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The menisci are responsible for several functions. They are shock absorbers during dynamic loading on the knee and provide a broader surface area on which to distribute stress evenly to the tibia and femur. These functions allow for smoother movement and greater stability of the knee joint. Meniscal injury can be a great impediment to the function of the knee. Therefore, in the case of meniscal injury, our main concern is the relief of patient symptoms, followed by consequent restoration of meniscal function to the greatest of our ability. To prevent the long terms effects of a meniscectomy, meniscal allograft transplantation (MAT) was developed. The potential of using the size of the contralateral healthy menisci, to determine the size of the menisci to be replaced, will be discussed. Knee MRIs done on healthy patients in the past 5 years were reviewed. Magnetic Resonance Imaging was performed using a 3-T scanner. Each individual was examined with knee joints in full extension. Measurements were performed two separate times, two weeks apart. A mean of three measurements was made during each session to reduce error. Thirty-eight normal bilateral knee joints MRIs remained (16 males, 22 females). Participants were sampled from the institutional Picture Archiving and Communication System (PACS). Age, gender, and the medial meniscal and lateral meniscal size of both knees were recorded. The laterality of the menisci was compared between both knees in each patient. A total of 38 patients were included in this study, with a mean age of 37.39 (±9.50) years. They were 16 (42.1%) men and 22 (57.9%) women. We didn't find any significant difference in the mid-coronal section between left and right knees meniscal measurements. None of the measurements were significantly different between men and women. There was no significant difference in the medial mid-sagittal section or lateral mid-sagittal section between left and right knee meniscal measurements. The results obtained in this study may support the use of MRI of the bilateral knee to obtain an appropriately sized allograft.

Introduction: Misconceptions surrounding the discipline of plastic surgery are widespread public and medical students and professionals, as well. The purpose of this study was to explore how the inclusion of plastic surgery rotation into the medical curriculum affects medical students’ knowledge, attitudes, and preferences regarding plastic surgery specialization and referral. Design and Methods: A descriptive-correlational design was utilized to collect data from 200 medical students in the final two years of education from two separate six-year medical programs in Jordan. Data was collected using self-reported questionnaires regarding knowledge of surgical procedures allocation, attitude towards plastic surgery, preference of specialization, and benefits of plastic surgery to physicians and patients. Results: Analysis showed that medical students of plastic surgery integrate rotation (program A) had a higher average score of correct procedure-allocation (M=12.57, SD = 3.14), compared to non-integrated plastic surgery rotation program (program B) (M=8.29, SD=3.05) . About 83% (n =83) of students in program A had their knowledge on plastic surgery from direct exposure to a plastic surgeon, compared to 43% (n=43) of program B, and 24% (n=24) of students in program A reported that their perception of plastic surgery influenced by media compared to 62% (n=62) of those in program B. Conclusions: Medical students exposed to plastic surgery education are more confident about procedures of plastic surgery and had more reliable sources of knowledge about plastic surgery than those who were not exposed to plastic surgery rotation. Significance for public health Plastic surgery procedures contribute to large proportion of the worldwide surgical disease burden. Appropriate and timely intervention using plastic surgery has significant impact on multiple medical conditions and reduce cost of complications. Plastic surgery interventions acknowledged as low cost to resolve disabling conditions. However, misconception about plastic surgery may contribute in delayed referral and untimely and inappropriate intervention that may cause further burden to individuals; medically and economically. Comparing between medical programs that include plastic rotation and those who are not will increase the public health awareness, and in particular among medical staff, regarding benefits and needs of plastic surgery interventions to health of individuals. Major medical conditions such as deformities and disabilities can be resolved with timely plastic surgery interventions that improves health of people and lowering medical cost and burden of diseases.

Study Design Systematic review and meta-analysis. OBJECTIVESSurgical decompression alone for patients with neurogenic leg pain in the setting of degenerative lumbar scoliosis (DLS) and stenosis is commonly performed, however, there is no summary of evidence for outcomes. Methods A systematic search of English language medical literature databases was performed for studies describing outcomes of decompression alone in DLS, defined as Cobb angle >10˚, and 2-year minimum follow-up. Three outcomes were examined: 1) Cobb angle progression, 2) reoperation rate, and 3) ODI and overall satisfaction. Data were pooled and weighted averages were calculated to summarize available evidence. Results Across 15 studies included in the final analysis, 586 patients were examined. Average preoperative and postoperative Cobb angles were 17.6˚ (Range: 12.7 - 25˚) and 18.0 (range 14.1 - 25˚), respectively. Average change in Cobb angle was an increase of 1.8˚. Overall rate of reoperation ranged from 3 to 33% with an average of 9.7%. Average ODI before surgery, after surgery, and change in scores were 56.4%, 27.2%, and an improvement of 29% respectively. Average from 8 studies that reported patient satisfaction was 71.2%. Conclusions Current literature on decompression alone in the setting of DLS is sparse and is not high quality, limited to patients with small magnitude of lumbar coronal Cobb angle, and heterogenous in the type of procedure performed. Based on available evidence, select patients with DLS who undergo decompression alone had minimal progression of Cobb angle, relatively low reoperation rate, and favorable patient-reported outcomes.

Study Design Retrospective cohort study. Objectives The purpose of this study was to report reference ranges for global sagittal alignment parameters stratified by age and sex in patients without spinal deformity. Methods This retrospective cohort study included consecutive patients undergoing biplanar full-body spine x-rays at a single institution, excluding those with spinal deformity or prior spine surgery. Global sagittal alignment parameters included cranial sagittal vertical axis to the sacrum (CrSVA-S), hip (CrSVA-H), knee (CrSVA-K), and ankle (CrSVA-A) as well as the cranium-hip-sacrum (CrHS), cranium-knee-sacrum (CrKS), and cranium-ankle-sacrum (CrAS) angles. Patients were stratified by age and sex, and ANOVA and multivariable logistic regression were used to compare groups, with age and sex as predictors of each radiographic parameter. Multivariable logistic regression models were created using age and sex as predictors, and each radiographic parameter as the outcome. In these models, age was treated as a continuous variable. Results A total of 518 patients were included, 253 (48.8%) male and 265 (51.2%) female, with ages ranging from 12 to 91 years old. In multivariable linear regression models, each 10-year increase in age was associated with a 0.6 cm increase in CrSVA-S (P < .001) and a 0.3 cm increase in CrSVA-H (P < .001). Conversely, age was associated with a 0.3 cm decrease in CrSVA-K per decade (P = .002), with no significant association observed between age and CrSVA-A. Male sex was associated with greater CrSVA-S (1.3 cm; P < .001), CrSVA-H (1.2 cm; P < .001), and CrSVA-A (1.2 cm; P < .001) compared to females. CrSVA-K did not differ significantly by sex. Conclusion This study establishes reference values for normal global sagittal alignment to support operative planning and improve understanding of global sagittal alignment in spinal deformity.

Background Patellofemoral pain is a common condition. The Kujala score is a well-established scoring system to assess anterior knee pain and has been translated into many languages including Arabic. The purpose of this cross-sectional study is to culturally adapt the Arabic version of the Kujala score and determine its validity. Methods The Kujala score is composed of 13 multiple-choice questions. We modified two questions in the score; running and squatting, and were replaced with questions related to walking on different terrain and prostration, each with the same number of answer choices as the original questions so as not to affect the final score. These modifications were written in Arabic by the same group who translated and validated the original score into Arabic. The original and modified Kujala scores was printed and given to patients complaining of patellofemoral pain to be filled during their visit to the orthopedic outpatient clinics. Final scores for the original and modified questionnaires were calculated. Data was analyzed using SPSS statistics version 21.0 measuring Cronbach’s alpha, intraclass correlation coefficient, and Pearson correlation. Results Ninety-four patients were included in the study, 28 (29.8%) men and 66 (70.2%) women. The mean age for the included patients was 43.67 (± 14.46) years. The mean score for the modified initial questionnaire was 63.91 (± 16.32), and the mean score for the modified re-test questionnaire was 66.52 (± 17.50). There was a statistically significant difference between the mean scores (p = 0.041), with a mean difference of 1.97 (95% CI 0.08 to 3.856). We found a significant strong correlation between the score before and after changing the questions with a p value of < 0.001. Conclusions The culturally modified Arabic Kujala questionnaire is shown to be a valid, well-designed tool and an appropriate method of measuring patellofemoral pain.

Objective Different classification systems for surgical tumor resections in the proximal humerus and scapula have been described, but none are specific or have been recently revised. The purpose of this article is to report modified surgical techniques and a new classification system for resections in the humerus and scapula. Methods Thirty-two patients with shoulder girdle bone tumors were operated upon. Two separate new classifications were assigned to resections in the humerus (types I–IV) and scapula (types I–III). An annotation is added to signify deltoid preservation (A) or sacrifice (B). Modified surgical techniques were devised. Results For extra-articular resections of the proximal humerus, we show that sacrificing the acromion and coracoid process is not required. Preservation of these structures can improve cosmetic shoulder outcome. For tumors with no large medial component, we show that there is no need to detach the muscle attachment from the coracoid process allowing earlier elbow extension postoperatively. After a mean follow-up period of 46 months, only two patients developed local recurrence. Postoperative infection was seen in two and stem loosening in one patient. The average MSTS functional score for all patients was 83%. Conclusion Our modified surgical techniques saved structures which were unnecessarily resected with no advantage in surgical series. We reserved the integrity of more muscular tissues and attachments leading to less restriction during the rehabilitation process. This new classification system is realistic, easy to implement, and applicable to all patients.

Background Anterior cruciate ligament (ACL) injuries have been increasing significantly over time. The relationship between the ACL injury and the knee joint structures is poorly understood. The purpose of this study is to examine whether the measurements of different structures in the knee joint are linked with ACL injury in affected patients. Methods This retrospective case–control study included patients who suffered from ACL tears and underwent magnetic resonance imaging (MRI). A control group of patients with no knee pathologies on MRI was included. Fourteen knee variables, including lateral meniscus (LM) posterior horn height, length, depth, and volume; medial meniscus (MM) posterior horn height, length, depth, and volume; lateral and medial (MFC) femoral condyle sphere diameter; lateral and medial tibial plateau length; and patella tendon horizontal and vertical diameter, were collected. A multivariate logistic regression including LM posterior horn depth, MM posterior horn length, MM volume, MFC sphere diameter, and patella tendon horizontal diameter and receiver operating characteristic curve, was used to compare the two groups. Results A total of 85 patients were included in our study; 54 suffered from ACL injuries and 31 as a control group with normal knee MRI. Logistic regression revealed that increased LM posterior horn depth (OR = 1.27; 95% CI = 1.03–1.56; p  = 0.028), decreased MM posterior horn length (OR = 0.71; 95% CI = 0.55–0.93; p  = 0.013), and MFC sphere diameter (OR = 1.20; 95% CI = 1.01–1.43; p  = 0.035) were independent risk factors for ACL rupture. The MFC sphere diameter yielded the highest area under the curve: 0.747 (95% CI, 0.632–0.862). No difference was found in the other measurements between the two groups. Conclusions Concerning the difference in anatomical variations, the lateral meniscus posterior horn depth and medial femoral condyle sphere diameter were higher, while medial meniscus posterior horn length was lower in patients with an ACL injury. These structural knee measurements could have a possible increase in the likelihood of sustaining an ACL injury and can be used by clinicians to predict ACL injury.

Background. Joint-sparing limb salvage surgery (JSLSS) is an advancement in the techniques and concepts of limb salvage surgery, which makes it possible to save not only the limb affected by malignancy but also the adjacent joint and the epiphyseal plate. In the growing child, this procedure is technically demanding due to the availability of small length of bone for implant purchase. Reconstruction options can be biological reconstruction or endoprosthesis; however, the outcome of endoprosthetic reconstruction after joint-sparing resection is not well described in the literature. Purposes. (1) To determine the prosthesis survival rates when using customized Joint-Sparing Endoprosthesis (JSE) after juxta-articular resection of bone tumors, (2) to investigate the rates of local recurrence, (3) to evaluate the need for revision surgery, and (4) to compare the outcome of customized JSE with that of joint-sacrificing techniques. Methods. In our study, joint sparing is defined as any procedure where a custom-made JSE is used in lieu of sacrificing the adjacent joint whenever the length of the remaining bone segment is not enough to accommodate the stem of a modular implant. Twenty-eight patients received JSE, and 31 joints were spared. Their age ranged from 4 to 55 years with a median age of 13 years. Twenty-one patients received surgery for primary reconstruction and 7 patients for revision of failed bone allograft or modular implant. Twenty-four joints are spared in the lower limbs and 7 in the upper limbs. Osteosarcoma was the most common pathological diagnosis (n = 13). Flat surface HA-coated custom JSE was used to spare 15 joints, and short-stemmed custom JSE was used to spare 16 joints. The length of the remaining bone epiphysis for JSE anchorage from the knee and ankle joints was 25–75 mm, median = 45 mm, and the length of the cortical bone remaining for the proximal femur and distal humerus was 5–70 mm, median = 10 mm. Results. Operative time was 2.5 to 4 hours (avg. 3 hr.) The bone resection surface fitted the prosthesis surface with <2 mm difference. Histological examination of all resected specimens shows clear bone resection margins; 2 patients had positive soft tissue margins. At mean follow-up period of 3 years (6 months–10 years), 6 patients developed local and systemic recurrences, three of them had a pathological fracture at the time of diagnosis (P=0.139), and 4 showed a poor response to chemotherapy (P=0.014); all recurrences occurred in the soft tissue. Implant survival at 5 years was 86.15%, and MSTS score was 90% (83–96%). Conclusions. Whenever this kind of implant is affordable and can be utilized, particularly in younger age groups, JSE may be a good reconstruction option to avoid the use of expandable implants and to avoid the potentially higher revision and complication rates associated with biological reconstruction, as well as the complications of conventional joint-sacrificing implant, mainly dislocations and polyethylene wear and tear.

Perceptions towards Complementary and Alternative Medicine (CAM) are highly variable but are improving globally. However, studies conducted in Jordan about CAM are insufficient. This study aims to explore the attitudes and barriers towards using CAM among university students in Jordan. This cross-sectional study was conducted at the University of Jordan. A self-administered paper questionnaire was distributed to 475 students from the Faculties of Medicine, Pharmacy and Engineering of all academic years. Descriptive and multivariate data analysis was done using SPSS v.20. Seventy percent of all the participants have used at least one type of CAM. Younger female pharmacy students were most likely to use CAM. There were significant differences between students of different academic years regarding their opinions on CAM (p < 0.024). The percentage of medical students who believed that combining CAM with modern medicine would improve the overall treatment quality was significantly lower than the other two faculties (p < 0.001). Of the students who never used CAM, 39% did not do because they doubted its effectiveness. There is a need for including CAM in the universities’ curriculum as mandatory courses for health faculties and elective courses for other disciplines.