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Journal Cover The Knee
  [SJR: 1.137]   [H-I: 44]   [15 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0968-0160
   Published by Elsevier Homepage  [2801 journals]
  • 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
       
  • Corrigendum to “The magnetic resonance aspect of a polyurethane
           meniscal scaffold is worse in advanced cartilage defects without
           deterioration of clinical outcomes after a minimum two-years
           follow-up” [Knee (2015) 389–394]
    • Abstract: Publication date: Available online 25 January 2016
      Source:The Knee
      Author(s): Pablo Eduardo Gelber, Alexandru Mihai Petrica, Anna Isart, Raquel Mari-Molina, Juan Carlos Monllau



      PubDate: 2016-01-30T11:59:46Z
       
  • The influence of posterior tibial slope changes on joint gap and range of
           motion in unicompartmental knee arthroplasty
    • Abstract: Publication date: Available online 29 January 2016
      Source:The Knee
      Author(s): Koji Takayama, Tomoyuki Matsumoto, Hirotsugu Muratsu, Kazunari Ishida, Daisuke Araki, Takehiko Matsushita, Ryosuke Kuroda, Masahiro Kurosaka
      Background The effect of posterior slope on joint gap in unicompartmental knee arthroplasty (UKA) has yet to be quantified. The purpose of this study was to quantify the effect of the tibial slope on the joint component gap and postoperative range of motion in UKA. Methods Forty consecutive patients were prospectively enrolled. The correlation between the tibial slope changes and the component gap, the component gap difference between flexion angles, the postoperative extension or flexion angles was examined. The correlation of joint looseness with tibial slope changes and postoperative extension angle was also examined. Results Increased tibial slope positively correlated with the differences between the component gap at 90° and 10°, 120° and 10°, or 135° and 10° knee flexion angle. Although tibial slope change did not affect postoperative flexion angle, increased tibial slope reduced postoperative extension angle. Moreover, increased tibial slope resulted in decreased joint looseness during 10° of knee flexion and decreased joint looseness during 10° of knee flexion resulted in reduced postoperative extension angle. Conclusions Increased tibial slope resulted in tight component gap at knee extension compared with that at knee flexion. Furthermore, tight component gap at extension lead to decreased postoperative extension angle. These results indicate that an individual anatomical tibial slope should be considered when tibial sagittal osteotomy was performed and increasing tibial slope should be avoided to achieve full extension angle after UKA. Level of evidence II.


      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
       
  • Prosthetic alignment after total knee replacement is not associated with
           dissatisfaction or change in Oxford Knee Score
    • Abstract: Publication date: Available online 27 January 2016
      Source:The Knee
      Author(s): Henricus J.T.A.M. Huijbregts, Riaz J.K. Khan, Daniel P. Fick, Olivia M. Jarrett, Samantha Haebich
      Background Approximately 18% of the patients are dissatisfied with the result of total knee replacement. However, the relation between dissatisfaction and prosthetic alignment has not been investigated before. Methods We retrospectively analysed prospectively gathered data of all patients who had a primary TKR, preoperative and one-year postoperative Oxford Knee Scores (OKS) and postoperative computed tomography (CT). The CT protocol measures hip–knee–ankle (HKA) angle, and coronal, sagittal and axial component alignment. Satisfaction was defined using a five-item Likert scale. We dichotomised dissatisfaction by combining ‘(very) dissatisfied’ and ‘neutral/not sure’. Associations with dissatisfaction and change in OKS were calculated using multivariable logistic and linear regression models. Results 230 TKRs were implanted in 105 men and 106 women. At one year, 12% were (very) dissatisfied and 10% neutral. Coronal alignment of the femoral component was 0.5 degrees more accurate in patients who were satisfied at one year. The other alignment measurements were not different between satisfied and dissatisfied patients. All radiographic measurements had a P-value>0.10 on univariate analyses. At one year, dissatisfaction was associated with the three-months OKS. Change in OKS was associated with three-months OKS, preoperative physical SF-12, preoperative pain and cruciate retaining design. Discussion Neither mechanical axis, nor component alignment, is associated with dissatisfaction at one year following TKR. Patients get the best outcome when pain reduction and function improvement are optimal during the first three months and when the indication to embark on surgery is based on physical limitations rather than on a high pain score. Level of evidence 2


      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
       
  • Final results of a phase I–II trial using ex vivo expanded
           autologous Mesenchymal Stromal Cells for the treatment of osteoarthritis
           of the knee confirming safety and suggesting cartilage regeneration
    • Abstract: Publication date: Available online 11 January 2016
      Source:The Knee
      Author(s): Robert Soler, Lluis Orozco, Ana Munar, Marina Huguet, Ramon López, Joaquim Vives, Ruth Coll, Margarita Codinach, Joan Garcia-Lopez
      Background Cellular therapies have shown encouraging results in the treatment of chronic osteoarthritis (OA). Herein, we present the final results of a phase I–II clinical trial assessing the feasibility, safety and efficacy of ex vivo expanded autologous bone marrow Mesenchymal Stromal Cells (MSC, XCEL-M-ALPHA), infused intra-articularly, in patients with knee OA. Methods Fifteen patients (median age=52years) with grade II(9) or III(6) gonarthrosis (Kellgren & Lawrence classification) and chronic pain were treated with an intra-articular infusion of 40.9×106 ±0.4×106 MSCin a phase I–II prospective, open-label, single-dose, single-arm clinical trial. Endpoints were safety and tolerability. Efficacy was measured by the Visual Analogue Scale for pain, algofunctional Health Assessment Questionnaire, Quality of Life (QoL) SF-36 questionnaire, Lequesne functional index and WOMAC score. Cartilage integrity was assessed by Magnetic Resonance Imaging and quantitative T2-mapping at 0, 6 and 12months. Results The cell-based product was well tolerated with few reported Adverse Events (mild arthralgia and low back pain). There was a relevant decrease in the intensity of pain since day 8 after the infusion, that was maintained after 12months. The SF-36 QoL test showed improvement of parameters including bodily pain, role physical and physical functioning at month 12. The health assessment questionnaire revealed a significant decrease of incapacity. Moreover, T2 mapping showed signs of cartilage regeneration in all patients at 12months post-treatment. Conclusions Single intra-articular infusion of XCEL-M-ALPHA is a safe and well-tolerated cell-based product, associated with a long-lasting amelioration of pain, improvement of QoL (up to four years), and signs of cartilage repair.


      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 retrograde tibial tunnel drilling decrease subchondral bone lesions
           during ACL reconstruction' A prospective trial comparing retrograde to
           antegrade technique
    • Abstract: Publication date: Available online 8 January 2016
      Source:The Knee
      Author(s): Ronny Lopes, Shahnaz Klouche, Guillaume Odri, Olivier Grimaud, Hubert Lanternier, Philippe Hardy
      Background The main goal of this study was to assess iatrogenic subchondral bone lesions following three different anterior cruciate ligament (ACL) reconstruction techniques and their association with early postoperative pain. Methods A multicenter prospective comparative study was conducted in 2012. Each center performed a specific ligamentoplasty technique: two used retrograde and the other antegrade tibial tunnel drilling. Peri- and postoperative analgesia and systematic early postoperative magnetic resonance imaging (MRI) protocols were standardized. The main assessment criterion was tibial subchondral lesions (microfractures or bone oedema) on MRI during the first postoperative week. Secondary criteria were the assessment of postoperative pain for two days using a Visual Analogical Scale (VAS 0–10) and consumption of analgesics. Results Forty-three patients were included in three centers, 15 in the “antegrade group” and 28 in the “retrograde group”, mean age is 32.5±9.1years, 14 women/29 men. All included patients underwent postoperative MRI. There were no subchondral tibial microfractures, but oedema was significantly more frequent in the antegrade group (p=0.0001). Tibial subchondral oedema was correlated to greater early postoperative pain (p=0.01). Multivariate analysis identified tibial tunnel diameter as an independent factor of early postoperative pain. The smaller the tibial tunnel diameter, the greater the mean early postoperative pain (≤8mm (18 patients) 3.4±1.5 vs. >8mm (25 patients) 1.8±1.7, p=0.004) and the more frequent the presence of edemas (10/18 vs. 2/25, p=0.001). Conclusion The present clinical study confirmed the benefit of retrograde tibial tunnel drilling for tibial subchondral bone lesions and showed a correlation between these lesions and early postoperative pain. Level of evidence II; therapeutic study — prospective cohort study


      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
       
  • Ligament and meniscus loading in the ovine stifle joint during normal gait
    • Abstract: Publication date: Available online 4 January 2016
      Source:The Knee
      Author(s): Joshua M. Rosvold, Mohammad Atarod, Bryan J. Heard, Etienne J. O'Brien, Cyril B. Frank, Nigel G. Shrive
      Background The ovine stifle joint is an ideal preclinical model to study knee joint biomechanics. Knowledge of the ovine ligamentous and meniscal loading during normal gait is currently limited. Methods The in vivo kinematics of the ovine stifle joint (N=4) were measured during “normal” gait using a highly accurate instrumented spatial linkage (ISL, 0.3±0.2mm). These motions were reproduced in vitro using a unique robotic testing platform and the loads carried by the anterior/posterior cruciate ligaments (ACL/PCL), medial/lateral collateral ligaments (MCL/LCL), and medial/lateral menisci (MM/LM) during gait were determined. Results Considerable inter-subject variability in tissue loads was observed. The load in the ACL was near zero at hoof-strike (0% gait) and reached a peak (100 to 300N) during early-stance (~10% gait). The PCL reached a peak load (200 to 500N) just after hoof-strike (~5% gait) and was mostly unloaded throughout the remainder of stance. Load in the MCL was substantially lower than the cruciate ligaments, reaching a maximum of 50 to 100N near the beginning of stance. The LCL carried a negligible amount of load through the entire gait cycle. There was also a major contribution of the MM and LM to load transfer from the femur to the tibia during normal gait. The total meniscal load reached a maximum average between 350 and 550N during gait. Conclusion Knowledge of joint function during normal motion is essential for understanding normal and pathologic joint states. The considerable variability in the magnitudes and patterns of tissue loads among animals simulates clinical variability in humans. Level of evidence III.


      PubDate: 2016-01-08T10:19:55Z
       
  • 2D versus 3D templating in total knee arthroplasty
    • Abstract: Publication date: Available online 5 January 2016
      Source:The Knee
      Author(s): Max Ettinger, Leif Claassen, Peter Paes, Tilman Calliess
      Background Preoperative digital templating in total knee arthroplasty (TKA) helps to determine the need of non-standard implants, prophesies the bony resections and helps to anticipate the intraoperative plan. Templating within the process of patient specific instrumentation (PSI) is fairly new and 2D planning has not been compared to PSI templating. Methods 94 patients underwent unilateral primary TKA with magnetic resonance imaging (MRI) based preoperative templating and PSI cutting blocks. Parallel to this, three observers templated all cases using digital planning on standard preoperative x-rays. The examiners templated all cases independently and were blinded to the component sizes used intraoperatively. Results Three-dimensional (3D) templating was accurate in predicting the correct implant size in 100% of the cases. The femoral and tibial two-dimensional (2D) digital templating varied from 43.6% to 59.5% and 52.1% to 68% of the cases. When allowing ±1 difference, femoral 2D digital templating varied from 93.6% to 97.8% of the cases and ranged from 94.6% to 98.9% on the tibial side. All observers show “very good” correlation. The coefficient indicates a very good agreement in between the three observers. Conclusion 3D templating has very high accuracy for the actual implant size prediction. Compared to this, 2D digital templating is an accurate method to approximately (±1 size) determine the size of TKA components. However, we judge this technique accurate enough, that 2D templating allows launching Template-directed instrumentation (TDI), while the examiner does not need a high level of clinical experience. Clinical relevance Within the process of digital planning, the surgeonmight focus evenmore on the upcoming operation.


      PubDate: 2016-01-08T10:19:55Z
       
  • Epidemiological characteristics of patellofemoral osteoarthritis in
           elderly Koreans and its symptomatic contribution in knee osteoarthritis
    • Abstract: Publication date: Available online 31 December 2015
      Source:The Knee
      Author(s): Hyung Joon Cho, Kiran Kumar GN, Jong Yeal Kang, Kuen Tak Suh, Tae Kyun Kim
      Background Many studies have reported the prevalence of knee osteoarthritis (OA) but have invariably focused on the tibiofemoral (TF) joint and overlooked the patellofemoral (PF) joint. Accordingly, little epidemiological information is available regarding the PF OA. The purpose of the current study was to document the epidemiological characteristics of PF OA in elderly Koreans. Methods Radiographic assessment was performed for 681 elderly (≥65years old) Koreans recruited from a community, and symptom severity was evaluated using Western Ontario and McMaster Universities Index (WOMAC) and Short Form-36 (SF-36) scales. Prevalence of different categories of knee OA (isolated PF OA, isolated TF OA and combined PF and TF OA) was calculated. The symptoms of isolated PF OA group and non-OA group were compared. Results The overall prevalence of OA was 22.0% in the PF compartment and 34.1% in the TF compartment. The prevalence of isolated PF OA, isolated TF OA, and combined PF and TF OA was 3.8%, 17.8%, and 19.2%, respectively. Female sex, aging, and obesity were not associated with isolated PF OA. No significant differences were found in any clinical outcome scales between the isolated PF and non-OA groups. Conclusion This study documents that OA in the PF joint is common in elderly Koreans, but isolated PF OA is rare. Demographic risk factors are not associated with isolated PF OA, suggesting that isolated PF OA may have a different pathophysiology from other types of knee OA. Our study also indicates that the presence of isolated PF OA should not be construed to be responsible for clinical symptoms.


      PubDate: 2016-01-03T08:03:53Z
       
  • The impact of custom cutting guides on patient satisfaction and residual
           symptoms following total knee arthroplasty
    • Abstract: Publication date: Available online 30 December 2015
      Source:The Knee
      Author(s): Denis Nam, Ryan M. Nunley, Keith R. Berend, Adolph V. Lombardi, Robert L. Barrack
      Background Custom cutting guides (CCGs) in total knee arthroplasty (TKA) use preoperative three-dimensional (3-D) imaging to manufacture cutting blocks specific to a patient's anatomy. The purpose of this study was to evaluate the impact of CCGs versus standard intramedullary and extramedullary guides on patient-reported satisfaction and residual symptoms following TKA. Methods A retrospective, multicenter study was performed to compare a magnetic resonance imaging-based CCG system versus standard instrumentation. All patients received the same, cemented, fixed-bearing, cruciate-retaining component, and had a primary diagnosis of osteoarthritis. Data was collected by an independent, third party survey center blinded to surgical technique that administered telephone questionnaires assessing patient satisfaction and symptoms. Patient age, gender, minority status, education level, income, length of follow-up, and pre-arthritic UCLA scores were considered potential confounders and accounted for using multivariate logistic regression analyses. Results 448 patients (107 CCGs, 341 standard) were successfully interviewed. At a mean follow-up of threeyears, there was no difference in percentage of patients reporting their knee to feel “normal” (74% CCG versus 78% standard, p=0.37). Residual symptoms including knee stiffness (37% CCG versus 28% standard, p=0.08) and difficulty getting in and out of car (34% CCG versus 30% standard, p=0.40) remained high. Multivariate regression analyses demonstrated no differences between the two cohorts for both patient-reported satisfaction and residual symptoms (odds ratios 0.72 to 1.48; p=0.10 to 0.81). Conclusion When interviewed by an independent, blinded third party, the use of CCGs in TKA did not improve patient-reported satisfaction or residual symptoms versus the use of standard alignment guides.


      PubDate: 2016-01-03T08:03:53Z
       
  • Focal intratendinous radiolucency: A new radiographic method for
           diagnosing patellar tendon ruptures
    • Abstract: Publication date: Available online 30 December 2015
      Source:The Knee
      Author(s): Jonathan P. Ng, Derek T. Cawley, Suzanne M. Beecher, Matthew J. Lee, Diane Bergin, Fintan J. Shannon
      Background Diagnosis of patellar tendon rupture is usually based on clinical history and examination. In equivocal cases, imaging may be required. Lateral radiograph is a simple and cost-effective method for prompt diagnosis. However, no specific radiological sign has been described. Rather than utilising patella alta as an indirect measure of patellar tendon rupture, we hypothesise that a focal intratendinous radiolucency is another reliable and accurate radiological sign for diagnosis. Sensitivity and specificity analysis was undertaken to evaluate the diagnostic value of this radiographic sign. Methods Lateral radiographs of mid-substance patellar tendon ruptures from 19 patients were analysed. These were then randomised with another 19 normal knee radiographs from age-matched patients to create a pool of 38 radiographs for interpretation. Six independent interpreters who were blinded to the diagnosis were requested to indicate whether rupture was present or absent based on the visualisation of a focal intratendinous radiolucency in the patellar tendon. The Insall–Salvati (IS), Caton–Deschamps (CD) and Blackburne–Peel (BP) ratios were measured in the same radiographs. Sensitivity and specificity for each of the radiographic measurements were calculated. Inter- and intraobserver correlations were reported in kappa statistics. Results The average sensitivity and specificity for focal radiolucency in the patellar tendon substance were 82.5% and 95.2%, respectively. Sensitivity and specificity for the IS ratio were 84.2% and 78.9%, for CD was 68.4% and 84.2% and for BP was 68.4% and 89.4% respectively. Conclusion The presence of a focal intratendinous radiolucency in the patellar tendon is both accurate and reliable in diagnosing patellar tendon ruptures.


      PubDate: 2016-01-03T08:03:53Z
       
  • Intravenous versus intra-articular tranexamic acid in total knee
           
    • Abstract: Publication date: Available online 30 December 2015
      Source:The Knee
      Author(s): Jerry Yongqiang Chen, Pak Lin Chin, Ing How Moo, Hee Nee Pang, Darren Keng Jin Tay, Shi-Lu Chia, Ngai Nung Lo, Seng Jin Yeo
      Background Despite the proven efficacy of both intravenous (IV) and intra-articular (IA) tranexamic acid (TXA) in reducing blood loss during total knee arthroplasty (TKA), the ideal route of administration remained debatable. This study aimed to compare the effect of IV versus IA TXA on transfusion incidences, perioperative blood loss and postoperative lower limb swelling during TKA. Methods One hundred patients were prospectively randomised into two groups: 1) IV TXA; and 2) IA TXA. In both groups, TXA was administered intraoperatively after cementing the prostheses. The perioperative blood loss was calculated using the haemoglobin balance method. The thigh, suprapatellar, and calf girths were measured preoperatively and on postoperative day (POD) 4. Results Two patients in the IV group and one patient in the IA group required blood transfusion (p=0.500). The median and interquartile range (IQR) of perioperative blood loss on POD1 and POD4 was 530 (IQR 386,704) and 730 (IQR 523,925) ml for the IV group, compared with 613 (IQR 506,703) and 799 (IQR 563,1067) ml for the IA group (p=0.090 and p=0.232 respectively). The median increment in thigh, suprapatellar, and calf girths were 1.5 (IQR 0, 3.0), 2.0 (IQR 0.5, 4.0) and 0 (IQR 0, 1.0) cm for the IV group, compared to 2.0 (IQR 1.0, 4.0), 2.0 (IQR 0, 4.5) and 0 (IQR 0, 1.5) cm for the IA group (p=0.246, p=0.562, and p=0.937 respectively). Conclusions Both IV and IA TXA had comparable effect on transfusion incidences, perioperative blood loss, and postoperative lower limb swelling during TKA. IA TXA is an alternative to IV TXA. Level of evidence: I.


      PubDate: 2016-01-03T08:03:53Z
       
  • Patellar instability and quadriceps avoidance affect walking knee moments
    • Abstract: Publication date: Available online 30 December 2015
      Source:The Knee
      Author(s): Damian A. Clark, Danielle L. Simpson, Jonathan Eldridge, G. Robert Colborne
      Purpose To classify patients with patellofemoral (PF) instability on the basis of their mechanical gait characteristics, and to relate gait deficits to patellofemoral congruence. Methods Thirteen patients awaiting patellar stabilisation surgery were recruited for gait analysis and magnetic resonance imaging, MRI assessment of PF congruence. Patients were grouped into two subgroups (P1, P2) based on knee joint moment during stance, and their total support moments (TSMs) during stance were compared against eight healthy Control subjects. PF congruence was compared between groups from MRI data captured at 0, 20 and 40° of passive knee flexion and during dynamic extension. Results Five patients were classified into group P1 because they demonstrated a knee extensor moment during early stance, and eight patients into group P2 because they did not. The TSM of the more affected limb in group P1 was not significantly different from Control values in early stance but the difference was significant (P<.05) in late stance. In group P2, both the less and more affected limbs were significantly different from Control TSM values in early stance, but only the more affected limb in late stance. Patellofemoral contact areas as measured by MRI were greatest for the Control patients, and least for patient group P2 especially during the active extension trials. Conclusions Patients with patellofemoral pain and instability walked with a slightly flexed knee, avoiding extension. The MRI measurements of joint contact agreed with the patient groupings according to gait mechanics. Cartilage contact across the PF joint can be an objective measure of instability.


      PubDate: 2016-01-03T08:03:53Z
       
  • Inter- and intra-rater reliability of patellofemoral kinematic and contact
           area quantification by fast spin echo MRI and correlation with cartilage
           health by quantitative T1ρ MRI
    • Abstract: Publication date: Available online 31 December 2015
      Source:The Knee
      Author(s): Brian C. Lau, Daniel U. Thuillier, Valentina Pedoia, Ellison Y. Chen, Zhihong Zhang, Brian T. Feeley, Richard B. Souza
      Background Patellar maltracking is a leading cause of patellofemoral pain syndrome (PFPS). The aim of this study was to determine the inter- and intra-rater reliability of a semi-automated program for magnetic resonance imaging (MRI) based patellofemoral kinematics. Methods Sixteen subjects (10 with PFPS [mean age 32.3; SD 5.2; eight females] and six controls without PFPS 19 [mean age 28.6; SD 2.8; three females]) participated in the study. One set of T2-weighted, fat-saturated fast spin-echo (FSE) MRIs were acquired from each subject in full extension and 30° of knee flexion. MRI including axial T1ρ relaxation time mapping sequences was also performed on each knee. Following image acquisitions, regions of interest for kinematic MRI, and patellar and trochlear cartilage were segmented and quantified with in-house designed spline- based MATLAB semi-automated software. Results Intraclass Correlations Coefficients (ICC) of calculated kinematic parameters were good to excellent, ICC > 0.8 in patellar flexion, rotation, tilt, and translation (anterior -posterior, medial -lateral, and superior -inferior), and contact area translation. Only patellar tilt in the flexed position and motion from extended to flexed state was significantly different between PFPS and control patients (p=0.002 and p=0.006, respectively). No significant correlations were identified between patellofemoral kinematics and contact area with T1ρ relaxation times. Conclusions A semi-automated, spline-based kinematic MRI technique for patellofemoral kinematic and contact area quantification is highly reproducible with the potential to help better understand the role of patellofemoral maltracking in PFPS and other knee disorders. Level of Evidence Level IV


      PubDate: 2016-01-03T08:03:53Z
       
  • Polypropylene mesh augmentation for complete quadriceps rupture after
           total knee arthroplasty
    • Abstract: Publication date: Available online 31 December 2015
      Source:The Knee
      Author(s): Scott R. Nodzo, Sridhar R. Rachala
      Introduction Polypropylene mesh has previously been shown to be an effective treatment for failed patellar tendon repairs after total knee arthroplasty (TKA), but there have been few reports of this synthetic mesh used in complete quadriceps rupture after TKA. Methods We retrospectively reviewed seven consecutive cases in six patients with complete quadriceps tears after TKA who had their quadriceps tendon repaired with suture and polypropylene mesh augmentation. All but two patients had previously failed primary suture repair. Patient outcomes were evaluated using the Knee Society Score. Standardized anterior-posterior (AP), lateral and merchant radiographs were evaluated preoperatively and at final follow-up. Results Seven knees in six patients were evaluated with a mean follow-up of 34±10 (range 24 to 49months) months. There were only four clinical successes defined as an extensor lag less than 30°. Of the functioning knees at final follow-up (n=5) the overall extensor lag in this group did significantly improve from 50±13° to 20±15° (range 5 to 40°) (p=.01). Mean postoperative flexion at final follow-up was 115±8°. Mean Knee Society Score for function improved from 20±30 to 45±54 (p=.03) as did the mean Knee Society Score for pain (44±18 vs. 74±78, p=.02). Discussion Polypropylene mesh offered limited postoperative functional results when used as an augment to the multiply operated knee that sustains a complete quadriceps rupture after TKA, but did allow for significant improvement in postoperative pain outcomes. Level of Evidence IV


      PubDate: 2016-01-03T08:03:53Z
       
  • Minimally invasive semitendinosus tendon harvesting from the popliteal
           fossa versus conventional hamstring tendon harvesting for ACL
           reconstruction: A prospective, randomised controlled trial in 100 patients
           
    • Abstract: Publication date: Available online 3 January 2016
      Source:The Knee
      Author(s): Wolfgang Franz, Andreas Baumann
      Background This study aims to compare a technique for hamstring tendon harvesting from a postero-medial incision in the popliteal fossa with the conventional method. Methods One hundred patients who underwent anterior cruciate ligament (ACL)-reconstruction were randomised to either have their tendon graft harvested from postero-medial (group 1) or via an antero-medial approach (group 2). Time for tendon harvest, length of skin incision and duration of tendon harvest were recorded as well as complications and sensory disturbances in the lower leg. Pain scores were documented on the VAS scale. Results Time for tendon harvesting averaged one minute 23 s in group 1 versus five minutes 20 s in group 2 (p<0.01). The skin incision measured 21 mm (group 1) versus 49 mm in group 2 (p<0.01). The length of the harvested tendon averaged 272 mm (group 1) and 292 mm in group 2 (p<0.01). There was one superficial wound infection in group 2 and none in group 1. Postoperative pain scores were similar in both groups. None of the patients in group 1 reported sensory disturbance in the lower leg, whilst seven patients in group 2 were found to have reduced sensation in the distribution of the saphenous nerve postoperatively (p<0.01). Conclusion This study confirms that harvesting the semitendinosus tendon from postero-medial is quicker, results in a shorter scar and reduces the risk of injury to branches of the saphenous nerve. However, harvesting the tendon from postero-medial resulted in a shorter tendon graft. Level of Evidence Level I (Randomised, controlled trial)


      PubDate: 2016-01-03T08:03:53Z
       
  • The anterolateral ligament of the knee: A dissection study
    • Abstract: Publication date: Available online 31 December 2015
      Source:The Knee
      Author(s): Armin Runer, Stephan Birkmaier, Mathias Pamminger, Simon Reider, Elmar Herbst, Karl-Heinz Künzel, Erich Brenner, Christian Fink
      Background Recent studies have described the presence of the anterolateral ligament (ALL). However, there is still no consensus regarding the anatomy of this structure with the topic controversially discussed. The aim of this study was to provide an anatomical description of the ligamentous structures on the anterolateral side of the knee with special emphasis on the ALL. Methods Forty-four human cadaveric knees were dissected to reveal the ALL and other significant structures in the anterolateral compartment of the knee joint. The ALL was defined as a firm structure running in an oblique direction from the lateral femoral epicondyle to a bony insertion at the anterolateral tibia. Results The ALL was identified in 45.5% (n=20) of the dissected knee joints. The structure originates together with the fibular collateral ligament (45%) or just posterior and proximal to it (55%). The ligament has an extra-capsular, anteroinferior, oblique course to the anterolateral tibia with a bony insertion between Gerdy's tubercle and the fibular head. The ALL had its greatest extend at 60° of knee flexion and maximal internal rotation. Conclusion The ALL is a firm ligamentous structure in the anterolateral part of the knee present in 45.5% of the cases. Given the course and characteristics of this structure, a function in providing rotational stability by preventing internal rotation of the knee is likely. Clinical relevance The ALL might be an important stabilizer in the knee and may play a significant role in preventing excessive internal tibial rotation and subluxation of the knee joint.


      PubDate: 2016-01-03T08:03:53Z
       
  • Inter-observer reliability of measurements performed on digital long-leg
           standing radiographs and assessment of validity compared to 3D CT-scan
    • Abstract: Publication date: Available online 31 December 2015
      Source:The Knee
      Author(s): B. Boonen, B. Kerens, M.G.M. Schotanus, P. Emans, B. Jong, N.P. Kort
      Background Long-leg radiographs (LLR) are often used in orthopaedics to assess limb alignment in patients undergoing total knee arthroplasty (TKA). However, there are still concerns about the adequacy of measurements performed on LLR. We assessed the reliability and validity of measurements on LLR using three-dimensional computed tomography (3D CT)-scan as a gold standard. Methods Six different surgeons measured the mechanical axis and position of the femoral and tibial components individually on 24 LLR. Intraclass correlation coefficients (ICC) were calculated to obtain reliability and Bland–Altman plots were constructed to assess agreement between measurements on LLR and measurements on 3D CT-scan. Results ICC agreement for the six observer measurements on LLR was 0.70 for the femoral component and 0.80 for the tibial component. The mean difference between measurements performed on LLR and 3D CT-scan was 0.3° for the femoral component and −1.1° for the tibial component. Variation of the difference between LLR and 3D CT-scan for the femoral component was 1.1° and 0.9° for the tibial component. 95% of the differences between measurements performed on LLR and 3D CT-scan were between −1.9 and 2.4° (femoral component) and between −2.9 and 0.7 (tibial component). Conclusion Measurements on LLR show moderate to good reliability and, when compared to 3D CT-scan, show good validity. Clinical trial registration number: institutional review board Atrium-Orbis-Zuyd, number: 11-T-15. Level of Evidence Prospective cohort study, Level II.


      PubDate: 2016-01-03T08:03:53Z
       
  • Criteria used when deciding on eligibility for total knee arthroplasty
           — Between thinking and doing
    • Abstract: Publication date: Available online 31 December 2015
      Source:The Knee
      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: 2016-01-03T08:03:53Z
       
  • Long-term mortality and causes of death among patients with a total knee
           prosthesis in primary osteoarthritis
    • Abstract: Publication date: Available online 29 December 2015
      Source:The Knee
      Author(s): Tuomo Visuri, Keijo Mäkelä, Pekka Pulkkinen, Mia Artama, Eero Pukkala
      Background Short and midterm mortality of patients with osteoarthritis (OA) who have undergone total knee arthroplasty (TKA) is generally lower than that of the general population. Due to an increasing number of young patients who undergo TKA the expected lifetime of these patients is increasing. The purpose of this study was to assess the causes of death and long-term mortality among Finnish TKA patients. Methods Standardized mortality ratios (SMRs) for total and site specific causes of death were calculated for 9443 TKA patients operated on in 1980 to 1996 for OA and followed until 2012. Results The mean follow-up time was 14years (maximum 33years). During follow-up, 77% of the patients had died. The all-cause SMR was 1.00. It was significantly lower than in the reference population (SMR 0.73) during the first 10years after operation, but higher during the next 10years (SMR 1.23), and even more after 20years (SMR 1.95). The SMR for cardiovascular mortality was 1.03 and accounted for 52% of all deaths. Significant excess mortality was observed in diseases of the digestive tract (SMR 1.29). Deaths due to cardiovascular diseases, Alzheimer's disease and dementia comprised 68% of all deaths that took place 10years or later after TKA. Conclusions The mortality of TKA patients with OA is significantly reduced during the first 10 postoperative years but exceeds the mortality of the general population after that. This trend should be taken into account when young patients undergo a TKA. Level of evidence Observational study, III.


      PubDate: 2015-12-30T07:41:31Z
       
  • Investigating the relationship between internal tibial torsion and medial
           collateral ligament injury in patients undergoing knee arthroscopy due to
           tears in the posterior one third of the medial meniscus
    • Abstract: Publication date: Available online 29 December 2015
      Source:The Knee
      Author(s): Olcay Guler, Mehmet Isyar, Dilek Karataş, Tugrul Ormeci, Halis Cerci, Mahir Mahirogulları
      Purpose To evaluate the relationship between medial collateral ligament (MCL) injury and degree of internal tibial torsion in patients who had undergone arthroscopic resection due to tears in the posterior one third of the medial meniscus. Methods Seventy-one patients were allocated into two groups with respect to foot femur angle (FFA) and transmalleolar angle (TMA) (Group 1 31 patients with FFA<8° and Group 2 40 patients with FFA≥8°). The groups were compared in terms of valgus instability, Lysholm score, magnetic resonance view, FFA, and TMA, both before and after the operation. Results Lysholm scores were higher in Group 2 at both postoperative week 1 (p<0.001) and month 1 (p=0.045) relative to Group 1. Preoperative cartilage injury was encountered more frequently in Group 1 (p=0.037) than in Group 2. MCL injury was detected more frequently in Group 1 compared to Group 2 postoperatively at week 1 (p=0.001). Conclusion We conclude that FFA and TFA, indicators of internal tibial torsion, may serve as markers for foreseeing clinical improvement and complications following arthroscopic surgery. Level of Evidence level III retrospective comparative study.


      PubDate: 2015-12-30T07:41:31Z
       
  • Modelling knee flexion effects on joint power absorption and adduction
           moment
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Hanatsu Nagano, Ichiroh Tatsumi, Eri Sarashina, W.A. Sparrow, Rezaul K. Begg
      Background Knee osteoarthritis is commonly associated with ageing and long-term walking. In this study the effects of flexing motions on knee kinetics during stance were simulated. Extended knees do not facilitate efficient loading. It was therefore, hypothesised that knee flexion would promote power absorption and negative work, while possibly reducing knee adduction moment. Methods Three-dimensional (3D) position and ground reaction forces were collected from the right lower limb stance phase of one healthy young male subject. 3D position was sampled at 100Hz using three Optotrak Certus (Northern Digital Inc.) motion analysis camera units, set up around an eight metre walkway. Force plates (AMTI) recorded ground reaction forces for inverse dynamics calculations. The Visual 3D (C-motion) ‘Landmark’ function was used to change knee joint positions to simulate three knee flexion angles during static standing. Effects of the flexion angles on joint kinetics during the stance phase were then modelled. Results The static modelling showed that each 2.7° increment in knee flexion angle produced 2.74°–2.76° increments in knee flexion during stance. Increased peak extension moment was 6.61Nm per 2.7° of increased knee flexion. Knee flexion enhanced peak power absorption and negative work, while decreasing adduction moment. Conclusions Excessive knee extension impairs quadriceps' power absorption and reduces eccentric muscle activity, potentially leading to knee osteoarthritis. A more flexed knee is accompanied by reduced adduction moment. Research is required to determine the optimum knee flexion to prevent further damage to knee-joint structures affected by osteoarthritis.


      PubDate: 2015-12-18T05:49:46Z
       
  • Joint contact forces when minimizing the external knee adduction moment by
           gait modification: A computer simulation study
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Ross H. Miller, Aryeh Y. Esterson, Jae Kun Shim
      Background and purpose Gait modification is often used to reduce the external knee adduction moment (KAM) in human walking, but the relationship between KAM reduction and changes in medial knee joint contact force (JCF) is not well established. Our purpose was to examine the limiting case of KAM-based gait modification: reducing the KAM as much as possible, and the resulting effects on JCF. Methods We used musculoskeletal modeling to perform three optimal control simulations: normal walking, a modified gait that reduced the KAM as much as theoretically possible (Min(KAM) simulation), and a second modified gait that minimized the KAM plus the metabolic cost of transport (Min(KAM+CoT) simulation). Results The two modified gaits both reduced the peak KAM from normal walking (−82% for Min(KAM) simulation, −74% for Min(KAM+CoT) simulation) by increasing trunk lean, toe-out, and step width, and reducing knee flexion. Even though the Min(KAM+CoT) simulation had the larger KAM, it had a greater reduction in peak medial JCF (−27%) than the Min(KAM) simulation (−15%) because it reduced the KAM using less knee muscle activity. These results were qualitatively robust to a sensitivity analysis of the knee joint model, but the magnitude of changes varied by an order of magnitude. Conclusions The results suggest that (i) gait modification can benefit from considering whole-body motion rather than single adjustments, (ii) accurate interpretation of KAM effects on medial JCF requires consideration of muscle forces, and (iii) subject-specific knee models are needed to accurately determine the magnitude of KAM reduction effects on JCF.


      PubDate: 2015-12-18T05:49:46Z
       
  • Comprehensive assessment of patellar morphology using computed
           tomography-based three-dimensional computer models
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Ai-Bing Huang, Xiao Luo, Chang-Hui Song, Ji-Ying Zhang, Yong-Qiang Yang, Jia-Kuo Yu
      Background The objectives of this study were to assess patellar morphology using computed tomography-based three-dimensional computer models and to determine the utility of the subchondral method for patellar resection in total knee arthroplasty (TKA). Methods Overall, 120 subjects (60 males, 60 females) from 20 to 50years old were included. Computer tomography images were used to construct 3D computer models of 240 knees. An anthropometric analysis of variance was used with the models to detect differences between the sides, age groups, and genders. Results Based on the available numbers, there were significant gender differences in the patellar length, width, and thickness even with strict control for the height and weight of the patients. The average patellar width/thickness ratio was 1.95, regardless of gender, and there was a good correlation between the patellar width and thickness (male: r=0.68, p<0.01; female: r=0.75, p<0.01). After using the subchondral method to virtually resect the patellae, the mean thickness for males and female was 14.0mm and 12.3mm, respectively. The proportion of the residual bony thickness that was less than 12mm was 5.83% (seven cases) in the male group and up to 42.5% (51 cases) in the female group. There was excellent intra-observer reliability and inter-observer reliability regarding the dimensional measurements in this study. Conclusions A robust method of measuring and virtually resecting the patella was established. The anthropometric dimensions of this study could provide basic data for guiding surgical management of the patella in TKA and are useful in designing patellar implants. Clinical relevance The anthropometric patellar information is essential for surgeons to perform patellar resurfacing in TKA.


      PubDate: 2015-12-18T05:49:46Z
       
  • Influence of mechanical unloading on histological changes of the patellar
           tendon insertion in rabbits
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Hirotaka Mutsuzaki, Hiromi Nakajima, Yasuyoshi Wadano, Hikaru Takahashi, Masataka Sakane
      Background The purpose of this study was to clarify the influence of mechanical unloading on histological changes of the patellar tendon (PT) insertion in rabbits. Materials and methods The PT was completely released from stress by drawing the patella toward the tibial tubercle with a stainless steel wire installed between the patella and tibial tubercle (mechanical unloading group, n=28). The animals of the sham group underwent the same surgical procedure; however, the wire was not tightened (n=28). The average thickness of the Safranin O-stained glycosaminoglycan (GAG) area, chondrocyte apoptosis rate and chondrocyte proliferation rate of the cartilage layer at the insertion were measured at one, two, four, and sixweeks. Results The chondrocyte apoptosis rate in the mechanical unloading group was significantly higher than that in the sham group at one and fourweeks (p <0.05). The chondrocyte proliferation rate in the mechanical unloading group was significantly lower than that in the sham group at four and sixweeks (p <0.05). The average thickness of the GAG-stained area in the mechanical unloading group was significantly lower than that in the sham group at sixweeks (p <0.05). Conclusion Mechanical unloading significantly affected the increase in the chondrocyte apoptosis rate, decrease in the chondrocyte proliferation rate, and decrease in the GAG layer thickness at the PT insertion for up to sixweeks in rabbits. Clinical relevance We suggest that more than 6weeks of mechanical unloading should be avoided to prevent degeneration at the PT insertion.


      PubDate: 2015-12-18T05:49:46Z
       
  • Implant labeling standards: A history of science behind the solution
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Kent Jason Lowry, William Milhalko



      PubDate: 2015-12-18T05:49:46Z
       
  • Erythropoietin stimulates patellar tendon healing in rats
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Mustafa Uslu, Ertuğrul Kaya, Kürşat Oğuz Yaykaşlı, Murat Oktay, Mustafa Erkan Inanmaz, Cengiz Işık, Havva Erdem, Melih Engin Erkan, Hayati Kandiş
      Backround Erythropoietin (EPO), regulating erythropoiesis, is used to provide protective and regenerative activity in non-haematopoietic tissues. There is insufficient knowledge about the role of EPO activity in tendon healing. Therefore, we investigated the effect of EPO treatment on healing in rat patellar tendons. Methods One hundred and twenty-six, four-month-old male Sprague–Dawley rats were randomly assigned to three experimental groups: 1, no treatment; 2, treatment with isotonic saline (NaCl) and 3, treatment with EPO. Each group was randomly subdivided into two groups for sacrifice at three (1a, 2a, 3a) or sixweeks (1b, 2b, 3b). Complete incision of the left patellar tendon from the distal patellar pole was performed. We applied body casts for 20days after the incised edges of the patellar tendon were brought together with a surgical technique. Both legs were harvested and specimens from each group underwent histological, biomechanical, and protein mRNA expression analyses. Results There were statistically significant differences in the ultimate breaking force between the EPO group and others at both weeks three and six (p<0.05); significant differences in fibroblast proliferation, capillary vessel formation, and local inflammation were found between groups 1a and 3a, and 2a and 3a (p<0.05). There were statistical differences between 1a, 3a and 2a, 3a for Col III, TGF-β1, and VEGF and between 1b, 3b and 2b, 3b for Col I, Col III, TGF-β1, and VEGF mRNA expressions. Conclusion EPO had an additive effect with surgery on the injured tendon healing process in rats compared to the control groups biomechanically, histopathologically and with tissue protein mRNA expression. Clinical relevance This is the first experimental study to analyze the relationship between EPO treatment and the patellar tendon repair process by biomechanical, histopathological, and tendon tissue mRNA expression methodologies.


      PubDate: 2015-12-18T05:49:46Z
       
  • Predictors of treatment response to strengthening and stretching exercises
           for patellofemoral pain: An examination of patellar alignment
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6
      Author(s): Hsien-Te Peng, Chen-Yi Song
      Background Closed kinetic chain and quadriceps strengthening, combined with flexibility exercises of the lower limb musculature, is a common treatment for patellofemoral pain syndrome (PFPS). The effectiveness has been well documented; however, very little is known about which factors predict treatment success. Methods A total of 43 female subjects with PFPS participated in an eight-week progressive leg press (LP) strengthening and stretching exercise program. A decrease of 1.5cm on a 10cm visual analog scale (VAS) score was used as an indicator for treatment success. The baseline patellar tilt angle difference (PTA-d) due to quadriceps contraction prior to treatment was evaluated as a predictor of treatment success. The logistic regression and receiver operating characteristics (ROC) curve analysis were performed to investigate the predictive value of PTA-d. Results PTA-d could significantly predict the treatment success of LP strengthening and stretching exercises. The odds ratio (OR) for having an unsuccessful outcome was 1.19 (95% confidence interval (CI), 1.03−1.39, P <0.021) per degree increment of PTA-d. The most optimal cut-off value for the clinical discrimination of treatment success after LP strengthening and stretching exercise was −1.5° of PTA-d (sensitivity=0.74, specificity=0.71). The area under the ROC curve was 0.73 (standard error=0.08). Conclusions Female patients with PFPS whose quadriceps contraction reduced the lateral patellar tilt prior to LP strengthening and stretching exercise treatment are more likely to experience pain relief. It seems clinically important to check dynamic patellar tilt characteristics before treatment to aid in clinical decision making. Level of evidence Cohort, II


      PubDate: 2015-12-18T05:49:46Z
       
  • Contents List
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6




      PubDate: 2015-12-18T05:49:46Z
       
  • Editorial Board
    • Abstract: Publication date: December 2015
      Source:The Knee, Volume 22, Issue 6




      PubDate: 2015-12-18T05:49:46Z
       
  • A Two-stage procedure for the treatment of a neglected posterolateral knee
           dislocation: Gradual reduction with an Ilizarov external fixator followed
           by arthroscopic anterior and posterior cruciate ligament reconstruction
    • Abstract: Publication date: Available online 10 December 2015
      Source:The Knee
      Author(s): Vasilios D. Polyzois, Ioannis P. Stathopoulos, Ioannis S. Benetos, Spyros G. Pneumaticos
      Background Neglected knee dislocations are extremely uncommon and their management cannot be evidence-based since only a few case reports have been published describing different treatment methods. We present the case of a young man with a neglected posterolateral knee dislocation and a concomitant sciatic nerve injury. Methods A two-stage treatment strategy with gradual reduction using the Ilizarov technique and subsequent arthroscopic anterior and posterior cruciate ligament reconstruction was followed. Results The two-stage treatment approach led to a satisfactory clinical outcome. At the latest follow-up evaluation the patient was fully ambulatory and the knee was painless with no anteroposterior instability. Conclusions In neglected knee dislocations treatment optios are guided by the severity of the concomitant injuries and the status of articulating surfaces. Gradual reduction with the Ilizarov technique and subsequent arthroscopic ligamentous reconstruction is a reliable alternative to open surgical procedures.


      PubDate: 2015-12-14T05:12:04Z
       
  • The effect of percutaneous release of the medial collateral ligament in
           arthroscopic medial meniscectomy on functional outcome
    • Abstract: Publication date: Available online 2 December 2015
      Source:The Knee
      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: 2015-12-09T04:35:20Z
       
  • Systematic review of medial versus lateral survivorship in
           unicompartmental knee arthroplasty
    • Abstract: Publication date: Available online 24 October 2015
      Source:The Knee
      Author(s): J.P. van der List, L.S. McDonald, A.D. Pearle
      Background Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. Methods A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship. Results The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p =0.133) but was significantly higher at ten years (90.5 vs. 84.1, p =0.015). Conclusion This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies. Level of evidence Systematic Review of level IV studies.


      PubDate: 2015-12-09T04:35:20Z
       
 
 
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