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Journal Cover   The Knee
  [SJR: 1.137]   [H-I: 44]   [13 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0968-0160
   Published by Elsevier Homepage  [2812 journals]
  • Immunohistochemical study of collagen types I and II and procollagen IIA
           in human cartilage repair tissue following autologous chondrocyte
    • Abstract: Publication date: October 2009
      Source:The Knee, Volume 16, Issue 5
      Author(s): S. Roberts , J. Menage , L.J. Sandell , E.H. Evans , J.B. Richardson
      This study has assessed the relative proportions of type I and II collagens and IIA procollagen in full depth biopsies of repair tissue in a large sample of patients treated with autologous chondrocyte implantation (ACI). Sixty five full depth biopsies were obtained from knees of 58 patients 8–60 months after treatment by ACI alone (n =55) or in combination with mosaicplasty (n =10). In addition articular cartilage was examined from eight individuals (aged 10–50) as controls. Morphology and semi-quantitative immunohistochemistry for collagen types I and II and procollagen IIA in the repair tissue were studied. Repair cartilage thickness was 2.89±1.5 mm and there was good basal integration between the repair cartilage, calcified cartilage and subchondral bone. Sixty five percent of the biopsies were predominantly fibrocartilage (mostly type I collagen and IIA procollagen), 15% were hyaline cartilage (mostly type II collagen), 17% were of mixed morphology and 3% were fibrous tissue (mostly type I collagen). Type II collagen and IIA procollagen were usually found in the lower regions near the bone and most type II collagen was present 30–60 months after treatment. The presence of type IIA procollagen in the repair tissue supports our hypothesis that this is indicative of a developing cartilage, with the ratio of type II collagen:procollagen IIA increasing from <2% in the first two years post-treatment to 30% three to five years after treatment. This suggests that cartilage repair tissue produced following ACI treatment, is likely to take some years to mature.

      PubDate: 2015-05-13T16:31:05Z
  • Change in body mass index during middle age affects risk of total knee
           arthoplasty due to osteoarthritis: A 19-year prospective study of 1003
    • Abstract: Publication date: August 2012
      Source:The Knee, Volume 19, Issue 4
      Author(s): A.S. Nicholls , A. Kiran , M.K. Javaid , D.J. Hart , T.D. Spector , A.J. Carr , N.K. Arden
      The evidence linking body mass index (BMI) to severe OA shows a strong association in the knee. There are limited data exploring the effect of BMI on the risk of joint arthroplasty in a healthy population with long periods of follow up. We compared the self-reported BMI at age 20, measured BMI at baseline, year 5 and year 10 with the year 19 risk of total knee arthroplasty (TKA) in a well-described, population based cohort of healthy women. A total of 733 women attended the 19th year visit, of whom 31 underwent TKA and 676 were used as a control group after 26 were removed for having hip arthoplasty. Using logistic regression, an increase in 1 unit of BMI at baseline was associated with a 10.5% increased risk of TKA (p=0.017) and at year 5 the increased risk is 8.6% (p=0.042). When adjusted for baseline age and smoking, baseline BMI was the only significant predictor of TKA at 10.0% with p=0.024. There was no significant association at 10years or for change in BMI over time. In this prospective, population based study, BMI predicted the risk of TKA for OA. The risk was greatest at baseline when the patients were in middle age suggesting that this is the most important time to target weight reduction interventions.

      PubDate: 2015-05-13T16:31:05Z
  • Probability of mechanical loosening of the femoral component in high
           flexion total knee arthroplasty can be reduced by rather simple surgical
    • Abstract: Publication date: January 2014
      Source:The Knee, Volume 21, Issue 1
      Author(s): S. van de Groes , M. de Waal-Malefijt , N. Verdonschot
      Background Some follow-up studies of high flexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implant fixation is dependant on two interfaces: the cement–implant and the cement–bone interface. The present finite-element model (FEM) is the first to analyse both the cement–implant interface and cement–bone interface. The cement–bone interface is divided into cement–cancellous and cement–cortical bone interfaces, each having their own strength values. The research questions were: (1) which of the two interfaces is more prone to failure' and (2) what is the effect of different surgical preparation techniques for cortical bone on the risk of early failure.' Methods FEM was used in which the posterior-stabilized PFC Sigma RP-F (DePuy) TKA components were incorporated. A full weight-bearing squatting cycle was simulated (ROM=50°–155°). An interface failure index (FI) was calculated for both interfaces. Results The cement-bone interface is more prone to failure than the cement implant interface. When drilling holes through the cortex behind the anterior flange instead of unprepared cortical bone, the area prone to early interface failure can be reduced from 31.3% to 2.6%. Conclusion The results clearly demonstrate high risk of early failure at the cement–bone interface. This risk can be reduced by some simple preparation techniques of the cortex behind the anterior flange. Clinical relevance High-flexion TKA is currently being introduced. Some reports show high failure rates. FEM can be helpful in understanding failure of implants.

      PubDate: 2015-05-13T16:31:05Z
  • The double flipped meniscus sign: Unusual MRI findings in bucket-handle
           tear of the lateral meniscus
    • Abstract: Publication date: January 2014
      Source:The Knee, Volume 21, Issue 1
      Author(s): Jin Hwan Ahn , Soo Jae Yim , Yu Seok Seo , Taeg Su Ko , Joon Hee Lee
      Bucket-handle meniscal tears are either longitudinal, vertical, or oblique in direction with an attached tear fragment displaced from the meniscus. Magnetic resonance imaging (MRI) signs are widely used in the diagnosis of these tears, including the ‘fragment within the intercondylar notch sign’, ‘flipped meniscus sign’, ‘double anterior horn sign’, ‘absence of the bow tie sign’, ‘double posterior cruciate ligament (PCL) sign’, ‘posterior double PCL sign’, and ‘triple PCL sign’. We report an unusual case, not yet described in previous studies, of a bucket-handle tear presenting as a double longitudinal tear of the lateral meniscus (LM). Two longitudinal tears were observed in the white–white zone and the red–white zone of the LM, where both fragments were shown to be displaced and locked within the intercondylar notch. Partial menisectomy was performed for the central fragment and a repair with modified all-inside sutures was performed for the peripheral fragment.

      PubDate: 2015-05-13T16:31:05Z
  • MPFL reconstruction using a quadriceps tendon graft Part 2: Operative
           technique and short term clinical results
    • Abstract: Publication date: December 2014
      Source:The Knee, Volume 21, Issue 6
      Author(s): Christian Fink , Matjaz Veselko , Mirco Herbort , Christian Hoser
      Background We describe the preliminary clinical results of a new operative technique for MPFL reconstruction using a strip of quadriceps tendon (QT). Methods Patients: 17 patients (7 male, 10 female; mean age 21.5years±3.9) have been operated on with this technique. All patients were evaluated clinically, radiologically and with subjective questionnaires (Tegner-, Lysholm-, Kujala Score) pre-operatively and post-operatively at 6 and 12months (m). Surgical technique: A 10 to 12mm wide, 3mm thick and 8 to 10cm long strip from the central aspect of quadriceps tendon is harvested subcutaneously. The tendon strip is then dissected distally on the patella, left attached, diverged 90° medially underneath the medial prepatellar tissue and fixed with 2 sutures. The graft is fixed in 20° of knee flexion with a bioabsorbable interference screw. Results Lysholm score at 6m was 81.9±11.7 and at 12m 88.1±10.9, Kujala score at 12m was 89.2±7.1 and Tegner Score was 4.9±2.0 (6m) and 5.0±1.9 (12m). Two patients had a positive apprehension test at 12months. There was no re-dislocation during the follow-up period. Conclusion MPFL reconstruction with a strip of QT harvested in a minimal invasive technique was found to be associated with good short term clinical results. We think that this technique presents a valuable alternative to common hamstring techniques for primary MPFL reconstruction in children and adults, as well as for MPFL revision surgery. Level of evidence IV, prospective case series.

      PubDate: 2015-05-13T16:31:05Z
  • MPFL reconstruction using a quadriceps tendon graft Part 1: Biomechanical
           properties of quadriceps tendon MPFL reconstruction in comparison to the
           Intact MPFL. A human cadaveric study
    • Abstract: Publication date: December 2014
      Source:The Knee, Volume 21, Issue 6
      Author(s): Mirco Herbort , Christian Hoser , Christoph Domnick , Michael J. Raschke , Simon Lenschow , Andre Weimann , Clemens Kösters , Christian Fink
      Background The aim of this study was to analyze the structural properties of the original MPFL and to compare it to a MPFL-reconstruction-technique using a strip of quadriceps tendon. Methods In 13 human cadaver knees the MPFLs were dissected protecting their insertion at the patellar border. The MPFL was loaded to failure after preconditioning with 10cycles in a uniaxial testing machine evaluating stiffness, yield load and maximum load to failure. In the second part Quadriceps-MPFL-reconstruction was performed and tested in a uniaxial testing machine. Following preconditioning, the constructs were cyclically loaded 1000 times between 5 and 50N measuring the maximum elongation. After cyclic testing, the constructs have been loaded to failure measuring stiffness, yield load and maximum load. For statistical analysis a repeated measures (RM) one-way ANOVA for multiple comparisons was used. The significance was set at P <0.05. Results During the load to failure tests of the original MPFL the following results were measured: stiffness 29.4N/mm (+9.8), yield load 167.8N (+80) and maximum load to failure 190.7N (+82.8). The results in the QT-technique group were as follows: maximum elongation after 1000cycles 2.1mm (+0.8), stiffness 33.6N/mm (+6.8), yield load 147.1N (+65.1) and maximum load to failure 205N (+77.8). There were no significant differences in all tested parameters. Conclusions In a human cadaveric model using a strip of quadriceps-tendon 10mm wide and 3mm deep, the biomechanical properties match those of the original MPFL when tested as a reconstruction. Clinical relevance The tested QT-technique shows sufficient primary stability with comparable biomechanical parameters to the intact MPFL.

      PubDate: 2015-05-13T16:31:05Z
  • One-step cartilage repair in the knee: Collagen-covered microfracture and
           autologous bone marrow concentrate. A pilot study
    • Abstract: Publication date: January 2015
      Source:The Knee, Volume 22, Issue 1
      Author(s): D. Enea , S. Cecconi , S. Calcagno , A. Busilacchi , S. Manzotti , A. Gigante
      Background Different single-stage surgical approaches are currently under evaluation to repair cartilage focal lesions. To date, only little is known on even short-term clinical follow-up and almost no knowledge exists on histological results of such treatments. The present paper aims to analyze the clinical and histological results of the collagen-covered microfracture and bone marrow concentrate (C-CMBMC) technique in the treatment of focal condylar lesions of knee articular cartilage. Methods Nine patients with focal lesions of the condylar articular cartilage were consecutively treated with arthroscopic microfractures (MFX) covered with a collagen membrane immersed in autologous bone marrow concentrate (BMC) from the iliac crest. Patients were retrospectively assessed using several standardized outcome assessment tools and MRI scans. Four patients consented to undergo second look arthroscopy and biopsy harvest. Results Every patient was arthroscopically treated for a focal condylar lesion (mean area 2.5 SD(0.4) cm2). All the patients (mean age 43 SD(9) years) but one experienced a significant clinical improvement from the pre-operative condition to the latest follow-up (mean 29 SD(11) months). Cartilage macroscopic assessment at 12months revealed that all the repairs appeared almost normal. Histological analysis showed a hyaline-like cartilage repair in one lesion, a fibrocartilaginous repair in two lesions and a mixture of both in one lesion. Conclusions The first clinical experience with single-stage C-CMBMC for focal cartilage defects in the knee suggests that it is safe, it improves the short-term knee function and that it has the potential to recreate hyaline-like cartilage. Level of evidence IV, case series

      PubDate: 2015-05-13T16:31:05Z
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