OBJECTIVE: To investigate the risk factors associated with the development of knee osteoarthritis (OA) following arthroscopic surgery for degenerative lesions of the posterior horn of the medial meniscus. METHODS: Between January 2012 and January 2014, a retrospective analysis was conducted on 506 patients who underwent arthroscopic surgery for degenerative disease of the posterior horn of the medial meniscus. The cohort included 230 males and 276 females, aged from 32 to 58 years old with an average of (46.77±9.02) years old. According to the results of postoperative follow-up, patients were categorized into a knee osteoarthritis(OA) group and a non-OA group. The following parameters were recorded for each subject:gender, medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKA), presence of bone edema on MRI, physical characteristics (including McMurray test results, locking symptoms, and medial knee tenderness points), meniscus protrusion, type of meniscus injury, and free body condition as observed via arthroscopy. Multivariate unconditional Logistic regression analysis was employed to investigate the associated factors influencing the 10-year postoperative incidence of knee osteoarthritis following surgery for degenerative injury of the posterior horn of the medial meniscus. Independent risk factors potentially influencing the development of postoperative OA were identified, and a nomogram-based predictive model for postoperative OA was established. The discriminatory ability and calibration accuracy of the model were assessed using the C-index and Hosmer-Lemeshow goodness-of-fit test, respectively. Furthermore, internal validation was performed using the bootstrap resampling method. RESULTS: Within a 10-year period following arthroscopic surgery, there were 123 patients in the OA group and 383 patients in the non-OA group. Significant differences were observed between two groups with respect to gender (χ²=5.156, P=0.023), MPTA<86.6° (χ²=21.671, P<0.001), varus lower limb alignment( χ²= 80.086, P<0.001). Additionally, meniscus extrusion (χ²=6.371, P=0.012), meniscus transverse tear (χ²=14.573, P<0.001), and bone edema detected on MRI(χ²=9.881, P=0.002) were identified as factors associated with the development of postoperative knee OA. The multifactorial Logistic regression analysis revealed that the lower limb line of force inversion OR=4.324, 95%CI (1.391, 13.443), P=0.011;MPTA <86.6°, OR=2.519, 95%CI (1.150, 5.519), P=0.021;transverse meniscus tear, OR=4.546, 95%CI (1.827, 11.310), P=0.001;meniscus ectropion, OR=5.401, 95%CI (1.992, 14.646), P=0.001;and bone edema manifestation on MRI OR=2.692, 95%CI (1.169, 6.200), P=0.020. They were independent risk factors associated with the development of postoperative OA. The area under the ROC curve predicted by the model was 0.927, 95%CI (0.903, 0.950). The Hosmer-Lemeshow goodness-of-fit test, used to evaluate the accuracy of the model, yielded P=0.689. Additionally, the internally sampled calibration curve demonstrated good consistency with the actual postoperative OA outcomes. CONCLUSION Varus alignment of the lower extremity, MPTA <86.6°, transverse meniscus tear, lateral meniscus injury, and bone marrow edema observed on MRI were independent risk factors for the development of knee osteoarthritis following arthroscopic surgery. Additionally, the prognostic model demonstrated excellent predictive performance.
Humans ; Male ; Female ; Middle Aged ; Arthroscopy/adverse effects* ; Adult ; Retrospective Studies ; Tibial Meniscus Injuries/surgery* ; Osteoarthritis, Knee/epidemiology* ; Risk Factors ; Menisci, Tibial/surgery* ; Incidence ; Postoperative Complications/epidemiology*

Objective To discuss the types, characteristics, and the evaluation of disability of knee injuries. Methods The data of 133 cases of knee injury from 2017 to 2019 were collected and statistically analyzed according to the region of injury, the degree of disability, etc. Results One hundred and twenty-five cases of injury were compound, and 8 cases were simple. The incidences of ligament injury, meniscus injury and fracture were 88.72%, 75.19% and 57.89%, respectively. Of the cruciate ligament injuries, 12 cases were posterior cruciate ligament injury while 51 cases were anterior cruciate ligament injury, and the differences between the two kinds of injury had statistical significance （P<0.05）; 32 cases were secondary traumatic arthritis. The rates of disability of knee injuries were 38.35% （Grade Ⅸ and Ⅹ）. Conclusion Compound knee injuries are common, and traumatic arthritis has a relatively high rate. Multiple injuries can affect the stability and weight-bearing of the knee joint. It is suggested that in addition to evaluating the range of motion of knee joint, multiple factors should be considered to assess disability.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Injuries/epidemiology* ; Humans ; Knee Injuries/epidemiology* ; Knee Joint ; Posterior Cruciate Ligament

PURPOSE: This study aimed to describe the pattern of injuries and illnesses among Korean athletes during the Almaty Winter Universiade 2017. METHODS: All medical staffs of Korean team recorded the daily occurrence of injuries and illnesses sustained during the Almaty Winter Universiade Games by using a standardized online form via kociss.com. The design of this study was a prospective study. RESULTS: In total, 98 athletes (68 men and 30 women) in 11 sports events from Korean Sport Olympic Committee participated in this study. Korean medical staffs reported 40 injuries (40.8%) and 26 illnesses (26.5%), equaling incidences of 6.3 injuries and 4.1 illnesses per 100 athletes. Men suffered more injury and illness than women (44.1% vs. 33.3%). The rate of Injury and illness in training was higher than the competition (13.3 vs. 2.0 athlete exposures). The risk of an athlete being injured was the highest in freestyle skiing, followed by snowboard and speed skating. Overall, the main common type and location of injury was the joint or ligaments sprain (13.3%) and knee (7.1%). The rate of main illness was 17.3% of the respiratory system with the main symptom of pain and the main cause of environment (22.4%). CONCLUSION: Injuries and illnesses occurred 40.8% and 26.5% during this winter game, and were higher during training than a competition. Based on the epidemiologic data of this study, it could provide the source for the injury prevention and improving the performance of the athlete and further develop scientific injury and illness surveillance systems.
Athletes* ; Athletic Injuries ; Epidemiology ; Female ; Humans ; Incidence ; Joints ; Knee ; Ligaments ; Male ; Medical Staff ; Prospective Studies ; Respiratory System ; Skating ; Skiing ; Sports ; Sprains and Strains

BACKGROUNDFew data are available concerning intercondylar notch dimensions in female nonathletes with knee osteoarthritis (OA) in plateau region. The aim of this study was to assess the relation of intercondylar notch morphology to anterior cruciate ligament (ACL) injuries in female nonathletes with knee OA aged 41-65 years from the Chinese Loess Plateau.

METHODSThe study was conducted on 330 patients with ACL injury (aged 31-65 years; 159 males, 171 females), 141 patients with OA (aged 31-65 years; 59 males, 82 females), and 89 female healthy controls (aged 41-65 years), and this evaluation included identifying the distribution of patients with OA or ACL injury and measuring the intercondylar notch width indexes (NWIs).

RESULTSThere was a significant rising trend in patients with OA (the Kellgren and Lawrence grade = 3) with ACL injury (OA-S + ACL) aged 41-65 years, especially in females. We found that the notches of OA-S + ACL had a smaller NWI compared with control and OA without ACL injury (OA-S-only, P = 0.000, 95% confidence interval [CI] = -0.059--0.030; P = 0.000, 95% CI = -0.049--0.016). A similar trend was found in notch shape index (NSI), but not in notch depth index and the cross-sectional area. The cutoff of NWI and NSI value was 0.26, and 0.65, and area under the receiver operating characteristic curve was 0.82, and 0.79, respectively. Further study displayed a significant correlation between a reduced NWI and NSI and OA-S + ACL (P = 0.000, χ2 = 14.012; P = 0.000, χ2 = 14.286).

CONCLUSIONA narrower intercondylar notch and a plateau environment are risk factors of predisposing female nonathletes with knee OA to ACL injury aged 41-65 years.

Adult ; Aged ; Anterior Cruciate Ligament Injuries ; diagnosis ; epidemiology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnosis ; epidemiology ; Risk Factors

Accidental Falls ; statistics & numerical data ; Accidents, Traffic ; statistics & numerical data ; Adult ; Age Distribution ; Anterior Cruciate Ligament Injuries ; epidemiology ; surgery ; Athletic Injuries ; epidemiology ; Female ; Humans ; Knee Injuries ; epidemiology ; surgery ; Male ; Medial Collateral Ligament, Knee ; injuries ; surgery ; Middle Aged ; Motorcycles ; Orthopedics ; Pedestrians ; Posterior Cruciate Ligament ; injuries ; surgery ; Reconstructive Surgical Procedures ; Retrospective Studies ; Sex Distribution ; Singapore ; epidemiology ; Trauma Centers ; Young Adult

BACKGROUND: We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. METHODS: We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. RESULTS: The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 +/- 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 +/- 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups. CONCLUSIONS: Surgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Female ; *Femur/injuries ; Humans ; Middle Aged ; Postoperative Complications/*epidemiology/physiopathology/radiography ; Prevalence ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors

PURPOSE: The aim of the study was to investigate and analyze bilateral incidence and morphology of complete discoid lateral meniscus (DLM) with possible relation to tears and symptoms in knee joints. MATERIALS AND METHODS: Thirty-eight consecutive patients with symptomatic or already-torn complete DLM on magnetic resonance imaging in a unilateral knee underwent diagnostic arthroscopy on both knee joints upon agreement. The presence and shape of complete DLM as well as presence and pattern of tear were recorded accordingly. RESULTS: In total, 89.5% (34 of 38 patients) showed bilateral complete DLM, and 84.2% yielded bilateralism with identical shape. Cape-slab was the most frequent shape, comprising 68.8% of patients with identically-shaped bilateral DLM overall. Tear patterns were more frequent, in the order of longitudinal, simple horizontal, radial, and degenerative; however, the morphological shape of complete DLM was not significantly related to tear incidence or pattern. Meniscus tears and knee symptoms occurred in the contralateral knee with incidences of 32.4% and 26.5% in patients with bilateral complete DLM, respectively. CONCLUSION: Based on these findings, more aggressive warning on the presence of discoid pathology and the need for evaluation on the contralateral knee should be considered during consultation with patients with symptomatic complete DLM in a unilateral knee in the outpatient clinic.
Adolescent ; Adult ; Arthroscopy/*methods ; Female ; Humans ; Incidence ; Knee Joint/*pathology ; Magnetic Resonance Imaging/methods ; Male ; Menisci, Tibial/*injuries/surgery ; Middle Aged ; Musculoskeletal Abnormalities/complications/diagnosis/epidemiology/*surgery ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate clinical characteristics of posterior cruciate ligament (PCL) injuries.

METHODSTo review all 326 patients with PCL injuries from January 2006 to June 2013 retrospectively, which were grouped according to injury patterns. The survey included the gender, age, sides, duration from injury to surgery, cause of injury and combined injuries. Compare the patient-specific factors between two groups.

RESULTSMale patients were the majority of PCL injuries (73%), and 30 to 50 years old patients accounted for 59%. 62.6% of all patients went for a doctor within one month after trauma. Traffic accidents were the main cause of PCL injuries (59%), especially motorcycle accidents (74.3%). Anterior cruciate ligament (ACL) injuries were the most common combined injuries (46.9%),followed by medial collateral ligament (MCL) (29.8%) and posterolateral corner (PLC) (26.1%). The meniscal tears accounted for 30.4% of total cases. The in-substance PCL injuries (71.5%) were far more than avulsion fractures (28.5%), and the former had more combined injuries than the later (P < 0.05). The causes of injuries were statistically different between two groups (P < 0.05). The prevalence of isolated avulsions was higher than isolated in-substance injuries (P < 0.05).

CONCLUSIONIn the general population, in-substance PCL tears were dominant on PCL injuries. The prevalence of combined injuries was quite high, among which ACL injuries were the most common. Insertion avulsion fractures emerged mainly at the tibial side, which had less combined injuries than those suffered in-substance PCL injuries. The incidence of isolated insertion avulsion fractures was higher than isolated in-substance injuries.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Incidence ; Knee Injuries ; epidemiology ; Male ; Middle Aged ; Posterior Cruciate Ligament ; injuries ; Retrospective Studies ; Young Adult

BACKGROUNDClinical features of anterior cruciate ligament (ACL) injury are important for its prevention, diagnosis and treatment. However, few studies have reported such data, especially in China. The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.

METHODSBetween 1993 and 2007, a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered. Data were collected using a special database system. And the distributions of characteristics in different groups were compared and analyzed statistically.

RESULTSAll subjects were confirmed with ACL tear during surgery. Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs. 24.95%, P < 0.001). This study also found that sports trauma was the main cause of ACL tears. Soccer, basketball, judo, wrestling and track and field were the five most responsible activities for athletes. The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs. 717.5 days, P < 0.001). Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04% single-bundle, 18.30% double-bundle). Three hundred and forty-five patients (7.92%) were combined with other ligaments injuries, 2667 (61.24%) were found with various grades of cartilage lesions, and 3377 (77.54%) were found with meniscal injury.

CONCLUSIONSSports trauma was the main cause of ACL tears in China, and reconstruction had become the principal surgical choice. In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury, patienttailored ACL reconstruction should be suggested at the right moment.

Adolescent ; Adult ; Age Distribution ; Anterior Cruciate Ligament ; pathology ; Child ; China ; epidemiology ; Female ; Humans ; Knee Injuries ; epidemiology ; etiology ; pathology ; Male ; Middle Aged ; Sex Distribution ; Young Adult

OBJECTIVETo study the therapeutic effects of combined anterior-posterior (small incision or micro-incision) approach for complex tibial plateau and posterior condylar fractures.

METHODSFrom 2000 to 2008, 79 patients (81 limbs) with complex tibial plateau and posterior condylar fractures were reviewed. There were 45 males and 34 females, ranging in age from 19 to 66 years, with an average of 40.6 years. Thirty-nine limbs were treated using small incision through combined anterior-posterior approach, in which 13 limbs were Schatzker type IV, 15 limbs were type V ,and 11 limbs were type VI. Other 42 limbs were treated using micro-incision through combined anterior-posterior approach, in which 18 limbs were Schatzker type IV, 16 limbs were type V, and 8 limbs were type VI. The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment. The complications such as cutaneous necrosis and incision infection were observed.

RESULTSAll the patients were followed up. According to Rasmussen criterion, in small incision group, 16 limbs got an excellent result, 13 good, 7 fair and 3 bad; in micro-incision group,above data were 19, 11, 8 and 4 respectively. Comparison between the two groups, P = 0.924. Comparison of complications such as cutaneous necrosis and incision infection: in small incision group,10 limbs had the complications, and in micro-incision group were 4 limbs; the occurrence rate of small incision group were higher than that of micro-incision group (P = 0.047).

CONCLUSIONThere are no significant differences between the two groups in the knee joint function rehabilitation; however, there is smaller rate for cutaneous necrosis and incision infection in micro-incision group.

Adult ; Aged ; Ankle Injuries ; surgery ; Case-Control Studies ; Female ; Fracture Fixation ; methods ; Humans ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Tibial Fractures ; surgery