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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  [3177 journals]
  • Exploring individual adaptations to an anterior cruciate ligament injury
           prevention programme
    • Authors: Aaron S. Fox; Jason Bonacci; Scott G. McLean; Natalie Saunders
      Abstract: Publication date: Available online 9 January 2018
      Source:The Knee
      Author(s): Aaron S. Fox, Jason Bonacci, Scott G. McLean, Natalie Saunders
      Background Individual responses to anterior cruciate ligament injury prevention programmes (ACL IPPs) have received little attention. This study examined the effects of an ACL IPP on neuromuscular control and lower limb biomechanics during landing at the group and individual levels. Methods Sixteen female athletes were randomly allocated to training (n =8) or control (n =8) groups. Electromyography, and three-dimensional kinematic and kinetic data were collected during landing at two testing sessions. Repeated measures ANOVA and effect sizes (Cohen's d) examined the effect of the IPP at the group and individual levels. A sub-group analysis comparing the effect of the IPP on ‘high-’ (i.e. large peak knee abduction moment at baseline) versus ‘low-risk’ individuals was also conducted. Results At the group level; the IPP increased activation of the medial hamstrings prior to landing (p<0.001; d =0.264) and the medial gastrocnemius at landing (p<0.001; d =0.426), and increased hip external rotation early after initial contact (p<0.001; d =0.476). Variable adaptations were seen across individuals within the training group for all variables (p<0.001). The IPP had a large effect in reducing frontal plane knee moments for ‘high-risk’ individuals (d >0.91), however these results did not reach statistical significance (p>0.05). Conclusions The IPP induced adaptations during landing, however, individual data revealed dissimilar responses to the programme. Individuals displaying a pre-existing high-risk strategy may incur greater benefits from IPPs, yet only if the programme targets the relevant high-risk strategy.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.11.011
  • Early comparative outcomes of unicompartmental and total knee arthroplasty
           in severely obese patients
    • Authors: Zachary C. Lum; David A. Crawford; Adolph V. Lombardi; Jason M. Hurst; Michael J. Morris; Joanne B. Adams; Keith R. Berend
      Abstract: Publication date: Available online 9 January 2018
      Source:The Knee
      Author(s): Zachary C. Lum, David A. Crawford, Adolph V. Lombardi, Jason M. Hurst, Michael J. Morris, Joanne B. Adams, Keith R. Berend
      Background Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA. Methods Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI >35kg/m2 (mean 41kg/m2) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared. Results UKA patients had higher preoperative ROM, and Knee Society pain (KSP), functional (KSF), and clinical (KSC) scores (p<0.001, p=0.0008, p=0.0003, p=0.051 respectively). Mean tourniquet times, operative times, and lengths of stay were lower after UKA. Four TKA patients required transfusion. Mean follow-up was 2.3years. The frequency of manipulation under anesthesia was higher in TKA patients (p<0.001), while the rate of component revision was similar between the two groups (1.2% vs. 1.7%, p=0.328). Frequency of deep infection was lower in the UKA group (p=0.016). Postoperative KSF, change in KSF, and ROM were higher (p<0.0001) after UKA, but KSP and KSC were equivalent. Conclusions Severely obese patients who underwent medial UKA demonstrated equal survivorship with substantially fewer reoperations, reduced deep infection, and less perioperative complications at short term follow-up. Severely obese patients had improved KSF scores and maintenance of ROM after UKA compared with TKA.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.10.006
  • A computed-tomography-scan-based template to place the femoral component
           in accurate rotation with respect to the surgical epicondylar axis in
           total knee arthroplasty
    • Authors: Yasushi Oshima; Norishige Iizawa; Tatsunori Kataoka; Tokifumi Majima; Shinro Takai
      Abstract: Publication date: Available online 9 January 2018
      Source:The Knee
      Author(s): Yasushi Oshima, Norishige Iizawa, Tatsunori Kataoka, Tokifumi Majima, Shinro Takai
      Background Femoral rotational alignment is considered an essential factor for total knee arthroplasty because malrotation of femoral components results in poor outcomes. To obtain proper alignment, we developed a superimposable computed tomography (CT) scan-based template to intraoperatively determine the accurate surgical epicondylar axis (SEA), and evaluated the effectiveness of this CT template. Methods In the experimental group (n=55), three serial slices of CT images, including medial and lateral epicondyles, were merged into a single image, and SEA was overlaid. SEA was traced onto an image of an assumed distal femoral resection level; this combined image was then printed out onto a transparent film as a CT template. Following a distal femoral resection in TKA, SEA was duplicated onto the femoral surface. Thereafter, the posterior condyle was resected parallel to this SEA. In the control group (n=53), posterior condyles were resected at three degrees of the external rotation from the posterior condylar line (PCL). A posterior condylar angle (PCA) between PCL of the femoral component and SEA was postoperatively evaluated. Positive values indicated external rotation of the femoral component from the SEA. Results In the experimental group, PCA was 0.01°±1.61°, and three cases were considered as outliers (more than three degrees of less than −3 degrees). Conversely, in the control group, PCA was 0.10°±2.4°, and 12 cases were considered as outliers. Consequently, dispersion of PCA data was significantly smaller in the experimental group (P =0.004). Conclusions The CT template accurately determined intraoperative SEA.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.11.009
  • Outcomes of total knee arthroplasty in degenerative osteoarthritic knee
           with genu recurvatum
    • Authors: Seung-Suk Seo; Chang-Wan Kim; Chang-Rack Lee; Jin-Hyuk Seo; Do-Hun Kim; Ok-Gul Kim
      Abstract: Publication date: Available online 9 January 2018
      Source:The Knee
      Author(s): Seung-Suk Seo, Chang-Wan Kim, Chang-Rack Lee, Jin-Hyuk Seo, Do-Hun Kim, Ok-Gul Kim
      Background This study aimed to assess the incidence of genu recurvatum without neuromuscular disorders in knees that underwent navigation-assisted total knee arthroplasty (TKA), to evaluate short-term radiologic and clinical results of navigation-assisted TKA in genu recurvatum, and to evaluate differences in results according to the degree of pre-operative hyperextension and type of implant and insert. Methods This study retrospectively reviewed 510 knees that underwent navigation-assisted TKA from January 2005 to December 2011. The incidence of knees that showed hyperextension of ≥5° (genu recurvatum) on navigation, and the accompanying alignment were evaluated. It assessed radiologic, intraoperative, and clinical results in recurvatum and control groups by using propensity score matching. Results A total of 465 knees underwent navigation-assisted TKA for degenerative osteoarthritis. Genu recurvatum was observed in 55 knees (11.8%). Of these, 41 knees (74.5%) had degree of hyperextension between five degrees and 10°, and 47 (85.4%) had varus alignment. The thickness of the resected distal femur in the recurvatum group (7.6±1.6mm) was less than that in the control group (8.4±1.4mm, P =0.001). The thickness of the insert in the recurvatum group (12.5±2.3mm) was greater than in the control group (10.8±1.5mm, P <0.001). The sagittal alignment at the final follow-up was 1.3±3.4° in the control group and −0.1±0.7° in the recurvatum group (P =0.003). Subgroup analyses in the recurvatum group showed no significant difference in sagittal alignment and patient-related outcomes by degree of pre-operative hyperextension and implant/insert type (P >0.05 for all parameters). Conclusions Genu recurvatum was not uncommon among patients undergoing primary TKA. This review obtained satisfactory short-term clinical and radiologic results, with a smaller distal femoral resection and thicker insert.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.10.008
  • Clinical and radiologic evaluation of medial epicondylar osteotomy for
           varus total knee arthroplasty
    • Authors: Jae Ang Sim; Young Gon Na; Jae Yun Go; Beom Koo Lee
      Abstract: Publication date: Available online 9 January 2018
      Source:The Knee
      Author(s): Jae Ang Sim, Young Gon Na, Jae Yun Go, Beom Koo Lee
      Background In varus total knee arthroplasty (TKA), a pathologic contracture of the medial soft tissue should be released for ligament balancing. A medial epicondylar osteotomy has been performed as an alternative method for this. The purpose of this study was to demonstrate the clinical and radiologic results of medial epicondylar osteotomy for varus TKA, focusing on the union type of osteotomy site. Methods The study retrospectively evaluated 61 cases with a mean femorotibial angle of 10.4° varus and a mean flexion contracture angle of 8.5±9.8°. Intraoperative medial and lateral gap difference in extension and 90° flexion was accepted at <2mm. Clinical outcomes (Knee Society Scores, range of motion) and radiologic outcomes (coronal alignment and valgus stability) were compared between the two groups divided by the union type of osteotomy site (bony union or fibrous union). Results The clinical and radiologic outcomes were significantly improved at the latest follow-up. Bony union was achieved in 39 (63.9%) patients, whereas 22 patients showed fibrous union. There was no difference in the varus–valgus angle on the stress radiographs between the bony union and fibrous union group (1.6±1.2° vs. 1.6±0.8°, P <0.916). The Knee Society Scores (knee, function), range of motion and radiographic alignment did not differ between the two groups. Conclusion Medial epicondylar osteotomy was a good option for gap balancing during TKA, as it provided satisfactory clinical and radiological results, regardless of union type of the osteotomy site.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.11.004
  • Associations between cartilage proteoglycan density and patient outcomes
           12months following anterior cruciate ligament reconstruction
    • Authors: Brian Pietrosimone; Daniel Nissman; Darin A. Padua; J. Troy Blackburn; Matthew S. Harkey; Robert A. Creighton; Ganesh M. Kamath; Kaitlin Healy; Randy Schmitz; Jeffrey B. Driban; Steve W. Marshall; Joanne M. Jordan; Jeffrey T. Spang
      Abstract: Publication date: Available online 9 January 2018
      Source:The Knee
      Author(s): Brian Pietrosimone, Daniel Nissman, Darin A. Padua, J. Troy Blackburn, Matthew S. Harkey, Robert A. Creighton, Ganesh M. Kamath, Kaitlin Healy, Randy Schmitz, Jeffrey B. Driban, Steve W. Marshall, Joanne M. Jordan, Jeffrey T. Spang
      Background Lower proteoglycan density (PGD) of the articular cartilage may be an early marker of osteoarthritis following anterior cruciate ligament (ACL) reconstruction (ACL-R). The purpose this study was to determine associations between the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and PGD of the articular cartilage in the femur and tibia 12-months following ACL-R. Methods We evaluated KOOS pain, symptoms, function in activities of daily living (ADL), function in sport and recreation (Sport), and quality of life (QOL), as well as PGD using T1rho magnetic resonance imaging in 18 individuals 12.50±0.70months (these are all mean±standard deviation) following unilateral ACL-R (10 females, eight males; 22.39±4.19years; Marx Score=10.93±3.33). Medial and lateral load-bearing portions of the femoral and tibial condyles were sectioned into three (anterior, central and posterior) regions of interest (ROIs). T1rho relaxation times in the ACL-R knee were normalized to the same regions of interest in the non-surgical knees. Alpha levels were set at P≤0.05. Results Worse KOOS outcomes were significantly associated with greater T1rho relaxation time ratios in the posterior-lateral femoral condyle [pain (r=−0.54), ADL (r=−0.56), Sport (r=−0.62) and QOL (r=−0.59)] central-lateral femoral condyle [Sport (r=−0.48) and QOL (r=−0.42)], and the anterior-medial femoral condyle [Sport (r=−0.46) and QOL (r=−0.40)]. There were no significant associations between the KOOS and T1rho outcomes for tibial ROI. Conclusions Lower PGD of the femoral cartilage in the ACL-R knees was associated with worse patient-reported outcomes.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.10.005
  • Synthetic mesh vs. allograft extensor mechanism reconstruction in total
           knee arthroplasty — A systematic review of the literature and
    • Authors: David Shau; Ryan Patton; Suhag Patel; Laura Ward; George Guild
      Abstract: Publication date: Available online 8 January 2018
      Source:The Knee
      Author(s): David Shau, Ryan Patton, Suhag Patel, Laura Ward, George Guild
      Background: Extensor mechanism disruption after total knee arthroplasty (TKA) is a devastating complication. Reconstruction with allograft and synthetic mesh has been described. However, these reports have typically been small case series, and controversy exists with regard to which reconstruction technique is optimal. Methods: The authors performed a systematic review using PUBMED, MEDLINE, EMBASE, BIOSIS,, and Cochrane Database of Systematic Reviews identifying 14 articles meeting inclusion criteria and producing 204 knees for comparison. Studies with repairs performed under full knee extension were included. Case reports and non-English studies were excluded. Available demographics and clinical outcome data were collected from each study. Appropriate statistical analysis was performed to compare the variables. Results: Baseline demographics and patient complexity were similar between the two cohorts. Reconstruction success rates (76% allograft vs. 74% mesh), average time to diagnosis/treatment, Knee Society Scores (KSS), knee range of motion/extensor lag, and complication rates yielded no statistical difference. Synthetic mesh was used more frequently with concomitant revision of components. Discussion: This systematic review shows equivalent success of allograft and synthetic mesh with approximately 25% failure rate in both groups. Periprosthetic joint infection remains a common and significant complication and reason for failure in both groups. Overall, synthetic mesh showed equivalent extensor mechanism reconstruction success as allograft but with much lower cost, near universal availability, lack of disease transmission, and potential for diminishing graft stretch-out. Future research in larger case series or comparative study is needed to help aid in management of this largely unsolved problem in total knee reconstruction.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.12.004
  • The effect of low-load exercise on joint pain, function, and activities of
           daily living in patients with knee osteoarthritis
    • Authors: Jason Peeler; Jacquie Ripat
      Abstract: Publication date: Available online 8 January 2018
      Source:The Knee
      Author(s): Jason Peeler, Jacquie Ripat
      Background Knee osteoarthritis has a lifetime risk of nearly one in two, with obese individuals being most susceptible. While exercise is universally recognized as a critical component for management, unsafe or ineffective exercise frequently leads to exacerbation of joint symptoms. Aim Evaluate the effect of a 12week lower body positive pressure (LBPP) supported low-load treadmill walking program on knee pain, joint function, and performance of daily activities in patients with knee osteoarthritis (OA). Design Prospective, observational, repeated measures investigation. Setting Community based, multidisciplinary musculoskeletal medicine clinic. Patients Thirty-one patients, aged 50–75, with a BMI ≥25kg/m2 and radiographic confirmed mild to moderate knee OA. Intervention Twelve week LBPP treadmill walking exercise regimen. Outcome measures The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Canadian Occupational Performance Measure (COPM) were used to quantify joint symptoms and patient function; isokinetic thigh muscle strength was evaluated; and a 10-point VAS was used to quantify acute knee pain while walking. Baseline and follow-up data were compared in order to examine the effect of the 12week exercise intervention. Results There was a significant difference between baseline and follow-up data: KOOS and COPM scores both improved; thigh muscle strength increased; and acute knee pain during full weight bearing walking diminished significantly. Conclusions Participation in a 12week LBPP supported treadmill walking exercise regimen significantly enhanced patient function and quality of life, as well as the ability to perform activities of daily living that patient's self-identified as being important, yet difficult to perform.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.12.003
  • Interleukin-6 and leptin levels are associated with preoperative pain
           severity in patients with osteoarthritis but not with acute pain after
           total knee arthroplasty
    • Authors: Syed Azim; James Nicholson; Mario J. Rebecchi; William Galbavy; Tian Feng; Sabeen Rizwan; Ruth A. Reinsel; Martin Kaczocha; Helene Benveniste
      Abstract: Publication date: Available online 8 January 2018
      Source:The Knee
      Author(s): Syed Azim, James Nicholson, Mario J. Rebecchi, William Galbavy, Tian Feng, Sabeen Rizwan, Ruth A. Reinsel, Martin Kaczocha, Helene Benveniste
      Background Identifying drivers of pain that can serve as novel drug targets is important for improving perioperative analgesia. Total knee arthroplasty (TKA) is associated with significant postoperative pain. Cytokines contribute to the pathophysiology of osteoarthritis (OA) and associated pain. However, the influence of perioperative cytokine levels after TKA surgery upon postoperative pain remains unexplored. Methods We designed a prospective observational study to profile three proinflammatory cytokines, interleukin-6 (IL-6), tumor necrosis factor α (TNFα), and leptin in serum, synovial, and cerebrospinal fluid of TKA patients perioperatively to determine associations between cytokine levels and pain. We characterized time-trajectories in cytokines pre- and post-surgery and explored their relationships to pain across gender. Results Preoperative pain, measured by functional pain disability scores (PDQ), was predictive of postoperative pain. There were no gender differences in severity of preoperative pain or acute postoperative pain. Serum IL-6, serum leptin, and synovial fluid leptin were positively correlated with body mass index and preoperative pain severity. Stratification of patients by gender revealed strong correlations between serum IL-6, leptin, and PDQ only in females, suggesting that females may be more sensitive to the nociceptive actions of these cytokines. Although serum IL-6 increased dramatically (and TNFα increased modestly) four hours after surgery and remained elevated at 72h; they were not associated with the severity of acute postoperative pain. Conclusions Our data suggest that while preoperative chronic pain is predictive of the severity of acute postoperative pain in TKA patients, the pre- and post-operative inflammatory status does not predict postoperative pain.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.12.001
  • Anterior tibial laxity using the GNRB® device in healthy knees
    • Authors: Y. Alqahtani; J. Murgier; P. Beaufils; P. Boisrenoult; C. Steltzlen; N. Pujol
      Abstract: Publication date: Available online 5 January 2018
      Source:The Knee
      Author(s): Y. Alqahtani, J. Murgier, P. Beaufils, P. Boisrenoult, C. Steltzlen, N. Pujol
      Background GRNB® is a non-radiating power tool that allows the evaluation of the anterior tibial translation. Hypothesis: The pressure exerted by the system against the patella and the body mass index (BMI) could affect the anterior tibial translation when we repeat the measurements in healthy knees. Materials and methods We retrospectively evaluated the measurements of anterior knee laxity in healthy knees carried out by the GNRB® in 69 consecutive patients who underwent anterior cruciate ligament (ACL) repair in the contralateral knee. Two measurements were carried out, the initial measurements (M1), and then repeated at a mean of seven months (M2) (4.9 to 13months). Results There were 38 women and 31 men with an average age of 31years. In healthy knees, the Mean average anterior translation was 5.4±4mm with an average patellar force of 35.8 at time M1. The average anterior translation was 4.9±4mm with an average patellar force of 47 at time M2. There was a significant difference between the measurements M1 and M2 (P <0.03). The tightening force was significantly different between the two sets of measurements (P <10–7). There was a negative correlation between the pressure applied on the patella and anterior knee laxity (P <0.01). Conclusion The pressure force exerted on the patella during GNRB® affects the measurement of anterior laxity in healthy knees. This raises the problem of the reproducibility of the measurements during repeated examinations at different times.

      PubDate: 2018-01-09T19:18:37Z
      DOI: 10.1016/j.knee.2017.03.004
  • Visual knee-kinetic biofeedback technique normalizes gait abnormalities
           during high-demand mobility after total knee arthroplasty
    • Authors: Jesse C. Christensen; Paul C. LaStayo; Robin L. Marcus; Gregory J. Stoddard; K. Bo Foreman; Ryan L. Mizner; Christopher L. Peters; Christopher E. Pelt
      Abstract: Publication date: Available online 2 January 2018
      Source:The Knee
      Author(s): Jesse C. Christensen, Paul C. LaStayo, Robin L. Marcus, Gregory J. Stoddard, K. Bo Foreman, Ryan L. Mizner, Christopher L. Peters, Christopher E. Pelt
      Background Abnormal knee mechanics frequently follow total knee arthroplasty (TKA) surgery with these deficits amplifying as task demands increase. Knee-kinetic biofeedback could provide a means of attenuating gait abnormalities. The purposes of this study were as follows: (1) to describe the gait characteristic differences between patients with TKA and non-TKA adults during level (low-demand) and decline (high-demand) walking; and (2) where differences existed, to determine the impact of knee-kinetic biofeedback on normalizing these abnormalities. Methods Twenty participants six months following a primary TKA and 15 non-TKA peers underwent gait analysis testing during level and decline walking. Knee-kinetic biofeedback was implemented to patients with TKA to correct abnormal gait characteristics if observed. Results Patients with TKA had lower knee extensor angular impulse (p<0.001), vGRF (p=0.001) and knee flexion motion (p=0.005) compared to the non-TKA group during decline walking without biofeedback. Patients with TKA normalized their knee extensor angular impulse (p=0.991) and peak vGRF (p=0.299) during decline walking when exposed to biofeedback. No between-group differences were observed during level walking. Groups were similar in age, gender, body mass index, physical activity level, pain interference and depression scores (p>0.05). Conclusion Patients with TKA demonstrate abnormal gait characteristics during a high-demand walking task when compared to non-TKA peers. Our findings indicate that knee-kinetic biofeedback can induce immediate improvements in gait characteristics during a high-demand walking task. There may be a potential role for the use of visual knee-kinetic biofeedback techniques to improve gait abnormalities during high-demand tasks following TKA.

      PubDate: 2018-01-03T18:49:39Z
      DOI: 10.1016/j.knee.2017.11.010
    • Authors: B.V. Bloch; A. Shah; S. Snape; T. Boswell; P.J. James
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): B.V. Bloch, A. Shah, S. Snape, T. Boswell, P.J. James

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.006
    • Authors: M.E. Berend; H.D. Clarke; J.B. Meding; J.L. Carter; K.E. Davis
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): M.E. Berend, H.D. Clarke, J.B. Meding, J.L. Carter, K.E. Davis

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.007
    • Authors: G.S. Turnbull; C.E.H. Scott; D. MacDonald; F.A. Wade; S.J. Breusch
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): G.S. Turnbull, C.E.H. Scott, D. MacDonald, F.A. Wade, S.J. Breusch

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.008
  • Age-related changes in the knee meniscus
    • Authors: Akira Tsujii; Norimasa Nakamura; Shuji Horibe
      Pages: 1262 - 1270
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Akira Tsujii, Norimasa Nakamura, Shuji Horibe
      Background Aging is the most prominent risk factor for the development of osteoarthritis (OA), which affects knees and causes major health burdens. Meniscal dysfunction mostly based on degeneration contributes to the development and progression of knee OA. Meniscal degeneration is caused by various extrinsic factors, such as repetitive trauma or leg malalignment, while meniscal aging is considered as internal changes, such as molecular or cellular changes. Little is known about age-related changes in the meniscus. Therefore, this review aimed to summarize and clarify the understanding of the aged meniscus. Methods There are few articles about natural aging in the meniscus, because most reports only demonstrate the effects of OA on the meniscus. We searched PubMed (1948 to November 2016) to identify and summarize all English-language articles evaluating natural aging in the meniscus. Results There is evidence of compositional change in the meniscus with aging, involving cells, collagens, and proteoglycans. In addition, as recent reports on the natural aging of cartilage have indicated, senescence of the meniscal cells may also lead to disruption of meniscal cells and tissue homeostasis. Due to the low turnover rate of collagen, accumulation of advanced glycation end-products largely contributes to tissue stiffness and vulnerability, and finally results in degenerative changes or tears. Furthermore, environmental factors such as joint fluid secreted by inflamed synovium could also contribute to meniscal tissue deterioration. Conclusions Age-related changes induce meniscal tissue vulnerability and finally lead to meniscal dysfunction.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.001
  • Knee instability as the primary cause of failure following Total Knee
           Arthroplasty (TKA): A systematic review on the patient, surgical and
           implant characteristics of revised TKA patients
    • Authors: Christopher J. Wilson; Annika Theodoulou; Raechel A. Damarell; Jeganath Krishnan
      Pages: 1271 - 1281
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Christopher J. Wilson, Annika Theodoulou, Raechel A. Damarell, Jeganath Krishnan
      Background The aim of this review was to systematically assess the current evidence available regarding knee instability after TKA to identify time to failure between primary and revision TKA. In addition, we considered the patient, surgical and implant characteristics of primary TKA patients revised for knee instability, and investigated methods used for knee instability diagnosis. Methods A systematic search of six databases and the unpublished literature was performed. Studies referring to instability in post-operative primary TKA patients, reporting on revision TKA due to instability, and published or available between 2005 to 30-Mar-2015 were eligible for inclusion. Quantitative data for continuous variables were pooled in statistical meta-analyses. Results A total of 1841 unique studies were identified, 42 of which met the selection criteria and a total of 22 studies included in the review. Time to failure between primary and revision TKA was 44.7months (95% CI [33.8, 55.7]), and the weighted mean age at time of revision surgery was 67.6years (95% CI [65.38, 69.75]). A gender distribution was identified, with approximately 16.4% more females revised for instability, however this was unable to be corrected for the baseline population. The majority of studies used a combination of radiographic and clinical testing to diagnose knee instability. Conclusion Research on knee instability following primary TKA reported early failure and subsequent revision knee surgery. The need for revision due to instability was frequently reported in a younger patient cohort and most commonly in female TKA patients. Early revision at a younger age highlights the severe implications of an unstable knee.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.060
  • Modified adductor sling technique: A surgical therapy for patellar
           instability in skeletally immature patients
    • Authors: Lena Alm; Matthias Krause; Carolin Mull; Karl-Heinz Frosch; Ralph Akoto
      Pages: 1282 - 1288
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Lena Alm, Matthias Krause, Carolin Mull, Karl-Heinz Frosch, Ralph Akoto
      Background Due to open femoral physis the therapy of patellar instability in skeletally immature patients is challenging. We developed a modified surgical technique of the ‘Adductor-Sling-Approach’ by Sillanpää. The purpose of this study was to evaluate the clinical outcome of the operative technique and to analyse the reasons for failure. Methods Thirty ‘modified adductor sling’ reconstructions in 28 patients were included in the study. From 2010 to 2016 modified adductor sling reconstruction was performed by looping the gracilis or semitendinosus tendon around the adductor magnus tendon and attaching it at the medial facet of the patella. Clinical outcome was retrospectively evaluated at a mean follow up of 25.6months (range 12–43). The evaluation also included subjective International Knee Documentation Committee (IKDC), Lysholm Score, Kujala Score and Tegner Activity Score. Results The average age at the time of operation was 15.10years (range 11–17). Eighty-seven percent of the patients, who underwent the modified adductor sling technique, gained a stable patella and excellent results in postoperative scores. Recurrent dislocation occurred in four of 30 cases (13%). Analysis showed that possible reasons for failure of the tendon graft could be maltracking of the patella due to patella alta, trochlear dysplasia or an elevated tibial tuberosity to trochlear groove distance. Conclusion The modified adductor sling technique for MPFL reconstruction in children and adolescents showed elevated redislocation rates. Only in absence of additional patellofemoral maltracking, caused by elevated tibial tubercle to trochlear groove distance (>15mm), patella alta or especially severe trochlear dysplasia, the modified adductor sling technique could be recommended.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.051
  • An anatomic study of trifurcate iliotibial bands for correcting valgus
           knee deformity
    • Authors: Yu-hang Zhu; Qin-li Xu; Guo-dong Liang; Yun-tao Wu; You-qiong Li; Qing-san Zhu
      Pages: 1289 - 1298
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Yu-hang Zhu, Qin-li Xu, Guo-dong Liang, Yun-tao Wu, You-qiong Li, Qing-san Zhu
      Background The iliotibial band (ITB) trifurcates into the anterior, central and posterior branches at the knee level, and sometimes the branches must be selectively released to correct the valgus knee deformity during total knee arthroplasty. However, the anatomical morphology of the trifurcate ITBs has not been investigated. Methods Fifty-two knees from 26 embalmed cadavers were dissected to observe and record the relationship of the three branches given off from the ITB trifurcation. Fourteen parameters with regard to the length, width, thickness, and trifurcate angle of each branch were measured. These parameters were compared between sex and sides (left or right). Meanwhile, the correlations between parameters and subject age, weight and height were assessed. Results The longest, widest and thickest branches of the ITB were the posterior band (59.82±5.14mm), anterior band (39.56±4.17mm) and central band (2.61±0.36mm), respectively. The length and thickness of ITB were significantly larger in males than in females (P <0.05). No significant differences were found between sides (P >0.05). The ITB thickness showed a negative correlation with subject age, while the length and width of the ITB were positively correlated with subject height and weight, respectively. Conclusions This study provided an anatomical reference of trifurcate ITBs to help the release of ITB in valgus knees. The anatomical variations regarding the subject's sex, age, height and weight should be considered in the selective release of ITB.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.052
  • The development and validation of a custom built device for assessing
           frontal knee joint laxity
    • Authors: Shiek Abdullah Ismail; Milena Simic; Jillian L. Clarke; Thiago Jambo Alves Lopes; Evangelos Pappas
      Pages: 1307 - 1316
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Shiek Abdullah Ismail, Milena Simic, Jillian L. Clarke, Thiago Jambo Alves Lopes, Evangelos Pappas
      Introduction This study reports the development and validation of a quantitative technique of assessing frontal knee joint laxity through a custom built device named KLICP. The objectives of this study were to determine: (i) the intra- and inter-rater reliability and (ii) the validity of the device when compared to real time ultrasound. Methods Twenty-five participants had their frontal knee joint laxity assessed by the KLICP, by manual varus/valgus tests and by ultrasound. Two raters independently assessed laxity manually by three repeated measurements, repeated at least 48h later. Results were validated by comparing them to the medial and lateral joint space opening measured by the ultrasound. Intraclass correlation coefficients and standard error of measurement reliability were calculated. Pearson's correlation coefficients were calculated to determine the correlation between the KLICP and the joint space. Results Intra-rater reliability (intra-session) for each rater was good on both sessions (0.91–0.98), intra-rater reliability (inter-sessions) was moderate to good (0.62–0.87), and inter-rater reliability (intra-session) was good (0.75–0.80). There is low agreement for intra-rater (inter-session) and for inter-rater (intra-session) reliability. The KLICP measurement has a significant positive fair to moderate correlation to the ultrasound measurement at the left (r: 0.61, p: 0.01) and right (r: 0.48, p: 0.02) knee in the valgus direction and at the left (r: 0.51, p: 0.01) and right (r: 0.39, p: 0.05) knee in the varus direction. There is low agreement between the KLICP and the RTU. Conclusions Reliability and agreement was good only when measured for intra-rater, within session.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.053
  • Sex-specific kinetic and kinematic indicators of medial tibiofemoral force
           during walking and running
    • Authors: Jean-Francois Esculier; Richard W. Willy; Michael W. Baggaley; Stacey A. Meardon; John D. Willson
      Pages: 1317 - 1325
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Jean-Francois Esculier, Richard W. Willy, Michael W. Baggaley, Stacey A. Meardon, John D. Willson
      Background Our aims were to (1) Evaluate sex-specific contributions of peak knee flexion moment (pKFM) and peak knee adduction moment (pKAM) in medial tibiofemoral joint (TFJ) force during walking and running; (2) identify kinematic variables to estimate peak medial TFJ force. Methods Eighty-seven runners participated (36 females, 51 males; age=23.0±3.8years (1 standard deviation)). Kinematics and kinetics data were collected during treadmill walking (1.3m/s) and running (3.0±0.4m/s). Peak medial TFJ contact force was estimated using a musculoskeletal model. Linear regression analyses were used to assess the contribution of pKFM, pKAM and kinematic indicators to estimated joint forces. Results During walking and running, pKAM and pKFM accounted for 74.9% and 64.5% of peak medial TFJ force variance (P <0.001), respectively. Similar pKAM contribution was found between males and females during walking (51.8% vs. 47.9%), as opposed to running (50.4% vs. 26.8%). Kinematic indicators during walking were peak knee flexion and adduction angles, regardless of sex. During running, indicators were ankle dorsiflexion at foot strike and center of mass (COM) vertical displacement in females (R2 =0.364, P =0.012), and peak knee abduction angle and step length in males (R2 =0.508, P =0.019). Conclusion We conclude from these results that pKAM and pKFM make significant but potentially sex-specific contributions to peak medial TFJ force during walking and running. Clinically, peak medial TFJ force during walking can be estimated using peak knee flexion and adduction angles in both sexes. During running, ankle dorsiflexion at foot strike and COM oscillation are best indicators among females, while knee abduction and step length are best among males.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.054
  • Effects of toe-in and toe-in with wider step width on level walking knee
           biomechanics in varus, valgus, and neutral knee alignments
    • Authors: Hunter J. Bennett; Guangping Shen; Harold E. Cates; Songning Zhang
      Pages: 1326 - 1334
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Hunter J. Bennett, Guangping Shen, Harold E. Cates, Songning Zhang
      Background Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments. Methods Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (p <0.05). Results The 1st peak knee adduction moment was reduced in both toe-in and toe-in with wider step width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait. Conclusion Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.058
  • Relationships of hamstring muscle volumes to lateral tibial slope
    • Authors: Randy J. Schmitz; Anthony S. Kulas; Sandra J. Shultz; Justin P. Waxman; Hsin-Min Wang; Robert A. Kraft
      Pages: 1335 - 1341
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Randy J. Schmitz, Anthony S. Kulas, Sandra J. Shultz, Justin P. Waxman, Hsin-Min Wang, Robert A. Kraft
      Background Greater posterior–inferior directed slope of the lateral tibial plateau (LTS) has been demonstrated to be a prospective ACL injury risk factor. Trainable measures to overcome a greater LTS need to be identified for optimizing injury prevention protocols. It was hypothesized that Healthy individuals with greater LTS who have not sustained an ACL injury would have a larger lateral hamstring volume. Methods Eleven healthy females (mean +/- standard deviation) (1.63±0.07m, 62.0±8.9kg, 22.6±2.9years) & 10 healthy males (1.80±0.08m, 82.3±12.0kg, 23.2±3.4years) underwent magnetic resonance imaging of the left knee and thigh. LTS, semitendinosus muscle volume, and biceps femoris long head muscle volume were obtained from imaging data. Results After controlling for potential sex confounds (R2 =.00; P=.862), lesser semitendinosus volume and greater biceps femoris-long head volume were indicative of greater LTS (R2 ∆=.30, P=.008). Conclusions Healthy individuals with greater LTS have a muscular morphologic profile that includes a larger biceps femoris-long head volume. This may be indicative of a biomechanical strategy that relies more heavily on force generation of the lateral hamstring and is less reliant on force generation of the medial hamstring. Level of evidence Level IV.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.09.006
  • The effect of knee flexor and extensor fatigue on shock absorption during
           cutting movements after a jump landing
    • Authors: Youkyung Kim; Changhong Youm; Minji Son; Jinhee Kim; Myeounggon Lee
      Pages: 1342 - 1349
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Youkyung Kim, Changhong Youm, Minji Son, Jinhee Kim, Myeounggon Lee
      Background Sporting situations include instances of continuous and/or integrated movements. However, the effect of fatigue on the performance of these movements remains unclear. Purpose To investigate the effect of knee flexor and extensor fatigue on the shock absorption strategy of the lower limb during cutting movements performed after jump landings. Methods Twenty-four healthy participants performed cutting movements following jump landings from two heights – 30cm and 40cm – and under three levels of lower limb fatigue: pre-fatigue (100% peak knee extension torque), and post-fatigue 50% (post-50%) and 30% (post-30%) peak knee extension torque. Fatigue was induced by repeated isokinetic flexion/extension of the knee (60°/s). Results Compared to the pre-fatigue condition, power and work at the knee joint decreased under both post-50% and post-30% conditions (P <0.001), while the work performed by the ankle (P <0.001) increased significantly. An increase in height from 30cm to 40cm was associated with an increase in the range of motion of the ankle (P <0.001) and knee (P =0.022), peak vertical ground reaction force (P <0.001), rate of loading (P <0.001), knee stiffness (P =0.026) and peak power of the knee (P <0.001), as well as the work performed by the knee (P <0.001) and hip (P <0.001) joints. Conclusions Under substantial muscle fatigue the proportion of shock absorption contributed by the knee for cutting movements performed after jump landings from a height of 40cm decreased; there was an adaptive increase in the contribution by the ankle.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.09.007
  • Does high location and thickness of the Wrisberg ligament affect discoid
           lateral meniscus tear type based on peripheral detachment'
    • Authors: Jin Hwan Ahn; Joon Ho Wang; Dong Uk Kim; Do Kyung Lee; Jun Ho Kim
      Pages: 1350 - 1358
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Jin Hwan Ahn, Joon Ho Wang, Dong Uk Kim, Do Kyung Lee, Jun Ho Kim
      Background The aim of this study was to evaluate the relationship between discoid lateral meniscus (DLM) types based on peripheral detachment and anatomic features of Wrisberg ligament (WL) such as location and thickness based on magnetic resonance image (MRI). Methods A total of 322 knees in 292 patients were reviewed. Patients were divided into four DLM types according to peripheral detachment: no shift (type 1), anterocentral shift (type 2), posterocentral shift (type 3) and central shift (type 4). We reviewed all MRI concentrating on the presence, location (high or low location), running angle, thickness of WL, and WL/posterior cruciate ligament (PCL) thickness ratio. The relationship between DLM types and anatomic features of WL were analyzed using one-way analysis of variance and chi-square test. Results According to DLM types based on peripheral detachment, 149 knees were type 1, 38 were type 2, 79 were type 3, and 56 were type 4. Among the 322 knees, 302 (93.8%) had WL on MRI. In DLM patients, type 3 showed a statistically significant (P <0.001) relationship with high location of WL. In addition, type 3 had significantly larger (P <0.0001) running angle of WL, thicker (P <0.0001) WL, and higher (P <0.0001) WL/PCL ratio compared to other types. Conclusion A high location and thick WL are related to posterocentral shift type of DLM based on peripheral detachment. Based on our results, the high location and thick WL might provide information to surgeons in predicting the direction of peripheral detachment in symptomatic DLM patients.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.07.012
  • Three dimensional-printed patient-specific cutting guides for femoral
           varization osteotomy: Do it yourself
    • Authors: Juan Arnal-Burró; Rubén Pérez-Mañanes; Eudaldo Gallo-del-Valle; Cristina Igualada-Blazquez; Manuel Cuervas-Mons; Javier Vaquero-Martín
      Pages: 1359 - 1368
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Juan Arnal-Burró, Rubén Pérez-Mañanes, Eudaldo Gallo-del-Valle, Cristina Igualada-Blazquez, Manuel Cuervas-Mons, Javier Vaquero-Martín
      Introduction In valgus knees of young patients, opening-wedge distal femoral osteotomy is a valid treatment option for axial corrections. It allows the surgeon to achieve accurate correction, which is directly related to the functional outcome and survivorship of the osteotomy. This study presents a new technique based on three-dimensional (3D)-printed cutting guides for opening-wedge distal femoral osteotomies, in which pre-operative planning and intraoperative executional accuracy play a major role. Material and methods Pursuing axial correction accuracy, 3D-printed patient-specific positioning guides and wedge spacers were both created and used by the surgeon to implement the femoral osteotomy. The proposed technique was performed in 12 consecutive patients (cases). The results were compared with 20 patients (controls) in which opening-wedge distal femoral osteotomies were performed following the traditional technique. Accuracy of the axial correction, surgical time, fluoroscopic time and costs were measured. Results More accurate axial correction with reduced surgical time (32min less), intraoperative fluoroscopic images (59 images less) and costs (estimated €412 less) were achieved with the use of the customized guides when compared with the traditional technique. Discussion Accurate correction of the axial alignment of the limb is a critical step in survivorship of the osteotomy. Improving the technique to enhance accuracy focused on this issue. Conclusions The use of patient-customized cutting guides minimised human error; therefore, surgical time was reduced and accurate axial correction was achieved. The surgeon mastered all steps in a do-it-yourself philosophy style.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.04.016
  • Association of fibulin-3 concentrations with the presence and severity of
           knee osteoarthritis: A cross-sectional study
    • Authors: Qian Wu; Xuecheng Sun; Lei Du
      Pages: 1369 - 1373
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Qian Wu, Xuecheng Sun, Lei Du
      Background Fibulin-3, a member of the extracellular matrix glycoproteins family, negatively regulates chondrocyte differentiation. This study aims to assess the correlation of fibulin-3 concentrations with the presence and severity of knee osteoarthritis. Methods This cross-sectional study was performed in a population of 209 knee osteoarthritis subjects who received hyaluronic acid treatment and 165 healthy controls. Knee osteoarthritis diagnosis was made according to the criteria of the American College of Rheumatology. Osteoarthritis severity was scored by the Kellgren–Lawrence grading method. Synovial fluid was obtained from the knees of osteoarthritis subjects who received the treatment of hyaluronic acid injection for the first time. Serum and synovial fluid fibulin-3 concentrations were examined by enzyme-linked immunosorbent assay method. Results Mann–Whitney U-test showed that there were higher serum fibulin-3 concentrations in the case group compared with the controls. Higher serum and synovial fluid fibulin-3 concentrations were found in knee osteoarthritis subjects compared with those with Kellgren–Lawrence grades 2 and 3. Knee osteoarthritis subjects with Kellgren–Lawrence grade 3 had higher serum and synovial fluid fibulin-3 concentrations compared with those with Kellgren–Lawrence grade 2. Serum and synovial fluid fibulin-3 concentrations were significantly correlated with Kellgren–Lawrence grading after Pearson correlation analysis (r =0.532, P <0.001 and r =0.613, P <0.001). Multinomial logistic regression analysis demonstrated a significant association between serum and synovial fluid fibulin-3 concentrations with Kellgren–Lawrence grades (P <0.001 and P <0.001). Conclusion Serum and synovial fluid fibulin-3 concentrations were correlated with the presence and severity of knee osteoarthritis.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.04.018
  • Is arthroscopic videotape a reliable tool for describing early joint
           tissue pathology of the knee'
    • Authors: Giovanni Trisolino; Marta Favero; Antonello Lazzaro; Ermanno Martucci; Alessandro Strazzari; Elisa Belluzzi; Steven Robert Goldring; Mary Brennan Goldring; Leonardo Punzi; Brunella Grigolo; Eleonora Olivotto
      Pages: 1374 - 1382
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Giovanni Trisolino, Marta Favero, Antonello Lazzaro, Ermanno Martucci, Alessandro Strazzari, Elisa Belluzzi, Steven Robert Goldring, Mary Brennan Goldring, Leonardo Punzi, Brunella Grigolo, Eleonora Olivotto
      Background The aim of this study was to assess the reliability of the videotape scoring system collected during knee arthroscopy for meniscal tears, and to test the consistency with intra-operative findings. Methods Fifty-seven patients undergoing arthroscopic treatment of meniscal tears were included in the analysis. The cartilage damage was assessed intra-operatively, at six sites, using the Outerbridge scoring system. The meniscal tears were graded according to the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification. The presence of synovial inflammation was scored, at four different sites, according to the macro-score method. The total cartilage, meniscal and synovial scores were calculated for each knee by the sum of the maximum grade of the lesions at each anatomic site. In order to assess the reliability of the arthroscopic scoring system, the videotapes recorded during the arthroscopy were reviewed by two independent observers one year after the surgery and compared with the scores completed by the surgeon during the operation. Results The total cartilage score showed substantial inter-rater and intra-rater reliability, and moderate consistency with the intra-operative score provided by the surgeon. The total meniscal score showed substantial inter-rater and intra-rater reliability, and good consistency with the intra-operative findings. The total synovial score showed substantial inter-rater agreement, substantial intra-rater reliability, and moderate consistency with intra-operative findings. Conclusions The videotape scoring system provided a reliable and reproducible system for recording the intra-operative state of the whole joint pathology in patients undergoing arthroscopic treatment of meniscal tears.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.07.014
  • The failing medial compartment in the varus knee and its association with
           CAM deformity of the hip
    • Authors: Jonathan S. Palmer; Antony J. Palmer; Luke D. Jones; Sujin Kang; Nicholas Bottomley; William M. Jackson; A. Paul Monk; David J. Beard; Kassim Javaid; Sion Glyn-Jones; Andrew J. Price
      Pages: 1383 - 1391
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Jonathan S. Palmer, Antony J. Palmer, Luke D. Jones, Sujin Kang, Nicholas Bottomley, William M. Jackson, A. Paul Monk, David J. Beard, Kassim Javaid, Sion Glyn-Jones, Andrew J. Price
      Background Since 2011, the knee service at the Nuffield Orthopaedic Centre has been offering a neutralising medial opening wedge high tibial osteotomy (HTO) to a specific group of patients with genu varum and early knee osteoarthritis. An observation was made concerning this group of patients and the presence of CAM deformity at the hip. The aim of this study is to establish whether or not any association exists between the OA phenotype shared by our HTO group and the incidence of CAM deformity at the hip. Methods A cross-sectional study was designed to estimate the prevalence of CAM-type lesions across different groups of individuals. Our HTO group (n=30) was compared to a pre-arthroplasty group (n=20) and control group (n=20). A total of 70 subjects were identified across the different groups all of whom had long-leg radiographs (LLRs) available for analysis. LLRs were analysed using an in house developed Matlab®-based (Matlab R2009b; MathWorks) software package for hip measurements and MediCAD® (Hectec GmbH, Germany) for lower limb alignment measurements. Results The HTO group had a significantly higher prevalence of CAM lesions (57%) than both the pre-arthroplasty (40%) and control (30%) groups. This difference was maintained when results were adjusted for potential confounding factors (age, gender and laterality). Across the groups, individuals with tibia vara were more likely to have CAM-deformity of the hip (p =0.021). Conclusion Patients with symptomatic early knee OA and varus deformity of the knee have a high prevalence of CAM deformity in the hip.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.003
  • Long-term clinical follow-up of microfracture versus mosaicplasty in
           articular cartilage defects of medial femoral condyle
    • Authors: Eirik Solheim; Janne Hegna; Eivind Inderhaug
      Pages: 1402 - 1407
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Eirik Solheim, Janne Hegna, Eivind Inderhaug
      Background The purpose of this study was to evaluate the outcome after cartilage repair surgery in focal defects of the knee by microfracture versus mosaicplasty. Methods A cohort of 102 patients undergoing microfracture (n=52) or mosaicplasty (n=50) of a single articular cartilage defect in the medial femoral condyle of ≤50mm2 was evaluated by Lysholm score before surgery, at six months, 12months, five years, 10years, and 15–18years after surgery. Results Median age of patients at the time of surgery was 36years (range 16–58) and median follow-up time was 16years (range 14–18). Defects were treated with a median size of three square centimetres (range one to five). A significant increase was seen in the Lysholm score from mean 48 (SD 16) at baseline to 66 (SD 23; P <0.001) at the 15–18year follow-up. The Lysholm score was higher in the mosaicplasty group at six months, 12months, five years and 10years (P <0.05 for all comparisons). These differences were clinically significant at all points (>10 points). However, at the final follow-up, the difference (eight points) did not reach statistical significance. Conclusions In the short-term, medium-term and long-term (10years), mosaicplasty in a single cartilage defect size one to five square centimetres of the femoral condyle resulted in clinically relevant better outcome than microfracture. However, at 15–18years after the surgery such a difference could not be found. In the six month to 10–15year (after surgery) perspective, the mosaicplasty procedure offered a better outcome in this type of lesion. Level of evidence Level III.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.061
  • Effects of lateral wedge insole application on medial compartment knee
           osteoarthritis severity evaluated by ultrasound
    • Authors: Yosuke Ishii; Masataka Deie; Naoto Fujita; Hiroshi Kurumadani; Masakazu Ishikawa; Atsuo Nakamae; Seiju Hayashi; Jiro Hata; Nobuo Adachi; Toru Sunagawa
      Pages: 1408 - 1413
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Yosuke Ishii, Masataka Deie, Naoto Fujita, Hiroshi Kurumadani, Masakazu Ishikawa, Atsuo Nakamae, Seiju Hayashi, Jiro Hata, Nobuo Adachi, Toru Sunagawa
      Background It is known that a lateral wedge insole (LWI) decreases medial loading stress in the knee. Medial meniscus pathology, such as a degenerative tear or a root tear, leading to malfunction and medial meniscus extrusion (MME), is a critical condition that leads to severe osteoarthritis (OA). However, the effect of LWI on MME is still unknown. The objective of this study was to investigate the effect of LWI use on MME in knee OA using ultrasonography. Methods Thirty-one knees from 18 patients with knee OA diagnosed radiographically were allocated to the OA group (mean age, 73.6years; sex M:F, 2:16). Twenty-two knees from 11 volunteers without knee OA were also enrolled as an age-matched control group. MME was evaluated using ultrasonography with the patients in three positions: supine, standing without LWI, and standing with LWI. Results In both groups, the mean values of the MME increased significantly when patients were in the standing position compared to the supine position. In the OA group, MME significantly decreased with LWI use. There was no significant difference in MME between use and non-use of an LWI in the control group. Conclusions The LWI could significantly decrease MME in patients with knee OA.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.09.001
  • Up to 10 year follow-up of the Oxford Domed Lateral Partial Knee
           Replacement from an independent centre
    • Authors: Simon D.S. Newman; Altay Altuntas; Helen Alsop; Justin P. Cobb
      Pages: 1414 - 1421
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Simon D.S. Newman, Altay Altuntas, Helen Alsop, Justin P. Cobb
      Background The Oxford Domed Lateral Partial Knee Replacement (ODLPKR) was designed specifically for the lateral compartment in response to the unacceptable dislocation rate seen with the Oxford Partial Knee. This paper presents the up to 10-year follow-up of an independent, single surgeon series using this implant. The aim of this study is to assess the medium term outcome of the ODLPKR. The primary outcome measures were 13 revision surgery, re-operation and functional outcome. Methods Sixty-four knees in 58 patients were performed between 2005 and 2009. Patients were interviewed by telephone to determine whether further surgery had been conducted on their knee and to complete an Oxford Knee Score (OKS) questionnaire. Results The status of 61 knees was confirmed with a median follow-up period of 84months. One patient sustained two bearing dislocations ultimately requiring an elective bearing exchange. Two knees underwent revision to TKR and five other patients reported further operations. Median OKS was 26 (range nine to 36) pre-operatively and 42 (10–48) at final follow-up. Conclusion The ODLPKR offers an effective and safe treatment for lateral compartment osteoarthritis. Bearing dislocation does not appear to be a significant issue with this implant and implant retention is similar to that achieved by medial unicompartmental knee replacements in the medium term.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.05.001
  • Perioperative comparison of blood loss and complications between
           simultaneous bilateral and unilateral total knee arthroplasty for knee
    • Authors: Yongjian Qi; Kai Tie; Hua Wang; Zhengqi Pan; Xinyu Zhao; Heqiang Chen; Liaobin Chen
      Pages: 1422 - 1427
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Yongjian Qi, Kai Tie, Hua Wang, Zhengqi Pan, Xinyu Zhao, Heqiang Chen, Liaobin Chen
      Objective This study aimed to compare the blood loss and complications between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA). Methods This study included 54 SBTKAs and 70 UTKAs performed between 2013 and 2014. Groups were compared with respect to blood loss, hemoglobin, hematocrit, D-dimer, blood transfusion, and complications. Results Hemoglobin between the groups was not significantly different (P >0.05). In the SBTKA group, the hematocrit on the 3rd postoperative day was lower (P <0.05), and the D-dimer on the 1st postoperative day was higher (P <0.05) than in the UTKA group. The total drain output of the UTKA group was not significantly different from any unilateral side of the SBTKA group (P <0.05). The mean autologous red blood cell (RBC) transfusion requirements were not significantly different between the two groups. However, the mean allogeneic RBC transfusion requirement was higher in the SBTKA group than in the UTKA group (P <0.001). The total drainage of the SBTKA group was significantly more than the UTKA group, but the total drain output of the UTKA group was not significantly different from any unilateral side of the SBTKA group (P >0.05). Also, the mean allogeneic RBC transfusion requirement was higher in the SBTKA group than in the UTKA group (P <0.001). Conclusion This study demonstrates that the rate of complication between SBTKA and UTKA is similar. The total drainage and transfusion of SBTKA are not twice that of UTKA, and after treatment, hemoglobin could be increased to a similar level. Thus, SBTKA is an effective and safe option.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.06.008
  • The accuracy of the “projected surgical transepicondylar axis”
           relative to the “true surgical transepicondylar axis” in total knee
    • Authors: Takaaki Ohmori; Tamon Kabata; Yoshitomo Kajino; Tadashi Taga; Kazuhiro Hasegawa; Daisuke Inoue; Takashi Yamamoto; Tomoharu Takagi; Junya Yoshitani; Takuro Ueno; Tomohiro Ojima; Hiroyuki Tsuchiya
      Pages: 1428 - 1434
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Takaaki Ohmori, Tamon Kabata, Yoshitomo Kajino, Tadashi Taga, Kazuhiro Hasegawa, Daisuke Inoue, Takashi Yamamoto, Tomoharu Takagi, Junya Yoshitani, Takuro Ueno, Tomohiro Ojima, Hiroyuki Tsuchiya
      Background In TKA, we have used the “projected SEA”, which is obtained by projecting the “true SEA” on the distal femoral cutting plane in clinical practice to determine the femoral component rotation. There are no reports examining the accuracy of the “projected SEA”. In this study, we investigated the difference between the “true SEA” and “projected SEA”. Methods The present study was a CT-based computer-simulated case series. We evaluated 34 knees without osteoarthritis changes. These patients were selected from the operative schedule prior to THA. We defined the “true SEA” on the 3D model and the “projected SEA” on the cutting plane parallel to the distal femoral axis obtained based on the “true SEA”. We changed the cutting angles from 20° flexion to 20° extension, and from five degrees varus to five degrees valgus. We measured the “true SEA angle” and “projected SEA angle” regarding the posterior condylar axis (PCA). Results The mean “true SEA angle” was 3.04°±1.34° (0.6–5.0°). The mean “projected SEA angle” was 3.43°±1.58° at 20° flexion, 3.42°±1.56° at 0° flexion, 3.43°±1.52° at 20° extension, 3.39°±1.59° at five degrees valgus, and 3.39°±1.50° at five degrees varus. At each cutting angle, the “projected SEA angle” was significantly larger than the “true SEA angle” (p<0.001). There was no significant difference between any of the “projected SEA angles” (p>0.001). Conclusions We found that the true SEA and projected SEA do not differ significantly (0.39°±0.29° [range 0–1.0°]).

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.07.017
  • Cementing technique affects the rate of femoral component loosening after
           high flexion total knee arthroplasty
    • Authors: Hyuk-Soo Han; Myung Chul Lee
      Pages: 1435 - 1441
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Hyuk-Soo Han, Myung Chul Lee
      Background The purpose of this study was to determine the effects of different cementing techniques on the rate of early femoral loosening of high-flexion total knee arthroplasties (TKAs). Methods A total of 734 knees from 486 patients treated with high-flexion design TKA between July 2001 and July 2010 were divided into two groups based on the cementing technique used. For 403 knees (group N), cement was applied onto the distal and anterior cut surfaces of the femur and the posterior flanges of the femoral component without pressurization. For 331 knees (group P), cement was applied onto distal and anterior femoral cut surfaces with digital pressurization and whole cement surfaces of the femoral component. Two groups were subjected to clinical and radiological evaluation with a minimum five year follow-up period. Cox proportional hazards model with revision surgery of the prosthesis or radiological loosening as an endpoint was used to evaluate the effect of the cementing technique and other covariates. Results The pressurizing and bi-surface cementing technique resulted in significant reduction in femoral radiological loosening incidence compared to that without pressurization (0.3% vs. 2.5%, P =0.015) and revision rate for aseptic causes (0.9% vs. 3.2%, P =0.032). Cox proportional hazard regression analysis revealed a significant difference in component survival rate between the two groups if femoral radiological loosening was considered as failure (hazard ratio, 4.229, 95% confidence interval (CI): 1.256–14.243, P =0.020). Conclusion Pressurizing and bi-surface cementation can reduce the occurrence rate of early loosening around the femoral component in high-flexion TKAs.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.002
  • Columbus® computer navigated total knee arthroplasty: Gap balancing
           versus measured resection
    • Authors: N.D. Clement; N. Makaram; J. Bell; C.H. Tiemessen; S.A. Mehdi; S.J. Livingston
      Pages: 1442 - 1447
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): N.D. Clement, N. Makaram, J. Bell, C.H. Tiemessen, S.A. Mehdi, S.J. Livingston
      Background The aim of this study was to compare the medium term functional outcome and patient satisfaction of gap balanced (GB) with measured resection (MR) total knee arthroplasty (TKA) using computer navigation. Methods A cohort of 144 consecutive computer navigated TKA were retrospectively identified from an arthroplasty database. Functional assessment using the Oxford Knee Score (OKS) and patient satisfaction were obtained from 113 patients at a mean follow-up of 5.4 (range four to seven) years. There were 44 patients in the GB group and 69 patients in the MR group. Results The mean OKS for the GB group was 36.9 (SD 9.2) and for the MR was 33.6 (SD 9.8), with a difference of 3.3 (95% CI 0.3 to 6.3) points, which was statistically significant (p=0.01). Linear regression analysis confirmed the independent effect of surgical technique when adjusting for confounding factors and surgeon, with the GB group achieving a greater post-operative OKS (R2 =0.39, 3.0 points, 95% CI 1.2 to 4.8, p=0.001). There was a greater rate of patient satisfaction in the GB group (88.6%, n=39/44) compared to the MR group (81.1%, n=56/69), but this was not statistically significant (odds ratio 1.8, 95% CI 0.6 to 5.5, p=0.31). Conclusion Computer navigated Columbus® TKA using a GB technique results in a statistically significantly greater functional outcome but no significant difference in patient satisfaction in the medium term compared to patients undergoing a MR technique.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.004
  • Differences in patellofemoral alignment as a result of patellar shape in
           cruciate-retaining total knee arthroplasty without patellar resurfacing at
           a minimum three-year follow-up
    • Authors: Atsuo Inoue; Yuji Arai; Shuji Nakagawa; Hiroaki Inoue; Yasushi Yoshihara; Shouichi Yamazoe; Toshikazu Kubo
      Pages: 1448 - 1453
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Atsuo Inoue, Yuji Arai, Shuji Nakagawa, Hiroaki Inoue, Yasushi Yoshihara, Shouichi Yamazoe, Toshikazu Kubo
      Background Although the patellofemoral (PF) joint shape of the femoral implant in a particular prosthetic design is identical, the articular surface shape of the patella varies between individuals. The present study investigated the effects of patellar shape on the postoperative PF joint in a cruciate-retaining total knee arthroplasty (CR-TKA) without patellar resurfacing and with at least three years of follow-up. Methods This study investigated 76 knees of 62 patients who underwent CR-TKA without patellar resurfacing for varus osteoarthritis. Shape of the patella was classified in terms of the patellar facet angle (angle formed by the medial and lateral articular surfaces) as measured on axial plain X-ray. Subjects were divided into Group A with patellar facet angle ≤126° (34 knees) and Group B with patellar facet angle >126° (42 knees). Results Anterior knee pain (AKP) was evident in four knees in Group A and one knee in Group B. Postoperative lateral patellar tilt angle was significantly larger in Group A than in Group B. Progression of osteosclerosis in the patella was present in 12 knees in Group A and three knees in Group B. Conclusion This study found that for a patella with a small patellar facet angle, lateral tilt of the patella was significantly increased after TKA, and a high rate of osteosclerosis was evident at >3years after operation. Performing TKA without patellar resurfacing on a patella with a small patellar facet angle may entail a higher risk of postoperative AKP; pre-operative evaluation of the shape of the patella is therefore important.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.050
  • A new topical hemostatic agent TT-173 reduces blood loss in a sheep model
           of total knee arthroplasty
    • Authors: Alberto Centeno; Santiago Rojas; Belén Arias; Ignasi Miquel; Pilar Sánchez; Claudia Ureta; Esther Rincón; Ramón López; Jesús Murat
      Pages: 1454 - 1461
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Alberto Centeno, Santiago Rojas, Belén Arias, Ignasi Miquel, Pilar Sánchez, Claudia Ureta, Esther Rincón, Ramón López, Jesús Murat
      Background Total knee arthroplasty is associated with blood loss during the intervention and may require allogenic blood transfusion. Treatments such as tranexamic acid and fibrin sealants improved the bleeding control in several clinical trials, but the hemorrhage associated with the intervention is still significant. Thus far, very few studies have evaluated hemostatic treatments in animal models of total knee arthroplasty. This work describes a sheep model of bleeding associated with total knee arthroplasty and investigates a new class of hemostatic treatment based on recombinant tissue factor. Methods Sheep were treated with the anticoagulant heparin, and the joint was accessed by a paramedial incision. Ligaments and menisci were eliminated and femoral condyles and tibia plateau were sectioned exposing the trabecular bone. An intra-articular drain was used to recover and quantify the blood loss during the 90-min period after treatment. The efficacy of one milligram and three milligrams of TT-173 was evaluated and compared with tranexamic acid. The occurrence of analytical alterations and systemic absorption was also investigated. Results Treatment with TT-173 reduced the blood loss in comparison with control or tranexamic acid. No significant differences were observed between the two doses evaluated. Moreover, a dose of six milligrams of TT-173 did not induce any clinical or analytical alteration, and significant systemic absorption was not observed. Conclusion Data obtained strongly suggest that TT-173 could be useful in reducing the blood loss associated with total knee arthroplasty and without safety concerns derived from the systemic absorption of the product.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.055
  • Preoperative knee deformity and kinematics impact postoperative knee
           kinematics in total knee arthroplasty
    • Authors: Naoki Seito; Tomohiro Onodera; Yasuhiko Kasahara; Eiji Kondo; Norimasa Iwasaki; Tokifumi Majima
      Pages: 1462 - 1468
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Naoki Seito, Tomohiro Onodera, Yasuhiko Kasahara, Eiji Kondo, Norimasa Iwasaki, Tokifumi Majima
      Background The purpose of this study was to evaluate the relationship between the preoperative knee deformity/kinematic pattern and the postoperative knee kinematic pattern in posterior cruciate ligament substituting (PS)-total knee arthroplasty (TKA). Methods This study involved 39 patients with medial osteoarthritis who underwent a primary PS-TKA using a computed-tomography-based navigation system. All the operations were performed by a single surgeon using a subvastus approach, modified gap technique and the same PS type of prosthesis (Genesis II™ total knee system, Smith & Nephew, Memphis, TN, USA). Knee deformity, kinematic pattern after capsule incision (preoperative knee kinematics), and kinematic pattern after implantation (postoperative knee kinematics) in PS-TKA were measured. Kinematic patterns were divided into two groups: a medial pivot group and a non-medial pivot group. Results Preoperative varus knee deformity was significantly larger in the non-medial pivot group than in the medial pivot group (femorotibial angle: 184.7±6.4° vs. 180.8±3.9°, P <0.05). In addition, preoperative knee kinematics were conserved postoperatively, at a rate of 82% (P <0.01). Conclusions The severity of varus knee deformity and the preoperative knee kinematic pattern might have affected the postoperative knee kinematics in PS-TKA. This must be confirmed with a randomized controlled trial on a large population study. Level of evidence: case control study, Level III.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.056
  • Three-dimensional analysis of accuracy of component positioning in total
           knee arthroplasty with patient specific and conventional instruments: A
           randomized controlled trial
    • Authors: Raf De Vloo; Pim Pellikaan; Aad Dhollander; Jos Vander Sloten
      Pages: 1469 - 1477
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Raf De Vloo, Pim Pellikaan, Aad Dhollander, Jos Vander Sloten
      Background Component malalignment remains a major concern in total knee arthroplasty (TKA). Patient-specific guides (PSG) were developed to increase accuracy of bone resections and component placement, but available evidence is contradictory. We assessed the accuracy of 3D component placement in TKA with PSG compared to conventional surgery using virtual 3D bone models. Methods Fifty patients were randomly assigned to the PSG or conventional instrumentation group, 44 were finally analyzed. Preoperatively, MRI and CT scans were converted into virtual 3D models and a surgical plan was developed. Surgery was performed and changes in component sizing were recorded. Postoperative CT images were converted to 3D models and aligned to the planned, preoperative models and implant orientation. Differences between planned and postoperative implant orientations were calculated in 3D. Results PSG allowed significantly more accurate varus/valgus placement for the femoral component (PSG: 0.14±1.47; control: 1.40±1.99; p<0.05), but more slope was introduced (PSG: 2.82±2.42; control: 0.90±2.28; p<0.05). Less variability in positioning accuracy for femoral flexion angle and tibial rotation was found with PSG, indicating a result closer to the planned position, but no significant differences in positioning accuracy were found. PSG allowed more accurate prediction of the femoral (PSG: 100%; control: 64%) and tibial (PSG: 79%; control 56%) component size. Conclusion PSG led to adequate component positioning accuracy compared to the pre-operative plan. For the femoral component, the positioning was significantly closer to the planned position in the coronal plane, a similar trend was observed for the sagittal plane. But, for the tibial component, significantly more slope was introduced. A better prediction of component sizing was found with PSG compared to conventional surgery.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.08.059
  • Medial rather than lateral knee instability correlates with inferior
           patient satisfaction and knee function after total knee arthroplasty
    • Authors: Hiroyuki Tsukiyama; Shinichi Kuriyama; Masahiko Kobayashi; Shinichiro Nakamura; Moritoshi Furu; Hiromu Ito; Shuichi Matsuda
      Pages: 1478 - 1484
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Hiroyuki Tsukiyama, Shinichi Kuriyama, Masahiko Kobayashi, Shinichiro Nakamura, Moritoshi Furu, Hiromu Ito, Shuichi Matsuda
      Background It is commonly thought that balanced medial and lateral tibiofemoral joint gaps are essential, but the effect of joint laxity on clinical outcome after total knee arthroplasty (TKA) is unclear. It was hypothesised that medial joint laxity correlates with inferior patient satisfaction and knee function, although lateral joint laxity is allowed to a certain degree in TKA. Methods This study included 50 knees that underwent primary TKA. Knee laxity was measured with postoperative stress radiographs in flexion and extension, and patient satisfaction and knee function were evaluated by the 2011 Knee Society Knee Scoring System. Results In a comparison of medially tight and medially loose knees in flexion, the scores for satisfaction, symptoms, standard activity, and advanced activity were significantly better in medially tight than in medially loose knees (satisfaction: 29.8, 22.2; symptoms: 20.3, 15.9; standard activities: 24.2, 19.1; and advanced activities: 15.3, 8.7, in the tight and loose knees, respectively). Neither lateral joint laxity during knee flexion nor medial joint laxity during knee extension was associated with a poor postoperative clinical outcome, whereas lateral joint laxity and the standard activity score in extension had a moderate positive correlation. Conclusions Knees with medial joint laxity during flexion resulted in an inferior postoperative outcome, and lateral joint laxity did not influence patient satisfaction or function. Care should be taken to maintain medial joint stability during the TKA procedure.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.09.004
  • Osteochondral autograft transplantation for isolated patellofemoral
    • Authors: Hiromitsu Yabumoto; Yasuaki Nakagawa; Shogo Mukai; Takahiko Saji
      Pages: 1498 - 1503
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Hiromitsu Yabumoto, Yasuaki Nakagawa, Shogo Mukai, Takahiko Saji
      Background The purpose of this retrospective study was to evaluate clinical outcomes of osteochondral autograft transplantation (OAT) for isolated patellofemoral (PF) osteoarthritis (OA). Methods OAT was performed in seven patients (six men, one woman; mean age, 61.1years) with isolated PF OA. The mean duration of follow up was 46.9months (range, 24–84months). Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee (IKDC) objective score and the knee scoring system of the Japanese Orthopaedic Association (JOA) score. The International Cartilage Repair Society (ICRS) score was recorded in three cases that underwent second-look arthroscopies postoperatively. For morphological evaluation, the Kellgren and Lawrence (KL) classification and the modified magnetic resonance observation of cartilage repair tissue (MOCART) score were used. Results The mean IKDC and JOA scores were both significantly improved. The percentage of normal and nearly normal on the IKDC score was increased from 28.6% (2/7) to 85.7% (6/7) (P =0.05). The mean JOA score was improved from 80.0 (range, 65.0–85.0) to 95.0 (range, 90.0–100) (P =0.0008). The mean ICRS scores were 10.3 (nearly normal) in the three cases that underwent second-look arthroscopies postoperatively. Regarding KL classification, the grade was unchanged in five cases (two cases in grade 1, three cases in grade 2) and improved in two cases (from grade 3 to 2, from grade 4 to 3). The mean modified MOCART score was 67.9 (range, 60.0–75) at 12-month follow up. There were no complications, and satisfaction was obtained in all cases. The study design was case series: level IV. Conclusions All clinical scores improved significantly postoperatively. Osteochondral plugs were transplanted perpendicular to the articular surface to obtain good congruity of the repaired articular surface. In this way, OAT is an effective procedure to prevent progression of isolated PF OA.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.07.016
  • Spontaneous healing of a tear of an anterior cruciate ligament graft: A
           case report
    • Authors: Natalie Yu Yi Ng; Barry Wei Loong Tan; Lingaraj Krishna
      Pages: 1504 - 1507
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): Natalie Yu Yi Ng, Barry Wei Loong Tan, Lingaraj Krishna
      Background Almost 30% of young athletic patients sustain a second anterior cruciate ligament (ACL) injury within 24months of their ACL reconstruction and returning to pivoting sports. Most patients with high athletic demand and significant anteroposterior instability often require ACL revision surgery to restore their pre-injury activity levels. Case report A 24-year old gentleman ruptured his hamstring tendon autograft during a twisting injury seven months after his ACL reconstruction. Eight months post-injury, it was observed that spontaneous healing of his graft had occurred. This was confirmed with clinical examination and radiological imaging. Conclusion Hamstring tendon autografts may demonstrate some self-reparative potential. This could be due to the higher response of extra-articular ligaments and tendons in response to growth factors observed in some studies. Limitations in diagnostic magnetic resonance imaging could also lead to over-interpretation of a partially torn graft.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.09.002
  • Reliability of two techniques and training level of the observer in
           measuring the correction angle when planning a high tibial osteotomy
    • Authors: Julia Blackburn; Aneel Ansari; Andrew Porteous; James Murray
      Abstract: Publication date: Available online 6 December 2017
      Source:The Knee
      Author(s): Julia Blackburn, Aneel Ansari, Andrew Porteous, James Murray
      Background In high tibial osteotomy, planning is critical for achieving successful realignment. Any method selected needs to be reliable, with inter-observer and intra-observer correlation. A literature review demonstrated two distinct methods of planning for high tibial osteotomy. Hypothesis: Both methods are precise and show excellent inter and intra-observer correlation. Method Fifty consecutive weight-bearing long leg alignment antero-posterior (AP) radiographs were identified and planning undertaken on suitable radiographs using the methods of Puddu (method 1) and Miniaci (method 2). Two observers, one junior trainee and one Specialist Knee Fellow, recorded measurements to calculate inter and intra-observer correlation. Results Thirty-two radiographs were included. Inter-observer and intra-observer correlation, and correlation between the two methods were all greater than 0.97 (p<0.0001). Conclusion Our results show excellent correlation between both methods and both observers. Both methods are reliable for planning and can be performed by both junior trainees and subspecialists. Further work should consider how planning can ensure adequate intraoperative correction.

      PubDate: 2017-12-08T06:38:57Z
      DOI: 10.1016/j.knee.2017.11.007
  • Content List
    • Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6

      PubDate: 2017-12-08T06:38:57Z
  • December 2017
    • Authors: Viste
      Abstract: Publication date: December 2017
      Source:The Knee, Volume 24, Issue 6
      Author(s): A. Viste

      PubDate: 2017-12-08T06:38:57Z
  • Patellofemoral arthritis treated with resurfacing implant: Clinical
           outcome and complications at a minimum two-year follow-up
    • Authors: Juan Pablo Zicaro; Carlos Yacuzzi; Juan Astoul Bonorino; Lisandro Carbo; Matias Costa-Paz
      Abstract: Publication date: Available online 8 October 2017
      Source:The Knee
      Author(s): Juan Pablo Zicaro, Carlos Yacuzzi, Juan Astoul Bonorino, Lisandro Carbo, Matias Costa-Paz
      Background This study evaluated the clinical and radiographic outcomes of a series of patients treated with an anatomic inlay resurfacing implant, with a minimum two-year follow-up. Methods Fifteen patients underwent patellofemoral-resurfacing procedures using a HemiCAP Wave Patellofemoral Inlay Resurfacing implant from 2010 to 2013. Clinical outcomes included: Visual Analog Scale (VAS), Lysholm score, Knee Society Score (KSS), and evaluation of Kujala, and Hospital for Special Surgery Patellofemoral score (HSS-PF). The postoperative complications were analyzed. Results Nineteen knees were evaluated; the average follow-up was 35.2months. Fourteen were women, with an average age of 54years. The pre-operative/postoperative clinical results presented a significant improvement: VAS 8/2.5, Lysholm 31.9/85.8, KSS 39.8/82.5, Kujala 32.1/79.3 and Hospital for Special Surgery Patellofemoral score (HSS-PF) 15.9/90.6. A total of 87% of patients were either satisfied or very satisfied with the overall outcome. There were no radiographic signs of loosening. Seven postoperative complications were recorded: two presented ongoing knee pain, one postoperative stiffness, one patellar bounce due to maltracking, two ilio-tibial band syndrome, and one tibial anterior tuberosity osteotomy nonunion. Two patients underwent a total knee arthroplasty conversion and were considered a failure. None of these complications were implant related. Conclusions Patellofemoral inlay resurfacing for isolated patellofemoral arthritis was an effective and safe procedure with high levels of patient satisfaction. No mechanical implant failure was seen at a minimum two-year follow-up. This implant design appeared to be an alternative to the traditional patellofemoral prostheses. Concomitant osteochondral lesions, patellofemoral dysplasia or patellar maltracking might be poor prognostic factors for this type of implant.

      PubDate: 2017-11-02T13:32:31Z
      DOI: 10.1016/j.knee.2017.09.003
  • Preoperative corrections are required for planning of patient-specific
           instrumentation in total knee arthroplasty
    • Authors: Yohei Okada; Atsushi Teramoto; Tomoyuki Suzuki; Yuichiro Kii; Kota Watanabe; Toshihiko Yamashita
      Abstract: Publication date: Available online 16 October 2017
      Source:The Knee
      Author(s): Yohei Okada, Atsushi Teramoto, Tomoyuki Suzuki, Yuichiro Kii, Kota Watanabe, Toshihiko Yamashita
      Background Patient-specific instrumentation (PSI) is attracting attention as a mechanical method of ensuring the accuracy of osteotomy during total knee arthroplasty (TKA). Few studies have focused on preoperative plans; thus, it is unclear how often initial plans have to be corrected preoperatively and intraoperatively. We investigated the frequency of corrections, the accuracy of intraoperative osteotomy, and postoperative alignment. Methods We analyzed 45 knees of 40 patients who underwent TKA using magnetic resonance imaging (MRI)-based PSI. We evaluated the frequency of corrections to preoperative plans and intraoperative corrections for each part. We also evaluated osteotomy error, defined as the difference between the planned and actual thickness of resected bone. Hip–knee–ankle angle (HKA), femoral component angle (FCA), and tibial component angle (TCA) on plain X-rays were evaluated for postoperative alignment. Results Corrections were made to the initial plans in 91.1% of cases with a mean of 3.3 corrections per knee. Intraoperative corrections were made in 57.8% of cases, with a mean of 0.6 corrections per knee. Mean absolute osteotomy error was around one millimeter, and values were within two millimeters over 80% of cases on most parts except the proximal lateral tibia. In terms of postoperative alignment, HKA was 178.5±1.7°, FCA was 89.0±1.6°, and TCA was 89.4±1.9°. Proportions of outliers were 11.1%, 15.6%, and 20.0%, respectively. Conclusions Most of the cases required preoperative corrections for planning of PSI. PSI may be useful for ensuring the accuracy of osteotomy and postoperative alignment.

      PubDate: 2017-10-26T04:19:15Z
      DOI: 10.1016/j.knee.2017.09.008
  • The effect of platelet-rich fibrin on autologous osteochondral
           transplantation: An in vivo porcine model
    • Authors: S.Y. Sheu; C.H. Wang; Y.H. Pao; Y.T. Fu; C.H. Liu; C.H. Yao; T.F. Kuo
      Abstract: Publication date: Available online 14 October 2017
      Source:The Knee
      Author(s): S.Y. Sheu, C.H. Wang, Y.H. Pao, Y.T. Fu, C.H. Liu, C.H. Yao, T.F. Kuo
      Background This work aimed to evaluate the efficacy of cartilage transplantation to the medial femoral condyle±platelet-rich fibrin (PRF) augmentation in a porcine model. The hypothesis of the study was that PRF may act as a bioactive cell scaffold to fill defects and enhance cartilage regeneration. Methods Thirty-two knees of 16 miniature pigs were randomly assigned to four groups. The critical-size osteochondral defects (8x5mm) in femoral condyle of both knees were treated with one of the following: group 1-untreated controls; group 2-cartilage fragments alone; group 3-PRF alone; group 4-PRFT+cartilage fragments. After completion of the surgical implantation, the periosteal patch harvested from the proximal tibia was sutured onto the cartilage of the medial condyle to cover the implanted defects. Animals were sacrificed at six months after treatment. The regenerated cartilages were assessed by gross inspection and histological examination. Results The best results were obtained with the repair tissue being hyaline-like cartilage (group 4). The grading score of histological evaluation demonstrated that group 4 had better matrix, cell distribution and cartilage mineralization than group 2 and group 3. PRF showed a positive effect on the cartilage repair; the procedure was more effective when PRF was combined with autologous chondrocytes. Conclusions This approach may provide a successfully employed technique to target cartilage defects in vivo. Larger groups and longer periods of study may provide more definitive and meaningful support for using this therapeutic approach as a new way of cartilage regeneration.

      PubDate: 2017-10-26T04:19:15Z
      DOI: 10.1016/j.knee.2017.08.049
  • Primary stability of different plate positions and the role of bone
           substitute in open wedge high tibial osteotomy
    • Authors: Ryohei Takeuchi; Jung Woon-Hwa; Hiroyuki Ishikawa; Yuichiro Yamaguchi; Katsunari Osawa; Yasushi Akamatsu; Koichi Kuroda
      Abstract: Publication date: Available online 13 October 2017
      Source:The Knee
      Author(s): Ryohei Takeuchi, Jung Woon-Hwa, Hiroyuki Ishikawa, Yuichiro Yamaguchi, Katsunari Osawa, Yasushi Akamatsu, Koichi Kuroda
      Background The purpose of this study was to compare the mechanical fixation strengths of anteromedial and medial plate positions in osteotomy, and clarify the effects of bone substitute placement into the osteotomy site. Methods Twenty-eight sawbone tibia models were used. Four different models were prepared: Group A, the osteotomy site was open and the plate position was anteromedial; Group B, bone substitutes were inserted into the osteotomy site and the plate position was anteromedial; Group C, the osteotomy site was open and the plate position was medial; and Group D, bone substitutes were inserted into the osteotomy site and the plate position was medial. The loading condition ranged from 0 to 800N and one hertz cycles were applied. Changes of the tibial posterior slope angle (TPS), stress on the plate and lateral hinge were measured. Results The changes in the TPS and the stress on the plate were significantly larger in Group A than in Group C. These were significantly larger in Group A than in Group B, and in Group C than in Group D. There was no significant difference between Group B and Group D, and no significant difference between knee flexion angles of 0° and 10°. Stress on the lateral hinge was significantly smaller when bone substitute was used. Conclusions A medial plate position was biomechanically superior to an anteromedial position if bone substitute was not used. Bone substitute distributed the stress concentration around the osteotomy gap and prevented an increase in TPS angle regardless of the plate position.

      PubDate: 2017-10-26T04:19:15Z
      DOI: 10.1016/j.knee.2017.07.015
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