Background: Repair of a posterior root tear of the medial meniscus (MRT) decreases peak contact pressure by restoring hoop tension and is expected to prevent progression to osteoarthritis. Purpose: The purposes of this study were (1) to report the clinical and magnetic resonance imaging (MRI) results of arthroscopic pull-out repair of the MRT and (2) to identify prognostic factors of poor outcome. Study Design: Case series; Level of evidence, 4. Methods: Fifty-one patients (47 women, 4 men) who underwent arthroscopic pull-out repair of the MRT by a single surgeon were enrolled. Mean follow-up after surgery was 33 months (range, 24-44 months). To identify factors affecting final outcome, patient-specific factors, such as gender, age, body mass index, meniscus extrusion, extrusion increase, subchondral edema, degree of varus alignment (<5° or >5°), and cartilage status in the medial compartment (Outerbridge grade 1 or 2 lesion vs grade 3 or 4 lesion), were investigated. Final clinical outcomes were determined using a visual analog scale (VAS) for pain and patient satisfaction scores, American Knee Society (AKS) scores, and Lysholm scores, and MRI outcomes were determined by evaluating meniscus extrusion and articular cartilage status. Multiple regression analysis was performed to identify variables that independently affected clinical and MRI-determined outcomes. Results: All clinical outcome measures significantly improved after surgery. Patients with Outerbridge grade 3 or 4 chondral lesions had poorer results than those with grade 1 or 2 lesions in terms of AKS function and Lysholm scores. Patients with varus alignment of >5° had poorer results than those with varus alignment of <5° in terms of VAS satisfaction, AKS function, and Lysholm scores. Mean meniscus extrusion increased from 3.6 mm preoperatively to 5.0 mm postoperatively. Chondral lesions progressed in 3 (9.7%) of 31 patients. Preoperative meniscus extrusion was found to be positively correlated with final extrusion. Conclusion: At a mean follow-up of 33 months after pull-out repair, extrusion of the meniscus was found to have progressed. Nevertheless, this technique provided patients with a clinical benefit. Outerbridge grade 3 or 4 chondral lesions and varus alignment of >5° were found to independently predict an inferior clinical outcome.
High tibial osteotomy is a realignment procedure to transfer weight-bearing load to the intact compartment of the knee to alleviate symptoms, slow disease progression, and defer subsequent total knee arthroplasty. To prevent overcorrection or undercorrection, it is not only important to have an exact preoperative calculation of the desired correction angle, but it is also critical to have an accurate intraoperative technique. 85 consecutive patients (90 knees) were enrolled, who were available at 1-year follow-up after a medial opening wedge high tibial osteotomy using a kinematic navigation system or a conventional method, for medial unicompartmental osteoarthritis. On radiographic assessment, the navigation group showed better results than the conventional group in both the mechanical axis and the coordinate of the weight-bearing line on a full-length standing anteroposterior radiograph (3.9 degrees +/- 1.0 degrees vs. 2.7 degrees +/- 2.2 degrees of valgus, P < 0.01), (62.3 +/- 2.9% vs. 58.7 +/- 6.6% coordinate at the tibial plateau, P < 0.01). There was no significant difference in the alteration of tibial slope between the two groups. On clinical assessment, the navigation group showed better results in both the mean Hospital for Special Surgery knee score (84 +/- 8 vs. 79 +/- 7, P < 0.01) and the mean Lysholm knee score (85 +/- 6 vs. 83 +/- 5, P < 0.05). There was no significant difference in operation times between the two groups. Kinematic navigation-guided high tibial osteotomy is a reproducible and reliable procedure compared to conventional high tibial osteotomy.
Context: An assessment of postural control is commonly included in the clinical concussion evaluation. Previous investigators have demonstrated learning effects that may mask concussion-induced balance decrements.Objective: To establish the test-retest reliability of the Balance Error Scoring System (BESS) and to provide recommendations that account for known learning effects.Design: Test-retest generalizability study. Setting: Balance research laboratory.Patients or Other Participants: Young adults (n 5 48) free from injuries and illnesses known to affect balance.Intervention(s): Each participant completed 5 BESS trials on each of the assessment dates, which were separated by 50 days.Main Outcome Measure(s): Total score of the BESS was used in a generalizability theory analysis to estimate the overall reliability of the BESS and that of each facet. A decision study was completed to estimate the number of days and trials needed to establish clinical reliability.Results: The overall reliability of the BESS was G 5 0.64. The test-retest reliability was improved when male (0.92) and female (0.91) participants were examined independently. Clinically acceptable reliability (greater than 0.80) was established when 3 BESS trials were administered in a single day or 2 trials were administered at different time points.Conclusions: Learning effects have been noted in individuals with no previous exposure to the BESS. Our findings indicate that clinicians should consider interpreting the mean score from 3 BESS administrations on a given occasion for both normative data comparison and pretest and posttest design. The multiple assessment technique yields clinically reliable scores and provides the sports medicine practitioner with accurate data for clinical decision making.
Posterior root tears of the medial meniscus are frequently encountered and should be repaired if possible to prevent osteoarthritis of the medial compartment. Various surgical techniques have been proposed to repair posterior root tears. The anterior arthroscopic approach can cause an iatrogenic chondral injury due to the narrow medial joint space. The posterior approaches might be technically unfamiliar to many surgeons because they require the establishment of a posteromedial or trans-septal portal. This paper describes the medial collateral ligament pie-crusting release technique for arthroscopic double transosseous pullout repair of posterior root tears of the medial meniscus through the anterior approach to provide the good visualization of the footprint and sufficient working space.
Summary: This paper reports on the photocuring kinetics of protonic‐acid‐initiated cationic polymerizations of UV‐curable epoxy‐based SU8‐negative photoresist systems with and without silica nanoparticles, as assessed using photo‐DSC, FTIR spectroscopy, UV‐vis spectroscopy, and SEM. Photo‐DSC analysis using an autocatalytic kinetic model demonstrated that the cross‐link density and cure rate increased as the concentration of silica nanoparticles with surface silanol groups increased to 2.5 wt.‐%. This result was confirmed by FTIR spectroscopy, and suggests that the presence of silica nanoparticles of up to 2.5 wt.‐% promoted the cure conversion and cure rate of the UV‐curable hybrid organic/inorganic negative photoresists due to the synergistic effect of silica nanoparticles acting both as an effective flow or diffusion‐aid agent and as a proton‐donor cocatalyst during the cationic photopolymerization process. The decrease in the cross‐link density that occurred when the silica content was higher than 2.5 wt.‐% was attributed to aggregation between silica nanoparticles due to their high surface energy.SEM photograph at the film‐air interface of the UV‐cured hybrid organic/inorganic photoresist containing 10 wt.‐% silica nanoparticles.magnified imageSEM photograph at the film‐air interface of the UV‐cured hybrid organic/inorganic photoresist containing 10 wt.‐% silica nanoparticles.
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