Journal of Experimental Orthopaedics最新文献

Purpose

To investigate if hip and knee alignment assessed 2 years after anterior cruciate ligament (ACL) injury is associated with compartment-specific radiographic knee osteoarthritis (OA) 3 years later.

Methods

An exploratory analysis was conducted in the knee ACL, nonsurgical versus surgical treatment (KANON) trial (ISRCTN84752559); 115 subjects with acute ACL injury were assessed at the 2-year follow-up; full-limb images of the injured leg were acquired, and the neck-shaft angle (NSA) and hip-knee-ankle angle (HKA) were measured. At the 5-year follow-up, weight-bearing tibiofemoral and patellofemoral radiographs were obtained. Radiographs were graded according to the OA Research Society International Atlas and Radiographic OA was defined as approximating Kellgren & Lawrence grade 2 or worse. Analysis of covariance adjusting for sex, age, body mass index, randomization and partial meniscectomy recorded at the 2-year follow-up was performed.

Results

In patients who had developed medial tibiofemoral OA at the 5-year follow-up, the NSA and the HKA at the 2-year follow-up were smaller (NSA, mean difference = −4.6° [95% confidence interval {CI} −7.9° to −1.1°]; HKA, mean difference = −2.3° [95% CI −4.2° to −0.4°]). No association was observed between the NSA or HKA at the 2-year follow-up and lateral tibiofemoral OA, nor patellofemoral OA at the 5-year follow-up.

Conclusion

A smaller NSA and HKA angle of the ACL injured leg (i.e., more varus hip and varus knee alignment) 2 years after the injury was associated with medial tibiofemoral radiographic OA 3 years later.

Level of Evidence

Level II exploratory post hoc analysis of an RCT.

Purpose

Chat Generative Pre-Trained Transformer (ChatGPT) may have implications as a novel educational resource. There are differences in opinion on the best resource for the Orthopaedic In-Training Exam (OITE) as information changes from year to year. This study assesses ChatGPT's performance on the OITE for use as a potential study resource for residents.

Methods

Questions for the OITE data set were sourced from the American Academy of Orthopaedic Surgeons (AAOS) website. All questions from the 2022 OITE were included. All questions, including those with images, were included in the analysis. The questions were formatted in the same manner as presented on the AAOS website, with the question, narrative text and answer choices separated by a line. Each question was evaluated in a new chat session to minimize confounding variables. Answers from ChatGPT were characterized by whether they contained logical, internal or external information. Incorrect responses were further categorized into logical, informational or explicit fallacies.

Results

ChatGPT yielded an overall success rate of 48.3% based on the 2022 AAOS OITE. ChatGPT demonstrated the ability to apply logic and stepwise thinking in 67.6% of the questions. ChatGPT effectively utilized internal information from the question stem in 68.1% of the questions. ChatGPT also demonstrated the ability to incorporate external information in 68.1% of the questions. The utilization of logical reasoning (p < 0.001), internal information (p = 0.004) and external information (p = 0.009) was greater among correct responses than incorrect responses. Informational fallacy was the most common shortcoming of ChatGPT's responses. There was no difference in correct responses based on whether or not an image was present (p = 0.320).

Conclusions

ChatGPT demonstrates logical, informational and explicit fallacies which, at this time, may lead to misinformation and hinder resident education.

Level of Evidence

Level V.

Meniscal extrusion (ME), defined as the radial displacement of the meniscal body outside the margins of the tibial plateau, has been seen as an independent and relevant predictor of intra-articular knee degeneration. Nonetheless, available classifications for ME are exclusively quantitative assessments not considering the context in which extrusion is identified. Indeed, ME can be the result of several different conditions spanning from acute tears to chronic degeneration and its definition cannot be only dependent on the numeric calculation of the radial displacement of the meniscal body. Furthermore, growing evidence supports the existence of a paraphysiological ME resulting from joint loading, limb malalignment, anatomical abnormalities of the meniscal attachments to the femur and tibia or a nonpathological finding after meniscal allograft transplantation. It is therefore clear that an exclusively quantitative assessment of ME cannot be sufficient since this condition can develop in such different clinical scenarios. For this reason, a novel qualitative classification for ME is proposed, differentiating between three distinct conditions: a paraphysiological ME, a pathological ME and ME related to degenerative conditions. Furthermore, a comprehensive review of the present literature has been conducted to report the most relevant and updated evidence on the topic highlighting the difference in the clinical management of each different category.

Level of Evidence

Not applicable.

Purpose

Non-contact anterior cruciate ligament (ACL) injuries are influenced by the anatomic and biomechanical characteristics of the lower limb. The combination of knee valgus, hip internal rotation and tibial external rotation are important contributors to non-contact ACL injuries. In this study, we aimed to evaluate the effect of femoral anteversion on the incidence of ACL injuries among athletes.

Methods

A retrospective comparative study was conducted on 137 adult male athletes with high suspicion of ACL injury following a sports-related injury. The patients were classified into two groups based on the presence of ACL tears: the ‘ACL tear’ and the ‘ACL intact’ groups. The femoral anteversion angle was measured by both a computed tomography (CT) scan using the method described by Hernandez et al. and a physical examination using Craig's test. The association of ACL tears with femoral anteversion angle was evaluated. Femoral anteversion cut-off values were calculated to find the best margin for a high probability of ACL tearing.

Results

The mean anteversion in patients with ACL tears was found to be higher compared to ACL-intact patients both in CT scan measures (18.4 ± 5.5 vs. 12.9 ± 6.9, p value < 0.001) and physical examination (20.2 ± 5.9 vs. 14.8 ± 7.7, p value < 0.001). The correlation analysis revealed an excellent correlation between femoral anteversion measured by CT scan and Craig's test results (r = 0.94). Cut-off values for femoral anteversion measured by CT scan concerning ACL tearing with the highest sensitivity and specificity were 12.7 and 19.0, respectively. The Craig-measured cut-off values were 1.5–2° more than the CT scan measurements.

Conclusion

This study reveals a significant correlation between increased femoral anteversion and a higher risk of ACL injury among male athletes. The results of this study aid in designing personalized prevention programmes for non-contact ACL injuries among athletes.

Level of Evidence

Level III.

Purpose

Artificial Intelligence is becoming increasingly integrated into healthcare, making it essential to assess its potential as a reliable information source for patient queries in the ambit of orthopaedic surgery. In literature, it is being employed in foot and ankle surgery and total hip arthroplasty. The aim of the present study was to evaluate the ability of Chat Generative Pretrained Transformer (ChatGPT) version 3.5 to give accurate, complete and comprehensive responses to the most common questions which are usually asked by the patient to the surgeon regarding total ankle arthroplasty.

Methods

Ten most common questions were selected by two ankle surgeons and then ChatGPT was used to answer these questions. The responses were analyzed using an accuracy score and the modified DISCERN score to assess clarity. WordCalc software package (educational-level indices) was used to assess the readability of the responses.

Results

Most of ChatGPT's responses were considered excellent not requiring clarification or satisfactory requiring minimal clarification. Indeed, the accuracy score was 2, suggesting that the overall responses were satisfactory requiring minimal clarification, and DISCERN score mean was 51, which is considered good-fair.

Conclusions

ChatGPT demonstrates potential as a tool for responding to common patient questions related to total ankle arthroplasty, offering clear and mostly accurate information. While its current performance is based on the available literature, ongoing advancements in artificial intelligence may further enhance its utility in healthcare communication. However, further studies are required to evaluate its role more precisely in patient information and clinical settings.

Levels of Evidence

Not applicable.

Purpose

Asymmetric anterior closing-wedge high tibial osteotomy (ACWHTO) allows correction of both excessive posterior tibial slope (PTS) and varus deformity. However, the complexity of this surgery requires a high degree of accuracy, which is less likely to be achieved with standard instrumentations. This study aimed to determine the accuracy of 3D patient-specific cutting guides (PSCGs) to provide the accurate planned correction in the frontal and sagittal planes.

Methods

Eight sawbones tibiae were identically printed from the same patient data. An ACWHTO with a PSCG was performed on each sawbone. Postoperative measurements of PTS, mechanical medial proximal tibial angle (mMPTA), hinge area and hinge–posterior cruciate ligament (hinge–PCL) distance were compared with the preoperative planned measurements. The precision was defined as the absolute difference (∆) between the target planned values and postoperative values.

Results

The mean accuracy was 0.6° ± 0.74° for PTS, 0.8° ± 0.71° for mMPTA, 0.3 ± 0.2 cm² for hinge area and 0.1 ± 0.06 mm for hinge–PCL distance.

Conclusion

In the setting of sawbones, the use of PSCGs was a reliable and accurate method of achieving simultaneous correction in the frontal and sagittal planes during asymmetric ACWHTO.

Level of Evidence

Level V, basic science biomechanical laboratory study.

Purpose

The relationship between sagittal lumbopelvic alignment and the bony pathomorphology of hip dysplasia is currently at the forefront of clinical and scientific interest. The aim of this study was to determine whether there is a compensatory lumbopelvic aspect associated with the two major acetabular phenotypes in dysplastic hips.

Methods

From September 2022 to March 2024, a total of 145 patients with symptomatic bilateral hip dysplasia were included in the study. Hips were categorized into either anterolateral or posterolateral morphologies based on anteroposterior pelvic x-rays. Additionally, the lumbopelvic sagittal alignment was determined radiographically. Furthermore, a multivariable linear regression analysis was conducted to assess the association of lumbopelvic sagittal alignment with additional independent factors.

Results

Pelvic tilt (PT) significantly differed between the anterolateral and posterolateral phenotypes of hip dysplasia (16.84° ± 8.75° vs. 11.51° ± 6.63°, respectively; p < 0.001). Similar significant findings were observed for pelvic incidence (57.19° ± 12.96° vs. 50.75° ± 13.1°, respectively; p < 0.001). A PT of >14.5° was identified as the most likely factor associated with anterolateral dysplasia.

Conclusions

The results of this study reveal a paradox in the hip–spine association in hip dysplasia. Contrary to previous theories, it seems that PT constitutes a component of the corresponding phenotype of dysplastic pathology, rather than functioning as a compensatory tilt.

Level Evidence

Level III.

Purpose

The objective was to use cyclic tensile loading to compare the gap formation at suture site of three different suture materials to repair bovine radial meniscal tears: (1) polyglactin sutures, (2) tough adhesive puncture sealing (TAPS) sutures and (3) ultra-high molecular weight polyethylene (UHMWPE) sutures.

Methods

Twelve ex vivo bovine knees were dissected to retrieve the menisci. Complete radial tears were performed on 24 menisci, which were then separated into three groups and repaired using either pristine 2–0 polyglactin sutures, TAPS sutures (2–0 polyglactin sutures coated with adhesive chitosan/alginate hydrogels) or 2-0 UHMWPE sutures with a single stitch. The repaired menisci were clamped onto an Instron machine and underwent cyclic loading between 5 and 25 N at a frequency of 0.16 Hz. Gap formation between the edges of the tear was measured after 500 cycles using an electronic caliper, when the meniscus was still on the Instron without any load applied.

Results

Mean gap formation was 5.22 mm (±1.70) for the 2–0 polyglactin sutures, 2.48 mm (±0.25) for the TAPS sutures, and 4.85 mm (±1.55) for the 2–0 UHMWPE sutures. The gap was significantly smaller in the TAPS sutures group compared to the two others because of better force dispersion, decreasing tissue damage by suture indentation and potentially leading to better meniscal healing.

Conclusions

From a biomechanical standpoint, coated sutures held the edges of radial meniscal tears closer together compared to conventional sutures. This technology has the potential to reduce tissue damage and improve the success rate of meniscal repairs.

Level of Evidence

controlled laboratory study.

Purpose

Using a thin semitendinosus tendon as an autograft is a risk factor for poor clinical outcomes after anterior cruciate ligament reconstruction. Preoperative evaluation of the cross-sectional area of the semitendinosus tendon using magnetic resonance imaging is useful. However, studies comparing the cross-sectional area of the semitendinosus tendon on magnetic resonance imaging and the collagen fibril diameter of the semitendinosus tendon are lacking. We aimed to investigate the relationship between collagen fibril diameter and cross-sectional area of the semitendinosus tendon using magnetic resonance imaging.

Methods

We included 14 patients (24.5 ± 12.3 years) who underwent anterior cruciate or medial patellofemoral ligament reconstruction using the semitendinosus tendon. Samples not used to prepare autografts were used to evaluate the collagen fibril diameter. Transmission electron microscopy was used to measure several hundred short fibril diameters per sample. Magnetic resonance imaging (T2-weighted imaging) was used to assess the cross-sectional area of the semitendinosus tendon, measured 8 cm proximal to the tibial attachment. Spearman's rank correlation coefficients were determined for collagen fibril diameter and cross-sectional area of the semitendinosus tendon on magnetic resonance imaging, and the relationship between both parameters was evaluated.

Results

The collagen fibril diameter of the semitendinosus tendon was calculated from 10,279 fibrils. The correlation coefficient between the collagen fibril diameter and the cross-sectional area of the semitendinosus tendon was 0.821 (p < 0.001).

Conclusions

A strong positive correlation was observed between the collagen fibril diameter and cross-sectional area of the semitendinosus tendon. A small cross-sectional area on the magnetic resonance image of the semitendinosus tendon indicated a thin collagen fibril diameter, which may affect the mechanical strength of the autograft for anterior cruciate ligament reconstruction. The collagen fibril diameter can be predicted preoperatively by measuring the cross-sectional area of the semitendinosus tendon using magnetic resonance imaging.

Level of Evidence

Level IV.

Purpose

The goals of this study were (1) to assess whether the preoperative difference between modalities and extent of deformity are associated with a higher difference between planned and achieved surgical correction and (2) if they yield a higher probability of intraoperative adjustments.

Methods

Retrospective single-centre analysis of patients undergoing patient-specific instrumented (PSI) total knee arthroplasty (TKA). Preoperative radiographic parameters were analysed on weightbearing (WB) long-leg radiographs (LLR) and nonweightbearing (NWB) computed tomography (CT). The 2D/3D difference was calculated as the difference between preoperative WB-LLR (2D) hip–knee–ankle angle (HKA), and NWB CT (3D) HKA. Surgical records were screened to retrieve intraoperative adjustments to the preoperative plan. Postoperative assessment was performed on WB LLR.

Results

Two-hundred-eighty-two knees of 263 patients were analysed. The difference of postoperative achieved to planned HKA (HKA_Difference) was 2.2° ± 1.7°. The preoperative 2D HKA showed the highest correlation with HKA_Difference (r = −0.37, 95% confidence interval [CI]: −0.48 to −0.26, p < 0.001). Intraoperative adjustments were performed in 60% (n = 170) of all knees. Patients with a preoperative coronal deformity of >7.8° had 10.55 higher odds for an intraoperative coronal adjustment (95% CI: 4.60–24.20, p < 0.001).

Conclusion

The extent of deformity is associated with residual coronal deformity following PSI-TKA. Patients with extensive coronal malalignment may benefit from an adaptation of the preoperative surgical plan to avoid unintended postoperative coronal malalignment. Despite the advancements with 3D preoperative planning, intraoperative adjustments in PSI-TKA are frequently performed, in particular in patients with a higher preoperative varus/valgus deformity.

Level of Evidence

Level III.