Search Results (429)

Background/Objectives: This is the first study to examine age-related patterns of meniscal/chondral lesions in women undergoing first-time knee arthroscopy. Methods: We analyzed meniscal tear type/location and evaluated cartilage damage in femoral condyles and the tibial plateau in a medium-sized Romanian cohort (n = 241). Results: Age was associated significantly (p ≤ 0.004) with medial meniscal damage (O.R. = 1.04, 95% CI: 1.01–1.06), medial femoral condyle chondropathy (O.R. = 1.06, 95% CI: 1.03–1.10), and medial tibial plateau chondropathy (O.R. = 1.07, 95% CI: 1.02–1.12). Medial meniscus tear patterns differed significantly between age groups (p < 0.001, Cramér’s V = 0.32). Bucket-handle tears—the most common tear type—peaked in middle age (p < 0.001, Cramér’s V = 0.30). The two menisci showed different distributions of tear patterns in women aged ≥40 years (p ≤ 0.023, Cramér’s V ≤ 0.41). Meniscal tears most commonly involved the posterior third. The distribution of tear sites in menisci (medial vs. lateral) varied significantly in women aged 40–59 years (p = 0.020, Cramér’s V = 0.28). The medial femoral condyle and medial tibial plateau showed significant intergroup differences in ICRS scores (p ≤ 0.024, Cramér’s V ≤ 0.34). The frequency of ICRS grade 4 cartilage lesions increased markedly in the 40–59 age group at both sites, continuing to rise in older patients for the medial tibial plateau. Conclusions: Knee pathology in women worsens with age, especially in the medial compartment. Early screening (intervention) in middle-aged women may help prevent advanced joint damage. Full article

This study aimed to evaluate the effectiveness of different rehabilitation protocols following osteochondral autograft transplantation (OAT) in patients with focal osteochondral defects of the femoral condyle, using the MOCART 2.0 knee score as a primary imaging outcome. Twenty-nine patients were divided into three groups: Group 1 (n = 9) received OAT with bone marrow aspirate concentrate (BMAC) and a 12-week two-phase rehabilitation program; Group 2 (n = 11) received OAT with a 12-week program without BMAC; and Group 3 (n = 9) received OAT with a shortened 6-week program. At the 12-month follow-up, Group 1 demonstrated a superior cartilage repair quality, with the highest mean MOCART 2.0 score (96.1), compared to Group 2 (80.2) and Group 3 (71.7). Notably, complete defect filling was observed in five patients in Group 1 versus four in Group 2 and only one in Group 3. The integration and surface integrity were also better preserved in Group 1. The addition of BMAC and an extended, progressive rehabilitation protocol significantly enhanced the morphological cartilage repair parameters. These results suggest that a biologically enhanced and prolonged recovery plan may offer a greater structural restoration of cartilage after OAT than conventional or accelerated protocols. Full article

Background/Objectives: This cross-sectional analytical study investigated the relationship between the craniofacial morphology, condylar displacement, and degenerative changes in the temporomandibular joints (TMJs) in adult patients with class II skeletal malocclusion. To compare cephalometric variables, joint space dimensions, and centric slide measurements between patients with and without CBCT-confirmed TMJ degenerative alterations. Methods: Sixty adults with class II malocclusion were divided into two equal groups (n = 30) based on the presence or absence of TMJ degenerative changes on CBCT. Joint spaces were measured, condylar displacement was evaluated using a condylar position indicator (CPI), and cephalometric analysis was performed in both maximal intercuspation and centric relation. Statistical comparisons were performed using t-tests, chi-squared tests, and Pearson’s correlation analysis. Significance was set at p < 0.05. Results: Patients with degenerative TMJ changes exhibited significantly greater overjet (p = 0.0001) and a trend toward increased ANB angles (p = 0.055). The superior joint space was reduced on the right side (p = 0.031). Condylar displacements ≥ 2 mm were more frequent in the affected group and correlated with sagittal cephalometric discrepancies (45% vs. 24% in controls). Conclusions: Aggravated skeletal class II malocclusion with increased overjet could be associated with TMJ degenerative changes. CR-based cephalometry and CBCT evaluation may aid in diagnostic assessment, but longitudinal studies are needed to confirm the clinical relevance. Full article

Background: The femur and tibia can suffer changes in rotation, mainly in the orthostatic position, causing errors in measurements when two-dimensional instruments are utilized. Objectives: To test the effects of thigh and leg rotation on sagittal knee angle measurement. Methods: A physical model simulating the right lower limb was constructed using two wooden rafters and a plastic protractor between the rafters. The thigh rotation and leg rotation were measured, ranging from 50° of internal rotation to 50° of external rotation. The sagittal knee angle was measured using the three-dimensional kinematics via three protocols (femoral condyle angle, head of fibula angle, and four points angle) with points marked on the model corresponding to the greater trochanter of the femur, lateral condyle of the femur, head of the fibula, and lateral malleolus. Results: During the internal rotation of the thigh and leg, the sagittal knee angle increased (varying from 3.1° to 6.3° for thing, and 0.9° to 3.6° for leg), whereas it decreased during the external rotation of the thigh and leg (varying from −5.2° to −7.8° for thing, and 0.1° to −5.5° for leg). Conclusions: Thigh rotation and leg rotation affect sagittal knee measurement and can lead to erroneous assessments if not considered. Full article

This study presents a methodology for optimizing the design of the fossa component in temporomandibular joint (TMJ) prostheses, particularly in cases requiring replacement due to severe pathology or trauma. Leveraging advancements in 3D printing, the research aims to align prosthetic function with natural jaw movements. A multibody simulation model was used to evaluate different designs based on key performance indicators: range of motion, condylar trajectory accuracy, and contact force magnitudes. Three designs were analyzed: a compact design fossa (CDF) with a spherical condyle, an enhanced design fossa (EDF) with a more anatomically realistic structure, and a simulation-driven design (MEDF) derived from condylar motion patterns. The results indicate that CDF could lead to dislocation at 13° of mouth opening. In contrast, EDF and MEDF safely enabled full opening (20°), closely replicated natural condyle trajectories (with deviations under 2.5 mm in all directions), and reduced contact forces, which can contribute to a longer prosthesis lifespan. MEDF showed the lowest peak contact force (−21% compared to EDF). The study successfully established a framework for evaluating and guiding patient-specific TMJ prosthetic designs, enhancing both functional rehabilitation and mechanical durability by minimizing wear through optimized contact dynamics. Full article

Introduction: This study aimed to evaluate the submental and masticatory muscles in patients of different age groups using magnetic resonance imaging (MRI) and computed tomography (CT) methods, and investigate potential associations between muscle morphology, temporomandibular joint (TMJ) structures, and disc displacement. Materials and Methods: A total of 185 MRI scans were retrospectively analyzed to assess the thickness of the digastric, geniohyoid, mylohyoid, medial pterygoid, masseter, and lateral pterygoid muscles bilaterally. TMJ hard tissue changes were classified using computed tomography (CT). Correlations between muscle thickness and TMJ structures were analyzed using Pearson correlation coefficients, with statistical significance set at p < 0.05. Results: The study population included 110 females and 75 males, with a mean age of 50.08 ± 20.15 years. The largest age group was 51–75 years (41%), followed by 18–35 years (28%). Significant correlations were observed between muscle thickness and TMJ structures as follows: Right digastric muscle showed a significant association with right disc–condyle position (p = 0.02). Right mylohyoid muscle exhibited a strong correlation with right disc–condyle position (p = 0.004). Left medial pterygoid muscle was significantly correlated with left condyle pathology (p = 0.02). Left masseter muscle showed a significant correlation with left condyle pathology (p = 0.014). Condylar flattening was the most frequent pathology, observed in 58% of right condyles and 53% of left condyles. Disc displacement was present in 41% of right TMJs and 34% of left TMJs. Conclusions: This study highlights the important associations between masticatory and submental muscle morphology and TMJ structures, suggesting that muscle function may play a role in condylar positioning and disc alignment. These findings emphasize the need for comprehensive muscle evaluation in TMJ disorder (TMD) diagnosis and treatment planning. Full article

Background/Objectives: The aim of this study was to establish the reliability and accuracy of a new noninvasive tool for FLLA (frontal plane lower limb alignment) assessment: a photometric method. Methods: Sixty-seven subjects (31 males, 36 females, age 11–47 years) participated in the study. Seventeen subjects with orthopedic disorders were marked with radiopaque markers over the anterior superior iliac spines and femoral condyles. One pelvis-to-floor radiograph and one photograph were taken in the same standardized standing position. The hip–knee–ankle (HKA) angle (radiography) and the pelvis–knee–ankle (PKA) angle (photography) were measured by one rater. In 50 healthy participants, anterior superior iliac spines and femoral condyles were marked, and two pelvis-to-floor photographs were taken in a standardized standing position. The PKA angle was measured two times by three raters. The accuracy of the photometric method was tested with Pearson’s correlation coefficient, simple linear regression, and Bland–Altman analysis. The reliability was tested with ICC(2,k) and Bland–Altman analysis. Results: The HKA angle was on average 3.9° more varus than the PKA angle, with a high correlation between measures (r = 0.97, p < 0.0001) and limits of agreement between −1.300 and −6.482. Intrarater (ICC(2,k) > 0.972), interrater (ICC(2,k) = 0.991), and test–retest (ICC(2,k) = 0.980) reliability were excellent. Conclusions: The photometric method is promising as a reliable and accurate noninvasive tool for assessing FLLA. Its accuracy across different study groups has yet to be confirmed in a larger cohort. The advantage of the presented photometric method is the use of the easily palpable anterior superior iliac spine as the proximal femoral axis point. Full article

Background: It has been suggested that the mandible may differ according to gender. The fact that the mandible and the anatomical structures on it show various changes with age and gender differences is important in gender and age determination. The aim of this study was to evaluate the morphometric variation in the condyle and coronoid processes and the gonial angle, which are anatomical structures forming the mandible, with gender and age. Methods: Cone beam CT images of 141 individuals (78 female, 63 male) were used in this study. The images of all patients were obtained with the same X-ray device; the images were obtained at 70 kVp, 10 mA, and a 32 s exposure time in accordance with the manufacturer’s recommendations. Images displayed with 0.3 mm voxel with the IRYS 15.0 program were examined in the axial, sagittal, and coronal planes, and measurements were taken. The gonial angle, coronoid notch, condyle height, condyle–coronoid distance, and sigmoid notch depths were evaluated. Results: The average age of 141 individuals was 43.21 ± 15.96 years, and 55.3% of them were female and 44.7% were male. The mean right gonial angle in females (128.66 ± 5.50°) was significantly higher than in males (125.68 ± 5.10°) (p < 0.005). Similarly, the mean left gonial angle in females (128.84 ± 5.97°) was significantly higher than in males (125.26 ± 4.89°) (p < 0.005). The sigmoid notch depth was found to be greater in men, with an average of 13.88 ± 2.46 mm, while in women, it had an average of 13.13 ± 1.80 mm, and this difference was statistically significant (p < 0.005). The relationship between the two sides’ coronoid notch height, sigmoid notch depth, condyle height, and condyle–coronoid distance and age groups was not statistically significant (p > 0.005). Conclusions: Overall, our findings indicate that the male mandible may have a longer condyle, a narrower gonial angle, and a wider sigmoid notch depth than that of females. It has been observed that ramus measurements such as condyle length and sigmoid notch depth may be important in gender discrimination, and the male mandible exhibits larger values in these parameters. No differences in parameters were observed between age groups. Full article

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

Naked mole-rats are extremely long-living rodents with a maximum lifespan of 37 years, and their cellular aging and tissue aging are almost nonexistent. Therefore, in this study, we aim to analyze the extracellular matrix of the temporomandibular joint (TMJ) of naked mole-rats at the molecular level and explore the molecules involved in anti-aging and their localization. Micro-computed tomography (CT) scans revealed increased mineral density and wear of the mandibular condyle in aged mice. Conversely, CT scans did not reveal wear of the mandibular condyle in naked mole-rats, and histological analysis did not reveal wear of the articular disk. Using various spectroscopies and artificial intelligence (AI), we found that the articular disk of naked mole-rats is composed of a cartilage-like layer with hyaluronic acid and collagen fibers with varying orientations, which is thought to have relieved mechanical stress and have protected the mandibular condyle. These results suggest that not only the amount, but also the spatial distribution of the extracellular matrix is important for the anti-aging properties of the TMJ, and may contribute to elucidating the pathology of TMJ disorders and other degenerative conditions and developing therapeutic drugs. Full article

Background: The morphology of the occipital condyles (OCs) and foramen magnum (FM) is critical for neurosurgical planning and forensic identification. However, pooled reference values and the impact of study-level moderators on morphometric estimates remain underexplored. Methods: A systematic review and meta-analysis were conducted to estimate pooled morphometric values of the OCs and FM. Databases were searched for studies reporting relevant data in adult human subjects. A random-effects model was used to calculate pooled means and mean differences (MDs) by sex and side (left vs. right). Risk of bias and study quality were assessed. Subgroup analyses were conducted based on study design (osteological vs. imaging) and geographical region. Meta-CART (classification and regression trees) was used to explore moderator interactions and identify data-driven subgroups contributing to heterogeneity. Results: A total of 61 studies comprising 8010 adult skulls met the inclusion criteria. Substantial heterogeneity was observed across studies; most were assessed as having low-to-moderate methodological quality and a high risk of bias. The pooled mean values were as follows: OC length (OCL): 21.51 mm, OC width (OCW): 11.23 mm, OC thickness (OCT): 9.11 mm, FM length (FML): 35.02 mm, and FM width (FMW): 28.94 mm. Morphometric values reported in imaging-based studies were consistently lower than those from osteological studies. Evident sexual dimorphism was identified, with males exhibiting larger dimensions than females. The most pronounced sex-based mean differences (MDs)—approximately 2 mm—were found in OCL, FML, and FMW. In contrast, differences in OCT and OCW were under 1 mm. No significant side-related asymmetries were observed overall. Subgroup analysis revealed that sex-related MDs were more prominent in imaging studies, particularly for the right OCL and OCW. Meta-CART analysis identified study design as the strongest moderator for OCL, OCW, and FML. Sexual dimorphism was more pronounced in imaging studies but statistically insignificant in osteological samples. Furthermore, sex emerged as a stronger predictor for OCL than OCW, while geographical region had a greater impact on OCW. For OCT, geographical region was the main influencing factor, whereas sex was the primary moderator for FMW. Conclusions: OC and FM morphometry exhibit substantial heterogeneity across studies. Imaging-based methods more effectively detect sex-related differences, underscoring their utility in forensic identification and neurosurgical planning. These findings emphasize the need for more standardized, high-quality morphometric research to support population-specific anatomical reference data. Full article

Micro-computed tomography assessment of osteochondral microstructural properties of the distal femur and proximal tibia was comprehensively conducted to compare adult patients with knee rheumatoid arthritis (RA) and primary knee osteoarthritis (KOA), with special focus on the effects of knee malalignment. This study encompassed 402 bone samples divided into three groups: the RA group [patients who were subjected to total knee arthroplasty (TKA) due to RA, n = 23, age: 61 ± 10 years], the KOA group [individuals subjected to TKA due to KOA, n = 24, age: 71 ± 9 years] and the control group [sex-matched cadavers without degenerative knee diseases, n = 20, age: 67 ± 11 years]. Our data revealed that the RA, KOA, and control groups differ significantly in osteochondral microstructural properties depending on the knee alignment. Specifically, increasing femoral and tibial cortical porosity, coupled with thinner articular cartilage, were noted in the RA and KOA groups, compared to the controls. Furthermore, larger femoral and tibial cortical pores, lower tibial and femoral subchondral trabecular bone fraction, and thinner tibial articular cartilage were noted in the RA group in comparison to the KOA group, implying that the medial-to-lateral load distribution in the knee joint could be most affected in these patients. Our data illustrated that the thinnest cartilage, a thicker and less porous cortex, along with lower trabecular bone volume, were present in the lateral femoral and tibial condyles of RA individuals with valgus knee alignment. Observed subchondral trabecular microarchitectural alterations could be morphological factors contributing to different effects of surgical treatment and variable implant stability in individuals with RA, warranting further research. Full article

Metallic biomaterials are prevalent in medical applications. In the treatment of mandibular fractures, the use of metallic biomaterials makes it possible to recover the ability to bite and partially recover speech through preventing ankylosis of the temporomandibular joints, the formation of pseudoarthritic joints, and the consolidation of reduced bones. This article presents the concept of a triaxial plate for osteosynthesis of basal fractures of the mandibular condyle, which are very common fractures in humans. Approximately half of patients with such fractures have wide (squat) condylar processes, which allows for the use of as many as three straight plates. However, installing three plates is quite troublesome, and the use of a single and transversely reinforced plate would facilitate treatment. This study proposes a plate with three reinforcements running along three divergent axes. The plate is fixed to the bone fragments with 11 screws. This concept for the treatment of basal fractures allows patients to quickly recover their primary system functions due to rigid fixation through the use of short (4 mm) screws, as there is no trauma to the medial pterygoid muscle and the mandible canal contents and no intermaxillary immobilization. Full article

Unmodified Ti6Al4V can osseointegrate, but sometimes this capacity needs to be improved. This study aimed to see how much porosity improves osseointegration in a Ti6Al4V implant. Three types of Ti6Al4V cylindrical-shaped implants (13.00 mm length × 5.00 mm diameter) were evaluated: solid sandblasted acid-etched, sintered, and porous 3D-printed (681.00 µm average pore size). Fifteen 20-week-old nullipara female parasite-free New Zealand California white rabbits were used, employing the femoral condyle defect model and undertaking µ-CT analysis and pull-out testing eight weeks later. On µ-CT densitometric analysis, the solid sandblasted rod showed the highest new bone growth around the implant. Bone growth was higher inside the implants for the porous 3D-printed (54.00 ± 5.00 mm³) than for the sintered (1.00 ± 0.05 mm³) and zero for the sandblasted implants. In the pull-out test, there were no statistically significant differences in the ANOVA analysis between the sintered (900.00 N ± 310.00 N) and porous 3D-printed (700.00 N ± 220.00 N) implants. Such differences did exist between the sandblasted material (220.00 N ± 50.00 N) and the two other materials (sintered p 0.002, porous p 0.034). The porous 3D-printed and sintered implant pull-out strength were significantly better than that of the solid rod sandblasted implant. Still, there were no statistically significant differences between the first two. Full article

Accurate femoral tunnel positioning is crucial for successful anterior cruciate ligament reconstruction (ACLR), yet traditional arthroscopic techniques face significant challenges in spatial orientation and precise anatomical localization. This study presents a novel marker-less computer-assisted navigation system that integrates three-dimensional femoral modeling with real-time arthroscopic guidance. The system employs advanced image processing techniques for accurate condyle segmentation and implements the Bernard and Hertel (BH) grid system for standardized positioning. A curvature-based feature extraction approach precisely identifies the capsular line reference (CLR) on the lateral condyle surface, forming the foundation for establishing the BH reference grid. The system’s two-stage registration framework, combining SIFT-ICP algorithms, achieves accurate alignment between preoperative models and arthroscopic views. Validation results from expert surgeons demonstrated high precision, with 71.5% of test groups achieving acceptable or excellent performance standards (mean deviation distances: 1.12–1.86 mm). Unlike existing navigation solutions, our system maintains standard surgical workflow without requiring additional surgical instruments or markers, offering an efficient and minimally invasive approach to enhance ACLR precision. This innovation bridges the gap between preoperative planning and intraoperative execution, potentially improving surgical outcomes through standardized tunnel positioning. Full article