Incidence of heterotopic ossification following total hip arthroplasty by approach: a systematic review

BACKGROUND

Heterotopic ossification (HO) formation has been increasingly recognized as a complication of major orthopedic surgeries, particularly total hip arthroplasty (THA). Though, the overall incidence of HO following THA has been well-documented, it is often not reported by severity or by surgical approach.

QUESTIONS/PURPOSES

(1) What are the demographics of patients with HO? (2) What is the severity of HO following THA using the Brooker classification? (3) What is the incidence and class of HO following different THA approaches (anterior, posterior, posterolateral, anterolateral, superior, lateral, trans-gluteal)? (4) What are the number and training level of surgeons who performed each procedure?

METHODS

The PubMed, Embase, and Web of Science databases were queried, and PRISMA guidelines were followed. Qualitative and quantitative analyses were performed using Microsoft Excel.

RESULTS

We isolated 26 studies evaluating 6512 total hip arthroplasties (THA). The mean HO percentage overall was 28.8%, mostly Class I (54.2%) or Class II (29.6%). The highest percentage of HO was associated with the modified direct lateral (57.2%) and the traditional lateral (34.6%) approaches. The lowest HO percentages were identified following posterolateral (12.8%) and direct superior approaches (1%). Most studies reported a singular senior surgeon operating within the same approach for all patients.

CONCLUSIONS

The traditional lateral and modified direct lateral approaches to THA resulted in the highest percentage of HO postoperatively. However, most ossification cases were not clinically significant and did not strongly affect overall patient morbidity. Further studies are warranted to identify an association between severity of ossification and different arthroplasty approaches.

Meniscus root tears: state of the art

BACKGROUND

Meniscus root tears represent significant pathology that, historically, has been underdiagnosed and undertreated. However, the recognition of their clinical and functional significance has recently surged, mainly due to their frequent association with anterior cruciate ligament injuries.

AIM

This comprehensive review discusses various aspects of meniscal root tears, including their epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management and surgical techniques.

Higher return to sport and lower revision rates when performing arthroscopic Bankart repair with remplissage for anterior shoulder instability with a Hill-Sachs lesion: a meta-analysis

BACKGROUND

Recurrent anterior shoulder instability remains the most common complication from a prior shoulder dislocation, especially among young and active individuals who engage in athletic activities. This instability can lead to repeated subluxation or dislocations of the humeral head from the glenoid fossa. The purpose of this study is to compare postoperative recurrence rates, instability-related revision and return to sport (RTS) rates between isolated arthroscopic Bankart repair (ABR) and ABR with remplissage (ABR + R) for anterior shoulder instability with subcritical glenoid bone loss (GBL) and a Hill-Sachs lesion (HSL).

METHODS

PubMed, Embase, and Web of Science were searched on June 2022. Studies sought were those comparing postoperative outcomes of ABR + R versus isolated ABR for subcritical GBL and an HSL. Study quality was evaluated using the revised Cochrane tool. Redislocations, instability-related revisions, and RTS rates were extracted and pooled estimates were calculated using the random-effect model.

RESULTS

Twelve studies were included with a mean follow-up of 48.2 months for isolated ABR and 43.2 months for ABR + R. The meta-analytic comparison demonstrated that ABR + R resulted in statistically significant improvement in Rowe and American Shoulder and Elbow Surgeons scores by 6.5 and 2.2 points, respectively; however, the improvements in patient-reported outcomes were not clinically meaningful. ABR + R resulted in reduced external rotation at the side by 1° which was not clinically meaningful and there was no significant difference in terms of forward elevation. ABR + R resulted in a statistically significant reduction of overall postoperative recurrences (odds ratio [OR]: 9.36), postoperative dislocations (OR: 6.28), instability-related revision (OR: 3.46), and RTS to any level (OR: 2.85).

CONCLUSION

The addition of remplissage to ABR for recurrent anterior shoulder instability with subcritical GBL and HSL results in significantly lower postoperative instability recurrence, lower instability-related revisions, and higher RTS to any level.

Short-term outcomes of anterior cruciate ligament reconstruction with or without lateral tenodesis or anterolateral ligament reconstruction: a retrospective cohort

PURPOSE

This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction.

METHODS

A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity.

RESULTS

A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups.

CONCLUSION

ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.

All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials

OBJECTIVES

The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs.

METHODS

Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool.

RESULTS

A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups.

CONCLUSIONS

While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement.

LEVEL OF EVIDENCE

I.

Higher sensitivity and accuracy of synovial next-generation sequencing in comparison to culture in diagnosing periprosthetic joint infection: a systematic review and meta-analysis

PURPOSE

The purpose of this meta-analysis was to compare the diagnostic parameters of synovial next-generation sequencing (NGS) and cultures in diagnosing periprosthetic joint infections (PJI).

METHODS

PubMed, Web of Science, Cochrane, and Google Scholar were searched from inception until 8 Jan 2022 for literature investigating the role of NGS in comparison to culture in the diagnosis of PJI. The studies were included if they investigated the diagnostic value of culture and NGS in diagnosing PJIs against the Musculoskeletal Infection Society (MSIS) criteria. Diagnostic parameters, such as sensitivity, specificity, positive predictive value, negative predictive value, positive-likelihood ratio, negative-likelihood ratio, accuracy, and area under the curve (AUC), were calculated for the included studies to evaluate the performance of NGS in comparison to culture in PJI diagnosis.

RESULTS

The total number of the included patients was 341 from seven articles. The pooled sensitivity, specificity, and diagnostic odds ratio of NGS were 94% (95% CI 91-97%), 89% (95% CI 82-95%), and 138.5 (95% CI 49.1-390.5), respectively. NGS has positive- and negative-likelihood ratios of 7.9 (95% CI 3.99-15.6) and 0.1 (95% CI 0.0-0.1), respectively. On the other hand, the pooled sensitivity, specificity, and diagnostic odds ratio of culture were 70% (95% CI 61-79%), 94% (95% CI 88-98%), and 28.0 (95% CI 12.6-62.2), respectively. The SROC curve for NGS showed that the accuracy (AUC) was 91.9%, and that the positive and negative predictive values were 8.6 (95% CI 5.0-19.5) and 0.1 (95% CI 0.0-0.1), respectively. While, culture SROC curve demonstrated that the accuracy (AUC) was 80.5% and the positive- and negative-likelihood ratio were 12.1 (95% CI 4.5-49.6) and 0.3 (95% CI 0.2-0.4).

CONCLUSIONS

NGS has a potential role in diagnosing hip and knee PJIs due to its high sensitivity, specificity, and accuracy. However, the sensitivity and specificity reported by the studies varied according to the time of synovial sampling (preoperative, postoperative, or mixed).

Diabetes-associated thigh muscle degeneration mediates knee osteoarthritis-related outcomes: results from a longitudinal cohort study

OBJECTIVES

We examined the association between diabetes mellitus (DM) and longitudinal MRI biomarkers for thigh muscle degeneration in patients with knee osteoarthritis (KOA) and their mediatory role in worsening KOA-related symptoms.

METHODS

The Osteoarthritis Initiative (OAI) participants with radiographic KOA (Kellgren-Lawrence grade ≥ 2) were included. Thighs and corresponding knees of KOA patients with versus without self-reported DM were matched for potential confounders using propensity score (PS) matching. We developed and used a validated deep learning method for longitudinal thigh segmentation. We assessed the association of DM with 4-year longitudinal muscle degeneration in biomarkers of muscle cross-sectional area (CSA) and contractile percentage (non-fat CSA/total CSA). We further investigated whether DM is associated with 9-year risk of KOA radiographic progression, knee replacement (KR), and symptoms worsening. Finally, we evaluated whether the DM-KOA worsening association is mediated through preceding muscle degeneration.

RESULTS

After PS matching, 698 thighs/knees were included (185:513 with:without DM; average ± SD age:64 ± 8-years; female/male:1.4). Baseline DM was associated with a decreased contractile percent of total thigh muscles and quadriceps (mean difference, 95%CI -0.16%/year, -0.25 to -0.07, and -0.21%/year, -0.33 to -0.08). DM was also associated with an increased risk of worsening KOA-related symptoms (hazard ratio, 95%CI 1.70, 1.18-2.46) but not radiographic progression or KR. The decrease in quadriceps contractile percent partially mediated the increased risk of symptoms worsening in patients with DM.

CONCLUSIONS

Baseline DM is associated with thigh muscle degeneration and KOA-related symptoms worsening. As a potentially modifiable risk factor, DM-associated longitudinal thigh muscle degeneration may partially mediate the symptoms worsening in patients with DM and coexisting KOA.

KEY POINTS

• Diabetes mellitus (DM) is associated with worsening knee osteoarthritis (KOA)-related symptoms. • As a potentially modifiable factor, DM-associated thigh muscle (quadriceps) degeneration partially mediates the worsening of KOA-related symptoms.

Complications of Elbow Arthroscopic Surgery: A Systematic Review and Meta-analysis

BACKGROUND

Elbow arthroscopic surgery has been popularized and has made significant progress during the past 3 decades. The elbow joint is relatively small and is in close proximity to many neurovascular structures. These factors make elbow arthroscopic surgery technically demanding and liable to complications.

PURPOSE

To evaluate the rate of complications after elbow arthroscopic surgery.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis. PubMed, Web of Science, and Embase were searched up to July 2021. All clinical studies that reported complications after elbow arthroscopic surgery were included; a total of 1208 articles were initially found. Case reports, reviews, abstracts, imaging studies, technique studies, nonclinical studies, and those not reporting postoperative complications were excluded. Complication rates were pooled across studies and reported as percentages. Complications were expressed as weighted proportions with 95% CIs.

RESULTS

A total of 95 studies (14,289 elbows) were included in the meta-analysis. The overall weighted complication rate was 11.0% (95% CI, 8.8%-13.5%), with postoperative stiffness being the most commonly encountered complication (4.5% [95% CI, 2.1%-7.6%]; 158/8818 procedures). The second most encountered complication was the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures) followed by nerve injury with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). The ulnar nerve was the most commonly injured nerve (2.6% [95% CI, 1.9%-3.4%]; 123/6290 procedures).

CONCLUSION

The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates.

Conventional MRI-derived subchondral trabecular biomarkers and their association with knee cartilage volume loss as early as 1 year: a longitudinal analysis from Osteoarthritis Initiative

OBJECTIVE

To study associations between MRI-derived subchondral trabecular biomarkers obtained from conventional MRI sequences and knee cartilage loss over 12 and 24 months, using the FNIH osteoarthritis (OA) biomarkers consortium.

MATERIALS AND METHODS

Data of the 600 subjects in the FNIH OA biomarkers consortium (a nested case-control study within Osteoarthritis Initiative [OAI]) were extracted from the online database. Baseline knee MRI (intermediate-weighted (IW) sequences) were evaluated to determine conventional MRI-derived trabecular thickness (cTbTh) and bone-to-total ratio (cBV/TV). The measurements for medial and lateral volumes of cartilages using baseline, 12-, and 24-month knee MRI were extracted from the OAI database, and cartilage volume loss over 12 and 24 months of follow-up were determined using Relative Change Index. The association between conventional MRI-based subchondral trabecular biomarkers and cartilage volume loss were studied using logistic regression models, adjusted for relevant confounders including age, sex, body mass index (BMI), vitamin D use, Kellgren Lawrence grade (KLG), and tibiofemoral alignment.

RESULTS

Higher medial cTbTh and cBV/TV at baseline were associated with increased odds of medial tibial cartilage volume loss over 12 months (ORs: 1.01 [1.00-1.02] and 1.24 [1.10-1.39] per 1-SD change) and 24 months (ORs: 1.01 [1.00-1.02] and 1.22 [1.08-1.37], per 1-SD change). No significant association was observed between medial subchondral trabecular biomarkers and lateral tibial or femoral (medial or lateral) cartilage volume loss over the first and second follow-up years.

CONCLUSIONS

Conventional MRI-derived subchondral trabecular biomarkers (higher medial cTbTh and cBV/TV) may be associated with increased medial tibial cartilage volume loss as early as 1 year.

Role of Thigh Muscle Changes in Knee Osteoarthritis Outcomes: Osteoarthritis Initiative Data

Background Longitudinal data on the association of quantitative thigh muscle MRI markers with knee osteoarthritis (KOA) outcomes are scarce. These associations are of clinical importance, with potential use for thigh muscle-directed disease-modifying interventions. Purpose To measure KOA-associated longitudinal changes in MRI-derived muscle cross-sectional area (CSA) and adipose tissue and their association with downstream symptom worsening and knee replacement (KR). Materials and Methods In a secondary analysis of the Osteoarthritis Initiative multicenter prospective cohort (February 2004 through October 2015), knees of participants with available good-quality thigh MRI scans at baseline and at least one follow-up visit were included and classified as with and without KOA according to baseline radiographic Kellgren-Lawrence grade of 2 or higher and matched for confounders with use of propensity score matching. An automated deep learning model for thigh MRI two-dimensional segmentation was developed and tested. Markers of muscle CSA and intramuscular adipose tissue (intra-MAT) were measured at baseline and 2nd- and 4th-year follow-up (period 1) and compared between knees with and without KOA by using linear mixed-effect regression models. Furthermore, in knees with KOA, the association of period 1 changes in muscle markers with risk of KR (Cox proportional hazards) and symptom worsening (mixed-effect models) during the 4th to 9th year (period 2) was evaluated. Results This study included 4634 matched thighs (2317 with and 2317 without KOA) of 2344 participants (mean age, 62 years ± 9 [SD]; 1292 women). Compared with those without, knees with KOA had a decrease in quadriceps CSA (mean difference, -8.21 mm2/year; P = .004) and an increase in quadriceps intra-MAT (1.98 mm2/year; P = .007). Decreased CSA and increased intra-MAT of quadriceps during period 1 was predictive of downstream (period 2) KOA symptom worsening (Western Ontario and McMaster Universities Osteoarthritis Index total score: odds ratio, 0.24 [negative association] [P < .001] and 1.38 [P = .012], respectively). Quadriceps CSA changes were negatively associated with higher future KR risk (hazard ratio, 0.70; P < .001). Conclusion Knee osteoarthritis was associated with longitudinal MRI-derived decreased quadriceps cross-sectional area and increased intramuscular adipose tissue. These potentially modifiable risk factors were predictive of downstream symptom worsening and knee replacement. Clinical trial registration no. NCT00080171 © RSNA, 2022 Online supplemental material is available for this article.

Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data

BACKGROUND

Increase in lateral patellar tilt-(LPT) can cause increased pressure on the lateral facet of the knee and can lead to patellar or femoral cartilage damage and further osseous changes. This study aims to test the hypothesis whether there is an association between increased LPT and MRI-based patellofemoral osteoarthritis-(OA) features at baseline and their worsening over a 2-year follow-up in participants of the Osteoarthritis Initiative-(OAI).

METHODS

Recorded clinical and imaging data of 600 participants in the FNIH-OA biomarkers consortium was extracted from its database. The LPT-(as the angle betweenthe longest patella diameter and posterior aspect of condyles) was measured using theaxial knee MRI. Associations of LPT (every 5° increase) with MRI OA Knee Scoring-(MOAKS) for OA-related features, including cartilage and bone marrow lesions (BMLs) in addition to knee cartilage volume at baseline and their worsening after 2-year follow-up were assessed using regression models adjusted for several possible confounders.

RESULTS

The mean LPT angle in this sample was 8.84° ± 5.19. In baseline, higher LPT was associated with lower cartilage volumes and higher cartilage lesions and BMLs MOAKS scores in the lateral trochlear and patellar subregions. Over the follow-ups, subjects with higher LPT measures in the baseline showed higher odds of experiencing BML score worsening in the lateral trochlear subregion-(OR:1.25[1.01-1.56]) over the 2-year follow-ups.

CONCLUSIONS

Increase in LPT measures may be associated with OA-related features in the trochlear subregion. Therefore, aside from its use as an indicator of patellofemoral instability syndrome, LPT may be associated with longitudinal progression of patellofemoral OA.

Association Between MRI-Based Tibial Slope Measurements and Mucoid Degeneration of the Anterior Cruciate Ligament: A Propensity Score-Matched Case-Control Study

Background

The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established.

Purpose

To investigate whether MTS and LTS measurements are associated with the presence of ACL MD.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models.

Results

Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD.

Conclusion

Excessive LTS was associated with the presence of ACL MD, independent of participants' age, sex, BMI, and cartilage damage severity.

Image-Guided Chondrocyte Harvesting for Autologous Chondrocyte Implantation: Initial Feasibility Study with Human Cadaver and Pilot Clinical Experience

Background:

Autologous chondrocyte implantation (ACI), a promising modality for repairing full-thickness cartilage defects, requires 2 consecutive arthroscopic procedures for chondrocyte harvesting and implantation. In the present study, we assessed the feasibility and efficacy of image-guided chondrocyte harvesting as an alternative to arthroscopic biopsy.

Methods:

We induced full-thickness cartilage defects in 10 human cadaveric knees. Computed tomographic arthrography (CTA) was performed following the intra-articular administration of Omnipaque 350 to measure the diameters of the induced cartilage defects. Subsequently, 2 independent operators conducted CTA-guided chondrocyte harvesting (from the medial and lateral trochlear ridges) in each knee. The time for chondrocyte harvesting, accuracy (distance between the predefined target on CTA and the final insertion site of the needle), and number of needle readjustments were recorded. In the institutional review board-approved clinical study, informed consent was obtained and chondrocyte harvesting was performed both with use of a conventional arthroscopic biopsy method and with use of a needle through an arthroscopy access site in 10 subjects for whom ACI was indicated. The samples were processed and cultured blindly, and the quantity and quality of the samples were determined.

Results:

CTA measurements of full-thickness cartilage defects showed high to perfect absolute agreement and consistency when compared with direct measurements (overall interclass correlation coefficient, 0.933 to 0.983; p < 0.05). For both operators, image-guided chondrocyte harvesting from the lateral ridge was more accurate (p = 0.007 and 0.040) and faster (p = 0.056 and 0.014) in comparison with harvesting from the medial ridge. In the clinical study, no significant difference was observed for the growth index of samples between the needle-harvest and conventional methods (p = 0.897).

Conclusions:

CTA can be used for precise measurement of full-thickness cartilage defects. Image-guided chondrocyte harvesting is a viable alternative to traditional arthroscopic biopsy for ACI.

Clinical Relevance:

We recognize the current pivotal role of arthroscopic biopsy, as a part of ACI, for chondrocyte harvesting as well as for delineating the nature of the lesion. However, on the basis of our results, image-guided chondrocyte retrieval may obviate the need for arthroscopic biopsy in some patients in the future.

Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative

OBJECTIVES

Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI).

METHODS

Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT-TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall-Salvati ratio (ISR). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd-4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. P values were corrected using the Benjamini-Hochberg procedure.

RESULTS

Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Only TT-TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04-1.14), corrected p value ≤ 0.01), BMLs (OR (95% CI), 1.1 (1.04-1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05-1.14), corrected p value ≤ 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03-1.16), corrected p value = 0.02).

CONCLUSIONS

Higher TT-TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression.

KEY POINTS

• Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. • Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years. • Using longitudinal MRI data, each millimeter increase of TT-TG distance is associated with a 9% (95% confidence interval, 3-16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years.

Meniscal Surgery: Risk of Radiographic Joint Space Narrowing Progression and Subsequent Knee Replacement-Data from the Osteoarthritis Initiative

Purpose To investigate the risk of radiographic joint space narrowing (JSN) progression evaluated in subjects with and those without underlying osteoarthritis at baseline and knee replacement (KR) associated with meniscal surgery in subjects with and those without a reported history of preceding knee trauma. Materials and Methods The HIPAA-compliant protocol was approved by the institutional review boards of the participating centers. Written informed consent was obtained from all participants. Subjects who underwent meniscal surgery with a preceding knee trauma at baseline (n = 564) and those without (n = 147) were drawn from the Osteoarthritis Initiative cohort (n = 4796). Radiographic JSN progression was evaluated by using Osteoarthritis Research Society International grading (progression in 1st-, 2nd-, 3rd-, 4th-, 6th-, or 8th-year radiographic findings compared with baseline). KR was assessed up to the 9th year of study (days passed from inclusion to KR or last follow-up). Cox hazard analysis was used to extract the adjusted hazard ratios (HRs) with adjustments for baseline age, sex, body mass index, physical activity, symptoms, and radiographic osteoarthritis features (Kellgren and Lawrence [KL] grade). Results Meniscal surgery with a history of preceding knee trauma was not associated with radiographic progression of JSN (adjusted HR, 0.91 [95% confidence interval {CI}: 0.78, 1.07]) or KR (adjusted HR, 1.02 [95% CI: 0.79, 1.34]; P = .854). However, meniscal surgery without a history of preceding knee trauma was associated with radiographic progression of JSN (adjusted HR, 1.27 [95% CI: 1.00, 1.63]) and KR (adjusted HR, 2.09 [95% CI: 1.52, 2.89]; P < .001). Additionally, there was a higher risk of KR in subjects with radiographic KL grade of less than 2 (adjusted HR, 6.97 [95% CI: 3.56, 13.64]; P < .001) at baseline in comparison with KL grade of at least 2 (adjusted HR, 1.76 [95% CI: 1.22, 2.54]; P < .05). Conclusion In contrast to subjects without a reported preceding trauma, meniscal surgery is not independently associated with increased risk of radiographic JSN progression and KR in patients with a reported preceding trauma. ^© RSNA, 2016 Online supplemental material is available for this article.

Determinants of knee replacement in subjects with a history of arthroscopy: data from the osteoarthritis initiative

OBJECTIVE

To investigate the risk and determinants of knee replacement (KR) in subjects with or at risk of osteoarthritis (OA) and a history of arthroscopy.

METHODS

Data from the osteoarthritis initiative cohort were analyzed (n = 4796, up to the seventh year of follow-up). Cox proportional hazard analysis was used to determine the risk of KR according to the history of arthroscopy. A multivariable model was used to determine the risk factors for KR among subjects with a history of arthroscopy (n = 842), including age, gender, body mass index, history of knee injury, and baseline physical activity scale for the elderly, Western Ontario and McMaster (WOMAC) total score, and radiographic Kellgren and Lawrence (KL) score.

RESULTS

History of arthroscopy was associated with risk of KR after adjustments for the mentioned determinants of OA (HR: 1.90 (1.49-2.44); P value <0.001). Female gender (HR: 1.86 (1.30-2.68); P value <0.001), higher WOMAC (HR: 1.02 (1.01-1.03); P value <0.001), and KL score (HR: 2.64 (2.08-3.35); P value <0.001) increased the risk of KR among subjects with a history of arthroscopy. Subjects with a history of knee injury had 50 % lower risk of KR (HR: 0.50 (0.35-0.72); P value <0.001) after arthroscopy.

CONCLUSION

Female gender, more clinical symptoms and radiographic signs of OA, was associated with higher risk of future KR in subjects with a history of arthroscopy. Subjects with arthroscopy in the setting of concomitant knee injury were 50 % less likely to undergo KR compared to subjects who underwent arthroscopy without a history of concomitant knee injury.

Long term use of analgesics and risk of osteoarthritis progressions and knee replacement: propensity score matched cohort analysis of data from the Osteoarthritis Initiative

OBJECTIVES

To determine the association between the long-term use of analgesics and progression of osteoarthritis (OA) as evidenced by up to 3-years follow-up worsening of radiographic Kellgren-Lawrence (KL) grade and incidence of knee replacement (KR).

DESIGN

Using nearest neighbor matching of the propensity scores with caliper in the Osteoarthritis Initiative (OAI) cohort, 173 index (Analgesic +) and 173 referent (Analgesic -) subjects were included. Analgesic + and - subjects had analgesics in all and none of their visits, respectively. Analgesic + and - subjects were balanced in their demographics, baseline, first, second and third year body mass index (BMI), Western Ontario and McMaster (WOMAC) total score, Physical and Mental health summary scales (SF-12), Physical Activity Scale for the Elderly (PASE) and Charleston Comorbidity Scale. Analgesic + and - subjects were also matched for baseline radiographic KL grade. Interval increase in the KL grade and incidence of KR were defined as the outcome.

RESULTS

Included subjects had average 6.5 years of follow-up. By the third year, 44 subjects had an interval increase in the KL grade; 29 in Analgesic + and 15 among Analgesic - subjects (P = 0.024). By the eighth-year, 41 subjects had their first KR; 29 in Analgesic + and 12 among Analgesic - subjects (P = 0.005). Hazard Ratio (HR) of OA progression and KR for Analgesic + subjects was 1.91 (1.02-3.57) and 2.57 (1.31-5.04), respectively.

CONCLUSIONS

Long-term use of analgesics may be associated with radiographic progression of knee OA and increased risk of future KR.

Extremity cone-beam CT for evaluation of medial tibiofemoral osteoarthritis: Initial experience in imaging of the weight-bearing and non-weight-bearing knee

PURPOSE

To investigate differences in joint space width (JSW) and meniscal extrusion (ME) between non-weight bearing (NWB) and weight bearing (WB) examinations of knee joints with medial compartment osteoarthritis (OA) using a cone-beam CT (CBCT) extremity imaging system.

MATERIALS AND METHODS

In this IRB approved prospective study, informed consent was obtained for 17 patients symptomatic for OA (11 F,6 M; 31-78 years, mean 56 years) and 18 asymptomatic controls (0 F,18 M; 29-48 years, mean 38.5 years) enrolled for CBCT exams in NWB and WB positions. Three independent observers measured medial tibiofemoral JSW and ME. Measurements were compared between NWB and WB images using paired Wilcoxon signed-rank sum test.

RESULTS

OA subjects exhibited a statistically significant reduction in JSW between NWB and WB scans (average JSW(NWB)(OA)=2.1 mm and JSW(WB)(OA)=1.5 mm, p=0.016) and increase in ME (average ME(NWB)(OA)=6.9 mm and ME(WB)(OA)=8.2 mm, p=0.018)). For non-OA subjects, the change in JSW and ME between NWB and WB exams was reduced (average JSW(NWB)(nonOA)=3.7 mm and JSW(WB)(nonOA)=3.4 mm; average ME(NWB)(nonOA)=2.6 mm and ME(WB)(nonOA)=2.7 mm) and was not statistically significant. Inter-observer agreement was evaluated using Bland-Altman limits of agreement, with good agreement for all measurements (correlation coefficient 0.89-0.98).

CONCLUSION

The ability to conduct NWB and WB exams in CBCT with a dose profile that is favorable in comparison to multidetector CT (MDCT) and with image quality sufficient for morphological analysis of joint space narrowing and meniscal extrusion could provide a valuable tool for OA diagnosis and treatment assessment.

Sterile pretibial cyst formation following anterior cruciate ligament reconstruction with a bioabsorbable screw

Sterile pretibial cysts are a complication after anterior cruciate ligament (ACL) reconstruction with bioabsorbable screws. We present a case series of sterile pretibial abscesses following ACL reconstruction with bioabsorbable poly-L-lactide (PLLA) screws, including a patient that developed a saphenous neuroma and a patient who underwent ACL reconstruction with tibialis anterior (TA) allograft. Neither of these circumstances has been previously reported in the literature.

Isolated tears of pectoralis minor muscle in professional football players: a case series

Our objective is to include pectoralis minor injuries in the comprehensive assessment of differential diagnoses for anterior chest wall pain or medial anterior shoulder pain sustained during blocking activities, which may present in football players. In this article, we report 2 cases of isolated pectoralis minor tears in professional football players and present mechanisms of injury, clinical presentations, appropriate diagnostic studies, and treatments.