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The objectives of this study are to evaluate the contributions of the popliteofibular ligament (PFL), the popliteus tendon (PT), and the lateral (fibular) collateral ligament (LCL) to the posterolateral stability of the knee by changing the sequence of selective transection. Twelve fresh-frozen cadaveric knees were divided into two groups. Group 1 has a cutting sequence as follows: PFL, PT, LCL. Group 2 has a cutting sequence as follows: PT, PFL, LCL. Each specimen was mounted on the apparatuses using the Ilizarov external fixator for measuring external rotatory and varus laxities at every 308 from 08 to 908 of knee flexion. In both groups, there was no significant difference between the PFL and PT in the increment of respective external rotatory laxity after transection at each knee flexion angle, except 08 in group 2. The transection of the LCL significantly increased the external rotation laxity at 08 and 308. Varus instability was increased significantly only after cutting the LCL at every knee flexion angle. In conclusion, both the PFL and PT equally contribute to the external rotatory stability. The LCL also contributes to the external rotatory stability at early range of knee flexion. The LCL is a main structure for varus stability in the knee. ß

Aim To investigate the relationship between knee osteoarthritis, mental health and health‐related quality of life (QoL). Methods This study included 6343 men and women aged ≥50 years from the Korean National Health and Nutrition Examination Survey. Osteoarthritis was defined as Kellgren–Lawrence grade ≥2 in the knee on radiographic images with knee pain. Mental health and health‐related QoL were assessed according to three dimensions (depressive mood, psychological distress and suicidal ideation) and five domains (impaired mobility, impaired self‐care, impaired usual activities, pain/discomfort and anxiety/depression). The odds ratios and 95% confidence intervals (CI) for mental health and health‐related QoL were calculated using multiple logistic regression analyses. Results Compared with the control group, the odds ratios for depressive mood, psychological distress and suicidal ideation in the osteoarthritis group were 2.80 (95% CI 1.31–3.31), 1.92 (95% CI 1.21–3.05) and 1.97 (95% CI 1.31–2.94) in men, and 1.51 (95% CI 1.16–1.95), 1.36 (95% CI 1.07–1.72) and 1.92 (95% CI 1.49–2.46) in women after adjusting for potential confounding variables. Similarly, the odds ratios for impaired mobility, impaired self‐care, impaired usual activities, pain/discomfort and anxiety/depression in the osteoarthritis group were 12.37 (95% CI 8.17–18.72), 3.02 (95% CI 1.84–4.94), 7.33 (95% CI 4.89–10.98), 8.92 (95% CI 5.92–13.45) and 2.56 (95% CI 1.52–4.29) in men, and 8.29 (95% CI 6.41–10.73), 2.53 (95% CI 1.74–3.69), 4.40 (95% CI 3.33–5.80), 4.79 (95% CI 3.72–6.17) and 1.85 (1.44–2.37) in women after adjusting for the same covariables. Conclusions Knee osteoarthritis was significantly associated with deteriorated mental health and health‐related QoL in middle‐aged and older men and women. Geriatr Gerontol Int 2020; 20: 379–383.

Purpose To investigate the clinical, radiological, and histological results of arthroscopic gel-type autologous chondrocyte implantation (GACI) in treating chondral defects of the knee. Methods This study prospectively examined five males and five females with a mean age of 40.3 ± 10.3 years who underwent arthroscopic GACI between March 2012 and February 2013. The gel comprised a mixture of 1 ml of fibrinogen plus 0.1-0.2 ml of thrombin. The mean size of chondral defect was 2.9 ± 1.2 cm 2 (range 1.2-5.4 cm 2 ). International knee documentation committee (IKDC) subjective score, knee injury and osteoarthritis outcome score (KOOS), knee society score, and visual analog scale (VAS) for pain were assessed preoperatively and during regular follow-up examinations performed for up to 5 years postoperatively. Serial magnetic resonance imaging was performed for up to 2 years after the surgery to observe healing, using the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In eight patients, second-look arthroscopy was performed at 1 year after the implantation to assess the status of treated cartilage, and a portion of regenerated cartilage was harvested for histologic evaluation. ResultsThe mean VAS score (p = 0.045), IKDC subjective score (p = 0.041), KOOS pain (p = 0.025), KOOS activities of daily living (p = 0.048), and KOOS quality of life (p = 0.029) showed significant improvement at 5 years after the surgery. The modified MOCART evaluation showed that the scores were 59.5 ± 29.4 and 85.0 ± 8.0 at 12 weeks and 2 years after the operation, respectively. Histologic examination demonstrated a mean regenerated cartilage thickness of 3.5 ± 0.8 mm and a mean Oswestry score of 8.2 ± 1.8. Immunohistochemistry analysis showed that the expression of collagen type II was more evident and more evenly distributed than collagen type I in regenerated cartilage. There was a significant correlation between Oswestry score and change in VAS scale from postoperative 2-5 years. Conclusions Arthroscopic GACI produces satisfactory clinical and radiologic outcomes, and histologic evaluation confirms sufficient regeneration of hyaline-like cartilage that correlates with improved symptoms. Therefore, it is an acceptable, minimally invasive, and technically simple option for the restoration of cartilage defects of the knee. Level of evidence IV.

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Osteosynthesis using modified oblique locking T-plate and autogenous iliac bone graft results in good to excellent outcomes with the functional improvement for symptomatic nonunions of type II fractures of the distal clavicle. Our method may be primarily considered an useful alternative for symptomatic nonunions of type II distal clavicle fractures, and bone grafting should be considered in all cases.

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