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Bone & Joint Open
Vol. 2, Issue 10 | Pages 879 - 885
20 Oct 2021
Oliveira e Carmo L van den Merkhof A Olczak J Gordon M Jutte PC Jaarsma RL IJpma FFA Doornberg JN Prijs J

Aims

The number of convolutional neural networks (CNN) available for fracture detection and classification is rapidly increasing. External validation of a CNN on a temporally separate (separated by time) or geographically separate (separated by location) dataset is crucial to assess generalizability of the CNN before application to clinical practice in other institutions. We aimed to answer the following questions: are current CNNs for fracture recognition externally valid?; which methods are applied for external validation (EV)?; and, what are reported performances of the EV sets compared to the internal validation (IV) sets of these CNNs?

Methods

The PubMed and Embase databases were systematically searched from January 2010 to October 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The type of EV, characteristics of the external dataset, and diagnostic performance characteristics on the IV and EV datasets were collected and compared. Quality assessment was conducted using a seven-item checklist based on a modified Methodologic Index for NOn-Randomized Studies instrument (MINORS).


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Purpose

The prevalence of focal chondral lesions reported inthe literature during knee arhroscopy can be as high as 63%. Of these, more than half are either grade III or grade IV lesions (Outerbridge). Full thickness cartilage lesions ranging from 2cm2 to 10cm2 are the most challenging to treat. To goal of this study was to evaluate clinical outcomes of pain, function and quality of life, along with radiological outcomes of cartilage repair using microfracture, autologous minced cartilage and polymeric scaffold.

Method

A cohort of thirty-eight patients with Outerbridge grade III or IV cartilage injuries larger than 2cm2 in the knee's femoral condyle, trochlea or patella were prospectively folowed since 2008. They were all treated with microfracture, fresh minced autologous cartilage grafting and a polymeric scaffold technique through mini-arthrotomy of the knee. Autografts and scaffolds were secured to subchondral bone using fibrin glue and tran-sosseous resorbable sutures. Patients were evaluated pre and postoperatively using VAS scores for pain, WOMAC and IKDC scores for knee function and SF-36 questionnaire for quality of life. Clinical evaluations were done by physical examination, and imaging was done using X-Rays, MRI and arthro-CT


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 559 - 559
1 Nov 2011
Ranger P Renaud A Dahan P Delisle J De Oliveira E Phan P
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Purpose: Knee dislocation, although very rare, remains a devastating injury with many complications because of the complex nature of this trauma. The best treatment for knee dislocation is yet to be determined. The purposes of the study were to describe our surgical method, to report our results and to compare them with those of other surgical reconstruction techniques for knee dislocation.

Method: Fifty-six (56) patients with knee dislocation underwent acute combined reparation and reconstruction using Ligament Advancement Reinforcement System (LARS) artificial ligament. Patients were divided in three different groups according to the follow-up period. Group 1 (G1) included patients with a follow-up between two and six months post-op, group 2 (G2) involved patients with a follow-up between six months and twenty-four (24) months and group 3 (G3) was composed of patients who had a follow-up between twenty-four (24) and ninety-one (91) months.

Results: There was a significant difference between G1 and G3 for the Lysholm score and for the posterior stability at 90o of flexion measured with the Telos.

Conclusion: The subjective and objective findings from our series are satisfactory and comparable to the results of other series of knee dislocations. Our findings suggest that with a follow-up at seven years, acute combined reparation and reconstruction with LARS ligaments is a valid alternative for the treatment of knee dislocation.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 113 - 113
1 Mar 2008
Ranger P Dahan P De Oliveira E Berry G Talbot M Fernandes J
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Acute total knee dislocations are uncommon injuries for which some surgeons use artificial ligaments as their choice of graft for reconstruction. The goal of this study is to evaluate on a short and long term basis the stability and function of the LARS reconstructed knee. Flexion ROM was the only parameter which showed significant difference (p< 0.05) between subgroups. Therefore this treatment option for dislocated knee reconstruction seems to give good and lasting results even though patient’s quality of life may suffer.

Although a variety of options have been proposed for the treatment of knee dislocations, the optimal one remains controversial. Allografts and autografts have both been used for reconstruction of the cruciate ligaments. The purpose of this study is to evaluate acute reconstruction of both cruciate ligaments using Ligament Advanced Reinforced System (LARS) artificial ligaments.

We reviewed treatment of forty-eight acute knee dislocations. All patients had reconstruction of both cruciate ligaments with LARS ligaments. Patients were assed using SF-36, Lysholm and IKDC questionnaires as well as a physical exam. Stability of the reconstructed knee was evaluated radiologically using TELOS instrumentation. The controlateral knee was used as reference.

The forty-eight patients were subdivided into four groups of post-operative intervals ranging from six months to seven years. The average ROM was 120°of flexion and −1.4° of extension. The differential average TELOS for LCA, LCP at 30° and LCP at 90° were respectively 2.9 mm, 2.8 mm, 6.9 mm. and their average Lysholm, SF-36 and IKDC scores were 72.0, 72.5, 53.5. Statistical results showed no significant difference (p> 0.05) between subgroups in terms function, laxity and extension but did in flexion.

Our data show that patients treated by this method can regain a functional knee in terms of motion, stability and functional status and does not seem to deteriorate with time.

Knee reconstruction with artificial ligaments shows promising results at short and longer term even though it seems to affect quality of life in this population.

Financing: This study was partially financed by JK Orthomedic Inc.