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Journal Cover The Knee
  [SJR: 1.137]   [H-I: 44]   [14 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0968-0160
   Published by Elsevier Homepage  [2970 journals]
  • Can chondral healing be improved following microfracture' The effect
           of adipocyte tissue derived stem cell therapy
    • Abstract: Publication date: Available online 6 April 2016
      Source:The Knee
      Author(s): Hasan H. Ceylan, Kerem Bilsel, Nur Buyukpinarbasili, Hamid Ceylan, Mehmet Erdil, Ibrahim Tuncay, Cengiz Sen
      Background We aimed to investigate the effect of adipose tissue-derived mesenchymal stem cells (ADSCs) on chondral healing using the microfracture (MF) technique. Methods Thirty male rabbits were randomly divided into three groups. Standard cylindrical osteochondral defects (OCDs) were created in the weight-bearing areas of the medial condyles of all the right knees; the defects were four millimeters in diameter and two millimeters in depth. The control group (group A) was restricted to spontaneous healing. For group B, we performed MF with a 1.5-mm drill. For group C, we applied MF using the same method and then applied 3×106 ADSCs to the defect area. At eight weeks post-operation, the subjects were sacrificed, and the distal femoral joint surfaces were evaluated histopathologically for chondral healing. The samples were scored according to the International Cartilage Repair Society (ICRS) scale. Results The results for group C were significantly better than those for group A in terms of the surface properties (p=0.003). The matrix evaluation was better for group A than for group C (p=0.01). The cell distribution, cell viability and subchondral bone parameters were similar between the groups (p=0.198, p=0.387 and p=0.699). The cartilage mineralization parameter was better for group C than for group A (p=0.001). The signs of healing were better for group C than for group B, but the differences were not significant (p=0.185). Conclusions Improvements with additional ADSC treatments were not statistically significant in cases in which ADSC treatment was compared with isolated MF treatment. Clinical Relevance Additional ADSCs treatment may have positive effect on chondral healing but it doesn’t seem significant.


      PubDate: 2016-04-08T03:47:40Z
       
  • Anthropometric measurements of the femur change with component positioning
           in total knee arthroplasty
    • Abstract: Publication date: Available online 30 March 2016
      Source:The Knee
      Author(s): Emmanuel Thienpont, Massimiliano Bernardoni, Tyler Goldberg
      Background To analyze aspect ratio (AP size/ (ML) size) of osteoarthritic knees at four different areas of the femur and to observe if proximalization of the femoral cut would change the ML size as well as confirm that external rotation increases the measurements for the AP dimensions of the femur. Method From the available MyKnee database (Medacta International, Castel San Pietro, Switzerland) 1030 patients were randomly selected within 20° of deformity consisting of 400 men with a mean (SD) age of 67.5 (9) years and 630 women with a mean (SD) age of 69 (10) years (p<0.0001). A specific software program was developed to measure AP and ML dimensions of the femur on CT-scans for (3D) planning in four areas. The AP femoral size was measured with neutral axial rotation following the epicondylar axis and without accepting anterolateral notching. Results Proximalization of the femur resulted in no changes except for a larger ML3 area in men. Increased axial rotation increased the AP dimensions for the same femur by a mean (SD) 2.5 (1) mm for males and females. Conclusions The crucial area for overhang of the femoral component is the anterior region (ML1) with an aspect ratio of about ±, but with an important range. Proximalization of the femoral cut is not accompanied by narrowing of the anterior femur but ML widening of the more posterior femur in men. Increased external rotation leads to a measurement of bigger AP size leading to an AP versus ML mismatch and change in aspect ratio.


      PubDate: 2016-04-04T15:35:40Z
       
  • Tibial component considerations in bicruciate-retaining total knee
           arthroplasty: A 3D MRI evaluation of proximal tibial anatomy
    • Abstract: Publication date: Available online 31 March 2016
      Source:The Knee
      Author(s): Vishal Saxena, Jason B. Anari, Alexander T. Ruutiainen, Pramod B. Voleti, Jason W. Stephenson, Gwo-Chin Lee
      Background Restoration of normal anatomy and proper ligament balance are theoretical prerequisites for reproducing physiological kinematics with bicruciate-retaining total knee arthroplasty (TKA). The purpose of this study was to use a 3D MRI technique to evaluate the topography of the proximal tibia and outline considerations in tibial component design for bicruciate-retaining TKA. Methods We identified 100 consecutive patients (50 males and 50 females) between ages 20 and 40 years with knee MRIs without arthritis, dysplasia, ACL tears, or prior knee surgery. A novel 3D MRI protocol coordinating axial, coronal, and sagittal images was used to measure: 1) medial and lateral posterior tibial slopes; 2) medial and lateral coronal slopes; and 3) distance from the anterior tibia to the ACL footprint. Results There was no overall difference in medial and lateral posterior tibial slopes (5.5° (95% CI 5.0 to 6.0°) vs. 5.4° (95% CI 4.8 to 6.0°), respectively (p=0.80)), but 41 patients had side-to-side differences greater than 3°. The medial coronal slope was greater than the lateral coronal slope (4.6° (95% CI 4.0 to 5.1°) vs. 3.3° (95% CI 2.9 to 3.7°), respectively (p<0.0001)). Females had less clearance between the anterior tibia and ACL footprint than males (10.8mm (95% CI 10.4 to 11.2mm) vs. 13.0mm (95% CI 12.5 to 13.5mm), respectively (p<0.0001)). Conclusions Due to highly variable proximal tibial topography, a monoblock bicruciate-retaining tibial baseplate may not reproduce normal anatomy in all patients. Level of Evidence Level IV - Anatomic research study.


      PubDate: 2016-04-04T15:35:40Z
       
  • The effects of knee direction, physical activity and age on knee joint
           position sense
    • Abstract: Publication date: Available online 21 March 2016
      Source:The Knee
      Author(s): Nicola Relph, Lee Herrington
      Background Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18–82years to evaluate the effects of age, physical activity and knee direction. Methods A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results. Results Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15–29, 30–44, 45–59, 60–74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension. Conclusions The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability.


      PubDate: 2016-03-22T14:52:58Z
       
  • Transportal femoral drilling creates more horizontal ACL graft orientation
           compared to transtibial drilling: A 3D CT imaging study
    • Abstract: Publication date: Available online 21 March 2016
      Source:The Knee
      Author(s): S. Clockaerts, A. Van Haver, J. Verhaegen, K. Vuylsteke, T. Leenders, K.C. Lagae, P. Verdonk
      Background The principle of anatomic anterior cruciate ligament (ACL) reconstruction is to create a femoral and tibial tunnel that resembles the insertion of the native ACL. Anatomic reconstruction leads to a more horizontal graft orientation that provides more rotational stability. The aim of this study is to investigate the best method to achieve anatomical reconstruction of femoral insertion of the ACL and thus, a more horizontal orientation of the ACL. We compared tunnel position and orientation between transportal femoral drilling technique and transtibial technique. Methods Thirty-two patients were included. Post-operative CT scans were obtained and femur, tibia and ACL tunnels were reconstructed. The position and orientation of tibial and femoral tunnels were quantified using the quadrant method, and femoral tunnel length, ellipticity and posterior wall breakage were assessed. We also investigated clinical outcome. Results Analyses show that transportal drilled femoral tunnels were situated significantly lower than transtibial drilled tunnels (p<0.0001), resulting in a significantly more horizontal oriented ACL in the transportal group in coronal (p<0.0001) and sagittal plane (p=0.01). No differences were observed in depth of femoral tunnel position (p=0.44). Femoral tunnel length was shorter in the transportal group (p=0.01) with a more ellipsoidal femoral aperture (p=0.01). There were no differences between both groups in tibial position. There were no differences in clinical outcome measure between the transportal and transtibial groups. Conclusion This study indicates that transportal drilling of the femoral tunnel leads to a more horizontal graft orientation of the ACL, without differences in clinical outcome.


      PubDate: 2016-03-22T14:52:58Z
       
  • Femoral insertion site in medial patellofemoral ligament reconstruction
    • Abstract: Publication date: Available online 17 March 2016
      Source:The Knee
      Author(s): Samuel C. Blatter, Philipp Fürnstahl, Anna Hirschmann, Matthias Graf, Sandro F. Fucentese
      Background The optimal femoral insertion point in MPFL (medial patellofemoral ligament)-reconstruction still remains ambiguous. Three-dimensional knee simulations based on computerized tomography (CT) images acquired under physiological loading conditions give further insights to predict the optimal femoral insertion site of the MPFL. The hypothesis of the present study is that the optimal insertion point is not as reliable as thought and is dependent on subject-specific anatomical factors. Methods High-resolution 3D images of the knee were acquired in ten weight-bearing knees of healthy subjects in five flexion angles (0 to 120°). The distance between different femoral insertion points and two defined patellar points was computed in each position to quantify length of respective bundles and isometry of the femoral insertion site. Results The median length of both bundles was maximal in full extension (proximal bundle: 62.2mm and distal bundle: 59.9mm). The shortest ligament length was obtained in the flexion position 90° for bundle I (57.3mm) and 30° for bundle II (85.3mm). The calculated most isometric femoral attachment point showed a non-uniform distribution pattern related to anatomic landmarks. The radiographic landmark showed the worst isometric score value compared to virtually defined spots by surgeons and the computed most isometric point. Conclusions This study provides results on the MPFL path length under physiological loading conditions using high-resolution bone geometry. The most important finding of this study was that the computed, best isometric femoral insertion point showed a variable anatomical distribution. This suggests that the optimal position for femoral MPFL-graft fixation is patient specific.


      PubDate: 2016-03-22T14:52:58Z
       
  • Myositis ossificans after navigated knee surgery: A report of two cases
           and literature review
    • Abstract: Publication date: Available online 15 March 2016
      Source:The Knee
      Author(s): Ryota Yamagami, Shuji Taketomi, Hiroshi Inui, Takaki Sanada, Takumi Nakagawa, Sakae Tanaka
      Computer-assisted surgery is now a common procedure in the field of orthopedics. We present two patients who developed myositis ossificans, a rare complication after navigated knee surgery. Due to careful follow-up and conservative treatment, surgical excision was avoided in both patients with good clinical results. Development of myositis ossificans after navigated knee surgery should be considered in cases of thigh pain and restricted range of motion of the knee.


      PubDate: 2016-03-17T13:56:14Z
       
  • Does a new implant design with more physiological kinematics provide
           better results after knee arthroplasty?
    • Abstract: Publication date: Available online 15 March 2016
      Source:The Knee
      Author(s): Pablo Sanz-Ruiz, Esther Carbo-Laso, Berta Alonso-Polo, Jose Antonio Matas-Diez, Javier Vaquero-Martín
      Background Improved knee kinematics is one of the major goals to obtain better satisfaction after total knee arthroplasty. This study examined whether a guided motion knee design improves functional outcome and satisfaction as compared to a conventional design. Methods In a retrospective manner, from January 2005 to December 2008, patients with two different kinematic TKA designs were enrolled. The 150 patients were divided into two groups: guided motion group (77) with kinematic design (Journey) and control group (73) with no kinematic design (LCS). All the patients had the same surgical technique and postoperative protocols. The functional and radiographic results were interpreted with the Hospital for Special Surgery (HSS) knee score and WOMAC score. Results After a mean follow-up of 84.2months, the guided motion group had higher mean postoperative range of motion (p=0.022), functional status in the WOMAC function subscale (p=0.002), but had higher residual pain in the WOMAC pain subscale (p=0.018 and p=0.013) and higher iliotibial band syndrome incidence (6.6% vs 0%; p=0.02). There were no significant differences in HSS score between the two groups. No differences were seen between groups in patient satisfaction in the WOMAC total score (p=0.46) and survival rate. Conclusion The guided motion design can improve functional status according to WOMAC but not to HSS knee scores. Poorer pain scores and no higher patient satisfaction were observed with this kinematic design.


      PubDate: 2016-03-17T13:56:14Z
       
  • Anatomic placement of the femoral tunnel by a modified transtibial
           technique using a large-offset femoral tunnel guide: A cadaveric study
    • Abstract: Publication date: Available online 16 March 2016
      Source:The Knee
      Author(s): Jun Young Chung, Chul-Won Ha, Do-Hyun Lee, Yong-Geun Park, Yong-Beom Park, Soo-Ik Awe
      Background The purpose of this study was to assess whether the use of a 10 mm-offset femoral tunnel guide with lateral rotation allows more anatomic placement of femoral tunnel compared to the conventional seven millimeters-offset guide in transtibial anterior cruciate ligament (ACL) reconstruction. Methods Sixteen knees from eight cadavers were employed. Four guide pins were inserted using a seven millimeters- or 10mm-offset transtibial femoral tunnel guide with or without lateral rotation technique in each knee. The pin positions were assessed by the quadrant method. Femoral tunnels were then reamed along the guide pins inserted through the laterally rotated guides: seven millimeters-offset for right knees and 10 mm- offset for left knees. The percentages of the coverage of native ACL femoral footprints were analyzed. Results Lateral rotation of the seven millimeters- & 10mm-offset guides placed the pins more posteriorly (lower) by 15.7% and 24.5%, respectively (p <0.001). Laterally rotated 10 mm-offset guides placed the guide pins more distally by 6.2% and more posteriorly by 6.6% than laterally rotated seven millimeters-offset guides. Laterally rotated seven millimeters- & 10 mm-offset guides resulted in average coverage of 52.3% and 61.8% of the native ACL femoral footprints, respectively (p <0.001). The lengths of the tunnels were acceptable. Conclusion Compared to the conventional seven millimeters-offset guide, the use of a 10mm-offset femoral tunnel guide with lateral rotation allows more anatomic placement of femoral tunnel in transtibial ACL reconstruction. Clinical relevance Anatomic single bundle ACL reconstruction by transtibial technique seems feasible by using the technique described in this study.


      PubDate: 2016-03-17T13:56:14Z
       
  • Medial unicompartmental knee arthroplasty improves congruence and restores
           joint space width of the lateral compartment
    • Abstract: Publication date: Available online 16 March 2016
      Source:The Knee
      Author(s): Saker Khamaisy, Hendrik A. Zuiderbaan, Jelle P. van der List, Denis Nam, Andrew D. Pearle
      Background Osteoarthritic progression of the lateral compartment remains a leading indication for medial unicompartmental knee arthroplasty (UKA) revision. Therefore, the purpose of this study was to evaluate the alterations of the lateral compartment congruence and joint space width (JSW) following medial UKA. Methods Retrospectively, lateral compartment congruence and JSW were evaluated in 174 knees (74 females, 85 males, mean age 65.5years; SD±10.1) preoperatively and six weeks postoperatively, and compared to 41 healthy knees (26 men, 15 women, mean age 33.7years; SD±6.4). Congruence (CI) was calculated using validated software that evaluates the geometric relationship between surfaces and calculates a congruence index (CI). JSW was measured on three sides (inner, middle, outer) by subdividing the lateral compartment into four quarters. Results The CI of the control group was 0.98 (SD±0.01). The preoperative CI was 0.88 (SD±0.01), which improved significantly to 0.93 (SD±0.03) postoperatively (p<0.001). In 82% of knees, CI improved after surgery, while in 18% it decreased. The preoperative significant JSW differences of the inner (p<0.001) and outer JSW (p<0.001) were absent postoperatively. Conclusion Our data suggests that a well-conducted medial UKA not only resurfaces the medial compartment but also improves congruence and restores the JSW of the lateral compartment.


      PubDate: 2016-03-17T13:56:14Z
       
  • A new method for the evaluation of the end-to-end distance of the knee
           ligaments and popliteal complex during passive knee flexion
    • Abstract: Publication date: Available online 10 March 2016
      Source:The Knee
      Author(s): G. Rochcongar, H. Pillet, E. Bergamini, S. Moreau, P. Thoreux, W. Skalli, P. Rouch
      Background Accurate knowledge about the length variation of the knee ligaments (ACL, PCL, MCL and LCL) and the popliteal complex during knee flexion/extension is essential for modelling and clinical applications. The aim of the present study is to provide this information by using an original technique able to faithfully reproduce the continuous passive knee flexion–extension kinematics and to reliably identify each ligament/tendon attachment site. Methods Twelve lower limbs (femur, tibia, fibula, patella) were tested and set in motion (0–120°) using an ad hoc rig. Tibio-femoral kinematics was obtained using an optoelectronic system. A 3D digital model of each bone was obtained using low-dosage stereoradiography. Knee specimens were dissected and the insertion of each ligament and popliteal complex were marked with radio opaque paint. ACL, PCL and MCL were separated into two bundles. Bone epiphyses were CT-scanned to obtain a digital model of each ligament insertion. Bones and attachment site models were registered and the end-to-end distance variation of each ligament/tendon was computed over knee flexion. Results A tibial internal rotation of 18°±4° with respect to the femur was observed. The different bundles of the ACL, MCL and LCL shortened, whereas all bundles of the PCL lengthened. The popliteal complex was found to shorten until 30° of knee flexion and then to lengthen. Conclusion The end-to-end distance variation of the knee ligaments and popliteal complex can be estimated during knee flexion using a robust and reliable method based on marking the ligaments/tendon insertions with radiopaque paint. Level of evidence Level IV


      PubDate: 2016-03-13T13:51:22Z
       
  • Functional recovery following primary ACL repair with dynamic
           intraligamentary stabilization
    • Abstract: Publication date: Available online 10 March 2016
      Source:The Knee
      Author(s): Lorenz Büchler, Dorina Regli, Dimitrios Stergios Evangelopoulos, Kathrin Bieri, Sufian S. Ahmad, Anna Krismer, Thorsten Muller, Sandro Kohl
      Background Recently, a new technique, dynamic intraligamentary stabilization (DIS) was introduced for the acute repair of ACL ruptures. The purpose of this study was to report the functional recovery for patients undergoing acute anterior cruciate ligament (ACL) repair alongside DIS. Methods Forty five patients sustaining acute ACL rupture and treated with DIS repair were retrospectively evaluated. Limb symmetry index of the hop test as well as knee function by means of range of motion, knee swelling, pain and maximum strength were evaluated. Following completion of the rehabilitation program, the difference in anterior–posterior translation (Δ-AP Translation), IKDC, Tegner score (TAS) was additionally analyzed. Results Forty five (13 females, 32 males) patients were included in the study. Mean age was 26years (range 18 to 54years). Median time to successfully complete hop test was 22.0weeks (range 11 to 32weeks) postoperatively. Median limb symmetry index 91.6%±8.3%. Median delta anterior-posterior translation compared to the healthy side was plus 0.0mm±1.6mm. Median IKDC was 89.5±6.5. Mean Tegner score (TAS) at 12months of follow-up was seven (range four to nine). Three patients suffered a rerupture during the first 12 postoperative months. Conclusions DIS technique with proper rehabilitation following acute ACL rupture provides successful functional recovery and low rerupture rate at one-year follow-up.


      PubDate: 2016-03-13T13:51:22Z
       
  • Three-dimensional knee kinematics in patients with discoid lateral
           meniscus during gait
    • Abstract: Publication date: Available online 12 March 2016
      Source:The Knee
      Author(s): Kengo Harato, Aiko Sakurai, Yutaka Kudo, Takeo Nagura, Ko Masumoto, Toshiro Otani, Yasuo Niki
      Background To date, the knee kinematics of discoid lateral meniscus (DLM) has not been elucidated. The aim was to investigate the three-dimensional knee kinematics in DLM using gait analysis. Methods Ten patients (mean: 14years) diagnosed with bilateral DLM and unilaterally symptomatic snapping as well as 10 healthy controls (mean: 23years) participated in the study. Each patient with DLM had unilaterally snapping knee in full extension and deep flexion. The three-dimensional gait analysis was performed with the point cluster technique. All subjects were asked to walk on a level floor at the speed of their choice. In the sagittal plane, knee excursion was separately evaluated during the weight acceptance phase and the mid-stance phase. In the axial plane, knee excursion during the stance phase was assessed. Finally, knee excursion during the whole gait cycle was evaluated in the frontal plane. Statistical comparison was conducted between groups, and between both sides in the DLM group. Results In the sagittal plane, knee excursions during the weight acceptance phase and the mid-stance phase were significantly smaller in the DLM group than in the control group; in addition, these were smaller on the symptomatic side than on the asymptomatic side in the DLM group. In the axial plane, knee excursion was also significantly smaller on the symptomatic side than on the asymptomatic side in the DLM group, whereas the frontal knee motion did not differ significantly. Conclusion Less knee motion in the sagittal plane may prevent snapping during extension and flexion in patients with DLM. Level of Evidence III.


      PubDate: 2016-03-13T13:51:22Z
       
  • Graft bending angle is correlated with femoral intraosseous graft signal
           intensity in anterior cruciate ligament reconstruction using the
           outside-in technique
    • Abstract: Publication date: Available online 8 March 2016
      Source:The Knee
      Author(s): Jin Hwan Ahn, Hwa Jae Jeong, Yong Seuk Lee, Jai Hyung Park, Jin Ho Lee, Taeg Su Ko
      Background The purposes of this study were as follows: 1) to determine the correlation between the bending angle of the anterior cruciate ligament (ACL) graft at the femoral tunnel and the magnetic resonance imaging (MRI) signal intensity of the ACL graft and 2) to analyze the difference in the MRI signal intensity of the reconstructed ACL graft in different areas of the graft after single-bundle hamstring autograft ACL (SB ACL) reconstruction using an outside-in (OI) technique with bone-sparing retro-reaming. Methods Thirty-eight patients who underwent SB ACL reconstruction with the hamstring tendon autograft using the OI technique were enrolled in this study. All patients were assessed using three-dimensional computed tomography (CT) to evaluate femoral tunnel factors, including tunnel placement, tunnel length, tunnel diameter, and femoral tunnel bending angle. At a mean of 6.3±0.8months after surgery, 3.0-T MRI was used to evaluate the graft signal intensity using signal/noise quotient for high-signal-intensity lesions. Results Among various femoral tunnel factors, only the femoral tunnel bending angle in the coronal plane was significantly (p =0.003) correlated with the signal/noise quotient of the femoral intraosseous graft. The femoral intraosseous graft had significantly (p =0.009) higher signal intensity than the other graft zone. Five cases (13.2%) showed high-signal-intensity zones around the femoral tunnel but not around the tibial tunnel. Conclusion After ACL reconstruction using the OI technique, the graft bending angle was found to be significantly correlated with the femoral intraosseous graft signal intensity, indicating that increased signal intensity by acute graft bending might be related to the maturation of the graft. Level of evidence This was a retrospective comparative study with Level III evidence.


      PubDate: 2016-03-13T13:51:22Z
       
  • The effect of percutaneous release of the medial collateral ligament in
           arthroscopic medial meniscectomy on functional outcome
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Guillem Claret, Jordi Montañana, José Rios, Miguel-Ángel Ruiz-Ibán, Dragos Popescu, Montse Núñez, Lluis Lozano, Andres Combalia, Sergi Sastre
      Background Pie crusting (PC) of the medial collateral ligament (MCL) in the knee has been used empirically to achieve more space in the medial compartment during knee arthroscopy. However, there are no reported studies analyzing the functional results of the application of the PC technique to the MCL in patients undergoing arthroscopic meniscectomy of the medial meniscus, and to determine the rate of iatrogenic injury and associated morbidity. Description of technique The patient was in a supine position with a tourniquet and a side post. Percutaneous controlled release of the posterior part of the MCL was performed using an intramuscular needle, and a mild valgus force was applied while viewing with the arthroscope of the controlled progressive gain in medial compartment space. Patients and methods A retrospective clinical study of 140 patients undergoing arthroscopic meniscectomy with or without MCL PC was conducted. Tegner and Lysholm tests and visual analogue scales were used to assess pain and functional results. Results The patients in the group with meniscectomy and PC had higher scores on the Lysholm scale, less pain at rest after two months, and achieved significantly better pain control during physical activity at six months. No complication, residual instability, or iatrogenic injury to the cartilage were observed in the meniscectomy plus PC group. Conclusion The MCL PC technique for medial meniscectomy is a safe and effective way to reduce iatrogenic injury to the cartilage and does not affect knee stability. Decompression of the medial compartment results in better functional outcomes at two months and lesser pain during physical activity at six months.


      PubDate: 2016-03-04T15:05:24Z
       
  • A new arthroscopic classification of degenerative medial meniscus root
           tear that correlates with meniscus extrusion on magnetic resonance imaging
           
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Seong-Il Bin, Tae-Wan Jeong, Su-Jin Kim, Dae-Hee Lee
      Background To determine a new classification system for medial meniscus root tears (MMRT) based on arthroscopic findings. Methods 24 knees (55%) belonged to the nondisplaced or overlapped group, and 20 knees (45%) to the widely displaced group. Absolute meniscal extrusion was defined as distance between outer edge of the articular cartilage of tibial plateau and meniscal outer edge. Relative extrusion was defined as extruded meniscus width divided by entire meniscal width, multiplied by 100. The proportion of knees with major (>3mm) extrusion were compared in two groups, as were the severity of chondral wear and osteoarthritic change. Results Absolute (4.6mm vs. 3.7mm, P=0.006) and relative (46% vs. 39%, P=0.042) extrusion of the medial meniscus were greater in widely displaced than in nondisplaced or overlapped group. Medial joint space width was significantly narrower in the widely displaced than in the nondisplaced or overlapped group (3.0mm vs. 4.0mm, P=0.007). The widely displaced group had a 4° greater varus deformity, and higher rates of major extrusion (>3mm), grade III or IV chondral wear in the medial femoral condyle (60% vs. 29%, P=0.039) and medial compartment osteoarthritis (75% vs. 21%, P=0.001) than did the nondisplaced or overlapped group. Conclusions Widely displaced MMRT had greater meniscal extrusion and more severe chondral wear and osteoarthritis than did nondisplaced or overlapped MMRT. In this novel classification system, the stage of MMRT severity was associated with tear site displacement. Level of evidence Case series (level IV).


      PubDate: 2016-03-04T15:05:24Z
       
  • Content List
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2




      PubDate: 2016-03-04T15:05:24Z
       
  • Editorial Board
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2




      PubDate: 2016-03-04T15:05:24Z
       
  • Editorial
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Oday Al-Dadah, Caroline Hing



      PubDate: 2016-03-04T15:05:24Z
       
  • Obesity and the absence of trochlear dysplasia increase the risk of
           revision in patellofemoral arthroplasty
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Ming Han Lincoln Liow, Graham Seow-Hng Goh, Darren Keng-Jin Tay, Shi-Lu Chia, Ngai-Nung Lo, Seng-Jin Yeo
      Purpose Proper indications and patient selection are of paramount importance in patellofemoral arthroplasty (PFA). Although factors predicting outcomes in total knee arthroplasty (TKA) have been studied, there are no such studies for modern PFA. This retrospective study reports the midterm clinical and radiological outcomes and survivorship of PFA, investigating the risk factors associated with poorer outcomes and higher revision rates. Methods Fifty-one patients (51 knees) with isolated patellofemoral arthritis underwent PFA with a second-generation implant. The mean follow-up duration was 4.1years (range, 2.2 to 6.1). The cohort was stratified into obese (body mass index (BMI)≥30kg/m2, n =16), overweight (BMI 25 to 29.9kg/m2, n =20) and control (BMI 18.5 to 24.9kg/m2, n =15) groups. The same cohort was stratified based on the presence (n =11) or absence (n =40) of trochlear dysplasia (TD). Results The mean Knee Society objective and function scores, the Melbourne Knee score and the Physical Component Score of Short Form 36 improved significantly. Obesity was associated with no significant improvement in the Melbourne Knee score and the Knee Society function score (p >0.05), a higher incidence of radiographic outliers and lower patient satisfaction. There was no significant difference in outcomes between the TD and non-TD groups at two years (p >0.05), with a survivorship of 92.2%. Three revisions for progression of tibiofemoral osteoarthritis were noted in the non-TD and obese or overweight groups. Conclusions Patients with obesity and the absence of TD are at a potentially higher risk of revision surgery to TKA, and they should be counselled that PFA may represent a ‘bridging’ procedure. Level of Evidence: III


      PubDate: 2016-03-04T15:05:24Z
       
  • Outcomes following impaction bone grafting for treatment of unstable
           osteochondritis dissecans
    • Abstract: Publication date: Available online 2 March 2016
      Source:The Knee
      Author(s): Robert A. Gallo, Michael Plakke, Timothy Mosher, Kevin P. Black
      Background Many methods have been proposed to treat unstable osteochondritis dissecans (OCD). Our purpose is to report outcomes in a cohort of patients undergoing impaction bone grafting for treatment of knee OCD. Methods Patients undergoing impaction bone grafting for knee OCD between 1998 and 2011 were contacted and stratified into (a) those who have undergone subsequent surgery on the affected knee and (b) those who have not had revision surgery performed on the affected knee since the impaction bone grafting procedure. For those not undergoing another procedure, physical examination, radiographs, MRI, and functional outcomes (SF12, Tegner, Activity Rating Scale, and IKDC) were obtained. Results Of nine patients (10 knees) undergoing the procedure, seven (eight knees) were available for follow-up. Three had revision surgery. One had debridement due to surface overgrowth and had no symptoms 43months following debridement, while two had osteochondral allograft and autograft procedures at three and 10years after initial surgery, respectively. Four patients did not require a revision surgical procedure at average follow-up of 55.4months (range, 21–116months). All had complete MRI fill of the cartilaginous defect with less than 50% of surface irregularity and redeveloped the tidemark and a heterogeneous cartilaginous surface. Follow-up Tegner, ARS, and SF12-PCS averaged 6.8, 67.5, and 56.6, respectively. All four had good/excellent IKDC results. Conclusion Impaction bone grafting can reliably restore osteocartilaginous defect produced by OCD and is a readily available and less-expensive option in treating OCD lesions. Further investigation is necessary to determine the long-term durability of the results. Level IV – Case series


      PubDate: 2016-03-04T15:05:24Z
       
  • Criteria used when deciding on eligibility for total knee arthroplasty
           — Between thinking and doing
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Søren T. Skou, Ewa M. Roos, Mogens B. Laursen, Michael S. Rathleff, Lars Arendt-Nielsen, Ole Simonsen, Sten Rasmussen
      Background Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (OA) eventually found eligible for TKA. Methods Nine OSs chose the five criteria most important when deciding on TKA eligibility. Cross-sectional data from 200 patients found either eligible (n=100) or not eligible (n=100) for TKA by one of the nine OS, were analyzed in a regression analyses with TKA eligibility as the dependent variable. Results Radiographic severity (n=8), pain (n=9), functional disability (n=8) and not responding to the recommended non-surgical treatment (n=7) were considered most important by OSs. Associations (P <0.25) between TKA eligibility and criteria found important by the OS were demonstrated for worse radiographic severity and more functional limitations, but not for pain and not responding to the recommended non-surgical treatment. Furthermore, more comorbidities and higher Body Mass Index (BMI) were associated with TKA-eligibility, but not found important for TKA eligibility by the OS. Conclusion Radiographic severity and functional limitations were confirmed as drivers for TKA eligibility, while pain was not. Not responding to non-surgical treatment was not included in the decision-making, suggesting low uptake of clinical guidelines in clinical practice. This study highlights the complexity of the decision-making with some overlap between the criteria that OSs think they apply and what is actually applied in clinical practice.


      PubDate: 2016-03-04T15:05:24Z
       
  • Minimally invasive medial patellofemoral ligament reconstruction for
           patellar instability using an artificial ligament: A two year follow-up
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Aditya Khemka, Sarah J. Lord, Zelda Doyle, Belinda Bosley, Munjed Al Muderis
      Background Recurrence of acute patellar dislocation affects approximately 30% of individuals, and up to 75% of those with grade IV instability. The medial patellofemoral ligament (MPFL) is considered to be critical for patellar stabilization. MPFL reconstruction with allografts has been proposed to reduce risk of recurrence, but there is limited evidence about the safety and effectiveness of techniques using synthetic allografts. Methods We present a retrospective case series of 29 individuals who underwent a MPFL reconstruction between 2009 and 2012, using an artificial ligament for patellar instability by a single surgeon. Clinical, radiological and functional outcomes were measured at a minimum of 24months. Results 31 knees (29 individuals) were followed up for a median of 43 (range: 24–68) months. Using the Crosby and Insall grading system, 21 (68%) were graded as excellent, nine (29%) were good, one (3%) as fair and none as worse at 24months. The mean improvement in Lysholm knee score for knee instability was 68 points (standard deviation 10). Ligamentous laxity was seen in 17 (55%) of individuals. In this subset, 12 were graded as excellent, four as good and one as fair. The mean improvement in patellar height was 11% at three months follow-up. All knees had a stable graft fixation with one re-dislocation following trauma. Conclusions We propose a minimally invasive technique to reconstruct the MPFL using an artificial ligament allowing early mobilization without bracing. This study indicates the procedure is safe, with a low risk of re-dislocation in all grades of instability. Level of Evidence Level IV Case Series


      PubDate: 2016-03-04T15:05:24Z
       
  • Mid-term survival analysis of closed wedge high tibial osteotomy: A
           comparative study of computer-assisted and conventional techniques
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Dae Kyung Bae, Sang Jun Song, Kang Il Kim, Dong Hur, Ho Yeon Jeong
      Background The purpose of the present study was to compare the clinical and radiographic results and survival rates between computer-assisted and conventional closing wedge high tibial osteotomies (HTOs). Methods Data from a consecutive cohort comprised of 75 computer-assisted HTOs and 75 conventional HTOs were retrospectively reviewed. The Knee Society knee and function scores, Hospital for Special Surgery (HSS) score and femorotibial angle (FTA) were compared between the two groups. Survival rates were also compared with procedure failure. Results The knee and function scores at one year postoperatively were slightly better in the computer-assisted group than those in conventional group (90.1 vs. 86.1) (82.0 vs. 76.0). The HSS scores at one year postoperatively were slightly better for the computer-assisted HTOs than those of conventional HTOs (89.5 vs. 81.8). The inlier of the postoperative FTA was wider in the computer-assisted group than that in the conventional HTO group (88.0% vs. 58.7%), and mean postoperative FTA was greater in the computer-assisted group that in the conventional HTO group (valgus 9.0° vs. valgus 7.6°, p<0.001). The five- and 10-year survival rates were 97.1% and 89.6%, respectively. No difference was detected in nine-year survival rates (p=0.369) between the two groups, although the clinical and radiographic results were better in the computer-assisted group that those in the conventional HTO group. Conclusions Mid-term survival rates did not differ between computer-assisted and conventional HTOs. A comparative analysis of longer-term survival rate is required to demonstrate the long-term benefit of computer-assisted HTO. Level of evidence III


      PubDate: 2016-03-04T15:05:24Z
       
  • Complications associated with opening wedge high tibial osteotomy —
           A review of the literature and of 15years of experience
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): T. Woodacre, M. Ricketts, J.T. Evans, G. Pavlou, P. Schranz, M. Hockings, A. Toms
      Background Complication rates following opening wedge high tibial osteotomy (OWHTO) is an issue that has not been comprehensively addressed in current literature. Methods We performed a retrospective study of local patients who underwent OWHTO for isolated medial compartment knee osteoarthritis from 1997 to 2013. We analysed survivorship and complication rates and compared this to a literature review of previously reported data. Results One hundred and fifteen patients met the inclusion criteria. Mean follow-up=8.4years. Mean age=47 (range 32 to 62). Mean Body Mass Index (BMI)=29.1 (range 20.3 to 40.2). Devices used consisted of Tomofix (72%), Puddu plate (21%) and Orthofix (seven percent) (no significant differences in age/sex/BMI). Wedge defects were filled with autologous graft (30%), Chronos (35%) or left empty (35%). Five years survival rate (without requiring conversion to arthroplasty)=80%. Overall complication rate=31%. Twenty five percent of patients suffered 36 complications including minor wound infections (9.6%), major wound infections (3.5%), metalwork irritation necessitating plate removal (seven percent), non-union requiring revision (4.3%), vascular injury (1.7%), compartment syndrome (0.9%), and other minor complications (four percent). No thromboembolic complications were observed. Conclusion No significant differences existed in complication rates following OWHTO relative to BMI, implant type, type of bone graft used or patient age at surgery. When the complications from OWHTO were analysed closely they appear higher than previously reported in the literature; however serious complications appear rare. Level of Evidence 3 Retrospective cohort study


      PubDate: 2016-03-04T15:05:24Z
       
  • Acute surgical management of traumatic knee dislocations — Average
           follow-up of 10years
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): R.S. Khakha, A.C. Day, J. Gibbs, S. Allen, P. Hill, J. Hull, A. Perry, H. Chissell
      Background Traumatic knee dislocations have been managed historically by means of either delayed reconstruction or non-operative methods. More recently, there has been a trend towards early reconstruction. There is no clear consensus in the literature as to how such patients should be managed and in what time frame. Objective The aim of this study was to establish the long-term outcome of patients who underwent acute surgical management of their traumatic knee dislocation. Methods Thirty-six patients with traumatic knee dislocations were treated by multi-ligament reconstruction. All surgical interventions occurred within 21days of presentation. The collateral ligament complexes were primarily repaired where possible and reconstructions were performed with either autograft, allograft or the ligament augmentation and reconstruction system (LARS) synthetic graft. Results The mean time to surgery was 12days (1 to 21) with a mean follow-up of 10.1years (7 to 19). The International Knee Documentation Committee (IKDC) assessment demonstrates that 56% of patients went on to have “nearly normal” knee function and the average Tegner–Lysholm score of 80 (57 to 91), is consistent with good function. The Knee Outcome score (KOS) was 84% for Activities of Daily Living and 74% for Sports. Conclusion This study demonstrates a high level of overall knee function following the acute surgical reconstruction of traumatic knee dislocations. Level of evidence Level 2B: Cohort Study with Outcome Measures.


      PubDate: 2016-03-04T15:05:24Z
       
  • The effect of femoral tunnel widening on one-year clinical outcome after
           anterior cruciate ligament reconstruction using ZipLoop® technology
           for fixation in the cortical bone of the femur
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Benjamin Basson, Rémi Philippot, Thomas Neri, Jean François Meucci, Bertrand Boyer, Frédéric Farizon
      Background The effect of femoral tunnel widening on clinical outcomes of anterior cruciate ligament (ACL) reconstruction has been rarely investigated. In this study, ACL reconstructions were performed using semitendinosus and gracilis (STG) tendon grafts and single cortical fixation on the femoral side. The aim was to analyze femoral tunnel widening at one year and to evaluate its effect on clinical and laximetric outcomes. Methods A total of 46 patients were enrolled in this prospective continuous single-operator monocenter study. Clinical protocol included pre-operative and one-year evaluation with subjective and objective International Knee Documentation Committee (IKDC) clinical scores. Computed tomography (CT) scan was used for radiographic examination during the follow-up period. The femoral tunnel widening was measured as a three-dimensional (3D) image using OsiriX software. The cross-sectional area of each tunnel was measured at four different locations. Results The subjective preoperative IKDC score was 50 and one-year postoperative score was 81.8. The side-to-side difference in knee laxity decreased from 2.94 to 0.74mm. The objective IKDC score during the final follow-up was rated A in 27 patients and B in 17. CT scan data revealed an average of 49.32% cone-shaped widening of the femoral tunnel. Femoral tunnel widening at the level of the joint (F4) was negatively correlated with the IKDC subjective score at one year. Conclusions This study revealed a significant widening of the femoral tunnel by demonstrating its conical shape at one year post-surgery. A significant correlation could be established between femoral tunnel widening close to the joint and IKDC scores.


      PubDate: 2016-03-04T15:05:24Z
       
  • The use of metaphyseal sleeves in revision total knee arthroplasty
    • Abstract: Publication date: Available online 2 March 2016
      Source:The Knee
      Author(s): David F. Dalury, William P. Barrett
      Background Bone loss in revision total knee arthroplasty is common. Various reconstruction options are available. The purpose of our study is to report on one such reconstruction option, titanium metaphyseal sleeves. Methods We describe a series of 45 patients (46 knees) who underwent revision total knee arthroplasty and were treated with a porous metaphyseal sleeve between August 2000 and September 2009 at two centers. Patients were followed for a minimum of four years, and at final follow-up, 40 patients (40 knees) were available for review. Patients were evaluated using The Knee Society's Knee Scoring System at each follow-up. Radiographs (standing anteroposterior, lateral, and sunrise views) were taken at six weeks, three months, and final evaluations. Results Mean Knee Society Scores increased from 36 (range 10 to 69) pre-operatively to 90 (range 38 to 100) at final follow-up. Mean alignment on final radiographic evaluation was 5° (range 3° to 8° valgus). Mean pre-operative alignment was 6° (range 15° varus to 18° valgus). Mean range of motion was 125° (range 80° to 140°) pre-operatively and 115° (range 95° to 130°) postoperatively. One device failed to achieve ingrowth and was revised at two years. All other knees were radiographically stable and ingrown. Conclusions Metaphyseal sleeves provide an alternative for bone loss reconstruction in revision total knee arthroplasty. Level of Evidence III


      PubDate: 2016-03-04T15:05:24Z
       
  • Evaluation and comparison of clinical results of femoral fixation devices
           in arthroscopic anterior cruciate ligament reconstruction
    • Abstract: Publication date: March 2016
      Source:The Knee, Volume 23, Issue 2
      Author(s): Deniz Aydin, Mert Ozcan
      Background Several femoral fixation devices are available for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction, but the best technique is debatable. Purpose We hypothesised that different suspensory femoral fixation techniques have no superiority over each other. The aim of this study was to evaluate and compare the clinical results of different suspensory femoral fixation devices in arthroscopic ACL reconstruction. Study design This was a Level III, retrospective, comparative study. Methods A total of 100 consecutive patients who underwent arthroscopic ACL reconstruction in a single institution with a mean follow-up time of 40months (12–67months) were divided into three groups according to femoral fixation devices as ‘Endobutton’ (n =34), ‘Transfix’ (n =35) and ‘Aperfix’ (n =31). The length of painful period after surgery, time to return to work and sporting activities, final range of motion, anterior drawer and Lachman tests, knee instability symptoms, International Knee Documentation Committee (IKDC) subjective knee evaluation score, Short Form 36 (SF-36) score, Lysholm knee score and Tegner point of the patients were evaluated and compared between groups. Results There were no significant differences between the groups. All techniques led to significant recovery in knee instability tests and symptoms. Conclusion In this study, the clinical results of different suspensory femoral fixation techniques were found to be similar. We believe that different femoral fixation techniques have no effect on clinical results provided that the technique is correctly applied. The surgeon must choose a technique appropriate to his or her experience.


      PubDate: 2016-03-04T15:05:24Z
       
  • A comparison of hamstring muscle activity during different screening tests
           for non-contact ACL injury
    • Abstract: Publication date: Available online 2 March 2016
      Source:The Knee
      Author(s): Rasmus S. Husted, Jesper Bencke, Lars L. Andersen, Grethe Myklebust, Thomas Kallemose, Hanne B. Lauridsen, Per Hölmich, Per Aagaard, Mette K. Zebis
      Background Reduced ability to activate the medial hamstring muscles during a sports-specific sidecutting movement has been found to be a potential risk factor for non-contact ACL injury. However, whether a reduced ability to activate the medial hamstring muscle is a general neuromuscular phenomenon and thereby observable independently of the type of clinical screening tests used is not known. This cross sectional study investigated the rank correlation of knee joint neuromuscular activity between three different ACL injury risk screening tests. Methods Sixty-two adolescent female elite football and handball players (16.7±1.3years) participated in the study. Using surface electromyography (EMG) assessment, the neuromuscular activity of medial hamstring muscle (semitendinosus, ST), lateral hamstring muscle (biceps femoris, BF) and quadriceps muscle (vastus lateralis, VL) were monitored during three standardized screening tests — i.e. one-legged horizontal hop (OLH), drop vertical jump (DJ) and sidecutting (SC). Neuromuscular pre-activity was measured in the time interval 10ms prior to initial contact on a force plate. Results For neuromuscular hamstring muscle pre-activity, correlation analysis (Spearman correlation coefficient) showed low-to-moderate correlations between SC and 1) DJ (rs =0.34–0.36, P<0.05) and 2) OLH (rs =0.40–0.41, P<0.05), respectively. Conclusions In conclusion, the present data suggest that hamstring pre-activity share some common variance during the examined tests. However, a lack of strong correlation suggests that we cannot generalize one risk factor during one test to another test. Clinical relevance The present data demonstrate that one-legged horizontal hop and drop vertical jump testing that are commonly used in the clinical setting does not resemble the specific neuromuscular activity patterns known to exist during sidecutting, a well known high risk movement for non-contact ACL injury.


      PubDate: 2016-03-04T15:05:24Z
       
  • Autologous chondrocyte implantation (ACI) for cartilage defects of the
           knee: A guideline by the working group “Clinical Tissue
           Regeneration” of the German Society of Orthopaedics and Trauma
           (DGOU)
    • Abstract: Publication date: Available online 3 March 2016
      Source:The Knee
      Author(s): P. Niemeyer, D. Albrecht, S. Andereya, P. Angele, A. Ateschrang, M. Aurich, M. Baumann, U. Bosch, C. Erggelet, S. Fickert, H. Gebhard, K. Gelse, D. Günther, A. Hoburg, P. Kasten, T. Kolombe, H. Madry, S. Marlovits, N.M. Meenen, P.E. Müller, U. Nöth, J.P. Petersen, M. Pietschmann, W. Richter, B. Rolauffs, K. Rhunau, B. Schewe, A. Steinert, M.R. Steinwachs, G.H. Welsch, W. Zinser, J. Fritz
      Background Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. Methods The present review of the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning therapeutic consequences of primary cartilage lesions and the suitable indication for ACI. Results Based on best available scientific evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than three to four square centimetres; in the case of young and active sports patients at 2.5cm2, while advanced degenerative joint disease needs to be considered as the most important contraindication. Conclusion The present review gives a concise overview on important scientific background and the results of clinical studies and discusses the advantages and disadvantages of ACI. Level of Evidence Non-systematic Review


      PubDate: 2016-03-04T15:05:24Z
       
  • Non-resurfacing techniques in the management of the patella at total knee
           arthroplasty: A systematic review and meta-analysis
    • Abstract: Publication date: Available online 1 February 2016
      Source:The Knee
      Author(s): I. Findlay, F. Wong, C. Smith, D. Back, A. Davies, A. Ajuied
      Background Recent meta-analyses support not resurfacing the patella at the time of TKA. Several different modes of intervention are reported for non-resurfacing management of the patella at TKA. Methods We have conducted a systematic review and meta-analysis of non-resurfacing interventions in TKA. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study methodology and reporting system was adopted, utilising the PRISMA checklist and statement. Classes of patella interventions were defined as: 0. No intervention. 1. Osteophyte excision only. 2. Osteophyte excision, denervation, with soft tissue debridement. 3. Osteophyte excision, denervation, soft tissue debridement, and drilling or micro-fracture of eburnated bone. 4. Patellar resurfacing. A meta-analysis was conducted upon the pre- and post-operative KSS for each technique. Results Four hundred and twenty-three studies were identified, 12 studies met the inclusion criteria for the systematic review and eight for the meta-analysis. Two studies compared different non-resurfacing patellar techniques, the other studies used the non-resurfacing cohort as controls for their prospective RCTs comparing patellar resurfacing with non-resurfacing. The meta-analysis revealed no significant difference between the techniques. Conclusions We conclude that there is no significant difference in KSS for differing non-resurfacing patellar techniques, but further trials using patellofemoral specific scores may better demonstrate superior efficacy of specific classes of patella intervention, by virtue of greater sensitivity for patellofemoral pain and dysfunction. Level of evidence I


      PubDate: 2016-02-09T13:45:09Z
       
  • Routine pre-operative group cross-matching in total knee arthroplasty: A
           review of this practice in an Asian population
    • Abstract: Publication date: Available online 26 January 2016
      Source:The Knee
      Author(s): You Wei Adriel Tay, Yew Lok Woo, Hwee Chye Andrew Tan
      Background Routine pre-operative group cross-match (GXM) and post-operative haemoglobin level measurements are performed for all total knee arthroplasty (TKA) patients in many institutions. We aimed to determine whether this practice is justified, and to identify predictors for post-operative transfusion. Materials and methods A retrospective review was performed on 226 TKA procedures performed between Jan. 2011 and Dec. 2013. Patients' demographics and clinical details including co-morbidities, pre-operative laboratory results, type of anaesthesia, surgery duration, post-operative haemoglobin level and transfusion requirement were reviewed. Results Overall transfusion rate was 10.6% (n=24). Cross-match to transfusion ratio was 6.5. The cross-match to transfusion ratio (C:T ratio) was measured as the ratio of number of units of blood cross-matched to units of blood transfused. In females, relative risk of transfusion between patients with pre-operative haemoglobin below 12.0 and those above or equal to 12.0 was significant at 4.53 (Confidence interval (CI) 2.16 to 9.53). The relative risk of transfusion between patients above 65years of age compared to those below 65years of age was 1.13 (CI 1.03 to 1.23). Multivariate analysis revealed advancing age (p=0.044) and lower preoperative haemoglobin (p<0.001) as significant variables associated with post-operative transfusion. Conclusion Post-operative transfusion rates are low and excessive pre-operative GXM and post-operative haemoglobin checks are contributing to unnecessary medical costs. Predictors of blood transfusion risk in unilateral TKA in our cohort of Asian population were advancing age and lower pre-operative haemoglobin level. Type and screen tests should be performed for all other patients. Level of Scientific Evidence: 3.


      PubDate: 2016-01-30T11:59:46Z
       
  • Surgical induced models of joint degeneration in the ovine stifle:
           Magnetic resonance imaging and histological assessment
    • Abstract: Publication date: Available online 27 January 2016
      Source:The Knee
      Author(s): Joaquin Moya-Angeler, Jimena Gonzalez-Nieto, Joaquin Sanchez Monforte, Jose R. Altonaga, Javier Vaquero, Francisco Forriol
      Background The purposes of this study were to (1) validate and assess the reliability of a modified magnetic resonance semi-quantitative score (sheep Magnetic Resonance osteoarthritis Knee Score (sMOAKS)) to evaluate joint degeneration in the ovine knee and to (2) investigate whether the transection of the anterior cruciate ligament (ACL), isolated or in combination with meniscal injuries, reproduce the degenerative changes described in the meniscectomized sheep. Methods Twenty sheep were randomly subjected to one of the following injuries to induce osteoarthritis (OA): ACL transection (ACLt), mid-body transection of the medial meniscus, ACLt combined with complete medial meniscectomy and complete medial meniscectomy. OA assessment was performed eight weeks postoperatively with sMOAKS, Mankin and Osteoarthritis Research Society International (OARSI) histological scores. Results sMOAKS showed very good to excellent reliability (kappa=0.61 to 1.0) for the majority of features evaluated. sMOAKS revealed small differences between groups (p <0.05) being the ACLt group the most affected. We observed a strong positive correlation between the three scales in the evaluation of femoro-tibial articular cartilage (AC) (r =0.829, r =0.917, r =0.879). Conclusions sMOAKS is a reliable semi-quantitative Magnetic Resonance (MR) scale to evaluate and quantify the effect of different OA induction lesions in the ovine knee and presents a high correlation with Mankin and OARSI scales in the evaluation of femoro-tibial AC. Although minor differences were observed between the different surgical procedures for the induction of OA, ACLt proved to be the intervention that produced the highest amount of degeneration eight weeks postoperatively. Level of Evidence II


      PubDate: 2016-01-30T11:59:46Z
       
  • Gel-type autologous chondrocyte implantation for cartilage repair in
           patients with prior ACL reconstruction: A retrospective two year follow-up
           
    • Abstract: Publication date: Available online 28 January 2016
      Source:The Knee
      Author(s): D.C. van Duijvenbode, F.J. Jonkers, Y.E. Könst, B.J. van Royen, R.J. Benink, M.J.M. Hoozemans
      Purpose To describe the early patient-reported outcomes of articular cartilage repair in patients with pain due to grade III or IV articular cartilage defects after prior anterior cruciate ligament (ACL) reconstruction. Methods Nineteen patients underwent a gel-type autologous chondrocyte implantation (GACI) procedure after ACL reconstruction. Median timeframe between ACL reconstruction and GACI procedure was 52months (range 16 to 369). The average age at chondrocyte implantation was 35 (standard deviation (SD) eight) years and average cumulative articular cartilage defect size was nine (SD four) square centimeter. Outcome was assessed prior to the GACI procedure and two years after GACI using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). Results Two year post-GACI scores showed a statistically significant improvement of IKDC (13, SD 22, p =.02) and KOOS quality of life (18, SD 27, p =.01) compared to the pre-GACI scores. The other KOOS domains did improve, but not statistically significant. Seven (37%) patients underwent reoperation after the GACI. Conclusion Patients with prior ACL reconstruction and suffering from ongoing pain associated with cartilage defects can benefit from cartilage repair with GACI.


      PubDate: 2016-01-30T11:59:46Z
       
  • Long-term results of total knee arthroplasty in young and active patients
           with posterior stabilized design
    • Abstract: Publication date: Available online 29 January 2016
      Source:The Knee
      Author(s): Morteza Meftah, Peter B. White, Amar S. Ranawat, Chitranjan S. Ranawat
      Background The aim of this study was to evaluate long-term quality and performance of cemented posterior-stabilized (PS) total knee arthroplasty (TKA) in young and active patients with gap balancing technique. Methods Between January 2000 and October 2001, 55 TKAs (21 rotating platform [RP] and 34 fixed bearing [FB]) in 41 patients, 60years and younger, with University of California Los Angeles (UCLA) activity score of five and above were included in this study and prospectively followed. Clinical assessments included Western Ontario and McMaster Universities (WOMAC), Knee Society, UCLA activity score, and Patient Administered Questionnaire (PAQ). Radiographic measurements included component positioning, patellar tilt and thickness, radiolucency, loosening or osteolysis. Results At a mean follow-up of 12.3±0.5years (11 to 13), there was no instability, malalignment, or patellofemoral maltracking. Sixty eight percent of patients were still participating in regular recreational activities at the final follow-up. The mean satisfaction score was 9.1±1.9 and 8.5±2.1 in RP-PS and FB-PS groups, respectively. There was no malalignment or osteolysis, no revision for osteolysis or loosening. One patient in the FB-PS group underwent open reduction and internal fixation for a peri-prosthetic fracture. Overall Kaplan–Meier survivorship was 98%. Conclusion The PS TKA in young and active patients can provide long-term durability and high quality of function. Level of evidence III


      PubDate: 2016-01-30T11:59:46Z
       
  • Ultrasonography imaging of the anterolateral ligament using real-time
           virtual sonography
    • Abstract: Publication date: Available online 23 January 2016
      Source:The Knee
      Author(s): Takeshi Oshima, Junsuke Nakase, Hitoaki Numata, Yasushi Takata, Hiroyuki Tsuchiya
      Background The anterolateral ligament (ALL) functions as a stabilizer in the internal rotation of the knee. Previous studies have reported the ALL can be identified using magnetic resonance imaging (MRI); however, there are no reports on using ultrasonography (US) for this purpose. Real-time virtual sonography (RVS) uses magnetic navigation and computer software for the synchronized display of real-time US and multiplanar reconstruction MRI images. This study investigated the ability of using US with RVS to evaluate the ALL. Methods Nine healthy subjects were enrolled. The Digital Imaging Communications in Medicine MRI dataset was loaded into the Hitachi Aloka Preirus, and US images were displayed on the same monitor. When the ALL was identified using MRI, the monitor was frozen to evaluate the ALL. The ALL was divided into the femoral, meniscal, and tibial portions. The portions and thickness of the ALLs and the lateral inferior genicular artery (LIGA), a landmark for the ALL, were evaluated. Results All portions of the ALL could be identified using MRI. Using US, the tibial portion of the ALL was detected in all subjects and the femoral portion was detected in seven subjects; however, the meniscal portions could not be identified. The average ALL thickness as measured by US was 1.3±0.1mm and the LIGA was identified in all cases. Conclusions Most portions of the ALL can be identified using US. As most ALL injuries occur at the femoral or tibial portion, US may be useful as a diagnostic tool for ALL injury. Level of Evidence: 4


      PubDate: 2016-01-24T11:47:42Z
       
  • Medial cortical fractures in computer-assisted closing-wedge high tibial
           osteotomy
    • Abstract: Publication date: Available online 17 January 2016
      Source:The Knee
      Author(s): Dae Kyung Bae, Cheol Hee Park, Eung Ju Kim, Sang Jun Song
      Background We evaluated the incidence of medial cortical fracture and influence on the loss of the correction angle in computer-assisted closing-wedge high tibial osteotomy. Methods Using a navigation system, 200 closing-wedge high tibial osteotomies were performed. The correction angle was defined as the difference between the pre- and postoperative medial proximal tibial angles. The change in the medial proximal tibial angle was calculated as the difference between the medial proximal tibial angles two weeks and one year postoperatively. The medial cortical fractures of the osteotomy site were evaluated. Their incidence, risk factors, and influence on the loss of correction angle were analyzed. Results The incidence of non-displaced cortical breakage and displaced cortical fracture was 28.0% and 6.5%, respectively. Medial cortical fracture was more frequent in younger patients and patients with severe preoperative varus deformity. The average correction angle was significantly larger in the displaced cortical fracture group (9.6° vs. 12.7°, p <0.001). The average change in the medial proximal tibial angle in the no fracture, non-displaced cortical breakage, and displaced cortical fracture groups was 0.7°, 1.8°, and 4.4°, respectively (p <0.001). Conclusions Medial cortical fracture could not be prevented in all knees, even using the navigation system. The risk of medial cortical fracture and loss of the correction angle was increased, particularly when a greater correction angle is required in young patients. Level of evidence IV


      PubDate: 2016-01-20T11:22:37Z
       
  • Pigmented villonodular synovitis diagnosed during revision total knee
           arthroplasty for flexion instability and patellar fracture
    • Abstract: Publication date: Available online 19 January 2016
      Source:The Knee
      Author(s): Christopher L. Camp, Brandon J. Yuan, Adam J. Wood, David G. Lewallen
      Occurring in either a localized or diffuse form, pigmented villonodular synovitis (PVNS) is a disease of unknown etiology that typically presents with insidious onset of pain, swelling, stiffness, or mechanical symptoms as a result of synovial tissue proliferation. PVNS preferentially affects large joints, most commonly the knee. Currently there is no known association with PVNS and total knee arthroplasty (TKA), and to date, there are only a few cases reported in the orthopedic literature in which PVNS was diagnosed after primary TKA. To our knowledge, this is the first case of diffuse PVNS that was discovered at the time of revision TKA for flexion instability and patellar fracture. In this patient, with no known history of PVNS, the diagnosis of diffuse PVNS was made at the time of surgery. She underwent revision TKA, partial patellectomy, and extensive synovectomy. Level of Evidence V, Case Report.


      PubDate: 2016-01-20T11:22:37Z
       
  • Computer assisted alignment of opening wedge high tibial osteotomy
           provides limited improvement of radiographic outcomes compared to
           flouroscopic alignment
    • Abstract: Publication date: Available online 18 January 2016
      Source:The Knee
      Author(s): Jeremy C. Stanley, Kerian G. Robinson, Brian M. Devitt, Anneka K. Richmond, Kate E. Webster, Timothy S. Whitehead, Julian A. Feller
      Introduction There are numerous methods available to assist surgeons in the accurate correction of varus alignment during medial opening wedge high tibial osteotomy (MOWHTO). Preoperative planning performed with radiographs or more recently intraoperative computer navigation software has been used. The aim of the study was to compare the accuracy of computer navigated versus non-navigated techniques to correct varus alignment of the knee. Method The preoperative and postoperative radiographs of 117 knees that underwent MOWHTO were investigated to assess radiographic limb alignment 12-months postoperatively. The desired correction was defined as a weight bearing line (Mikulicz point {MP}) 58% of the width of the tibial plateau from the medial tibial margin. Sixty-five knees were corrected using a conventional technique and 52 knees were corrected using computer navigation. Results The mean MP percentage was 59% in the navigated group, compared with 56% in the fluoroscopic group (p=0.183). 51.9% of the navigation knees were corrected to within five percent of the desired correction, in contrast to 38.5% of the fluoroscopically corrected knees (p=0.15). 71.2% of the navigated knees were corrected to within 10% of the desired correction, compared with 63.1% of the fluoroscopically corrected knees (p=0.36). Large preoperative deformities were more accurately corrected with navigation assistance (57% vs 49%, p=0.049). Conclusion No statistically significant difference was found in the radiographic correction of varus alignment twelve months postoperatively between navigated and fluoroscopic techniques of MOWHTO. However, a subgroup analysis demonstrated that larger preoperative varus deformities may be more accurately corrected using computer navigation.


      PubDate: 2016-01-20T11:22:37Z
       
  • The Norwich Patellar Instability Score: Validity, internal consistency and
           responsiveness for people conservatively-managed following first-time
           patellar dislocation
    • Abstract: Publication date: Available online 18 January 2016
      Source:The Knee
      Author(s): T.O. Smith, R. Chester, N. Hunt, J.L. Cross, A. Clark, S.T. Donell
      Background This paper assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) Score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD). Methods Fifty patients were recruited, providing 130 completed datasets over 12months. The NPI Score, Lysholm Knee Score, Tegner Level of Activity Score and isometric knee extension strength were assessed at baseline, six weeks, six and 12months post-injury. Results There was high convergent validity with a statistically significant correlation between the NPI Score and the Lysholm Knee Score (p<0.001), Tegner Level of Activity Score (p<0.001) and isometric knee extension strength (p<0.002). Principal component analysis revealed that the NPI Score demonstrated good concurrent validity with four components account for 70.4% of the variability. Whilst the NPI Score demonstrated a flooring-effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency with a Cronbach Alpha value of 0.93 (95% CI: 0.91 to 0.93). The NPI Score was responsive to change over the 12months period with an effect size of 1.04 from baseline to 12months post-injury. Conclusions The NPI Score is a valid tool to assess patellar instability symptoms in people conservatively managed following FTPD. Level of evidence Level II


      PubDate: 2016-01-20T11:22:37Z
       
  • The use of calcium carbonate beads containing gentamicin in the second
           
    • Abstract: Publication date: Available online 13 January 2016
      Source:The Knee
      Author(s): Dariusz Marczak, Marek Synder, Marcin Sibiński, Tomasz Okoń, Jacek Kowalczewski
      Background The aim of the study was to analyze effectiveness and safety of packing the medullary canal of the tibia and femur with Herafill (Heraeus Medical GmbH, Wehrheim, Germany), a void filler and antibiotic carrier, during second stage revision total knee arthroplasty (TKA) for periprosthetic joint infection (PJI). Methods Two groups were formed of 28 consecutive patients during second stage revision TKA, comparable for gender and age. The study group received Herafill, while the control group did not. The average follow-up was 52months (minimum 36months). Results No reinfections were observed in the study group, while five were seen in the control group. No other differences were observed between the study and control groups, including mean clinical KSS (Knee Society score) (67.4 and 68.4 points, respectively) and functional score (72.5 and 70.5 points respectively). No side effects related to the use of Herafill beads were noted. Conclusions Herafill packed into the tibial and femoral intramedullary canal during second stage of septic revision TKA is a reliable bone substitute, may reduce recurrence of infection and incorporates well with host bone. However, results after PJI treatment are less than optimal measured by KSSs as compared to patients who do not require revision.


      PubDate: 2016-01-16T11:00:10Z
       
  • Favourable rotational alignment outcomes in PSI knee arthroplasty: A Level
           1 systematic review and meta-analysis
    • Abstract: Publication date: Available online 15 January 2016
      Source:The Knee
      Author(s): A. Mannan, T.O. Smith
      Background Implant malposition in total knee arthroplasty (TKA) often results in unsatisfactory outcomes. Rotational malalignment leads to impaired patellar tracking, stability and joint biomechanics. Patient-specific instrumentation aims to improve three-dimensional implant positioning while reducing overall costs of instrumentation. Methods A PRISMA compliant search of all relevant literature between 2000 and 2014 was performed. The primary outcome of interest was deviation from a neutral femoral and tibial axial alignment of patient-specific instrumentation (PSI) vs conventional instrumentation. Femoral rotation was measured with reference to the transepicondylar axis. Tibial rotation was reported with reference to the anterior tibial tuberosity and a “best fit” with the anterior tibial cortex. Results Six randomised studies met the inclusion criteria reporting on a total of 444knees. Computed tomography (CT) based PSI systems were used exclusively in three studies, and two further studies in association with magnetic resonance imaging (MRI). MRI was used exclusively in one study. Mean femoral rotation in the conventional group was: −1.7 to 1.6° (vs −1.7 to 1° in the PSI group). Meta-analysis demonstrated a significant treatment effect favouring PSI with increased accuracy in “three-degree outliers” with femoral rotation: Z=2.07, P=0.04. A single study reported tibial rotational outcomes with no significant difference demonstrated in conventional instrumentation vs PSI. Conclusions This Level 1 meta-analysis demonstrates favourable femoral rotational alignment outcomes in PSI knee arthroplasty. Only limited data is available for tibial rotational outcomes. Further studies with standardised “gold-standard” measurement criteria are required to clarify tibial rotational outcomes in PSI TKA. Level of evidence 1.


      PubDate: 2016-01-16T11:00:10Z
       
  • Inter-observer and intra-observer reliability of mechanical axis alignment
           before and after total knee arthroplasty using long leg radiographs
    • Abstract: Publication date: Available online 13 January 2016
      Source:The Knee
      Author(s): Anneka Bowman, Meenalochani Shunmugam, Amy R. Watts, Donald C. Bramwell, Christopher Wilson, Jeganath Krishnan
      Background Long leg radiographs (LLRs) are commonly performed for assessment of mechanical alignment and operative planning in patients undergoing total knee arthroplasty (TKA). The aim of this study was to determine the inter- and intra-observer reliability of alignment measured by observers of different levels of experience. Methods Forty patients on the waiting list for a TKA had pre- and post-operative standardised LLRs. We analysed the measurements of mechanical axis alignment between an orthopaedic surgeon, a senior orthopaedic registrar, a junior orthopaedic registrar, and a medical student. Reviewers performed blinded measurements on the same computer screen. These measurements were repeated three months later to assess intra-observer reliability. Furthermore high-resolution screens were compared with standard hospital computer screens to investigate whether monitoring quality influenced the accuracy of measurements of alignment. Results Inter-observer reliability was high for pre-operative LLRs with an intra-class correlation (ICC) of >0.9 at all experience levels. Post-operative ICC was lowest between the surgeon and the medical student at 0.7. Intra-observer reliability was high at all experience levels. Larger deformities appeared to have exaggerated measurements for both pre- and post-operative images. There appeared to be no effect of the monitor size and quality on the accuracy of measurement. Conclusions Long leg radiographs can be used to measure mechanical axis alignment with strong reliability across different levels of experience. This information is important for the evaluation of knee alignment measurements in current clinical practice, to assess severity of deformity and to accompany pre-operative planning and post-operative evaluation. Level of evidence III


      PubDate: 2016-01-16T11:00:10Z
       
  • Is there a need for routine post-operative hemoglobin level estimation in
           total knee arthroplasty with tranexamic acid use'
    • Abstract: Publication date: Available online 12 January 2016
      Source:The Knee
      Author(s): Navendu Goyal, Ritik Kaul, Ian A. Harris, Darren B. Chen, Samuel J. MacDessi
      Background Total knee arthroplasty (TKA) can result in significant blood loss, leading to a need for blood transfusion. The major indication of transfusion is post-operative hemoglobin (Hb) levels in association with symptomatic anemia. The aim of this study was to determine the possibility of eliminating routine post-operative Hb tests in patients undergoing TKA with intra-articular tranexamic acid (TXA) use based on the predictability of pre-operative factors. Methods We conducted a retrospective analysis of 487 patients who underwent TKA with intra-articular TXA use. Statistical analysis was done to predict the transfusion risk based on multiple pre-operative parameters. Results Post-operative blood transfusions were required in 2.5% of all patients. Pre-operative-Hb was the only significant predictor of post-operative transfusion (p<0.0001). Age, sex, weight, height and body mass index (BMI) were not related to post-operative transfusion risk. Transfusions were needed in 4.2% of patients with pre-operative Hb levels <14g/dl. No patient with a pre-operative Hb >14g/dl required a transfusion (p<0.0001). Conclusions Pre-operative Hb is a strong predictor of post-operative blood transfusion risk. Patients who receive TXA in TKA, with a pre-operative Hb >14g/dl do not require routine post-operative Hb evaluation.Level of evidence: IV


      PubDate: 2016-01-12T10:38:37Z
       
  • In vivo kinematics of healthy male knees during squat and golf swing using
           image-matching techniques
    • Abstract: Publication date: Available online 9 January 2016
      Source:The Knee
      Author(s): Koji Murakami, Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Takeshi Shimoto, Daisuke Hara, Hideki Mizu-uchi, Hidehiko Higaki, Yukihide Iwamoto
      Purpose Participation in specific activities requires complex ranges of knee movements and activity-dependent kinematics. The purpose of this study was to investigate dynamic knee kinematics during squat and golf swing using image-matching techniques. Methods Five healthy males performed squats and golf swings under periodic X-ray images at 10 frames per second. We analyzed the in vivo three-dimensional kinematic parameters of subjects' knees, namely the tibiofemoral flexion angle, anteroposterior (AP) translation, and internal–external rotation, using serial X-ray images and computed tomography-derived, digitally reconstructed radiographs. Results During squat from 0° to 140° of flexion, the femur moved about 25mm posteriorly and rotated 19° externally relative to the tibia. Screw-home movement near extension, bicondylar rollback between 20° and 120° of flexion, and medial pivot motion at further flexion were observed. During golf swing, the leading and trailing knees (the left and right knees respectively in the right-handed golfer) showed approximately five millimeters and four millimeters of AP translation with 18° and 26° of axial rotation, respectively. A central pivot motion from set-up to top of the backswing, lateral pivot motion from top to ball impact, and medial pivot motion from impact to the end of follow-through were observed. Conclusions The medial pivot motion was not always recognized during both activities, but a large range of axial rotation with bilateral condylar AP translations occurs during golf swing. This finding has important implications regarding the amount of acceptable AP translation and axial rotation at low flexion in replaced knees. Level of evidence IV


      PubDate: 2016-01-12T10:38:37Z
       
  • The distance from the extramedullary cutting guide rod to the skin surface
           as a reference guide for the tibial slope in total knee arthroplasty
    • Abstract: Publication date: Available online 12 January 2016
      Source:The Knee
      Author(s): Tadashi Tsukeoka, Yoshikazu Tsuneizumi
      Background Although sagittal tibial alignment in total knee arthroplasty (TKA) is important, no landmarks exist to achieve a reproducible slope. The purpose of this study was to evaluate the clinical usefulness of the distance from the guide rod to the skin surface for the tibial slope in TKA. Methods Computer simulation studies were performed on 100 consecutive knees scheduled for TKA. The angle between the line connecting the most anterior point of the predicted tibial cut surface and the skin surface 20cm distal to the predicted cut surface (Line S) and the mechanical axis (MA) of the tibia in the sagittal plane was measured. Results The mean (±SD) absolute angle difference between the Line S and the MA was 0.9°±0.7°. The Line S was almost parallel to the MA in the sagittal plane (95% and 99% within two degrees and three degrees of deviation from MA, respectively). Conclusion The guide rod orientation is a surrogate for the tibial cut slope because the targeted posterior slope is usually built into the cutting block and ensuring the rod is parallel to the MA in the sagittal plane is recommended. Therefore the distance between the skin surface and the rod can be a useful guide for the tibial slope. Level of evidence II


      PubDate: 2016-01-12T10:38:37Z
       
  • Limited utility of routine early postoperative radiography after primary
           ACL reconstruction
    • Abstract: Publication date: Available online 12 January 2016
      Source:The Knee
      Author(s): Brian C. Werner, M. Tyrrell Burrus, Michelle E. Kew, Ian J. Dempsey, F. Winston Gwathmey, Mark D. Miller, David R. Diduch
      Background Given the overall success of anterior cruciate ligament (ACL) reconstruction and the infrequent occurrence of complications detectable on radiographs, the clinical utility and cost-effectiveness of routine radiographs in the early postoperative setting is questionable. Methods Nine hundred thirty-three consecutive adult patients undergoing uncomplicated ACL reconstruction at a single institution were retrospectively reviewed to determine whether a postoperative knee radiograph was obtained within the first three months postoperatively. Images, reports and clinical notes were reviewed to determine if any clinical management change occurred due to x-ray findings. Radiograph charges, including imaging, technical and professional charges were calculated. Results Five hundred ninety-nine of 933 primary ACL reconstruction patients (64.8%) had postoperative knee radiography at an average of 6.3±3.5weeks postoperatively. A musculoskeletal radiologist read 97.7% of x-rays as normal. In the associated visit note, 70.3% of x-ray results were documented. Only 14.1% of patients with a postoperative x-ray had subsequent imaging. There were no significant management changes based on the routine postoperative radiographs using the defined criteria. A total of $336,683 ($562 per patient) was billed to patients for postoperative radiographs. Conclusions Routine early postoperative radiography after primary ACL reconstruction is of questionable utility. The significant per-patient expense is not balanced by the low yield of clinically meaningful data, as nearly all radiographs in the present series were normal and none resulted in significant changes in postoperative clinical management. These results suggest that routine radiographs after uncomplicated ACL reconstruction may be unnecessary although larger, multicenter studies are necessary to confirm these findings. Level of evidence Level IV, retrospective case series.


      PubDate: 2016-01-12T10:38:37Z
       
  • Coronal lower limb alignment in normal knees—A radiographic analysis
           of 797 normal knee subjects
    • Abstract: Publication date: Available online 7 January 2016
      Source:The Knee
      Author(s): Naoki Nakano, Tomoyuki Matsumoto, Masataka Hashimura, Koji Takayama, Kazunari Ishida, Daisuke Araki, Takehiko Matsushita, Ryosuke Kuroda, Masahiro Kurosaka
      Background This study aimed to resolve uncertainty regarding sex differences in alignment changes with age. Methods We measured various parameters of weight-bearing long leg radiographs of 797 legs without osteoarthritic changes, which were classified according to sex and age (young [15–39years], middle-aged [40–54years], aged [55–69years], and elderly [≥70years]), and performed morphological analysis of the lower extremities. The mean measurements in each group were calculated and compared among the groups. Results In the young and middle-aged populations, the femorotibial angle was significantly more varus in male than in female participants (p <0.001). In addition, medial femoral bowing was seen both in male and female participants, but it was more significant in male participants (p <0.005). This was due to greater femoral condylar orientation (p <0.01) and tibial plateau inclination (p <0.01) in male participants compared to female participants with nearly identical joint space narrowing. In aged and elderly populations, on the contrary, lateral femoral bowing was seen in both male and female participants, and there were no differences in any measured values, including the femorotibial angle, between male and female participants. Conclusions In relatively young Japanese individuals, male participants' femorotibial angles were more varus and had more medial femoral bowing than female participants, while there was no difference in any measured values between male and female participants in older adults by a radiographic analysis on the alignment of the lower extremities. Level of evidence: Level 2.


      PubDate: 2016-01-08T10:19:55Z
       
  • Does activity affect the outcome of the Oxford unicompartmental knee
           replacement'
    • Abstract: Publication date: Available online 3 January 2016
      Source:The Knee
      Author(s): Adam M. Ali, Hemant Pandit, Alexander D. Liddle, Cathy Jenkins, Stephen Mellon, Christopher A.F. Dodd, David W. Murray
      Background High levels of activity are considered to be a contraindication to unicompartmental knee replacement (UKR) and are not recommended after UKR. To determine if these recommendations should apply to the mobile-bearing Oxford UKR, this study assessed the effect of post-operative activity level on the outcome of this device. Methods The outcome of the first 1000 Phase 3 cemented Oxford UKRs implanted between 1998 and 2010 was assessed using survival analysis, the Oxford Knee Score (OKS) and the American Knee Society Objective (KSS-O) and Functional (KSS-F) Scores. Patients were grouped according to the maximum post-operative Tegner Activity Score. Results The mean follow-up was 6.1years (range 1 to 14). Overall, increasing activity was associated with superior survival (p=0.025). In the high activity group, with Tegner≥5 (n=115) 2.6% were revised and the 12-year survival was 97.3% (confidence interval (CI): 92.0% to 99.1%). In the low activity group, with Tegner≤4, (n=885) 4.3% were revised and the 12-year survival was 94.0% (CI: 91.4 to 95.8). The difference between the two groups was not significant (p=0.44). Although the final OKS and KSS-F were significantly better in the high activity group compared to the low activity group (OKS 45v40, KSS-F 95v78), there was no difference in the change in OKS or KSS-O. Conclusions High activity does not compromise the outcome of the Oxford UKR and may improve it. Activity should not be restricted nor considered to be a contraindication.


      PubDate: 2016-01-08T10:19:55Z
       
 
 
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