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Journal Cover The Knee
  [SJR: 1.236]   [H-I: 53]   [15 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0968-0160
   Published by Elsevier Homepage  [3041 journals]
  • Editorial
    • Authors: Caroline Hing; Oday Al-Dadah
      First page: 1
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Caroline Hing, Oday Al-Dadah

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2017.01.005
  • Why do patellofemoral arthroplasties fail today' A systematic review
    • Authors: J.P. van der List; H. Chawla; J.C. Villa; A.D. Pearle
      Pages: 2 - 8
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): J.P. van der List, H. Chawla, J.C. Villa, A.D. Pearle
      Background Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies. Methods Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies. Results Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p =0.005). Conclusion This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2015.11.002
  • The Genovese grading scale is not reliable for MR assessment of collagen
           meniscus implants
    • Authors: A. Hirschmann; F.F. Schiapparelli; L. Schenk; L. Keller; F. Amsler; M.T. Hirschmann
      Pages: 9 - 15
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): A. Hirschmann, F.F. Schiapparelli, L. Schenk, L. Keller, F. Amsler, M.T. Hirschmann
      Background The purpose of the study was to evaluate the intra- and inter-observer reliabilities of the Genovese grading on MRI in patients after collagen meniscus substitution. Methods 84 MRI images of 74 consecutive patients who underwent partial meniscus substitution using collagen meniscus implant (CMI) were assessed. MRIs were evaluated using the Genovese grading system. Furthermore, meniscal extrusion was assessed. Two observers performed the grading twice, blinded to each other and to the previous results, with a six weeks interval. The inter- and intra-observer reliabilities were assessed using kappa and weighted kappa values. Results The criterion “morphology/size” showed a weighted kappa value inter-observer reliability of 0.069 (rater 1)/0.352 (rater 2) and intra-observer reliability of 0.170 (1st rating)/0.582 (2nd rating). The criterion “signal intensity” showed a weighted kappa value inter-observer reliability of 0.175/0.284 and intra-observer reliability of 0.294/0.458. The criterion “cartilage lesions” showed a kappa value inter-observer reliability of 0.091/0.525 and intra-observer reliability of 0.409/0.413. The criterion “bone marrow edema” showed a kappa value inter-observer reliability of 0.667/0.808 and intra-observer reliability of 0.702/0.715. The criterion “cartilage lesions” showed a kappa value inter-observer reliability of 0.091/0.525 and intra-observer reliability of 0.409/0.413. Regarding meniscal extrusion kappa values for the inter-observer reliability were 0.625/0.940 and 0.625/0.889 for intra-observer reliability. Conclusions Three of the four Genovese grading items showed only slight to moderate inter- and intra-observer reliabilities in evaluating CMI on MRI. Hence, such grading results need to be considered with all due care. Only the criteria “bone marrow edema” and “meniscal extrusion” showed a good agreement for both inter- and intra-observer reliabilities.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.10.011
  • Open wedge high tibial osteotomy using three-dimensional printed models:
           Experimental analysis using porcine bone
    • Authors: Jun-Dae Kwun; Hee-June Kim; Jaeyoung Park; Il-Hyung Park; Hee-Soo Kyung
      Pages: 16 - 22
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Jun-Dae Kwun, Hee-June Kim, Jaeyoung Park, Il-Hyung Park, Hee-Soo Kyung
      Background The purpose of this study was to evaluate the usefulness of three-dimensional (3D) printed models for open wedge high tibial osteotomy (HTO) in porcine bone. Methods Computed tomography (CT) images were obtained from 10 porcine knees and 3D imaging was planned using the 3D-Slicer program. The osteotomy line was drawn from the three centimeters below the medial tibial plateau to the proximal end of the fibular head. Then the osteotomy gap was opened until the mechanical axis line was 62.5% from the medial border along the width of the tibial plateau, maintaining the posterior tibial slope angle. The wedge-shaped 3D-printed model was designed with the measured angle and osteotomy section and was produced by the 3D printer. The open wedge HTO surgery was reproduced in porcine bone using the 3D-printed model and the osteotomy site was fixed with a plate. Accuracy of osteotomy and posterior tibial slope was evaluated after the osteotomy. Results The mean mechanical axis line on the tibial plateau was 61.8±1.5% from the medial tibia. There was no statistically significant difference (P =0.160). The planned and post-osteotomy correction wedge angles were 11.5±3.2° and 11.4±3.3°, and the posterior tibial slope angle was 11.2±2.2° pre-osteotomy and 11.4±2.5° post-osteotomy. There were no significant differences (P =0.854 and P =0.429, respectively). Conclusion This study showed that good results could be obtained in high tibial osteotomy by using 3D printed models of porcine legs.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.026
  • Effects of measurement methods for tibial rotation axis on the morphometry
           in Korean populations by gender
    • Authors: Kyoung-Tak Kang; Juhyun Son; Oh-Ryong Kwon; Changhyun Baek; Dong Beom Heo; Kyoung-Mi Park; Ho-Joong Kim; Yong-Gon Koh
      Pages: 23 - 30
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Kyoung-Tak Kang, Juhyun Son, Oh-Ryong Kwon, Changhyun Baek, Dong Beom Heo, Kyoung-Mi Park, Ho-Joong Kim, Yong-Gon Koh
      Background There have been arguments for methodology in tibial rotation axis measurement, which accordingly determines the morphometry of the proximal tibia in total knee arthroplasty. The morphometry of the proximal tibia for the Korean population is determined by gender, based on the anatomical tibial axis and reliable rotational orientation in knee replacements, to evaluate the size suitability of the currently available prostheses in Korea. Methods This study reconstructed the MRI images in three-dimensions for identification and measurement of the mediolateral (ML) and anteroposterior (AP) lengths of the proximal tibia and the tibial aspect ratio (ML/AP) using proximal tibial anthropometric data for 700 osteoarthritic knees (587 females and 113 males). The ML and AP lengths were measured using tibial rotation axis techniques based on the medial one-third tibial tubercle and Cobb's method. Results Significant differences (P <0.05) in ML, medial anteroposterior (MAP), lateral anteroposterior (LAP) lengths, and aspect ratio (ML/LAP) were observed for males and females with respect to different measurement techniques for the tibial rotation axis. However, the measured aspect ratio (ML/MAP) of tibiae for the Korean population did not show significance. The measured aspect ratio (ML/AP) ratio of tibiae for the Korean population was higher than that of currently available tibial components. Conclusions Results from this study can guide development of gender-specific tibial prosthesis designs with different ML and AP aspect ratios based on the tibial anatomical rotation axis for the Korean population.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.012
  • A three dimensional approach for quantifying resultant loading at the knee
    • Authors: Ryan T. Lewinson; Chad P. Maag; Victor M.Y. Lun; J. Preston Wiley; Chirag Patel; Darren J. Stefanyshyn
      Pages: 31 - 39
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Ryan T. Lewinson, Chad P. Maag, Victor M.Y. Lun, J. Preston Wiley, Chirag Patel, Darren J. Stefanyshyn
      Background Clinical effectiveness of lateral wedges for knee osteoarthritis is inconsistent across studies. One explanation is that knee loading is not fully described by the peak frontal-plane knee moment. The purpose of this study was to propose a 3D resultant approach to describing moments at the knee and evaluate how this moment changes in response to lateral wedges. Methods Walking gait analysis was performed on 20 individuals with knee osteoarthritis, in their own shoes, with and without a six millimeter lateral wedge insole. Frontal-plane and 3D resultant moments were calculated for each participant and footwear condition. Paired t-tests identified differences between footwear conditions, correlations identified relationships between frontal-plane and 3D resultant moments, and regressions assessed relationships between moments and pain. Results Significant reductions to peak frontal-plane moments (p=0.001) and 3D resultant moments at the same time point (p=0.042) were observed with lateral wedges. While an overall significant correlation was observed between change in frontal-plane moments and change in 3D resultant moments with a lateral wedge (r =0.68, p=0.001), 5/20 participants experienced disparate results where the frontal-plane moment was reduced yet the 3D moment increased. Conclusions While lateral wedges alter frontal-plane moment magnitude, the direction of change does not always correspond to the direction of change observed in the 3D resultant moment. Thus resultant knee load may sometimes increase with lateral wedges. Clinical relevance Future prospective studies should evaluate if changes in 3D resultant moments, and thus total knee load, offer an explanation as to why some participants do not experience clinical benefit from lateral wedges.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.08.005
  • Arthroscopic anterior cruciate ligament repair for proximal anterior
           cruciate ligament tears in skeletally immature patients: Surgical
           technique and preliminary results
    • Authors: Marco Bigoni; Diego Gaddi; Massimo Gorla; Daniele Munegato; Marco Pungitore; Massimiliano Piatti; Marco Turati
      Pages: 40 - 48
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Marco Bigoni, Diego Gaddi, Massimo Gorla, Daniele Munegato, Marco Pungitore, Massimiliano Piatti, Marco Turati
      Background Anterior cruciate ligament (ACL) tears in children are increasingly common and present difficult treatment decisions due to the risk of growth disturbance. Although open primary ACL repair was abandoned in the historical literature, recent studies have suggested that there is a role for arthroscopic primary repair in patients with proximal tears. Methods This is a retrospective review of five consecutive patients aged 9.2years (range 8 to 10) who underwent suture anchor ACL reinsertion. Patients were included if they were Tanner stages 1–2 and proximal ACL tears with adequate tissue quality confirmed arthroscopically. The time frame was 81days. Arthroscopic ACL reinsertion was performed with bioabsorbable suture anchor. Clinical evaluation, KT-1000™, and MRI were re-evaluated. Clinical outcomes were measured using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score. Results At a mean follow-up of 43.4months (range 25 to 56), no re-injury and leg length discrepancies were observed. Four patients had negative Lachman tests. The remainder had a grade 1 Lachman test. The mean side-to-side difference was 3 (2–4mm). In MRI obtained at the last follow-up, no articular lesions or growth arrest were observed and the reinserted ACL was recognized in every exam. All patients returned to previous level of activity and presented normal and nearly normal IKDC score. The mean Lysholm score was 93.6. Conclusion Arthroscopic ACL repair can achieve good short-term results with joint stability and recovery of sport activity in skeletally immature patients, with proximal ACL avulsion tear.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.017
  • Extension deficit after anterior cruciate ligament reconstruction: Is
           arthroscopic posterior release a safe and effective procedure'
    • Authors: Guido Wierer; Armin Runer; Peter Gföller; Christian Fink; Christian Hoser
      Pages: 49 - 54
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Guido Wierer, Armin Runer, Peter Gföller, Christian Fink, Christian Hoser
      Background Postoperative extension deficits following anterior cruciate ligament (ACL) reconstruction can cause major limitation during daily life. The purpose of this study was to evaluate the efficiency of an all-arthroscopic approach and posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction. Methods Between 2009 and 2013 a total of 10 patients with knee flexion contractures after ACL reconstruction were assessed following an all-arthroscopic approach and posterior capsulotomy. The clinical outcomes were reviewed using the range of motion (ROM), Tegner Activity Level, Lysholm score and visual analogue pain scale (VAS). Results Four women and six men with a median age of 34years (range: 17 to 49years) were included in the study. The median follow-up period was 25months (range: 14 to 69months). The median preoperative extension deficit was 15° (range: 10 to 20°) compared to the normal contralateral knee. Postoperatively at final follow-up the median extension deficit was one degree (range: 0 to five degrees) (P <0.01). The median preoperative Lysholm score improved from 52 (range: 32 to 67) to 92 (range: 84 to 100) postoperatively (P <0.01), while the median Tegner Activity Level improved from three (range: two to six) to six (range: three to seven) respectively (P <0.02). The median VAS status for pain decreased from five (range: one to 10) to one (range: 0 to three) (P <0.01). No complications were observed. Conclusions Arthroscopic posterior capsulotomy is a safe and effective additional procedure in the treatment of persistent knee extension deficits following ACL reconstruction with excellent results regarding ROM and subjective outcomes. Level of evidence Level IV.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.018
  • Clinical outcomes of anatomic, all-inside, anterior cruciate ligament
           (ACL) reconstruction
    • Authors: Sam K Yasen; Zakk M Borton; Alistair I Eyre-Brook; Harry C Palmer; Stewart T Cotterill; Mike J Risebury; Adrian J Wilson
      Pages: 55 - 62
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Sam K Yasen, Zakk M Borton, Alistair I Eyre-Brook, Harry C Palmer, Stewart T Cotterill, Mike J Risebury, Adrian J Wilson
      Background This paper reports the outcomes of patients undergoing ACL reconstruction using a TransLateral single bundle, all-inside hamstring technique at a minimum of two year follow-up. Methods The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory fixation devices. Femoral and tibial sockets are produced using a retrograde drill. The graft is deployed, fixed and tensioned on both tibia and femur. Patients were evaluated preoperatively using the KOOS, Lysholm and Tegner scores and at six, 12 and 24months postoperatively. Objective assessment of knee laxity was performed using the KT-1000 along with goniometric measurement of range or motion. Results One hundred and eight patients, mean age 30.9years (range 15 to 61) were included. Mean follow-up 49.8months (range 30–66). The mean increase in KOOS at two years was 30.3 points; Lysholm, 33.1 points; Tegner Activity scale, 2.0 levels. These were all statistically significant (p<0.001). Range of motion in the reconstructed knee approximated the uninjured knee by 12months and was restored by two years. KT-1000 showed significant reduction in side-side difference to no more than 2.4mm at all postoperative time points (p<0.001). Re-rupture rate in this series was 6.5%, all following episodes of significant additional postoperative trauma to the knee. Conclusions TransLateral all-inside ACL reconstruction demonstrates good medium term subjective and objective outcomes with a low complication and failure rate.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.007
  • Coronal alignment on the single-limb stance radiograph in posterolateral
           rotatory instability, osteoarthritis and healthy knees
    • Authors: Young Gon Na; Moon Jong Chang; Sang Hwa Eom; Seok Jin Kim; Seong Cheol Park; Tae Kyun Kim
      Pages: 63 - 69
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Young Gon Na, Moon Jong Chang, Sang Hwa Eom, Seok Jin Kim, Seong Cheol Park, Tae Kyun Kim
      Background We aimed to determine whether coronal alignment measured on the single-limb stance (SLS) radiographs differs from those on the double-limb stance (DLS) images. We also investigated whether the size of such differences was affected by the knee pathology, lower limb alignment, and geometry of the tibia or femur. Methods We measured coronal alignment with mechanical tibiofemoral angle (MTFA) on the DLS and SLS radiographs in patients with posterolateral rotatory instability (PLRI, 30 knees), osteoarthritis (OA) with varus deformity who were scheduled for high tibial osteotomy (HTO) (60 knees), and in normal control (60 knees). The measurements on the SLS radiographs were compared with those on DLS images and the size of the differences were compared between the three groups. The correlation between the radiograph-related differences of coronal alignment and the limb alignment or geometry of tibia/femur was investigated. In the OA group, the size of the radiograph-related differences before HTO were compared with those after surgery. Results The coronal alignment on the SLS radiographs indicated varus accentuation compared to those on the DLS radiographs in the PLRI and OA groups (1.6 and 2.4°, respectively), while it was negligible in the normal group. Greater varus inclination of the tibial plateau was related to greater varus accentuation (r=0.249). The HTO decreased the extent of varus accentuation in the OA group (reduction of varus accentuation=1.5°). Conclusions Coronal alignment on the SLS radiograph is different from static alignment measured on the DLS radiograph, which may reflect dynamic alignment.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.003
  • Coronal subluxation of the proximal tibia relative to the distal femur
           after opening wedge high tibial osteotomy
    • Authors: Yasushi Akamatsu; Satoshi Ohno; Hideo Kobayashi; Yoshihiro Kusayama; Ken Kumagai; Tomoyuki Saito
      Pages: 70 - 75
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Yasushi Akamatsu, Satoshi Ohno, Hideo Kobayashi, Yoshihiro Kusayama, Ken Kumagai, Tomoyuki Saito
      Background The coronal subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). Methods Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The subluxation-C and subluxation-L were converted to a percentage of the tibial plateau width. Results The mean subluxation-C of 6.5% before OWHTO significantly increased to a mean subluxation-C of 7.3% one year after OWHTO. The mean subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in subluxation-L correlated with the change in femorotibial angle and correction loss (r =0.634, P <0.001 and r =0.463, P <0.001, respectively). Conclusion The proximal tibia shifted medially relative to the distal femur after OWHTO. This medial shift correlated with the correction loss. The coronal subluxation might be one cause of correction loss.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.009
  • Immediate effects of foot orthoses on pain during functional tasks in
           people with patellofemoral osteoarthritis: A cross-over, proof-of-concept
    • Authors: Natalie J. Collins; Rana S. Hinman; Hylton B. Menz; Kay M. Crossley
      Pages: 76 - 81
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Natalie J. Collins, Rana S. Hinman, Hylton B. Menz, Kay M. Crossley
      Background The purpose of the study was to determine whether prefabricated foot orthoses immediately reduce pain during functional tasks in people with patellofemoral osteoarthritis, compared to flat insoles and shoes alone. Methods Eighteen people with predominant lateral patellofemoral osteoarthritis (nine women; mean [SD] age 59 [10]years; body mass index 27.9 [3.2]kg/m2) performed functional tasks wearing running sandals, and then wearing foot orthoses and flat insoles (random order). Participants rated knee pain during each task (11-point numerical rating scales), ease of performance and knee stability (five-point Likert scales), and comfort (100mm visual analogue scales). Results Compared to shoes alone, foot orthoses (p =0.002; median difference 1.5 [IQR 3]) and flat insoles (p <0.001; 2 [3]) significantly reduced pain during step-downs; foot orthoses reduced pain during walking (p =0.008; 1 [1.25]); and flat insoles reduced pain during stair ambulation (p =0.001; 1 [1.75]). No significant differences between foot orthoses and flat insoles were observed for pain severity, ease of performance or knee stability. Foot orthoses were less comfortable than flat insoles and shoes alone (p <0.05). Conclusions In people with patellofemoral osteoarthritis, immediate pain-relieving effects of prefabricated, contoured foot orthoses are equivalent to flat insoles. Further studies should investigate whether similar outcomes occur with longer-term wear or different orthosis designs.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.016
  • Should the position of the patellar component replicate the vertical
           median ridge of the native patella'
    • Authors: Rae Hyeong Lee; Hae Won Jeong; Jin Kyu Lee; Choong Hyeok Choi
      Pages: 82 - 90
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Rae Hyeong Lee, Hae Won Jeong, Jin Kyu Lee, Choong Hyeok Choi
      Background In total knee arthroplasty (TKA), the position of the patellar component can affect patellar tracking. However, the patellar component cannot always replicate the original high point of the patella because of anatomical variance. This study investigated whether altering the highest point of the patella can affect outcomes of primary TKA, especially in patients having a patella with a far-medialized median ridge. Methods A retrospective review was performed for 177 knees (143 patients) treated with primary TKA between July 2011 and March 2014. Group 1 (34 knees) had the patellar component displaced over three millimeters from the median ridge, while Group 2 (143 knees) had the patellar component placed on the original median ridge position. The one-year follow-up outcomes were reviewed, including: patellar tilt angle, Knee Society Score, Feller Patellar Score, and modified Kujala Anterior Knee Pain Score. Results Mean (±standard deviation) displacement of the patellar component in Group 1 was 3.97±0.97mm lateral to the original position of the median ridge, with a significant decrease in lateral patellar tilt angle (P <0.001). Lateral patellar tilt showed a positive correlation with the medialization of the patellar component (P <0.001, r =0.401). Ability to rise from a chair was better in Group 1 (P =0.025). There were no other between-group differences in other clinical outcomes. Conclusions There should be no need for the patellar component to replicate the original highest point of the native patella in primary TKA.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.014
  • Knee arthrodesis by the Ilizarov method in the treatment of total knee
           arthroplasty failure
    • Authors: Andrea Antonio Maria Bruno; Alexander Kirienko; Andrea Peccati; Paolo Dupplicato; Massimo De Donato; Enrico Arnaldi; Nicola Portinaro
      Pages: 91 - 99
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Andrea Antonio Maria Bruno, Alexander Kirienko, Andrea Peccati, Paolo Dupplicato, Massimo De Donato, Enrico Arnaldi, Nicola Portinaro
      Background Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of knee arthrodesis by circular external fixation performed in the treatment of TKA failure in which revision arthroplasty was not indicated. Methods The study involved 19 patients who underwent knee arthrodesis by the Ilizarov method. Clinical and functional assessments were performed, including Knee Society Score (KSS). A postoperative clinical and radiographic evaluation was conducted every three months until the end of the treatment. Postoperative complications and eventual leg shortening were recorded. Results KSS results showed a significant improvement with respect to the preoperative condition. Of the 16 patients in the final follow-up, 15 patients (93.7%) achieved complete bone fusion. Major complications occurred in patients treated for septic failure of TKA and most occurred in patients over 75years of age; the mean final leg shortening was four centimeters. Conclusion In our experience, the Ilizarov method is effective for performing a knee arthrodesis in the case of extensive bone loss. At the same time, it is possible to correct the associated leg deformities or limb length difference. In addition, only the Ilizarov method provides a mechanical stimulus for bone formation and improves the quality of the bone and of the microcirculation, which enhances the host response against infection. Despite these attributes, knee arthrodesis by the Ilizarov method must be considered a ‘salvage procedure’ in cases of severe outcomes from knee surgery in which revision arthroplasty is not indicated.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.11.002
  • Optimizing effectivity of tranexamic acid in bilateral knee arthroplasty
           — A prospective randomized controlled study
    • Authors: Rajesh N. Maniar; Tushar Singhi; Aniket Patil; Gaurav Kumar; Parul Maniar; Jaivardhan Singh
      Pages: 100 - 106
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Rajesh N. Maniar, Tushar Singhi, Aniket Patil, Gaurav Kumar, Parul Maniar, Jaivardhan Singh
      Introduction Tranexamic acid (TEA) is used in reducing surgical blood loss. Literature shows no optimal regimen recommended for Bilateral Total Knee Arthroplasty (TKA). We evaluated three TEA regimens differing in dosage, timing and mode of administration in bilateral TKA to identify the most effective regimen to reduce blood loss. Methods We prospectively studied three TEA regimens (25 patients each) as follows: (1) two intraoperative, intravenous doses (IOIO), (2) two intraoperative local applications (LALA), and (3) one preoperative plus two intraoperative, intravenous doses (POIOIO). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method were statistically evaluated. Results Mean drain loss was least (412.9ml) in the POIOIO group, greatest (607.2ml) in the IOIO group and LALA group in between (579.4ml), with a statistically significant difference among them (p=0.0022). On paired evaluation, the drain loss in the POIOIO group was significantly less as compared to the other two groups, whereas the difference between IOIO and LALA was not significant. Mean total blood loss was least in the POIOIO group (1207ml) and greatest in LALA group (1270ml). The difference among the groups was not statistically significant (p=0.80). There was no incidence of any thromboembolic phenomenon. On correlation with our study on Most Effective Regimen in Unilateral TKA, both results were found to substantiate each other.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.10.014
  • Radiographic assessment of knee–ankle alignment after total knee
           arthroplasty for varus and valgus knee osteoarthritis
    • Authors: Fuqiang Gao; Jinhui Ma; Wei Sun; Wanshou Guo; Zirong Li; Weiguo Wang
      Pages: 107 - 115
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Fuqiang Gao, Jinhui Ma, Wei Sun, Wanshou Guo, Zirong Li, Weiguo Wang
      Background There are unanswered questions about knee–ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee–ankle alignment after TKA. Methods The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis. Results The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (P <0.05). The pre-operative malalignment of the knee was corrected (P <0.05), and the ankle tilt angle was accordingly improved in the operative side after TKA (P <0.05). In addition, TKA had little effect on knee–ankle alignment on the non-operative side (P >0.05). Conclusion These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA. Level of evidence Level III.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.023
  • Length of stay and short-term functional outcomes after total knee
           arthroplasty: Can we predict them'
    • Authors: Emanuele Maiorano; Bruno Dino Bodini; Francesca Cavaiani; Catia Pelosi; Valerio Sansone
      Pages: 116 - 120
      Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1
      Author(s): Emanuele Maiorano, Bruno Dino Bodini, Francesca Cavaiani, Catia Pelosi, Valerio Sansone
      Background To identify variables influencing length of stay (LOS) and short-term functional outcome in patients undergoing total knee arthroplasty (TKA). A secondary aim was to verify the effect of the same variables on blood management and the rate of postoperative infection. Method We retrospectively reviewed 353 patients, 258 females and 85 males, who underwent primary TKA in a single specialist orthopaedic centre. Anamnestic and anthropometric data and the Modified Barthel Index Score (MBI) at admission were recorded, and entered as covariates in four longitudinal regression models, separately carried out for female and male groups. The regression outcomes were LOS, MBI change, rate of infection and blood transfusion. Statistical significance was set at p<0.05. Results Mean LOS was 15.93±4.97days for females and 13.41±3.63days for males. Mean MBI improvement was statistically significant in both groups. 46.3% females and 29.4% males needed at least one blood transfusion, while infections complicated the hospitalization in 14.6% and 4.7% cases respectively. Among females, older age was predictive for a longer LOS and poorer post-operative MBI improvement. Lower MBI at admission was related to a longer LOS and to a higher risk of post-surgical infections in the female group, but to a better improvement of functional outcome in both groups. A higher rate of blood transfusion postoperatively was associated to lower pre-surgical haemoglobin levels and, for females, to older age and lower BMI. Conclusion An accurate characterization of TKA candidates might help in reducing LOS and in achieving a better early functional outcome.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.09.022
  • Management of septic arthritis after arthroscopic anterior cruciate
           ligament reconstruction using a standard surgical protocol
    • Authors: Michael E. Hantes; Vasilios A. Raoulis; Nikolaos Doxariotis; Athanasios Drakos; Theofilos Karachalios; Konstantinos N. Malizos
      Abstract: Publication date: Available online 12 March 2017
      Source:The Knee
      Author(s): Michael E. Hantes, Vasilios A. Raoulis, Nikolaos Doxariotis, Athanasios Drakos, Theofilos Karachalios, Konstantinos N. Malizos
      Background To report the incidence of septic arthritis after anterior cruciate ligament (ACL) reconstruction and management of this complication using a specific treatment protocol. Methods All primary ACL reconstructions performed in our institution between January 2002 and January 2014 were included in this study. Time to presentation, clinical symptoms, and culture results of all infected patients were analyzed. According to our protocol, an arthroscopic debridement and irrigation of the knee joint was performed immediately after a diagnosis of infection was made. In case of recurrence, knee irrigation with hardware and graft removal and later re-implantation was performed. Patients were evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) Form, KT 1000 arthrometer and radiographic evaluation. Results Postoperative septic arthritis occurred in seven of 1242 patients (0.56%). After initial arthroscopic debridement, infection recurred in six out of seven cases (85%). Graft and hardware removal was performed in these patients. Graft re-implantation was performed in four patients at an average five months after infection. At the final follow-up (mean 6.3years) all patients had full range of motion, while in patients with graft re-implantation the mean Lysholm score was 92, and the mean IKDC score was 87. Radiographs demonstrated that three patients had normal knees and one patient had a grade one, knee arthritis according to Kellgren–Lawrence classification. Conclusions Management of septic arthritis after ACL reconstruction using a specific surgical protocol which includes graft removal in case of infection recurrence with later re-implantation, can provide good and excellent results. Level of evidence Level IV, case series.

      PubDate: 2017-03-12T20:28:06Z
      DOI: 10.1016/j.knee.2017.02.007
  • The impact of symptomatic knee osteoarthritis on overall gait pattern
           deviations and its association with performance-based measures and
           patient-reported outcomes
    • Authors: Josefine E Naili; Anna-Clara Esbjörnsson; Maura D Iversen; Michael H Schwartz; Margareta Hedström; Charlotte K Häger; Eva W Broström
      Abstract: Publication date: Available online 6 March 2017
      Source:The Knee
      Author(s): Josefine E Naili, Anna-Clara Esbjörnsson, Maura D Iversen, Michael H Schwartz, Margareta Hedström, Charlotte K Häger, Eva W Broström
      Background Limited knowledge exists regarding the impact of symptomatic knee osteoarthritis (OA) on the overall gait pattern; and whether gait deviations are associated with performance-based measures (PBMs) and patient-reported outcomes (PROs). This cross-sectional study evaluated overall gait patterns in patients with knee OA using the Gait Deviation Index for kinematics (GDI) and kinetics (GDI-kinetic), and explored associations between gait deviations, PBMs, and PROs. Methods Forty patients with knee OA and 25 age and gender-matched controls underwent three-dimensional gait analysis. Participants performed the Timed Up and Go (TUG), Five Times Sit-to-Stand (5STS), and Single Limb Mini Squat (SLMS) tests and completed a disease-specific PRO. Associations between gait deviations, PBMs, and PROs were assessed by Pearson's correlation and multiple linear regression. Results Patients with OA demonstrated significantly lower GDI and GDI-kinetic scores of the OA and contralateral limbs compared to controls; with GDI-kinetic scores on the contralateral limb more impacted than the OA limb. On the contralateral limb, GDI-kinetic score significantly correlated with TUG (r=−0.42) and 5STS (r=−0.33), while on the OA limb with TUG (r=−0.68), 5STS (r=−0.38), SLMS (r=−0.38), activities of daily living (r=0.35) and Knee-related Quality of Life (r=0.35). No significant associations existed between kinematic GDI scores, PBMs and PROs. Conclusion The overall gait pattern, as represented by GDI and GDI-kinetic scores, in patients with symptomatic knee OA is affected both on the painful OA limb and the contralateral limb. The GDI and GDI-kinetic scores provide different information regarding function that is not revealed by PBMs or PROs.

      PubDate: 2017-03-08T19:37:33Z
      DOI: 10.1016/j.knee.2017.02.006
  • Letter to editor “Intravenous versus intra-articular tranexamic acid in
           total knee arthroplasty: A double-blinded randomized controlled
           noninferiority trial”
    • Authors: Anil Mehtani; Jatin Prakash
      Abstract: Publication date: Available online 2 March 2017
      Source:The Knee
      Author(s): Anil Mehtani, Jatin Prakash

      PubDate: 2017-03-03T19:06:02Z
      DOI: 10.1016/j.knee.2016.02.009
  • Total knee arthroplasty with computer-assisted navigation more closely
           replicates normal knee biomechanics than conventional surgery
    • Authors: Jodie A. McClelland; Kate E. Webster; Alankar A. Ramteke; Julian A. Feller
      Abstract: Publication date: Available online 21 February 2017
      Source:The Knee
      Author(s): Jodie A. McClelland, Kate E. Webster, Alankar A. Ramteke, Julian A. Feller
      Background Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated. Methods This study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants. Results Standing lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P <0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P <0.01). Conclusions In summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA.

      PubDate: 2017-02-23T21:19:11Z
      DOI: 10.1016/j.knee.2016.12.009
  • Reply to letter to the editor on “Intravenous versus intra-articular
           tranexamic acid in total knee arthroplasty: A double-blinded randomised
           controlled noninferiority trial”
    • Authors: Jerry Yongqiang Chen; Pak Lin Chin; Ing How Moo; Hee Nee Pang; Darren Keng Jin Tay; Shi-Lu Chia; Ngai Nung Lo; Seng Jin Yeo
      Abstract: Publication date: Available online 16 February 2017
      Source:The Knee
      Author(s): Jerry Yongqiang Chen, Pak Lin Chin, Ing How Moo, Hee Nee Pang, Darren Keng Jin Tay, Shi-Lu Chia, Ngai Nung Lo, Seng Jin Yeo

      PubDate: 2017-02-16T20:41:14Z
      DOI: 10.1016/j.knee.2016.07.006
  • Kinematic alterations of the lower limbs and pelvis during an ascending
           stairs task are associated with the degree of knee osteoarthritis severity
    • Authors: Glaucia Helena Gonçalves; Luiz Fernando Approbato Selistre; Marina Petrella; Stela Márcia Mattiello
      Abstract: Publication date: Available online 30 January 2017
      Source:The Knee
      Author(s): Glaucia Helena Gonçalves, Luiz Fernando Approbato Selistre, Marina Petrella, Stela Márcia Mattiello
      Background Individuals with knee osteoarthritis (OA) generally demonstrate great difficulty in ascending stairs. The strategies and compensations used by these individuals in stair activities have not been fully established. The purpose of this study was to investigate the joint kinematics of the pelvis, hip, knee and ankle throughout the gait cycle, in the sagittal and frontal planes, in individuals with mild and moderate knee OA, during an ascending stairs task. Methods Thirty-one individuals with knee OA and 19 controls were subjected to clinical and radiographic analysis, divided into three groups: control, mild knee OA, and moderate knee OA. Participants answered a self-reported questionnaire, carried out performance-based tests, and their kinematic data were recorded during an ascending stairs task using an eight-camera Qualisys 3D-Motion analysis system. Results The individuals with moderate degrees of knee OA demonstrated kinematic alterations in the pelvis, hip, knee, and ankle in the sagittal plane. The individuals with mild degrees of knee OA demonstrated kinematic alterations of the hip in the frontal plane, and kinematic alterations of the ankle in the sagittal plane. Conclusions The ascending stairs task allowed verification of meaningful information regarding gait strategies used by individuals with mild and moderate knee OA. The strategies of these two groups of individuals are different for this task, although more pronounced in individuals with moderate knee OA. The findings should be taken into account in the development of rehabilitation programs.

      PubDate: 2017-02-16T20:41:14Z
      DOI: 10.1016/j.knee.2017.01.007
  • Total knee arthroplasty after patellectomy: A meta-analysis of
           case–control studies
    • Authors: Saeed Asadollahi; Rami Sorial; Simon Coffey; Manish Gupta; Guy D Eslick
      Abstract: Publication date: Available online 9 February 2017
      Source:The Knee
      Author(s): Saeed Asadollahi, Rami Sorial, Simon Coffey, Manish Gupta, Guy D Eslick
      Background Post-patellectomy patients represent a specific subset of patients who can develop painful and disabling knee osteoarthritis that requires Total Knee Arthroplasty (TKA). The aim of this study was to conduct a meta-analysis comparing the outcome of TKA in patients with previous patellectomy to those with an intact patella. Methods A systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane Library) was performed. Data on study setting, type of implant, outcome and associated complications were extracted. Quality assessment was performed using the Newcastle–Ottawa Scale. Random effects meta-analyses were used to combine the results of included studies. Results Seven case–control studies were found that met the search criteria. Compared to patients with an intact patella, patients with a previous patellectomy were less likely to have an ‘excellent’ or ‘good’ outcome (OR: 0.3, 95% CI: 0.14 to 0.65). The weighted mean post-operative knee flexion arc was 6.58° less in patients with a previous patellectomy (95% CI: −12.79, −0.37). The risk of complication occurring in a patella-deficient knee was higher, with a pooled OR of 1.97 (95% CI=1.10 to 3.51). Conclusions The current evidence that compares the outcome of knee arthroplasty in patients with a previous patellectomy to patients with an intact patella is mostly based on TKAs performed in the 1980s and 1990s. Total knee replacement in patients with an intact patella results in superior outcomes compared to those with a previous patellectomy. In patients with a previous patellectomy, the arc of flexion is slightly less and the complication rate is significantly higher.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2017.01.004
  • Registration accuracy enhancement of a surgical navigation system for
           anterior cruciate ligament reconstruction: A phantom and cadaveric study
    • Authors: Youngjun Kim; Byung Hoon Lee; Kinde Mekuria; Hyunchul Cho; Sehyung Park; Joon Ho Wang; Deukhee Lee
      Abstract: Publication date: Available online 9 February 2017
      Source:The Knee
      Author(s): Youngjun Kim, Byung Hoon Lee, Kinde Mekuria, Hyunchul Cho, Sehyung Park, Joon Ho Wang, Deukhee Lee
      Background Recently, surgical navigation systems have been widely used to improve the results of various orthopaedic surgeries. However, surgical navigation has not been successful in anterior cruciate ligament reconstruction, owing to its inaccuracy and inconvenience. This study investigated the registration of preoperative and intraoperative data, which are the key components in improving accuracy of the navigation system. Methods An accurate registration method was proposed using new optical tracking markers and landmark retake. A surgical planning and navigation system for anterior cruciate ligament reconstruction was developed and implemented. The accuracy of the proposed system has been evaluated using phantoms and eight cadaveric knees. The present study investigated only the registration accuracy excluding the errors of optical tracking hardware and surgeon. Results The target registration errors of femoral tunnelling for anterior cruciate ligament reconstruction in phantoms were found to be 0.24±0.03mm and 0.19±0.10° for the tunnel entry position and tunnel direction, respectively. The target registration errors measured using cadavers were 0.9mm and 1.94°, respectively. Conclusions The preclinical experimental results showed that the proposed methods enhanced the registration accuracy of the developed system. As the system becomes more accurate, surgeons could more precisely position and orient the femoral and tibial tunnels to their original anatomical locations.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.007
  • Minimally invasive surgery (MIS) for total knee replacement; medium term
           results with minimum five year follow-up
    • Authors: Olivia Unwin; Mohammed Hassaballa; James Murray; William Harries; Andrew Porteous
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Olivia Unwin, Mohammed Hassaballa, James Murray, William Harries, Andrew Porteous
      Background MIS TKA has been shown to offer a reduced in-patient stay, but no clinical difference at two years. Whilst there may be a benefit from earlier discharge, we need to ensure that there are no detrimental effects in the medium and long-term following MIS-TKA. To report the mid-term result from a prospective randomised controlled trial (RCT) comparing MIS-TKA with standard approach for TKA. Methods Using knee score questionnaires, we collected patient reported outcome measures (PROMs) regarding pain and function. Sixty-six patients (from an eligible cohort of 83 patients) completed the mid-term postal follow-up. Results There was no significant difference between groups for change in score from pre-operative to final follow-up in all three PROMs. Mean MIS and standard group improvement was: AKSS 53 and 51 (p=0.7644), OKS 15 and 16 (p=0.2341) or WOMAC 15 and 15 (p=0.9900) respectively. Both groups showed improvement in pain and function with no significant difference between groups. There was no difference between groups for revision due to malalignment at a mean six year follow-up. Conclusions In addition to the early benefits regarding hospital stay and complications, we have found that at a mean of six years there was no increase in malalignment, pain or function with MIS techniques.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2017.01.010
  • Biomechanical evaluation of knee endpoint during anterior tibial loading:
           Implication for physical exams
    • Authors: Ata A. Rahnemai-Azar; Fabio V. Arilla; Kevin M. Bell; Freddie H. Fu; Volker Musahl; Richard E. Debski
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Ata A. Rahnemai-Azar, Fabio V. Arilla, Kevin M. Bell, Freddie H. Fu, Volker Musahl, Richard E. Debski
      Background Physical exams that apply anterior tibial loads are typically used to evaluate knees with anterior cruciate ligament (ACL) injuries. The amount of anterior tibial translation that occurs during these exams can be difficult to assess due to a “soft” endpoint. Therefore, the objective of this study is to determine the biomechanical characteristics of the endpoint for the intact and ACL deficient knee using quantitative criteria. Methods Eight porcine knees were tested using a robotic testing system. An 89N anterior tibial load was applied to the intact and ACL deficient knee at 30°, 45°, 60° and 75° of flexion. The stiffness of the toe and linear regions was determined from the load–translation curve. The width of the transition region was defined by the distance between the points where the best-fit lines used to define the stiffness of the toe and linear regions diverged from the load–translation curve. Results Stiffness of the toe and linear regions significantly decreased after transecting the ACL at all flexion angles (71–85% and 38–62%, respectively). Width of the transition region was significantly increased in the ACL deficient knee at all flexion angles (approximately four to five times and four to nine times, respectively). Conclusions The novel quantitative criteria developed in this study have the potential to be deployed in clinical practice by coupling them with data from knee arthrometers that are commonly used in clinical practice. Thus, additional information from the load–translation curve can be provided to improve the diagnosis of ACL injury.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.11.015
  • CT-based morphological analysis of the posterior femoral condyle in
           patients with trochlear dysplasia
    • Authors: Xiaohui Liu; Gang Ji; Xinmin Wang; Huijun Kang; Fei Wang
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Xiaohui Liu, Gang Ji, Xinmin Wang, Huijun Kang, Fei Wang
      Background The anterior part of the distal femur in trochlear dysplasia has been well investigated; however, to date, posterior morphological characteristics have not been well studied. This study aimed to evaluate whether the posterior femoral condyle in patients with trochlear dysplasia differs from those without trochlear dysplasia. Methods Computed tomography scans of 75 knees with trochlear dysplasia and 55 knees with normal anatomy of the patellofemoral joint were analyzed retrospectively. Three observers assessed the width, length, and height of the posterior condyle between the two groups. The intra-class correlation coefficient was used to evaluate inter-observer reliability. The independent Student's t-test was used to assess the statistical significance of the qualitative variables. Results There was excellent inter-observer reliability (intra-class correlation coefficient 0.91–0.99) for all of the quantitative measurements. There were significant differences between trochlear dysplastic and normal knees. The trochlear dysplasia group had a larger medial posterior condyle and smaller lateral posterior condyle than the control group. Furthermore, proportion of the posterior condyle in the distal femur markedly differed between the two groups: in the trochlear dysplasia group, the medial posterior condyle accounted for a bigger proportion, while the lateral posterior condyle accounted for a smaller proportion. Conclusion Patients with trochlear dysplasia have different posterior femoral condyles compared with those without trochlear dysplasia. Patients with this condition have bigger medial posterior condyles and smaller lateral posterior condyles. A greater amount of attention needs to be paid to this abnormality.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.008
  • Comparison of articular and backside polyethylene wear in mobile bearing
           unicompartmental knee replacement
    • Authors: Matthew G. Teeter; James L. Howard; Richard W. McCalden; Douglas D. Naudie
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Matthew G. Teeter, James L. Howard, Richard W. McCalden, Douglas D. Naudie
      Background Unicompartmental knee replacement (UKR) is an alternative to total knee replacement for selected patients with isolated medial or lateral compartment osteoarthritis. One of the most popular UKR implants was introduced as a mobile-bearing design in part to reduce polyethylene wear. However, backside wear of the mobile-bearing implant has not been examined independently from the articular surface. Methods Sixteen retrieved polyethylene inserts from a medial mobile-bearing UKR from 16 patients were examined after an average of 4.2years implantation (range 1.5 to 10.0years). Reasons for revision included aseptic loosening, pain, and progression of osteoarthritis. Each retrieved insert was evaluated using visual damage scoring across the articular and backside surfaces. Inserts were also micro-CT scanned and compared to a reference insert of the same size, to measure wear on the articular and backside surfaces. Results The total damage scores were greater (p=0.01) on the articular surface (27.2±5.7 (standard deviation)) than the backside surface (23.8±6.2). Burnishing, abrasions, and pitting were the most common damage modes on both surfaces, with only pitting greater (p=0.03) on the articular surface than the backside surface. There was no difference (p=0.46) in wear rate between the articular surface (0.028±0.025mm/year) and backside surface (0.029±0.017mm/year). Conclusions The retrieved mobile-bearing UKR polyethylenes demonstrated good overall wear resistance, with no evidence of severe damage. However, backside wear was equal to articular wear, suggesting that the backside surface is a potential source of polyethylene wear debris.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.010
  • Clinical results of alumina medial pivot total knee arthroplasty at a
           minimum follow-up of 10years
    • Authors: Suguru Nakamura; Yukihide Minoda; Shigeru Nakagawa; Yoshinori Kadoya; Susumu Takemura; Akio Kobayashi; Shigekazu Mizokawa; Yoichi Ohta; Sinji Takahashi; Kazumasa Yamamura; Hiroaki Nakamura
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Suguru Nakamura, Yukihide Minoda, Shigeru Nakagawa, Yoshinori Kadoya, Susumu Takemura, Akio Kobayashi, Shigekazu Mizokawa, Yoichi Ohta, Sinji Takahashi, Kazumasa Yamamura, Hiroaki Nakamura
      Background The medial pivot total knee prosthesis with alumina ceramic femoral components was introduced to reproduce physiological knee kinematics and reduce polyethylene wear. The five-year clinical outcomes of alumina medial pivot total knee arthroplasties (TKA) have previously been reported. The purpose of this study was to provide the longer-term clinical results at a minimum follow-up of 10years. Methods The clinical results of 70 alumina medial pivot TKA in 51 consecutive patients, with a minimum follow-up period of 10years, were evaluated. Results Mean follow-up was 11.8years (range 10 to 13). Alumina medial pivot TKAs improved the patients' Knee Society knee scores, function scores, and postoperative ranges of motion compared with their pre-operative statuses (P <0.05 for each). Revision surgery was required in one knee due to a postoperative fracture of the tibial plateau after a fall that occurred two years postoperatively. Osteolysis and femoral component loosening was identified in one case after the initial five-year time point of analysis. The survival rate was 99.1% at 10years. Conclusions This study demonstrated excellent clinical results for patients receiving the alumina medial pivot prosthesis at a minimum follow-up period of 10years.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.011
  • Surgical treatments of cartilage defects of the knee: Systematic review of
           randomised controlled trials
    • Authors: Brian M Devitt; Stuart W Bell; Kate E Webster; Julian A Feller; Tim S Whitehead
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Brian M Devitt, Stuart W Bell, Kate E Webster, Julian A Feller, Tim S Whitehead
      Background The aim of this systematic review was to identify high quality randomised controlled trials (RCTs) and to provide an update on the most appropriate surgical treatments for knee cartilage defects. Methods Two reviewers independently searched three databases for RCTs comparing at least two different treatment techniques for knee cartilage defects. The search strategy used terms mapped to relevant subject headings of MeSH terms. Strict inclusion and exclusion criteria were used to identify studies with patients aged between 18 and 55 years with articular cartilage defects sized between one and 15cm2. Risk of bias was performed using a Coleman Methodology Score. Data extracted included patient demographics, defect characteristics, clinical outcomes, and failure rates. Results Ten articles were included (861 patients). Eight studies compared microfracture to other treatment; four to autologous chondrocyte implantation (ACI) or matrix-induced ACI (MACI); three to osteochondral autologous transplantation (OAT); and one to BST-Cargel. Two studies reported better results with OAT than with microfracture and one reported similar results. Two studies reported superior results with cartilage regenerative techniques than with microfracture, and two reported similar results. At 10years significantly more failures occurred with microfracture compared to OAT and with OAT compared to ACI. Larger lesions (>4.5cm2) treated with cartilage regenerative techniques (ACI/MACI) had better outcomes than with microfracture. Conclusions Based on the evidence from this systematic review no single treatment can be recommended for the treatment of knee cartilage defects. This highlights the need for further RCTs, preferably patient-blinded, using an appropriate reference treatment or a placebo procedure.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.002
  • Survivorship and patient satisfaction of robotic-assisted medial
           unicompartmental knee arthroplasty at a minimum two-year follow-up
    • Authors: Andrew D. Pearle; Jelle P. van der List; Lily Lee; Thomas M. Coon; Todd A. Borus; Martin W. Roche
      Abstract: Publication date: Available online 6 February 2017
      Source:The Knee
      Author(s): Andrew D. Pearle, Jelle P. van der List, Lily Lee, Thomas M. Coon, Todd A. Borus, Martin W. Roche
      Background Successful clinical outcomes following unicompartmental knee arthroplasty (UKA) depend on lower limb alignment, soft tissue balance and component positioning, which can be difficult to control using manual instrumentation. Although robotic-assisted surgery more reliably controls these surgical factors, studies assessing outcomes of robotic-assisted UKA are lacking. Therefore, a prospective multicenter study was performed to assess outcomes of robotic-assisted UKA. Methods A total of 1007 consecutive patients (1135 knees) underwent robotic-assisted medial UKA surgery from six surgeons at separate institutions between March 2009 and December 2011. All patients received a fixed-bearing metal-backed onlay implant as tibial component. Each patient was contacted at minimum two-year follow-up and asked a series of five questions to determine survivorship and patient satisfaction. Worst-case scenario analysis was performed whereby all patients were considered as revision when they declined participation in the study. Results Data was collected for 797 patients (909 knees) with average follow-up of 29.6months (range: 22–52months). At 2.5-years of follow-up, 11 knees were reported as revised, which resulted in a survivorship of 98.8%. Thirty-five patients declined participation in the study yielding a worst-case survivorship of 96.0%. Of all patients without revision, 92% was either very satisfied or satisfied with their knee function. Conclusion In this multicenter study, robotic-assisted UKA was found to have high survivorship and satisfaction rate at short-term follow-up. Prospective comparison studies with longer follow-up are necessary in order to compare survivorship and satisfaction rates of robotic-assisted UKA to conventional UKA and total knee arthroplasty.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.001
  • Femoral component rotations in different gap tensions in total knee
           arthroplasty: A prospective randomized controlled trial
    • Authors: Joong Il Kim; Sae Hyung Chun; Hyuk Soo Han; Sahnghoon Lee; Myung Chul Lee
      Abstract: Publication date: Available online 6 February 2017
      Source:The Knee
      Author(s): Joong Il Kim, Sae Hyung Chun, Hyuk Soo Han, Sahnghoon Lee, Myung Chul Lee
      Background In total knee arthroplasty (TKA), femoral component rotation is an important factor in the flexion stability and biomechanics of the patellofemoral joint. However, it remains unclear how much tension is appropriate when performing TKA using the gap technique. Methods One hundred fifty TKAs that used the gap technique were randomized into one of the three groups. Gravity group (n=50) included patients who underwent TKA using only the weight of the patient's lower leg. In 20-lbf group (n=50) and 30-lbf group (n=50), a gap-tensioning device was set at 20lbf and 30lbf respectively. The femoral component rotation was measured based on the clinical transepicondylar axis (cTEA) on postoperative CT and any outliers (a femoral component rotation diverging from the cTEA over 3°) were evaluated. Results The mean femoral component rotation was −0.82°±2.44° (95% confidence interval [CI], −1.52° to −0.13°) in gravity group, −0.40°±2.22° (95% CI, −1.03° to 0.23°) in 20-lbf group, and 1.37°±2.70° (95% CI, 0.61° to 2.14°) in 30-lbf group. The mean femoral component rotation in 30-lbf group was significantly different from that in gravity group (p<0.001) and 20-lbf group (p<0.001). There were more outliers in 30-lbf group (18% in gravity group, 18% in 20-lbf group, and 36% in 30-lbf group; p=0.043). Conclusions The use of a tensioning device set at 30lbf resulted in an externally rotated femoral component and frequent outliers.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2017.01.003
  • Tibial tubercle osteotomy: A biomechanical comparison of two techniques
    • Authors: Christopher J. Maugans; Matthew G. Scuderi; Frederick W. Werner; Stefanos F. Haddad; John P. Cannizzaro
      Abstract: Publication date: Available online 6 February 2017
      Source:The Knee
      Author(s): Christopher J. Maugans, Matthew G. Scuderi, Frederick W. Werner, Stefanos F. Haddad, John P. Cannizzaro
      Purpose The purpose of this study was to determine whether a modified step-cut tibial tubercle osteotomy (Maquet–Fulkerson hybrid) might produce comparable or better results than a standard oblique anteromedialization tibial tubercle osteotomy (Fulkerson type) and thus warrant the surgical need for additional cuts. Methods Six pairs of cadaveric knees were evaluated prior to and after tibial tubercle osteotomies. Simulation was done via a shallow knee bend simulator through 20 to 70° of knee flexion for the intact specimens and following the surgical procedures. The variables tested were trochlear contact forces and pressures and patellar motion. Results Testing showed a decreased force (P=0.027), peak contact pressure (P=0.01) and contact area (P=0.034) on the lateral trochlea of the femur for both types of osteotomies. There was no significant difference in the lateral femoral peak pressure or in the medial femoral peak pressure between the oblique cut and the step-cut. Also, there was no difference in patellar motion after either procedure. Conclusion We conclude that both osteotomies decrease lateral patellofemoral trochlear pressure. The oblique osteotomy may decrease lateral pressure to a greater extent. Regarding biomechanical testing, there was no demonstrable advantage to performing a step-cut osteotomy.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.11.013
  • Smartphone assessment of knee flexion compared to radiographic standards
    • Authors: Matthew J. Dietz; Daniel Sprando; Andrew E. Hanselman; Michael D. Regier; Benjamin M. Frye
      Abstract: Publication date: Available online 5 February 2017
      Source:The Knee
      Author(s): Matthew J. Dietz, Daniel Sprando, Andrew E. Hanselman, Michael D. Regier, Benjamin M. Frye
      Background Measuring knee range of motion (ROM) is an important assessment for the outcomes of total knee arthroplasty. Recent technological advances have led to the development and use of accelerometer-based smartphone applications to measure knee ROM. The purpose of this study was to develop, standardize, and validate methods of utilizing smartphone accelerometer technology compared to radiographic standards, visual estimation, and goniometric evaluation. Methods Participants used visual estimation, a long-arm goniometer, and a smartphone accelerometer to determine range of motion of a cadaveric lower extremity; these results were compared to radiographs taken at the same angles. Results The optimal smartphone position was determined to be on top of the leg at the distal femur and proximal tibia location. Between methods, it was found that the smartphone and goniometer were comparably reliable in measuring knee flexion (ICC=0.94; 95% CI: 0.91–0.96). Visual estimation was found to be the least reliable method of measurement. Conclusions The results suggested that the smartphone accelerometer was non-inferior when compared to the other measurement techniques, demonstrated similar deviations from radiographic standards, and did not appear to be influenced by the person performing the measurements or the girth of the extremity.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.11.014
  • Plateau–patella angle: An option for the evaluation of patellar height
           in patients with patellar instability
    • Authors: Marcelo Batista Bonadio; Camilo Partezani Helito; Julio Augusto do Prado Torres; Riccardo Gomes Gobbi; José Ricardo Pécora; Gilberto Luis Camanho; Marco Kawamura Demange
      Abstract: Publication date: Available online 5 February 2017
      Source:The Knee
      Author(s): Marcelo Batista Bonadio, Camilo Partezani Helito, Julio Augusto do Prado Torres, Riccardo Gomes Gobbi, José Ricardo Pécora, Gilberto Luis Camanho, Marco Kawamura Demange
      Background Patellar instability is a debilitating disease. An important factor related to recurrent dislocation is patellar height. A new method of patellar height measurement, the plateau–patella angle (PPA), was proposed in 2011. However, to date, there is no study evaluating the use of this method in patients with patellar instability. The aim of this study was to evaluate the PPA in patients with recurrent patellar dislocation. Methods This was a retrospective evaluation of the radiographs of 78 knees with patellar instability. Patellar height was measured using the Insall–Salvati (I/S), Caton–Deschamps (C/D) and Blackburne–Peel (B/P) indices and the PPA. The qualitative and quantitative correlations between the various methods and between observers were calculated. Results The PPA had a Pearson correlation of 0.76 (P <0.001) with the I/S index, 0.78 (P <0.001) with the C/D index and 0.90 (P <0.001) with the B/P index. In the qualitative correlation using the Spearman coefficient, the PPA had a correlation of 0.52 (P <0.001) with the I/S index, 0.72 (P <0.001) with the C/D index and 0.70 (P <0.001) with the B/P index. The correlations between the conventional methods were as follows: 0.57 (P <0.001) between the I/S and C/D indices; 0.61 (P <0.001) between the I/S and B/P indices; and 0.73 (P <0.001) between the C/D and B/P indices. Conclusion The determination of the PPA is a reproducible method that is consistent with the methods currently used to measure patellar height in patients with recurrent patellar dislocation.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2017.01.006
  • Gender differences in the restoration of knee joint biomechanics during
           gait after anterior cruciate ligament reconstruction
    • Authors: Makoto Asaeda; Masataka Deie; Naoto Fujita; Yoshifumi Kono; Chiaki Terai; Wataru Kuwahara; Hodaka Watanabe; Hiroaki Kimura; Nobuo Adachi; Toru Sunagawa; Mitsuo Ochi
      Abstract: Publication date: Available online 4 February 2017
      Source:The Knee
      Author(s): Makoto Asaeda, Masataka Deie, Naoto Fujita, Yoshifumi Kono, Chiaki Terai, Wataru Kuwahara, Hodaka Watanabe, Hiroaki Kimura, Nobuo Adachi, Toru Sunagawa, Mitsuo Ochi
      Background The aim of our study was to evaluate the effects of gender on recovery of knee joint biomechanics over the stance phase of gait after reconstruction of the anterior cruciate ligament (ACL). Methods Gait parameters and knee joint kinematics and kinetics were compared in 32 patients (16 male and 16 female) who underwent ACL reconstruction for a unilateral ACL deficiency, with comparison to an age-, height-, and weight-matched Control group. Knee flexion, adduction and tibial rotation angles were measured and knee extension and abduction moment was calculated by inverse dynamics methods. Results Females exhibited more tibial external rotation, in both the Control and ACL groups (P <0.05), which was not changed after ACL reconstruction. Prior to reconstruction, sagittal plane biomechanics were changed, in both males and females, compared to the Control groups (P <0.05). These abnormal sagittal plane mechanics were recovered at 12months, but not six months post-reconstruction. Conclusions We identified gender-based differences in tibial rotation that influenced the kinematics and kinetics of the knee over the stance phase of gait, both pre-operatively and post-ACL reconstruction. Evaluation of biomechanical effects of ACL injury, before and after reconstruction, should be separately evaluated for females and males.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2017.01.001
  • Knee joint moments during high flexion movements: Timing of peak moments
           and the effect of safety footwear
    • Authors: Helen C. Chong; Liana M. Tennant; David C. Kingston; Stacey M. Acker
      Abstract: Publication date: Available online 4 February 2017
      Source:The Knee
      Author(s): Helen C. Chong, Liana M. Tennant, David C. Kingston, Stacey M. Acker
      Aim (1) Characterize knee joint moments and peak knee flexion moment timing during kneeling transitions, with the intent of identifying high-risk postures. (2) Determine whether safety footwear worn by kneeling workers (construction workers, tile setters, masons, roofers) alters high flexion kneeling mechanics. Methods Fifteen males performed high flexion kneeling transitions. Kinetics and kinematics were analyzed for differences in ascent and descent in the lead and trail legs. Results Mean±standard deviation peak external knee adduction and flexion moments during transitions ranged from 1.01±0.31 to 2.04±0.66% body weight times height (BW∗Ht) and from 3.33 to 12.6% BW∗Ht respectively. The lead leg experienced significantly higher adduction moments compared to the trail leg during descent, when work boots were worn (interaction, p=0.005). There was a main effect of leg (higher lead vs. trail) on the internal rotation moment in both descent (p=0.0119) and ascent (p=0.0129) phases. Conclusion Peak external knee adduction moments during transitions did not exceed those exhibited during level walking, thus increased knee adduction moment magnitude is likely not a main factor in the development of knee OA in occupational kneelers. Additionally, work boots only significantly increased the adduction moment in the lead leg during descent. In cases where one knee is painful, diseased, or injured, the unaffected knee should be used as the lead leg during asymmetric bilateral kneeling. Peak flexion moments occurred at flexion angles above the maximum flexion angle exhibited during walking (approximately 60°), supporting the theory that the loading of atypical surfaces may aid disease development or progression.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.12.006
  • Analysis of the factors that correlate with increased knee adduction
           moment during gait in the early postoperative period following total knee
    • Authors: Takeo Nagura; Yasuo Niki; Kengo Harato; Takeshi Mochizuki; Yoshimori Kiriyama
      Abstract: Publication date: Available online 4 February 2017
      Source:The Knee
      Author(s): Takeo Nagura, Yasuo Niki, Kengo Harato, Takeshi Mochizuki, Yoshimori Kiriyama
      Background Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee. Methods Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3months following surgery. A cut-off moment was determined as mean+1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed. Results Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm. Conclusions The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.11.012
  • Three-dimensional relationships between secondary changes and selective
           osteotomy parameters for biplane medial open-wedge high tibial osteotomy
    • Authors: Byung Hoon Lee; Chul Won Ha; Sang Won Moon; Minho Chang; Hun Yeong Kim; Sin Hyung Park; Joon Ho Wang
      Abstract: Publication date: Available online 4 February 2017
      Source:The Knee
      Author(s): Byung Hoon Lee, Chul Won Ha, Sang Won Moon, Minho Chang, Hun Yeong Kim, Sin Hyung Park, Joon Ho Wang
      Background To assess the axial rotational change of distal tibia and posterior tibial slope (PTS) change after OWHTO in 3-D planes and to identify the causal relationship on the effect of variation in the posterior slope angle and rotational errors. Methods A total of 21 patients (23 knees) underwent OWHTO and were evaluated with 3D-CT before and after surgery. Medial proximal tibial angle in the coronal plane, PTS in the sagittal plane, and rotational axis in axial plane were evaluated and compared between pre- and post-operative 3D models constructed by applying reverse-engineering software. As a selective osteotomy parameter, hinge axis and gap ratio were measured in the postoperative 3D models Results The increasing tendency of internal rotation of the distal tibia after OWHTO was positively related to hinge axis (β=0.730, p=0.001, R2 =0.546) and gap ratio (β=−0.283, p=0.001, R2 =0.520), which also showed statistically significant linear correlations to PTS changes after multivariate regression analysis that controlled for the rotational change of the distal tibia (hinge axis: β=0.443, p=0.006; gap ratio: β=0.144, p=0.017). Conclusion Hinge axis more posterolaterally was related to a greater increase in internal rotation after biplane medial open-wedge HTO, and hinge axis and gap ratio were significant predictors of PTS change after rotational change was controlled for. Hinge axis has to be considered an important independent variable for limiting unintended axial rotation change as well as PTS change as secondary. Clinical relevance The relationship of the hinge axis with the rotational change and its influence to PTS change, acknowledged from by-product of the statistical analysis, might provide a deeper understanding of HTO, and should have constitutional effects on the development of HTO procedures and implants.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.11.010
  • The role of medial meniscus posterior root tear and proximal tibial
           morphology in the development of spontaneous osteonecrosis and
           osteoarthritis of the knee
    • Authors: Ryota Yamagami; Shuji Taketomi; Hiroshi Inui; Keitaro Tahara; Sakae Tanaka
      Abstract: Publication date: Available online 4 February 2017
      Source:The Knee
      Author(s): Ryota Yamagami, Shuji Taketomi, Hiroshi Inui, Keitaro Tahara, Sakae Tanaka
      Background Medial meniscus posterior root tear (MMPRT) has been reported to play a key role in the development of spontaneous osteonecrosis of the knee (SONK) and osteoarthritis (OA) of the knee. However, little is known about the differences in the development of SONK and OA after MMPRT. The purpose of this study was to investigate the factors contributing to the development of these conditions. Methods We evaluated the existence of MMPRT and the extent of medial meniscal extrusion in preoperative magnetic resonance images and proximal tibial morphology in radiographs of 45 patients with SONK and 104 patients with OA who underwent knee surgery. Results There were no significant differences in age, gender, height, weight, and body mass index between the two groups. The incidence of MMPRT and the mean posterior tibial slope (PTS) were significantly higher in SONK than in OA patients (62.2% versus 34.3%, P =0.002, and 12.8° versus 10.5°, P <0.001, respectively). The mean extent of meniscal extrusion was larger in OA than in SONK patients (7.5mm versus 5.3mm, P <0.001). The mean tibial varus angle was 4.8° in SONK and 5.4° in OA, with no significant difference between the two (P =0.088). Multivariable logistic regression analysis showed that compared with OA, SONK was more closely associated with the existence of MMPRT and had a smaller extent of medial meniscus extrusion and higher PTS. Conclusion MMRPT and higher PTS were more closely associated with the development of SONK than with that of OA.

      PubDate: 2017-02-05T18:07:16Z
      DOI: 10.1016/j.knee.2016.12.004
  • Contents List
    • Abstract: Publication date: January 2017
      Source:The Knee, Volume 24, Issue 1

      PubDate: 2017-02-05T18:07:16Z
  • A long term clinical outcome of the Medial Pivot Knee Arthroplasty System
    • Authors: George A. Macheras; Spyridon P. Galanakos; Panagiotis Lepetsos; Panagiotis P. Anastasopoulos; Stamatios A. Papadakis
      Abstract: Publication date: Available online 29 January 2017
      Source:The Knee
      Author(s): George A. Macheras, Spyridon P. Galanakos, Panagiotis Lepetsos, Panagiotis P. Anastasopoulos, Stamatios A. Papadakis
      Background The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system. Methods Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2years. Results All patients showed a statistically significant improvement (p<0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°–135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17years. Conclusion The obtained results demonstrate excellent long-term clinical outcome for this knee design.

      PubDate: 2017-01-29T17:37:06Z
      DOI: 10.1016/j.knee.2017.01.008
  • Validity of rotational laxity coupled with anterior translation of the
           knee: A cadaveric study comparing radiostereometry and the Rotab®
    • Authors: A. Senioris; T. Rousseau; M. L'Hermette; S Gouzy; F. Duparc; F. Dujardin
      Abstract: Publication date: Available online 28 January 2017
      Source:The Knee
      Author(s): A. Senioris, T. Rousseau, M. L'Hermette, S Gouzy, F. Duparc, F. Dujardin
      Background In current practice, anterior cruciate ligament (ACL) tears can be diagnosed using several devices to measure anterior tibial translation and rotational knee laxity, but these measures are never collected together. The Rotab®, which yields simultaneous measurements of anterior tibial translation and passive lower limb rotation under stress, would therefore be advantageous in current practice, but its reliability has never been tested. Aim of study To evaluate the accuracy and reliability of the Rotab® compared to the reference system, radiostereometric analysis (RSA). Methods This anatomical study was conducted on 14 lower limbs collected from fresh cadavers. Simultaneous measurements of anterior tibial translation and rotation were obtained with both systems, with antero-posterior (AP) forces of 134N and 250N using the Rotab®. Measurements were made on intact ACL and then repeated after ACL section. Variables were analyzed in univariate analysis by ANOVA, and the intraclass correlation coefficient (ICC) between the systems was determined by the Bland and Altman method. Results The difference between the two methods for evaluating anterior tibial translation was 0.05±0.98mm at 134N and 0.29±1.04mm at 250N. The correlation between the tests was high (r134 =r250 =0.97, p=0.8). The difference between the two methods for rotational laxity was 0.69±2.7° at 134N and 0.5±0.6° at 250N. The Rotab® showed a significant difference only at 250N for rotational laxity after the ACL tear. Conclusion The Rotab® is a reliable device to measure rotational laxity coupled with anterior translation of the knee.

      PubDate: 2017-01-29T17:37:06Z
      DOI: 10.1016/j.knee.2017.01.009
  • Experience of total knee arthroplasty using a novel navigation system
           within the surgical field
    • Authors: Richard Niehaus; David Schilter; Paolo Fornaciari; Christian Weinand; Marcus Boyd; Marcel Ziswiler; Stefan Ehrendorfer
      Abstract: Publication date: Available online 20 January 2017
      Source:The Knee
      Author(s): Richard Niehaus, David Schilter, Paolo Fornaciari, Christian Weinand, Marcus Boyd, Marcel Ziswiler, Stefan Ehrendorfer
      Background With the aim of improving component alignment and outcome in total knee arthroplasty (TKA), several computer-assisted devices (CAD) have been developed. Methods In February 2014, the present unit started to use a new imageless navigation system with accelerometric pods within the surgical field for all primary TKAs; there was no need for optical trackers or cameras. This paper presents the results of the first 72 TKAs using this iAssist system in 71 prospectively collected and retrospectively analyzed patients. It analyzed component positioning in standard and full-length leg x-rays. Results The mean age of the patients was 70years (range 52–88). The center of hip, knee and ankle (mechanical axes) deviated on average 0.5° (standard deviation (SD) of 1.8) valgus from the targeted straight alignment. Three TKAs had >3° deviation (i.e. four degree varus, five degree and seven degree valgus). The frontal tibial tray alignment was an average of 89.9° (range 86.4–100.1°, SD ±2.0) with the target being 90°, and the sagittal slope was as targeted at 85.0° (range 78.4–88.8°, SD ±1.7). Conclusions This CAD facilitated good mechanical alignment and reproducible accuracy in component positioning. Pods clipped onto cutting jigs within the surgical field provided simple and accurate navigation, with little extra time needed for calibration and no need for optical trackers or pre-operative imaging.

      PubDate: 2017-01-23T13:49:16Z
      DOI: 10.1016/j.knee.2016.10.021
  • Outpatient versus inpatient anterior cruciate ligament reconstruction: A
           systematic review with meta-analysis
    • Authors: Deisi Ferrari; Thiago J.A. Lopes; Paulo F.A. França; Fábio M. Azevedo; Evangelos Pappas
      Abstract: Publication date: Available online 20 January 2017
      Source:The Knee
      Author(s): Deisi Ferrari, Thiago J.A. Lopes, Paulo F.A. França, Fábio M. Azevedo, Evangelos Pappas
      Background Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes. Aim To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR. Methods Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes. Results Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p=0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p=0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p=0.78 (mean difference −0.16; 95% confidence interval −1.28 to 0.96) and p=0.44 (0.48, −0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p=0.0001 (−0.39, −0.57 to −0.21) and p=0.0001(−0.39, −0.39 to −0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group. Conclusion and key findings Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies. Registration number PROSPERO (CRD42015024990).

      PubDate: 2017-01-23T13:49:16Z
      DOI: 10.1016/j.knee.2017.01.002
  • Letter to the Editor — “Cementing the femoral component in total knee
           arthroplasty: Which technique is the best?” by Michaël Vaninbroukx et
    • Authors: Martin Schwarze; Virag Borsai; Rudi Georg Bitsch; Johannes Adrian Eckert; Sebastian Jäger
      Abstract: Publication date: Available online 18 January 2017
      Source:The Knee
      Author(s): Martin Schwarze, Virag Borsai, Rudi Georg Bitsch, Johannes Adrian Eckert, Sebastian Jäger

      PubDate: 2017-01-23T13:49:16Z
      DOI: 10.1016/j.knee.2016.08.004
  • Good functional results following high tibial opening-wedge osteotomy of
           knees with medial osteoarthritis
    • Authors: Arne Ekeland; Tor Kjetil Nerhus; Sigbjørn Dimmen; Elisabeth Thornes; Stig Heir
      Abstract: Publication date: Available online 9 January 2017
      Source:The Knee
      Author(s): Arne Ekeland, Tor Kjetil Nerhus, Sigbjørn Dimmen, Elisabeth Thornes, Stig Heir
      Background To report time dependent functional improvement and predictive risk factors for failure when the load in varus knees with medial osteoarthritis is shifted from the medial to the lateral knee compartment. Methods Forty-nine consecutive patients (52 knees), mean age 47 (31–64) years, underwent a high tibial opening-wedge valgus osteotomy stabilized with a Puddu plate and bone grafting. The patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at three and six months, one, two, five and 10years postoperatively with a mean follow-up time of 8.3years (2.0–10.6). Results Mean angular correction was 8.0° (four to 12). The five subscores of KOOS increased significantly during the first year by 40–131% from preoperative values, the good results remaining throughout the 10-year follow-up for those with a surviving osteotomy. The outcome was related to the grade of preoperative osteoarthritis. Seven knees were converted to total knee arthroplasty (TKA) mean 6.2years (two to nine) post-operatively, and had a lower KOOS preoperatively than those of surviving osteotomies. The osteotomy survival rate at five years was 94% and at 10years 83%. Patients with KOOS subscore quality of life (QoL) <44 at the two-year follow-up had a 11.7 times higher risk for later TKA than those with QoL ≥44 (P=0.017). Conclusion High tibial opening-wedge osteotomy for medial knee osteoarthritis resulted in good functional recovery after one year and favorable mid-term results. It may be a good treatment option for middle-aged patients with varus knees and medial osteoarthritis in order to prevent or postpone TKA.

      PubDate: 2017-01-16T11:07:04Z
      DOI: 10.1016/j.knee.2016.12.005
  • The incidence and impact of arthroscopy in the year prior to total knee
    • Authors: S.B. Barton; G.J. McLauchlan; S.J. Canty
      Abstract: Publication date: Available online 9 January 2017
      Source:The Knee
      Author(s): S.B. Barton, G.J. McLauchlan, S.J. Canty
      Background Prior knee surgery and arthroscopy is known to increase complications and re-operations in subsequent total knee arthroplasty (TKA). We set out to examine the time dependant effect of arthroscopy on Patient Reported Outcome Measures following subsequent TKA. Methods A retrospective review of theatre and clinical records identified 186 patients who underwent TKA within a year of arthroscopy (2009–2013). Oxford knee score (OKS) data was compared with a published cohort from the same department (1708 patients). Results One hundred and eighty six patients were identified who underwent TKA within a year of arthroscopy; 112 females, 74 males; mean age 64 (SD 10); mean BMI 31.4 (SD 4.6). There was no significant difference between groups with respect to sex, age, BMI, or pre-operative OKS. One hundred and three patients underwent TKA within six months of arthroscopy. This group had a significant reduction in OKS compared to the previously published cohort (32.8 vs 35.3, p <0.005). There was no significant difference in OKS when TKA was performed more than six months after arthroscopy (35.3). The re-operation rate was 14% in the arthroscopy group, with a revision rate of 3.8% vs 1.6% in a previously published large cohort from the same institution. Conclusions There appears to be a negative impact of arthroscopy in relation to subsequent TKA which seems to be time dependent. TKA should not routinely be performed within six months of arthroscopy. This should inform guidelines on the management knee osteoarthritis.

      PubDate: 2017-01-16T11:07:04Z
      DOI: 10.1016/j.knee.2016.12.003
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