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Journal Cover The Knee
   [12 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 0968-0160
     Published by Elsevier Homepage  [2571 journals]   [SJR: 0.923]   [H-I: 38]
  • Functional outcome after tibial plateau fracture osteosynthesis: A mean
           follow-up of 6years
    • Abstract: Publication date: Available online 11 October 2014
      Source:The Knee
      Author(s): Tim K. Timmers , Denise J.C. van der Ven , Luuk S. de Vries , Ger D.J. van Olden
      Background Tibial plateau fractures often require surgical treatment. Functional outcome depends mainly on the range of knee motion, joint stability, and pain. Only a few studies evaluate the functional outcome of a tibial plateau fracture after operation. The primary aim of this study was to evaluate the results and functional outcome of surgically treated (ORIF) tibial plateau fractures. Methods Between January 2000 and December 2010 all consecutive patients undergoing osteosynthesis of a tibial plateau fracture were included if they were discharged alive and completed the questionnaire. The primary outcome measures were functional outcome (“Knee injury and Osteoarthritis Score” (KOOS) questionnaire) and Health-related quality of life (HrQoL) using the EuroQol-6D (EQ-6D) questionnaire at the end of the study follow-up period (May 2013). Results Eighty-two patients were included in the functional outcome and HrQoL analysis. The functional outcome results were concluded as “Fair” for the overall cohort within the sections Symptoms/Pain/Self-care. A significant difference was seen in the Sport/Recreation section (functional outcome: “Poor”). Dividing our cohort in a low-energy and a high-energy-trauma group, significant lower functional outcome score was seen in the KOOS section Pain for the high-energy-trauma patients. The HrQoL of the total study-population was worse in comparison to an age-matched general Dutch population on the EQ-us (difference of 0.15). This decrease in HrQoL was seen in all dimensions of the EuroQol questionnaire. Conclusions Six years after discharge from hospital, patients still alive had a “Fair” functional knee outcome. However, HrQoL was lower in comparison to the general Dutch population.


      PubDate: 2014-10-12T08:51:08Z
       
  • Knee joint changes in patients with neglected developmental hip dysplasia:
           A prospective case–control study
    • Abstract: Publication date: Available online 7 October 2014
      Source:The Knee
      Author(s): Qiwei Li , Muayad Kadhim , Lijun Zhang , Xiangjun Cheng , Qun Zhao , Lianyong Li
      Background Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Methods Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. Results In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Conclusions Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level of evidence Level 2.


      PubDate: 2014-10-10T08:37:23Z
       
  • Effect of cyclic tension on the biomechanical properties of flexor tendon
           grafts. Results of an ex-vivo porcine study
    • Abstract: Publication date: Available online 27 September 2014
      Source:The Knee
      Author(s): Mario Orrego , José Matas , Sebastián Abusleme , Rodrigo Guzmán-Venegas , Diego Amenabar
      Background Autologous flexor tendons are widely used for anterior cruciate ligament (ACL) reconstruction. Pretension of the graft before fixation has been described as part of the surgical technique, nevertheless there is no consensus on the type and amount to tension needed to increase the stiffness without affecting its biomechanical properties.Our hypothesis is cyclic tension increases flexor tendon stiffness without affecting its ultimate failure at maximum loads (UFML). Methods Forty-five flexor digitorum profundus tendons harvested from domestic pigs (Sus scrofa domestica) were randomly divided into three groups: E1 (n=15), E2 (n=15) and C (n=15). Groups E1 and E2 were subjected to 50 cyclic loads at a 1 Hz frequency, at 70N and 100N respectively, group C was not intervened. The three groups were then tested for UFML. Cyclic loads and measurements were performed using a Stress-Strain machine (SST 1.0 Kinetecnic ®). Results were analyzed using GrapgPad statistical software. Groups were compared using Mann-Whitney test with a 95% confidence interval. Results Significant increased stiffness for group E1 (p=0.02) and group E2 ( p<0.01) when compared to group C. The stiffness of group E2 was also significantly higher than E1 (p=0.03). There was a significant reduction on the UFML between group E2 and C (p<0.01), which was not observed when comparing groups E1 and C. Conclusion Cyclic loads at 70N result in an increased stiffness of flexor tendons without affecting its ultimate failure at maximum loads. Cyclic loads at higher tensions might cause a deleterious effect on the biomechanical properties of flexor tendon grafts.


      PubDate: 2014-10-01T06:31:45Z
       
  • Notchplasty in anterior cruciate ligament reconstruction in the setting of
           passive anterior tibial subluxation
    • Abstract: Publication date: Available online 30 September 2014
      Source:The Knee
      Author(s): Hendrik A. Zuiderbaan , Saker Khamaisy , Danyal H. Nawabi , Ran Thein , Joseph T. Nguyen , Joseph D. Lipman , Andrew D. Pearle
      Purpose In an effort to minimize graft impingement among various ACL deficient states, we sought to quantitatively determine requirements for bone resection during notchplasty with respect to both volumetric amount and location. Methods A validated method was used to evaluate Magnetic Resonance Imaging scans. We measured the ATT of the medial and lateral compartments in the following four states: intact ACL (27 patients), acute ACL disruption; <2months post-injury (76 patients), chronic ACL disruption; 12months post-injury (42 patients) and failed ACL reconstruction (75 patients). Subsequently, 11 cadaveric knees underwent Computed Tomography (CT) scanning. Specialized software allowed virtual anterior translation of the tibia according to the average ATT measured on MRI. Impingement volume was analyzed by performing virtual ACLRs onto the various associated CT scans. Location was analyzed by overlaying an on-screen protractor. The center of the notch was defined as 0°. Results Average impingement volume changed significantly in the various groups compared to the intact ACL group (acute 577±200mm3, chronic 615±199mm3, failed ACLR 678±210mm3, p=0.0001). The location of the required notchplasty of the distal femoral wall border did not change significantly. The proximal femoral border moved significantly towards the center of the notch (acute 8.6°±4.8°, chronic 7.8°±4.2° (p=0.013), failed ACLR 5.1°±5.9° (p=0.002)). Conclusion Our data suggests that attention should be paid peri-operatively to the required volume and location of notchplasty among the various ACL deficient states to minimize graft impingement.


      PubDate: 2014-10-01T06:31:45Z
       
  • The knee adduction angle of the osteo-arthritic knee: A comparison of 3D
           supine, static and dynamic alignment
    • Abstract: Publication date: Available online 26 September 2014
      Source:The Knee
      Author(s): Lynsey D. Duffell , Jameel Mushtaq , Milad Masjedi , Justin P. Cobb
      Background End-stage knee osteoarthritis (OA) commonly results in knee arthroplasty. Three dimensional (3D) supine imaging is often used for pre-operative planning to optimise post-operative knee adduction angles (KAA). However, supine imaging may not represent loaded knee alignment. The aim of this study was to investigate differences in knee alignment under supine, static and dynamic conditions in healthy subjects and subjects with knee OA. Methods Nine healthy subjects and 15 subjects with end-stage knee OA were recruited. All subjects underwent supine imaging and motion capture during gait. KAAs were calculated from supine images (SUPINE), upright standing (STATIC) and at the first peak ground reaction force during gait (DYNAMIC), and were compared. Results KAAs were significantly higher (more varus) during gait compared with static (loaded and unloaded) in healthy subjects (p <0.01) but not in subjects with knee OA. There was a good correlation between SUPINE and DYNAMIC for both healthy and OA subjects (R 2 >0.58), with differences in the two relationships; healthy knees had a higher KAA during gait for any given KAA in the supine position, whereas OA knees that were valgus in imaging became more valgus during gait, and the opposite occurred for varus knees. Conclusions Factors that may contribute to the noted differences between healthy and OA subjects include morphological changes in the joint as a result of OA, and gait compensation strategies in people with end-stage OA. Dynamic 3D motion capture provides important information about functional alignment that is not provided by supine imaging or static motion capture. Clinical Relevance Gait analysis may provide useful information to the surgeon during surgical planning of knee arthroplasties.


      PubDate: 2014-09-26T05:36:40Z
       
  • Releasing the circumferential fixation of the medial meniscus does not
           affect its kinematics
    • Abstract: Publication date: Available online 26 September 2014
      Source:The Knee
      Author(s): A.C.T. Vrancken , T.G. van Tienen , G. Hannink , D. Janssen , N. Verdonschot , P. Buma
      Background Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical behavior of the meniscus. Therefore, we aimed to determine whether detaching and resuturing the circumferential fixation of the medial meniscus influence its kinematic pattern. Methods Human cadaveric knee joints were flexed (0°–30°–60°–90°) in a knee loading rig, in neutral orientation and under internal and external tibial torques. Roentgen stereophotogrammetric analysis was used to determine the motion of the meniscus in anteroposterior (AP) and mediolateral (ML) directions. Three fixation conditions were evaluated: (I) intact, (II) detached and (III) resutured. Results Detaching and resuturing the circumferential fixation did not alter the meniscal motion pattern in either the AP or ML direction. Applying an additional internal tibial torque caused the medial meniscus to move slightly anteriorly, and an external torque caused a little posterior translation with respect to the neutral situation. These patterns did not change when the circumferential fixation condition was altered. Conclusions This study demonstrated that the motion pattern of the medial meniscus is independent of its fixation to the knee capsule and medial collateral ligament. Clinical relevance The outcomes of this study can be deployed to design the fixation strategy of a permanent meniscus prosthesis. As peripheral fixation is a complicated step during meniscal replacement, the surgical procedure is considerably simplified when non-resorbable implants do not require circumferential fixation.


      PubDate: 2014-09-26T05:36:40Z
       
  • The outcome of all-inside meniscal repair with relation to previous
           anterior cruciate ligament reconstruction
    • Abstract: Publication date: Available online 23 September 2014
      Source:The Knee
      Author(s): R.P. Walter , A.S. Dhadwal , P. Schranz , V. Mandalia
      Background Arthroscopically assisted all-inside meniscal repair has become a popular treatment for meniscal tears. Previous studies have suggested a beneficial effect of concomitant anterior cruciate ligament reconstruction on meniscal repair outcomes. The effect of prior cruciate ligament reconstruction (predating the meniscal injury) on meniscal repair success is unreported. The aim of this study was to assess the success of meniscal repair in our practice. Further aims were to analyze the effect of concomitant- and past-anterior cruciate ligament reconstruction on meniscal repair outcomes. Methods Retrospective review of all patients undergoing arthroscopic meniscal repair during a 53month period was performed. Mean followup was 13.5months (mean 6–50). The primary outcome measure was meniscal reoperation. Results Sixteen of 104 patients required reoperation, giving an overall meniscal repair success rate of 85%. Patients undergoing concomitant anterior cruciate ligament reconstruction enjoyed significantly improved outcomes (91%, p=0.049), while those with a past history of anterior cruciate ligament reconstruction had significantly worse meniscal repair success rates (63%, p=0.016). Conclusions Arthroscopic meniscal repair in a selected patient group offers good success rates, especially when performed with concomitant anterior cruciate ligament reconstruction. We have identified a subgroup of patients, those with a past history of anterior cruciate ligament reconstruction predating the meniscal injury, who appear to have relatively poor outcomes from meniscal repair. Potential reasons for this finding are discussed. Level of Evidence Level IV, case series.


      PubDate: 2014-09-26T05:36:40Z
       
  • The effect of videotape augmented feedback on drop jump landing strategy:
           Implications for anterior cruciate ligament and patellofemoral joint
           injury prevention
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Allan Munro , Lee Herrington
      Background Modification of high-risk movement strategies such as dynamic knee valgus is key to the reduction of anterior cruciate ligament (ACL) and patellofemoral joint (PFJ) injuries. Augmented feedback, which includes video and verbal feedback, could offer a quick, simple and effective alternative to training programs for altering high-risk movement patterns. It is not clear whether feedback can reduce dynamic knee valgus measured using frontal plane projection angle (FPPA). Methods Vertical ground reaction force (vGRF), two-dimensional FPPA of the knee, contact time and jump height of 20 recreationally active university students were measured during a drop jump task pre- and post- an augmented feedback intervention. A control group of eight recreationally active university students were also studied at baseline and repeat test. Results There was a significant reduction in vGRF (p =0.033), FPPA (p <0.001) and jump height (p <0.001) and an increase in contact time (p <0.001) post feedback in the intervention group. No changes were evident in the control group. Conclusion Augmented feedback leads to significant decreases in vGRF, FPPA and contact time which may help to reduce ACL and PFJ injury risk. However, these changes may result in decreased performance. Clinical relevance Augmented feedback reduces dynamic knee valgus, as measured via FPPA, and forces experienced during the drop jump task and therefore could be used as a tool for helping decrease ACL and PFJ injury risk prior to, or as part of, the implementation of injury prevention training programs.


      PubDate: 2014-09-22T05:18:49Z
       
  • Knee joint laxity and passive stiffness in meniscectomized patients
           compared with healthy controls
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Jonas B. Thorlund , Mark W. Creaby , Tim V. Wrigley , Ben R. Metcalf , Kim L. Bennell
      Background Passive mechanical behavior of the knee in the frontal plane, measured as angular laxity and mechanical stiffness, may play an important role in the pathogenesis of knee osteoarthritis (OA). Little is known about knee laxity and stiffness prior to knee OA onset. We investigated knee joint angular laxity and passive stiffness in meniscectomized patients at high risk of knee OA compared with healthy controls. Methods Sixty patients meniscectomized for a medial meniscal tear (52 men, 41.4±5.5years, 175.3±7.9cm, 83.6±12.8kg, mean±SD) and 21 healthy controls (18 men, 42.0±6.7years, 176.8±5.7cm, 77.8±13.4kg) had their knee joint angular laxity and passive stiffness assessed twice ~2.3years apart. Linear regression models including age, sex, height and body mass as covariates in the adjusted model were used to assess differences between groups. Results Greater knee joint varus (−10.1 vs. −7.3°, p<0.001), valgus (7.1 vs. 5.6°, p=0.001) and total (17.2 vs. 12.9°, p<0.001) angular laxity together with reduced midrange passive stiffness (1.71 vs. 2.36Nm/°, p<0.001) were observed in patients vs. healthy controls. No differences were observed in change in stiffness over time between patients and controls, however a tendency towards increased laxity in patients was seen. Conclusions Meniscectomized patients showed increased knee joint angular laxity and reduced passive stiffness ~3months post surgery compared with controls. In addition, the results indicated that knee joint laxity may increase over time in meniscectomized patients.


      PubDate: 2014-09-22T05:18:49Z
       
  • Contents List
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5




      PubDate: 2014-09-22T05:18:49Z
       
  • Editorial Board
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5




      PubDate: 2014-09-22T05:18:49Z
       
  • Tibial component rotation: The inveterate problem
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Henry D. Clarke



      PubDate: 2014-09-22T05:18:49Z
       
  • Frontal plane knee mechanics and medial cartilage MR relaxation times in
           individuals with ACL reconstruction: A pilot study
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Deepak Kumar , Abbas Kothari , Richard B. Souza , Samuel Wu , C. Benjamin Ma , Xiaojuan Li
      Background The objective of this pilot study was to evaluate cartilage T1ρ and T2 relaxation times and knee mechanics during walking and drop-landing for individuals with anterior cruciate ligament reconstruction (ACL-R). Methods Nine patients (6 men and 3 women, age 35.8±5.4years, BMI 23.5±2.5kg/m2) participated 1.5±0.8years after single-bundle two-tunnel ACL reconstruction. Peak knee adduction moment (KAM), flexion moment (KFM), extension moment (KEM), and peak varus were calculated from kinematic and kinetic data obtained during walking and drop-landing tasks. T1ρ and T2 times were calculated for medial femur (MF), and medial tibia (MT) cartilage and compared between subjects with low KAM and high KAM. Biomechanical variables were compared between limbs. Results The high KAM group had higher T1ρ for MT (p=0.01), central MT (p=0.05), posterior MF (p=0.04), posterior MT (p=0.01); and higher T2 for MT (p=0.02), MF (p=0.05), posterior MF (p=0.002) and posterior MT (p=0.01). During walking, ACL-R knees had greater flexion at initial contact (p=0.04), and lower KEM (p=0.02). During drop-landing, the ACL-R knees had lower KAM (p=0.03) and KFM (p=0.002). Conclusion Patients with ACL-R who have higher KAM during walking had elevated MR relaxation times in the medial knee compartments. These data suggest that those individuals who have undergone ACL-R and have higher frontal plane loading, may be at a greater risk of knee osteoarthritis.


      PubDate: 2014-09-22T05:18:49Z
       
  • Clinical features and injury patterns of medial collateral ligament tibial
           side avulsions: “Wave sign” on magnetic resonance imaging is
           essential for diagnosis
    • Abstract: Publication date: Available online 20 September 2014
      Source:The Knee
      Author(s): Shuji Taketomi , Eiji Uchiyama , Takumi Nakagawa , Hideki Takeda , Shuichi Nakayama , Atsushi Fukai , Takaki Sanada , Hiroshi Iwaso
      Background Medial collateral ligament tibial avulsion is rare. Consequently, diagnostic criteria and a treatment regimen for medial collateral ligament tibial side avulsions remain to be established. The purpose of this study is to clarify the clinical features of medial collateral ligament tibial side avulsions. Methods We performed a retrospective clinical and magnetic resonance imaging review of a consecutive series of 12 medial collateral ligament tibial side avulsions. All patients were treated operatively and the final diagnosis was made based on the intraoperative findings. Post-injury magnetic resonance imaging studies were reviewed to assess injury patterns with respect to the intraoperative findings. Results Eleven of 12 cases (92%) had grade III valgus laxity (unstable to valgus stress at both 0° and 30° of flexion) on an examination under anesthesia. Concomitant anterior cruciate ligament tear was noticed in all cases. Intraoperative findings were classified into 3 types depending on the location of the ruptured end of the superficial medial collateral ligament with respect to the pes anserinus tendons. Magnetic resonance imaging depicted characteristic waving (“wave sign”) of the superficial layer of medial collateral ligament in all cases. Conclusions “Wave sign” of the superficial layer of medial collateral ligament on magnetic resonance imaging is essential for diagnosing medial collateral ligament tibial side avulsions. Based on the clinical features and injury patterns, operative treatment is primarily recommended for medial collateral ligament tibial side avulsions. Level of evidence Case series, Level IV.


      PubDate: 2014-09-22T05:18:49Z
       
  • Prepatellar continuation rupture: Report of an unusual case
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Haroon Majeed , Ian dos Remedios , Praveen Datta , David Griffiths
      In anatomical studies the deepest soft tissue layer, related to the deep rectus femoris tendinous fibers, has been described as the “prepatellar quadriceps continuation”. We present an unusual case of an isolated prepatellar continuation rupture, which to our knowledge is the first described case in the literature. Injuries to the extensor mechanism may include isolated rupture of the prepatellar continuation with intact quadriceps and patellar tendons. Diagnosis may be difficult with ultrasound scan and requires MRI scan for confirmation. Appropriate clinical assessment and regular physiotherapy lead to a full functional recovery.


      PubDate: 2014-09-22T05:18:49Z
       
  • Sustainable approaches to early knee osteoarthritis
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Roland Jakob



      PubDate: 2014-09-22T05:18:49Z
       
  • British Association for Surgery of the Knee
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5




      PubDate: 2014-09-22T05:18:49Z
       
  • Instructions for Authors
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5




      PubDate: 2014-09-22T05:18:49Z
       
  • Neglected rotatory knee dislocation: A case report
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Saker Khamaisy , Amgad M. Haleem , Riley J. Williams , S. Robert Rozbruch
      We report here a unique case of a 3year neglected rotatory tibiofemoral dislocation associated with a lateral patellar dislocation. The rotational deformity was gradually corrected using a Taylor spatial frame and the patella was realigned by tibial tubercle osteotomy and transfer. The patient also underwent multiple soft tissue releases and quadricepsplasty to improve knee flexion. At nine year follow-up, the patient has good knee range of motion, a congruent knee joint and a good functional result. Clinical relevance: Taylor spatial frame combined with other orthopedic approaches can be a useful tool while dealing with neglected knee dislocations.


      PubDate: 2014-09-22T05:18:49Z
       
  • Clinical alignment variations in total knee arthroplasty with different
           navigation methods
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Byron F. Stephens , Sam Hakki , Khaled J. Saleh , William M. Mihalko
      Background We compared the resulting alignment in 90° of flexion and in full extension after total knee arthroplasty (TKA) with two navigation systems using different techniques: a measured resection (MR) system and a gap — balancing (GB) system. Methods Varus and valgus alignment in extension and flexion was compared in 100 consecutive patients who had TKA with an MR distal–femoral-cut-first technique at one institution and 100 consecutive patients in whom a GB tibial-cut-first technique was used at another institution. Alignment deviation of three degrees or more from neutral was considered an outlier. Results No significant difference between the groups in coronal alignment in extension or flexion was found, but there were three times the number of outliers for clinical alignment in flexion for the MR group compared to the GB group. Conclusions The use of the GB tibial-cut-first computer-assisted TKA navigation may provide a more consistent clinical alignment in flexion than systems using an MR technique. Level of evidence Therapeutic study. Level 2.


      PubDate: 2014-09-22T05:18:49Z
       
  • Ten year survivorship after cemented and uncemented medial Uniglide®
           unicompartmental knee arthroplasties
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Klaus Schlueter-Brust , Karoline Kugland , Gregor Stein , Johann Henckel , Hildegard Christ , Peer Eysel , Gustav Bontemps
      Background Results of knee replacement registries have shown that unicompartmental knee arthroplasty (UKA) has a significantly higher revision and failure rate than current state-of-the-art TKA. The aim of this prospective study is to evaluate the long-term outcomes and to calculate the 10year survival of knees with medial osteoarthritis treated with Uniglide® UKA. Methods Two hundred thirty-four patients were assessed by an independent clinical observer using the American Knee Society Clinical Rating System, a validated outcome measure. Kaplan–Meier analysis was used to calculate the 10year survival rates using revision surgery for any cause as the end point. Results There were no revisions due to progression of lateral osteoarthritis or polyethylene failure. There were one traumatic and three non-traumatic bearing dislocations and two revisions due to aseptic loosening of the tibial component. One joint was revised for traumatic ligament rupture, one for synovitis from bearing impingement, one due to femoral component mal-positioning and one for infection. A total of 10 cases were revised due to failures for any cause in the 61 patients withdrawn because they had died, thus giving a cumulative survival rate at 10years of 95.57%. The knee (function) score showed an increase from 33.4 (54.7) pre-operatively to 94 (83.4) points post-operatively. The average range of motion increased from 107 to 122° (p<0.01). Conclusion Based on our findings we believe that the Uniglide® unicompartmental knee prosthesis offers a safe and effective solution for the treatment of medial compartment osteoarthritis.


      PubDate: 2014-09-22T05:18:49Z
       
  • Mobile-bearing total knee arthroplasty: More rotation is evident during
           more demanding tasks
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Arthur W. Zürcher , Kim van Hutten , Jaap Harlaar , Caroline B. Terwee , G.H. Rob Albers , Ruud G. Pöll
      Background Some reports showed few but significant more axial femorotibial rotation in favor of mobile-bearing (MB) versus fixed-bearing (FB) total knee arthroplasty (TKA), mostly during knee bend fluoroscopic studies. The goal of the current study was to submit MB and FB groups of TKA patients to a turning activity, in which additional rotation was to be expected. Methods Two consecutive cohorts of patients after TKA (10 FB and 11 MB knees in a total of 18 patients) were assessed using motion analysis five year postoperatively, while performing gait and sit-to-walk (STW) movements with and without turning steps. Results Mean range of rotation in the FB group increased from 9.7° during gait, to 11.7° during STW straight, and to 14.3° during STW turning. Mean range of rotation in the MB group increased from 13.4° during gait to 21.0° during STW straight, and stayed at 21.1° during STW turning. Conclusions Too many uncontrolled variables in the current study hinder a meaningful discrimination of MB from FB TKA rotation. However, the study does illustrate how more demanding task loads could be helpful in exploring the geometric constraints of TKA variants. Level of Evidence Level III, therapeutic study.


      PubDate: 2014-09-22T05:18:49Z
       
  • The effect of tibial component sizing on patient reported outcome measures
           following uncemented total knee replacement
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Simon G.F. Abram , Andrew G. Marsh , Alistair S. Brydone , Fiona Nicol , Aslam Mohammed , Simon J. Spencer
      When performing total knee replacement (TKR), surgeons are required to decide on the most appropriate size of tibial component. As implants are predominantly selected from incremental sizes of a preferred design, it may be necessary for a surgeon to slightly under or oversize the component. There are concerns that overhang could lead to pain from irritation of soft tissues, and an undersized component could lead to subsidence and failure. Patient reported outcome measures were recorded in 154 TKRs at one year postoperatively (in 100 TKRs) and five years post-operatively (in 54 TKRs) in 138 patients. The Oxford Knee Score (OKS), WOMAC and SF-12 were recorded, and a composite pain score was derived from the OKS and WOMAC pain questions. Tibial component size and position were assessed on scaled radiographs and implants were grouped into anatomic sized tibial component (78 TKRs), undersized component (48 TKRs), minor overhang one to three mm (10 TKRs) or major overhang ≥3mm (18 TKRs). There was no statistically significant difference between the mean post-operative OKS, WOMAC, SF-12 or composite pain score of each group. Furthermore, localisation of the site of pain did not correlate with medial or lateral overhang of the tibial component. Our results suggest that tibial component overhang or undersizing is not detrimental to outcome measures or pain. Level of evidence: II


      PubDate: 2014-09-22T05:18:49Z
       
  • Similar early migration when comparing CR and PS in Triathlon™ TKA:
           A prospective randomised RSA trial
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Mats Molt , Sören Toksvig-Larsen
      Objectives The objective of this study was to compare the early migration of the cruciate retaining and posterior stabilising versions of the recently introduced Triathlon™ total knee system, with a view to predicting long term fixation performance. Methods Sixty patients were prospectively randomised to receive either Triathlon™ posterior stabilised cemented knee prosthesis or Triathlon™ cruciate retaining cemented knee prosthesis. Tibial component migration was measured by radiostereometric analysis postoperatively and at three months, one year and two years. Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score. Results There were no differences in rotation around the three coordinal axes or in the maximum total point motion (MTPM) during the two year follow-up. The posterior stabilised prosthesis had more posterior–anterior translation at three months and one year and more caudal–cranial translation at one year and two years. There were no differences in functional outcome between the groups. Conclusion The tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability. Level of evidence Level I. Article summary Article focus: This was a prospective randomised trial aiming to compare the single radius posterior stabilised (PS) Triathlon™ total knee arthroplasty (TKA) to the cruciate retaining Triathlon™ TKA system with regard to fixation. Strengths and limitations of this study: Strength of this study was that it is a randomised prospective trial using an objective measuring tool. The sample size of 25–30 patients was reportedly sufficient for the screening of implants using RSA [1]. Trial registration: ClinicalTrials.gov Identifier: NCT00436982.


      PubDate: 2014-09-22T05:18:49Z
       
  • Five-year follow-up of minimally invasive computer assisted total knee
           arthroplasty (MICATKA) versus conventional computer assisted total knee
           arthroplasty (CATKA) — A population matched study
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): R.S. Khakha , M. Chowdhry , M. Norris , A. Kheiran , N. Patel , S.K. Chauhan
      Background Minimally invasive surgery (MIS) has perceived advantages in the early post-operative stage such as reduced blood loss, decreased pain, earlier return to function and earlier discharge. The aim of our study was to confirm that longer term clinical outcome of TKA is not compromised when MIS is combined with computer assisted surgery. Methods Eighty patients matched for age, gender, pre-operative Knee Society Score (KSS) and mechanical axis were prospectively studied. Forty patients underwent minimally invasive computer assisted total knee arthroplasty (MICATKA) and 40 patients underwent conventional computer assisted TKA (CATKA). Functional scores were determined at 6weeks, 6, 12, 18, and 24months and 5years post-surgery. Long-leg alignment views were obtained 3months post-operatively. Results KSSs in the short term were significantly better in the MICATKA group than in the CATKA group (p<000.1). Tourniquet-time was 58min in the MICTKA group and 60min in the CATKA group (p=0.3). Straight leg raise was achieved by day one in 93% of the MICATKA group compared to 30% of the CATKA group (p<0.001). Length of stay for the MICATKA group has a mean of 3.25days and a mean of 6days for the CATKA group (p<0.001). KSSs up to 2-years were significantly better in the MICTKA group (p<0.001). At 5-years there was no significant difference in KSSs (p=0.46) in the MICATKA and CATKA groups. Conclusion We confirm that the use of navigation in minimally invasive TKA permits a number of early post-operative advantages and that longer-term functional outcome is not compromised with its usage. Level of evidence Level II


      PubDate: 2014-09-22T05:18:49Z
       
  • Partial harvesting technique in anterior cruciate ligament reconstruction
           with autologous semitendinosus tendon to prevent a postoperative decrease
           in deep knee flexion torque
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Jun Sasahara , Masato Takao , Wataru Miyamoto , Kenji Oguro , Takashi Matsushita
      Background A significant decrease in deep knee flexion torque has been reported after harvesting the semitendinosus tendon for anterior cruciate ligament (ACL) reconstruction. Thus, we have developed a partial harvesting technique that leaves part of the width of the insertion of semitendinosus tendon by splitting it. Our hypothesis was that the partial harvesting technique would reduce postoperative functional deficits in deep knee flexion by achieving regeneration of harvested tendon without shortening. Methods A total of 36 patients who underwent ACL reconstruction with an autologous semitendinosus tendon by means of either the conventional whole harvesting technique (whole-ST group, n=16) or the partial harvesting technique (partial-ST group, n=20) were included in this study. Clinical outcome, semitendinosus muscle length, and deep knee flexion torque were assessed 2years after surgery. Results No significant group differences were found in terms of range of motion, Lysholm score, or anterior knee laxity. Shortening of the semitendinosus muscle was significantly less in the partial-ST group (mean 8mm) than in the whole-ST group (mean 36mm; P<0.001). The side-to-side ratio of isometric knee flexion torque in the prone position with 90° of knee flexion was statistically different between the partial-ST (87.0±20.4%) and whole-ST (55.3±13.9%; P<0.001) groups. Conclusions The present partial harvesting technique not only prevented shortening of the semitendinosus muscle, but also reduced the deficit in the maximum knee flexion angle in the standing position and a decrease in the deep knee flexion torque in the prone position with the partial harvesting technique compared to the nonoperated side with good clinical outcomes. Level of evidence Case–control study, Level III.


      PubDate: 2014-09-22T05:18:49Z
       
  • Surgical treatment of recurrent proximal tibio-fibular joint ganglion
           cysts
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Aashish Gulati , Philipp Lechler , Robert Steffen , Tom Cosker , Nick Athanasou , Duncan Whitwell , Christopher L.M.H. Gibbons
      Background Complex symptomatic ganglion cysts arising from the proximal tibio-fibular joint (PTJ) are not an uncommon presentation in specialist knee clinics and can be managed by aspiration or excision. There is, however, a high rate of recurrence and often there is progressive involvement of the common peroneal nerve (CPN) and its branches, and permanent nerve damage may result. Methods This study is a review of the outcome of recalcitrant and recurrent cyst disease with CPN involvement treated by proximal fibulectomy. Nine patients with clinical and radiological diagnosis of a ganglion cyst involving the proximal tibio-fibular joint were treated by proximal fibulectomy. Average age was 47.2years (19 to 75). Patients were followed up clinically and radiologically. Medical notes were reviewed to assess clinical/pathological characteristics, surgical outcome, recurrence rate and the symptoms of instability and nerve function. Results None of the patients were lost to follow-up. After an average follow-up of 83months (15 to 150), none of the patients had clinical or radiological evidence of recurrence. All patients were pain-free and had a complete resolution of nerve symptoms and no evidence of CPN injury. None of the patients complained of localised pain or knee instability and there were no wound healing problems. Conclusions MRI now confirms TFJ-ganglion cysts to be more common than previously recognised. Where there is refractory disease with progressive nerve symptoms and evidence of nerve sheath involvement, joint excision by proximal fibulectomy gives a satisfactory functional result in controlling disease and preventing further nerve damage. Level of evidence IV


      PubDate: 2014-09-22T05:18:49Z
       
  • Reliability of a semi-automated 3D-CT measuring method for tunnel
           diameters after anterior cruciate ligament reconstruction: A comparison
           between soft-tissue single-bundle allograft vs. autograft
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Cedric Robbrecht , Steven Claes , Michiel Cromheecke , Peter Mahieu , Kyriakos Kakavelakis , Jan Victor , Johan Bellemans , Peter Verdonk
      Background Post-operative widening of tibial and/or femoral bone tunnels is a common observation after ACL reconstruction, especially with soft-tissue grafts. There are no studies comparing tunnel widening in hamstring autografts versus tibialis anterior allografts. The goal of this study was to observe the difference in tunnel widening after the use of allograft vs. autograft for ACL reconstruction, by measuring it with a novel 3-D computed tomography based method. Methods Thirty-five ACL-deficient subjects were included, underwent anatomic single-bundle ACL reconstruction and were evaluated at oneyear after surgery with the use of 3-D CT imaging. Three independent observers semi-automatically delineated femoral and tibial tunnel outlines, after which a best-fit cylinder was derived and the tunnel diameter was determined. Finally, intra- and inter-observer reliability of this novel measurement protocol was defined. Results In femoral tunnels, the intra-observer ICC was 0.973 (95% CI: 0.922–0.991) and the inter-observer ICC was 0.992 (95% CI: 0.982–0.996). In tibial tunnels, the intra-observer ICC was 0.955 (95% CI: 0.875–0.985). The combined inter-observer ICC was 0.970 (95% CI: 0.987–0.917). Tunnel widening was significantly higher in allografts compared to autografts, in the tibial tunnels (p =0.013) as well as in the femoral tunnels (p =0.007). Conclusions To our knowledge, this novel, semi-automated 3D-computed tomography image processing method has shown to yield highly reproducible results for the measurement of bone tunnel diameter and area. This series showed a significantly higher amount of tunnel widening observed in the allograft group at one-year follow-up. Level of evidence Level II, Prospective comparative study.


      PubDate: 2014-09-22T05:18:49Z
       
  • Assessment of the lateral patellar facet in varus arthritis of the knee
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Wenzel Waldstein , Shari T. Jawetz , Nadja A. Farshad-Amacker , Christian Merle , Tom Schmidt-Braekling , Friedrich Boettner
      Background Lateral patellar arthritis has been associated with poor outcomes in unicompartmental knee arthroplasty. The current study correlates intraoperative findings with MRI imaging, skyline radiographs and the presence of anterior knee pain. Methods In 92 consecutive knees with varus arthritis, the patellofemoral compartment was assessed during surgery, on skyline radiographs and on MRI. Anterior knee pain was recorded on a visual-analog-scale. Intraoperative assessment was based on the Outerbridge grading scale. Skyline radiographs were evaluated according to the Ahlbäck grading scale; MRIs were assessed according to a modified Outerbridge grading scale. Results There was an excellent correlation (rs=0.833; p<0.001) in the cartilage assessment of the lateral patellar facet between MRI and surgery. A good correlation (rs=0.664; p<0.001) was seen between Ahlbäck Grades and macroscopic Outerbridge Grades of the lateral patella. Ahlbäck Grades and MRI modified Outerbridge Grades showed a good correlation (rs=0.643; p<0.001) for the lateral patella. Twelve percent of knees (seven out of 60) with Ahlbäck Grade 0 or 1 and mild to moderate anterior knee pain had a macroscopic Outerbridge Grade of 3 on the lateral patella. None of these 60 knees had a full-thickness cartilage defect on MRI. Conclusion Normal skyline radiographs in patients with mild to moderate anterior knee pain can rule out full-thickness cartilage defects of the lateral patellar facet as observed during surgery and on MRI. The MRI allows for the most accurate assessment of the patellofemoral joint and is warranted in all patients with radiographic abnormalities or severe anterior knee pain. Level of evidence Diagnostic study, Level II.


      PubDate: 2014-09-22T05:18:49Z
       
  • Management of extreme patella baja using in-situ hamstring tendon
           autograft
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): L.S. Moulton , A.P. Davies
      Successful total knee arthroplasty requires a functioning extensor mechanism. Patella baja following total knee arthroplasty can cause extensor mechanism dysfunction and produce poor outcomes. We present a case of severe patella tendon shortening following revision total knee arthroplasty with almost complete ankylosis of the distal pole of the patella to the proximal tibia. This resulted in effective extensor mechanism dysfunction with pain and severely limited knee flexion. We report a novel method of reconstruction of the patella tendon at the time of revision arthroplasty together with the one-year clinical outcome and review of the literature.


      PubDate: 2014-09-22T05:18:49Z
       
  • A prospective double blinded randomized study of anterior cruciate
           ligament reconstruction with hamstrings tendon and spinal anesthesia with
           or without femoral nerve block
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Diego Costa Astur , Vinicius Aleluia , Ciro Veronese , Nelson Astur , Saulo Gomes Oliveira , Gustavo Gonçalves Arliani , Ricardo Badra , Camila Cohen Kaleka , Joicemar Tarouco Amaro , Moisés Cohen
      Background Current literature supports the thought that anesthesia and analgesia administered perioperatively for an anterior cruciate ligament (ACL) reconstruction have a great influence on time to effective rehabilitation during the first week after hospital discharge. Purpose The aim of this study is to answer the research question is there a difference in clinical outcomes between the use of a femoral nerve block with spinal anesthesia versus spinal analgesia alone for people undergoing ACL reconstruction' Methods ACL reconstruction with spinal anesthesia and patient sedation (Group one); and spinal anesthesia with patient sedation and an additional femoral nerve block (Group two). Patients were re-evaluated for pain, range of motion (ROM), active contraction of the quadriceps, and a Functional Independence Measure (FIM) scoring scale. Results Spinal anesthesia with a femoral nerve block demonstrates pain relief 6h after surgery (VAS 0.37; p =0.007). From the third (VAS=4.56; p =0.028) to the seventh (VAS=2.87; p =0.05) days after surgery, this same nerve blockage delivered higher pain scores. Patients had a similar progressive improvement on knee joint range of motion with or without femoral nerve block (p <0.002). Group one and two had 23.75 and 24.29° 6h after surgery and 87.81 and 85.36° of knee flexion after 48h post op. Conclusion Spinal anesthesia associated with a femoral nerve block had no additional benefits on pain control after the third postoperative day. There were no differences between groups concerning ability for knee flexion and to complete daily activities during postoperative period. Level of Evidence Randomized Clinical Trial Level I.


      PubDate: 2014-09-22T05:18:49Z
       
  • Comparison of the ceiling effect in the Lysholm score and the IKDC
           subjective score for assessing functional outcome after ACL reconstruction
           
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Ho Jong Ra , Hyoung Soo Kim , Jung Yun Choi , Jeong Ku Ha , Ji Yeong Kim , Jin Goo Kim
      Background To compare the ceiling effect of the Lysholm and IKDC subjective scores for assessing functional outcome after ACL reconstruction and evaluated the correlation with the one-leg hop test. Methods A total of 134 patients who underwent ACL reconstruction between 2007 and 2011 were enrolled in this study. All patients fulfilled the postoperative 6- and 12-month evaluations. The ceiling effect of the Lysholm and IKDC subjective scores was assessed, and the correlations between two scales and one-leg hop test were analysed. Results For the entire sample, the ceiling effect for the Lysholm score was 14.9% and 30.6% at 6 and 12months postoperatively. The values for the IKDC subjective score were 5.2% and 17.2%, respectively. In all subjects, the correlation coefficients [95% confidence intervals] between the IKDC subjective score and one-leg hop test at 6 and 12months (r =0.492, [0.34 to 0.62]; r =0.296, [0.12 to 0.46]) were higher than those for the Lysholm score (r =0.355, [0.18 to 0.51]; r =0.241, [0.06 to 0.41]), respectively.(p <0.05). Conclusion With regard to evaluating ACL reconstruction outcomes in patients, no significant difference between the IKDC subjective and the Lysholm scores exists in terms of the amount of ceiling effect and the correlation with the LSI. However, the concern that the ceiling effect of the Lysholm score was greater than the IKDC subjective score, should be addressed in assessing the patient's functional status postoperatively. Level of evidence: III, retrospective comparative study.


      PubDate: 2014-09-22T05:18:49Z
       
  • Arthroscopic BPTB graft reconstruction in ACL ruptures: 15-year results
           and survival
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): E. Carlos Rodríguez-Merchán , David Durán , Carlos Revilla , Primitivo Gómez-Cardero , Ángel Martínez-Lloreda , Santiago Bello
      Purpose The aim of this study is to investigate the 15-year results and survival of arthroscopic ACL reconstruction using the central-third patellar bone–tendon–bone (BPTB) autograft. Methods ACL BPTB reconstruction was performed in 250 consecutive patients. Of these patients, 88% returned for a follow-up examination at 15years after reconstruction. Therefore, 220 patients were studied. Mean time from injury to intervention was 3.4months (range 2 to 16). The parameters for assessment of results were subjective satisfaction, clinical examination (pivot-shift test, Lachman test with KT-1000), recovery of pre-injury activity level, and long-leg standing radiographs. We also evaluated the presence of meniscal and/or chondral injuries during the procedure. Failure rates were also evaluated. We defined a failure as severe instability not compatible with the activities of daily living (ADL) due to graft rupture. Results 8.2% of patients required a revision procedure because of graft rupture. In subjective terms, 98.1% of patients said that they were satisfied with the surgical outcomes after 15years. Pivot shift test was normal in 93.5% at 15years. Lachman test (KT-1000) was normal in 95.4% at 15years. Fifteen years after surgery, 90% of patients recovered their pre-injury activity level. In 25.4% of patients symptomatic osteoarthritic changes in the knee were found at 15years. Conclusions The survival prevalence of arthroscopic ACL reconstruction using the central-third patellar bone–tendon–bone (BPTB) autograft at 15years was 94.8%. Fifteen years after surgery, 90% of patients recovered their pre-injury activity level. In 25.4% of patients symptomatic osteoarthritic changes in the knee were found at 15years. Level of evidence Level IV.


      PubDate: 2014-09-22T05:18:49Z
       
  • Development and evaluation of a novel low-cost sensor-based knee flexion
           angle measurement system
    • Abstract: Publication date: October 2014
      Source:The Knee, Volume 21, Issue 5
      Author(s): Giovanni Saggio , Lucia R. Quitadamo , Lorenzo Albero
      Background Knee injuries form a large part of musculoskeletal trauma in sporting activities and the rehabilitation can require a long period, for both the patients and the specialists, to restore healthy condition. A reliable, portable, and low-cost system that could allow quick, simple, and effective measurement of knee flexion angles would greatly improve the evaluation of the rehabilitation process and the subsequent planning procedure, with meaningful reduction of recovery time and cost. Methods A novel tool for nonstop measurements of knee flexion angles based on the adoption of an elastic sensor embedded in an easy-to-realize wearable kneepad has been proposed. We fully characterized this tool in terms of accuracy, repeatability, and reliability of measure, and validated it against the gold-standard Vicon. Results Our tool demonstrated good reproducibility and repeatability among testers (mean range of measures=5.82°±1.93°) and high accuracy (root mean square error<1.28°), together with good reliability (intraclass correlation coefficient between 0.80 and 0.91). Conclusions The proposed tool demonstrates good performance, is portable, cheap, easy to use, and allows automatic measurements, so as to be a valuable system for accurate nonstop measurement of knee angles. Clinical Relevance Our sensor-based measurement system is suitable for the evaluation of the rehabilitation course after knee traumas, because it furnishes a low-cost but accurate monitor of knee flexion movements, during an amount of time as long as desired.


      PubDate: 2014-09-22T05:18:49Z
       
  • Primary diffuse large B-cell lymphoma associated with chronic
           osteomyelitis of the knee
    • Abstract: Publication date: Available online 8 September 2014
      Source:The Knee
      Author(s): Alfredo E. Romero-Rojas , Julio A. Diaz-Perez , Sharat Raju , Oscar Messa-Botero , Andres Prieto-Bletan , Felipe Criollo-Palacios
      Diffuse large B-cell lymphoma (DLBCL) associated with chronic inflammation is a recently adopted category of DLBCL, which describes an aggressive B-cell lymphoma raised in the setting of non-immune chronic inflammation. Primary presentation of this subtype of DLBCL in bone is extremely rare. Here, we present the case of a 27year old woman with DLBCL of the right distal femur, identified after a three-year history of chronic osteomyelitis. In this report, we describe the clinical and histopathologic features of this unusual presentation of DLBCL and discuss aspects relevant to diagnosis and treatment of this entity.


      PubDate: 2014-09-13T04:15:38Z
       
  • Gender optimized patellar component designs are needed to better match
           female patellar anatomy
    • Abstract: Publication date: Available online 8 September 2014
      Source:The Knee
      Author(s): Henry D. Clarke , Mark J. Spangehl
      Background Avoidance of both over-resection of the native patella, and over-stuffing of the patello-femoral joint are advocated to reduce the risk of patellar complications following patellar resurfacing. Female gender, due to thinner native patella, and use of patellar prostheses from one specific manufacturer that were thicker for comparable diameters than the patellar prostheses from a second manufacturer were hypothesized to be risk factors for these undesirable technical outcomes. Methods A retrospective review was undertaken of 803 consecutive knee replacements, performed by one surgeon, during which the same patellar resurfacing technique had been used, but with two different patellar implant designs. Results Female gender, and use of one specific design of patella prostheses were associated with both increased risk of patellar over resection to ≤13mm residual patellar thickness, and creation of a patella construct that was thicker than the native patella (p<0.001). Conclusions Patellar prostheses design can contribute to compromises in surgical technique during patellar resurfacing in TKA in female patients with thinner patellae. Modifications to current patellar prosthesis dimensions may be considered to allow surgeons to more accurately resurface the thinner, native female patella. Level of Evidence III


      PubDate: 2014-09-13T04:15:38Z
       
  • The limited use of a tourniquet during total knee arthroplasty: A
           randomized controlled trial
    • Abstract: Publication date: Available online 9 September 2014
      Source:The Knee
      Author(s): Yu Fan , Jin Jin , Zhijian Sun , Wenjing Li , Jin Lin , Xisheng Weng , Guixing Qiu
      Background Total knee arthroplasty (TKA) is commonly performed using a tourniquet. However, some studies have reported that several complications were associated with the use of a tourniquet in TKA. In this study we investigate whether the limited use of a tourniquet in TKA would reduce complications and facilitate postoperative recovery. Methods Sixty patients were randomly divided into two groups (30 cases/group): group A using the tourniquet throughout the surgical procedure, and group B using the tourniquet starting from the cementation to the completion of the procedure. Operation time, total measured blood loss, and incidence of complications were all recorded. Results There was no significant difference in operation time, total measured blood loss, and hemoglobin concentration between the two groups. Incidence of postoperative complications in group B was significantly decreased in comparison to that in group A. The limb circumference at 10cm above the superior patellar pole or below the inferior patellar pole and the pain score in group B were significantly decreased compared with that in group A at any time point. Range of motion in group B was significantly increased at three and 5days postoperatively in comparison to that in group A. Conclusions The limited use of a tourniquet in TKA provides the benefit of decreased limb swelling and knee joint pain while not compromising the operation time or blood loss and recovery. Level of evidence Level I (Therapeutic). Trial registration number NCT02102581.


      PubDate: 2014-09-13T04:15:38Z
       
  • Radiographic evaluation of factors affecting bearing dislocation in the
           domed lateral Oxford unicompartmental knee replacement
    • Abstract: Publication date: Available online 10 September 2014
      Source:The Knee
      Author(s): A. Gulati , S. Weston-Simons , D. Evans , C. Jenkins , H. Gray , C.A.F. Dodd , H. Pandit , D.W. Murray
      Background The rate of bearing dislocation with the domed lateral Oxford Unicompartmental Knee Replacement (OUKR) in different series varies from 1% to 6% suggesting that dislocation is influenced by surgical technique. The aim of this study was to identify surgical factors associated with dislocation. Methods Aligned post-operative antero-posterior knee radiographs of seven knees that had dislocated and 87 control knees were compared. Component alignment and position and the alignment of the knee were assessed. All bearing dislocations occurred medially over the tibial wall. Results Knees that dislocated tended to be overcorrected: Compared with those that did not dislocate, they were in 2° less valgus (p=0.019) and the tibial components were positioned 2mm more proximal (p<0.01). Although the relative position of the centre of the femoral component and the tibial component was the same (p=0.8), in the dislocating group the gap between the edge of the femoral component and the top of the wall in flexion was 3mm greater (p=0.019) suggesting that the components were internally rotated. Conclusions To minimise the risk of dislocation it is recommended that the knee should not be overstuffed. This is best achieved by selecting the bearing thickness that just tightens the ligaments in full extension, and re-cutting the tibia if necessary. In addition to minimise the gap between the femoral and tibial components through which the bearing dislocates, the femoral component should be implanted in neutral rotation and should not be internally rotated. Level of evidence Level IV


      PubDate: 2014-09-13T04:15:38Z
       
  • Outcome of revision total knee arthroplasty with the use of trabecular
           metal cone for reconstruction of severe bone loss at the proximal tibia
    • Abstract: Publication date: Available online 10 September 2014
      Source:The Knee
      Author(s): Claus L. Jensen , Nikolaj Winther , Henrik M. Schrøder , Michael M. Petersen
      Background The relative effectiveness of different methods for reconstructing large bone loss at the proximal tibia in revision total knee arthroplasty (rTKA) has not been established. The aim of this study was to evaluate the clinical and radiological outcome after the use of trabecular metal technology (TMT) cones for the reconstruction of tibial bone loss at the time of rTKA. Methods Thirty-six patients had rTKA with the use of a TMT Cone. Bone loss was classified according to the AORI classification and 25% of the patients suffered from T3 AORI defects and 75% of the patients from T2 AORI defects. Implants used were from the NexGen® series. At follow-up, radiographs were evaluated according to the Knee Society Roentgenographic Scoring System. Knee and function score was calculated using the Knee Society Clinical Rating System. Average follow-up time was 47months (range 3–84months). Results Clinical and radiological follow-up data were available in 30 patients and missing in six patients: two died and four patients had re-revision (reinfection (n=2), aseptic loosening (n=1), and knee hyperextension (n=1)). Knee- and function scores (follow-up 43months (range 12–84months)) improved from 42 to 77 points (p<0.0005) and 19 to 63 points (p<0.0005) respectively. Twenty-seven patients (follow-up 44months (range 12–72months)) showed no signs of radiological loosening of rTKA components. Conclusion Based on our study, it was concluded that the use of TMT Cones provided an effective treatment in terms of surgical efficacy, clinical results and radiological results and was evidently at least as effective as the other options reviewed in the literature. Level of evidence IV.


      PubDate: 2014-09-13T04:15:38Z
       
  • Quadriceps/hamstrings co-activation increases early after total knee
           arthroplasty
    • Abstract: Publication date: Available online 11 September 2014
      Source:The Knee
      Author(s): Abbey C. Thomas , Dana L. Judd , Bradley S. Davidson , Donald G. Eckhoff , Jennifer E. Stevens-Lapsley
      Quadriceps and hamstrings weakness and co-activation are present following total knee arthroplasty (TKA) and may impair functional performance. How surgery and post-operative rehabilitation influence muscle activation during walking early after surgery is unclear. Purpose Examine muscle strength and activation during walking before and one and 6-months post-TKA. Methods Ten patients (n=6 female; age: 64.7±7.9years; body mass index[BMI]:29.2±2.5kg/m2) and 10 healthy adults (n=6 female; age: 60.6±7.4years; BMI: 25.5±4.0kg/m2) participated. The patients underwent bilateral quadriceps and hamstrings strength testing and assessment of quadriceps/hamstrings co-activation and on/off timing using surface electromyography during a six-minute walk test (6MW). Groups, limbs, and changes with TKA surgery were compared. Results Patients reported greater 6MW knee pain pre- versus post-TKA and compared to controls (P <0.05). Patients had weaker surgical limb hamstrings (P <0.05) and bilateral quadriceps (P <0.05) strength than controls pre- and post-TKA. Before and 1-month post-TKA, patients had side-to-side differences in quadriceps and hamstrings strength (P <0.05). Controls walked farther than patients (P <0.01). Patients demonstrated greater surgical limb co-activation pre-operatively than controls (P <0.05). Co-activation was higher bilaterally one-month post-TKA compared to controls (P <0.05). Patients turned off their quadriceps later during stance than controls before and 1-month post-TKA (P <0.05). Conclusions Muscle strength, co-activation, and timing differed between patients and controls before and early after surgery. Rehabilitation to improve strength and muscle activation seems imperative to restore proper muscle firing patterns early after surgery.


      PubDate: 2014-09-13T04:15:38Z
       
  • Radiographic outcome of limb-based versus knee-based patient specific
           guides in total knee arthroplasty
    • Abstract: Publication date: Available online 11 September 2014
      Source:The Knee
      Author(s): Catherine Crane , Kanniraj Marimuthu , Darren B. Chen , Ian A. Harris , Emma Wheatley , Samuel J. MacDessi
      Background Patient specific guides (PSG's) were developed to improve overall component alignment in total knee arthroplasty (TKA). The aim of this study was to undertake a comparative radiographic study of two commonly used PSG and determine whether the radiographic technique used to construct the PSG had a significant effect on overall alignment. Methods This prospective cohort study examined the accuracy of limb-based (n=112) versus knee-based (n=105) MR PSG in restoring the mechanical axis in three planes according to post-operative Perth CT scan protocol. Results Limb-based MR and knee-based MR PSG systems both restored overall hip–knee–ankle angle (HKAA), femoral coronal alignment, tibial coronal alignment, femoral sagittal alignment, tibial sagittal alignment and femoral rotation alignment to within 3° of a neutral mechanical axis with similar precision (91.1% vs. 86.7% p=0.30, 97.3% vs. 96.2% p=0.63, 97.3% vs. 97.1% p=0.94, 94.6% vs. 89.4% p=0.16, 90.2% vs. 81.0% p=0.05, 91.1% vs. 86.7% p=0.30, respectively). However, when the secondary outcome measure of alignment within 2° was assessed, limb-based MR PSG restored HKAA, femoral coronal and tibial sagittal alignment with greater precision than knee-based MR PSG (73.2% vs. 64.8% p=0.016, 93.8% vs. 80.8% p=0.004 and 82.1% vs. 62.9% p=0.001, respectively). Conclusions The findings of this study recommend the use of limb-based MR PSG for improved precision in the restoration of neutral mechanical alignment over knee-based MR PSG in TKA. Level of Evidence Therapeutic level III


      PubDate: 2014-09-13T04:15:38Z
       
  • High protracted 99mTc-HDP uptake in synthetic bone implants — A
           potentially misleading incidental finding on bone scintigraphy
    • Abstract: Publication date: Available online 12 September 2014
      Source:The Knee
      Author(s): Claire Tabouret-Viaud , Ismini Mainta , Sana Boudabbous , Gaël Amzalag , Osman Ratib , Olivier Rager , Frédéric Paycha
      We report the case of a 56-year-old male with bilateral total knee prostheses suffering from bilateral knee pain mainly on the right side and referred for bone scintigraphy. The medical history of the patient revealed an opening wedge high tibial osteotomy performed nine years earlier, with insertion of two blocks of ceramic made of hydroxyapatite and tricalcium phosphate in a wedge configuration as synthetic bone substitutes. The porous structure of these implants is analogous to the architecture of cancellous bone and permits fibrovascular and bone ingrowth, promoting the healing process. Planar scintigraphy and SPECT/CT showed an intense uptake within those implants in the early phase as well as in the late phase of the bone scan. It also showed bilateral patellofemoral arthritis. A 99mTc-labeled antigranulocyte antibody scintigraphy was negative for infection or inflammation. Bilateral patellar resurfacing led to complete symptom regression, confirmed at 10months follow-up. To the best of our knowledge, this scintigraphic pattern with such a high tracer uptake reflecting bone substitute osteointegration has not yet been published. This should be considered in patients with such bone replacement materials that are increasingly used, in order to avoid false diagnosis of inflammation or infection.


      PubDate: 2014-09-13T04:15:38Z
       
  • Inferior outcomes of total knee replacement in early radiological stages
           of osteoarthritis
    • Abstract: Publication date: Available online 6 September 2014
      Source:The Knee
      Author(s): C.N. Peck , J. Childs , G.J. McLauchlan
      Background Total knee replacement (TKR) for osteoarthritis (OA) is a common and successful operation; the severity of radiographic changes plays a key role as to when it should be performed. This study investigates whether an early radiological grade of OA has an adverse effect on the outcome of TKR in patients with arthroscopically confirmed OA. Methods Between January 2006 and January 2011 data was collected prospectively on all patients undergoing a primary TKR for OA. We included all patients with a Kellgren–Lawrence score of two or less on their pre-operative radiograph who had had an arthroscopy to confirm significant OA. Our primary outcomes were the Oxford Knee Score (OKS) and a satisfaction rating. Results Over the study period 1708 primary TKRs were performed in 1381 patients. We identified 44 TKRs in 43 patients with a Kellgren–Lawrence score of two or less on their pre-operative radiograph. In this group the mean age was 63years, 66% were female and the mean BMI was 31.7kg/m2. At a mean follow-up of 37months the mean OKS was only 30 points compared to 36 in all TKRs performed over the same period (p =0.0004). Only 68% were either satisfied or very satisfied. Eight knees (18%) underwent further surgery, three (6.8%) of which were revision procedures, compared to a revision rate of 1.6% in all patients. Conclusion The outcomes of TKR in patients with early radiological changes of OA are inferior to those with significant radiological changes and should be performed with caution. Level of evidence Level IV case-series.


      PubDate: 2014-09-08T03:05:11Z
       
  • Effect of medial–lateral malpositioning of the femoral component in
           total knee arthroplasty on anterior knee pain at greater than 8years of
           follow-up
    • Abstract: Publication date: Available online 4 September 2014
      Source:The Knee
      Author(s): S.A.W. van de Groes , S. Koëter , M. de Waal Malefijt , N. Verdonschot
      Background The trochlea is often medialized after total knee arthroplasty (TKA) resulting in abnormal patellar tracking, which may lead to anterior knee pain. However, due to the difference in shape of the natural trochlea and the patellar groove of the femoral component, a medialization of the femoral component of 5mm results in an equal patellar position at 0–30° of flexion. We tested the hypothesis that more medialization of the trochlea results in a higher VAS pain score and lower Kujala anterior knee pain score at midterm follow-up. Methods During surgery a special instrument was used to measure the mediolateral position of the natural trochlea and the prosthetic groove in 61 patients between 2004 and 2005. Patient reported outcome measures were used to investigate the clinical results (NRS-pain, NRS-satisfaction, KOOS-PS and Kujala knee score). Results In total 40 patients were included. The mean follow-up was 8.8years. A medialization of ≥5mm resulted in a significantly lower NRS-pain (0.2 vs. 1.4; p=0.004) and higher NRS-satisfaction (9.6 vs. 8.2; p=0.045). Overall clinical results were good; KOOS-PS was 33.9 and Kujala knee score was 72.1. Conclusions The present study showed that a more medial position may result in a better postoperative outcome, which can probably be explained by the non-physiological lateral orientation of the trochlear groove in TKA designs. Level of evidence: Level III


      PubDate: 2014-09-08T03:05:11Z
       
  • Altered dynamic foot kinematics in people with medial knee osteoarthritis
           during walking: A cross-sectional study
    • Abstract: Publication date: Available online 4 September 2014
      Source:The Knee
      Author(s): John Arnold , Shylie Mackintosh , Sara Jones , Dominic Thewlis
      Background Footwear and insoles are used to reduce knee load in people with medial knee osteoarthritis (OA), despite a limited understanding of foot function in this group. The aim of this study was to investigate the differences in foot kinematics between adults with and without medial knee OA during barefoot walking. Methods Foot kinematics were measured during walking in 30 adults; 15 with medial knee OA (mean age was 67.0 with a standard deviation (SD) of 8.9years; height was 1.66 with SD of 0.13m; body mass was 84.2 with SD of 15.8kg; BMI was 30.7 with SD of 6.2 kg/m2; K–L grade 3: 5, grade 4: 10) and 15 aged and gender matched control participants with 12 motion analysis cameras using the IOR multi-segment foot model. Motion of the knee joint, hindfoot, midfoot, forefoot and hallux were compared between groups using clustered linear regression. Results The knee OA group displayed reduced coronal plane range of motion of the midfoot (mean 3.8° vs. 5.4°, effect size=1.1, p=0.023), indicating reduced midfoot mobility. There was also a reduced sagittal plane range of motion at the hallux in the knee OA group compared to the control group (mean 29.6° vs. 36.3°, effect size=1.2, p=0.008). No statistically significant differences in hindfoot or forefoot motion were observed. Conclusions People with medial knee OA display altered foot function compared to healthy controls. As foot and knee function are related, it is possible that altered foot function in people with knee OA may influence the effects of footwear and insoles.


      PubDate: 2014-09-08T03:05:11Z
       
  • Comparison of MRI- and CT-based patient-specific guides for total knee
           arthroplasty
    • Abstract: Publication date: Available online 6 September 2014
      Source:The Knee
      Author(s): Shigeki Asada , Shigeshi Mori , Tetsunao Matsushita , Koichi Nakagawa , Ichiroh Tsukamoto , Masao Akagi
      Background The patient-specific guide for total knee arthroplasty (TKA) is created from the data provided by magnetic resonance imaging (MRI) or computed tomography (CT) scans. It remains unknown which imaging technology is suitable for the patient-specific guide. The purpose of this study was to compare the accuracy of implant positioning and operative times between the two types of patient-specific guides for TKA. Methods Forty arthritic knees were divided into two treatment groups using MRI-based (PS-MRI group) or CT-based (PS-CT group) patient-specific guides in this prospective, comparative study. The guide in the PS-MRI group had a cutting slot, whereas that in the PS-CT group only had a pin locator. The operative times were compared between the two groups. The angular error and number of outliers (deviations >3°) of the implant position using pre- and postoperative CT were investigated in both groups. Results The mean operative time was significantly shorter in the PS-MRI group (109.2±16.5min) than in the PS-CT group (129.5±19.4min) (p <0.001). There were no significant differences in the accuracy of the implant position regarding the coronal, sagittal, and axial planes between the groups (p >0.05). Conclusions To reduce the operative time, guides with additional functions, such as cutting and positioning, should be used. Both CT- and MRI-based-guides would result in the same accuracy in three planes but high inaccuracy in the sagittal plane. The use of patient-specific guide based on MRI might not be cost-effective. Level of evidence: level 2.


      PubDate: 2014-09-08T03:05:11Z
       
  • Anterior cruciate ligament reconstruction in patients over 50years of age
    • Abstract: Publication date: Available online 28 August 2014
      Source:The Knee
      Author(s): David Figueroa , Francisco Figueroa , Rafael Calvo , Alex Vaisman , Gonzalo Espinoza , Federico Gili
      Purpose To describe the clinical outcomes of patients over 50years of age with following anterior cruciate ligament (ACL)reconstruction for acute rupture. Methods A prospective series of patients over the age of 50years with a diagnosis of ACL rupture who underwent ACL reconstruction was examined. Lysholm and International Knee Documenting Committee (IKDC) subjective scores were assessed preoperatively and at the final follow-up. All associated injuries were documented, and complications were reported. The patients' satisfaction and return to sports were documented. The statistical analyses were preformed with Student's t-tests for independent samples. Results Fifty patients with a mean age of 52.12years (50–64) and a mean follow-up period of 53.17months (36–68) exhibited a mean postoperative Lysholm score of 93.7 (60–100) and IKDC score of 90.96 (57.5–100). Associated injuries occurred in 90% (45) of the patients and included the following: 76% (38) meniscal tears and 36% (18) osteochondral lesions. Complications occurred in 6% (3) of the patients and included the following: 4% (2) ACL re-ruptures and 2% (1) infections. Among all patients, 88% (44) returned to pre-injury sports levels, and 96% (48) were satisfied. Conclusions For patients above the age of 50years, ACL reconstruction appears to be a safe procedure with good to excellent results that are comparable to those for younger patients, and the possibility for returning to pre-injury sports levels for these patients is high.


      PubDate: 2014-09-04T01:39:12Z
       
  • When the tendon autograft drops accidently on the floor: A study about
           bacterial contamination and antiseptic efficacy
    • Abstract: Publication date: Available online 11 August 2014
      Source:The Knee
      Author(s): O. Barbier , J. Danis , G. Versier , D. Ollat
      Background Inadvertent contamination of the autograft could occur during ACL reconstruction if the autograft drops on the floor during surgery. A study was undertaken to determine the incidence of contamination when a graft dropped on the operating room floor and the efficacy of antimicrobial solutions to decontaminate it. Methods Samples from 25 patients undergoing ACL reconstruction with a hamstring tendon were sectioned and dropped onto the floor. Cultures were taken after immersion in an antiseptic solutions (a chlorhexidine gluconate solution (group 1), a povidone-iodine solution (group 2), a sodium-hypochlorite solution (group 3)). A fourth piece (group 0) was cultured without being exposed to any solution. Cultures of a floor swab were taken at the same time. Results The floor swab cultures were positive in 96% of cases. The rate of contamination was 40% in group 0, 8% in group 1, 4% in group 2, and 16% in group 3. There was a significant difference between groups 1–2 and 0 (p<0,05) but not between group 3 and 0. Conclusion Immersing a graft dropped onto the floor during surgery into in a chlorhexidine gluconate solution or povidone-iodine solution significantly reduces contamination of the graft. Soaking of the hamstring autograft in one of theses solutions is recommended in case of inadvertent contamination. Clinical relevance laboratory investigation (level 2)


      PubDate: 2014-08-14T23:35:12Z
       
  • MPFL Reconstruction using a Quadriceps tendon graft Part 1: Biomechanical
           Properties of Quadriceps Tendon MPFL Reconstruction in Comparison to the
           Intact MPFL. A Human Cadaveric Study
    • Abstract: Publication date: Available online 7 August 2014
      Source:The Knee
      Author(s): Mirco Herbort , Christian Hoser , Christoph Domnick , Michael J. Raschke , Simon Lenschow , Andre Weimann , Clemens Kösters , Christian Fink
      Background The aim of this study was to analyze the structural properties of the original MPFL and to compare it to a MPFL-reconstruction-technique using a strip of quadriceps tendon. Methods In 13 human cadaver knees the MPFLs have been dissected protecting their insertion at the patellar border. The MPFL has been loaded to failure after preconditioning with 10cycles in a uniaxial testing machine evaluating stiffness, yield load and maximum load to failure. In the second part Quadriceps-MPFL-reconstruction has been performed and tested in a uniaxial testing machine. Following preconditioning, the constructs were cyclically loaded 1000 times between 5 and 50N measuring the maximum elongation. After cyclic testing, the constructs have been loaded to failure measuring stiffness, yield load and maximum load. For statistical analysis a RM one-way ANOVA for multiple comparisons has been used. The significance was set at p<0.05. Results During the load to failure tests of the original MPFL the following results have been measured: Stiffness 29.4N/mm(+9.8), yield load 167.8N(+80) and maximum load to failure 190.7N(+82.8). The results in the QT-technique group: Maximum elongation after 1000cycles 2.1mm(+0.8), stiffness 33.6N/mm(+6.8), yield load 147.1N(+65.1) and maximum load to failure 205N(+77.8). There were no significant differences in all tested parameters. Conclusion In a human cadaveric model using a strip of quadriceps-tendon 10mm wide and 3mm deep, the biomechanical properties match those of the original MPFL when tested as a reconstruction. Clinical relevance The tested QT-technique shows sufficient primary stability with comparable biomechanical parameters to the intact MPFL.


      PubDate: 2014-08-09T23:17:43Z
       
  • Repair of a Radial Tear in the Posterior Horn of the Lateral Meniscus
    • Abstract: Publication date: Available online 4 August 2014
      Source:The Knee
      Author(s): Hyun-Seok Song , Tae-Yong Bae , Bum-Yong Park , Jungin Shim , Yong In
      Background Although meniscal repair using the FasT-Fix meniscal repair system has become popular, there are no studies evaluating the clinical results after repair of a radial tear in the posterior horn of the lateral meniscus (PHLM) using the FasT-Fix system. This study was undertaken to evaluate the clinical outcomes after repair of a radial tear in the PHLM using the FasT-Fix system in conjunction with anterior cruciate ligament (ACL) reconstruction. Methods Between September 2008 and August 2011, 15 radial tears in the PHLM identified during 132 consecutive ACL reconstructions were repaired using the FasT-Fix meniscal repair system. We classified the radial tears into 3 types according to the tear patterns; simple radial tear, complex radial tear, and radial tear involving the popliteal hiatus. Postoperative evaluation was performed using the Lysholm knee score and Tegner activity level. Second-look arthroscopy was performed in all cases. Results The mean follow-up period was 24months. None of the patients had a history of recurrent effusion, joint line tenderness or a positive McMurray test. The meniscal repair was considered to have a 100% clinical success rate. At the final follow-up, the Lysholm knee score and Tegner activity level were significantly improved compared to the preoperative values. On second-look arthroscopy, repair of radial tears in the PHLM in conjunction with ACL reconstruction using the FasT-Fix device resulted in complete or partial healing in 86.6% of cases. Conclusion Clinical results after meniscal repair of a radial tear in the PHLM by using the FasT-Fix system were satisfactory. Level of evidence Case series, Level IV.


      PubDate: 2014-08-05T23:13:16Z
       
 
 
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