Early medial reconstruction combined with severely injured medial collateral ligaments can decrease residual medial laxity in anterior cruciate ligament reconstruction.

Introduction: This study aimed to describe an anatomic medial knee reconstruction technique for combined anterior cruciate ligament (ACL) and grade III medial collateral ligament (MCL) injuries and to assess knee function and stability restoration in patients who underwent primary MCL reconstruction compared with primary repair.

Methods: A total of 105 patients who had undergone anatomic ACL reconstruction between 2008 and 2017 were enrolled in this retrospective study and divided into two groups according to concomitant MCL ruptures. Group A included patients with isolated ACL ruptures without MCL injuries.

Three-column subdivision for isolated posterolateral tibial plateau fractures and perspective surgical approaches.

Background: This study aimed (1) to introduce a computed tomography (CT)-based classification of the posterolateral compartment of the tibial plateau based on the fibula and to propose the individualized surgical approaches for each zone; and (2) to determine the surgical approach based on the classification, that would achieve a safe and effective reduction and could improve postoperative clinical outcomes.

Methods: Eighteen cases of tibia plateau fracture involving the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of the tibial plateau was segmented into three zones based on the fibular position and an individualized surgical approach was proposed for each zone.

Relationship of Bone Mineral Density and Knee Osteoarthritis (Kellgren-Lawrence Grade): Fifth Korea National Health and Nutrition Examination Survey.

Background: Osteoarthritis (OA) and osteoporosis (OP) are the 2 most common bone disorders associated with aging. We can simply assume that older patients have a higher incidence of OA and OP with more severity. Although several papers have conducted studies on the relationship between OA and OP, none of them has demonstrated a conclusive link.

Machine-learning algorithm that can improve the diagnostic accuracy of septic arthritis of the knee.

Purpose: Prompt diagnosis and treatment of septic arthritis of the knee is crucial. Nevertheless, the quality of evidence for the diagnosis of septic arthritis is low. In this study, the authors developed a machine learning-based diagnostic algorithm for septic arthritis of the native knee using clinical data in an emergency department and validated its diagnostic accuracy.

Patellar fractures in elderly patients: a multicenter computed tomography-based analysis.

Introduction: This study aimed to demonstrate the characteristics of patellar fractures and evaluate clinical outcomes in elderly patients.

Patients And Methods: Medical records of patients aged ≥ 60 years who presented with patellar fractures were retrospectively reviewed from an institutionally approved multicenter (five institutions) orthopedic database. Patient characteristics and fracture patterns were identified, and the clinical outcomes were investigated.

Alignment changes after open-wedge high tibial osteotomy result in offloading in the patellofemoral joint: a SPECT/CT analysis.

Purpose: The patellofemoral (PF) joint may be adversely affected by medial open-wedge high tibial osteotomy (OWHTO). This study aimed to evaluate the PF compartmental changes using combined single-photon emission computed tomography (SPECT) and conventional computed tomography (CT) after OWHTO to provide clinical guidance regarding the PF joint pressure and force.

Methods: Patients with medial osteoarthritis and varus malalignment > 5° were treated using OWHTO.

The risk of concomitant injuries of the contralateral side in valgus injured knee by lateral bumper impact - "Windswept injury mechanism".

Purpose: Valgus injury of high energy of the lateral bumper impact can lead blows to the inside of the knee that push the knee outwards or indirect injury where a varus force is applied to the contralateral knee, which injury pattern named as "Windswept injury mechanism" in this study. The objective of this study was to establish injury pattern in the contralateral side knee on the basis of this pattern recognition to enhance a diagnosis of interrelated osseous and soft-tissue injuries.

Methods: Sixteen patients by "Windswept injury mechanism" were identified, who visited a level 1 trauma center between Jan 2007 and Dec 2016.

Changes in patellar fracture characteristics: A multicenter retrospective analysis of 1596 patellar fracture cases between 2003 and 2017.

Purpose: This study aimed to investigate the characteristics of patellar fracture and the changes in these characteristics over time in Korea.

Methods: A total of 1596 patients with patellar fractures who visited 5 university hospitals from 2003 to 2017 were included in the analysis. The demographic characteristics of the patients, including age, sex, body mass index, and fracture characteristics, including the fracture classification, injury mechanism, fixation method, and postoperative complication rate, were analyzed through a review of the medical records and plain radiographs.

Factors affecting stability after medial opening wedge high tibial osteotomy using locking plate: A cadaveric study.

Objectives: To investigate the effect of screw length, lateral hinge fracture, and gap filling on stability after medial opening wedge high tibial osteotomy (MOW HTO) using a locking plate.

Methods: Forty tibiae from fresh-frozen cadavers were randomly allocated into five groups. Group A was bicortically fixated, while Group B and Group C were unicortically fixated: 90% and 55% of drilled tunnel length, respectively.

Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial.

Background: Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure.

Methods: One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional (n = 80) or lower inflation pressure group (n = 80).

Navigated versus Conventional Technique in High Tibial Osteotomy: A Meta-Analysis Focusing on Weight Bearing Effect.

Purpose: We aimed to determine whether navigated opening wedge high tibial osteotomy (HTO) is superior to the conventional technique in terms of accuracy of the coronal and sagittal alignment correction, functional outcome, and operative time.

Methods: Studies comparing navigated and conventional HTO were included in this meta-analysis. We compared the incidence of radiological outliers in coronal alignment and tibial slope maintenance, mean differences in functional outcome scales, and operative time.

A new femoral fixation device for anterior cruciate ligament reconstruction using the outside-in technique and hamstring tendon graft: A comparison between two devices in cadaveric human knee models.

Background: A new device (T-anchor) was developed for ACL reconstruction and is implanted via the outside-in technique using hamstring grafts. The purpose of this study was to compare the T-anchor with the EndoButton Direct.

Methods: This study was conducted on 30 cadaveric knees (15 matched pairs).

What is the Ideal Route of Administration of Tranexamic Acid in TKA? A Randomized Controlled Trial.

Background: TKA commonly involves substantial blood loss and tranexamic acid has been used to reduce blood loss after TKA. Numerous clinical trials have documented the efficacy and safety of intravenous (IV) or intraarticular (IA) use of tranexamic acid. Combined administration of tranexamic acid also has been suggested; however, there is no consensus regarding the ideal route of tranexamic acid administration.

Coronal alignment on the single-limb stance radiograph in posterolateral rotatory instability, osteoarthritis and healthy knees.

Background: We aimed to determine whether coronal alignment measured on the single-limb stance (SLS) radiographs differs from those on the double-limb stance (DLS) images. We also investigated whether the size of such differences was affected by the knee pathology, lower limb alignment, and geometry of the tibia or femur.

Methods: We measured coronal alignment with mechanical tibiofemoral angle (MTFA) on the DLS and SLS radiographs in patients with posterolateral rotatory instability (PLRI, 30 knees), osteoarthritis (OA) with varus deformity who were scheduled for high tibial osteotomy (HTO) (60 knees), and in normal control (60 knees).

Surgical techniques and radiological findings of meniscus allograft transplantation.

Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals.

Clinical Performance of the 1st American Academy of Orthopaedic Surgeons Clinical Guideline on Prevention of Symptomatic Pulmonary Embolism after Total Knee Arthroplasty in Korean Patients.

We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding. One of three options was administered according to the groups (aspirin in group 1 or 4; enoxaparin and following aspirin in group 2; antithrombotic stocking in group 3).

After early release of tourniquet in total knee arthroplasty, should it be reinflated or kept deflated? A randomized trial.

Purpose: This study was undertaken to determine the efficacy of reinflation of the tourniquet after its early release in TKA compared to early release alone, in terms of surgical field visualization and operative time. We also questioned whether tourniquet reinflation after its early release is safe, with respect to post-operative blood loss, post-operative pain and other tourniquet-related complications.

Methods: Two hundred and six patients undergoing TKA were randomly allocated to either the early release (deflation) group (n = 105) or reinflation after early release (reinflation) group (n = 101).

The use of navigation in medial opening wedge high tibial osteotomy can improve tibial slope maintenance and reduce radiation exposure.

Purposes: We sought to determine the usefulness and the disadvantages of the navigation in medial opening wedge high tibial osteotomy (MOWHTO) compared to the conventional technique, in terms of target coronal alignment achievement, tibial slope maintenance, radiation exposure and operative time.

Methods: We retrospectively compared 40 knees treated with navigated MOWHTO by one surgeon with 20 knees treated with conventional MOWHTO by another surgeon. Screw length of the plate was predetermined using validated simple algorithms only in the navigation group to facilitate the operation.

Do glycemic markers predict occurrence of complications after total knee arthroplasty in patients with diabetes?

Background: Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated.

Questions/purposes: We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA.

Prevalence and predictors of post-operative coronal alignment outliers and their association with the functional outcomes in navigated total knee arthroplasty.

We aimed to determine the prevalence and predictors for being an outlier after navigated TKA and asked whether navigated TKAs with perfect coronal alignment have better functional outcomes than those without it. Alignment was measured in 124 patients (191 knees) with navigated TKAs who were available for 1year functional outcome assessment. The outcomes were compared among the 3 subgroups divided by the deviation of mechanical axis from neutral (0°): the perfect, 0° or within 1°; the acceptable, 1°-3°; and the outlier, beyond 3°.