Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The aim of this study was to evaluate which lower extremity alignment (knee and ankle joint) parameters affect knee joint line obliquity (KJLO) in the coronal plane after open wedge high tibial osteotomy (OWHTO). Overall, 69 knees of patients that underwent OWHTO were evaluated using radiographs obtained preoperatively and from 6 weeks to 3 months postoperatively. We measured multiple parameters of knee and ankle joint alignment (hip-knee-ankle angle [HKA], joint line height [JLH], posterior tibial slope [PS], femoral condyle-tibial plateau angle [FCTP], medial proximal tibial angle [MPTA], mechanical lateral distal femoral angle [mLDFA], KJLO, talar tilt angle [TTA], ankle joint obliquity [AJO], and the lateral distal tibial ground surface angle [LDTGA]; preoperative [-pre], postoperative [-post], and the difference between -pre and -post values [-Δ]). We categorized patients into two groups according to the KJLO-post value (the normal group [within ± 4 degrees, 56 knees] and the abnormal group [greater than ± 4 degrees, 13 knees]), and compared their -pre parameters. Multiple logistic regression analysis was used to examine the contribution of the -pre parameters to abnormal KJLO-post. The mean HKA-Δ (-9.4 ± 4.7 degrees) was larger than the mean KJLO-Δ (-2.1 ± 3.2 degrees). The knee joint alignment parameters (the HKA-pre, FCTP-pre) differed significantly between the two groups ( < 0.05). In addition, the HKA-pre (odds ratio [OR] = 1.27, = 0.006) and FCTP-pre (OR = 2.13, = 0.006) were significant predictors of abnormal KJLO-post. However, -pre ankle joint parameters (TTA, AJO, and LDTGA) did not differ significantly between the two groups and were not significantly associated with the abnormal KJLO-post. The -pre knee joint alignment and knee joint convergence angle evaluated by HKA-pre and FCTP-pre angle, respectively, were significant predictors of abnormal KJLO after OWHTO. However, -pre ankle joint parameters were not significantly associated with abnormal KJLO after OWHTO.

We reviewed thirty patients with degenerative posterior root tear of the medial meniscus to investigate clinical results of non-operative treatment retrospectively. There were 3 men and 27 women at a median age of 59 years old (range, 51-65). The median follow-up period was 36 months (range, 24-51). Non-operative treatments included non-steroidal anti-inflammatory drugs daily for 8-12 weeks and supervised physical therapy twice a week at least during a period of 8 weeks. The symptoms, physical signs, the Visual Analog Scale pain, the Lysholm Knee Scoring scale and IKDC subjective activity level were analyzed at the time of pre-intervention, 6 months, 12 months and the final follow-ups. Most patients had intense mechanical pain initially, but the severity and frequency of pain was decreased within 3 months. Clinical outcome was improved at 12 months follow-up and then declined to a level that was still improved over initial scores at final follow-up. Two patients with Kellgren-Lawrence grade 2 progressed to grade 3 at the median follow-up of 36 months. In conclusion, this study demonstrated that non-operative treatment provided symptomatic relief in most patients with the degenerative posterior root tear of the medial meniscus and functional improvements in a short term follow-up.

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We evaluated the biomechanical properties of two different methods of fixation for unstable fractures of the proximal humerus. Biomechanical testing of the two groups, locking plate alone (LP), and locking plate with a fibular strut graft (LPSG), was performed using seven pairs of human cadaveric humeri. Cyclical loads between 10 N and 80 N at 5 Hz were applied for 1,000,000 cycles. Immediately after cycling, an increasing axial load was applied at a rate of displacement of 5 mm/min. The displacement of the construct, maximum failure load, stiffness and mode of failure were compared. The displacement was significantly less in the LPSG group than in the LP group (p = 0.031). All maximum failure loads and measures of stiffness in the LPSG group were significantly higher than those in the LP group (p = 0.024 and p = 0.035, respectively). In the LP group, varus collapse and plate bending were seen. In the LPSG group, the humeral head cut out and the fibular strut grafts fractured. No broken plates or screws were seen in either group. We conclude that strut graft augmentation significantly increases both the maximum failure load and the initial stiffness of this construct compared with a locking plate alone.

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