Oblique lumbar interbody fusion (OLIF) improves the spinal canal, with favorable clinical outcomes. However, it may not be useful for treating concurrent, severe central canal stenosis (SCCS). Therefore, we added biportal endoscopic spinal surgery (BESS) after OLIF, evaluated the combined procedure for one-segment fusion with clinical outcomes, and compared it to open conventional TLIF. Patients were divided into two groups: Group A underwent BESS with OLIF, and Group B were treated via TLIF. The length of hospital stay (LOS), follow-up period, operative time, estimated blood loss (EBL), fusion segment, complications, and clinical outcomes were evaluated. Clinical outcomes were measured using Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and the modified Macnab criteria. All the clinical parameters improved significantly after the operation in Group A. The only significant between-group difference was that the EBL was significantly lower in Group A. At the final follow-up, no clinical parameter differed significantly between the groups. No complications developed in either group. We suggest that our combination technique is a useful, alternative, minimally invasive procedure for the treatment of one-segment lumbar SCCS associated with foraminal stenosis or segmental instability.

Background and Objectives: This study investigated associated meniscus and ligament injuries in tibial plateau fractures using magnetic resonance imaging (MRI) and assessed soft tissue injuries in relation to the Schatzker classification and Tscherne classification. Materials and Methods: The data of 185 patients who sustained tibial plateau fractures from January 2010 to April 2021 were retrospectively reviewed. Fractures were classified according to the Schatzker classification system. Soft-tissue injuries were assessed using the Tscherne classification. Menisci and ligaments were evaluated using preoperative MRI. Nerve injuries, compartment syndrome and wound problems were also assessed. The incidence of soft tissue injuries, as well as the relationship between the Schatzker and Tscherne classification systems, were analyzed. Results: Evidence of derangement of meniscus and ligament around the knee was found in 183 (98.9%) patients. The most common injury was a medial collateral ligament injury. The incidence of lateral collateral ligament injury, nerve injury, compartment syndrome and wound problem was higher in high-energy tibial plateau fractures. A tendency was observed between the Schatzker and the Tscherne classifications (p value < 0.001). Higher Tscherne grade was also associated with the incidence of posterior cruciate ligament injury, nerve injury and compartment syndrome. Conclusions: In tibial plateau fractures, soft tissue injuries were highly prevalent. High-energy fractures tended to exhibit higher Tscherne classification grades and showed an increased incidence of meniscus and ligament injuries. The Tscherne classification appears to be a helpful system for predicting soft tissue injuries in tibial plateau fractures. And preoperative MRI can be a helpful tool.

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following arthroscopic resection of the infrapatellar fat pad in patients with IFPIS. Materials and Methods: Eighteen patients (10 females, 8 males; median age 22) diagnosed with IFPIS and unresponsive to conservative therapy underwent arthroscopic partial or subtotal resection between 2007 and 2013. Diagnosis was based on physical examination (Hoffa’s test), MRI findings, and response to lidocaine injection. Clinical outcomes (VAS, IKDC-2000, Kujala, Lysholm, Tegner activity scores) and radiologic assessments (ISR, CDI, PFJ osteoarthritis grade) were evaluated preoperatively, at 2 years, and at a final follow-up (mean 148.7 months). Results: All clinical scores significantly improved postoperatively. VAS decreased from 7.25 ± 0.79 to 2.43 ± 1.50 at 2 years, and to 3.66 ± 1.50 at the final follow-up (p < 0.001). Similar long-term improvements were observed in the Kujala, IKDC-2000, Lysholm, and Tegner scores (all p < 0.001). Radiographic parameters including ISR and CDI remained stable, and there was no statistically significant progression in patellofemoral osteoarthritis. However, 5 of 18 patients (27.8%) reported persistent symptoms at long-term follow-up. Conclusions: Arthroscopic resection of the infrapatellar fat pad in patients with IFPIS showed favorable and sustained clinical outcomes over a 10-year follow-up, without significant radiological changes. These results suggest that arthroscopic resection is a viable treatment option when accurate diagnosis is established.

Background and Objectives: Postoperative delirium (PODil) is a cognitive condition characterized by sudden fluctuations in consciousness and orientation after surgery. PODil following total knee arthroplasty (TKA) is associated with prolonged hospital stays and increased morbidity. Therefore, prevention of PODil is particularly important. Life’s Simple 7 score, published by the American Heart Association, is a new measure of cardiovascular health (CVH). Better CVH is associated with a lower risk of cognitive impairment. Hence, this study aimed to determine whether Life’s Simple 7 score is associated with PODil following TKA. Materials and Methods: This retrospective study included 973 patients who underwent TKA between January 2015 and January 2020. Patients were divided into two groups (group I: delirium group, n = 60; group II: non-delirium group, n = 913). Demographic data, use of analgesics, surgical factors, underlying diseases, laboratory results, and Life’s Simple 7 score were evaluated. Results: Significant differences were observed between the two groups for Parkinson’s disease, intraoperative hypotension, preoperative duloxetine administration, and Life’s Simple 7 score. In the receiver operating characteristic (ROC) curve analysis, the optimal cut-off value for Life’s Simple 7 score was determined to be 8 at the maximal Youden index, with an area under the curve (AUC) of 0.82, a sensitivity of 0.92, and a specificity of 0.58. Conclusions: Lower Life’s Simple 7 score is an independent risk factor for the incidence of PODil after TKA. Given its ease of measurement, Life’s Simple 7 score may be a useful measure for predicting PODil and will aid in preoperative risk assessment and post-operative patient management.

Background and Objectives: Subcortical bone cysts at the tibial attachment of the medial meniscus posterior root (MMPR) may reflect chronic degenerative changes; however, their clinical significance in medial meniscus posterior root tear (MMPRT) remains unclear. This study assessed whether bone cysts are associated with symptom duration and whether their presence influences healing status or medial meniscus extrusion (MME) after transtibial pullout repair (TPR). Materials and Methods: Seventy-four consecutive patients who underwent arthroscopic TPR for MMPRT between January 2022 and December 2024 were retrospectively reviewed. After applying exclusion criteria, 50 patients were included and divided into cyst-positive (n = 20) and cyst-negative (n = 30) groups based on preoperative MRI findings. Clinical outcomes, MME, and second-look arthroscopic healing status at 6 months postoperatively were compared between groups. Multivariable linear regression analysis was performed to identify independent predictors of postoperative MME. Results: The cyst-positive group had significantly longer symptom duration than the cyst-negative group (13.8 ± 3.0 vs. 8.8 ± 2.8 weeks, p < 0.001) and demonstrated higher grades of MMPR degeneration (p < 0.05). Complete healing was observed in 60.0% of patients in each group, and no failed healing cases were noted. Postoperative MME at 6 months was comparable between groups (3.8 ± 0.8 vs. 3.8 ± 1.0 mm). Multivariable regression analysis identified baseline MME as the strongest independent predictor of postoperative MME (β = 0.67, p < 0.001), whereas bone cyst presence was not independently associated with postoperative extrusion. Conclusions: Subcortical bone cysts at the MMPR attachment are associated with longer symptom duration and more advanced root degeneration. However, their presence was not significantly associated with healing status or postoperative MME after MMPRT repair. These findings suggest that bone cyst formation may be associated with chronic degenerative changes at the root attachment, but should not discourage surgeons from performing root repair.