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Journal Cover The Knee
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 0968-0160
     Published by Elsevier Homepage  [2563 journals]   [SJR: 0.923]   [H-I: 38]
  • Fixed bearing lateral unicompartmental knee arthroplasty—Short to
           midterm survivorship and knee scores for 101 prostheses
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): James R.A. Smith , James R. Robinson , Andrew J. Porteous , James R.D. Murray , Mohammad A. Hassaballa , Neil Artz , John H. Newman
      Background Isolated unicompartmental knee arthritis is less common laterally than medially. Lateral unicompartmental knee arthroplasty (UKA) constitutes only 1% of all knee arthroplasty performed. Use of medial UKA is supported by several published series showing good long-term survivorship and patient satisfaction, in large patient cohorts. Results of lateral UKA however have been mixed. We present the short and mid-term survivorship and 5-year clinical outcome of 101 lateral UKAs using a single prosthesis. Methods Over a 9year period, 100 patients who satisfied inclusion criteria underwent a lateral fixed-bearing unicompartmental arthroplasty. American Knee Society (AKSS), Oxford Knee (OKS) and modified Western Ontario McMaster Universities Arthritis Index (WOMAC) scores were completed preoperatively and at 1, 2 and 5years postoperatively. Kaplan–Meier survival analysis was used to determine the 2-year and 5-year survivorship, using revision for any cause as end point. Results Survivorship was 98.7% and 95.5% at 2 and 5years respectively. 1 knee was revised for subsidence of the tibial component and 1 knee for progression of medial compartment osteoarthritis. Of a possible 35 knees in situ at 5year follow-up, 33 knees were fully scored. Median AKSS, OKS and modified WOMAC scores were 182, 41, and 16 respectively. Conclusions The mid-term survivorship and outcome scores at 5-years suggest that lateral unicompartmental knee arthroplasty provides a valuable alternative to total joint replacement in selected patients with isolated lateral tibio-femoral arthritis at mid-term follow-up. Level II evidence.


      PubDate: 2014-06-10T16:13:21Z
       
  • Surgical treatment of Recurrent Proximal Tibio-fibular Joint Ganglion
           Cysts
    • Abstract: Publication date: Available online 3 June 2014
      Source:The Knee
      Author(s): Aashish Gulati , Philipp Lechler , Robert Steffen , Tom Cosker , Nick Athanasou , Duncan Whitwell , Christopher L.M.H. Gibbons
      Background Complex symptomatic ganglion cysts arising from the proximal tibio-fibular joint (TFJ) are not an uncommon presentation in specialist knee clinics and can be managed by aspiration or excision. There is however a high rate of recurrence and often there is progressive involvement of the common peroneal nerve (CPN) and its branches, and permanent nerve damage may result. Methods This study is a review of the outcome of recalcitrant and recurrent cyst disease with CPN involvement treated by proximal fibulectomy. Nine patients with clinical and radiological diagnosis of a ganglion cyst involving the proximal tibio-fibular joint were treated by proximal fibulectomy. Average age was 47.2years (19 to 75). Patients were followed up clinically and radiologically. Medical notes were reviewed to assess clinical/pathological characteristics, surgical outcome, recurrence rate and the symptoms of instability and nerve function. Results None of the patients were lost to follow up. After an average follow up of 83months (15 to 150), none of the patients had clinical or radiological evidence of recurrence. All patients were pain free and had a complete resolution of nerve symptoms and no evidence of CPN injury. None of the patients complained of localised pain or knee instability and there were no wound healing problems. Conclusions MRI now confirms TFJ-ganglion cysts to be more common than previously recognised. Where there is refractory disease with progressive nerve symptoms and evidence of nerve sheath involvement, joint excision by proximal fibulectomy gives a satisfactory functional result in controlling disease and preventing further nerve damage. Level of evidence IV


      PubDate: 2014-06-10T16:13:21Z
       
  • Letter regarding “Does cruciate-retaining total knee arthroplasty
           enhance knee flexion in Western and East Asian patient populations' A
           meta-analysis”
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Xiaobo Xie , Lijun Lin , Qi Li



      PubDate: 2014-06-10T16:13:21Z
       
  • British Association for Surgery of the Knee
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4




      PubDate: 2014-06-10T16:13:21Z
       
  • Instructions for Authors
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4




      PubDate: 2014-06-10T16:13:21Z
       
  • Similar Early Migration when Comparing Cr and Ps In Triathlon™ TKA A
           Prospective Randomized Rsa Trial
    • Abstract: Publication date: Available online 7 June 2014
      Source:The Knee
      Author(s): Mats Molt , Sören Toksvig-Larsen
      Objectives The objective of this study was to compare the early migration of the cruciate retaining and posterior stabilising versions of the recently introduced Triathlon™ total knee system, with a view to predicting long term fixation performance. Methods Sixty patients were prospectively randomised to receive either Triathlon™ posterior stabilized cemented knee prosthesis or Triathlon™ cruciate retaining cemented knee prosthesis. Tibial component migration was measured by radiostereometric analysis postoperatively and at three months, one year and two years. Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score. Results There were no differences in rotation around the three coordinal axes or in the maximal total point motion (MTPM) during the two year follow-up. The posterior stabilised prosthesis had more posterior-anterior translation at three months and one year and more caudal-cranial translation at one year and two years. There were no differences in functional outcome between the groups. Conclusion The tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability. Level of evidence Level I. Article Summary Article focus: This was a prospective randomised trial aiming to compare the single radius posterior stabilised (PS) Triathlon™ total knee arthroplasty (TKA) to the cruciate retaining Triathlon™ TKA system with regard to fixation. Strengths and limitations of this study: Strength of this study was that it is a randomized prospective trial using an objective measuring tool. The sample size of 25-30 patients was reportedly sufficient for the screening of implants using RSA [1]. Trial registration: ClinicalTrials.gov Identifier: NCT00436982.


      PubDate: 2014-06-10T16:13:21Z
       
  • Tricompartmental resurfacing arthroplasty with a follow-up of more than
           30years
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Emmanuel Thienpont , Philippe Cartier
      Background Unicompartmental and patellofemoral joint replacements are proven solutions for arthritis limited to one compartment of the knee. Bicompartmental replacement has been considered lately as an alternative for combined medial and patellofemoral arthritis. The main idea behind these resurfacing solutions is tissue preservation with conservation of bone stock and both cruciate ligaments. Tricompartmental replacement with selective resurfacing of all three compartments with different modular implants is exceptional. Methods The authors present a case with more than thirty year follow-up both clinically and radiographically. Results Excellent function and patient satisfaction are observed at 30year follow-up. Radiographs show no osteolysis or loosening of components. Conclusions Conservation of both anterior and posterior cruciate ligaments seems to protect against polyethylene wear at long-term follow-up. Level of evidence IV.


      PubDate: 2014-06-10T16:13:21Z
       
  • An original arthroscopic fixation of adult's tibial eminence fractures
           using the Tightrope® devi A report of 8 cases and review of
           literature
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Bruno Faivre , Horea Benea , Shahnaz Klouche , Florent Lespagnol , Thomas Bauer , Philippe Hardy
      Purpose The objective of this study is to asset the efficiency of the use of the Tightrope® device to treat isolated tibial spine fractures in adults. Methods All patients treated for isolated tibial spine fracture between November 2007 and February 2011 have been retrospectively included. The main judgment criteria was the post-operative knee laxity measured by Rolimeter® (Aircast) and the secondary criteria were the IKDC scores, the knee mobility, the Lachman test and the bone union. 8 patients have been included. The mean age was 34.2years (±12.5). The classification of Meyers and McKeever identified 5 types II, 2 types IIIa and 1 type IIIb. The mean follow-up period was 10months. Results The mean post-operative anterior knee laxity was 6±2.14mm for the operated side and 5.6±1.85mm for the opposite side. No significant difference was found (P =0.73). According to the IKDC classification 3 patients were normal (A), 2 were nearly normal (B), 1 was abnormal (C) and 1 was very abnormal (D). The mean IKDC subjective score was 70.71±17.56. All 8 fractures achieved union without elevation. 3 patients developed motion complications and 2 required an arthroscopic arthrolysis. No other significant complication was noted. The outcome was compared to the different series published during the last 10years. Conclusion The use of the Tightrope® device is a simple technique occurring a rigid fixation, allowing early rehabilitation with a high rate of arthrofibrosis. Level of evidence Level IV, case series.


      PubDate: 2014-06-10T16:13:21Z
       
  • Fracture of titanium nitride-coated femoral component after total knee
           arthroplasty
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Se-Wook Park , Hyungsuk Kim , Yong In
      We report a case of fracture of a titanium nitride-coated femoral component 3years after primary total knee arthroplasty (TKA). The fracture was at the medial condylar area just posterior to the medial peg of the femoral component. The backside of the broken medial condylar portion of the femoral component was devoid of cement. Debonding of the component is a possible cause of the stress fracture. To our knowledge, this is the first case report of the fracture of the femoral component manufactured from titanium alloy. Level of evidence IV


      PubDate: 2014-06-10T16:13:21Z
       
  • Patient satisfaction after posterior-stabilized total knee arthroplasty: A
           functional specific analysis
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Hui Du , Hao Tang , Jian-Ming Gu , Yi-Xin Zhou
      Background Despite the success of total knee arthroplasty (TKA) in treating end-stage knee arthritis, 11% to 19% of patients are dissatisfied with the outcome of their surgery. In this study we investigated how satisfied overall patients are with the outcome of posterior stabilized TKA and what particular functional deficits or residual symptoms cause the most dissatisfaction for patients after surgery. Methods Using patient-completed validated questionnaires, we retrospectively analyzed data for 1013 posterior-stabilized TKAs performed in 748 Chinese patients regarding the overall satisfaction with surgery and the importance ranking of each of 15 specific functions and residual symptoms. Results Our data demonstrate an overall satisfaction rate of 87.4%. Satisfaction percentages ranged from 45.0% to 89.0%. The top 6 dissatisfactory items were sitting with legs crossed (dissatisfaction rate of 55.0%), squatting (51.7%), walking fast or jogging (45.4%), knee clunking (34.5%), abnormal feeling in knee (31.2%), and climbing stairs (28.2%). The top 6 important functions or issues were pain relief, walking on flat ground, climbing stairs, ability to return to household work, decreased limping, and squatting. Conclusions Approximately 1 in 8 patients was dissatisfied with overall outcome. Patients were most dissatisfied with climbing stairs and squatting, functions that they considered most important.


      PubDate: 2014-06-10T16:13:21Z
       
  • No effect of obesity on limb and component alignment after
           computer-assisted total knee arthroplasty
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Gautam M. Shetty , Arun B. Mullaji , Sagar Bhayde , A.P. Lingaraju
      Purpose This retrospective study aimed to determine if computer navigation provides consistent accuracy for limb and component alignment during TKA irrespective of body mass index (BMI) by comparing limb and component alignment and the outlier rates in obese versus non-obese individuals undergoing computer-assisted TKA. Methods Six hundred and thirty-five computer assisted total knee arthroplasties (TKAs) performed in non-obese individuals (BMI<30kg/m2) were compared with 520 computer-assisted TKAs in obese individuals (BMI≥30kg/m2) for postoperative limb and component alignment using full length standing hip-to-ankle radiographs. Results No significant difference in postoperative limb alignment (179.7°±1.7° vs 179.6°±1.8°), coronal femoral (90.2°±1.6° vs 89.8°±1.9°) and tibial component (90.2°±1.6° vs 90.3°±1.7°) alignment and outlier rates (6.2% vs 7.5%) was found between non-obese and obese individuals. Similarly, alignment and the outlier rates were similar when non-obese individuals and a subgroup of morbidly obese individuals (BMI >40kg/m2) were compared. Conclusions Computer navigation can achieve excellent limb and component alignment irrespective of a patient's BMI. Although obesity may not be an indication per se for using computer navigation during TKA, it will help achieve consistently accurate limb and component alignment in obese patients. Level of Evidence Level II


      PubDate: 2014-06-10T16:13:21Z
       
  • Effects of increased step width on frontal plane knee biomechanics in
           healthy older adults during stair descent
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Max R. Paquette , Songning Zhang , Clare E. Milner , Jeffrey T. Fairbrother , Jeffrey A. Reinbolt
      Background Peak internal knee abduction moment is a common surrogate variable associated with medial compartment knee loading. Stair descent has been shown to yield a greater peak knee abduction moment compared to level-walking. Changes in step width (SW) may lead to changes in frontal plane lower extremity limb alignment in the frontal plane and alter peak knee abduction moment. The purpose of this study was to investigate the effects of increased SW on frontal plane knee biomechanics during stair descent in healthy older adults. Methods Twenty healthy adults were recruited for the study. A motion analysis system was used to obtain three-dimensional lower limb kinematics during testing. An instrumented 3-step staircase with two additional customized wooden steps was used to collect ground reaction forces (GRF) data during stair descent trials. Participants performed five stair descent trials at their self-selected speed using preferred, wide (26% leg length), and wider (39% leg length) SW. Results The preferred normalized SW in older adults during stair descent was 20% of leg length. Wide and wider SW during stair descent reduced both first and second peak knee adduction angles and abduction moments compared to preferred SW in healthy adults. Conclusions Increased SW reduced peak knee adduction angles and abduction moments. The reductions in knee abduction moments may have implications in reducing medial compartment knee loads during stair descent.


      PubDate: 2014-06-10T16:13:21Z
       
  • Development and validation of formulae to predict leg length following
           medial opening-wedge osteotomy of the proximal tibia with hemicallotasis
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Eiichi Nakamura , Nobukazu Okamoto , Hiroaki Nishioka , Hiroki Irie , Hiroshi Mizuta
      Background A medial open-wedge osteotomy of the proximal tibia with hemicallotasis (HCO) affects the relative coronal alignment of the femur and tibia with respect to the floor; this also potentially reflects a change in leg length. Purpose The aims of this study are to develop and verify formulae for predicting the postoperative whole leg length (WLL) in HCO. Methods We analyzed a training set of 25 HCOs in 25 patients. Formulae for predicting the postoperative leg length were developed using various factors including the length and coronal alignment of the femur and tibia, the length of the proximal or distal fragment from the tibial osteotomy site, the femoro–tibial angle, and the correction angle. The formulae were then verified using the interclass correlation coefficient in an independent consecutive set of 25 HCOs. Results Significant postoperative increases in tibial bone length and WLL were noted with no postoperative change in femoral bone length. Furthermore, the coronal alignments of femoral and tibial bone axes were significantly abducted. For the formulae for predicting postoperative WLL developed in the training set, the interclass correlation coefficients between the predicted values and the real radiographic measurements in the validation set were more than 0.90, showing great consistency. Conclusion The mathematical models established in this study seemed to predict almost completely the change in leg length after HCO. Our results suggest that these formulae may offer accurate, extremely useful information about the postoperative possibility of leg lengthening for patients planning an HCO. Level of evidence Therapeutic case series; level 4.


      PubDate: 2014-06-10T16:13:21Z
       
  • Oxidized zirconium femoral component for TKA: A follow-up note of a
           previous report at a minimum of 10years
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Massimo Innocenti , Fabrizio Matassi , Christian Carulli , Lorenzo Nistri , Roberto Civinini
      Background New bearing surfaces for total knee replacement have been described in an attempt to reduce polyethylene wear and secondary osteolysis and improve longevity of implants. Oxidized zirconium is a new material that combines the strength of a metal with the wear properties of a ceramic. However, there are no reports as to who documents the long term results. We report a 10year follow-up note of a selected series of TKAs with an oxidized zirconium femoral component. Methods We prospectively follow 98 TKAs performed in 94 patients with an oxidized zirconium femoral component. Five patients (5 knees) had died and 6 (6 knees) were lost to follow-up at a minimum of 2years (mean, 6.3years; range, 2–9years) after the operation. For the remaining 83 patients (87 knees), the minimum follow-up was 10years (mean, 11.3years; range, 10.0–12.6years). In 51 cases (58.6%), a cruciate-retaining implant with a deep-dished, more conforming PE was used, and in 36 cases (41.4%), a posterior-stabilized design was used. The patellae were resurfaced in 32 cases (36.7%) and in 55 cases (63.3%) were left unresurfaced. Results Survivorship was 97.8% at 10years postoperatively. Two knees were revised for aseptic loosening of the femoral component. No major complication was observed clinically or radiologically. Mean Knee Society score improved from 36 to 84 and functional score from 37 to 83. Conclusions Oxidized zirconium femoral component in TKA performs well over the first 10years following implantation, with excellent survival rates and good clinical and radiological outcomes. Level of evidence Level IV, therapeutic study.


      PubDate: 2014-06-10T16:13:21Z
       
  • Sealing of the intramedullar femoral canal in a TKA does not reduce
           postoperative blood loss: A randomized prospective study
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Raúl Torres-Claramunt , Pedro Hinarejos , Daniel Pérez-Prieto , Sergi Gil-González , Xavier Pelfort , Joan Leal , Lluís Puig
      Background Sealing of the femoral canal, usually with autologous bone, is a surgical procedure that is often performed during TKA surgery to decrease blood loss in the postoperative period. However, evidence as to the effectiveness of this surgical procedure is not conclusive. The objective of this study was to assess the effectiveness of this surgical action in reducing postoperative blood loss and the blood transfusion rate. Methods A randomized prospective study that included 201 TKAs divided into three groups (67 in each one) was carried out. The three groups were; A) bone graft sealing, B) cement sealing and C) unsealed canal. All groups were comparable with regard to pre and intra-operative data. The haemoglobin decrease at 2, 24 and 72h was compared to the preoperative haemoglobin value. Subsequently, blood drainage at 12 and 24h and the rate of blood transfusion were also assessed. The different complications that arose were reported. Results No statistical differences were obtained with regard to blood drainage at 12h (p=0.102) and 24h (p=0.542), the haemoglobin value decrease at 72h (p=0.95) and the number of blood transfusions (p=0.597) in the three groups studied. Conclusion There was no significant difference, whether sealing the femoral canal with a bone graft, cement or when it was left unsealed, in decreasing blood loss or blood transfusion requirements in the postoperative period. Level of evidence Therapeutic type I.


      PubDate: 2014-06-10T16:13:21Z
       
  • Comparison of peripheral nerve block with periarticular injection
           analgesia after total knee arthroplasty: A randomized, controlled study
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Kazuhide Uesugi , Naoko Kitano , Tadashi Kikuchi , Miho Sekiguchi , Shin-ichi Konno
      Background Pain after total knee arthroplasty (TKA) is usually severe. Recently, the usefulness of local periarticular injection analgesia (PAI) and peripheral nerve block (PNB) has been reported. We report a prospective blinded randomized trial of PAI versus PNB in patients undergoing primary TKA, in accordance with the CONSORT statement 2010. Methods A total of 210 patients undergoing TKA under spinal anesthesia were randomized to receive PNB group or PAI group. In the PNB group, femoral nerve block and sciatic nerve block were performed. In the PAI group, a special mixture containing ropivacaine, saline, epinephrine, morphine hydrochloride, and dexamethasone was injected into the periarticular soft tissue. Pain intensity at rest was assessed using a numerical rating scale (NRS: 0–10) after surgery. Use of a diclofenac sodium suppository (25mg) was allowed for all patients at any time after surgery, and the diclofenac sodium suppository usage was assessed. The NRS for patient satisfaction at 48hours after surgery was examined. Results The average NRS for pain at rest up to 48hours after surgery was low in both groups. Within 48hours after surgery, the diclofenac sodium suppository usage was similar in both groups. There were no significant differences in the NRS for patient satisfaction in both groups. Conclusions The analgesic effects of PAI and PNB are similar. PAI may be considered superior to PNB because it is easier to perform. Level of Evidence Therapeutic Level 1.


      PubDate: 2014-06-10T16:13:21Z
       
  • Contents List
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4




      PubDate: 2014-06-10T16:13:21Z
       
  • Editorial Board
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4




      PubDate: 2014-06-10T16:13:21Z
       
  • The management of early osteoarthritis
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Roland Jakob



      PubDate: 2014-06-10T16:13:21Z
       
  • Influence of the posterior tibial slope on the flexion gap in total knee
           arthroplasty
    • Abstract: Publication date: August 2014
      Source:The Knee, Volume 21, Issue 4
      Author(s): Ken Okazaki , Yasutaka Tashiro , Hideki Mizu-uchi , Satoshi Hamai , Toshio Doi , Yukihide Iwamoto
      Background Adjusting the joint gap length to be equal in both extension and flexion is an important issue in total knee arthroplasty (TKA). It is generally acknowledged that posterior tibial slope affects the flexion gap; however, the extent to which changes in the tibial slope angle directly affect the flexion gap remains unclear. This study aimed to clarify the influence of tibial slope changes on the flexion gap in cruciate-retaining (CR) or posterior-stabilizing (PS) TKA. Methods The flexion gap was measured using a tensor device with the femoral trial component in 20 cases each of CR- and PS-TKA. A wedge plate with a 5° inclination was placed on the tibial cut surface by switching its front–back direction to increase or decrease the tibial slope by 5°. The flexion gap after changing the tibial slope was compared to that of the neutral slope measured with a flat plate that had the same thickness as that of the wedge plate center. Results When the tibial slope decreased or increased by 5°, the flexion gap decreased or increased by 1.9±0.6mm or 1.8±0.4mm, respectively, with CR-TKA and 1.2±0.4mm or 1.1±0.3mm, respectively, with PS-TKA. Conclusions The influence of changing the tibial slope by 5° on the flexion gap was approximately 2mm with CR-TKA and 1mm with PS-TKA. Clinical relevance This information is useful when considering the effect of manipulating the tibial slope on the flexion gap when performing CR- or PS-TKA.


      PubDate: 2014-06-10T16:13:21Z
       
  • A randomized double-blind clinical trial on the treatment of knee
           osteoarthritis: The efficacy of polynucleotides compared to standard
           hyaluronian viscosupplementation
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Laura S. Giarratana , Bruno M. Marelli , Calogero Crapanzano , Silvia E. De Martinis , Luca Gala , Marcello Ferraro , Niccolò Marelli , Walter Albisetti
      Background This randomized, double-blind, parallel-group clinical trial aims to assess the equivalence of intra-articular polynucleotides compared to standard hyaluronic acid (HA) viscosupplementation in the treatment of knee osteoarthritis (OA). Methods 75 patients affected by knee OA were assessed for eligibility and 72 were enrolled and randomized to receive either intra-articular polynucleotides (Condrotide-36 patients) or hyaluronic acid (Hyalubrix-36 patients) at the Orthopedic Institute “Gaetano Pini” (Milan). All patients underwent three intra-articular injections of Condrotide or Hyalubrix with an interval of 1week. Participants, care givers, and investigators responsible for outcome assessment were all blinded to group assignment. Primary outcome measurements (KOOS and pain level (1)at rest, (2)at weight-bearing and (3) during physical activity) were evaluated at baseline (T0) and after one (T1), two (T2), six (T6), ten (T10), and 26 (T26)weeks. Secondary measurements included the determination of COMP serum levels at T0, T6 and T26. Results The reduction of pain and the increase of KOOS values from baseline were statistically significant for both treatments; nevertheless, for parameter KOOS “symptoms” the treatment with Condrotide showed significant results already after twoweeks (at T2 p=0.003) while the results obtained with Hyalubrix became significant only after 18weeks (at T18 p=0.01). No significant adverse events were reported. Conclusions Condrotide is as effective as Hyalubrix in reducing knee OA symptoms but showed an earlier response on pain reduction and can therefore be considered a valid alternative to the use of HA in the treatment of OA, avoiding the adverse events of NSAIDs and of intra-articular corticosteroids.


      PubDate: 2014-05-27T16:22:48Z
       
  • Editorial
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Caroline B. Hing , Jim B. Stiehl



      PubDate: 2014-05-27T16:22:48Z
       
  • Clinimetric quality of the new 2011 Knee Society Score: High validity, low
           completion rate
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Remco N. Dinjens , Rachel Senden , Ide C. Heyligers , Bernd Grimm
      Background The demands of the younger and more active current total knee arthroplasty (TKA) patients are not in line with the current outcome assessments. Therefore, new questionnaires are developed or adjusted, as with the popular 1989 Knee Society Score (KSS). This study is the first to investigate the clinimetric parameters of the patient-reported outcome measurement (PROM) part of the 2011 KSS. Methods Four-hundred-fifteen primary Dutch TKA patients were scored using the PROM part of the 2011 KSS. The scale is subdivided into an Objective (not evaluated), Satisfaction, Expectation and Function subscales. Clinimetric quality was evaluated by response and completion rate, test–retest reliability (n=29, intraclass correlation coefficient), internal consistency (n=172, Cronbach's alpha), construct validity (Pearson's correlations with 1989 KSS (n=75) and KOOS-PS (n=139)) and responsiveness (n=20, paired-samples t-test, effect sizes and floor and ceiling effects). Results A response rate of 96% and completion rate of 43% were found. Reliability and internal consistency proved excellent with ICCs≥0.79 and Cronbach's alpha≥0.76 for all subscales. Strong correlations were found between the Function subscales of the 2011 KSS and KOOS-PS (r=−0.60 to −0.83). All subscales improved significantly after intervention, with exception of Walking & Standing and Discretionary Activities. 23% reached the maximum score postoperatively in Walking & Standing, indicating a ceiling effect. Conclusions The 2011 KSS is a reliable, internal consistent, construct valid and responsive questionnaire to assess the outcome of the Dutch TKA patients. Optimizations (e.g. shortening the scale, simplified design) are recommended to increase the disappointing completion rate. Clinical relevance The 2011 KSS is a reliable, internal consistent, construct valid and responsive questionnaire to assess the outcome of the Dutch TKA patients.


      PubDate: 2014-05-27T16:22:48Z
       
  • Comparison of second-look arthroscopic findings and clinical results
           according to the amount of preserved remnant in anterior cruciate ligament
           reconstruction
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Min Kyu Kim , Sung Rak Lee , Jeong Ku Ha , Ho Jong Ra , Sang Bum Kim , Jin Goo Kim
      Background Although ACL reconstruction is prevalent, the most effective method for ACL reconstruction still remains controversial. The purpose of this study was to evaluate the effect of the preserved remnant in ACL reconstruction on graft morphology at second-look arthroscopy and clinical outcomes. Methods 66 consecutive patients who underwent a second-look arthroscopy after a remnant-preserving ACL reconstruction were enrolled. The patients were divided into two groups according to whether the remnant ACL fibers could be preserved by over 50% (Group I) or not (Group II). The Lysholm score, IKDC subjective score, Tegner activity score, pivot-shift test, and KT-2000 arthrometric findings were evaluated preoperatively and just prior to the second-look arthroscopy to assess clinical outcomes. At second-look arthroscopy, graft morphology was evaluated using hypertrophy rate and synovialization. Results At second-look arthroscopy, the hypertrophy rate of Group I (42.1%) was higher than Group II (25.1%), which was statistically significant (p=0.002). In graft synovialization, there was a statistically significant difference between the two groups (p<0.001). The IKDC subjective score improved from 42.9, 43.1 to 77.8, 75.0 for Group I and Group II, respectively (p=0.025). For the Lysholm score, Group I and Group II improved from 55.4 and 55.7 to 87.8 and 84.9 (p=0.031). There was also a significant difference between the pivot shift tests between the groups (p=0.039). Other clinical tests showed no statistically significant differences. Conclusion Preserving the remnant ACL tissue during ACL reconstruction could have a positive effect on graft hypertrophy, synovialization and clinical outcomes. Level of evidence III, retrospective comparative study.


      PubDate: 2014-05-27T16:22:48Z
       
  • Change of the tunnel configuration in the non-anatomic trans-tibial double
           bundle ACL reconstruction
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Yong Seuk Lee , Won Seok Oh , Dong-Il Chun
      Background The objectives of this study were to evaluate tunnel widening and morphologic change at the tunnel aperture. Methods A prospective study that included 17 trans-tibial double bundle anterior cruciate ligament (ACL) patients was conducted for the evaluation of serial computed tomography (CT) scan. The OsiriX® was used for remodeling of CT images with a tunnel direction. Tunnel widening and change of the aperture morphology were assessed. Results With regard to the comparison of tunnel widening of the anteromedial (AM) tunnel, the entrance (p=0.01) and mid (p=0.02) of the coronal image, and the entrance (p < 0.01) and mid (p < 0.01) of the sagittal image showed statistically significant differences. The entrance (p=0.01) of the sagittal image only showed statistical significance in the posterolateral (PL) tunnel. With regard to the comparison between the AM and PL tunnels, the mid-portion (p = 0.04) of the sagittal image showed statistical differences, and the AM tunnel showed larger widening than the PL tunnel. Change of tunnel aperture was observed in the posterior, medial, and lateral portions of the AM tunnel and the anterior, posterior, and lateral portions of the PL tunnel. Conclusions In some aspects, occurrence of tunnel widening was observed in most sites. Widening occurred mainly at the entrance and mid-portions of the AM tunnel and the entrance of the PL tunnel. Change of tunnel aperture was observed at most directions in both tunnels. This is a non-anatomic ACL reconstruction and similar study with anatomic ACL reconstruction would be required in the future.


      PubDate: 2014-05-27T16:22:48Z
       
  • Internal derangement of the knee in fibular hemimelia: Radiographic and
           MRI findings
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Philip Yoong , Ramy Mansour
      Background Fibular hemimelia is a rare bone dysplasia with partial or complete absence of the fibula. There are many associated lower limb deformities. Methods We describe the commonly associated bone and soft tissue abnormalities in the knee joint in a case series of six knees in five patients with fibular hemimelia who underwent both radiographic and MR imaging. Results In all knees, there was an elongated conjoint tendon of the lateral collateral ligament and biceps femoris. In five out of six knees, there was trochlear dysplasia. In four out of six, there was complete absence of the anterior cruciate ligament. In four out of six, there was an abnormal lateral meniscus (three were hypoplastic and one absent). Conclusion These associations in fibular hemimelia, although unpredictable, have relevance in the guidance of further orthopaedic management in this complex condition.


      PubDate: 2014-05-27T16:22:48Z
       
  • Mechanical properties of suspensory fixation devices for anterior cruciate
           ligament reconstruction: Comparison of the fixed-length loop device versus
           the adjustable-length loop device
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Akio Eguchi , Mitsuo Ochi , Nobuo Adachi , Masataka Deie , Atsuo Nakamae , Muhammad Andry Usman
      Background No definite consensus has been reached regarding the optimal technique for graft fixation to the femur in an anterior cruciate ligament reconstruction. The purpose of this study was to evaluate the mechanical strength of two cortical suspension devices which were the TightRope (TR), a new adjustable-length loop device, and the EndoButton (EB), a well-established fixed-length loop device. Methods The devices were tested under cyclic and pull-to-failure loading conditions in both an isolated device setup and a specimen setup using porcine femora and bovine flexor tendons. In particular, we examined the influence of tendon and device lengths, whereby the total length of the bone tunnel was fixed to 35mm and an effective length of tendon in the bone tunnel was adjusted. Results In the isolated device testing, the EB showed significantly higher ultimate tensile strength than the TR. The displacement after preloading for the EB was statistically lower than that for the TR, and retained a significant difference after the cyclic load. In contrast, specimen testing showed no statistical difference in the displacement among the EB group and TR groups. Conclusion This study indicated that the EB provides greater mechanical strength than the TR. An important new finding was the measurement of initial displacement from the initiation of fixation until loading began using 50N of tension. In isolated device testing, the TR induced significantly more displacement than the EB during preloading, which could reflect the TR loop's stretching capacity until a certain amount of tension is applied.


      PubDate: 2014-05-27T16:22:48Z
       
  • Contributions of neural excitability and voluntary activation to
           quadriceps muscle strength following anterior cruciate ligament
           reconstruction
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Adam S. Lepley , Hayley M. Ericksen , David H. Sohn , Brian G. Pietrosimone
      Background Persistent quadriceps weakness is common following anterior cruciate ligament reconstruction (ACLr). Alterations in spinal-reflexive excitability, corticospinal excitability and voluntary activation have been hypothesized as underlying mechanisms contributing to quadriceps weakness. The aim of this study was to evaluate the predictive capabilities of spinal-reflexive excitability, corticospinal excitability and voluntary activation on quadriceps strength in healthy and ACLr participants. Methods Quadriceps strength was measured using maximal voluntary isometric contractions (MVIC). Voluntary activation was quantified via the central activation ratio (CAR). Corticospinal and spinal-reflexive excitability were measured using active motor thresholds (AMT) and Hoffmann reflexes normalized to maximal muscle responses (H:M), respectively. ACLr individuals were also split into high and low strength subsets based on MVIC. Results CAR was the only significant predictor in the healthy group. In the ACLr group, CAR and H:M significantly predicted 47% of the variance in MVIC. ACLr individuals in the high strength subset demonstrated significantly higher CAR and H:M than those in the low strength subset. Conclusion Increased quadriceps voluntary activation, spinal-reflexive excitability and corticospinal excitability relates to increased quadriceps strength in participants following ACLr. Clinical relevance Rehabilitation strategies used to target neural alterations may be beneficial for the restoration of muscle strength following ACLr.


      PubDate: 2014-05-27T16:22:48Z
       
  • Return to sport after anterior cruciate ligament reconstruction in
           professional soccer players
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): S. Zaffagnini , A. Grassi , G.M. Marcheggiani Muccioli , K. Tsapralis , M. Ricci , L. Bragonzoni , S. Della Villa , M. Marcacci
      Background To investigate time to return to sport and rate of professional sport activity in a homogenous group of competitive soccer players 4years after anterior cruciate ligament (ACL) reconstruction and rehabilitation. Methods Twenty-one male professional soccer players (mean age 22.9±5.4years) underwent non-anatomical double-bundle autologous hamstring ACL reconstruction and followed the same rehabilitative protocol. Clinical evaluation was performed preoperatively and at 3, 6 and 12-month follow-up. Data regarding return to train and official match, sport activity, complications and revision surgeries were collected at 4-year follow-up. Results Laxity test (KT-2000) and total KOOS mean score resulted in a significant improvement from the preoperative status to the 12-month follow-up (p<0.0001). The KOOS mean value showed a significant progressive improvement from the preoperative status to 6-month follow-up (p=0.0010) as well, while values collected at 6 and 12-month follow-up were comparable (p=0.2349). Returned to official matches 186±53days after surgery. After 12months, 95% came back to the same activity level performed before injury. Four years after ACL reconstruction, 15 patients (71%) were still playing competitive soccer. One patient (5%) underwent ACL failure and subsequent revision. Conclusions The ACL reconstruction with the presented technique followed by patient-tailored rehabilitation, allowed 95% and 62% professional male soccer players to return to the same sport activity 1year and 4years after surgery respectively. However, 71% were still able to play competitive soccer at final follow-up. Clinical scores were restored after 6months. Level of eviden IV, case series.


      PubDate: 2014-05-27T16:22:48Z
       
  • Percutaneous reconstruction of patellar tendon using semitendinosus tendon
           in chronic patellar tendon injury — case series and outcome
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Jitesh Kumar Jain , J.V.S. Vidyasagar , Ravish Chabra
      Background Chronic patellar tendon injuries are rare. Patients with these debilitating injuries present with extension lag and quadriceps atrophy. Diagnosis is usually made on a clinical background. Various methods of reconstruction of torn patellar tendon have been described and the ideal method of treatment is a matter of debate. Methods We retrospectively reviewed the medical records of nine patients with chronic patellar tendon injury that came to us between June 2006 and July 2012. In all patients, the patellar tendon was reconstructed percutaneously using semitendinosus tendon. Picrusting of quadriceps was required in two patients to pull the patella down. Result Average follow-up was 4.5years. At final follow-up Lysholm score, Siwek and Rao grading were good to excellent in all patients, and at 12months, all patients showed quadriceps strength 80% or more of opposite quadriceps. Conclusion Percutaneous reconstruction of the patellar tendon in chronic patellar tendon injury using semitendinosus tendon gives excellent result. Picrusting of quadriceps along with lateral release may be required to pull the patella down. Level of evidence Level IV.


      PubDate: 2014-05-27T16:22:48Z
       
  • The architecture of the ipsilateral quadriceps two years after successful
           anterior cruciate ligament reconstruction with bone–patellar
           tendon–bone autograft
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Umile Giuseppe Longo , Giacomo Rizzello , Francesco Frnaceschi , Stefano Campi , Nicola Maffulli , Vincenzo Denaro
      Background We undertook a cross-sectional study to evaluate the pennation angle and muscle thickness of the vastus lateralis muscle in patients undergoing unilateral anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone autograft, and compared these values with the contralateral non-operated limb. Methods Twenty three consecutive athletic males who underwent ACL reconstruction using the central third of the patellar ligament were evaluated at 25.9±1.5months. The International Knee Documentation Committee (IKDC) score was administered, and angles of pennation and muscle thickness were measured by ultrasonography. Results There was no significant difference in the pennation angle of the operated leg comparing to the contralateral leg (12.5°±1.81° in the operated leg; 13.25°±2.40° after the test; p=0.117). Quadriceps thickness in the operated leg was significantly decreased in all subjects compared to the contralateral leg (28.4±5.3mm in the operated leg; 32.7±4.85mm in the contralateral leg; p=0.007). Conclusions Two years after surgery, there is no difference in pennation angle of the vastus lateralis when compared to the contralateral side in patients undergoing unilateral ACL reconstruction with bone–patellar tendon–bone autograft. There is a significant difference in quadriceps muscle thickness, which was less in the operated side on the operated side in all patients. Further studies are required to study the influence of muscle architecture on clinical outcome after ACL reconstruction surgery, and whether there are differences associated with the use of different grafts. Level of evidence Case–control study; level IV.


      PubDate: 2014-05-27T16:22:48Z
       
  • Septic arthritis in ACL reconstruction surgery with hamstring autografts.
           Eleven years of experience
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Rafael Calvo , David Figueroa , Zoy Anastasiadis , Alex Vaisman , Arturo Olid , Federico Gili , Juan José Valderrama , Paulina De La Fuente
      Background Knee joint infection after ACL reconstruction is a rare complication with a low reported incidence, but the consequences can be devastating. The purpose of the study was to determine the incidence of septic arthritis after primary ACL reconstruction with hamstring auto-graft and the risk factors that may be associated. Method A retrospective study of all primary ACL reconstruction from January 2000 to May 2011. Electronic medical records were reviewed to determine the number of infections, operating time, associated procedure, time of presentation after surgery, infection treatment, microbiological cultures and graft retention. At the end of the follow-up (18–108months) a functional assessment of all the infected patients was performed using the Lysholm score with the Lysholm score. Results We analyzed 1564 cases of primary ACL reconstruction with hamstring autograft, of which seven cases were diagnosed with postoperative joint infection (incidence rate of 0.45%). The infectious agent most frequently isolated was a coagulase-negative Staphylococcus. Neither intraoperative factors nor age correlated with the development of the infection. The average Lysholm score was 95 points (range 89–100 points). All but two patients retained their reconstructed ACL. The results of the five patients in which the graft was preserved were significantly better than the two patients that had their grafts removed (p=0.03). Conclusion We conclude that septic arthritis post ACL reconstruction has a low incidence rate, which if handled at an early stage allows the patients a satisfactory return to their previous activities. Graft retention is important to obtain better functional results. Level of evidence IV.


      PubDate: 2014-05-27T16:22:48Z
       
  • Biomechanical effectiveness of a distraction–rotation knee brace in
           medial knee osteoarthritis: Preliminary results
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Davy Laroche , Claire Morisset , Clementine Fortunet , Vincent Gremeaux , Jean-Francis Maillefert , Paul Ornetti
      Background Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. Methods Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. Results VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. Conclusion This new knee brace with distraction–rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2months). Level of Eviden level IV.


      PubDate: 2014-05-27T16:22:48Z
       
  • Measurement and comparison of tibial posterior slope angle in different
           methods based on three-dimensional reconstruction
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Yang Zhang , Jian Wang , Jun Xiao , Liang Zhao , Zhi-han Li , Ge Yan , Zhan-jun Shi
      Background The tibial posterior slope (PTS) is an important parameter for sagittal alignment which is associated with postoperative range of motion. However, the variations of different population subsets and different referential axes are still uncertain. Methods In this study, 80 healthy people from South China were recruited and measured on three-dimensional reconstruction of CT, with application of three referential axes, the proximal tibial long axis, the anterior and posterior cortices. Results The averages and standard deviations of medial PTS (MPTS) in the three methods were 8.43±3.06, 11.45±2.82 and 6.31±3.24, separately. The results of lateral PTS (LPTS) were 7.56±2.51, 10.17±2.42 and 5.22±2.59. There was no significant difference between the male and the female, and the two sides of one body. The results of the three axes varied but correlated with each other significantly. Through comparison it was found that, MPTS/LPTS of people from South China were different from the published data of other countries. Conclusions Although PTS change markedly according to the reference axis, they show significant correlations with each other, and may be used safely. There are differences associated with races, but not gender nor the two sides of the body. Clinical relevance The results of the study provided references for the reconstruction of the knee PTS, if the differences of reference axes, races and genders were considered.


      PubDate: 2014-05-27T16:22:48Z
       
  • Does increasing step width alter knee biomechanics in medial compartment
           knee osteoarthritis patients during stair descent'
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): Max R. Paquette , Songning Zhang , Clare E. Milner , Gary Klipple
      Background Research shows that one of the first complaints from knee osteoarthritis (OA) patients is difficulty in stair ambulation due to knee pain. Increased step width (SW) has been shown to reduce first and second peak internal knee abduction moments, a surrogate variable for medial compartment knee joint loading, during stair descent in healthy older adults. This study investigates the effects of increased step width (SW) on knee biomechanics and knee pain in medial compartment knee OA patients during stair descent. Methods Thirteen medial compartment knee OA patients were recruited for the study. A motion analysis system was used to obtain three-dimensional joint kinematics. An instrumented staircase was used to collect ground reaction forces (GRF). Participants performed stair descent trials at their self-selected speed using preferred, wide, and wider SW. Participants rated their knee pain levels after each SW condition. Results Increased SW had no effect on peak knee abduction moments and knee pain. Patients reported low levels of knee pain during all stair descent trials. The 2nd peak knee adduction angle and frontal plane GRF at time of 2nd peak abduction moment were reduced with increasing SW. Conclusions The findings suggest that increases in SW may not influence knee loads in medial compartment knee OA patients afflicted with low levels of knee pain during stair descent.


      PubDate: 2014-05-27T16:22:48Z
       
  • Acute influence of restricted ankle dorsiflexion angle on knee joint
           mechanics during gait
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3
      Author(s): S. Ota , M. Ueda , K. Aimoto , Y. Suzuki , S.M. Sigward
      Background Restrictions in range of ankle dorsiflexion (DF) motion can persist following ankle injuries. Ankle DF is necessary during terminal stance of gait, and its restricted range may affect knee joint kinematics and kinetics. The purpose of this study was to investigate the acute influence of varied levels of restricted ankle DF on knee joint sagittal and frontal plane kinematics and kinetics during gait. Methods Thirty healthy volunteers walked with a custom-designed ankle brace that restricted ankle DF. Kinematics and kinetics were collected using a 7-camera motion analysis system and two force plates. Ankle dorsiflexion was restricted in 10-degree increments, allowing for four conditions: Free, light (LR), moderate (MR) and severe restriction (SR). Knee angles and moments were measured during terminal stance. Results Real peak ankle DF for Free, LR, MR, and SR were 13.7±4.8°, 11.6±5.0°, 7.5±5.3°, and 4.2±7.2°, respectively. Peak knee extension angles under the same conditions were −6.7±6.7°, −5.4±6.4°, −2.5±7.5°, and 0.6±7.8°, respectively, and the peak knee varus moment was 0.48±0.17Nm/kg, 0.47±0.17Nm/kg, 0.53±0.20Nm/kg, and 0.57±0.20Nm/kg. The knee varus moment was significantly increased from MR condition with an 8-degree restriction in ankle DF. Conclusion Knee joint kinematics and kinetics in the sagittal and frontal planes were affected by reduced ankle DF during terminal stance of gait. Differences were observed with restriction in ankle DF range of approximately 8°. Level of evidence level III


      PubDate: 2014-05-27T16:22:48Z
       
  • Editorial Board
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3




      PubDate: 2014-05-27T16:22:48Z
       
  • Contents List
    • Abstract: Publication date: June 2014
      Source:The Knee, Volume 21, Issue 3




      PubDate: 2014-05-27T16:22:48Z
       
  • Magnetic resonance evaluation of Trufit® plugs for the treatment of
           osteochondral lesions of the knee shows the poor characteristics of the
           repair tissue
    • Abstract: Publication date: Available online 9 May 2014
      Source:The Knee
      Author(s): Pablo Eduardo Gelber , Jorge Batista , Angélica Millan-Billi , Luciano Patthauer , Silvia Vera , Mireia Gomez-Masdeu , Juan Carlos Monllau
      Background Treatment of osteochondral lesions of the knee with synthetic scaffolds seems to offer a good surgical option preventing donor site morbidity. The Trufit® plug has shown that frequently is not properly incorporated. Objective To evaluate the relationship between the MRI findings and the functional scores of patients with osteochondral lesions of the knee treated with Trufit®. Methods Patients were evaluated with the MOCART score for MRI’s assessment of the repair tissue. KOOS, SF-36 and VAS were used for clinical evaluation. Correlation between the size of the treated chondral defect and functional scores were were also analyzed. Results Fifty-seven patients with a median follow-up of 44.8months (range 24–73) were included. KOOS, SF-36 and VAS improved from a mean 58.5, 53.9 and 8.5 points to a mean 87.4, 86.6 and 1.2 at last follow-up (p<0.001). Larger lesions showed less improvement in KOOS (p=0.04) and SF-36 (p=0.029). Median Tegner’s values were restored to the preinjury situation (5, range 2–10). Mean MOCART score was 43.2±16.1. Although the cartilage layer had good integration, it showed high heterogeneity and no filling of the subchondral bone layer. Conclusions Trufit® failed to restore the normal MRI aspect of the subchondral bone and lamina in most cases. The aspect of the chondral layer in MRI was partially re-established. This unfavorable MRI aspect did not adversely influence the patient’s outcome in the short time and they restored their previous level of activity. There was an inverse linear relationship between the size of the lesion and the functional scores. Level of Evidence Therapeutic case series; level 4.


      PubDate: 2014-05-12T06:37:47Z
       
  • 5-year cost/benefit analysis of revision of failed uni-compartmental Knee
           (UKR) replacements; not “just” a primary total knee
           replacement (TKR)
    • Abstract: Publication date: Available online 6 May 2014
      Source:The Knee
      Author(s): Sam C. Jonas , Rushabh Shah , Aveek Mitra , Sunny D. Deo
      Background A number of studies suggest that one advantage of a Unicompartmental knee replacement (UKR) is ease of revision to a total (TKR). We aimed to perform a cost/benefit analysis of patients undergoing this procedure at our centre to evaluate its economic viability. Patients and Methods From our own prospective joint replacement database we identified 812 consecutive tibio-femoral UKRs performed (1994–2007) of which 23 were revised to TKR (2005–2008). These were then matched to a cohort of primary TKRs (42 patients). Data were collected regarding patient demographics, cost of surgery, clinical outcome (OKS) and follow up costs at five years. Results There was no significant difference in implant costs or in length of stay, however tourniquet time was significantly higher in the revision group (Average 93minutes (UKR) vs 75minutes (TKR) p<0.0001). At five years there was no significant difference in clinical outcome between the revision UKR and primary TKR group, mean OKS 27 and 32 respectively (p=0.20). The revision group had a greater complication and revision rate, attending significantly more follow-up appointments (Average 6 (UKR) vs 2 (TKR) p<0.0001) and consultant appointments (Average 4 (UKR) vs 0.4 (TKR) p<0.0001). This was translated to significantly higher follow up costs. Conclusion Revision of UKR to TKR is not universally a straightforward procedure comparable to a standard primary replacement. Despite cost of components not being significantly higher than primary TKR there are multiple hidden follow up costs. The clinical outcomes are however similar at 5years, indicating a favourable cost benefit.


      PubDate: 2014-05-07T06:48:24Z
       
  • Intraoperative assessment of midflexion laxity in total knee prosthesis
    • Abstract: Publication date: Available online 26 April 2014
      Source:The Knee
      Author(s): Yukihide Minoda , Shigeru Nakagawa , Ryo Sugama , Tessyu Ikawa , Takahiro Noguchi , Masashi Hirakawa , Hiroaki Nakamura
      Purpose Soft-tissue balancing of the knee is fundamental to the success of a total knee arthroplasty (TKA). In posterior-stabilized TKA, there is no stabilizer of the anterior-posterior translation in the midflexion range in which the cam-post mechanism does not engage yet. Therefore, instability in the midflexion range is suspected to occur in posterior-stabilized TKA. The purpose of this study was to measure the joint gap throughout full range of motion and to analyze the joint gap laxity in midflexion range after implantation of a mobile-bearing posterior-stabilized total knee prosthesis. Methods Joint gap kinematics in 259 knees with varus osteoarthritis were measured during TKAs using a tensor device with the same shape of a total knee prosthesis of the same design was used. After the implantation of a mobile-bearing posterior-stabilized prosthesis and the reduction of the patellofemoral joint, the joint gap was measured at 0°, 30°, 60°, 90°, 120°, and 145° of flexion. Results The center size of the joint gap was tight in extension and deep flexion and loose at midflexion ranges, especially at 30° of flexion (p<0.001). The symmetry of the joint gap was varus at 0° and 145°of flexion (p<0.001). Conclusions Our results showed the joint gap laxity in midflexion range after the implantation of a mobile-bearing posterior-stabilized prosthesis. Our new tensor device, which can attach the polyethylene insert trial, will provide the important information about the joint gap kinematics after implantation of total knee prostheses.


      PubDate: 2014-04-27T11:15:35Z
       
  • Surface extraction can provide a reference for micro-CT analysis of
           retrieved total knee implants
    • Abstract: Publication date: Available online 26 April 2014
      Source:The Knee
      Author(s): Matthew G. Teeter , Jaques S. Milner , Douglas D.R. Naudie , Steven J. MacDonald
      Background Quantitative measurements of damage and wear in orthopaedic components retrieved from patients during revision surgery can provide valuable information. However, to perform these measurements there needs to be an estimate of the original, unworn geometry of the component, often requiring multiple scans of the various sizes of components that have been retrieved. The objective of this study was to determine whether the articular and backside surfaces could be independently segmented from a micro-CT reconstruction of a tibial insert, such that a tibial insert of one thickness could be used as a reference for a tibial insert of a different thickness. Methods New tibial inserts of a single width but six different thicknesses were obtained and scanned with micro-CT. An automated method was developed to computationally segment the articular and backside surfaces of the components. Variability between intact and extracted components was determined. Results The deviations between the comparisons of the extracted surfaces (range, 0.0004 to 0.010mm) were less (p<0.001) than the baseline deviation between the intact surfaces (range, 0.0002 to 0.053mm). Conclusions An extracted surface from one insert thickness could be used to accurately represent the surface of an insert of a different thickness. This greatly enhances the feasibility of performing retrieval studies using micro-CT as a quantitative tool, by reducing the costs and time associated with acquiring, scanning, and reconstructing multiple reference tibial insert geometries. This will add greater detail to studies of retrieved implants, to better establish how implants are functioning in vivo.


      PubDate: 2014-04-27T11:15:35Z
       
  • Vascular Anatomy of the Patella: Implications for Total Knee Arthroplasty
           Surgical Approaches
    • Abstract: Publication date: Available online 2 April 2014
      Source:The Knee
      Author(s): Lionel E. Lazaro , Michael B. Cross , Dean G. Lorich
      Background Iatrogenic disruption of the patellar vascular supply has been identified as a possible contributing factor to the commonly reported patellofemoral complications following total knee arthroplasty (TKA). We performed an anatomic cadaveric study evaluating the extra-osseous vascular anatomy of the patella, and correlated our findings to routine TKA surgical dissection to determine how to better preserve patellar vascularity. Methods and Materials In twenty-one cadaveric knees arterial cannulas were placed proximally and distally to the patella. A polyurethane compound was then injected producing a visible arterial network. Specimens underwent gross dissection. Results In all 21 specimens, the supreme genicular (SGA), medial/lateral superior genicular (MSGA/LSGA), medial/lateral inferior genicular and anterior tibial recurrent arteries communicate forming a peripatellar anastomotic ring supplying the intraosseous patellar system. Both, the SGA (24%) and MSGA (76%) demonstrated dual medial ring contribution. Relating the arterial location to common TKA exposures suggested severe compromise of patellar vascularity. Conclusion The medial sided vessels seem to contribute more significantly to the peripatellar anastomotic ring when compared to the lateral sided vessels. Careful soft tissue management has the potential to preserve key vascular structures that could maintain the intraosseous vascular supply to the patella. Understanding the anatomic locations of major arterial systems around the knee joint can potentially help during hemostasis, and can minimize blood lost during TKA. Clinical Relevance Recognition of major arterial systems around the knee joint has the potential to minimize iatrogenic disruption of the vascular supply and the complications that can follow (patella devascularization and blood lost).


      PubDate: 2014-04-07T16:20:09Z
       
  • Efficacy of Passive Extension Mobilization in Addition to Exercise in the
           Osteoarthritic Knee: An observational parallel-group study
    • Abstract: Publication date: Available online 27 March 2014
      Source:The Knee
      Author(s): Olaf Kappetijn , Emiel van Trijffel , Cees Lucas
      Study design Pretest-posttest observational parallel-group design. Objectives To evaluate the efficacy of passive knee extension mobilization in addition to exercise therapy on extension range of motion (ROM) in patients with osteoarthritis (OA) of the knee. Secondary objectives were to determine changes in pain and functional abilities. Background Patients with knee OA complain of pain, limited range of motion, and impaired activities. Efficacy of mobilization as a treatment option next to exercises has not been studied rigorously. Methods and Measures Thirty-four participants with persistent knee pain, a positive radiography for knee OA, and a passive extension deficit were included. Seventeen participants (mean age±SD, 59.8±6.1years) were treated with an exercise protocol and were additionally given manual mobilizations to improve passive extension ROM. The other group (mean age±SD, 61.5±7.3years) with equal characteristics was treated with an identical exercise therapy protocol only. Prior to participation, detailed ROM measurements were recorded next to muscle function tests, pain (VAS), six-minute walking tests (6MWT), a condition-specific questionnaire, and the patient-specific function scale (PSFS). Participants in both groups completed 16 treatment sessions each. Results Passive mobilizations significantly improved extension ROM in the intervention group (5.2 versus 8.6 degrees, p=.017). The manually mobilized group also had better physical capacities as assessed by 6MWT, less pain, and a lower PSFS score. Conclusion A combined protocol including exercise therapy and passive mobilization was beneficial for patients with OA of the knee complaining of pain, decreased extension ROM and decreased limited abilities. Level of evidence Therapy, 2b.


      PubDate: 2014-03-28T06:24:20Z
       
  • Plateau-Patella Angle in Evaluation of Patellar Height in Osteoarthritis
    • Abstract: Publication date: Available online 20 March 2014
      Source:The Knee
      Author(s): Matthew Ellington , Brett Robin , Daniel Jupiter , Bryce Allen
      Background The plateau-patella angle (PPA), recently introduced as a new and simpler method of measuring patellar height from the lateral radiograph, has the advantage of simplicity over previously described methods as it involves a single angular measurement without the need for calculations. The purpose of this study was to validate the use of the PPA as a measurement for patellar height in knees with moderate to severe osteoarthritis. Methods A total of 331 patients who underwent total knee arthroplasty at our institution with radiographs prior to surgery were evaluated. Of those, 297 (89.2%) were felt to be adequate for review. Three observers with different levels of orthopedic training measured PPA, Insall-Salvati, Caton-Deschamps, and Blackburne-Peele indices on a subset of 50 consecutive patients. Interobserver agreement for each of the four measurements was calculated and correlation between each of the measurements within each observer was calculated. The measurement of the PPA was repeated. Intraobserver agreement for the PPA was determined and a normal range and distribution was defined for this population. Results For the three observers, the mean PPA for the entire cohort was 25.55, 25.31, and 24.42. The intraclass correlation coefficient (ICC) was 0.81, The ICC and intraobserver assessment were highest for the PPA compared with the other ratios. The PPA was found to correlate most strongly with the Blackburne-Peel method. Conclusions The plateau-patella angle is a reliable way to evaluate patellar height in the osteoarthritic population. The measurement demonstrated a higher interobserver reliability compared with previously described methods. Level of eviden Retrospective Level IV


      PubDate: 2014-03-23T07:21:26Z
       
  • Knee biomechanics during popular recreational and daily activities in
           older men
    • Abstract: Publication date: Available online 19 March 2014
      Source:The Knee
      Author(s): Julie L. Pfeiffer , Songning Zhang , Clare E. Milner
      Background Physical activity is recommended for older adults, including those with knee pathology. However, demands on the knee during popular recreational activities are unclear. The study purpose was to determine knee biomechanics in healthy older men during golf and bowling and compare them to activities of daily living. Methods Three-dimensional motion analysis was used to determine knee biomechanics in 19 healthy males (45–73years): 11 golfers and eight bowlers. Subjects performed walking, stair ascent, stair descent, and either golf or bowling. Comparisons were made between the recreational activity and activities of daily living. Results During bowling, flexion angle at peak extensor moment was as high as during stair descent, and peak extensor moment was as high as during stair ascent. For the golf lead knee, flexion angle at peak extensor moment and peak extensor moment were as high as during stair ascent, and peak abduction moment, internal and external rotation angles were larger than during all activities of daily living. Peak external rotation angle for the golf trail knee was larger than all activities of daily living. Conclusion The greatest challenge for the knee of healthy older males during bowling is eccentric control of knee flexion. Golf poses challenges in all three planes of motion for the lead knee and in the transverse plane for the trail knee. Clinical Relevance Comparing mechanical demands on the knee during bowling and golf to those of stair negotiation provides a reference for clinicians when recommending recreational activities for older adults with knee pathology.


      PubDate: 2014-03-23T07:21:26Z
       
  • Effect of lower limb malalignment in the frontal plane on transverse plane
           mechanics during gait in young individuals with varus knee alignment
    • Abstract: Publication date: Available online 20 March 2014
      Source:The Knee
      Author(s): Felix Stief , Harald Böhm , Chakravarthy U. Dussa , Christel Multerer , Ansgar Schwirtz , Andreas B. Imhoff , Leonhard Döderlein
      Background Varus knee alignment has been identified as a risk factor for the progression of medial knee osteoarthrirtis (OA). This study tested the hypothesis that not only frontal plane kinematics and kinetics but also transverse plane lower extremity mechanics during gait are affected by varus malalignment of the knee. Methods Eighteen, otherwise healthy children and adolescents with varus malalignment of the knee were studied to examine the association between static varus malalignment and functional gait parameters. Kinematic data were collected using a Vicon motion capture system (VICON Motion Systems, Oxford, UK). Two AMTI force plates (Advanced Mechanical Technology, Inc., Watertown, MA, USA) were used to collect kinetic data. Results The results indicated that changes in transverse plane mechanics occur concomitantly with changes in knee malalignment in the frontal plane. A mechanical consequence of varus knee malalignment is obviously an increased endorotation of the foot (internal foot placement) and an increased internal knee rotation (tibia rotation) during stance phase. The linear correlation between the maximum external knee adduction moment in terminal stance and the internal knee rotation in terminal stance (r=0.823, p<0.001) shows that this transverse plane gait mechanics is directly in conjunction with intrinsic compressive load on the medial compartment during gait. Conclusions Understanding factors that influence dynamic knee joint loading in healthy, varus malaligned knees may help us to identify risk factors that lead to OA. Thus, three-dimensional gait analysis could be used for clinical prognoses regarding the onset or progression of medial knee OA.


      PubDate: 2014-03-23T07:21:26Z
       
  • Screw loosening and iliotibial band friction after posterolateral corner
           reconstruction
    • Abstract: Publication date: Available online 13 March 2014
      Source:The Knee
      Author(s): Camilo Partezani Helito , Marcelo Batista Bonadio , Marco Kawamura Demange , Roberto Freire da Mota Albuquerque , José Ricardo Pécora , Gilberto Luis Camanho , Fábio Janson Angelini
      Background Many reconstruction techniques have already been developed for treating posterolateral corner (PLC) injuries, with still no consensus regarding what would be the best option. Some of them use non-bone tunnel fixation, attaching the graft to the femur using a cortical screw with toothed washer. The main objective of the present study is to evaluate complications related to fixation performed by screw and toothed washer technique. Methods A prospective study with surgical reconstruction of the PLC structures of the knee between January 2008 and December 2009 was performed. PLC reconstruction included reconstruction of the lateral collateral ligament, popliteofibular ligament and popliteal muscle tendon. Fixation of the grafts in the femur was achieved by means of a 4.5mm screw with a toothed washer. The assessments were done using the following methods: objective IKDC, subjective IKDC, Lysholm and Tegner. Radiographic evaluations were performed immediately after the operation, at three, six and twelve months after surgery, and yearly thereafter. Complications were documented. Results The mean subjective IKDC score after the operation was 69.2, Lysholm scale was 80.7. Two patients presented failure of reconstructions of the PLC. In the radiographic evaluations, signs of loosening of the screw with toothed washer in the femur were observed in eight cases (66.6%). Six patients(50%) complained of lateral pain after the operation. Conclusion The technique of femoral fixation shown to be efficient to restoration of stability. However there was a high rate of complications secondary to implant, such as loosening of the screws and iliotibial tract friction.


      PubDate: 2014-03-18T07:20:27Z
       
  • Efficacy and safety of single-dose local infiltration of analgesia in
           total knee arthroplasty: A meta-analysis of randomized controlled trials
    • Abstract: Publication date: Available online 13 March 2014
      Source:The Knee
      Author(s): Chang-Peng Xu , Xue Li , Zhi-Zhong Wang , Jin-Qi Song , Bin Yu
      Purpose To examine the efficacy and safety of single-dose local infiltration of analgesia (LIA) for post-operative pain relief in total knee arthroplasty (TKA) patients. Methods A systematic electronic literature search (up to Aug 2013) was conducted to identify the RCTs that addressing the efficacy and safety of single-dose LIA in the pain management after TKA. Subgroup analysis was conducted to determine changes of visual analog scores (VAS) values at six different postoperative time points. Weighted mean differences or relative risks with accompanying 95% confidence intervals were calculated and pooled using a random effect model. Results Eighteen trials involving 1,858 TKA patients met the inclusion criteria. The trials were liable to medium risk of bias. The VAS values at postoperative 2h, 4h, 6h, 12h, 24h, 48h per patient were significantly lower in the LIA group than in the placebo group, and the former group also had less morphine consumption and better early functional recovery including range of motion, time to straight leg raise and 90° knee flexion than the latter group. No significant difference in length of hospital stay or side effects was detected between the two groups. Conclusions The current evidence shows that use of single-dose LIA is effective for postoperative pain management in TKA patients, with satisfactory short-term safety. More high-quality RCTs with long-term follow-ups are highly required for examining the long-term safety of single-dose LIA. Level of evidence I, II.


      PubDate: 2014-03-18T07:20:27Z
       
  • Double Bundle PCL Reconstruction Using Autogenous Quadriceps Tendon and
           Semitendinous Graft: Surgical Technique with Two-Year Follow-up Clinical
           Results
    • Abstract: Publication date: Available online 5 March 2014
      Source:The Knee
      Author(s): Ricardo de Paula Leite Cury , Marcos Barbieri Mestriner , Camila Cohen Kaleka , Nilson Roberto Severino , Victor Marques de Oliveira , Osmar Pedro Arbix Camargo
      Objectives To evaluate the results obtained of PCL reconstruction with the double femoral tunnel technique, using quadriceps tendon and semitendinous autograft, in patients with isolated PCL tears or PCL tears associated with other ligament lesions, two years after surgery. Methods 14 patients with isolated PCL lesions and 20 with combined ligament lesions, underwent PCL reconstruction using the double femoral tunnel technique, and were evaluated 24months after surgery using the IKDC and Lysholm scores, KT1000 and the graduation of the posterior drawer test. Results knees were considered normal (“A”) or nearly normal (“B”) in 92,9% of patients with isolated lesions and in 95,0% of patients with combined tears, according to the IKDC score. Good or excellent results were obtained in 100% of patients in both groups according to the Lysholm score. Absence or outstanding reduction of posterior tibial translation was seen in 92,9% of patients with isolated lesions and in 100% of patients with combined ligament tears, in the posterior drawer evaluation. Conclusion The PCL double femoral tunnel reconstruction technique using autografts was effective in restoring posterior knee stability, in isolated and or combined PCL tears, showing remarkable clinical improvement in all patients. Level of evidence: 2C


      PubDate: 2014-03-08T07:18:37Z
       
 
 
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