Preoperative Medial Meniscus Extrusion on Magnetic Resonance Imaging Is Associated With a Tendency Toward Varus Shifting of Open-Wedge High Tibial Osteotomy: A Minimum 5-Year Follow-Up Study.

Purpose: To investigate serial changes in postoperative alignment over 5 years after open-wedge high tibial osteotomy (OWHTO) and to identify risk factors associated with alterations in the postoperative weightbearing line (WBL) ratio.

Methods: Patients who underwent OWHTO during 2011-2017 were retrospectively reviewed. The inclusion criteria were (1) follow-up duration ≥5 years and (2) serial postoperative longstanding hip-to-ankle radiographs to evaluate alignment alterations.

Midterm Clinical and Radiological Outcomes of Revision Lateral Meniscal Allograft Transplantation.

Background: It is unknown whether the outcomes achieved in the early period after revision lateral meniscal allograft transplantation (RLMAT) are maintained through the midterm period.

Purpose: To evaluate the midterm clinical and radiological results of patients who underwent RLMAT.

Study Design: Case series; Level of evidence, 4.

Risk Factor for Clinical Failure of Medial Meniscal Allograft Transplant: Early vs Late Graft Tear.

Background: Graft tears are common postoperative findings in meniscal allograft transplant (MAT). Graft tear in medial MAT may be different from that of lateral MAT, considering the difference between medial meniscal tears and lateral meniscal tears. Moreover, medial MAT is frequently accompanied by ligament reconstruction, which is associated with graft tear.

Early Graft Tear As a Major Risk Factor for the Clinical Failure of Lateral Meniscal Allograft Transplantation.

Background: Graft tears are often observed on magnetic resonance imaging after lateral meniscal allograft transplantation (MAT). Their characteristics, such as the location and configuration, are likely to be different depending on the timing of the injury. However, the clinical relevance of early and late graft tears has not been investigated.

Association of Medial Meniscal Volume With Decreased Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy.

Background: Medial opening-wedge high tibial osteotomy (MOWHTO) reduces contact stress by altering the weightbearing axis from the medial to the lateral compartment, relieves knee pain, and slows the progression of osteoarthritis.

Purpose/hypothesis: To evaluate whether the volume of the medial meniscus affects outcomes after MOWHTO. It was hypothesized that reduced medial meniscal volume would be associated with worse midterm clinical and radiographic outcomes.

Novel Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus in Wild Birds, South Korea.

We isolated 5 highly pathogenic avian influenza A(H5N1) clade 2.3.4.

Difference in Joint Stability Between Small Posterior Malleolar Fragments With Fixation and Those Without Fixation: A Biomechanical Cadaver Study.

The indication for the surgical treatment of ankle fractures that involve a posterior malleolar fragment remains controversial. This cadaver study assessed the biomechanical results of rotation stiffness of Haraguchi type 1 posterior malleolar fragments with or without cannulated screw fixation. Twelve anatomic lower-extremity specimens from 6 cadavers were tested.

Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis.

Objective: Albeit with no disease-modifying effects, intra-articular steroid injections (IASIs) are still widely used to relieve symptoms of knee osteoarthritis. Previous literature has reported conflicting results regarding the safety of IASI in terms of periprosthetic joint infection (PJI) in total knee arthroplasty (TKA). This study tried to determine whether preoperative IASIs increased the risk of PJI, with different time intervals between the injections and surgery.

Graft Extrusion of 3 Millimeters Is Acceptable at a Minimum of 5-Year Outcomes for Lateral Meniscal Allograft Transplantation.

Purpose: To determine the acceptable amount of graft extrusion based on long-term radiographic outcomes in lateral meniscal allograft transplantation (MAT).

Methods: 94 lateral MAT patients with a minimum 5-year follow-up period were reviewed. Graft extrusion was measured on MRI scans taken 1 year after surgery, and the study population was divided according to the amount of extrusion: group A, extrusion <3 mm; group B, 3 mm ≤ extrusion <5 mm; and group C, extrusion ≥5 mm.

Topical Tranexamic Acid Can Be Used Safely Even in High Risk Patients: Deep Vein Thrombosis Examination Using Routine Ultrasonography of 510 Patients.

Background and Objectives: Previous studies regarding tranexamic acid (TXA) in total knee arthroplasty (TKA) investigated only symptomatic deep vein thrombosis (DVT), or did not include high risk patients. The incidence of DVT including both symptomatic and asymptomatic complications after applying topical TXA has not been evaluated using ultrasonography. Materials and Methods: The medical records of 510 patients who underwent primary unilateral TKA between July 2014 and December 2017 were retrospectively reviewed.

Age and Meniscal Extrusion Are Determining Factors of Osteoarthritis Progression after Conservative Treatments for Medial Meniscus Posterior Root Tear.

Background: With a growing understanding of biomechanical disadvantages following medial meniscus posterior root tear (MMPRT), recent studies have focused on surgical repair of MMPRT. Because not all tears are repairable, surgical indications can be properly established when the outcomes of conservative treatments are revealed. This study tried to identify risk factors for osteoarthritis progression after conservative treatments for isolated MMPRT.

Risk Factors for Increase in Posterior Slope After Medial Open-Wedge High Tibial Osteotomy.

Background: Whether lateral hinge fracture (LHF) after open-wedge high tibial osteotomy (OWHTO) is associated with the change in tibial posterior slope (PS) has not been determined. Risk factors for PS increase are still unknown.

Hypothesis: There will be no difference in patient characteristics and radiographic factors when stratified by change in tibial PS (ΔPS).

Hidden Unstable Flap Should Be Suspected in Treating Intractable Pain from Medial Meniscus Horizontal Tear.

(1) Background: The medial meniscus horizontal tear (MMHT) is known as a lesion that can be treated nonoperatively. However, some patients show persistent pain despite conservative treatments. In arthroscopic surgery for MMHT, surgeons often encounter unexpected unstable flaps, which can explain the intractable pain.

Age alone does not affect the joint survivorship after arthroscopic partial meniscectomy for degenerative medial meniscus tears: a propensity-score matched survival analysis.

Purpose: To evaluate the effect of age itself on the joint survivorship after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus tears (DMTs).

Methods: Patients undergoing APM for DMTs during 1999-2010 were retrospectively reviewed. The inclusion criteria were as follows: (1) DMTs identified on preoperative MRI scans, (2) no definite history of trauma, and (3) follow-up duration more than 5 years.

Signal intensity of lateral meniscal allografts deteriorates over time: a longitudinal MRI analysis during a minimum follow-up of 8 years.

Purpose: To evaluate the serial change of magnetic resonance imaging (MRI) signal intensity (SI) of lateral meniscal allografts in a long-term period of > 8 years and to determine whether the SI change adversely affected clinical outcomes.

Methods: Thirty-three lateral meniscal allograft transplantation (LMAT) patients with MRI taken > 8 years after surgery were included. The allograft was assessed using MRI at five serial time points (1, 2-4, 4-6, 6-8, and > 8 years after surgery), based on the following grading system: grade 1, globular increased SI not adjacent to the articular surface; grade 2, linear SI within the meniscus; and grade 3, increased SI extended to the articular surface.

Insufficient Correction and Preoperative Medial Tightness Increases the Risk of Varus Recurrence in Open-Wedge High Tibial Osteotomy.

Purpose: To assess serial changes of limb alignment after open wedge high tibial osteotomy (HTO) using the weightbearing line (WBL) ratio in the midterm, with a focus on varus recurrence.

Methods: Patients undergoing open wedge HTO from January 2010 to December 2016 were retrospectively reviewed. Those without serial postoperative weightbearing long-leg alignment films, those who showed remained varus alignment after osteotomy, and those who had <2 years of follow-up were excluded.

Meniscal allograft transplantation shows a mismatch between anatomic and clinical failures.

Purpose: Clinical results of meniscal allograft transplantation (MAT) are not always consistent with graft status. This study aimed to investigate (1) the degree and pattern of mismatch between anatomic and clinical failures in MAT and (2) preoperative factors associated with the mismatch.

Methods: Two hundred and ninety-eight consecutive patients who underwent primary medial or lateral MAT during 2004-2015 were reviewed.

Increased MRI Signal Intensity of Allografts in the Midterm Period After Meniscal Allograft Transplant: An Evaluation of Clinical Significance According to Location and Morphology.

Background: Magnetic resonance imaging (MRI) is an effective tool for objective evaluation after meniscal allograft transplant (MAT). Little is known about the association between MRI features of allograft and clinical outcomes.

Purpose/hypothesis: To assess the degree and location of signal intensity (SI) as well as the morphology of allografts on MRI after MAT and evaluate the association between clinical outcomes and MRI features in the midterm period.

Flexion contracture can be relieved by concurrent notchplasty in medial open wedge high tibial osteotomy.

Background: Given that medial open wedge high tibial osteotomy (OWHTO) not only delays the progression of osteoarthritis but also alleviates the resulting pain, surgical outcomes would be improved if limited ROM can also be managed. In this regard, the effect of concurrent notchplasty on flexion contracture has not been evaluated.

Hypothesis: (1) Concurrent notchplasty in OWHTO would relieve flexion contracture regardless of the severity of osteoarthritis and this effect would be maintained over time, and (2) concurrent notchplasty would not cause any added complications compared to the same procedure without notchplasty.

Unstable Lateral Hinge Fracture or Occult Complete Osteotomy Adversely Affects Correction Accuracy in Open-Wedge High Tibial Osteotomy.

Purpose: To verify whether lateral hinge fracture (LHF) affects correction accuracy in open-wedge high tibial osteotomy (OWHTO) and to identify the fracture characteristics responsible for inaccurate correction, including LHF type and hinge location.

Methods: Patients undergoing OWHTO with locking plate fixation between 2010 and 2016 were retrospectively reviewed. Patients who did not have a minimum 2-year of follow-up or postoperative long-standing hip-to-ankle radiographs were excluded.

Learning Curve For Lateral Meniscal Allograft Transplantation: Preventing Meniscal Extrusion.

Purpose: This study analyzes the large number of lateral meniscal allograft transplantation (LMAT) procedures conducted by a single surgeon over 23 years to determine whether the absolute amount of graft subluxation and the incidence of extrusion are different at the present time compared to the early MAT era.

Methods: We reviewed 320 cases of LMAT performed by a single surgeon between 1996 and 2019. This cohort was chronologically divided into 8 groups (of 40 subjects).

Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy.

Purpose: To evaluate the serial changes in the joint space width (JSW) of the medial and lateral compartments after medial open-wedge high tibial osteotomy (MOWHTO) and its associated factors.

Methods: The medial and lateral weight-bearing JSWs were measured on serial radiographs and analyzed preoperatively and postoperatively within 2 weeks, as well as at 3 months, 6 months, 1 year, and 2 years. Associations between the medial and lateral JSWs and age, body mass index, mechanical axis, correction angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA), JLCA on stress radiographs, and arthroscopic cartilage status were examined.