Introduction To investigate the efficacy of the transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSCs) under arthroscopy with microfracture (MFX) compared with microfracture alone. Methods Eleven patients with a symptomatic articular cartilage defect of the knee were included in the study. They were randomized to receive BMSCs with MFX (cell-T group, n=7) or MFX alone (control group, n=4). Clinical results were evaluated using International Knee Documentation committee (IKDC) knee evaluation questionnaires and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before and 48 weeks after surgery. Quantitative and qualitative assessments of repair tissue were carried out at 48 weeks by T2 mapping of magnetic resonance images (MRIs) and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system with follow-up MRI. Results No significant differences between preoperative and postoperative IKDC and KOOS were observed in the cell-T or control group. However, forty-eight weeks after surgery, the cell-T group showed a trend for a greater KOOS QOL score compared with the control group (79.4 vs. 39.1, respectively; P=0.07). The T2 value did not differ significantly between the two groups, but the mean MOCART score was significantly higher in the cell-T group than in the control group (P=0.02). Conclusions Compared with MFX alone, BMSC transplantation with MFX resulted in better postoperative healing of the cartilage and subchondral bone as determined by the MOCART score. Clinically, BMSC transplantation with MFX gave a higher KOOS QOL score after 48 weeks.

The clinical and radiographic outcomes after OAT associated with unstable OCD of the humeral capitellum were better for central lesions than for lateral lesions. However, satisfactory outcomes and a high rate of return to sports were obtained for unstable lateral lesions after OAT.

Background: Although the sensitivity and specificity of magnetic resonance imaging (MRI) for the diagnosis of primary meniscal tears are high, these values are lower for the assessment of healing status of repaired menisci. Purpose: To compare the accuracy of MRI T2 mapping and conventional MRI in assessing meniscal healing after repair. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent meniscal repair with concurrent anterior cruciate ligament reconstruction between 2012 and 2016 and had a follow-up second-look arthroscopy were enrolled. The patients were divided into healed and incompletely/not healed groups based on the second-look arthroscopy findings. For the repaired menisci, the following were compared between the groups, (1) Stoller and Crues classification on conventional MRI with a proton density-weighted fat-saturated sequence and (2) the remaining colored meniscal tear line on T2 mapping coincident with the high signal line showing the primary tear on conventional MRI were compared. The change of T2 relaxation time (ΔT2) of the colored meniscal tear line pre- to postoperatively was compared between the groups. The mean T2 relaxation time of the whole area of the postoperative meniscus at each slice was also compared with that of control menisci to assess the whole quality of the repaired meniscus. Results: A total of 26 menisci from 24 knees were assessed (16 healed menisci, 10 incompletely/not healed menisci). According to the Crues classification on conventional MRI, 8 of 16 healed menisci and 3 of 10 incompletely/not healed menisci improved from grade 3 to 2, with there being no significant difference between the groups ( P = .43). However, the colored meniscal tear line remained in only 3 of the 16 healed menisci as compared with 9 of the 10 incompletely/not healed menisci, and the presence of this colored line allowed differentiation between healed menisci and incompletely/not healed menisci (sensitivity, 81.3%; specificity, 90.0%; odds ratio, 39.0; P = .001). The mean (SD) ΔT2 was −31.1 ± 3.2 and −19.9 ± 4.4 ms in the healed and incompletely/not healed groups, respectively ( P < .001). Receiver operating characteristic curve analysis showed a cutoff ΔT2 value of −22.3 ms for separation of meniscal healing ( P < .001). The T2 relaxation times of the whole area of the repaired menisci were 31.7 ± 3.4 and 32.8 ± 3.8 ms in the healed and incompletely/unhealed groups, respectively ( P = .69), with these values being significantly longer than the 26.9 ± 2.2 ms in the controls ( P < .001). Conclusion: MRI T2 mapping allowed the differentiation of healing status after meniscal repair, with high sensitivity and specificity as compared with conventional MRI.

Purpose The purpose of this study was to compare femoral graft bending angle between patients with femoral tunnel reamed at less than 80° of knee flexion and those with 80° and above in anatomical anterior cruciate ligament (ACL) reconstruction using modified transtibial technique. Methods Forty-eight patients who underwent ACL reconstruction using bone-patellar-tendon-bone autograft in modified transtibial technique and CT scan at 1 week postoperatively were included in this study. A femoral guidewire insertion into aimed femoral position at the medial wall of the femoral lateral condyle was started at about 75° of knee flexion. When the tip of the guidewire was blown out into femoral posterior wall, the guidewire was inserted again after increasing knee flexion angle. Distance from femoral tunnel exit on the femoral lateral cortex-femoral posterior cortex (Distance-E) was measured on postoperative lateral radiograph. Femoral and tibial tunnel position was measured on 3-D CT images. In addition, femoral graft bending angle was measured on reconstructed 2-D CT images. Patients were divided into two groups depending on whether femoral tunnel was created at less than 80° of knee flexion (group A) or 80° or more (group B). Results There were 32 patients in group A and 16 patients in group B, respectively. Average knee flexion angle was 77.2° [standard deviation (SD) 1.6] in group A and 83.6° (SD 2.4) in group B, respectively (p < 0.05). Average Distance-E was 5.1 mm (SD 2.6) in group A and 6.6 mm (SD 3.8) in group B, respectively. There was no significant difference in the femoral and tibial tunnel position between group A and B. Femoral graft bending angle was significantly smaller in group A [average angle: 50.9° (SD 6.6)] than in group B [average angle: 55.0° (SD 6.6)] (p < 0.05). Conclusions Anatomical femoral tunnel was able to be created at less than 80° of knee flexion in two-thirds of patients. Shallower flexion angle (less than 80°) provided gentler femoral graft bending angle compared to 80° or more of knee flexion. Therefore, femoral tunnel creation in modified transtibial technique should be started at between 75° and 80° of knee flexion to reduce femoral graft bending angle. Shallow knee flexion angle during femoral tunnel creation using modified transtibial technique can reduce femoral graft bending angle and may lead to better clinical outcomes in ACL reconstruction. Levels of evidence Retrospective comparative study, Level III.

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