bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnetic Resonance Imaging of the knee anteromedial quadrant
Authors: Jorge PB , Jorge RB , Oliveira DE , Helito CP , Sato FT , Silva IP 
Published: November 2024

Objectives This study aims to evaluate the possibility of characterizing an extra-articular thickening in the knee anteromedial quadrant in routine MRI scans, the Anterior Oblique Ligament (AOL). Methods Firstly, in a pilot study, for a better understanding of this extra-articular thickening trajectory in MRI, polytetrafluoroethylene (PTFE) tubes were attached to the ligament structure topography in two dissected pieces. Afterward, 100 knee MRI studies were randomly selected from our database, and 97 met the inclusion criteria. Two musculoskeletal radiologists interpreted the exams separately. Both had previously studied the ligament in the cadaveric knee MRI with the PTFE tube. Results The intraobserver and interobserver agreement for the ligament identification was calculated using Cohen’s Kappa coefficient. The first radiologist identified the structure in 41 of the 97 scans (42.2%), and the second radiologist in 38 scans (39.2%). The interobserver agreement was substantial, with a Kappa of 0.68 and an agreement of 84.5%. The results suggest that this extra-articular thickening, recently called Anterior Oblique Ligament (AOL) in the literature, is a structure that can be frequently visualized on MRI scans with a high level of interobserver agreement in a relatively large number of exams. Conclusion Therefore, this study indicates that MRI is a promising method for evaluating this anteromedial thickening, and it may be used for future studies of the Anterior Oblique Ligament.
Patients with knee hyperextension who regained preoperative range of motion after ACL reconstruction have worse knee stability but better subjective outcomes than patients who did not regained preoperative range of motion
Authors: Helito CP 
Published: November 2024

Objectives To evaluate patients submitted to ACL reconstruction with preoperative hyperextension and compare patients who recovered the entire range of motion with patients who recovered full extension but not hyperextension. Methods Patients submitted to surgery from June 2013 to June 2021 were evaluated. Patients aged 18 to 60 years with acute or chronic ACL injuries submitted to anatomical ACL reconstruction with a single bundle and any graft with at least 24 months of follow-up were included. The following data were collected: age, sex, time from injury to surgery, passive knee hyperextension, pre-and postoperative KT-1000 arthrometer laxity and pivot-shift, associated meniscal injury and treatment (meniscectomy or repair), type of graft used, intra-articular graft diameter, associated extra-articular procedure, follow-up time, and postoperative Lysholm Knee Scoring Scale and International Knee Documentation Committee (IKDC) subjective scores. Results Among 225 patients evaluated, 48 (21.3%) did not recover preoperative hyperextension, and 177 recovered range of motion. Regarding the pre-and intraoperative variables, there was no difference between the groups, except that who did not recover hyperextension had a larger diameter graft than patients who recovered hyperextension (8.7 ± 0.7 vs. 8.3 ± 0.7; p = 0.018). Regarding the postoperative variables evaluated, patients who recovered the preoperative hyperextension showed improvement on all scales evaluated compared to patients who did not recover the range of motion. However, patients who recovered hyperextension showed more laxity on physical examination, measured by the KT-1000 and the pivot-shift. Conclusion Patients with knee hyperextension greater than 5 degrees who regained preoperative range of motion after ACL reconstruction have worse knee stability according to KT-1000 and pivot-shift tests than patients who regained full extension but not hyperextension. However, patients who recover full range of motion show improvement on all subjective function scales.
Evaluation of KLIC and CRIME80 scores for analysis of the risk of failure of the debridement, antibiotics and implant retention procedure in acute postoperative periprosthetic joint infections of the knee
Authors: Oliveira Filho NG , Mozella AP , De Oliveira ACL , Corrêa VK 
Published: November 2024

Objectives The primary objective of the study was to evaluate the efficiency of KLIC and CRIME80 scores in assessing the risk of failure of the Debridement, Antibiotics and Implant Retention (DAIR) procedure for the treatment of acute postoperative periprosthetic joint infection after total knee arthroplasty (TKA). Secondary objectives included determining the failure rate of DAIR and identifying factors related to DAIR treatment failure. Methods A retrospective study was conducted with patients undergoing DAIR within 30 days post-TKA or TKA revision at a specialized SUS hospital for high-complexity orthopedic surgeries. Patient records were evaluated to collect the necessary information for score assessment. Procedure failures were considered if re-intervention was required within 60 days, death occurred within 60 days, or if suppressive antibiotic therapy was needed. Results The study included 17 patients undergoing the DAIR procedure. 52% of infections were caused by Staphylococcus aureus, and 29% occurred after revision surgery. Six (35%) patients experienced DAIR failure, and the mortality rate was 11%. Patients who failed had a higher score on the KLIC score (p<0.0001). Regarding the CRIME80 score, only 33% of those with a score of less than 3 experienced procedure failure. Results also showed that for patients with a KLIC score between 2,5 and 5, the presence of a comorbidity or risk factor resulted in DAIR failure. Additionally, 100% of patients with chronic kidney disease experienced treatment failure, with 66% of them progressing to death. Conclusion Our results demonstrated that the KLIC and CRIME80 scores proved to be effective methods in predicting the likelihood of failure in the treatment of acute postoperative periprosthetic joint infection with DARI and patients in intermediate KLIC groups with comorbidities are subject to a higher chance of failure.
Evaluation of the peroneus longus tendon as an autologous graft in knee surgery
Authors: De Oliveira DE , Canuto SMG , De Padua VBC , Horita MM , Malpaga JMD , Jorge PB 
Published: November 2024

Objectives Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. Methods A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Results Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 1.02, 98.69± 1.08, 99.92± 0.27, and 99.92± 0.27 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). Conclusion The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results.
Unicompartimental Knee Arthroplasty In Patients With or Without Patellofemoral Arthritis: 2-Year Clinical Outcome
Authors: IGN Reis , GMA Silva , TVO Campos , MAP Andrade 
Published: November 2024

Objectives Evaluate patients submitted to unicompartimental knee arthroplasty (UKA) by two surgeons with partial knee replacement expertise and, analyze the outcomes comparing a group of patients with preoperative isolated medial compartment arthritis to another group of patients with associated patellofemoral arthritis. Methods We conducted a retrospective cohort study to compare the clinical results of all patients submitted to UKA by two senior surgeons, between 2009 and 2020. All patients were submitted to partial knee arthroplasty using fixed-bearing Zimmer Unicondylar Knee System (ZUK). During analysis, they were divided into two groups, without patellofemoral arthritis (Group 1) and with patellofemoral arthritis (Group 2). Data collected from patient’s records included demographic information, range of motion (ROM), patient-reported outcome measures (PROMs) and preoperative radiographs. Only patients with minimum 2-year follow-up were included. Results Preoperative ROM was 122.6º (±6.2º) and 122.2º (±9.2º), in Group 1 and in Group 2, respectively (p-value = 0.9). While postoperative ROM was 114.5º (±2.9º) in Group 1 and 112.5º (±3.6) in Group 2 and, there was no statistical significance (p-value = 0.4). There was also no statistical significance regarding PROMs (Table 3). In Group 1, Oxford Knee Score was 17.1 (±1.8) and 40.2 (±2.1), before and after surgery, respectively. In Group 2, Oxford Knee Score changed from 18.8 (±1.9) to 40.5 (±2.5). The KOOS went from 129.3 (±15.2) preoperatively to 61.4 (±18.3) after surgery, in Group 1, while Group 2 evolved from 137.2 (±14.8) to 57.3 (±11.9). No complications were identified during the period studied. Conclusion UKA is an acceptable treatment option for unicompartimental tibiofemoral arthritis of the knee in patients with associated PFOA. There was an improvement in ROM of the knee, Oxford Knee Score and KOOS, with no differences between patients with or without PFOA.
Calculation of the Minimal Important Clinical Difference of the Lysholm and IKDC Scores After Anterior Cruciate Ligament Reconstruction
Authors: BF Nascimento , Mendes AF , Dias JM , J Antunes Filho 
Published: November 2024

Objectives To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction.To calculate the minimal important clinical difference (MICD) value for the Lysholm and International Knee Documentation Committee (IKDC) scores in a sample of patients submitted to anterior cruciate ligament reconstruction. Methods Primary, observational, retrospective, analytical study of participants submitted to anterior cruciate ligament reconstruction from March 2019 to December 2020 by the same surgeon, with a minimum follow-up of 6 months, analysis of knee function in the pre- and postoperative period by the Lysholm and IKDC scores, and answer to an anchor question at 6 months postoperatively for the calculation of the MICD of each score. Results A total of 59 patients participated in the study, with a mean age of 27.1 +- 5.7 years old. In the comparison between pre- and postoperative scores of all groups, there was an increase in values with statistical significance after intervention. The MICD was 5.5 for the Lysholm score, and the MICD value for the IKDC score could not be determined. Conclusion For the Lysholm score, the calculation of the MICD value by the anchor question method in the sample evaluated was 5.5. It was not possible to determine the value of the MICD for the IKDC score.
Challenges of Implementing a Human Multi-Tissue Bank in a Public Hospital: From the Perspective of the Quality Management System
Authors: GC Campos , LH Freitas Filho , CCS Neves , SR Piedade , JB Miranda , AR Zorzi 
Published: November 2024

Objectives: Various techniques have been developed to manage bone defects in revision knee arthroplasties, including bone grafts, which can be sourced from living or deceased donors as fresh-frozen or freeze-dried bone allografts, typically from bone banks. Human Multi-tissue Banks (HMTB) are crucial health institutions specializing in the procurement, processing, and distribution of human tissues for transplantation and research. They aim to ensure safety and quality in providing tissues for reconstructive surgeries and injury repair, while also advancing research in regenerative medicine. This study reports on the experience of implementing an HMTB and developing its own Quality Management System. Methods: This descriptive, experience report study identifies the historical actions of the HMTB over five years of implementing and operating the bone bank service. Results: The establishment of an HMTB with modern infrastructure and technological advancements, alongside the development and implementation of a quality management system, enabled excellent organization of work processes and the acquisition of the necessary health license to initiate activities. Conclusion: This report serves as a valuable source of information and provides recommendations applicable to the implementation of other human HMTBs.
Combined Anterior Cruciate Ligament and Anterior Oblique Ligament Reconstruction Using the Rectus Femoris Tendon: Surgical Technique Description
Authors: MCF Rego , BG Barroso , CP Helito , MCF Rego , SMG Canuto , PB Jorge 
Published: November 2024

Objectives: Present a combined anterior cruciate ligament (ACL) and anterior oblique ligament (AOL) reconstruction technique using a rectus femoris tendon graft harvested in a minimally invasive approach. Methods: Examination under anesthesia should confirm ACL insufficiency and associated anteromedial rotational instability. The graft is harvested from the lateral portion of the rectus femoris tendon using a closed tendon stripper with the knee at 20 degrees of flexion. The distal portion is folded to form a double graft for the ACL, while the proximal remainder is used for the AOL without folding. The femoral tunnel is made using an outside-in technique, and the tibial tunnel is created within the native ACL tibial footprint. ACL graft fixation is performed with an interference screw in both the femur and tibia, with the knee at 20° of flexion. The medial epicondyle is identified by palpation (or fluoroscopy) for AOL graft fixation. The remaining graft is tunneled subcutaneously and fixed with an interference screw at the femoral tunnel in neutral rotation and full extension. Results: The technique improved knee stability and controlled anteromedial rotational instability. It is reproducible and presents few complications. Conclusion: The described technique using the rectus femoris graft harvested via a minimally invasive approach is a viable alternative for combined ACL reconstruction and anteromedial reinforcement in both primary and revision surgeries.
Transtibial Femoral Tunnel Technique in ACL Reconstruction and Osteoarthritis Incidence
Authors: DANIELI MARCUS VINICIUS , MOLINARI ALLAN VIKTOR PIRES , SUZZE JOÃO VITOR GUEDES , DE ABREU VICTORIA , GUERREIRO JOÃO PAULO FERNANDES 
Published: November 2024

Objectives Evaluate osteoarthritis incidence in patients that undergone ACL reconstruction using the transtibial technique, with a minimum of 5 years of follow up, with isolated ACL injury. Methods Patients from a private clinic who underwent to ACL reconstruction by transtibial technique, with hamstrings graft, and with at least 5 years of follow-up, without any associated injury to the operated knee at the day of the surgery, were selected. All patients were operated on by the same surgeon. The patients were invited to perform X-Ray images of the operated knee to assess the presence of osteoarthritis. The Kellgren & Lawrence radiographic osteoarthritis classification was used. The grade I classification was already considered as the presence of osteoarthritis. The obtained results were analyzed by simple descriptive statistics, ie, obtaining the percentage of patients with osteoarthritis among those analyzed. Patients were also divided into 2 groups: between 5 and 10 of surgery, and with more than 10 years. The obtained data were evaluated by descriptive statistics. Results Forty-two patients (44 knees) were evaluated, with a mean age of 31 years old (SD: 8), being 23 right knees and 28 male patients. Mean time from surgery to imaging evaluation was 94.1 months (ranging from 60 to 154 months; SD: 28). Of the evaluated knees, 37 did not have osteoarthritis (83.3%) and 7 had (16.7%). Conclusion The ACL reconstruction performing the femoral tunnel through the transtibial technique in patients without another associated injuries to the operated knee, using quadruple hamstring graft, with a minimum of 5 years of follow up, showed an osteoarthritis incidence of 16.7% with a mean follow-up of 94.1 months.
Complete medial meniscal root injury and medial collateral ligament injury are risk factors for increased medial meniscal extrusion
Authors: Astur DC , Cohen M 
Published: November 2024

Objectives To evaluate the association between medial meniscus posterior root tear (MMRT) with anthropometric characteristics of the patient (age, weight, and height) and associated injuries identified on MRI (meniscal extrusion, medial collateral ligament [MCL] injury, bone edema, and subchondral fracture of the tibia). Methods The characteristics and associated injuries of 55 patients diagnosed with an injury (either partial or complete) of the root of the posterior horn of the medial meniscus, diagnosed on MRI and confirmed arthroscopically, were compared. Specifically, age, sex, anthropometric data, meniscal extrusion, associated MCL injury, and presence of associated bone edema were evaluated. Results There was a moderate positive correlation between the age of the patients and the degree of extrusion (r = 0.565; p < 0.0001). Greater meniscal extrusion was observed in patients who had complete medial meniscus root tear (C-MMRT) (p = 0.008). Patients with MCL injury presented with significantly greater meniscal extrusion when compared to individuals without MCL injury (p = 0.042). Similarly, the incidence of bone bruising was higher in patients with a MMRT with an associated MCL injury, when compared to patients without concomitant MCL injury (p=0.012). Conclusion Patients with a C-MMRT had greater meniscal extrusion than patients with a partial medial meniscus root tear (P-MMRT). The presence of a concomitant MCL injury was significantly associated with the meniscal extrusion in patients with concomitant meniscal root injury. The presence of associated bony edema was not associated with meniscal extrusion, but was significantly more common in patients with C-MMRT when there was an associated MCL injury compared to those without an associated MCL injury.
Defining Risk Factors for Medial Meniscus Posterior Root Repair Surgical Failure
Authors: Helito CP , Sobrado MF , Guimaraes TM , Silva da AGM , Pecora JR , Gobbi RG 
Published: November 2024

Objectives To evaluate the risk factors for failure of a repair of the posterior root of the medial meniscus, including the patient's preoperative factors, factors related to surgery and rehabilitation, already excluding factors such as uncorrected varus axis deviation and changes advanced degenerative diseases in the medial compartment. Methods Patients who underwent repair of the posterior root of the medial meniscus were evaluated retrospectively, although with prospective data collection. Repair of the meniscal root was performed using an arthroscopic method, using stitches tying the meniscus using high-resistance suture threads or tapes and fixation through one or two transtibial tunnels in the anterior cortex of the tibia with a button or anchor. Results Among the 125 patients evaluated, considering the adopted failure criteria, 28 (22.4%) were considered repair failure and 97 (77.6%) were considered successful. Comparing the groups, patients who were considered to have repair failure presented as pre- and intra-operative factors a greater proportion of female patients (p=0.0004), higher BMI (p=0.0009), greater number of associated procedures at the time of root repair (0.02) and greater number of chondral injuries in the femur (0.0005). Patients who failed the repair underwent surgery with a greater number of stitches (p=0.02), although only repairs with 2 or 3 stitches were included, and had worse compliance with rehabilitation (p=0.0001). Conclusion Repairs of injuries to the posterior root of the medial meniscus with transtibial tunnel have 77.6% good results with an average follow-up of around 4 years. Female gender, high BMI, surgery to correct the axis or treatment of cartilage injury concomitant with root repair, more pronounced chondral injury in the femoral cartilage, repair with 3 stitches instead of 2, and poor patient compliance with rehabilitation were related factors of repair failure.
Caregiver's Knowledge of Childhood Diarrhea Disease Prevention Strategies and Their Associated Factors in Dodoma, Tanzania. A Cross-Sectional Study
Authors: Saguda Nonhy , Msisiri Laidi S. , Masika Golden M. , Masanja Pendo P. 
Published: November 2024

Introduction Childhood diarrhea remains a leading cause of death in children under 5 years of age worldwide, although the disease is both preventable and treatable. Effective caregiver involvement, rotavirus vaccinations, and parallel diarrhea prevention are critical. Objectives This study aimed to assess caregiver's knowledge of childhood diarrheal disease prevention, rotavirus vaccination knowledge, and associated factors in Dodoma, Tanzania. Methods A hospital-based analytical cross-sectional study was conducted at Makole Health Center, Dodoma. Data were collected from 274 caregivers of children under 5 years of age who attended a routine immunization clinic. Respondents were interviewed using a semi-structured, pretested questionnaire. Data were analyzed for frequency, percentages, and mean, followed by multivariable linear logistic regression to examine the association between sociodemographic factors and caregiver's knowledge. Results A total of 274 subjects were involved in the study. The majority (93.8%) were women, all had formal education, (62.8%) knew that diarrhea in children can be prevented by proper handwashing, and only (9.9%) knew about the rotavirus vaccine. Educational level (β = 0.565 CI; 0.490, 0.873) p-value < .001, age of parents (β = 0.738 CI; 0.427, 1.050) p-value .022 and age of child (β = −0.306 CI; − 0.490, −0.122), p-value <.001 and the fact that the child was male (β = 1.116, 95% CI = 0.712, 1.520) p-value < .001) were the factors associated with participants’ knowledge. Conclusion The results highlight the great need for public health programs to increase awareness of rotavirus vaccines and parallel diarrhea prevention interventions, which in turn will significantly improve caregivers’ knowledge and therefore the prevention of diarrhea in children
Is allogeneic transplantation for sickle cell disease still relevant in the era of gene therapy?
Authors: Jones Richard J. , Kassim Adetola A. , Brodsky Robert A. , DeBaun Michael R. 
Published: November 2024

Abstract
Sickle cell disease (SCD) is the most common inherited blood disease. Disease-modifying therapy and supportive care have improved the survival of children with SCD in the United States and Europe. Yet, adults with SCD continue to have high risks of morbidity and early death. Recently, 2 US Food and Drug Administration–approved genetic therapies offer the potential for a short-term decrease in acute vaso-occlusive pain events if not cure. Allogeneic hematopoietic cell transplantation (allo-HCT) is also curative but, until recently, was constrained by limited donor availability and the risks of graft-versus-host disease, graft rejection, and death. Importantly, recent advances have attenuated these barriers. Here, we discuss the current state of therapies with curative intent for SCD. Both genetic therapy and allo-HCT offer the potential for cure for most with SCD. However, the cost (∼5 times higher), the current need for myeloablation, and associated late-health effects may make genetic therapies less favorable choices than allo-HCT.