for Journals by Title or ISSN
for Articles by Keywords
  Subjects -> BIOLOGY (Total: 2985 journals)
    - BIOCHEMISTRY (232 journals)
    - BIOENGINEERING (105 journals)
    - BIOLOGY (1422 journals)
    - BIOPHYSICS (46 journals)
    - BIOTECHNOLOGY (216 journals)
    - BOTANY (219 journals)
    - CYTOLOGY AND HISTOLOGY (28 journals)
    - ENTOMOLOGY (63 journals)
    - GENETICS (162 journals)
    - MICROBIOLOGY (253 journals)
    - MICROSCOPY (10 journals)
    - ORNITHOLOGY (25 journals)
    - PHYSIOLOGY (70 journals)
    - ZOOLOGY (134 journals)

BIOLOGY (1422 journals)

The end of the list has been reached or no journals were found for your choice.
Journal Cover The Knee
  [SJR: 1.236]   [H-I: 53]   [14 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0968-0160
   Published by Elsevier Homepage  [3042 journals]
  • Editorial
    • Authors: Davide Edoardo Bonasia
      Pages: 495 - 496
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Davide Edoardo Bonasia

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.05.005
  • Outcomes of cementless unicompartmental and total knee arthroplasty: A
           systematic review
    • Authors: Jelle P. van der List; Dana L. Sheng; Laura J. Kleeblad; Harshvardhan Chawla; Andrew D. Pearle
      Pages: 497 - 507
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Jelle P. van der List, Dana L. Sheng, Laura J. Kleeblad, Harshvardhan Chawla, Andrew D. Pearle
      Background Aseptic loosening is a common failure mode in cemented unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This led to the development of cementless designs but the historical outcomes were poor. Recent developments in cementless designs have improved outcomes, but the current status is unknown. Therefore, a systematic review was performed to assess recent outcomes of cementless knee arthroplasty. Methods A search was performed using PubMed, Embase and Cochrane systems and national registries for studies reporting outcomes since 2005. Fifty-two cohort studies and four registries reported survivorship, failure modes or functional outcomes of cementless UKA and TKA. Results Nine level I studies, six level II studies, three level III studies, 34 level IV studies and four registries were included. Three hundred eighteen failures in 10,309 cementless TKA procedures and 62 failures in 2218 cementless UKA procedures resulted in extrapolated five-year, 10-year and 15-year survivorship of cementless TKAs of 97.7%, 95.4% and 93.0%, respectively, and cementless UKA of 96.4%, 92.9% and 89.3%, respectively. Aseptic loosening was more common in cementless TKA (25%) when compared to UKA (13%). Functional outcomes of cementless TKA and UKA were excellent with 84.3% and 84.5% of the maximum possible scores, respectively. Conclusions This systematic review showed that good to excellent extrapolated survivorship and functional outcomes are seen following modern cementless UKA and TKA, with a low incidence of aseptic loosening following cementless UKA. Level of evidence Level IV.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2016.10.010
  • The effects of graft size and insertion site location during anterior
           cruciate ligament reconstruction on intercondylar notch impingement
    • Authors: Alexander D. Orsi; Paul K. Canavan; Askhan Vaziri; Ruben Goebel; Onaly A. Kapasi; Hamid Nayeb-Hashemi
      Pages: 525 - 535
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Alexander D. Orsi, Paul K. Canavan, Askhan Vaziri, Ruben Goebel, Onaly A. Kapasi, Hamid Nayeb-Hashemi
      Background Intercondylar notch impingement is detrimental to the anterior cruciate ligament (ACL). Notchplasty is a preventative remodeling procedure performed on the intercondylar notch during ACL reconstruction (ACLR). This study investigates how ACL graft geometry and both tibial and femoral insertion site location may affect ACL-intercondylar notch interactions post ACLR. A range of ACL graft sizes are reported during ACLR, from six millimeters to 11mm in diameter. Variability of three millimeters in ACL insertion site location is reported during ACLR. This study aims to determine the post-operative effects of minor variations in graft size and insertion location on intercondylar notch impingement. Methods Several 3D finite element knee joint models were constructed using three ACL graft sizes and polar arrays of tibial and femoral insertion locations. Each model was subjected to flexion, tibial external rotation, and valgus motion. Impingement force and contact area between the ACL and intercondylar notch compared well with experimental cadaver data from literature. Results A three millimeter anterior–lateral tibial insertion site shift of the maximum size ACL increased impingement force by 242.9%. A three millimeter anterior–proximal femoral insertion site shift of the maximum size ACL increased impingement by 346.2%. Simulated notchplasty of five millimeters eliminated all impingement for the simulation with the greatest impingement. For the kinematics applied, small differences in graft size and insertion site location led to large increases in impingement force and contact area. Conclusions Minor surgical variations may increase ACL impingement. The results indicate that notchplasty reduces impingement during ACLR. Notchplasty may help to improve ACLR success rates.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.010
  • Effects of foot rotation positions on knee valgus during single-leg drop
           landing: Implications for ACL injury risk reduction
    • Authors: P.S.P. Teng; P.W. Kong; K.F. Leong
      Pages: 547 - 554
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): P.S.P. Teng, P.W. Kong, K.F. Leong
      Background Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The position of the foot at landing may influence the transmission of forces from the ankle to the knee. Using an experimental approach to manipulate foot rotation positions, this study aimed to provide new insights on how knee valgus during single-leg landing may be influenced by foot positions. Methods Eleven male recreational basketball players performed single-leg drop landings from a 30-cm high platform in three foot rotation positions (toe-in, toe-forward and toe-out) at initial contact. A motion capture system and a force plate were used to measure lower extremity kinematics and kinetics. Knee valgus angles at initial contact (KVA) and maximum knee valgus moments (KVM), which were known risk factors associated with ACL injury, were measured. A one-way repeated measures Analysis of Variance was conducted (α=0.05) to compare among the three foot positions. Results Foot rotation positions were found to have a significant effect on KVA (p<0.001, η2 =0.66) but the difference between conditions (about 1°) was small and not clinically meaningful. There was a significant effect of foot position on KVM (p<0.001, η2 =0.55), with increased moment observed in the toe-out position as compared to toe-forward (p=0.012) or toe-in positions (p=0.002). Conclusions When landing with one leg, athletes should avoid extreme toe-out foot rotation positions to minimise undesirable knee valgus loading associated with non-contact ACL injury risks.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.01.014
  • Femoral articular geometry and patellofemoral stability
    • Authors: Farhad Iranpour; Azhar M Merican; Seow Hui Teo; Justin P Cobb; Andrew A Amis
      Pages: 555 - 563
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Farhad Iranpour, Azhar M Merican, Seow Hui Teo, Justin P Cobb, Andrew A Amis
      Background Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry. Methods Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175N and 30N, respectively. The force required to displace the patella 10mm laterally and medially at 0°, 20°, 30°, 60° and 90° knee flexion was measured. Patellofemoral contact points at these knee flexion angles were marked. The trochlea cartilage geometry at these flexion angles was visualized by Computed Tomography imaging of the femora in air with no overlying tissue. The sulcus, medial and lateral facet angles were measured. The facet angles were measured relative to the posterior condylar datum. Results The lateral facet slope decreased progressively with flexion from 23°±3° (mean±S.D.) at 0° to 17±5° at 90°. While the medial facet angle increased progressively from 8°±8° to 36°±9° between 0° and 90°. Patellar lateral stability varied from 96±22N at 0°, to 77±23N at 20°, then to 101±27N at 90° knee flexion. Medial stability varied from 74±20N at 0° to 170±21N at 90°. There were significant correlations between the sulcus angle and the medial facet angle with medial stability (r=0.78, p<0.0001). Conclusions These results provide objective evidence relating the changes of femoral profile geometry with knee flexion to patellofemoral stability.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.01.011
  • Nerve injury during anterior cruciate ligament reconstruction: A
           comparison between patellar and hamstring tendon grafts harvest
    • Authors: Barak Haviv; Shlomo Bronak; Ehud Rath; Mustafa Yassin
      Pages: 564 - 569
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Barak Haviv, Shlomo Bronak, Ehud Rath, Mustafa Yassin
      Background Tendon harvesting for anterior cruciate ligament reconstruction often injures sensory branches of the saphenous nerve. The reports on the prevalence of these injuries are scarce, while the implications on patient satisfaction are not known. Our objective was to compare the prevalence of sensory nerve injuries in patellar to hamstring autograft harvesting for anterior cruciate ligament reconstructions and follow up their postoperative course. Methods Between 2012 and 2014, patients who had a primary anterior cruciate ligament reconstruction with bone patellar tendon bone or hamstring autografts were included (n=94). We evaluated and compared demographic details, level of activity and postoperative sensation disturbances between both groups. Data was analyzed retrospectively. Results The mean postoperative follow-up time was 23months. At the last follow-up 46 (77%) patients of the patellar tendon group and 22 (58%) of the hamstring tendons group reported on reduced sensation; however, in both groups a quarter of these patients experienced full recovery within an average of seven to eight months. There were more patients in the hamstring tendons group that reported on partial recovery. In most cases midline incisions for patellar tendons harvesting injured the infrapatellar branch and medial incisions for hamstring tendons harvesting injured the sartorial branch of the saphenous nerve. Conclusions Harvesting tendon autografts for anterior cruciate ligament reconstructions by vertical incisions had high prevalence of saphenous nerve branches injury with a minor possibility for complete recovery within the first year. The loss of sensation was perceived by patients as a minor complication. Level of evidence Level IV, therapeutic case series.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.009
  • Effects of eccentric overload training on patellar tendon and vastus
           lateralis in three days of consecutive running
    • Authors: Fernando Sanz-López; César Berzosa; Fidel Hita-Contreras; Antonio Martínez-Amat
      Pages: 570 - 579
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Fernando Sanz-López, César Berzosa, Fidel Hita-Contreras, Antonio Martínez-Amat
      Background The analysis of structural changes in patellar tendon and muscle of healthy subjects in response to mechanical loads provides useful insight into the mechanism underlying overuse injuries. Methods Changes produced in tendon and muscles structures after eccentric overload training and three consecutive running days were examined. Twenty healthy subjects were recruited and divided into two groups. One group (ECC) performed eccentric overload squat training (six weeks). After such training, the ECC group performed three running sessions on consecutive days, as did the control group (CONT). The structure of their patellar tendons and vastus lateralis muscles was quantified using ultrasound and Doppler imaging. Images were obtained before and after eccentric training for the ECC group and on every day of running performance for both groups. Results After eccentric training, the ECC group experienced an increase in cross-sectional area (CSA) of patellar tendon (P =0.012). After every day of running, the ECC group experienced a decrease in CSA (P =0.027). In the CONT group, after one day of running a significant increase was observed in anteroposterior width of their patellar tendon (P =0.028), as well as a decrease in pennation angle of vastus lateralis muscle (P =0.028) within three days of running sessions. Conclusions Eccentric overload training brought about changes in the patellar tendon consistent with an improvement in the quality of the tissue. The ECC group in our study showed a more normalised pattern than the CONT group in the running performance, in agreement with previous research. Level of evidence Level 3, controlled trial.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.002
  • Comparison of anterior cruciate ligament volume after anatomic
           double-bundle anterior cruciate ligament reconstruction
    • Authors: Byung Hoon Lee; Rajat Jangir; Hun Yeong Kim; Jung Min Shin; Minho Chang; Kwon Kim; Joon Ho Wang
      Pages: 580 - 587
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Byung Hoon Lee, Rajat Jangir, Hun Yeong Kim, Jung Min Shin, Minho Chang, Kwon Kim, Joon Ho Wang
      Backgroud To determine whether anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) can restore the native ACL volume, and whether the volume change after reconstruction affects clinical outcomes and re-rupture rates following the contemporary techniques. Methods Eighty patients undergoing anatomic DB-ACLR using transportal or outside-in technique were prospectively evaluated with magnetic resonance imaging (MRI) before and after surgery. The ACL volumes were determined from 3-D models constructed by applying reverse engineering software. In all participants, measured reconstructed ACL volume were compared with the ACL on the opposite uninjured side. Participants were divided into two groups according to the volume of reconstructed graft; larger volume than native ACL of contra-lateral side (Group 1) or smaller (Group 2). Results The mean ACL volume on the reconstructed side (1726.5mm3, 982.1 - 2733.8) was significantly smaller than that on the uninjured opposite side (1857.6mm3, 958.2 - 2871.5) (P <0.001). A total of 31 patients in Group 1 and 49 in Group 2 showed no significant difference of improvement in the clinical outcome scales at the postoperative two-year follow-up (Lysholm knee score, P =0.830, Tegner activity score, P =0.848). Four patients with ACL re-rupture during the two-year follow-up after reconstruction had smaller reconstructed ACL volumes than native ligament on the opposite site. Conclusion Anatomic DB-ACLR technique restored the graft volume rather smaller than the volume of the native ACL. Based on the volumetric consideration, graft reconstructed by anatomic DB-ACLR might have increased probability of re-rupture due to its smaller volume related to native ACL on the contralateral side.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.009
  • Patient-related risk factors for infection following knee arthroscopy: An
           analysis of over 700,000 patients from two large databases
    • Authors: Jourdan M. Cancienne; Harrison S. Mahon; Ian J. Dempsey; Mark D. Miller; Brian C. Werner
      Pages: 594 - 600
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Jourdan M. Cancienne, Harrison S. Mahon, Ian J. Dempsey, Mark D. Miller, Brian C. Werner
      Background To determine patient-related risk factors for infection following knee arthroscopy using two large databases. Methods A private-payer (PP) and Medicare national insurance database were queried for patients undergoing simple knee arthroscopy procedures from 2005 to 2015. Patients undergoing concomitant open or complex procedures with grafts were excluded. Postoperative infection within 90days was assessed using ICD-9 and CPT codes. A multivariate logistic regression analysis was utilized to evaluate patient-related risk factors for postoperative infection. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor, with P <0.05 considered statistically significant. Results One hundred thousand three hundred ninety nine patients from the PP database and 629,842 patients from the Medicare database met all inclusion and exclusion criteria. In the PP database, there were 250 patients with documented infections (0.25%); the incidence of infection was similar in the Medicare database (1755 patients, 0.28%). There were numerous patient-related comorbidities and demographics independently associated with a significantly increased risk of postoperative infection that were similar across the PP and Medicare patient populations, respectively, including younger age (OR=1.27, 1.43), morbid obesity (OR=1.26, 1.74), tobacco use (OR=1.34, 1.48), inflammatory arthritis (OR=1.61, 1.60), chronic kidney disease (OR=1.65, 1.14), hemodialysis (OR=1.93, 1.36), depression (OR=2.02, 1.73), and a hypercoagulable disorder (OR=2.76, 1.58). Conclusion The present study identified numerous patient-related risk factors independently associated with an increased risk of infection following knee arthroscopy in PP and Medicare-aged patients.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.002
  • The ACL injury response: A collagen-based analysis
    • Authors: Joshua S. Everhart; John H. Sojka; Christopher C. Kaeding; Alicia L. Bertone; David C. Flanigan
      Pages: 601 - 607
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Joshua S. Everhart, John H. Sojka, Christopher C. Kaeding, Alicia L. Bertone, David C. Flanigan
      Background Anterior cruciate ligament (ACL) injuries do not effectively heal. Tendon graft tissue after reconstruction shows rapid tissue turnover and ‘ligamentization.’ It is unknown whether native torn ACL tissue undergoes significant collagen turnover after injury or is arrested by the intraarticular environment. It is also unknown whether injury mechanism or chronicity affect torn ligament tissue turnover. Methods Thirty-three mid-substance ACL biopsies were obtained during primary arthroscopic ACL reconstruction (n=31; nine contact injuries, 22 non-contact injuries, 22 males, 11 females; mean age 28.5 years; median injury to surgery time 12 weeks), or from cadavers as uninjured ACL (n=2). As a marker for collagen turnover, immature collagen cross-link content was determined by ninhydrin reagent assays. The immature cross-link content was assessed against injury mechanism, patient age, and injury to surgery time. Histochemical analysis was conducted on two uninjured ACL cadaveric controls, a four-week-old ACL tear, and a four-year-old ACL tear. Results Contact and non-contact groups were not demographically different with respect to sex, patient age, injury to surgery time, and activity involvement prior to injury, which ranged from basketball to logging. Collagen crosslink content was very low across all samples, suggesting high tissue turnover between injury and surgery regardless of injury mechanism (non-contact: 1.68ng/mol, CI 0.48-2.89; contact: 1.50ng/mol, CI 0.14-2.86; p=0.842). Conclusion Collagen turnover occurs rapidly after ACL injury regardless of contact or non-contact mechanism. Robust tissue turnover starts within the first several weeks after injury and persists to some extent throughout the life of the torn ACL.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.01.013
  • Patellar instability treated with distal femoral osteotomy
    • Authors: Ishaan Swarup; Osama Elattar; S. Robert Rozbruch
      Pages: 608 - 614
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Ishaan Swarup, Osama Elattar, S. Robert Rozbruch
      Background Patellar instability can cause significant disability in both pediatric and adult patients, and it is associated with several factors including genu valgum. In this study, we describe the role of a lateral opening wedge distal femoral osteotomy (DFO) combined with lateral retinacular release in addressing genu valgum with associated patellar instability. The rationale for this approach is to medialize the patellar tendon insertion and decrease the Q angle with DFO. Methods A consecutive series of patients were studied, and our outcomes of interest included improvements in radiographic measures and patient outcomes. Radiographic improvement was assessed using patella congruency angle (PCA), mechanical axis deviation (MAD), and lateral distal femoral angle (LDFA). Patient outcomes were assessed using Oxford Knee scores, KOOS-PS scores, VAS pain scores, and Kujala scores. Results We studied eight patients (10 knees) that underwent a lateral opening wedge DFO for genu valgum and patellar instability. Mean follow-up duration was 27 months. PCA improved from 30.4° lateral preoperatively to 5.7° lateral postoperatively (p=0.016). Similarly, MAD improved from 33.1mm lateral to 6.5mm medial, and LDFA improved from 82.4° to 92.7° after surgery (p=0.002). There were significant improvements in VAS pain and Kujala scores after surgery (p<0.05), and a trend towards improvement in KOOS-PS scores (p=0.14). The mean Oxford Knee score at follow-up was 36.25. Conclusion There is an important relationship between mechanical alignment and patellar instability. Lateral opening wedge DFO is an effective treatment for patellar instability in patients with genu valgum.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.004
  • Value of the cumulative sum test for the assessment of a learning curve:
           Application to the introduction of patient-specific instrumentation for
           total knee arthroplasty in an academic department
    • Authors: Marco De Gori; Benjamin Adamczewski; Jean-Yves Jenny
      Pages: 615 - 621
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Marco De Gori, Benjamin Adamczewski, Jean-Yves Jenny
      Background The purpose of the study was to use the cumulative summation (CUSUM) test to assess the learning curve during the introduction of a new surgical technique (patient-specific instrumentation) in total knee arthroplasty (TKA) in an academic department. Methods The first 50TKAs operated on at an academic department using patient-specific templates (PSTs) were scheduled to enter the study. All patients had a preoperative computed tomography scan evaluation to plan bone resections. The PSTs were positioned intraoperatively according to the best-fit technique and their three-dimensional orientation was recorded by a navigation system. The position of the femur and tibia PST was compared to the planned position for four items for each component: coronal and sagittal orientation, medial and lateral height of resection. Items were summarized to obtain knee, femur and tibia PST scores, respectively. These scores were plotted according to chronological order and included in a CUSUM analysis. The tested hypothesis was that the PST process for TKA was immediately under control after its introduction. Results CUSUM test showed that positioning of the PST significantly differed from the target throughout the study. There was a significant difference between all scores and the maximal score. No case obtained the maximal score of eight points. The study was interrupted after 20 cases because of this negative evaluation. Conclusion The CUSUM test is effective in monitoring the learning curve when introducing a new surgical procedure. Introducing PST for TKA in an academic department may be associated with a long-lasting learning curve. The study was registered on the website (Identifier NCT02429245).

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.007
  • Computed navigated total knee arthroplasty compared to computed tomography
    • Authors: Ron Batash; Guy Rubin; Alexander Lerner; Hussein Shehade; Nimrod Rozen; David E. Rothem
      Pages: 622 - 626
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Ron Batash, Guy Rubin, Alexander Lerner, Hussein Shehade, Nimrod Rozen, David E. Rothem
      Background Successful total knee arthroplasty (TKA) includes accurate alignment. Controversy remains as to whether computer-navigated TKA improves the overall result and clinical outcome. Our aim is to compare the limb alignment and prosthesis positioning according to the pre- and postoperative computed tomography (CT) scans with the data collected from the navigation system. Methods We compared the pre- and postoperative limb alignments and prosthesis alignment provided by the Orthopilot navigation system, Aesculap®, with CT scans measured by the Traumacad® software of 70 TKAs. Results A positive correlation with statistical significance (P =0.00001, r =0.874) between the navigation system data and the CT images was found. Mean femoral cut was five degrees (valgus), and mean tibial cut was one degree (varus). Our study revealed that the navigation system assisted the surgeon to implant the prosthesis at a good acceptable alignment. Conclusion We found that the navigation system is accurate and correlates to the pre- and postoperative CT scans. Furthermore, the navigation system can assist the surgeon to achieve good limb alignment and cutting planes of the prosthesis.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.006
  • Does standing limb alignment after total knee arthroplasty predict dynamic
           alignment and knee loading during gait?
    • Authors: Charles Rivière; Matthieu Ollivier; Damien Girerd; Jean Noël Argenson; Sébastien Parratte
      Pages: 627 - 633
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Charles Rivière, Matthieu Ollivier, Damien Girerd, Jean Noël Argenson, Sébastien Parratte
      Background A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait. Therefore, the aim of our study is to assess the relationship between the standing and the dynamic (gait activity) HKAs. Methods A prospective study on a cohort of 35 patients treated with a posterior-stabilized TKA for primary osteoarthritis. Three months after surgery each patient had a long-leg radiograph and the limb was classified as neutrally aligned (17 patients), varus aligned (nine patients), or valgus aligned (four patients). Patients then performed a gait analysis for level walking. Results Standing HKA has a moderate correlation with the peak dynamic varus (r=0.318, p=0.001) and the mean and peak adduction moments (r=0.31 and r=−0.352 respectively). No significant correlation between standing HKA and the mean dynamic coronal alignment (r=0.14, p=0.449). No differences were found for dynamic frontal parameters (dynamic HKA and adduction moment) between patients defined as neutrally or varus aligned. Conclusions The standing HKA after TKA was of little value to predict dynamic behaviour of the limb during gait, this may explain why standing coronal alignment after TKA may have limited influence on long-term implant fixation and wear.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.001
  • Preoperative body mass index and physical function are associated with
           length of stay and facility discharge after total knee arthroplasty
    • Authors: Matthew G. Prohaska; Benjamin J. Keeney; Haaris A. Beg; Ishaan Swarup; Wayne E. Moschetti; Stephen R. Kantor; Ivan M. Tomek
      Pages: 634 - 640
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Matthew G. Prohaska, Benjamin J. Keeney, Haaris A. Beg, Ishaan Swarup, Wayne E. Moschetti, Stephen R. Kantor, Ivan M. Tomek
      Background Hospital length of stay (LOS) and facility discharge are primary drivers of the cost of total knee arthroplasty (TKA). We sought to identify modifiable patient factors that were associated with increased LOS and facility discharge after TKA. Methods Prospective data were reviewed from 716 consecutive, primary TKA procedures performed by two arthroplasty surgeons between 2006 and 2012 at a single institution. Preoperative body mass index (BMI), Veterans RAND-12 (VR-12) physical component score (PCS), and hemoglobin level were collected in addition to other adjusters. Multivariate linear and logistic models were constructed to predict LOS and facility discharge, respectively. Results After adjustment, higher BMI was associated with increased LOS in a dose–response effect: Compared to normal weight (BMI <25) overweight (25–29.9) was associated with longer LOS by 0.32days (P=0.038), class-I obesity (30–34.9) by 0.33days (P=0.024), class-II obesity (35–39.9) by 0.67days (P=0.012) and class-III obesity (>40) by 1.15days (P<0.001). Class-III obesity was associated with facility discharge (odds ratio=2.08, P=0.008). Poor PCS was associated with increasing LOS: compared to PCS≥50, PCS 20–29 was associated with a LOS increase of 0.40days (P=0.014) and PCS<20 with a LOS increase of 0.64days (P=0.031). Conclusion Patient BMI has a dose–response effect in increasing LOS. Poor PCS was associated similarly with increased LOS. These associations for of BMI and PCS suggest that improvement preoperatively, by any amount, may potentially translate to decreased LOS and perhaps lower the cost associated with TKA.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.005
  • Does new instrumentation improve radiologic alignment of the Oxford®
           medial unicompartmental knee arthroplasty?
    • Authors: Ki-Mo Jang; Hong Chul Lim; Seung-Beom Han; Chandong Jeong; Seul-Gi Kim; Ji-Hoon Bae
      Pages: 641 - 650
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Ki-Mo Jang, Hong Chul Lim, Seung-Beom Han, Chandong Jeong, Seul-Gi Kim, Ji-Hoon Bae
      Background A new instrument system has been introduced to improve the accuracy and reproducibility of implant positioning in Oxford® unicompartmental knee arthroplasty (UKA). This study aimed to determine if the new instrumentation could improve postoperative implant positioning and limb alignment, and reduce the occurrence of outliers in Oxford® UKA. Methods A total of 77 cases of Oxford® UKA with the new instrumentation were included. Individual matching for the conventional instrument group was performed according to age, sex, and body mass index. Postoperative radiological variables, including the hip-knee-ankle angle and the varus/valgus and flexion/extension angles of the femoral and tibial implants, were measured and compared between the new instrumentation group and the conventional group. The outliers in implant positions and postoperative complications were also compared. Results No significant between-group differences were observed in terms of lower limb alignment and tibial implant alignment. However, statistically significant differences were identified in the varus/valgus and flexion/extension angles of the femoral implant (P =0.01 and P <0.001, respectively). More outliers were observed in the flexion/extension angles of the femoral and tibial implants in the new instrumentation group. Eight meniscal bearing dislocations and three lateral compartmental degenerative changes were found in the conventional group, while there were two meniscal bearing dislocations in the new instrumentation group during the study period. Conclusion The present study did not confirm any benefit of the new instrument system in terms of postoperative limb alignment, positioning of the implant, or reducing outliers beyond the use of the conventional instruments.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.001
  • Extensor reconstruction of the knee using the fibular transposition
           technique after proximal tibial resection
    • Authors: Hiroyuki Kawashima; Akira Ogose; Tetsuo Hotta; Takashi Ariizumi; Tetsuro Yamagishi; Naoto Endo
      Pages: 657 - 662
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Hiroyuki Kawashima, Akira Ogose, Tetsuo Hotta, Takashi Ariizumi, Tetsuro Yamagishi, Naoto Endo
      Background Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several surgical procedures are available. The purpose of this study was to determine the outcome of the fibular transposition technique for reconstruction of the extensor mechanism of the knee after proximal tibial resection. Methods We retrospectively reviewed five consecutive patients who underwent resection of the proximal tibia with prosthetic reconstruction and reconstruction of the extensor using fibular transposition between 1997 and 2011. There were two female and three male patients with a mean age of 50years (range, 27 to 76years). A follow-up evaluation included both passive and active range of motion, extensor lag, the MSTS score and complications. Results Patients were followed up for 93months (range, 44 to 160months). The mean extensor lag and active flexion were four degrees (range, 0 to 10°) and 103° (range, 85 to 110°), respectively. The mean MSTS score was 80% (range, 73 to 90%). All patients were able to ambulate without crutches at the latest follow-up. Conclusions The utilization of the fibular transposition technique is a simple, reliable, and successful procedure for extensor reconstruction after proximal tibial resection.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2016.11.005
  • Younger patients have less severe radiographic disease and lower reported
           outcome scores than older patients undergoing total knee arthroplasty
    • Authors: Jacob Haynes; Adam Sassoon; Denis Nam; Loren Schultz; James Keeney
      Pages: 663 - 669
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Jacob Haynes, Adam Sassoon, Denis Nam, Loren Schultz, James Keeney
      Background Total knee arthroplasty (TKA) has been successful for many younger patients, but some experience residual symptoms or dissatisfaction. We performed this study to assess the relationship between radiographic disease severity and patient demographic features on patient reported TKA outcome scores. Methods We compared 100 TKAs performed for 82 patients ≤55years old with 100 gender-matched TKAs performed for 85 patients between 65 and 75years old. These study cases represented 25% and 21%, respectively, of TKAs performed between January 2006 and June 2011. Radiographic disease severity was determined from preoperative weight bearing AP and lateral radiographs. Patient reported outcome instruments (SF-12, Knee Society function, and WOMAC) were assessed for all patients within six months before surgery and postoperatively at a mean of 20months after TKA. Results Although younger patients had less mean articular cartilage loss (p<0.01), osteoarthritis severity (p<0.01), and Kellgren–Lawrence grade (p=0.05), they reported lower preoperative scores (p<0.01) exceeding the MCID for SF-12 mental health (8.3 points), WOMAC pain (12.1 points), and WOMAC physical function (6.9 points). While substantial improvement was noted, WOMAC pain scores remained lower than those reported by older TKA patients (11.5 points, p<0.05). Conclusion Younger patients with less severe radiographic arthritis experience significant improvement with TKA, but outcome scores do not match those attained by older patients with more severe radiographic disease.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2016.11.004
  • Unplanned readmissions after primary total knee arthroplasty in Korean
           patients: Rate, causes, and risk factors
    • Authors: Seon Woo Lee; Kiran Kumar GN; Tae Kyun Kim
      Pages: 670 - 674
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Seon Woo Lee, Kiran Kumar GN, Tae Kyun Kim
      Background Unplanned hospital readmissions are indicators of the quality and performance of a health care system, but data on early readmission after primary total knee arthroplasty (TKA) in the Asian population are limited. The purpose of this study was to determine the causes, risk factors, and rate of unplanned readmission after primary TKA at a single institution in Korea. Methods We analyzed all primary TKAs from 2004 to 2013 using the data from our institutional electronic database. A total of 4596 TKAs were performed on 3049 patients. All unplanned readmissions within 30 and 90days of discharge were identified, categorized into arthroplasty-related, medical, and other orthopedic causes. Results The overall unplanned readmission rate was 1.9% (n=59) within 30days and 3.3% (n=101) within 90days, and both the 30 and 90day readmission rates remained stable over the entire study period. The majority of readmissions involved arthroplasty-related causes; the most common cause being wound problems, accounting for 22% (13/59) within 30days and 24% (24/101) within 90days. Age (P =0.029) and hypertension (P =0.021) were identified as risk factors for unplanned readmissions after TKA. Conclusion This study demonstrates that unplanned readmissions after TKA are not infrequent in Korean patients and has identified wound complication as the most frequent cause of unplanned readmissions. Optimized care systems should be established to minimize unplanned readmissions, particularly for patients with high risk factors.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2016.05.011
  • Angioleiomyoma in the posterior knee: A case report and literature review
    • Authors: Raymond Klumpp; Riccardo Compagnoni; Gianluigi Patelli; Carlo Lauro Trevisan
      Pages: 675 - 679
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Raymond Klumpp, Riccardo Compagnoni, Gianluigi Patelli, Carlo Lauro Trevisan
      The authors present a case of angioleiomyoma situated in the posterior knee. A 47-year-old Caucasian woman presented in 2011 with recurrent stabbing pain on the lateral aspect of her right knee. She reported having pain for the last 6years. She had no history of trauma. In 2008 she was treated with a diagnostic arthroscopy and transposition of the tibial tuberosity, with no benefit to her symptoms. Electromyography of the lower limbs showed asymmetry of the amplitude of sensitive action potential of the superficial fibular nerve. Based on the clinical suspicion of entrapment of the common fibular nerve at its bifurcation, a surgical exploration was performed, but pain persisted. In 2014, ultrasonography localized at the trigger point showed a solid ovular formation of 1cm in diameter situated on the posterior aspect of the external femoral condyle in proximity to the joint capsule, which was confirmed by magnetic resonance imaging (MRI). Surgical excision of the 1-cm diameter tumor mass relieved the symptoms immediately and permanently. Histology evidenced the presence of a solid-type angioleiomyoma. The presence of an angioleiomyoma at the knee joint is very rare and few cases are reported in the literature. To the authors' knowledge this is the first time an angioleiomyoma in the posterior knee has been described. In case of unexplained and persistent pain in and around the knee, clinicians should be aware of the atypical locations of this tumor, considering that its surgical excision alone may relieve symptoms permanently.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.008
  • Acquired femoral flexion deformity due to physeal injury during medial
           patellofemoral ligament reconstruction
    • Authors: Gerd Seitlinger; Philipp Moroder; Christian Fink; Guido Wierer
      Pages: 680 - 685
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Gerd Seitlinger, Philipp Moroder, Christian Fink, Guido Wierer
      Background Reconstruction of the medial patellofemoral ligament (MPFL) is the most frequent surgical procedure performed in patients with patellar instability. Recently, concerns regarding physeal injury during femoral tunnel placement for anatomical MPFL reconstruction in children have been discussed. Methods This is the first case to report partial posterior physeal growth arrest and subsequent flexion deformity of the distal femur after MPFL reconstruction in a skeletally immature patient. The cause and treatment are discussed. Results Postoperative knee extension deficit and recurrent patellar instability were successfully treated with revision surgery including, distal femoral extension osteotomy, medialization of the tibial tuberosity, trochleoplasty and MPFL graft tensioning. Conclusion This case highlights that care should be taken during femoral tunnel placement for anatomic graft fixation to avoid physeal injuries in skeletally immature patients.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.02.003
  • Patellar tendon reconstruction using an extended gastrocnemius flap
           following cryogenic injury to the knee
    • Authors: Raymond H. Kim; Amanda H. Randolph; Conrad J. Tirre; Matthew Morrey; Jason M. Jennings
      Pages: 686 - 691
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Raymond H. Kim, Amanda H. Randolph, Conrad J. Tirre, Matthew Morrey, Jason M. Jennings
      Cryogenic thermal necrosis after knee surgery is rare. We describe a patient who presented with an anterior knee soft tissue defect in conjunction with an extensor mechanism deficiency secondary to a cold thermal injury after an anterior cruciate ligament reconstruction. We treated the patient with a single stage surgical procedure combining patellar tendon reconstruction and soft tissue coverage utilizing the superficial portion of the patient's vascularized Achilles tendon attached to a medial gastrocnemius flap. The patient returned to unrestricted activities and has demonstrated this through a five year follow-up.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.01.012
  • Staged total knee arthroplasty for bilateral complex knee deformities from
           Kashin–Beck disease and skeletal dysplasia
    • Authors: Ming Ling; Xueyuan Wu; Yanhai Chang; Xianghui Dong; Zhengming Sun; Li Ling; Shixun Wu; Bo Yang
      Pages: 692 - 698
      Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3
      Author(s): Ming Ling, Xueyuan Wu, Yanhai Chang, Xianghui Dong, Zhengming Sun, Li Ling, Shixun Wu, Bo Yang
      This study reported two cases of patients with Grade III Kashin–Beck disease (KBD) with skeletal dysplasia concomitant with complex knee deformity and functional limitation treated by staged total knee arthroplasty (TKA). Detailed pre-operative planning, bone resection, and soft tissue balancing in affected knees were performed in the surgeries in this report. The results demonstrated that TKA could correct lower limb alignment, alleviate knee pain, improve function, and provide good quality of life in people with KBD. Surgical efficacy is still lower compared with treatment for osteoarthritis; contributing factors include weak muscle strength, severe deformity and unequal length of the lower limb, weak extensor apparatus of the knee, and patient-specific factors.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2016.11.011
  • Two-stage knee arthrodesis with a modular intramedullary nail due to
           septic failure of revision total knee arthroplasty with extensor mechanism
    • Authors: Max J. Friedrich; Jan Schmolders; Matthias D. Wimmer; Andreas C. Strauss; Milena M. Ploeger; Dieter C. Wirtz; Sascha Gravius; Thomas M. Randau
      Abstract: Publication date: Available online 13 June 2017
      Source:The Knee
      Author(s): Max J. Friedrich, Jan Schmolders, Matthias D. Wimmer, Andreas C. Strauss, Milena M. Ploeger, Dieter C. Wirtz, Sascha Gravius, Thomas M. Randau
      Background Periprosthetic joint infection is a serious complication and reconstruction after failed revision total knee arthroplasty with significant bone loss and compromised soft-tissues can be challenging. Objective of this study was to assess clinical and functional results, implant survival and infection recurrence rates in patients treated with two-stage arthrodesis after failed revision TKA with extensor mechanism deficiencies due to PJI, and to identify the factors that affect outcomes after surgery. Methods Thirty seven patients with PJI treated within a two-stage exchange and reimplantation of an arthrodesis nail between 2008 and 2014 were included. Systemic and local risk factors were graded preoperatively according to McPherson et al. All patients were treated according to a structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford Knee Score and the Visual Analogue Scale. Results Thirty two of 37 patients (86.5%) were graded as free of infection. Five patients (13.5%) had recurrent infection after arthrodesis with the need of revision surgery. Mean leg-length discrepancy was 2.2cm. The mean VAS for pain was three, the mean Oxford Knee Score was 38±9. Total implant survival at a 74month follow-up was 74.3% (95% CI: 45.4 to 91.1%), as determined by Kaplan–Meier survival curves. Local McPherson Score, as well as number of revisions was found to be of significant influence to the survival rate. Conclusions Septic failure of revision knee arthroplasty can be effectively treated with two-stage arthrodesis using a modular intramedullary nail, providing a stable and painless limb with satisfactory functional results and acceptable infection eradication rates.

      PubDate: 2017-06-16T23:23:02Z
      DOI: 10.1016/j.knee.2017.05.019
  • Fatal pulmonary embolism following elective total knee replacement using
           aspirin in multi-modal prophylaxis — A 12year study
    • Authors: C. Quah; E. Bayley; N. Bhamber; P. Howard
      Abstract: Publication date: Available online 13 June 2017
      Source:The Knee
      Author(s): C. Quah, E. Bayley, N. Bhamber, P. Howard
      Background The National Institute for Health and Clinical Excellence (NICE) has issued guidelines on which thromboprophylaxis regimens are suitable following lower limb arthroplasty. Aspirin is not a recommended agent despite being accepted in orthopaedic guidelines elsewhere. We assessed the incidence of fatal pulmonary embolism (PE) and all-cause mortality following elective primary total knee replacement (TKR) with a standardised multi-modal prophylaxis regime in a large teaching district general hospital. Methods We utilised a prospective audit database to identify those that had died within 42 and 90days postoperatively. Data from April 2000 to 2012 were analysed for 42 and 90day mortality rates. There were a total of 8277 elective primary TKR performed over the 12year period. The multi-modal prophylaxis regimen used unless contraindicated for all patients included 75mg aspirin once daily for four weeks. Case note review ascertained the causes of death. Where a patient had been referred to the coroner, they were contacted for post mortem results. Results The mortality rates at 42 and 90days were 0.36 and 0.46%. There was one fatal PE within 42days of surgery (0.01%) who was taking enoxaparin because of aspirin intolerance. Two fatal PE’s occurred at 48 and 57days post-operatively (0.02%). The leading cause of death was myocardial infarction (0.13%). Conclusions Fatal PE following elective TKR with a multi-modal prophylaxis regime is a very rare cause of mortality.

      PubDate: 2017-06-16T23:23:02Z
      DOI: 10.1016/j.knee.2017.05.021
  • Implications of the getting it right first time initiative for regional
           knee arthroplasty services
    • Authors: Richard Barksfield; James Murray; James Robinson; Andrew Porteous
      Abstract: Publication date: Available online 12 June 2017
      Source:The Knee
      Author(s): Richard Barksfield, James Murray, James Robinson, Andrew Porteous
      Study aim The aim of this case study of regional orthopaedic practice was to estimate the potential impact of the GIRFT recommendations (iGIRFT) of minimum unit and surgeon specific volumes to orthopaedic units within the Severn Region, UK. Method Practice profiles for surgeons and units were generated using the UK National Joint Registry Surgeon and Hospital Profile Database. Minimum volume thresholds were set at 13 procedures/year for surgeons and 30 procedures/year for units. Results Five thousand five hundred seventeen knee arthroplasty procedures were recorded within the Severn Region between 1st of January and 31st December 2012 and these were performed by 94 surgeons in 18units. During this time, 4232 (76.7%) primary TKR, 751 (13.6%) primary UKR, 97 (1.7%) primary PFJR and 437 (7.9%) revision TKR were performed. Median surgeon volumes were 33 (range two to 180) for primary TKR, ten (range 2 to 64) for UKR, two (range two to 41) for PFJR and five (range two to 57) for Revision TKR. Amongst 48 surgeons performing UKR, 26 (54%) performed less than 13 procedures per year accounting for 108 (14%) procedures. Amongst 20 surgeons performing PFJR, 19 (95%) performed <13/year, accounting for 56 (58%) of cases. Fifty surgeons performed revision TKR with 37 (74%) performing <13 revisions per annum, accounting for 151 (35%) procedures. Amongst 16units performing UKR, eight (50%) performed <30/year, accounting for 16% overall. Revision TKR was performed in 15units whilst eight (53%) performed <30/year, accounting for 62 (15%) cases. Conclusion We have hypothesised the impact of implementing minimum unit and surgeon volume thresholds for the organisation of regional arthroplasty services. Our analysis suggests that whilst these effects may be considerable, they may be mitigated by local rationalisation to achieve an appropriate caseload mix.

      PubDate: 2017-06-16T23:23:02Z
      DOI: 10.1016/j.knee.2017.05.020
  • Oxidized zirconium versus cobalt–chromium against the native patella in
           total knee arthroplasty: Patellofemoral outcomes
    • Authors: Fabrizio Matassi; Tommaso Paoli; Roberto Civinini; Christian Carulli; Massimo Innocenti
      Abstract: Publication date: Available online 7 June 2017
      Source:The Knee
      Author(s): Fabrizio Matassi, Tommaso Paoli, Roberto Civinini, Christian Carulli, Massimo Innocenti
      Background Oxidized zirconium (OxZr) has demonstrated excellent mechanical properties in vitro when used against articular cartilage; less coefficient of friction and less chondral damage have been found when compared with cobalt–chromium (CoCr) implants. However, controversy exists as to whether implants with a zirconium femoral component articulate safely with a native patella in total knee arthroplasty (TKA). To answer this question, the clinical and radiographic results were analysed from a group of patients who underwent a TKA with patella retention; the OxZr versus CoCr femoral components were compared. Methods The present study prospectively evaluated 83 knees of 74 patients from 2009 to 2010. Each patient was evaluated clinically (visual analogue scale, Knee Society score, patellar score) and radiographically (long leg standing radiograph, anterior–posterior and latero-lateral projections, axial view of the patella) pre-operatively and postoperatively with a mean follow-up of 4.47years. The patellar tilt and shift, and progression of patellofemoral osteoarthritis were calculated with the axial view. Results There were no patient reported adverse reactions and none of the evaluated prostheses failed. Both the clinical and radiographic evaluations showed no statistically significant between-group differences. Conclusion No adverse events were observed clinically or radiologically. These results justify pursuing the use of oxidized zirconium as an alternative bearing surface for a femoral component associated with patellar retention in TKA.

      PubDate: 2017-06-11T22:48:08Z
      DOI: 10.1016/j.knee.2017.04.012
  • Validating the forgotten joint score-12 in patients after ACL
    • Authors: Henrik Behrend; Karlmeinrad Giesinger; Vilijam Zdravkovic; Johannes M. Giesinger
      Abstract: Publication date: Available online 3 June 2017
      Source:The Knee
      Author(s): Henrik Behrend, Karlmeinrad Giesinger, Vilijam Zdravkovic, Johannes M. Giesinger
      Background The forgotten joint score-12 (FJS-12), used to measure postoperative joint awareness, has been extensively validated to assess outcomes after arthroplasty, however the new score has never been validated in evaluating anterior cruciate ligament (ACL) reconstruction. The purpose of our study was to validate the FJS-12 versus the knee injury and osteoarthritis outcome score (KOOS) for patients who have undergone ACL reconstruction. Methods All patients who had undergone ACL reconstruction with the same arthroscopic surgical technique at our institution between 2011 and 2014 (medium-term follow-up group (M-FU)) or between 2000 and 2005 (long-term follow-up group (L-FU)) were considered for inclusion in the study. To analyze unidimensionality of the FJS-12, we calculated Cronbach's alpha, item-total correlations and conducted an exploratory principal component factor analysis. To assess convergent validity, we calculated Spearman correlation coefficients for the FJS-12 and its comparable scales. Results We analyzed 58 patients of the M-FU (mean follow-up 31.5 (SD13.4) months, range 12–54), and 58 patients of the L-FU (mean follow-up 139 (SD15.2) months, range 120–179). The FJS-12 showed high internal consistency (Cronbach's alpha=0.95). Ceiling effects were considerably lower for the FJS-12 (M-FU 12.1%, L-FU 15.5%) compared with the KOOS subscales (M-FU 5.2–37.9%; L-FU 13.8–55.2%) and WOMAC subscales (M-FU 37.9–62.1%; L-FU 44.8–60.3%). Conclusions The FJS-12 is a valid measurement tool to evaluate outcomes of ACL reconstruction. This study extends the possibilities of measuring joint awareness as a patient-reported outcome parameter from joint arthroplasty to ACL reconstruction.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.05.007
  • Contents List
    • Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3

      PubDate: 2017-06-06T22:09:14Z
  • Awards for most citations and downloads for 2016
    • Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3

      PubDate: 2017-06-06T22:09:14Z
  • British Association for Surgery of the Knee
    • Abstract: Publication date: June 2017
      Source:The Knee, Volume 24, Issue 3

      PubDate: 2017-06-06T22:09:14Z
  • Optimization of sagittal and coronal planes with robotic-assisted
           unicompartmental knee arthroplasty
    • Authors: Michael A. Gaudiani; Benedict U. Nwachukwu; Jayesh V. Baviskar; Mrinal Sharma; Anil S. Ranawat
      Abstract: Publication date: Available online 1 June 2017
      Source:The Knee
      Author(s): Michael A. Gaudiani, Benedict U. Nwachukwu, Jayesh V. Baviskar, Mrinal Sharma, Anil S. Ranawat
      Background One of the anatomic goals of total knee arthroplasty (TKA) is optimizing in the coronal and sagittal plane. Accurate alignments of both planes have been correlated to functional outcome and range of motion. There is a paucity of evidence on the accuracy of unicompartmental knee arthroplasty (UKA) in balancing biplanar knee alignment – specifically sagittal plane alignment. Because robotic assisted UKA has an advantage of more accurately manipulating sagittal plane for optimal alignment and kinematics based on pre-operative and intraoperative CT planning we assessed the accuracy. Methods We reviewed the clinical and radiographic information of 94 robotic assisted UKA surgeries for balancing of sagittal and coronal knee anatomy using radiographic parameters, such as posterior condylar offset ratio (PCOR), posterior tibial slope (PTS), femoral-tibial angle, and joint line. Results In the sagittal plane, we found no significant difference between pre and postoperative PCOR values. As planned, PTS was significantly lower after UKA compared to the native knee (4.91° vs 2.28°; p<0.0001). In the coronal plane, there was no significant difference in the joint line however pre and post-operative mechanical axis were significantly different (5.43°±2.58 of varus vs. 2.76°±2.14 of varus; p<0.0001). Conclusion This study attempts to quantify sagittal and coronal plane alignment after robotic assisted UKA. More attention should be paid to the role of sagittal plane alignment after UKA. We believe modifying posterior tibial slope, while maintaining PCOR is fundamental in achieving native kinematics and optimizing range of motion in the sagittal plane. This may be best-accomplished using robotic techniques for UKA.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.05.002
  • Coronal alignment predicts the use of semi-constrained implants in
           contemporary total knee arthroplasty
    • Authors: J. Ryan Martin; Keith A. Fehring; Chad D. Watts; Daniel L. Levy; Bryan D. Springer; Raymond H. Kim
      Abstract: Publication date: Available online 30 May 2017
      Source:The Knee
      Author(s): J. Ryan Martin, Keith A. Fehring, Chad D. Watts, Daniel L. Levy, Bryan D. Springer, Raymond H. Kim
      Background Semi-constrained, or varus–valgus constrained, implants are occasionally necessary to achieve stability in primary total knee arthroplasty (TKA). However, outcomes with these implants are largely unknown. Therefore, the primary goals of this study were to determine 1) can we identify preoperatively which patients might require a semi-constrained implant and 2) are there any clinical and or radiographic differences for those that require a semi-constrained implant? Methods A multicenter retrospective study was performed to retrospectively review patients that had a Stryker Triathlon (Kalamazoo, MI) TKA with a Total Stabilized (TS) tibial insert (n=75). This TS cohort was subsequently matched 1:1 based on age, gender, and BMI to a cohort of patients with the same primary TKA design with a PS insert (n=75). Preoperative and postoperative radiographic and clinical data were compared between the two groups. Results Preoperatively, the TS cohort had significantly greater varus (9.72 vs. 3.48; p=0.0001) and valgus (14.1 vs. 7.57; p=0.0001) deformity. Post-operatively, there were no statistically significant differences in revisions (p=1), reoperations (p=1), or complications (p=1). Mean clinical and radiographic follow-ups were equivalent between groups (25.5 vs. 25.8months, p=0.8851). Conclusion As suspected, use of a semi-constrained insert to achieve intraoperative coronal stability was most predicted by preoperative coronal deformity (either varus or valgus). Longer follow-up and larger patient cohorts are necessary to determine.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.013
  • Mobile bearing medial unicompartmental knee arthroplasty in patients whose
           lifestyles involve high degrees of knee flexion: A 10–14year follow-up
    • Authors: Won Sik Choy; Kwang Won Lee; Ha Yong Kim; Kap Jung Kim; Young Sub Chun; Dae Suk Yang
      Abstract: Publication date: Available online 30 May 2017
      Source:The Knee
      Author(s): Won Sik Choy, Kwang Won Lee, Ha Yong Kim, Kap Jung Kim, Young Sub Chun, Dae Suk Yang
      Background Because Asian populations have different lifestyles, such as squatting and sitting on the floor, from those of Western populations, it is possible that the clinical results and survival rate of unicompartmental knee arthroplasty (UKA) for Asian patients may be different. This study described outcomes of mobile bearing medial UKA for Korean patients. Methods A total of the 164 knees treated with mobile bearing UKAs in 147 patients (14 males and 133 females) were reviewed. The mean follow-up period was 12.1years (range 10.1–14). Results The clinical outcomes, such as the Hospital for Special Surgery Knee score, the Oxford Knee Score and the Knee Society rating system, showed statistically significant improvement from pre-operative to final follow-up (P <0.05). A total of 26 UKAs (15.8%) required revision; the most common reason was bearing dislocation. The 95% confidence interval of survival rate at 12years was 84.1%, with revision for any reason as the end point. Conclusions Minimally invasive mobile bearing UKA in Asian patients who required high degrees of knee flexion showed rapid recovery and good clinical outcome. However, they also showed relatively high rates of bearing dislocation and aseptic loosening. Therefore, mobile bearing UKA should only be performed in patients whose lifestyle involves high flexions after carefully considering these risks and benefits.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.05.004
  • Variability in static alignment and kinematics for kinematically aligned
    • Authors: Willy Theodore; Joshua Twiggs; Elizabeth Kolos; Justin Roe; Brett Fritsch; David Dickison; David Liu; Lucy Salmon; Brad Miles; Stephen Howell
      Abstract: Publication date: Available online 30 May 2017
      Source:The Knee
      Author(s): Willy Theodore, Joshua Twiggs, Elizabeth Kolos, Justin Roe, Brett Fritsch, David Dickison, David Liu, Lucy Salmon, Brad Miles, Stephen Howell
      Background Total knee arthroplasty (TKA) significantly improves pain and restores a considerable degree of function. However, improvements are needed to increase patient satisfaction and restore kinematics to allow more physically demanding activities that active patients consider important. The aim of our study was to compare the alignment and motion of kinematically and mechanically aligned TKAs. Methods A patient specific musculoskeletal computer simulation was used to compare the tibio-femoral and patello-femoral kinematics between mechanically aligned and kinematically aligned TKA in 20 patients. Results When kinematically aligned, femoral components on average resulted in more valgus alignment to the mechanical axis and internally rotated to surgical transepicondylar axis whereas tibia component on average resulted in more varus alignment to the mechanical axis and internally rotated to tibial AP rotational axis. With kinematic alignment, tibio-femoral motion displayed greater tibial external rotation and lateral femoral flexion facet centre (FFC) translation with knee flexion than mechanical aligned TKA. At the patellofemoral joint, patella lateral shift of kinematically aligned TKA plateaued after 20 to 30° flexion while in mechanically aligned TKA it decreased continuously through the whole range of motion. Conclusions Kinematic alignment resulted in greater variation than mechanical alignment for all tibio-femoral and patello-femoral motion. Kinematic alignment places TKA components patient specific alignment which depends on the preoperative state of the knee resulting in greater variation in kinematics. The use of computational models has the potential to predict which alignment based on native alignment, kinematic or mechanical, could improve knee function for patient's undergoing TKA.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.002
  • Tibial insertions of the anterior cruciate ligament and the anterior horn
           of the lateral meniscus: A histological and computed tomographic study
    • Authors: Masashi Kusano; Yasukazu Yonetani; Tatsuo Mae; Ken Nakata; Hideki Yoshikawa; Konsei Shino
      Abstract: Publication date: Available online 27 May 2017
      Source:The Knee
      Author(s): Masashi Kusano, Yasukazu Yonetani, Tatsuo Mae, Ken Nakata, Hideki Yoshikawa, Konsei Shino
      Background A positional relationship between the anterior cruciate ligament (ACL) and the anterior horn of the lateral meniscus (AHLM) has not previously been a topic of interest in the literature because the AHLM is already known to be obviously adjacent to the ACL and is assumed as a lateral border. The objective of this study was to investigate the positional anatomic relationship between the ACL and AHLM by histological evaluation of sequential slices and computed tomography (CT) of the tibial insertion sites. Hypothesis/purpose The ACL has a specific positional relationship with the AHLM and there is an identifiable distinct bony border between them. The position of the AHLM could be an important and useful landmark for accurate tibial tunnel positioning in anatomical ACL reconstruction. Study design Descriptive laboratory study. Methods Twelve ACL-intact knees from embalmed cadavers were used in this study. Six knees were sectioned into four slices for histologic examination in the coronal planes parallel to the AHLM alignment. Before sectioning, these knees were subjected to three-dimensional (3-D) volume-rendering CT. Each of the four slices demonstrated the insertion area of the ACL relative to the position of the AHLM. Each histologic slice was compared with the corresponding CT image. Only histological examination in the sagittal planes was performed in the other six knees. Results The ACL fibres were broadly attached at the region anterior to the AHLM. However, the ACL and AHLM shared a clear border identifiable on the coronal CT images and appeared as a prominence of the bony ridge on the 3-D CT images. No dense ACL fibres were attached to the region posterior to the AHLM. Based on the histological data, the geometry of the ACL tibial insertion was L-shaped along the AHLM. Conclusion The ACL and AHLM have a specific positional relationship not only in the mediolateral direction but also anteroposteriorly. The AHLM serves not only as a lateral border, but also as a useful reference in an anterioposterior direction for tunnel positioning in ACL reconstruction. Specifically, the ACL fibres were found to be broadly attached onto the bony surface in the region anterior to the AHLM and there was no firm attachment of the ACL in the region posterior to the AHLM on the tibial side, which is useful in avoiding posterior tunnel placement.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.014
  • ACL graft metabolic activity assessed by 18FDG PET–MRI
    • Authors: Robert A. Magnussen; Katherine Binzel; Jun Zhang; Wenbo Wei; Melanie U. Knopp; David C. Flanigan; Timothy E. Hewett; Christopher C. Kaeding; Michael V. Knopp
      Abstract: Publication date: Available online 27 May 2017
      Source:The Knee
      Author(s): Robert A. Magnussen, Katherine Binzel, Jun Zhang, Wenbo Wei, Melanie U. Knopp, David C. Flanigan, Timothy E. Hewett, Christopher C. Kaeding, Michael V. Knopp
      Background To demonstrate the use of 18Fluorodeoxyglucose positron emission tomography (PET) and magnetic resonance imaging (MRI) in combination (18FDG-PET) to assess the metabolic activity of ACL graft tissue and evaluate the utility of this technique for ligament imaging. Methods Twenty-one knees with intact ACL grafts in 19 patients at multiple time points following ACL reconstruction were recruited to participate. PET–MRI imaging was performed using a custom device to place knees in the same position for both studies. Images were co-registered for quantification of 18FDG-PET standardized uptake value (SUV) for the proximal, middle, and distal ACL was quantified. Signal in extra-articular muscle tissue in the index knee was also recorded as a control. Signal from each location was compared based on how far post-operative each knee was from ACL reconstruction (<6months, six to 12months, 12–24months, or >24months). Results Significant differences in 18FDG PET SUV between the four time points were observed in the proximal (p=0.02), middle (p=0.004), and distal (p=0.007) portions of the ACL graft. The greater than 24months group was noted to be different from other groups in each case. No difference in PET 18FDG SUV was noted in the extra-articular muscle in the index knee in each time group (p=0.61). Conclusions Metabolic activity was noted to be significantly lower in grafts imaged greater than two years post-reconstruction relative to those grafts that had been in place for shorter periods of time.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.008
  • Detection of bone defects around zirconium component after total knee
    • Authors: Yukihide Minoda; Kazumasa Yamamura; Kazutaka Sugimoto; Shigekazu Mizokawa; Shingo Baba; Hiroaki Nakamura
      Abstract: Publication date: Available online 26 May 2017
      Source:The Knee
      Author(s): Yukihide Minoda, Kazumasa Yamamura, Kazutaka Sugimoto, Shigekazu Mizokawa, Shingo Baba, Hiroaki Nakamura
      Background It is difficult to detect bone defects caused by loosening or osteolysis around the femoral component after total knee arthroplasty (TKA) because the thick metal hinders visualization of bone defects. Previous reports have shown that tomosynthesis, a novel tomographic technique, is advantageous over fluoroscopically guided plain radiography, computed tomography (CT) and magnetic resonance imaging (MRI) for the early detection of bone defects around a conventional cobalt–chromium alloy component. However, there have been no reports on a zirconium component. The purpose of this study was to examine the sensitivity and specificity of the detection of bone defects around a zirconium component using fluoroscopically guided plain radiography, tomosynthesis, CT and MRI. Methods Six zirconium femoral components were implanted in pig knees. Two were cemented without any bone defects. Two were cemented with cystic defects. Two were cemented with four-millimeter-thick defects between the bone cement and the bone. Defects were filled with agarose gel. Eight orthopedic surgeons examined the fluoroscopically guided plain radiography, tomosynthesis, CT and MRI images. Sensitivity and specificity of each method were analyzed. Results No bone defects were detected with plain radiography. The sensitivity and specificity of tomosynthesis were 21.9% and 36.8%, respectively. The sensitivity and specificity of CT were 15.1% and 33.0%, respectively. The sensitivity and specificity of MRI were 84.4% and 86.6%, respectively. Conclusions For the detection of bone defects around a zirconium component after TKA, MRI is advantageous over fluoroscopically guided plain radiography, tomography and CT, in terms of sensitivity and specificity.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.020
  • Long-term outcome of knee arthroplasty in the setting of pigmented
           villonodular synovitis
    • Authors: Matthew T. Houdek; Maurizio Scorianz; Cody C. Wyles; Robert T. Trousdale; Franklin H. Sim; Michael J. Taunton
      Abstract: Publication date: Available online 25 May 2017
      Source:The Knee
      Author(s): Matthew T. Houdek, Maurizio Scorianz, Cody C. Wyles, Robert T. Trousdale, Franklin H. Sim, Michael J. Taunton
      Background Pigmented villonodular synovitis (PVNS) is a rare, benign proliferation of the synovium, commonly affecting the knee. Arthroplasty can successfully manage arthrosis in this population; however, outcome data is limited. The purpose of this study was to investigate the oncologic and functional outcome of patients undergoing total knee arthroplasty (TKA) in the setting of PVNS. Methods 48 patients were identified at our institution with histologically confirmed PVNS that subsequently received TKA. The cohort consisted of 28 females and 20 males with a mean age and body mass index of 61years and 29.2kg/m2. 37patients had “active” disease, defined as diffuse in 40 patients and focal in eight. Mean follow-up was 14years. Results The 10-year disease free-survival was 88%. Recurrence occurred in 6 patients and was treated with synovectomy and revision arthroplasty (n=4), local excision (n=1) and transfemoral amputation (n=1). 25 patients sustained at least 1 complication, most commonly decreased knee range of motion. Complications resulted in revision TKA in 10 patients (21%). There was no difference (P=0.74) between mean pre- and postoperative ROM; however, there was a significant reduction in the number of patients with a flexion contracture >15° (P=0.03). The mean Knee Society score and functional score significantly improved following surgery (P <0.001). Conclusions This study indicates arthroplasty in the setting of PVNS improves patient function and reduces the presence of flexion contractures. Patients with a history of PVNS should be cautioned when undergoing arthroplasty on the elevated risk of subsequent procedures. Level of evidence Level III.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.019
  • Multifactorial analysis of dissatisfaction after primary total knee
    • Authors: Kunal Dhurve; Corey Scholes; Sherif El-Tawil; Aseem Shaikh; Lai Kah Weng; Kumbelin Levin; Brett Fritsch; David Parker; Myles Coolican
      Abstract: Publication date: Available online 24 May 2017
      Source:The Knee
      Author(s): Kunal Dhurve, Corey Scholes, Sherif El-Tawil, Aseem Shaikh, Lai Kah Weng, Kumbelin Levin, Brett Fritsch, David Parker, Myles Coolican
      Background The aims of this study were to identify the prevalence and causes of dissatisfaction in a cohort of private practice patients, and to compare the psychological characteristics of dissatisfied patients to matched, satisfied controls. Methods Unilateral TKR patients were evaluated to identify those dissatisfied with their TKR. Dissatisfied and satisfied patients were matched in terms of age, gender, follow-up duration and body mass index (BMI). Psychological evaluation was performed using the Pain Catastrophizing Scale (PCS), Depression, Anxiety and Stress Scale (DASS) and the Multidimensional Health Locus of Control (MHLC) scale. The preoperative grade of osteoarthritis, prevalence of comorbidities, and postoperative functional outcomes, were also compared. Results A cohort comprised 301 patients (response rate 71%), with 24 patients (eight percent) dissatisfied at a mean follow-up of 37months (range eight to 74months). Persistent pain was the most common reason for dissatisfaction (n=10). Dissatisfied patients reported a significantly higher mean PCS score (P=0.03), higher depression component of the DASS (P=0.02) and lower internal locus of control (P=0.02). The dissatisfied group exhibited reduced improvement (P<0.05) in the Oxford Knee Score (OKS) and range of motion (ROM), as well as a lower preoperative grade of osteoarthritis compared to satisfied patients. Conclusions Dissatisfied patients exhibit an altered psychological profile to matched satisfied controls. In addition, they have lesser improvements in the OKS and ROM. Thus, both physical as well as psychological factors contribute to dissatisfaction. Identification of these factors may help in planning focused interventions to address dissatisfaction.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.005
  • Single-limb landing biomechanics are altered and patellar tendinopathy
           related pain is reduced with acute infrapatellar strap application
    • Authors: Adam B. Rosen; Jupil Ko; Cathleen N. Brown
      Abstract: Publication date: Available online 24 May 2017
      Source:The Knee
      Author(s): Adam B. Rosen, Jupil Ko, Cathleen N. Brown
      Background Patellar tendinopathy, a common condition of the knee, is often treated with patellar tendon straps to control pain during dynamic activity. Little is known regarding their effect on pain, landing kinematics and kinetics with their application. The purpose of this study was to determine if patellar tendon straps influenced pain, kinematics at landing and ground reaction forces in individuals with patellar tendinopathy versus healthy controls. Methods Thirty participants with patellar tendinopathy and 30 controls participated. They completed single-limb landings with and without patellar tendon straps while pain, three-dimensional kinematics and vertical ground reaction forces were measured. A multivariate analysis of variance was completed to determine the differences in strapping condition and group for the dependent variables. Results Individuals with patellar tendinopathy demonstrated a significant decrease in pain (no strap=37.1±22.1mm (mean±SD), strap=28.0±18.5mm (mean±SD)). With the strap at landing all participants displayed less hip rotation (F =7.16, p =.01), knee adduction (F =10.20, p =.002), ankle inversion (F =4.60, p =.04), and peak vertical ground reaction force (F =7.30, p =.009). Conclusions Patellar tendon straps reduced pain in those with patellar tendinopathy. Additionally, with the strap, individuals landed in a more neutral alignment and decreased landing forces which could provide a benefit to those with patellar tendinopathy.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.03.003
  • Rapidly growing non-tuberculous mycobacteria infection of prosthetic knee
           joints: A report of two cases
    • Authors: Manyoung Kim; Chul-Won Ha; Jae Won Jang; Yong-Beom Park
      Abstract: Publication date: Available online 24 May 2017
      Source:The Knee
      Author(s): Manyoung Kim, Chul-Won Ha, Jae Won Jang, Yong-Beom Park
      Non-tuberculous mycobacteria (NTM) cause prosthetic knee joint infections in rare cases. Infections with rapidly growing non-tuberculous mycobacteria (RGNTM) are difficult to treat due to their aggressive clinical behavior and resistance to antibiotics. Infections of a prosthetic knee joint by RGNTM have rarely been reported. A standard of treatment has not yet been established because of the rarity of the condition. In previous reports, diagnoses of RGNTM infections in prosthetic knee joints took a long time to reach because the condition was not suspected, due to its rarity. In addition, it is difficult to identify RGNTM in the lab because special identification tests are needed. In previous reports, after treatment for RGNTM prosthetic infections, knee prostheses could not be re-implanted in all cases but one, resulting in arthrodesis or resection arthroplasty; this was most likely due to the aggressiveness of these organisms. In the present report, two cases of prosthetic knee joint infection caused by RGNTM (Mycobacterium abscessus) are described that were successfully treated, and in which prosthetic joints were finally reimplanted in two-stage revision surgery.

      PubDate: 2017-06-06T22:09:14Z
      DOI: 10.1016/j.knee.2017.04.015
  • Management of septic arthritis after arthroscopic anterior cruciate
           ligament reconstruction using a standard surgical protocol
    • Authors: Michael E. Hantes; Vasilios A. Raoulis; Nikolaos Doxariotis; Athanasios Drakos; Theofilos Karachalios; Konstantinos N. Malizos
      Abstract: Publication date: Available online 12 March 2017
      Source:The Knee
      Author(s): Michael E. Hantes, Vasilios A. Raoulis, Nikolaos Doxariotis, Athanasios Drakos, Theofilos Karachalios, Konstantinos N. Malizos
      Background To report the incidence of septic arthritis after anterior cruciate ligament (ACL) reconstruction and management of this complication using a specific treatment protocol. Methods All primary ACL reconstructions performed in our institution between January 2002 and January 2014 were included in this study. Time to presentation, clinical symptoms, and culture results of all infected patients were analyzed. According to our protocol, an arthroscopic debridement and irrigation of the knee joint was performed immediately after a diagnosis of infection was made. In case of recurrence, knee irrigation with hardware and graft removal and later re-implantation was performed. Patients were evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) Form, KT 1000 arthrometer and radiographic evaluation. Results Postoperative septic arthritis occurred in seven of 1242 patients (0.56%). After initial arthroscopic debridement, infection recurred in six out of seven cases (85%). Graft and hardware removal was performed in these patients. Graft re-implantation was performed in four patients at an average five months after infection. At the final follow-up (mean 6.3years) all patients had full range of motion, while in patients with graft re-implantation the mean Lysholm score was 92, and the mean IKDC score was 87. Radiographs demonstrated that three patients had normal knees and one patient had a grade one, knee arthritis according to Kellgren–Lawrence classification. Conclusions Management of septic arthritis after ACL reconstruction using a specific surgical protocol which includes graft removal in case of infection recurrence with later re-implantation, can provide good and excellent results. Level of evidence Level IV, case series.

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

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

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

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

      PubDate: 2017-02-16T20:41:14Z
      DOI: 10.1016/j.knee.2016.07.006
  • Surgical treatments of cartilage defects of the knee: Systematic review of
           randomised controlled trials
    • Authors: Brian M Devitt; Stuart W Bell; Kate E Webster; Julian A Feller; Tim S Whitehead
      Abstract: Publication date: Available online 8 February 2017
      Source:The Knee
      Author(s): Brian M Devitt, Stuart W Bell, Kate E Webster, Julian A Feller, Tim S Whitehead
      Background The aim of this systematic review was to identify high quality randomised controlled trials (RCTs) and to provide an update on the most appropriate surgical treatments for knee cartilage defects. Methods Two reviewers independently searched three databases for RCTs comparing at least two different treatment techniques for knee cartilage defects. The search strategy used terms mapped to relevant subject headings of MeSH terms. Strict inclusion and exclusion criteria were used to identify studies with patients aged between 18 and 55 years with articular cartilage defects sized between one and 15cm2. Risk of bias was performed using a Coleman Methodology Score. Data extracted included patient demographics, defect characteristics, clinical outcomes, and failure rates. Results Ten articles were included (861 patients). Eight studies compared microfracture to other treatment; four to autologous chondrocyte implantation (ACI) or matrix-induced ACI (MACI); three to osteochondral autologous transplantation (OAT); and one to BST-Cargel. Two studies reported better results with OAT than with microfracture and one reported similar results. Two studies reported superior results with cartilage regenerative techniques than with microfracture, and two reported similar results. At 10years significantly more failures occurred with microfracture compared to OAT and with OAT compared to ACI. Larger lesions (>4.5cm2) treated with cartilage regenerative techniques (ACI/MACI) had better outcomes than with microfracture. Conclusions Based on the evidence from this systematic review no single treatment can be recommended for the treatment of knee cartilage defects. This highlights the need for further RCTs, preferably patient-blinded, using an appropriate reference treatment or a placebo procedure.

      PubDate: 2017-02-10T18:30:34Z
      DOI: 10.1016/j.knee.2016.12.002
  • Experience of total knee arthroplasty using a novel navigation system
           within the surgical field
    • Authors: Richard Niehaus; David Schilter; Paolo Fornaciari; Christian Weinand; Marcus Boyd; Marcel Ziswiler; Stefan Ehrendorfer
      Abstract: Publication date: Available online 20 January 2017
      Source:The Knee
      Author(s): Richard Niehaus, David Schilter, Paolo Fornaciari, Christian Weinand, Marcus Boyd, Marcel Ziswiler, Stefan Ehrendorfer
      Background With the aim of improving component alignment and outcome in total knee arthroplasty (TKA), several computer-assisted devices (CAD) have been developed. Methods In February 2014, the present unit started to use a new imageless navigation system with accelerometric pods within the surgical field for all primary TKAs; there was no need for optical trackers or cameras. This paper presents the results of the first 72 TKAs using this iAssist system in 71 prospectively collected and retrospectively analyzed patients. It analyzed component positioning in standard and full-length leg x-rays. Results The mean age of the patients was 70years (range 52–88). The center of hip, knee and ankle (mechanical axes) deviated on average 0.5° (standard deviation (SD) of 1.8) valgus from the targeted straight alignment. Three TKAs had >3° deviation (i.e. four degree varus, five degree and seven degree valgus). The frontal tibial tray alignment was an average of 89.9° (range 86.4–100.1°, SD ±2.0) with the target being 90°, and the sagittal slope was as targeted at 85.0° (range 78.4–88.8°, SD ±1.7). Conclusions This CAD facilitated good mechanical alignment and reproducible accuracy in component positioning. Pods clipped onto cutting jigs within the surgical field provided simple and accurate navigation, with little extra time needed for calibration and no need for optical trackers or pre-operative imaging.

      PubDate: 2017-01-23T13:49:16Z
      DOI: 10.1016/j.knee.2016.10.021
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
Home (Search)
Subjects A-Z
Publishers A-Z
Your IP address:
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016