mehdi moghtadaei

Reducing pain is the most important goal of total knee arthroplasty (TKA). 

The present study aimed to evaluate the effect of systemic corticosteroids on pain control after TKA.

The present study was performed as a randomized controlled clinical trial study on 75 patients. Patients were randomly assigned to three groups (n=25): the dexamethasone (Dex) group received Dex 8 mg/IV at three times (24 mg), the Met group received methylprednisolone  (Met)125 mg/IV, and the control group received isotonic fluid IV (placebo). Primary outcomes included knee nausea, vomiting, and pain 4, 12, and 24 hours after surgery. The pain was assessed using the visual analog scale. Also, patients’ performance indices were evaluated based on the Western Ontario and McMaster universities osteoarthritis (WOMAC) index after surgery.

The mean scores of pain, 4, 12, and 24 h after surgery in the Dex and Met groups were significantly lower than the placebo group (P<0.001). The mean score of WOMAC and subscales in the Dex, Met, and placebo groups was not significantly different. Postoperative nausea was reduced significantly in the Dex group (P=0.002).

This study shows that administering 24 mg Dex or 125 mg Met significantly reduces pain and nausea 6, 12, and 24 hours after TKA. The effect of Met is significantly less than Dex in controlling pain and nausea. In contrast, Dex and Met had no impact on improvement based on the WOMAC index in patients after TKA.

The effect of spinopelvic alignment on low back pain (LBP) incidence has been studied in many investigations. However, the interrelation between spinopelvic parameters and LBP is poorly understood. In particular, it is unknown whether particular patterns of spinopelvic parameters render nonspecific LBP. In this study, we aimed to evaluate the role of spinopelvic parameters as risk factors of nonspecific LBP.  

In this case-control study, spinopelvic parameters, including lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI), were compared between 148 patients with nonspecific LBP and 148 healthy controls. Demographic characteristics of the patients, such as age, gender, occupation, smoking, diabetes mellitus, and body mass index (BMI), were recorded as confounders. Spinopelvic parameters were assessed using radiographic findings in 2 groups. The analysis was done once as univariate (Kolmogorov-Smirnov test) and once as multivariate (multivariate logistic regression) analysis.  

Univariate analysis showed that female gender, higher BMI, smoking, and blue-collar jobs were associated with a higher risk of nonspecific LBP. LL, SS, and PI, but not PT, were all greater in LPB patients in the univariate analysis regarding the spinopelvic parameters. Multivariate analysis showed female gender (odds ratio adjusted (ORAdj) = 4.26 [95% CI, 2.11-9.58]; P = 0.001) and LL (ORAdj = 1.58; [95% CI, 1.18-3.22]; P = 0.026) were predictable risk factors for Nonspecific LBP.  

Spinopelvic parameters, particularly LL, could be considered as risk factors of nonspecific LBP so that a more significant LL might indicate a greater risk of LBP. However, the role of other parameters in this association could not be neglected.

 Health systems must have functional and efficient preparedness and response plans to manage pandemics. Moreover, it is essential to adjust to changing circumstances and the dynamic character of pandemics. The World Health Organization (WHO) introduced the Strategic Preparedness and Response Plan (SPRP), emphasizing 144 measures across 10 pillars, helping governments prepare and respond to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to determine how the Iranian health system, based on the WHO—SPRP, addresses strategic preparedness and response plan in the COVID-19 pandemic at the national level.

 The WHO–SPRP was adopted and translated into Persian by 2 bilingual natives. The chief of the health office requested that authorized officers complete the SPRP. Then, a meeting was held by officers of related units involved in COVID-19 management to address the SPRP at regional and national levels. 

 Our findings suggest that up to August 2020, effective risk communication and community engagement were not fully established. Our response plan lacked evidence-based information and educational messaging to consistently shape public opinion and impression of a respiratory pandemic.

 The Iranian health care system and services were almost able to address the SPRP and perform the major indicators that the WHO had proposed.  However, special attention should be paid to risk communication and community engagement to empower informed decision-making by individuals and communities.

Calcifying tendinitis (CT) is an enigmatic lesion with several obscure aspects and it is a common disorder of the upper extremity characterized by the presence of calcifications in rotator cuff tendons and synovial tissues. In this study, we aimed to review the demographic and clinical characteristics, as well as radiologic and treatment history in CT patients who were referred with shoulder pain.  

In this cross-sectional study, a total of 146 patients who were referred with a shoulder CT were included.  The definitive diagnosis was based on a combination of plain radiograph and magnetic resonance imaging (MRI). A predesigned independent t test was used to capture demographic and clinical data, as well as radiologic and treatment histories, and a chi-square test was utilized to assess the statistical correlation between qualitative variables.  

The median age of the patients was 42.5 years. The female to male ratio was 2.3 to 1. The complaint of restricted shoulder movement was recorded in 107 (73.3%) patients and more frequently in women (p = 0.042). Night pain was present in 109 (74.7%) patients. The current and previous diagnoses matched in 36.1% (13 out of 36) of patients who only had MRI and in 63.6% (35 out of 55) patients who had both MRI and plain radiograph with them. Supraspinatus tendon was the main site of calcified deposition 65% (95 out of 146).   

CT is frequent at the age of around 40 and in the female gender. The diagnosis should be based on a combination of radiography and MRI and not based on MRI alone. The efficacy of different conservative treatments remains to be unwrapped.

Flatfoot is a relatively frequent deformity seen in almost 5% of children. It is classified into flexible and rigid flatfoot. Symptomatic flexible flatfoot (FFF) can be managed using several procedures, and calcaneostop is one of the procedures that has gained popularity recently. This study aimed to evaluate the outcome of the calcaneostop procedure using screws.  

We retrospectively evaluated 57 feet in 44 consecutive patients with FFF undergoing calcaneostop surgery. The same pediatric orthopedic surgeon performed all surgeries. Following a 10-mm incision on the sinus tarsi, a partial thread 6.5 cancellous screw size 40 was inserted. Achilles tendon lengthening was performed on all patients, and a short leg cast was applied. Pain relief, complications, and the change in the talocalcaneal (Kite), talometatarsal (Meary’s), and calcaneal inclination (Pitch) angles were evaluated on plain radiographs using a paired t test.  

Pain relief was achieved in 55 (96.5%) cases, and 2 (3.5%) patients experienced pain after surgery. Other complications, including nerve damage, infection, screw loosening, fracture, or position loss, were not observed. The mean preoperative and postoperative Meary’s, Kite, and Pitch angles were 15.74 ± 2.02 (12.30-21.60), 8.72 ± 1.03 (7.20-10.60), 31.23 ± 1.97 (27.80-37.30), 21.30 ± 1.98 (18.50-24.60), 12.40 ± 1.64 (8.50-16.60), and 18.52 ± 1.97 (15.90-22.60), respectively. A significant improvement was observed in each angle following surgery (p<0.001).  

Calcaneostop is an inexpensive and simple procedure that avoids the involvement of several joints and uses a simple incision leaving a small scar. This procedure is remarkably successful and can be quite convenient.

 Training is a complex process, especially when the students are being prepared for patient's management. Therefore, the development of effective teaching methods is critical for to improvement of learning and communication between the content and concepts. In algorithm-based education, more focus is placed on more involvement of students in the subject, thereby providing a better understanding of the concept. In this study, we compared students' attitudes about the effectiveness of algorithm-based education (education based on the patient's complaints and symptoms) with lecture-based education in the learning ability of the medical students presented in the clinical course of the orthopedic group. 

 This research is a single-group quasi-experimental study; we assessed the students' attitudes on a five-point Likert scale questionnaire with confirmed validity and reliability. The scores of two teaching methods were assessed after the training course, which was presented using the algorithmic method for selective titles and lectures for the other titles. Data were analyzed on SPSS software using a paired t-test.

 A total of 220 internship medical students, including 58.7% of girls with a mean age of 22.9 ± 1.19 years, participated in the study. The mean score of the questions was 3.92±0.54 and 2.17±0.58 in the algorithmic and the lecture training, respectively. After comparing the results with a paired t-test, there was a significant difference between students' attitudes toward the two teaching methods (p ˂ 0.001), so the students’ attitude was more positive toward the algorithm-based method.

 For the education of medical students, algorithm-based training is more efficacious compared to traditional methods such as lecture-based training.

The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications of gunshot injuries to long-bones. A total of 50 patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=4) or surgically (n=46). The external fixator, nailing, or plating was used for surgical fixation.  The mean age and follow-up duration of the patients were 32.3±9.9 years and 13.1±5.6 months, respectively. The most common injured long bone was the femur (32 of 50). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were observed in 37, 7, and 5 patients, respectively. The Masquelet technique was used for 7 (14%) patients, and 12 (24%) cases had skin flaps. Furthermore, the vascular injury was present in 5 (10%) patients, and Malunion of the fracture site was observed in 5 (10%) cases. Nonunion of the fractured bone occurred in 13 (26%) patients that was significantly associated with the presence of vascular injuries (P=0.02). Postoperative infection occurred in 9 (18%) patients and was significantly associated with the presence of skin flap (P=0.014).  Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.Level of evidence: III

Assessing the reduction of syndesmosis is highly recommended due to the complications occurring after the malreduction of the syndesmosis. This study evaluated the post-operative Computed Tomography (CT) scans and standard plain radiographs for assessing the reduction of syndesmosis post-operatively.

Evaluating the radiologic assessments of post-operative reduction of syndesmosis.

In this retrospective cohort study, 45 patients presented with ankle fractures and syndesmosis failure to the emergency department of our hospital between 2015 and 2019 were evaluated by post-operative CT scans and plain radiographs.

Diastasis was demonstrated in 18 patients (40%) in plain radiographs, in 4 patients (8%) by tibial clear space, in 5 patients (11%) by medial clear space, in 10 patients (22%) by AP tibiofibular overlap, and in patients 8 (17%) by mortise tibiofibular overlap. Diastasis was demonstrated in 24 patients (53%) in CT scans, of whom 18 patients had abnormal radiographic parameters, while 6 patients had normal radiographic parameters.

We found a post-operative CT scan more useful than standard plain radiographic measurement for assessing the reduction of the syndesmosis. We suggest the use of post-operative CT scan as a routine to evaluate the syndesmosis reduction.

Acrometastases are rare and account for approximately 0.1% of metastases. The most common primarycancer site is the lung, followed by colorectal and genitourinary system.

We searched PubMed (www. pubmed.com), Google scholar (www.scholar.google.com), Science Direct (http://www.sciencedirect.com), and Springer (http://link.springer.com) databases, using a combination of controlled vocabularyand text word terms and reviewed the last 10 years literature in order to describe demographic trends, anatomicaldistribution, the most common primary sources of malignancy, and survival rates in the reports of foot metastases.

In conclusion 38 cases were included in this review analysis. Lung and genitourinary system were the mostfrequent primary sites.

Forefoot was involved in 71% of all metastases to foot either alone or in combination with other areas ofthe foot. Calcaneus was involved in about 23% of patients either alone or in combination with other foot bones.Level of evidence: IV

Objective:

 Veterinary and human orthopedics is widely applied to stimulate fracture healing, accelerate junction connection, and repair bone defects. In this regard, several studies have been conducted on selecting the best material for bone repair. This study aimed to evaluate the effect of aqueous extract of Elaeagnus angustifolia fruit on the process of bone repair in a rabbit animal model.

 Experimental Study

 For this purpose, 12 rabbits were obtained.

 Rabbits randomly divided into 3 groups. The control group, in which a twosided hole was created in the femur and did not receive the treatment. The second group underwent surgery and received an aqueous extract of Elaeagnus angustifolia fruit at a dose of 250 mg/kg, and the third group received 500 mg/kg intraperitoneal. On weeks 2 and 4 following the bone defect, a histopathologic sample was taken from the site. The bone tissue samples were stained with hematoxylin and eosin.

According to histopathologic results, the best and weakest performances occurred in the group treated with 500 mg/kg of extract and in the control group, respectively. This group had a significant difference with other groups in terms of osteoplasia (p < 0.05).

In general, the results showed that the aqueous extract of Elaeagnus angustifolia can play an important role in the healing of bone fractures.

Despite the advances in the methods of treating femoral neck fractures, treating some types of these fractures is still challenging. Therefore, understanding these fractures, their treatments, and the ways to control their complications are necessary for the orthopedists. 

In this study, we evaluate patients with acute femoral neck fractures with respect to the type of fractures and complications.

In a 4-year cross-sectional study, the patients with acute femoral neck fractures who were admitted to Rasoul Akram Hospital were selected. Anatomical features and the type of fracture were determined by using plain radiography and CT scan. Fractures were classified according to the Garden classification. The patients were also evaluated for any postoperative complications for at least 6 months.

A total of 124 patients were enrolled. The Mean±SD age of the patients was 64.9±12.7 years and 87 (74.4%) were male. Based on the Garden classification, 7 fractures (5.9%) belonged to type I, 10 fractures (8.5%) to type II, 48 fractures (41%) to type III, and 52 fractures (44.4%) to type IV. Avascular necrosis in 28 cases (23.9%), non-union in 14 cases (12%), and claudication and pain in 35 cases (29.9%) were noted. The mean age of patients was different between fracture groups (P=0.01). 

Our results showed that most of the patients with femoral neck fractures admitted to Rasoul Akram Hospital were associated with displacement. In this study, the most common complications were pain and claudication, avascular necrosis of the femoral head, and nonunion. In sum, further displacement of the fracture will result in more complications.

There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies. 

In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm.

In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation).

Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).  

The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.

Recent studies have revealed the increasing importance of sagittal spinopelvic alignment. Knowing the values of sagittal spinopelvic parameters, which are affected by ethnicity, is essential in the normal asymptomatic population. In the current study, these parameters were measured in a sample of asymptomatic Iranian population.

Seventy asymptomatic participants without complaint of musculoskeletal problems were enrolled. They had no complaint about musculoskeletal problems. Lateral full-length spinal and pelvic x–rays were taken. The following parameters were measured on x-rays and presented as mean ± standard deviation: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), lumbar tilt (LT) and thoracic tilt (TT).

The population consisted of 37 males and 33 females aged 26.6 ± 4.27 years. The mean values of PI, SS, PT, LL, TK, LT, and TT were 44.5 ± 10.1, 35.4 ± 6.7, 9.1 ± 7.9, 41.9 ± 14.7, 28.8 ± 8.3, 11.9 ± 7.4 and –7.5 ± 5.7 (median: –10; 5th percentile: –14; 95th percentile: 4.4) degrees, respectively. The variables were similar between males and females except for LL which was significantly higher in females (37.8 ± 16.5 versus 46.5 ± 11; P = 0.013). In addition, the linear regression model revealed age to be independently related with PI (beta = 0.344; P = 0.004) and PT (beta = 0.366; P = 0.002). PI (r = 0.344, P = 0.004) and PT (r = 0.359, P = 0.002) were positively correlated with age. Additionally, PI was positively correlated to SS, PT and LL and negatively to TT.

These findings may be used as referential values for sagittal spinopelvic parameters in the Iranian population. The positive correlation of PI with age questions the constancy of PI throughout life. However, larger studies are required.

Combined injuries of Mid-shaft clavicle fracture and Acromioclavicular (AC) joint dislocation are rare, and only a few cases have been reported. Several treatment options including surgical, conservative and hybrid approach have been described. Yet, there is no consensus regarding the optimal management approach for this injury.

Here we reported a case of Mid-shaft clavicle fracture with associated type IV AC joint dislocation in a 29-year-old male following a cycling accident.

Both parts of the injury were fixed surgically. Meanwhile, the patient did not follow the postoperative protocol and started the heavy sports activities one month after the surgery.

The patient showed up 6weeks after the surgery with slightly uncorrected AC joint. However, he was satisfied with the results and accordingly no intervention was done for the correction of the AC joint. 

Our case reveals the importance of adherence to the postoperative protocol in this combined and challenging injury and we recommend surgical fixation for such injury.

Ankle dislocations are a group of injuries requiring immediate orthopedic interventions to avoid subsequent neurovascular complications and impairments. In most cases, they are associated with a malleolar fracture in the ankle. However, in the sporadic cases, especially the ones due to high-energy traumas, ankle dislocations are not associated with malleolar fractures and are referred to as "pure ankle dislocations".

Here, we report a rare case of pure ankle dislocation in a 38-year-old female athlete with no previously established predisposing risk factors. The patient was referred to our emergency department following a catastrophic fall down during exercise, resulting in severe ankle pain and deformity. The patient was treated with urgent reduction of the displacement and 6 weeks of immobilization by casting followed by intensive physiotherapy.

At the end of the 3-month follow-up, no symptoms of instability were observed, and the patient could walk normally; at the 6-month follow-up, the patient could perform her sport activates similar to the initial level.

Femoral nonunion is an important complication, which can occur after intramedullary nailing and it requires surgical intervention. Plate augmentation over intramedullary nail is emerging as an acceptable option with satisfactory results for femoral nonunion. The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture. Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded. All patients achieved bony union during an average time of 21 weeks (± 3.94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formation was seen at mean time of 10 weeks. There was no statistically significant difference in union time among different types of nonunion (P: 0.466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed. Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures.

Application of fix-bearing-(FB) or mobile-bearing (MB) total knee arthroplasty (TKA) is an area of controversy. Introduction of mobile-bearing implants has become an appealing option for some surgeons leading to more favorable structural and weight-bearing outcomes in TKA; however, the beneficial long-term outcome is still unclear. This study was carried out to compare TKA outcomes by MB-versus FB implants with respect to long-term outcome. A total of 140 patients who met our inclusion criteria were enrolled in this retrospective cohort study from March 2015 to April 2016. They were divided into two groups of 85 patients with MB TKA and 55 subjects with FB TKA. The range of motion (ROM), knee injury and osteoarthritis outcomes score (KOOS), and patient satisfaction were compared between two groups. The ROM and KOOS scores were not significantly different between the two groups (P > 0.05). With regard to the patient’s satisfaction, there was no significant difference between the two groups (P > 0.05). According to our results in this retrospective cohort study, regarding the outcome of TKA by MB versus FB implants, we showed comparable mechanical and functional outcome.

Management of acetabular bone defects, especially massive ones, is a challenging issue for surgeons during total hip arthroplasty (THA). Inadequate bone coverage can lead to weakness of acetabular component fixation and instability, and finally, failure of surgery. In recent decades, different techniques and methods have been reported in literature to manage these defects according to their size and location. However, the routine use of many of these new methods is impossible in the majority of patients because of existing financial limitations. The aim of the present study was to evaluate the clinical and radiographic outcomes of THA with acetabular defect reconstruction using shelf-autograft.

This study was designed and conducted in two phases of retrospective and prospective. Between 2012 and 2017, 423 THA surgeries were performed in two hospitals by senior surgeon. A total of 38 THA procedures using shelf autograft were performed. The short-term clinical and radiological results were evaluated in the present study.

The mean coverage angle by graft was 45.5 ± 7.3% (range: 33 - 72%) and horizontal coverage percentage by graft was 79.3 ± 12.8% (range: 54 - 100%). After a mean follow-up of 26 months (range: 12 - 56 months), no evidence of instability was found in any of these hips. Considering loosening and revision as an end-point, the survival rate was 100%. The patients’ mean Harris hip score (HHS) improved from a mean of 35.50 ± 9.11 preoperatively to 95.10 ± 4.71 at the last follow-up. Rigid fixation of graft to host bone, medial insertion of acetabular cementless cup, and avoidance of lateral or high hip center were found to result in excellent THA with shelf graft outcomes.

Despite the development of more advanced methods to manage acetabular defects during total hip replacement, using shelf-graft is a valuable and accessible strategy for hip surgeons, and by the use of suitable techniques, we can expect excellent outcomes even in massive defects

Anterior cruciate ligament reconstruction (ACLR) surgery is frequently used to manage anterior cruciate ligament (ACL) tear. The non-anatomic positioning of the graft may cause graft failure. This study aimed at evaluating the association of the ACLR outcome with factors affecting the anatomic positioning of the graft, including the tibial tunnel, femoral tunnel, and graft inclination angles. A total of 37 patients, who had undergone ACLR surgery, were included in this retrospective study. All surgeries were performed by the transportal arthroscopic reconstruction technique. The tibial and femoral tunnel angles were evaluated on both anteroposterior (AP) and lateral radiographs. Graft inclination angle was evaluated on AP radiograph. Outcome measures included: International Knee Documentation Committee (IKDC), the Lachman and the pivot shift test, and KT-1000 arthrometer score. The mean age of the patients was 30.1 ± 9.4 years. The ACLR surgery was successful in 36 (97.3%) patients and failed in one patient (2.7%). No significant association was found between the femoral/tibial tunnel angles and outcome measures on both AP and lateral view. A negative significant correlation was found between the IKDC score and the graft inclination angle (P = 0.049, r = -0.326), indicating that with graft angle between 20° and 36°, the more horizontal graft was associated with better IKDC score. According to the results, graft inclination angle, yet not femoral/tibial tunnel angles, were associated with the outcome of the ACLR surgery However, further studies are required to address ‎the inconsistent results of different investigations

Adult degenerative disorders of hip and spine are common. The recent studies inconsistently have
discussed about the influence of spinal disorders on total hip arthroplasty (THA). In this review, we discussed clearly
about these relationships and their effects on the most appropriate position of the acetabular component. We searched on databases and evaluated the articles about spinopelvic parameters in patients with spinal
disorders who needed THA. The literature search showed a prevalence of 21.2 % to 60.4% of low back pain (LBP) in patients, who
are candidates for primary THA. The coexistence of degenerative disease of hip and spine or other diseases can
significantly alter spinopelvic alignment. Accordingly, pain management or any other treatment in these patients
requires proper understanding about the biomechanics of the hip and the spinal and their corresponding interactions.
In this review article, we discussed about these interactions and their effects on the most appropriate position of the
acetabular component. We concluded that counseling sessions among patients, orthopedic surgeons and spine surgeons
can result in obtaining the best outcome for these individuals.

Nowadays open meniscal repair approach is completely replaced by arthroscopic meniscal repair.
The current study aimed at assessing the results of arthroscopic meniscal repair using the outside-in technique.
Patients diagnosed with meniscal tearing from 2008 to 2014 fulfilling the inclusion criteria were entered to the current cohort study. Outcomes of arthroscopic meniscal repair were assessed by 2 known questionnaires, IKDC (international knee documentation committee) and KOOS (knee injury and osteoarthritis outcome score), as well as magnetic resonance imaging (MRI) of knee.
A total of 63 patients were assessed. The mean age and follow-up period were 28.8 ± 4.8 years and 44.3 ± 20.3 months, respectively; 82% of the subjects were male and 60.3% had injuries in both meniscus and anterior cruciate ligament (ACL); 76% of the patients had medial meniscal injury; 67% had posterior horn tear, and 56% had longitudinal meniscal tear. There was no significant association between age, gender, grade of tear, number of sutures, anatomic site of tear, and type of tear with the level of patient’s satisfaction. Patients with simultaneous reconstruction of ACL had significant difference compared with the ones with isolated meniscal injury. Grading of tear in MRI had no association with the better outcomes according to the questionnaires.
Arthroscopic meniscal repair using the outside-in technique yielded acceptable results.

During a total knee arthroplasty, it is common to make a distal femoral cut based on the femoral mechanical-anatomical angle (FMA), which in most patients is six degrees. However, in patients with a higher FMA, there is not yet a consensus between surgeons regarding the degree of the cutting angle.
The aim of this study is to assess the treatment outcomes of patients with a FMA of more than seven degrees who were treated by distal femoral cuts of six degrees during a total knee arthroplasty.
We retrospectively reviewed the clinical and radiological results of patients who were treated at our center by a conventional valgus cut of six degrees during a total knee arthroplasty and had a FMA of more than seven degrees. A knee society score (KSS) was completed for all patients during follow-up visits.
A total of 31 cases with knee osteoarthritis and a FMA of more than seven degrees were enrolled in this study. The cases consisted of 8 men and 23 women with an average age of 65.41 (range 46 - 77 years) (SD ± 7.61) years and a mean follow-up time of 11.51 months (range 3 - 24 months) (SD ± 6.08). The mean KSS was 148.51 (SD ± 7.43), (range 132 to 167), which is considered good. There was a statistically significant relationship between the lateral distal femoral angle (LDFA) and FMA. However, there was not a statistically significant correlation between LDFA and KSS.
Although the overall alignment of the lower extremity in our patients was in varus, this amount of varus does not prove to have an effect on the outcome.

The correlation between depression and pain is reported in several chronic diseases including osteoarthritis (OA). This depression could lead to more pain perception and is considered as one of the confounding factors of the association between radiographic symptoms and the pain level in patients with OA.
Assessment of comorbid depression and its predictors could significantly improve assessment and management of the OA. The current study aimed to evaluate the association between depression and pain in patients with OA and explore the determinants of this depression in Iranian population with OA, as well.
The study evaluated the clinico-socio-demographic predictors of depression in 100 patients with OA. Depression was recorded using Beck depression inventory-II (BDI-II) and pain was measured by self-reporting visual analogue scale (VAS).
Depression score was significantly higher in younger (P = 0.04), unmarried (P = 0.01), physically inactive (P = 0.03) and patients with higher grade of OA (P = 0.02). In addition, a significant correlation was observed between comorbid depression and pain (r = 0.381, P = 0.008, 95% confidence interval), OA grade (r = 0.332, P = 0.009, 95% CI) and age (r = -0.259, P = 0.024, 95% CI).
Given the confounding role of comorbid depression in the assessment and management of OA, and the high prevalence of depression in patients with OA, the predictors of comorbid depression in these patients should be considered to improve the outcome of therapeutic interventions.

Maintaining proper size and rotation of components of total knee arthroplasty is mandatory for optimal longevity. Ethnical differences may affect the fitness of prostheses that were manufactured mainly based on Caucasian dimensions.
To evaluate the distal femur morphology of the Iranian population at the level of standard cuts simulated via computed tomography.
Patients and During 2013, 150 consecutive patients (96 males and 54 females) from the outpatient Department of Orthopedic Surgery of Rasoul Akram Hospital with knee CT scans were studied. We entered cases with apparent normal extremity alignment and bone maturity. Exclusion criteria were history of fracture or conditions affecting knee profile. Standard cuts were simulated on the CT scan using the Marco Pacs program. For each bone, anteroposterior (AP), mediolateral (ML), and aspect ratio (ML/AP) were measured. Values were compared with the sizing of four currently available prostheses.
The mean age of the patients was 43 years (range: 17 to 80). All isolated parameters were higher in men significantly (P Our findings may be applied by manufacturers to design prostheses more compatible with Asian populations. Alterations to the shape of components should be considered to provide optimal coverage.