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Journal Cover The Knee
  [SJR: 1.236]   [H-I: 53]   [15 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0968-0160
   Published by Elsevier Homepage  [3039 journals]
  • Hereditary bilateral genu recurvatum: Case report of a family
    • Authors: Peter Feczko; Pieter Emans
      Abstract: Publication date: Available online 20 November 2016
      Source:The Knee
      Author(s): Peter Feczko, Pieter Emans
      Background Genu recurvatum is a rare condition in children and adolescents. The origin can be osseous, ligamentous and mixed. Methods We describe for the first time a family inclusive two brothers and their mother with hereditary bilateral genu recurvatum of unknown etiology. The possible underlying pathology and treatment are discussed. Results The underlying pathology of the early closure of the apophysis of the tibial tuberosity remained unclear. The mother was never treated, one of the brothers received a tibial osteotomy as a young adult. Both patients developed end-stage osteoarthritis of both knees which was successfully treated by a bilateral computer-navigated TKA. At seven to eight years after implantation in the older brother (left and right knee, respectively) and three to four years after implantation in the younger brother (right and left knee, respectively), the Visual Analogue Scale (VAS) pain score on a 0 to 100 scale was 0 of both brothers, the EQ-5D health status was 80 (scale of 0 to 100), the satisfaction was 10 (scale of 10) of both brothers. The Knee Injury and Osteoarthritis Outcome Score (KOOS) function of the younger brother of 75 (scale 0 to 100) and of the older brother 100. The KOOS sport of the younger brother was 10 (scale 0 to 100), whereas that of the older brother 85. Conclusions Hereditary bilateral genu recurvatum with end-stage osteoarthritis can be successfully treated with computer-navigated TKAs; however, impingement of the patella on the proximal tibia and the position of the tibial keel are of concern.

      PubDate: 2016-11-24T08:46:36Z
      DOI: 10.1016/j.knee.2016.09.025
  • Knee arthrodesis by the Ilizarov method in the treatment of total knee
           arthroplasty failure
    • Authors: Andrea Antonio Maria Bruno; Alexander Kirienko; Andrea Peccati; Paolo Dupplicato; Massimo De Donato; Enrico Arnaldi; Nicola Portinaro
      Abstract: Publication date: Available online 18 November 2016
      Source:The Knee
      Author(s): Andrea Antonio Maria Bruno, Alexander Kirienko, Andrea Peccati, Paolo Dupplicato, Massimo De Donato, Enrico Arnaldi, Nicola Portinaro
      Background Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of knee arthrodesis by circular external fixation performed in the treatment of TKA failure in which revision arthroplasty was not indicated. Methods The study involved 19 patients who underwent knee arthrodesis by the Ilizarov method. Clinical and functional assessments were performed, including Knee Society Score (KSS). A postoperative clinical and radiographic evaluation was conducted every three months until the end of the treatment. Postoperative complications and eventual leg shortening were recorded. Results KSS results showed a significant improvement with respect to the preoperative condition. Of the 16 patients in the final follow-up, 15 patients (93.7%) achieved complete bone fusion. Major complications occurred in patients treated for septic failure of TKA and most occurred in patients over 75years of age; the mean final leg shortening was four centimeters. Conclusion In our experience, the Ilizarov method is effective for performing a knee arthrodesis in the case of extensive bone loss. At the same time, it is possible to correct the associated leg deformities or limb length difference. In addition, only the Ilizarov method provides a mechanical stimulus for bone formation and improves the quality of the bone and of the microcirculation, which enhances the host response against infection. Despite these attributes, knee arthrodesis by the Ilizarov method must be considered a ‘salvage procedure’ in cases of severe outcomes from knee surgery in which revision arthroplasty is not indicated.

      PubDate: 2016-11-24T08:46:36Z
      DOI: 10.1016/j.knee.2016.11.002
  • A prospective randomized comparison of two distinct allogenic tissue
           constructs for anterior cruciate ligament reconstruction
    • Authors: Michael B Rose; Christopher Domes; Mehwish Farooqi; Dennis C Crawford
      Abstract: Publication date: Available online 18 November 2016
      Source:The Knee
      Author(s): Michael B Rose, Christopher Domes, Mehwish Farooqi, Dennis C Crawford
      Background Conduct a prospective randomized study to compare clinical outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendon (HT) allograft or doubled tibialis anterior (TA) allograft. Limited level 1 data exist comparing outcomes of different soft tissue allograft constructs for ACL reconstruction. We hypothesized no difference would exist in the patient reported outcomes (PRO), arthrometric testing, or rate of re-rupture between the two constructs. Methods Ninety eight subjects undergoing primary ACL reconstruction were randomized to HT (n=47) or TA (n=51) allograft. Subjects completed validated (PRO) measures pre-operatively, and six months and two years post-operatively. Arthrometric testing was performed at six months to assess integrity of the reconstruction. Results Fifty-eight percent of subjects (57/98) completed a two-year follow up. Allograft re-tear rates were similar between groups (6.2% HT vs. 4.0% TA, respectively, p=1.0). The relative risk of re-tear in the HT group was 1.5 compared to the TA group (p=0.7). The TA group improved significantly more on the physical portion of the VR-12 (p=0.046) and Lysholm score (p=0.014) compared to the HT group. There was no difference in the change from baseline for the other PRO scores at two years. Conclusions Our data indicate no difference in graft failure rate and similar improvement from baseline in most PRO scores between treatment groups after two years. Based on these findings, TA allograft appears to provide a reliable and satisfactory option for patients who elect to undergo allograft ACL reconstruction.

      PubDate: 2016-11-24T08:46:36Z
      DOI: 10.1016/j.knee.2016.08.011
  • Open wedge high tibial osteotomy using three-dimensional printed models:
           Experimental analysis using porcine bone
    • Authors: Jun-Dae Kwun; Hee-June Kim; Jaeyoung Park; Il-Hyung Park; Hee-Soo Kyung
      Abstract: Publication date: Available online 19 November 2016
      Source:The Knee
      Author(s): Jun-Dae Kwun, Hee-June Kim, Jaeyoung Park, Il-Hyung Park, Hee-Soo Kyung
      Background The purpose of this study was to evaluate the usefulness of three-dimensional (3D) printed models for open wedge high tibial osteotomy (HTO) in porcine bone. Methods Computed tomography (CT) images were obtained from 10 porcine knees and 3D imaging was planned using the 3D-Slicer program. The osteotomy line was drawn from the three centimeters below the medial tibial plateau to the proximal end of the fibular head. Then the osteotomy gap was opened until the mechanical axis line was 62.5% from the medial border along the width of the tibial plateau, maintaining the posterior tibial slope angle. The wedge-shaped 3D-printed model was designed with the measured angle and osteotomy section and was produced by the 3D printer. The open wedge HTO surgery was reproduced in porcine bone using the 3D-printed model and the osteotomy site was fixed with a plate. Accuracy of osteotomy and posterior tibial slope was evaluated after the osteotomy. Results The mean mechanical axis line on the tibial plateau was 61.8±1.5% from the medial tibia. There was no statistically significant difference (P =0.160). The planned and post-osteotomy correction wedge angles were 11.5±3.2° and 11.4±3.3°, and the posterior tibial slope angle was 11.2±2.2° pre-osteotomy and 11.4±2.5° post-osteotomy. There were no significant differences (P =0.854 and P =0.429, respectively). Conclusion This study showed that good results could be obtained in high tibial osteotomy by using 3D printed models of porcine legs.

      PubDate: 2016-11-24T08:46:36Z
      DOI: 10.1016/j.knee.2016.09.026
  • Endoscopic debridement and fibrin glue injection of a chronic
           Morel-Lavallée lesion of the knee in a professional soccer player: A case
           report and literature review
    • Authors: Baris B. Koc; Nicolaas Somorjai; Egid P.M. Kiesouw; Kurt Vanderdood; Marleen Meesters-Caberg; Frits W. Draijer; Edwin J.P. Jansen
      Abstract: Publication date: Available online 23 November 2016
      Source:The Knee
      Author(s): Baris B. Koc, Nicolaas Somorjai, Egid P.M. Kiesouw, Kurt Vanderdood, Marleen Meesters-Caberg, Frits W. Draijer, Edwin J.P. Jansen
      A Morel-Lavallée lesion is a post-traumatic closed degloving injury of soft tissue. The lesion is due to a shearing trauma with separation of subcutaneous tissue from underlying fascia. When conservative treatment fails, surgical treatment is imperative. Commonly, open drainage and debridement is performed. This case report describes a Morel-Lavallée lesion of the knee in a professional soccer player who was successfully treated with endoscopic debridement and fibrin glue injection after failure of conservative management. This method achieves the goal of an open surgical debridement without exposing patients to an increased morbidity.

      PubDate: 2016-11-24T08:46:36Z
      DOI: 10.1016/j.knee.2016.10.017
  • Optimizing effectivity of tranexamic acid in bilateral knee arthroplasty
           — A prospective randomized controlled study
    • Authors: Rajesh N. Maniar; Tushar Singhi; Aniket Patil; Gaurav Kumar; Parul Maniar; Jaivardhan Singh
      Abstract: Publication date: Available online 23 November 2016
      Source:The Knee
      Author(s): Rajesh N. Maniar, Tushar Singhi, Aniket Patil, Gaurav Kumar, Parul Maniar, Jaivardhan Singh
      Introduction Tranexamic acid (TEA) is used in reducing surgical blood loss. Literature shows no optimal regimen recommended for Bilateral Total Knee Arthroplasty (TKA). We evaluated three TEA regimens differing in dosage, timing and mode of administration in bilateral TKA to identify the most effective regimen to reduce blood loss. Methods We prospectively studied three TEA regimens (25 patients each) as follows: (1) two intraoperative, intravenous doses (IOIO), (2) two intraoperative local applications (LALA), and (3) one preoperative plus two intraoperative, intravenous doses (POIOIO). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method were statistically evaluated. Results Mean drain loss was least (412.9ml) in the POIOIO group, greatest (607.2ml) in the IOIO group and LALA group in between (579.4ml), with a statistically significant difference among them (p=0.0022). On paired evaluation, the drain loss in the POIOIO group was significantly less as compared to the other two groups, whereas the difference between IOIO and LALA was not significant. Mean total blood loss was least in the POIOIO group (1207ml) and greatest in LALA group (1270ml). The difference among the groups was not statistically significant (p=0.80). There was no incidence of any thromboembolic phenomenon. On correlation with our study on Most Effective Regimen in Unilateral TKA, both results were found to substantiate each other.

      PubDate: 2016-11-24T08:46:36Z
      DOI: 10.1016/j.knee.2016.10.014
  • Corrigendum to “Pain evaluation after all-inside anterior cruciate
           ligament reconstruction and short term functional results of a prospective
           randomized study” [Knee 21 (2014) 102–106]
    • Authors: Horea Benea; Henri d'Astorg; Shahnaz Klouche; Thomas Bauer; Gheorghe Tomoaia; Philippe Hardy
      Abstract: Publication date: Available online 11 November 2016
      Source:The Knee
      Author(s): Horea Benea, Henri d'Astorg, Shahnaz Klouche, Thomas Bauer, Gheorghe Tomoaia, Philippe Hardy

      PubDate: 2016-11-17T07:36:27Z
      DOI: 10.1016/j.knee.2016.10.015
  • A three dimensional approach for quantifying resultant loading at the knee
    • Authors: Ryan T. Lewinson; Chad P. Maag; Victor M.Y. Lun; J. Preston Wiley; Chirag Patel; Darren J. Stefanyshyn
      Abstract: Publication date: Available online 12 November 2016
      Source:The Knee
      Author(s): Ryan T. Lewinson, Chad P. Maag, Victor M.Y. Lun, J. Preston Wiley, Chirag Patel, Darren J. Stefanyshyn
      Background Clinical effectiveness of lateral wedges for knee osteoarthritis is inconsistent across studies. One explanation is that knee loading is not fully described by the peak frontal-plane knee moment. The purpose of this study was to propose a 3D resultant approach to describing moments at the knee and evaluate how this moment changes in response to lateral wedges. Methods Walking gait analysis was performed on 20 individuals with knee osteoarthritis, in their own shoes, with and without a six millimeter lateral wedge insole. Frontal-plane and 3D resultant moments were calculated for each participant and footwear condition. Paired t-tests identified differences between footwear conditions, correlations identified relationships between frontal-plane and 3D resultant moments, and regressions assessed relationships between moments and pain. Results Significant reductions to peak frontal-plane moments (p=0.001) and 3D resultant moments at the same time point (p=0.042) were observed with lateral wedges. While an overall significant correlation was observed between change in frontal-plane moments and change in 3D resultant moments with a lateral wedge (r =0.68, p=0.001), 5/20 participants experienced disparate results where the frontal-plane moment was reduced yet the 3D moment increased. Conclusions While lateral wedges alter frontal-plane moment magnitude, the direction of change does not always correspond to the direction of change observed in the 3D resultant moment. Thus resultant knee load may sometimes increase with lateral wedges. Clinical relevance Future prospective studies should evaluate if changes in 3D resultant moments, and thus total knee load, offer an explanation as to why some participants do not experience clinical benefit from lateral wedges.

      PubDate: 2016-11-17T07:36:27Z
      DOI: 10.1016/j.knee.2016.08.005
  • Radiographic assessment of knee–ankle alignment after total knee
           arthroplasty for varus and valgus knee osteoarthritis
    • Authors: Fuqiang Gao; Jinhui Ma; Wei Sun; Wanshou Guo; Zirong Li; Weiguo Wang
      Abstract: Publication date: Available online 14 November 2016
      Source:The Knee
      Author(s): Fuqiang Gao, Jinhui Ma, Wei Sun, Wanshou Guo, Zirong Li, Weiguo Wang
      Background There are unanswered questions about knee–ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee–ankle alignment after TKA. Methods The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis. Results The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (P <0.05). The pre-operative malalignment of the knee was corrected (P <0.05), and the ankle tilt angle was accordingly improved in the operative side after TKA (P <0.05). In addition, TKA had little effect on knee–ankle alignment on the non-operative side (P >0.05). Conclusion These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA. Level of evidence Level III.

      PubDate: 2016-11-17T07:36:27Z
      DOI: 10.1016/j.knee.2016.09.023
  • Generalised ligamentous laxity and revision ACL surgery: Is there a
    • Authors: M. Adeel Akhtar; R. Bhattacharya; J.F. Keating
      Abstract: Publication date: Available online 14 November 2016
      Source:The Knee
      Author(s): M. Adeel Akhtar, R. Bhattacharya, J.F. Keating
      Background The aim of the present study was to investigate the relationship between generalised ligamentous laxity (GLL) and requirement for revision anterior cruciate ligament (ACL) reconstruction. Methods The study cohort consisted of 139 patients undergoing primary ACL reconstruction, 44 patients undergoing revision ACL surgery and a control group of 70 patients without any knee ligament injury. A Beighton score of four or more was classified as generalised ligamentous laxity. Results The primary and revision ACL surgery groups had an increased incidence of GLL compared to the control group (p<0.05). The revision ACL surgery group also had higher incidence of GLL as compared to primary ACL surgery group (p<0.05). There was a sub group within the revision cohort, who had failure of the original surgery without an identifiable cause (biological failure). The incidence of GLL in this group was significantly higher than the primary surgery group (p<0.05). Conclusions The findings of this study suggest that GLL may be associated with a higher risk of ACL injury and an increased risk of graft failure after primary ACL reconstruction. Based on the results of our study we feel that in the presence of GLL an autogenous graft may not be the best option for either primary or revision ACL reconstruction. Level of Evidence 3 (III).

      PubDate: 2016-11-17T07:36:27Z
      DOI: 10.1016/j.knee.2015.11.006
  • Postoperative hyperglycaemia control reduces postoperative complications
           in patients subject to total knee arthroplasty
    • Authors: Diego Reátegui; Eduard Tornero; Dragos Popescu; Sergi Sastre; Miquel Camafort; Gracia Gines; Andrés Combalía; Luis Lozano
      Abstract: Publication date: Available online 15 November 2016
      Source:The Knee
      Author(s): Diego Reátegui, Eduard Tornero, Dragos Popescu, Sergi Sastre, Miquel Camafort, Gracia Gines, Andrés Combalía, Luis Lozano
      Background The aim of our study was the early detection and treatment of patients with unknown alterations of the hydrocarbon metabolism subject to total knee arthroplasty in order to reduce the incidence of postoperative complications. Methods Patients were classified as non-diabetic patients (group 1), diabetic patients (group 2) and patients with stress hyperglycaemia (group 3). The last two groups were recommended assessment by a primary care physician (PCP). After one year follow-up the groups were compared with respect to incidence of postoperative complications. The groups were also compared regarding the decrease or increase of HbA1c levels with the incidence of complications. Results Of the 228 patients, 116 (50%) were included in group 1, 40 (17.5%) in group 2 and 72 (31.6%) in group 3. Patients that consulted their PCP presented lower medical complication rates than those who did not (9.2% vs. 26.4%, P =0.020). Not being attended by a PCP was an independent predictive factor of medical complication (odds ratio (OR): 21.3; 95% confidence interval (95% CI): 4.6–98.5), surgical site infection (OR: 4.1; 95% CI: 1.1–15.0) and mechanical complication (OR: 5.0; 95% CI: 1.3–18.8). A decrease of HbA1c value was related to less medical systemic complications (7.3% vs. 24.2%, P =0.035). Conclusions Patients with hyperglycaemia during the postoperative total knee arthroplasty period, who are controlled by the PCP present lower incidence of complications. Decrease of HbA1c value during postoperative total knee arthroplasty period leads to a lower rate of medical complications.

      PubDate: 2016-11-17T07:36:27Z
      DOI: 10.1016/j.knee.2016.09.011
  • Effects of measurement methods for tibial rotation axis on the morphometry
           in Korean populations by gender
    • Authors: Kyoung-Tak Kang; Juhyun Son; Oh-Ryong Kwon; Changhyun Baek; Dong Beom Heo; Kyoung-Mi Park; Ho-Joong Kim; Yong-Gon Koh
      Abstract: Publication date: Available online 5 November 2016
      Source:The Knee
      Author(s): Kyoung-Tak Kang, Juhyun Son, Oh-Ryong Kwon, Changhyun Baek, Dong Beom Heo, Kyoung-Mi Park, Ho-Joong Kim, Yong-Gon Koh
      Background There have been arguments for methodology in tibial rotation axis measurement, which accordingly determines the morphometry of the proximal tibia in total knee arthroplasty. The morphometry of the proximal tibia for the Korean population is determined by gender, based on the anatomical tibial axis and reliable rotational orientation in knee replacements, to evaluate the size suitability of the currently available prostheses in Korea. Methods This study reconstructed the MRI images in three-dimensions for identification and measurement of the mediolateral (ML) and anteroposterior (AP) lengths of the proximal tibia and the tibial aspect ratio (ML/AP) using proximal tibial anthropometric data for 700 osteoarthritic knees (587 females and 113 males). The ML and AP lengths were measured using tibial rotation axis techniques based on the medial one-third tibial tubercle and Cobb's method. Results Significant differences (P <0.05) in ML, medial anteroposterior (MAP), lateral anteroposterior (LAP) lengths, and aspect ratio (ML/LAP) were observed for males and females with respect to different measurement techniques for the tibial rotation axis. However, the measured aspect ratio (ML/MAP) of tibiae for the Korean population did not show significance. The measured aspect ratio (ML/AP) ratio of tibiae for the Korean population was higher than that of currently available tibial components. Conclusions Results from this study can guide development of gender-specific tibial prosthesis designs with different ML and AP aspect ratios based on the tibial anatomical rotation axis for the Korean population.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.09.012
  • Analysis of risk factors for poor prognosis in conservatively managed
           juvenile osteochondritis dissecans of the lateral femoral condyle
    • Authors: Hiroshi Nakayama; Tomoya Iseki; Syunichiro Kambara; Shinichi Yoshiya
      Abstract: Publication date: Available online 7 November 2016
      Source:The Knee
      Author(s): Hiroshi Nakayama, Tomoya Iseki, Syunichiro Kambara, Shinichi Yoshiya
      Background The purpose of this study was to examine factors affecting the prognosis of conservative treatment for stable juvenile osteochondritis dissecans (OCD) of the lateral femoral condyle based on review of our patient population. Methods A consecutive series of 43 knees in 37 patients with stable OCD of the lateral femoral condyle with open physes undergoing conservative treatment were included in the study. The mean age of the included subjects was 10.7±2.5years (range, seven to 16years) with the mean follow-up period of 33.3±15.1months (range, 12 to 67months). Conservative treatment consisting of prohibition of sports activities and use of a brace locking the knee in full extension was applied to all included patients. Potential prognostic factors examined were the presence of discoid meniscus, radiographic stage, lesion size on radiographs, time period from onset of symptoms to evaluation/consultation, number of hours of sporting activity per week, and age at starting sports activities. Prognosis of a patient was deemed to be poor when an apparent healing response was not detected in follow-up radiographic studies within six months. Results The prognosis was defined to be poor for 14 knees (32.6%). The presence of discoid meniscus was identified in 100% of the knees in the poor prognosis group and time-period from onset to consultation of six months or more was shown to be a risk factor with statistical significance. Conclusions A majority of patients with juvenile OCD in the lateral femoral condyle could be managed with conservative treatment. The presence of discoid meniscus and longer time-period from onset to consultation were significantly related with poor prognosis. Level of evidence IV (case series).

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.09.021
  • Clinical outcomes of ACL reconstruction with tibialis anterior allograft
           using an anteromedial portal approach
    • Authors: Jason Capo; Steven D. Shamah; Laith Jazrawi; Eric Strauss
      Abstract: Publication date: Available online 9 November 2016
      Source:The Knee
      Author(s): Jason Capo, Steven D. Shamah, Laith Jazrawi, Eric Strauss

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.06.002
  • Should the position of the patellar component replicate the vertical
           median ridge of the native patella?
    • Authors: Rae Hyeong Lee; Hae Won Jeong; Jin Kyu Lee; Choong Hyeok Choi
      Abstract: Publication date: Available online 8 November 2016
      Source:The Knee
      Author(s): Rae Hyeong Lee, Hae Won Jeong, Jin Kyu Lee, Choong Hyeok Choi
      Background In total knee arthroplasty (TKA), the position of the patellar component can affect patellar tracking. However, the patellar component cannot always replicate the original high point of the patella because of anatomical variance. This study investigated whether altering the highest point of the patella can affect outcomes of primary TKA, especially in patients having a patella with a far-medialized median ridge. Methods A retrospective review was performed for 177 knees (143 patients) treated with primary TKA between July 2011 and March 2014. Group 1 (34 knees) had the patellar component displaced over three millimeters from the median ridge, while Group 2 (143 knees) had the patellar component placed on the original median ridge position. The one-year follow-up outcomes were reviewed, including: patellar tilt angle, Knee Society Score, Feller Patellar Score, and modified Kujala Anterior Knee Pain Score. Results Mean (±standard deviation) displacement of the patellar component in Group 1 was 3.97±0.97mm lateral to the original position of the median ridge, with a significant decrease in lateral patellar tilt angle (P <0.001). Lateral patellar tilt showed a positive correlation with the medialization of the patellar component (P <0.001, r =0.401). Ability to rise from a chair was better in Group 1 (P =0.025). There were no other between-group differences in other clinical outcomes. Conclusions There should be no need for the patellar component to replicate the original highest point of the native patella in primary TKA.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.09.014
  • Location of the natural knee axis for internal–external tibial
    • Authors: Daniel V. Boguszewski; Nirav B. Joshi; Paul R. Yang; Keith L. Markolf; Frank A. Petrigliano; David R. McAllister
      Abstract: Publication date: Available online 4 November 2016
      Source:The Knee
      Author(s): Daniel V. Boguszewski, Nirav B. Joshi, Paul R. Yang, Keith L. Markolf, Frank A. Petrigliano, David R. McAllister
      Background Rotating hinge and mobile bearing tray knee replacement designs utilize a single fixed axis for tibial rotation, yet there is little published information regarding the natural internal–external axis (IEA) for tibial rotation. Identifying the IEA should provide an opportunity for reproducing normal knee kinematics and maintaining the balance of forces in the soft tissues that help control rotation of the tibia. Methods The location and orientation of the IEA relative to the tibial plateau were calculated in 46 fresh frozen human cadaveric specimens using an instant center of rotation analysis at fixed knee flexion angles ranging from five degrees to 105°. Results IEA location ranged from 4.0 to 4.9mm medial and 1.7 to 5.5mm posterior to the center of the tibial plateau (from 5° to 105° of knee flexion). IEA orientation was reported relative to a reference axis perpendicular to the plane of the tibial plateau. In the frontal plane, the IEA was not significantly different from the reference axis from five degrees to 45° flexion, and 2.0° to 2.7° valgus to the reference axis from 60° to 105° flexion. In the sagittal plane, the IEA was not significantly different from the reference axis from 5° to 15° flexion, and 3.0° to 7.0° extended from the reference axis from 30° to 105° flexion. Conclusions The IEA moves posteriorly with increasing knee flexion on the tibial plateau. Placement of the IEA relative to the tibial plateau for a rotating hinge or mobile bearing tray implant may represent a compromise between design objectives for moderate and deeper knee flexion. Clinical relevance This study has relevance for future knee implant designs.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2015.11.003
  • A soft-tissue preserving method for evaluating the impact of posterior
           tibial slope on kinematics during cruciate-retaining total knee
           arthroplasty: A validation study
    • Authors: Yifei Dai; Laurent D Angibaud; Jean-Yves Jenny; Cyril Hamad; Amaury Jung; Michael B Cross
      Abstract: Publication date: Available online 4 November 2016
      Source:The Knee
      Author(s): Yifei Dai, Laurent D Angibaud, Jean-Yves Jenny, Cyril Hamad, Amaury Jung, Michael B Cross
      Background The reconstructed posterior tibial slope (PTS) plays a significant role in restoring knee kinematics in cruciate-retaining total knee arthroplasty. However, conventional methods for the investigation of PTS can be limited by sample size or prone to errors due to damages to the bone and/or soft tissues. The purpose of this study was to validate a novel method for the evaluation of the effects of PTS on knee kinematics. Methods Seven computer-assisted cruciate-retaining TKAs were performed by two surgeons on healthy cadaveric knees. The implanted tibial baseplates allowed precise and easy modification of the PTS in situ. Knee kinematics were evaluated during passive full range of motion test. The evaluation was performed three times at each of the five PTSs in the order of 10°, seven degrees, four degrees, one degree, and back to ten degrees. The variability of the repeated measurements, inter-surgeon variation of the data, and test reproducibility were investigated. Results The test method was shown to be highly repeatable (low root-mean-squared errors) and has low sensitivity to surgeon variability (ANOVA). No statistical difference was found in the knee kinematics between the first and last measurements at 10° PTS (paired t-test). Conclusion The results suggested that the developed method can be used to investigate the impact of PTS on knee kinematics without disrupting the soft-tissue environment of the knee. The use of the novel tibial baseplate allowed for adjusting the PTS without re-cutting the tibia and removing the components. The method may be applied to improve the future investigation of PTS.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.08.007
  • Immediate effects of foot orthoses on pain during functional tasks in
           people with patellofemoral osteoarthritis: A cross-over, proof-of-concept
    • Authors: Natalie J. Collins; Rana S. Hinman; Hylton B. Menz; Kay M. Crossley
      Abstract: Publication date: Available online 4 November 2016
      Source:The Knee
      Author(s): Natalie J. Collins, Rana S. Hinman, Hylton B. Menz, Kay M. Crossley
      Background The purpose of the study was to determine whether prefabricated foot orthoses immediately reduce pain during functional tasks in people with patellofemoral osteoarthritis, compared to flat insoles and shoes alone. Methods Eighteen people with predominant lateral patellofemoral osteoarthritis (nine women; mean [SD] age 59 [10]years; body mass index 27.9 [3.2]kg/m2) performed functional tasks wearing running sandals, and then wearing foot orthoses and flat insoles (random order). Participants rated knee pain during each task (11-point numerical rating scales), ease of performance and knee stability (five-point Likert scales), and comfort (100mm visual analogue scales). Results Compared to shoes alone, foot orthoses (p =0.002; median difference 1.5 [IQR 3]) and flat insoles (p <0.001; 2 [3]) significantly reduced pain during step-downs; foot orthoses reduced pain during walking (p =0.008; 1 [1.25]); and flat insoles reduced pain during stair ambulation (p =0.001; 1 [1.75]). No significant differences between foot orthoses and flat insoles were observed for pain severity, ease of performance or knee stability. Foot orthoses were less comfortable than flat insoles and shoes alone (p <0.05). Conclusions In people with patellofemoral osteoarthritis, immediate pain-relieving effects of prefabricated, contoured foot orthoses are equivalent to flat insoles. Further studies should investigate whether similar outcomes occur with longer-term wear or different orthosis designs.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.09.016
  • Morphometry of femoral rotation for total knee prosthesis according to
           gender in a Korean population using three-dimensional magnetic resonance
    • Authors: Kyoung-Tak Kang; Juhyun Son; Oh-Ryong Kwon; Changhyun Baek; Dong Beom Heo; Kyoung-Mi Park; Ho-Joong Kim; Yong-Gon Koh
      Abstract: Publication date: Available online 4 November 2016
      Source:The Knee
      Author(s): Kyoung-Tak Kang, Juhyun Son, Oh-Ryong Kwon, Changhyun Baek, Dong Beom Heo, Kyoung-Mi Park, Ho-Joong Kim, Yong-Gon Koh
      Background We aimed to evaluate differences in femoral arthometric data for 700 osteoarthritic knees (587 females and 113 males) with respect to gender in a Korean population. Methods We identified and measured the mediolateral (ML) and anteroposterior (AP) lengths, femoral aspect ratio (ML/AP), surgical epicondylar axis (SEA), and Whiteside's line (WL). In addition, the anterior, posterior, and distal bone resections of the implanted femurs were evaluated using SEA and WL as references using a three-dimensional analysis method. Results ML and AP lengths significantly differed according to gender. ML dimension and aspect ratio were greater in males than in females for a given AP dimension in the femur. No statistically significant differences in femoral rotation with SEA as a reference were observed between male and female knees; however, a significant difference was shown using WL as a reference and both affected the amount of bone resection irrespective of gender. Conclusion This study provides important guidelines for gender-specific femoral prosthesis design with different ML and AP aspect ratios and femoral rotation based on SEA and WL for Korean populations.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.07.002
  • The contribution of leg press and knee extension strength and power to
           physical function in people with knee osteoarthritis: A cross-sectional
    • Authors: Michael A Tevald; Amanda M Murray; Brittney Luc; Kafai Lai; David Sohn; Brian Pietrosimone
      Abstract: Publication date: Available online 4 November 2016
      Source:The Knee
      Author(s): Michael A Tevald, Amanda M Murray, Brittney Luc, Kafai Lai, David Sohn, Brian Pietrosimone
      The purposes of this study were to 1) determine the additional contributions of leg press and knee extensor power, over and above that of strength, to the performance of physical function tasks in people with knee osteoarthritis, and 2) compare the ability of bilateral leg press to unilateral knee extensor strength and power to predict functional task performance. Methods A cross-sectional, exploratory study of 40 individuals with tibiofemoral knee osteoarthritis resulting in moderate impairments in physical function was conducted. Physical function (Get-up and Go, timed stair climb and descent, and five time chair rise) and muscle performance (leg press and knee extension strength and power) were assessed. Results After controlling for covariates and strength, leg press, but not knee extensor, power explained additional variance in physical function (11% and 21%). Conversely, adding strength to regression models including covariates and power did not consistently improve the prediction of physical function. Additionally, leg press power consistently explained more variance in physical function (44 to 57%) than involved (24 to 34%) or uninvolved (28 to 48%) knee extension power. Conclusions Leg press power may be a more functionally relevant measure of muscle performance than knee extension strength in this population. Future studies should investigate the effectiveness of interventions specifically designed to improve leg press power in people with knee osteoarthritis.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.08.010
  • Why do patellofemoral arthroplasties fail today? A systematic review
    • Authors: J.P. van der List; H. Chawla; J.C. Villa; A.D. Pearle
      Abstract: Publication date: Available online 5 November 2016
      Source:The Knee
      Author(s): J.P. van der List, H. Chawla, J.C. Villa, A.D. Pearle
      Background Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies. Methods Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies. Results Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p =0.005). Conclusion This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2015.11.002
  • Location of the ankle center for total knee arthroplasty
    • Authors: Shigeki Asada; Shigeshi Mori; Shinji Inoue; Ichiroh Tsukamoto; Masao Akagi
      Abstract: Publication date: Available online 5 November 2016
      Source:The Knee
      Author(s): Shigeki Asada, Shigeshi Mori, Shinji Inoue, Ichiroh Tsukamoto, Masao Akagi
      Background The purpose of this study was to investigate the ankle center position as determined from the malleoli for total knee arthroplasty (TKA). Methods We retrospectively analyzed computed tomography data from 102 patients with osteoarthritic knees. The tibial anteroposterior (AP) axis and transmalleolar axis (TMA) were used as rotational reference axes of the knee and ankle joint, respectively. With these axes, we regarded the offset distance from the intermalleolar midpoint as the position of the ankle center and investigated any angular osteotomy errors on the proximal tibia when the ankle center was assumed to the intermalleolar midpoint. Results The mean offset distances relative to the tibial AP axis were 1.8±0.9mm medial and 4.2±1.2mm anterior, and the distances relative to the TMA were 3.0±0.9 and 3.6±1.1mm in the coronal and sagittal planes, respectively. Mean angular osteotomy errors were 0.3±0.2° in the coronal plane and 0.8±0.2° in the sagittal plane. Conclusions The ankle center was located around the intermalleolar midpoint. The position of the ankle center observed along the knee reference axis further approached the intermalleolar midpoint than when observed along the ankle reference axis in the coronal plane, but not in the sagittal plane. And the coronal angular osteotomy error was smaller than the sagittal error. Therefore, the intermalleolar midpoint in the coronal plane is a reliable landmark for the ankle center during TKA. However, surgeons should be cognizant of this sagittal angular error.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.09.019
  • Corrigendum to “An original arthroscopic fixation of adult's tibial
           eminence fractures using the Tightrope® device: A report of 8 cases and
           review of literature” [Knee 21 (2014) 833–839]
    • Authors: Bruno Faivre; Horea Benea; Shahnaz Klouche; Florent Lespagnol; Thomas Bauer; Philippe Hardy
      Abstract: Publication date: Available online 9 November 2016
      Source:The Knee
      Author(s): Bruno Faivre, Horea Benea, Shahnaz Klouche, Florent Lespagnol, Thomas Bauer, Philippe Hardy

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.10.016
  • The Genovese grading scale is not reliable for MR assessment of collagen
           meniscus implants
    • Authors: A. Hirschmann; F.F. Schiapparelli; L. Schenk; L. Keller; F. Amsler; M.T. Hirschmann
      Abstract: Publication date: Available online 9 November 2016
      Source:The Knee
      Author(s): A. Hirschmann, F.F. Schiapparelli, L. Schenk, L. Keller, F. Amsler, M.T. Hirschmann
      Background The purpose of the study was to evaluate the intra- and inter-observer reliabilities of the Genovese grading on MRI in patients after collagen meniscus substitution. Methods 84 MRI images of 74 consecutive patients who underwent partial meniscus substitution using collagen meniscus implant (CMI) were assessed. MRIs were evaluated using the Genovese grading system. Furthermore, meniscal extrusion was assessed. Two observers performed the grading twice, blinded to each other and to the previous results, with a six weeks interval. The inter- and intra-observer reliabilities were assessed using kappa and weighted kappa values. Results The criterion “morphology/size” showed a weighted kappa value inter-observer reliability of 0.069 (rater 1)/0.352 (rater 2) and intra-observer reliability of 0.170 (1st rating)/0.582 (2nd rating). The criterion “signal intensity” showed a weighted kappa value inter-observer reliability of 0.175/0.284 and intra-observer reliability of 0.294/0.458. The criterion “cartilage lesions” showed a kappa value inter-observer reliability of 0.091/0.525 and intra-observer reliability of 0.409/0.413. The criterion “bone marrow edema” showed a kappa value inter-observer reliability of 0.667/0.808 and intra-observer reliability of 0.702/0.715. The criterion “cartilage lesions” showed a kappa value inter-observer reliability of 0.091/0.525 and intra-observer reliability of 0.409/0.413. Regarding meniscal extrusion kappa values for the inter-observer reliability were 0.625/0.940 and 0.625/0.889 for intra-observer reliability. Conclusions Three of the four Genovese grading items showed only slight to moderate inter- and intra-observer reliabilities in evaluating CMI on MRI. Hence, such grading results need to be considered with all due care. Only the criteria “bone marrow edema” and “meniscal extrusion” showed a good agreement for both inter- and intra-observer reliabilities.

      PubDate: 2016-11-10T06:55:01Z
      DOI: 10.1016/j.knee.2016.10.011
  • Correlation between a 2D simple image analysis method and 3D bony motion
           during the pivot shift test
    • Authors: Fabio V. Arilla; Amir Ata Rahnemai-Azar; Carlos Yacuzzi; Daniel Guenther; Benjamin S. Engel; Freddie H. Fu; Volker Musahl; Richard E. Debski
      Abstract: Publication date: Available online 1 November 2016
      Source:The Knee
      Author(s): Fabio V. Arilla, Amir Ata Rahnemai-Azar, Carlos Yacuzzi, Daniel Guenther, Benjamin S. Engel, Freddie H. Fu, Volker Musahl, Richard E. Debski
      Background The pivot shift test is the most specific clinical test to detect anterior cruciate ligament injury. The purpose of this study was to determine the correlation between the 2D simple image analysis method and the 3D bony motion of the knee during the pivot shift test and assess the intra- and inter-examiner agreements. Methods Three orthopedic surgeons performed three trials of the standardized pivot shift test in seven knees. Two devices were used to measure motion of the lateral knee compartment simultaneously: 1) 2D simple image analysis method: translation was determined using a tablet computer with custom motion tracking software that quantified movement of three markers attached to skin over bony landmarks; 2) 3D bony motion: electromagnetic tracking system was used to measure movement of the same bony landmarks. Results The 2D simple image analysis method demonstrated a good correlation with the 3D bony motion (Pearson correlation: 0.75, 0.76 and 0.79). The 3D bony translation increased by 2.7 to 3.5 times for every unit increase measured by the 2D simple image analysis method. The mean intra-class correlation coefficients for the three examiners were 0.6 and 0.75, respectively for 3D bony motion and 2D image analyses, while the inter-examiner agreement was 0.65 and 0.73, respectively. Conclusions The 2D simple image analysis method results are related to 3D bony motion of the lateral knee compartment, even with skin artifact present. This technique is a non-invasive and repeatable tool to quantify the motion of the lateral knee compartment during the pivot shift test.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.003
  • Stemmed tibial revision component alignment: Does an anatomic conflict
    • Authors: Kevin M. Smith; Andrew Moorman; Sabir K. Ismaily; Stephen J. Incavo
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Kevin M. Smith, Andrew Moorman, Sabir K. Ismaily, Stephen J. Incavo
      Introduction Obtaining satisfactory coronal plane alignment is important for success in revision total knee arthroplasty (TKA). The study objective was to determine tibial coronal plane alignment after TKA when a tibial stem was used and assess if there was an anatomic conflict in tibial stemmed component alignment. Materials and methods A radiographic review of 88 revision TKA cases was performed. Full length leg radiographs were examined for varus/valgus alignment, defined as greater than or equal to three degrees from neutral 180 degrees, canal or non-canal filling tibial stems, and any native tibial bow. Results In tibias with a native valgus alignment of three or more degrees, a canal-filling stem allowed little flexibility to improve final positioning of the tibial stem and resulted in a valgus alignment of the tibial stem in 87.5% of cases, where a canal filling stem was utilized. A non-canal filling stem utilized in native valgus tibias allowed on average a two-degree improvement in tibial alignment and 64.7% of cases resulted in a neutral placement of the tibial stem. Conclusion Implanting the tibial component in a desired position is limited by type of stem and the native angulation of the tibia. When anatomic conflict exists between tibial mechanical axis and the intramedullary canal, canal filling stems may compromise coronal alignment.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.08.009
  • Impact of Charlson indices and comorbid conditions on complication risk in
           bilateral simultaneous total knee arthroplasty
    • Authors: S.K.S. Marya; Priyadarshi Amit; Chandeep Singh
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): S.K.S. Marya, Priyadarshi Amit, Chandeep Singh
      Background The purpose of this study was to evaluate the influence of Charlson indices and comorbid conditions on the risk of perioperative complications in bilateral simultaneous total knee arthroplasty (BSTKA). Methods In our retrospective analysis, 556 patients including 133 males and 423 females (mean age 65.8years), who had undergone bilateral simultaneous total knee arthroplasty between 2011 and 2014 were included. Risk factors (Charlson comorbidity index (CCI), age-adjusted Charlson comorbidity index (ACCI), and comorbid illnesses) and perioperative complications were noted, and subsequently, statistical tests were applied. Results There was significant association between Charlson indices and most of the complications (P <0.05) with high-risk ACCI groups (a score>5) bearing maximum odds for cumulative major complication (OR 4.165, P <0.001, 95% CI 1.874 to 9.256). In addition, hypertension, non-ischemic cardiac illness, and moderate to severe chronic kidney disease proved be to be determinants for major complications (P =0.031, P =0.041, and P =0.014, respectively). We also found significant associations between organ-specific illnesses and complications such as cardiac, pulmonary, neurological and renal complications (P <0.05). Conclusions Both CCI and ACCI are predictors of post-operative complications with ACCI being the better predictive determinant. Hence, these predictors should be used for risk stratification prior to patient selection for BSTKA. The influence of hypertension, non-ischemic cardiac illness and moderate to severe chronic kidney disease should also be considered during patient selection. Moreover, optimum organ function at the time of surgery should be a priority to avoid these complications.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.05.013
  • Forced knee extension test is a manual test that correlates with the
           unstable feelings of patients with ACL injury before and after
    • Authors: Shinichi Shirasawa; Hideyuki Koga; Masafumi Horie; Tomomasa Nakamura; Toshifumi Watanabe; Ichiro Sekiya; Takeshi Muneta
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Shinichi Shirasawa, Hideyuki Koga, Masafumi Horie, Tomomasa Nakamura, Toshifumi Watanabe, Ichiro Sekiya, Takeshi Muneta
      Background To investigate fear in patients with anterior cruciate ligament (ACL) injury before and after reconstruction, a forced knee extension (FKE) test was performed. The correlation of the test results was evaluated with the subjective function, sports performance and objective parameters. Methods The study included 102 patients with unilateral ACL reconstruction using a semitendinosus tendon with full clinical evaluation. This study was retrospective and determined the longitudinal results of the FKE test and investigated the effects on the subjective and objective outcomes at 2years. Results Preoperatively, 47% of patients showed positive FKE tests. The number of positive FKE tests was 31% at six months and 15% at 24months after ACL reconstruction. At two years, there were statistically significant differences between the FKE test positives and negatives regarding both subjective knee recovery (P =0.0095) and sports performance (P =0.0006). Conclusions A new manual test, called the forced knee extension test, for fear in patients with ACL injury before and after reconstruction was introduced. The apprehension remained positive in 15% of the patients two years after ACL reconstruction, which affected subjective recovery of knee function and sports performance.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.016
  • Clinical and arthrometric outcomes of an anatomic outside-in single-bundle
           anterior cruciate ligament reconstruction using a retrodrill
    • Authors: David Figueroa; Rafael Calvo; Francisco Figueroa; Daniel Paccot; Guillermo Izquierdo; Nelson Morales
      Abstract: Publication date: Available online 2 November 2016
      Source:The Knee
      Author(s): David Figueroa, Rafael Calvo, Francisco Figueroa, Daniel Paccot, Guillermo Izquierdo, Nelson Morales
      Background The main option to perform an anatomic anterior cruciate ligament (ACL) reconstruction is the anteromedial portal (AMP) technique. It has several reported complications (iatrogenic chondral injury, posterior-wall blowout, short sockets, increased risk of injury to common peroneal nerve). In an attempt to avoid these complications the outside-in (OI) technique was revived with the addition of a retrodrill. The aim of this study is to evaluate the clinical and arthrometric outcomes of a series of anatomical OI single bundle ACL reconstruction using a retrodrill. Methods Prospective case series. KT-1000 and Pivot Shift Test were done at 24 months follow-up. International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores preoperatively and at final follow-up. Complications were reported. Statistical analysis was done with t-test. Results 275 knees of 200 (73%) males and 75 (27%) females were enrolled in the study. Mean age 29.1 years (15–54). Mean follow-up 34.5 months (24–49). Mean preoperatively Lysholm Score 62 (25–95) versus 95 (76–100) at final follow-up (p<0.001) Mean preoperatively IKDC score 60 (26.4–90.8) versus 92 (59.8–100) at final follow-up (p<0.001) Mean Tegner activity Score pre injury 5 versus 5 at final follow-up. (p=0.59) Mean KT-1000 side-to-side difference 2mm (1–6). Pivot Shift test negative in 243 patients (90%); positive in 32 (10%) patients. 13 (5%) ACL re-ruptures. 2 (0.7%) infections. No other complications were reported. Conclusion OI single bundle anatomic ACL reconstruction using a retrodrill is a valid and safe option that avoids the complications reported with the AMP technique.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.07.007
  • Can an expansion device be used in anterior cruciate ligament
           reconstruction' An in vitro study of soft tissue graft tibial fixation
    • Authors: Oscar Martel; Gerardo L. Garcés; Alejandro Yánez; Alberto Cuadrado; Juan F. Cárdenes
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Oscar Martel, Gerardo L. Garcés, Alejandro Yánez, Alberto Cuadrado, Juan F. Cárdenes
      Background The purpose of this study was to compare the mechanical properties of an interference screw with an expansion device in anterior cruciate ligament (ACL) reconstruction. Methods A total of 52 porcine tibia and 20 polyurethane foam blocks (0.16g/cm3) were used. Forty pullout tests were carried out to combine the two types of bones – surrogate and porcine – with the two fixation systems: interference screw and expansion device (n=10 per group). Thirty-two cyclic tests (n=8 per group) were carried out with both fixation devices in porcine bone at two different force amplitudes (100N and 200N). Results Stiffness and load values (mean±SD) at six millimeters of displacement for the expansion device and the interference screw were 74±33N/mm, 318±135N, and 52±28N/mm, 205±70N, respectively, showing a difference in stiffness (P =0.016) and load at six millimeters of displacement (P =0.001). No correlation between insertion torque and the ultimate failure load was found for both fixation devices tested. In cyclic tests, significantly higher (P<0.001) numbers of cycles (mean±SD) were reached with the expansion device (81,014±30,291 at 100N; 13,462±11,351 at 200N) than with the interference screw (15,100±8623 at 100N; 343±113 at 200N) at six millimeters of displacement. Conclusion The use of an expansion device for ACL reconstructions seemed to be a promising alternative to an interference screw. Insertion torque alone was not a useful predictor of graft fixation strength in ACL reconstructions.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.009
  • Improved ACL reconstruction outcome using double-layer BPTB allograft
           compared to that using four-strand hamstring tendon allograft
    • Authors: Yingzhen Niu; Chao Niu; Xiaomeng Wang; Junhang Liu; Pengkai Cao; Fei Wang; Jinghui Niu
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Yingzhen Niu, Chao Niu, Xiaomeng Wang, Junhang Liu, Pengkai Cao, Fei Wang, Jinghui Niu
      Background This study compared the clinical outcomes of anterior cruciate ligament reconstruction using double-layer bone–patellar tendon–bone (DBPTB) allografts and four-strand hamstring (4SHS) grafts. Methods This prospective randomized controlled trial included 101 patients. Of these, 50 patients received DBPTB allografts, and 51 received 4SHS grafts. Evaluations included KT-1000 arthrometer measurements, Lachman tests, pivot-shift tests, the International Knee Documentation Committee (IKDC) classification and Lysholm scores at three year postoperative follow-up. Results Two DBPTB patients (four percent) and nine 4SHS patients (17.6%) had graft failures, which was significantly different (P =0.028). The DBPTB group had significantly better Lachman test, IKDC knee score and Lysholm score results than the 4SHS group (P <0.05). However, these differences were below the threshold for clinical significance. Conclusions DBPTB allografts had fewer graft failures at three years than 4SHS grafts for anterior cruciate ligament reconstruction; and there were statistically significant differences but not clinically significant differences between DBPTB and 4SHS grafts in terms of the KT1000 test, IKDC and Lysholm scores.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.015
  • Subjective evaluation before and after total knee arthroplasty using the
           2011 Knee Society Score
    • Authors: Yuichi Kuroda; Tomoyuki Matsumoto; Koji Takayama; Kazunari Ishida; Ryosuke Kuroda; Masahiro Kurosaka
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Yuichi Kuroda, Tomoyuki Matsumoto, Koji Takayama, Kazunari Ishida, Ryosuke Kuroda, Masahiro Kurosaka
      Background Patient satisfaction has been recognized as an important evaluation of total knee arthroplasty (TKA). Therefore, the 2011 Knee Society Knee Scoring System (2011 KSS) was developed in order to quantify patient satisfaction, expectations, and physical activities following TKA. However, very few reports have described subjective evaluation before TKA using the 2011 KSS, as the scoring system is still relatively new. Therefore, the degree of improvement and change over time after TKA has not been evaluated. Methods Forty-nine consecutive patients (79 knees) with a mean age of 74.8±7.3years were prospectively included in the study and evaluated preoperatively and one year postoperatively. The following questions were assessed using the 2011 KSS: (1) Do patient-derived clinical scores improve after TKA' (2) Do patient-derived clinical scores before TKA correlate with those after TKA' and (3) Are there correlations among each category of the 2011 KSS score' Results The majority of categories showed significant improvements after TKA. The preoperative functional activities score was positively correlated with the postoperative symptoms, functional activities, and objective score. Each category of the 2011 KSS score correlated with others postoperatively. Conclusions All patient-derived scores except for patient expectation significantly improved postoperatively. The more functionally active patients before receiving TKA acquired more successful objective and functional outcomes, and the postoperative knee condition was directly influenced by each subscale of the 2011 KSS.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.008
  • Validation of varus stress radiographs for anterior cruciate ligament and
           posterolateral corner knee injuries: A biomechanical study
    • Authors: Lucas S. McDonald; Robert A. Waltz; Joseph R. Carney; Christopher B. Dewing; Joseph R. Lynch; Dean B. Asher; Dustin J. Schuett; Lance E. LeClere
      Abstract: Publication date: Available online 30 October 2016
      Source:The Knee
      Author(s): Lucas S. McDonald, Robert A. Waltz, Joseph R. Carney, Christopher B. Dewing, Joseph R. Lynch, Dean B. Asher, Dustin J. Schuett, Lance E. LeClere
      Purpose The purpose of this study was to determine the effect of isolated anterior cruciate ligament (ACL) insufficiency on the radiographic varus stress test, and to provide reference data for the increase in lateral compartment opening under varus stress for a combined ACL and PLC injury. Methods Ten cadaveric lower extremities were fixed to a jig in 20° of knee flexion. Twelve Newton-meter (Nm) and clinician-applied varus loads were tested, first with intact knee ligaments, followed by sequential sectioning of the ACL, fibular collateral ligament (FCL), popliteus tendon and the popliteofibular ligament (PFL). Lateral compartment opening was measured after each sequential sectioning. Results Maximum increase in lateral compartment opening for an isolated ACL deficient knee was 1.06mm with mean increase of 0.52mm (p=0.021) for the clinician-applied load. Mean increase in lateral compartment opening in an ACL and FCL deficient knee compared to the intact knee was 1.48mm (p<0.005) and 1.99mm (p<0.005) for the 12-Nm and clinician-applied loads, respectively, increasing to 1.94mm (p<0.005) and 2.68mm (p<0.005) with sectioning of the ACL and all PLC structures. Conclusions Anterior cruciate ligament deficiency contributes to lateral compartment opening on varus stress radiographs though not sufficiently to confound previously established standards for lateral ligament knee injuries. We did not demonstrate the same magnitude of lateral compartment opening with sectioning of the PLC structures as previously reported, questioning the reproducibility of varus stress radiographic testing among institutions. Clinicians are cautioned against making surgical decisions based solely on current standards for radiographic stress examinations.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.07.001
  • Does the tibial remnant of the anterior cruciate ligament promote
    • Authors: Byung Ill Lee; Byoung Min Kim; Duk hwan Kho; Sai Won Kwon; Hyeung June Kim; Hyun Ryong Hwang
      Abstract: Publication date: Available online 30 October 2016
      Source:The Knee
      Author(s): Byung Ill Lee, Byoung Min Kim, Duk hwan Kho, Sai Won Kwon, Hyeung June Kim, Hyun Ryong Hwang
      Background The purpose of this study was to clarify the difference in ligamentization between the remnant-preserving (RP) and remnant-sacrificing (RS) techniques in anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI). Methods A retrospective comparative study was carried out on 98 patients undergoing ACL reconstruction using either an RP (n=56) or RS (n=42) technique. MRI was performed at one of four time points postoperatively, and the signal intensity of the ACL graft was analyzed using the signal to noise quotient (SNQ) ratio and inter-bundle high signal intensity, along with an analysis of the survival rate of remnant tissue. Results The mean SNQ ratio of grafted tendons in the RP group was significantly higher than that seen in the RS group in the proximal and middle regions two to four months after surgery (P<0.05) and was significantly lower than that seen in the RS group in all regions at 12 –18months (P<0.05). The inter-bundle high signal intensity was observed more frequently in the RP group (73.7%) at two to four months. Tibial remnants were observed on postoperative MRI regardless of when MRI was conducted. Conclusion The ACL graft of the RP group showed higher signal intensity in the early stage and lower signal intensity in the late stage compared to that of the RS group. The ligamentization of grafts in the RP group proceeded more quickly. Preserving the remnant in ACL reconstruction appears to have a positive effect on ligamentization.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.09.008
  • Total knee arthroplasty conversion after open-wedge high tibial osteotomy:
           A report of three cases
    • Authors: Hee-June Kim; Young-Gun Kim; Seung-Gi Min; Hee-Soo Kyung
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Hee-June Kim, Young-Gun Kim, Seung-Gi Min, Hee-Soo Kyung
      Background The changes in the anatomy that occur due to a high tibial osteotomy (HTO), including the ligament release, can affect the clinical results after a subsequent total knee arthroplasty (TKA). We present three cases in which patients underwent conversion to a TKA after an open-wedge HTO. Of particular interest is the medial instability that was noted during the TKA procedures. Methods Three patients underwent conversion to a TKA after an open-wedge HTO. Results One case was converted to a TKA using a conventional posterior-stabilized type implant, and the other case was converted to a TKA using varus–valgus constraint-type implants due to the medial instability. The final case was converted to TKA using a conventional posterior-stabilized type implant, but a revision TKA using constrained-type implant was performed due to neglected medial instability. Conclusion Conversion to a TKA after open-wedge HTO requires careful preparation and a constrained-type implant should be prepared to address the medial structure release. Furthermore, medial structures should be repaired during open-wedge HTO, in case the patient requires a future TKA conversion.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.010
  • Outcomes of surgical stabilization in patients with combined ACL
           deficiency and patellofemoral instability — A case series
    • Authors: Laurie A. Hiemstra; Sarah Kerslake; Mark Heard; Gregory Buchko; Mark Lafave
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Laurie A. Hiemstra, Sarah Kerslake, Mark Heard, Gregory Buchko, Mark Lafave
      Background The purpose of this study was to assess the disease-specific quality of life, and the objective clinical and functional outcomes of patients with symptomatic ACL deficiency and patellofemoral instability following surgical stabilization of both ligaments. Methods Between February 2010 and August 2013, 22 subjects underwent a combined ACL reconstruction and patellofemoral stabilization. The anterior cruciate ligament quality of life questionnaire (ACL-QOL) was completed pre-operatively and two-years post-operatively. Clinical and functional assessments were performed two-years post-operatively. A paired t-test assessed the difference between the pre- and post-operative ACL-QOL scores. Effect size was calculated manually using the Eta squared formula. A Pearson r correlation coefficient assessed for a relationship between the post-operative ACL-QOL scores and functional tests. Results Twenty patients completed the 24-month ACL-QOL, 17/20 completed clinical assessment, and 14/20 completed functional testing. The mean pre-operative ACL-QOL score was 21.20 (SD=7.25, range 5.8 to 31.7) and two-years post-operative it was 65.24 (SD=21.38, range 34.5 to 99.1). The paired t-test demonstrated a statistically significant improvement in ACL-QOL scores; t (19)=9.119, p<.001 (two-tailed). The Eta squared statistic (0.81) indicated a very large effect size. Statistically significant correlations (p<.05) were evident between post-operative ACL-QOL scores and all the operative limb single-leg hop tests. Conclusions Combined ACL reconstruction and patellofemoral stabilization surgery leads to good results. This patient cohort with chronic ACL–MPFL injuries demonstrated a statistically significant change in disease-specific quality of life following surgery. In addition, the patient-reported outcomes and objective functional testing results correlated. Level of evidence Case series — IV.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.08.006
  • Clinical results after treatment for bidirectional patellar subluxation:
           Minimum 2-years follow-up
    • Authors: Michael Saper; Candice Brady; Robert Zondervan; David Shneider
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Michael Saper, Candice Brady, Robert Zondervan, David Shneider
      Background We describe the preliminary clinical results of a patellar stabilization technique to treat bidirectional patellar subluxation (BPS). Methods Patients: six patients (one male, five females; mean age 30.2years) underwent this procedure with a minimum of 24months follow-up. Patients were assessed for clinical instability, patellar complications, and need for revision surgery. Patient functional outcomes were evaluated using the criteria of Crosby and Insall and the Kujala Anterior Knee Pain Scale at the time of final follow-up. Patient satisfaction was assessed using a subjective questionnaire. Operative technique: A semitendinosus tendon autograft is coursed through a transverse tunnel in the distal quadriceps tendon. The medial and lateral aspects of the graft are passed from the quadriceps tendon within subfascial tunnels to the MPFL attachment site and lateral epicondyle, respectively. The graft is fixed in 60° of knee flexion with suture anchors. Results Surgery for recurrent instability was performed in one case. There were no cases of infection, quadriceps tendon rupture, or patella fracture. At average follow-up of 29.2months (range, 24 to 38months), outcomes were good to excellent in 4/6 of cases. Kujala scores improved significantly from 33.3 (range, three to 58) preoperatively to 70.8 (range, 39 to 96) postoperatively (p <0.05). 5/6 patients reported being satisfied to completely satisfied with their result. Conclusion Patients undergoing bidirectional patellar stabilization with a single tendon graft showed improved postoperative functional scores. The technique is successful in reducing pain and restoring bidirectional patellar stability at 2-years follow-up. Level of Evidence: IV, retrospective case series.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2015.11.005
  • Patients with isolated lateral osteoarthritis: Unicompartmental or total
           knee arthroplasty'
    • Authors: J.P. van der List; H. Chawla; H.A. Zuiderbaan; A.D. Pearle
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): J.P. van der List, H. Chawla, H.A. Zuiderbaan, A.D. Pearle
      Background Lateral unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are both reliable treatment options for patients with isolated lateral osteoarthritis (OA). However, studies comparing both procedures are scarce. Aims of this study were to (I) compare short-term functional outcomes following lateral UKA and TKA and (II) assess the role of patient characteristics on outcomes as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Methods In this retrospective cohort study, 82 patients (48 undergoing lateral UKA and 34 undergoing TKA) were identified that presented with lateral OA and completed the WOMAC. Independent t-tests were used to compare outcomes following lateral UKA and TKA. Results Mean follow-up was 2.8 years (range: 2.0 – 5.0 years). Preoperatively, no differences between lateral UKA and TKA were seen (50.1±13.5 and 53.3±17.1, respectively, p =0.551). Postoperatively, lateral UKA patients reported better overall outcomes than TKA (90.5±11.7 vs. 81.8±17.9, p =0.017). Subgroup analysis showed better outcomes following lateral UKA than TKA in patients younger than 75 years (92.1±9.9 vs. 81.3±19.6, p =0.014) and in females (91.6±9.9 vs. 81.0±18.2, p =0.014). Conclusion These findings indicate that lateral UKA has superior short-term functional outcomes compared to TKA in patients with isolated lateral OA. Better outcomes were especially seen in younger patients and females. These findings may help orthopedic surgeons choose treatment for patients presenting with lateral OA and optimize treatment for individual patients.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.007
  • Coronal subluxation of the proximal tibia relative to the distal femur
           after opening wedge high tibial osteotomy
    • Authors: Yasushi Akamatsu; Satoshi Ohno; Hideo Kobayashi; Yoshihiro Kusayama; Ken Kumagai; Tomoyuki Saito
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Yasushi Akamatsu, Satoshi Ohno, Hideo Kobayashi, Yoshihiro Kusayama, Ken Kumagai, Tomoyuki Saito
      Background The coronal subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). Methods Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The subluxation-C and subluxation-L were converted to a percentage of the tibial plateau width. Results The mean subluxation-C of 6.5% before OWHTO significantly increased to a mean subluxation-C of 7.3% one year after OWHTO. The mean subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in subluxation-L correlated with the change in femorotibial angle and correction loss (r =0.634, P <0.001 and r =0.463, P <0.001, respectively). Conclusion The proximal tibia shifted medially relative to the distal femur after OWHTO. This medial shift correlated with the correction loss. The coronal subluxation might be one cause of correction loss.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.09.009
  • Different optimal alignment but equivalent functional outcomes in medial
           and lateral unicompartmental knee arthroplasty
    • Authors: Jelle P. van der List; Harshvardhan Chawla; Jordan C. Villa; Andrew D. Pearle
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Jelle P. van der List, Harshvardhan Chawla, Jordan C. Villa, Andrew D. Pearle
      Introduction Several differences in kinematics, functional outcomes and alignment exist between medial and lateral unicompartmental knee arthroplasty (UKA). Therefore, the purpose of this study was (1) to compare functional outcomes between both procedures with the hypothesis that both have equivalent outcomes and (2) to assess the role of preoperative and postoperative alignment on functional outcomes in both procedures. Methods Patients who underwent UKA were included when overall function — using Western Ontario and McMaster Universities Arthritis (WOMAC) score – and joint awareness – using Forgotten Joint Score (FJS) — were available preoperatively and at minimum two-year follow-up. A total of 143 medial UKA and 36 lateral UKA patients reported outcomes at mean 2.4-years follow-up (range 2.0 to 5.0year). Results Preoperatively and postoperatively, no differences were seen between medial and lateral UKA in overall function (89.8±11.7 vs. 90.2±12.4, respectively, p =0.855) and joint awareness (71.2±24.5 vs. 70.9±28.2, respectively, p =0.956). With neutral postoperative alignment (−1° to three degrees), less joint awareness was noted following medial UKA than lateral UKA (72.6±22.6 vs. 55.3±28.5, p=0.024). With undercorrection (three degrees to seven degrees), however, following lateral UKA less joint awareness (85.3±19.5 vs. 68.2±26.8, p=0.020) and better functional outcomes (96.0±5.4 vs. 88.5±11.6, p=0.001) were noted than medial UKA. Conclusion Equivalent functional outcomes were noted between medial and lateral UKA at short-term follow-up but different optimal alignment angles seem to exist for both procedures. Level of evidence Level III therapeutic study.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.08.008
  • A case study: Glycosaminoglycan profiles of autologous chondrocyte
           implantation (ACI) tissue improve as the tissue matures
    • Authors: Aarti Sharma; Dai Rees; Sally Roberts; Nicola J. Kuiper
      Abstract: Publication date: Available online 20 October 2016
      Source:The Knee
      Author(s): Aarti Sharma, Dai Rees, Sally Roberts, Nicola J. Kuiper
      Background Autologous chondrocyte implantation (ACI) has been used to treat cartilage defects in thousands of patients worldwide with good clinical effectiveness 10–20years after implantation. Information concerning the quality of the repair cartilage is still limited because biopsies are small and rare. Glycosaminoglycan structure influences physiological function and is likely to be important in the long term stability of the repair tissue. The aim of this study was to assess glycosaminoglycans in ACI tissue over a two year period. Methods Biopsies were taken from one patient (25years old) at 12months and 20months post-ACI-treatment and from three normal cadavers (21, 22 and 25years old). Fluorophore-assisted carbohydrate electrophoresis (FACE) was used to quantitatively assess the individual glycosaminoglycans. Results At 12months the ACI biopsy had 40% less hyaluronan than the age-matched cadaveric biopsies but by 20months the ACI biopsy had the same amount of hyaluronan as the controls. Both the 12 and 20month ACI biopsies had less chondroitin sulphate disaccharides and shorter chondroitin sulphate chains than the age-matched cadaveric biopsies. However, chondroitin sulphate chain length doubled as the ACI repair tissue matured at 12months (3913Da±464) and 20months (6923Da±711) and there was less keratan sulphate as compared to the controls. Conclusions Although the glycosaminoglycan composition of the repair tissue is not identical to mature articular cartilage its quality continues to improve with time.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.10.002
  • Snapping knee syndrome caused by semitendinosus and semimembranosus
           tendons. A case report
    • Authors: Nikolaus von Dercks; Jan Dirk Theopold; Bastian Marquass; Christoph Josten; Pierre Hepp
      Abstract: Publication date: Available online 26 October 2016
      Source:The Knee
      Author(s): Nikolaus von Dercks, Jan Dirk Theopold, Bastian Marquass, Christoph Josten, Pierre Hepp
      We report the case of a 24-year-old female triathlon athlete with a snapping syndrome of both the distal semimembranosus and the semitendinosus tendon which has not been described so far. The semitendinosus tendon was harvested whereupon snapping has diminished. Tenoscopy and digital palpation showed the semimembranosus tendon to cause the snapping, as well. A careful step-by-step release of the anterior insertion of the tendon was performed with the result of a snapping-free range of motion of the patient's knee.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.10.003
  • How accurately does high tibial osteotomy correct the mechanical axis of
           an arthritic varus knee' A systematic review
    • Authors: Maxim Van den Bempt; Wouter Van Genechten; Toon Claes; Steven Claes
      Abstract: Publication date: Available online 22 October 2016
      Source:The Knee
      Author(s): Maxim Van den Bempt, Wouter Van Genechten, Toon Claes, Steven Claes
      Background The aim of this study was to give an overview of the accuracy of coronal limb alignment correction after high tibial osteotomy (HTO) for the arthritic varus knee by performing a systematic review of the literature. Methods The databases PubMed, MEDLINE and Cochrane Library were screened for relevant articles. Only prospective clinical studies with the accuracy of alignment correction by performing HTO as primary or secondary objective were included. Results Fifteen studies were included in this systematic review and were subdivided in 23 cohorts. A total of 966 procedures were considered. Nine cohorts used computer navigation during HTO and the other 14 cohorts used a conventional method. In seven computer navigation cohorts, at least 75% of the study population fell into the accepted “range of accuracy” (AR) as proposed by the different studies, but only six out of 14 conventional cohorts reached this percentage. Four out of eight conventional cohorts that provided data on under- and overcorrection, had a tendency to undercorrection. Conclusions The accuracy of coronal alignment corrections using conventional HTO falls short. The number of procedures outside the proposed AR is surprising and exposes a critical concern for modern HTO. Computer navigation might improve the accuracy of correction, but its use is not widespread among orthopedic surgeons. Although HTO procedures have been shown to be successful in the treatment of unicompartmental knee arthritis when performed accurately, the results of this review stress the importance of ongoing efforts in order to improve correction accuracy in modern HTO.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.10.001
  • Patellar inversion: 180 degree rotation of the patella around its vertical
           axis within the intercondylar notch
    • Authors: Samarth Mittal; Arkesh M; Vivek Shankar; Swapnil Singh; Pankaj Sharma; Ravi Mittal
      Abstract: Publication date: Available online 28 October 2016
      Source:The Knee
      Author(s): Samarth Mittal, Arkesh M, Vivek Shankar, Swapnil Singh, Pankaj Sharma, Ravi Mittal
      Background Dislocation of the patella can occur around its vertical as well as horizontal axis. However, near 180 degree rotation of the patella around its vertical axis within the intercondylar notch without its complete dislocation has never been previously reported to the best of our knowledge. We report one such neglected case along with its management. Methods The patient underwent open reduction and de-rotation of patella with repair of the medial and lateral patellar retinacula. The orientation of the patellar tendon intra-operatively was used as a guide for the reduction manoeuvre required. Results The patient had a good functional result at more than one year of follow-up. Conclusions A skyline view of the knee in symptomatic patients with normal AP and lateral radiographs of the knee can be useful in diagnosing a rare intra-articular dislocation of the patella around its vertical axis. Neglected cases of such injuries can be easily treated with open reduction with the orientation of the patellar tendon guiding the manoeuvre to de-rotate the patella. Careful repair of lateral and medial retinacula in such cases is important in preventing future patellar instability.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.10.005
  • Candidate methylated genes in osteoarthritis explored by bioinformatics
    • Authors: Jie Liu; Yangquan Hao; Yugui Wang; Shouye Hu; Ke Xu; Chao Lu
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Jie Liu, Yangquan Hao, Yugui Wang, Shouye Hu, Ke Xu, Chao Lu
      Background This study aimed to explore potential novel genes correlated with osteoarthritis (OA). Methods The gene expression profile of GSE48422 was downloaded from the Gene Expression Omnibus (GEO) database. This dataset included five arthritic cartilage samples and five non-arthritic cartilage samples from five female OA patients. Differentially methylated genes (DMGs) between the two kinds of samples were identified, followed by their functional analysis and protein–protein interaction (PPI) analysis. Furthermore, the Comparative Toxicogenomics Database (CTD) was used to further identify OA-related genes among these DMGs. Results In total, 965 hypermethylated genes and 112 hypomethylated genes were identified in the arthritic cartilage samples. The hypermethylated genes (e.g., ADCY4 and ADCY6) were significantly related to the calcium signaling pathway and gonadotropin-releasing hormone signaling pathway, while the hypomethylated genes were implicated in the mammalian target of rapamycin signaling pathway. In the PPI network, several genes had a higher degree, such as ADCY4, ADCY6 and GPR17, and they interacted with each other. Additionally, 565 DMGs were predicted to be associated with OA, and five of them (e.g., COMP and EDIL3) were previously identified as OA markers. Conclusions The methylation of genes ADCY4, ADCY6 and GPR17, as well as the gonadotropin-releasing hormone signaling pathway, was newly found to be potentially associated with OA. They may be novel OA markers.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.09.020
  • A cost comparison of unicompartmental and total knee arthroplasty
    • Authors: Sheila Shankar; Matthew W. Tetreault; Briana J. Jegier; Gunnar B. Andersson; Craig J. Della Valle
      Abstract: Publication date: Available online 31 October 2016
      Source:The Knee
      Author(s): Sheila Shankar, Matthew W. Tetreault, Briana J. Jegier, Gunnar B. Andersson, Craig J. Della Valle
      Background Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) in appropriately selected patients. There is a paucity of data comparing hospital resource utilization and costs for UKA versus TKA. Methods We retrospectively reviewed 128 patients who underwent UKA or TKA for osteoarthritis by a single surgeon in the 2011 Fiscal Year. Sixty-four patients in each group were matched based on sex, age, race, body mass index, Charlson Comorbidity Index, and insurance type. Clinical data were obtained from medical records while costs were obtained from hospital billing. Bivariate analyses were used to compare outcomes. Results Both anesthesia and operative time (minutes) were significantly shorter for patients undergoing UKA (125.7 vs. 156.4; p <0.001, and 81.4 vs. 112.2; p <0.001). UKA patients required fewer transfusions (0% vs. 11.0%; p =0.007) and had a shorter hospital stay (2.2 vs. 3.8days; p <0.001). 96% of UKAs were discharged home compared with 75% of TKAs (p <0.001). Hospital direct costs were lower for UKA ($7893 vs. $11,156; p <0.001) as were total costs (hospital direct costs plus overhead; $11,397 vs. $16,243; p <0.001). Supply costs and implant costs were similarly lower for UKA ($701 vs. $781; p <0.001, and $3448 vs. $5006; p <0.001). Conclusion Our data suggest that UKA provides a cost-effective alternative to TKA in appropriately selected patients. As the number of patients with end-stage arthritis of the knee requiring surgical care continues to rise, the costs of caring for these patients must be considered. Level of Evidence Level III, case control study.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2015.11.012
  • An unambiguous technique for locating the adductor tubercle and using it
           to identify the joint line
    • Authors: Ing-Ho Chen; Wen-Tien Wu; Chen-Chie Wang; Kuan-Lin Liu; Kuang-Ting Yeh; Cheng-Huan Peng
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Ing-Ho Chen, Wen-Tien Wu, Chen-Chie Wang, Kuan-Lin Liu, Kuang-Ting Yeh, Cheng-Huan Peng
      Background If the adductor tubercle could be accurately located, it would be a useful landmark for identifying the joint line during knee arthroplasty. This study aimed to develop an intraoperative technique to improve its locating accuracy. Methods Evaluation of bone specimens and cadaveric knees revealed that the proximal slope of the adductor tubercle (PSAT) turns from the medial surface vertically into the superior surface of the medial condyle, which forms a distinctive edge. This provided an ideal landmark that could be unambiguously engaged using a tipped instrument. Using the PSAT as a reference point, we measured the distance to the joint line (the proximal–distal condylar length; PDCL) in eight pairs of cadaveric knees, and evaluated the inter-observer variability. Next, we measured 120 knees undergoing total knee arthroplasty to test this technique in a normal population. Finally, we divided each PDCL by the respective anterior–posterior condylar length (APCL) to create a ratio that could predict the PDCL regardless of knee size. Results The intra-class correlation coefficient (ICC) was 0.86 for the cadaveric measurements. The mean PDCL from the operated knees was 46mm (coefficient of variance (CV): eight percent). The mean PDCL/APCL ratio was 0.77 (CV: six percent). The high ICC and low CV indicated that using the PSAT was a reliable technique. Conclusion The PSAT is an ideal surgical landmark. The tipped instrument engagement technique with it may help to unambiguously locate the adductor tubercle in order to identify the joint line during knee arthroplasty.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.05.014
  • Effects of suture site or penetration depth on anchor location in
           all-inside meniscal repair
    • Authors: Ryohei Uchida; Tatsuo Mae; Kunihiko Hiramatsu; Ryo Iuchi; Kazutaka Kinugasa; Konsei Shino; Hideki Yoshikawa; Ken Nakata
      Abstract: Publication date: Available online 29 October 2016
      Source:The Knee
      Author(s): Ryohei Uchida, Tatsuo Mae, Kunihiko Hiramatsu, Ryo Iuchi, Kazutaka Kinugasa, Konsei Shino, Hideki Yoshikawa, Ken Nakata
      Background To evaluate the effects of suture site or penetration depth on anchor location in all-inside meniscal repair. Methods Eight fresh-frozen cadaveric knees were evaluated after meniscal repair using eight FasT-Fix360 (FF360) devices (Smith & Nephew Endoscopy, Andover, MA) (16 anchors) for each knee. The penetration depth was 14mm, the distance same from the periphery to insertion point, in four knees (Group A) and that in the remaining four knees (Group B) was 18mm. The anchor location in two groups was evaluated after attentive dissection. Results Of 32 anchors for the medial meniscus, 94% were on the capsule, including the superficial medial collateral ligament (sMCL) in both groups. For the lateral meniscus, 47% anchors in Group A and 44% anchors in Group B were on the capsule. Total three anchors were over the lateral collateral ligament (LCL), whereas 15 anchors were behind the popliteus tendon (POP). Although all three anchors settled in the subcutaneous fat were in Group B, no significant difference was observed in anchor location between two groups. Conclusions Secure fixation to thin membranous tissue can be achieved for the medial meniscal repair using FF360, while some were located in/on bunchy LCL or POP in lateral meniscal repair. Only anchors with additional four-millimeter penetration depth were in the subcutaneous fat, although there was no effect of the penetration depth to anchor location. Clinically, for lateral meniscal repair, penetrating toward POP/LCL should be avoided and four-millimeter deeper penetration depth might be a risk for the subcutaneous irritation.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.012
  • Arthroscopic anterior cruciate ligament repair for proximal anterior
           cruciate ligament tears in skeletally immature patients: Surgical
           technique and preliminary results
    • Authors: Marco Bigoni; Diego Gaddi; Massimo Gorla; Daniele Munegato; Marco Pungitore; Massimiliano Piatti; Marco Turati
      Abstract: Publication date: Available online 2 November 2016
      Source:The Knee
      Author(s): Marco Bigoni, Diego Gaddi, Massimo Gorla, Daniele Munegato, Marco Pungitore, Massimiliano Piatti, Marco Turati
      Background Anterior cruciate ligament (ACL) tears in children are increasingly common and present difficult treatment decisions due to the risk of growth disturbance. Although open primary ACL repair was abandoned in the historical literature, recent studies have suggested that there is a role for arthroscopic primary repair in patients with proximal tears. Methods This is a retrospective review of five consecutive patients aged 9.2years (range 8 to 10) who underwent suture anchor ACL reinsertion. Patients were included if they were Tanner stages 1–2 and proximal ACL tears with adequate tissue quality confirmed arthroscopically. The time frame was 81days. Arthroscopic ACL reinsertion was performed with bioabsorbable suture anchor. Clinical evaluation, KT-1000™, and MRI were re-evaluated. Clinical outcomes were measured using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score. Results At a mean follow-up of 43.4months (range 25 to 56), no re-injury and leg length discrepancies were observed. Four patients had negative Lachman tests. The remainder had a grade 1 Lachman test. The mean side-to-side difference was 3 (2–4mm). In MRI obtained at the last follow-up, no articular lesions or growth arrest were observed and the reinserted ACL was recognized in every exam. All patients returned to previous level of activity and presented normal and nearly normal IKDC score. The mean Lysholm score was 93.6. Conclusion Arthroscopic ACL repair can achieve good short-term results with joint stability and recovery of sport activity in skeletally immature patients, with proximal ACL avulsion tear.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.09.017
  • Rotating platform versus fixed bearing total knee arthroplasty at mid-term
    • Authors: J. Ryan Martin; Taylor R. Beahrs; Keith A. Fehring; Robert T. Trousdale
      Abstract: Publication date: Available online 2 November 2016
      Source:The Knee
      Author(s): J. Ryan Martin, Taylor R. Beahrs, Keith A. Fehring, Robert T. Trousdale
      Background Rotating platform posterior stabilized (RP) total knee arthroplasty (TKA) was initially developed in part to decrease polyethylene wear and to improve patellar tracking. There have been limited studies evaluating the longevity and causes of reoperation or revision for this implant. The following study compares mid-term survival rates and causes for reoperation between fixed bearing (FB) TKAs. Methods We identified 11,416 patients who underwent a primary posterior stabilized TKA between 2001 and 2013. This group was stratified to include patients with a RP (n=926) and FB (n=10,490) TKA design. Kaplan–Meier survival rates for each complication that led to reoperation were determined at five- and 10-years. Univariate hazard ratios were determined for the most common causes for reoperation and overall implant survival rates. A multivariate analysis was performed to account for the age, gender and preoperative diagnosis discrepancy between groups. Results The reoperation data demonstrated statistically increased all-cause reoperation rate (p=<0.001) and reoperation rate for stiffness in the RP group (p=0.001). After adjusting for demographic variables we noted no statistically significant differences in reoperation rate and reoperation for stiffness. Additionally, a statistically significant decrease was noted in all-cause revision (p=0.024) and revision for aseptic loosening or osteolysis in the RP group (p=0.029). Conclusion After adjusting for patient demographic differences, we noted a statistically significant decrease in the overall revision and revision for aseptic loosening or osteolysis rates in the RP group.

      PubDate: 2016-11-03T05:38:26Z
      DOI: 10.1016/j.knee.2016.06.004
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