufficient to upregulate expression of DECTIN2 family C-type lectin receptor. Blocking TNF with the TNFR2-Fc fusion protein etanercept abrogated, as expected, the effect of recombinant TNF and impaired induction of DECTIN2 family C-type lectin receptor by Bacille Calmette-Guérin and lipopolysaccharide. Flow cytometry confirmed upregulation of MCL at the protein level by recombinant TNF and showed inhibition of Bacille Calmette-Guérin–induced MCL by etanercept. To investigate the impact of TNF on C-type lectin receptor expression in vivo, we analyzed peripheral blood mononuclear cells of patients with inflammatory bowel disease and observed downregulation of MINCLE and MCL expression after therapeutic TNF blockade. Together, TNF is sufficient to upregulate DECTIN2 family C-type lectin receptor in human myeloid cells and contributes to this process after encounter with Bacille Calmette-Guérin or lipopolysaccharide. Impaired C-type lectin receptor expression in patients receiving TNF blockade may dampen the sensing of microbes and defense against infection. [ABSTRACT FROM AUTHOR]

Background: Terrible triad of the elbow presents a rare combination of posterior elbow dislocation with a radial head fracture and the ulnar coronoid process fracture. Such injuries usually have variable outcomes. Case report: We report the case of a 44-year-old male who presented with a bilateral terrible triad of the elbow, occurring after a fall from height. We performed a surgical fixation of the radial head through a lateral approach on one side and an excision of the fractured fragment on the opposite side. A simultaneous repair of the lateral collateral ligament (LCL), medial collateral ligament (MCL), and coronoid was fixed bilaterally through an anteromedial incision. Three months after surgery, bone union was observed. The patient was able to resume his daily activities after five months of surgery with good functional outcomes. Conclusion: Precise surgical planning and rehabilitation can achieve good functional and clinical outcomes in terrible triad injuries with minimal use of implants.

Background: Chronic combined medial collateral ligament (MCL) and anterior cruciate ligament (ACL) injuries are frequent. Medial residual laxity is a risk factor for ACL rerupture. It should be treated at the same time as the ACL reconstruction (ACLR) if necessary, but there are still questions surrounding the indications for abstention or surgery of the medial plan, especially for grade 2 MCL injuries of the Fetto and Marshall classification. Indications: The purpose is to come back to a simple test, the "Rotatory Instability Test" as described by Slocum and Larson in 1968 for systematic clinical examination of the knee to improve the sensitivity and accuracy of the deep MCL (dMCL) and superficial MCL (sMCL) examination and to propose a decision-making algorithm for the treatment of the chronic combined ACL/MCL injuries based on the assessment of anteromedial rotatory instability (AMRI). Technique Description: Examination of the ACL with Lachman test, anterior drawer in neutral rotation, and pivot shift test confirm the ACL injury. Valgus laxity is tested in extension and at 20° of flexion. Then, an anterior drawer test at 90° of flexion with external rotation is done (the anterior drawer in external rotation [ADER] test) allowing to identify isolated dMCL, dMCL + sMCL, or MCL + posterior oblique ligament (POL) injuries. Discussion: As persistent medial laxity is a risk factor for ACL graft failure and there is no reliable method of instrumented laxity assessment, careful clinical examination remains essential. Systematic examination of the medial side with valgus laxity testing at 0° and 20° flexion combined with the ADER test assessment of AMRI can guide treatment of the MCL injury component. Where there is no valgus laxity and the ADER test is negative, isolated ACLR is indicated. If there is significant medial laxity at 0°, this suggests combining sMCL and POL reconstruction with ACLR. Where the knee is stable at 0° but there is valgus laxity at 20° and a positive ADER test, the dMCL can be reconstructed using a gracilis graft or a combined sMCL and dMCL reconstruction can be added to the ACLR depending on the degree of laxity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Graphical Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Reactor startup to the minimum controlled level (MCL) of power is one of the most hazardous nuclear operations in the service life of the reactor. Currently, codes for neutronic calculations such as reactor simulator (RS) and BIPR-7A are used at the NPPs that operate VVER reactors. These codes calculate the critical concentration of boric acid without using data from side ionization chambers (SICs), as a result of which inaccuracies may occur in determining the critical concentration. In addition, makeup of the first circuit with clean condensate should be stopped no less 15 min before the MCL is reached, while these codes do not calculate the time of the startup to the critical state. A code that forecasts the time needed to attain the critical state and the critical concentration of boric acid has been developed using only the measuring equipment readings without involvement of other calculations. [ABSTRACT FROM AUTHOR]

Activation of the emergency protection entails the injection of a boric acid solution into the reactor core to the standstill value, after which the control rods are raised, and then it is possible to obtain permission to start the reactor. The first stage of reaching the minimum controlled power level (MCL) is associated with feeding the pure condensate to the start-up interval at a high injection rate; the second stage is the mixing of the first circuit and then the injection of the pure condensate, but at a low rate. At the same time, the technical guidelines for safe operation indicate that the flow rate of pure condensate in the start-up interval should not exceed the flow rate of pure condensate to compensate for xenon poisoning by more than 10 t/h, and the rate of introducing the positive reactivity should not exceed 0.02 βeff/min. At the same time, it is not entirely clear how to estimate the flow rate of pure condensate in the start-up interval, since there is no equipment on the power unit for measuring the magnitude of xenon poisoning and the rate of reactivity input. This study answer the question of what is the permissible flow rate of pure condensate the operator can use in the start-up interval in the presence of xenon processes. [ABSTRACT FROM AUTHOR]

Introduction: Ligament bracing augments ligament repair using a non-absorbable suture tape. Although biomechanically an increase in primary stability has been proven, there is a lack of clinical evidence. Purpose of this study was to evaluate clinical results of patients treated with ligament bracing due to primary elbow instability, including an analysis of complications. Furthermore, clinical results for patients treated with and without early functional mobilization were compared.Materials and Methods: This prospective case-series evaluated clinical and functional results from patients treated with ligament bracing due to primary elbow instability. Clinical outcome measures were range of motion (ROM) as well as objective and subjective elbow scores [Mayo Elbow Performance Score (MEPS); Disabilities of Arm, Shoulder and Hand Score (DASH score)]. Stability was evaluated sonographically by humero-radial gapping under varus stress.Results: This study involved 34 patients treated with ligament bracing. After a mean follow-up of 12.9 months ROM was 112° ± 29, MEPS 88 ± 13 points, DASH 91 ± 11 points, and 84% were satisfied with their result. Lateral joint gapping was 2.4 mm. No significant difference was observed regarding a postoperative mobilization with and without limitations. Most common complication after ligament bracing was elbow stiffness including heterotopic ossifications in four patients (12%).Conclusion: Operatively treated elbow instability with additional ligament bracing results in good clinical outcomes with high patient satisfaction and recovery of elbow stability. The high primary stability of the ligament bracing allows early functional mobilization without bracing, which facilitates postoperative rehabilitation. Elbow stiffness with heterotopic ossification seems to be a potential complication. Furthermore, the optimal tensioning of the ligament bracing remains challenging, including the risk of an over tensioning.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Abstract Mantle cell lymphoma (MCL) is a rare B‐cell non‐Hodgkin lymphoma (NHL) that is aggressive and incurable with existing therapies, presenting a significant unmet clinical need. MCL occurs mainly in elderly patients with comorbidities; thus, intense treatment options including allogeneic stem cell transplantation (Allo‐SCT) are not feasible. New treatment options are emerging for this elderly/unfit treatment group, we therefore conducted a systematic review to determine whether they offered an advance on the existing recommended treatment, R‐CHOP. The search strategies to identify MCL therapies were designed to capture the most relevant studies from 2013 to 2020. Following preferred reporting items for systematic reviews and meta‐analyses and population,interventions, observations and study design analysis, R‐CHOP, ibrutinib and bendamustine plus rituximab (BR) were taken forward for critical and statistical analysis. All three therapies were effective in increasing the overall survival (OS) and progression‐free survival of elderly/unfit patients with MCL. However, none resulted in a significant increase in OS compared to R‐CHOP. In addition, R‐CHOP had a better toxicity profile when compared to both ibrutinib and BR. We therefore conclude that treatment of elderly/unfit patients with MCL is still a significant unmet clinical need; and suggest that outside of the clinical trial setting, R‐CHOP should remain the recommended front‐line treatment for this patient group.

Abstract Purpose Ligament balancing is a prerequisite for good function and survival in total knee arthroplasty (TKA). Various balancing techniques exist, but none have shown superior results. The pie‐crusting technique by Bellemans of the medial collateral ligament is commonly utilized; however, it can be difficult to achieve repeatable ligament lengthening with this technique. Therefore, we invented a novel instrument to standardize the pie‐crusting technique of the superficial and deep medial collateral ligament (hereafter MCL). The purpose was to examine if pie‐crusting with the instrument could produce repeatable ligament lengthening. Methods The MCL was isolated in 16 human cadaveric knees, and subjected to axial tension. The instrument was composed of a specific grid of holes in rows, used to guide sequential pie‐crusting puncturing of the MCL with a Ø1.6 mm end‐cutting cannula. Ligament lengthening was measured after each row of punctures. Regression analysis was performed on the results. Results Mean lengthening ± SD in human cadaveric MCL for puncturing of row 1 in the instrument was 0.06 ± 0.09 mm, 0.06 ± 0.04 mm for row 2, 0.09 ± 0.08 mm for row 3, 0.06 ± 0.05 mm for row 4 and 0.06 ± 0.04 mm for row 5, giving a mean total lengthening of 0.33 ± 0.20 mm. Linear regression revealed that MCLs were repeatably lengthened by 0.07 mm per row when punctured using the instrument. Conclusions MCLs showed linear lengthening in human cadavers for subsequent use of the instrument. Our instrument shows promising results for repeatable ligament lengthening.

Mantle cell lymphoma (MCL) with testicular involvement is a rare presentation and only a few cases have been described in the literature. We present a case of MCL with testicular involvement and the first analysis of all previously reported cases assessing trends in immunohistochemical features, prognostic indicators, and survival. Our data suggest that among all MCL, testicular MCL is more likely to present with aggressive features: blastoid/pleomorphic morphology, high Ki-67 proliferative index, and CNS involvement. Testicular MCL is also associated with shorter overall survival.

Background: The tibial collateral ligament, also known as the medial collateral ligament (MCL), is a ligament extending from the medial epicondyle of the femur to the posteromedial crest of the tibia. The ligament is a broad and strong band that mainly functions to stabilize the knee joint in the coronal plane on the medial side Since MCL calcification is not a frequent knee pain manifestation, exclusion of other confusing clinical mimicries is of paramount importance. Here, in this report, we describe a well-circumscribed calcific deposit in the left femoral condylar attachment of MCL reported very rarely in the medical literature. Case Report: A 37-year-old laborer presented to the Outpatient department with pain and flexion deformity of the Right knee for 6 months. He walked on a flexed knee with a limping gait. A plain radiograph of the right was taken in AP and Lateral view which showed a massive well-defined calcification at the medial side of the knee joint. Considering the large size of the lesion, surgical treatment was chosen. Intra-operatively, as the MCL was involved a reconstruction was done using the semitendinosus tendon. Conclusion: Chronic pain located at the medial side of the knee is not always osteoarthritic pain. Thorough clinical and radiological investigation with plain radiographs and MRI in some cases is mandatory. Calcification or ossification of the medial collateral ligament of the knee responds well to conservative treatment. Surgical resection is needed in some cases with larger lesions.