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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  [3038 journals]
  • Maximum load to failure of high dose versus low dose gamma irradiation of
           anterior cruciate ligament allografts: A meta-analysis
    • Authors: Alex C. DiBartola; Joshua S. Everhart; Christopher C. Kaeding; Robert A. Magnussen; David C. Flanigan
      Pages: 755 - 762
      Abstract: Publication date: Available online 11 June 2016
      Source:The Knee
      Author(s): Alex C. DiBartola, Joshua S. Everhart, Christopher C. Kaeding, Robert A. Magnussen, David C. Flanigan
      Background The objective of this study was to systematically evaluate the existing literature to compare the biomechanical effects of low dose and high dose gamma irradiation on commonly used ACL allografts. Methods A systematic search was performed in PubMed, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Cochrane Reviews, SCOPUS, and SportDiscus. Nine studies were identified that met the following inclusion criteria: 1) controlled laboratory study, 2) investigation of standard allografts for anterior cruciate ligament reconstruction (ACLR), 3) gamma irradiation (dose reported) and a negative control group, and 4) mechanical loading (results reported). Results Nine studies met all inclusion and exclusion criteria. There was a dose-dependent relationship between radiation and decreased mechanical tendon integrity. Low dose radiation (<2.5Mrad [Mrad]) showed graft weakening with an average of 4.3% decrease in load to failure (standardized mean difference [SMD], 0.23; 95% CI 0.216, 0.68; p=0.31), whereas high-dose radiation showed a significantly larger (32.4% average) decrease in load to failure (SMD, 1.79; 95% CI 1.194, 2.38; p<0.001). Conclusions Gamma irradiation has a negative effect on tendon allograft strength that is dose-dependent, with particularly large effects noted at irradiation doses of ≥2.5Mrad.

      PubDate: 2016-06-15T07:30:43Z
      DOI: 10.1016/j.knee.2016.05.012
      Issue No: Vol. 23, No. 5 (2016)
  • Nanohydroxyapatite promotes the healing process in open-wedge high tibial
           osteotomy: A CT study
    • Authors: F. Conteduca; P. Di Sette; R. Iorio; L. Caperna; G. Argento; D. Mazza; A. Ferretti
      Pages: 763 - 769
      Abstract: Publication date: Available online 11 June 2016
      Source:The Knee
      Author(s): F. Conteduca, P. Di Sette, R. Iorio, L. Caperna, G. Argento, D. Mazza, A. Ferretti
      Background The aim of this prospective and randomized study was to evaluate the effectiveness of adding nanohydroxyapatite (NHA) to heterologous bone graft in open wedge high tibial osteotomy (OWHTO) by measuring the bone density of the tibial osteotomy gap. Methods Twenty-seven patients (26 knees) were operated by OWHTO and randomly divided into two groups: pure graft group, in which the osteotomy gap was filled with only heterologous bone graft; nanohydroxyapatite group, in which the osteotomy gap was filled with heterologous bone graft and NHA. All patients underwent computed tomography (CT) examination within one week after operation (Time 0), and after two months (Time 1) and 12months (Time 2). CT volume acquired Hounsfield Units (HU) were calculated and the mean value of bone density on three planes was measured. Results At Time 0, the mineral density of the nanohydroxyapatite group appeared significantly higher compared with the pure graft group, due to the presence of NHA. At Time 1, the mineral density of the nanohydroxyapatite group had decreased relative to Time 0, while in the pure graft group it remained unchanged. At Time 2, the mineral density in the nanohydroxyapatite group had further decreased, reaching values close to the mineral density of normal bone. In contrast, in the pure graft group the mineral density had increased, probably due to the lack of reabsorption of the graft and the development of sclerosis in the osteotomy borders. Conclusions The results of the present study show better osseointegration of the heterologous graft when nanohydroxyapatite is added.

      PubDate: 2016-06-15T07:30:43Z
      DOI: 10.1016/j.knee.2016.04.011
      Issue No: Vol. 23, No. 5 (2016)
  • Tibiofemoral joint subchondral surface conformity: Individual variability
           with race and sex-specific trends
    • Authors: Joshua S. Everhart; David C. Flanigan; Ajit M.W. Chaudhari; Robert A. Siston
      Pages: 770 - 776
      Abstract: Publication date: Available online 7 June 2016
      Source:The Knee
      Author(s): Joshua S. Everhart, David C. Flanigan, Ajit M.W. Chaudhari, Robert A. Siston
      Background Femoral and tibial subchondral surface morphology has been extensively studied to aid in anatomically correct total knee arthroplasty (TKA) implant design. Emphasis has been placed on shape variations in individual bones, and person-to-person variability in joint conformity has been overlooked. The purpose of this study is to 1) determine individual variability in key measures of tibiofemoral joint conformity, and 2) determine whether variability differs by sex or race. Methods Laser-scanner-generated surface models of tibiofemoral joints were obtained from 165 archival skeletons (at death: age 28.8±7.6years; 85 African-American, 80 Caucasian, 86 men, 79 women). Ratios and correlations were determined among related femoral and tibial subchondral surface areas (SA), alignment, curvatures, and linear dimensions between opposing surfaces with stratification by race and sex. Results Anterior–posterior length (R=0.80, p<0.001) and medial–lateral width (R=0.93, p<0.001) were the only linear measures that were highly correlated between the femur and tibia. Tibial and femoral surface areas were correlated among Caucasian men only (R=0.58, p<0.001; R<0.20), with a wide range of surface area ratios regardless of sex or race (SA ratio total sample: 2.32±0.39, range 1.36 to 3.62). Conclusions There is high individual variability in tibiofemoral joint conformity at the subchondral surface, and for some measures this variability is sex-or-race specific. Key measures of joint conformity including surface area, curvature, width, and depth covary weakly or not at all, and a wide range of TKA component sizes and shapes would be required to accurately replicate native joint conformity in most people.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.05.004
      Issue No: Vol. 23, No. 5 (2016)
  • The relationship between the midpoints connecting the tibial attachments
           of the anterior and posterior cruciate ligaments and the transepicondylar
           axis: In vivo three-dimensional measurement in the Chinese population
    • Authors: Guang Yang; Zhuo Wang; Xiaoyu Wen; Zhengang Jiang; Xin Qi; Chen Yang
      Pages: 777 - 784
      Abstract: Publication date: Available online 18 June 2016
      Source:The Knee
      Author(s): Guang Yang, Zhuo Wang, Xiaoyu Wen, Zhengang Jiang, Xin Qi, Chen Yang
      Background To determine the relationship between the midpoints connecting the tibial attachments of the anterior and posterior cruciate ligament (ACL and PCL, APCL line) and the transepicondylar axis (TEA) in normal healthy Chinese, as well as the comparison with other rotational lines. Methods Left knees of 17 male and 15 female healthy Chinese volunteers were scanned by magnetic resonance imaging (MRI) and computer tomography (CT) respectively. 3D contours of each knee, the tibial attachments of ACL, PCL, the medial and lateral collateral ligaments were reconstructed separately from CT and MRI data. Using an iterative closest point algorithm, we superimposed them individually. The APCL line, the tibial posterior condylar line (PC line), the medial third of the tibial tubercle (1/3 line), the Akagi's line, and the midsulcus of the tibial spine (Midsulcus line), the clinical and surgical TEA (CTEA and STEA) were determined. The paired intersection angles of them were measured. Results The mean angle CTEA with APCL line, Akagi's line, Midsulcus line, 1/3 line, and PC line, respectively, was 90.3°±2.9°, 95.0°±3.0°, 94.0°±3.9°, 102.4°±2.7°, and 87.1°±3.0°. The APCL–CTEA was significant different than other angles (p<0.001). The mean angle STEA to the above lines, respectively, was 94.8°±3.1°, 99.4°±3.1°, 98.5°±4.0°, 106.9°±2.9°, and 91.6°±3.2°. The PC line-STEA was significantly different than other angles (p<0.05). Conclusions APCL line was the closest perpendicular to the CTEA in normal Chinese subjects comparing with other rotational lines.

      PubDate: 2016-06-18T18:48:13Z
      DOI: 10.1016/j.knee.2016.05.003
      Issue No: Vol. 23, No. 5 (2016)
  • Asymmetric ground reaction forces and knee kinematics during squat after
           anterior cruciate ligament (ACL) reconstruction
    • Authors: Brooke A. Sanford; John L. Williams; Audrey Zucker-Levin; William M. Mihalko
      Pages: 820 - 825
      Abstract: Publication date: Available online 2 June 2016
      Source:The Knee
      Author(s): Brooke A. Sanford, John L. Williams, Audrey Zucker-Levin, William M. Mihalko
      Background This bilateral squat study tests whether people with anterior cruciate ligament (ACL) reconstruction have symmetric three-dimensional ground reaction forces (GRFs) and symmetric anterior–posterior (AP) translation rates of the femur with respect to the tibia when compared with healthy control subjects. We hypothesized that there would be no long-term asymmetry in knee kinematics and kinetics in ACL reconstructed subjects following surgery and rehabilitation. Methods Position and GRF data were collected on eight ACL reconstructed and eight control subjects during bilateral squat. The rate of relative AP translation was determined for each subject. Principal component models were developed for each of the three GRF waveforms. Principal component scores were used to assess symmetry within the ACL reconstructed group and within the control group. Results ACL reconstructed knees analyzed in early flexion during squat descent displayed a four-fold greater rate of change in anterior translation in the reconstructed knee relative to the contralateral side than did a similar comparison of normal knees. Differences were found between the ACL reconstructed subjects' injured and uninjured limbs for all GRFs. Conclusions Subjects following ACL reconstruction had asymmetric GRFs and relative rates of AP translation at an average of seven years after ACL reconstructive surgery when compared with control subjects. Clinical Relevance These alterations in loading may lead to altered load distributions across the knee joint and may put some subjects at risk for future complications such as osteoarthritis.

      PubDate: 2016-06-05T06:24:58Z
      DOI: 10.1016/j.knee.2015.11.001
      Issue No: Vol. 23, No. 5 (2016)
  • The effectiveness of an exercise programme on dynamic balance in patients
           with medial knee osteoarthritis: A pilot study
    • Authors: Lara Al-Khlaifat; Lee C. Herrington; Sarah F. Tyson; Alison Hammond; Richard K. Jones
      Pages: 849 - 856
      Abstract: Publication date: Available online 15 June 2016
      Source:The Knee
      Author(s): Lara Al-Khlaifat, Lee C. Herrington, Sarah F. Tyson, Alison Hammond, Richard K. Jones
      Background Dynamic balance and quiet standing balance are decreased in knee osteoarthritis (OA), with dynamic balance being more affected. This study aimed to investigate the effectiveness of a group exercise programme of lower extremity muscles integrated with education on dynamic balance using the Star Excursion Balance test (SEBT) in knee OA. Methods Experimental before-and-after pilot study design. Nineteen participants with knee OA attended the exercise sessions once a week for six weeks, in addition to home exercises. Before and after the exercise programme, dynamic balance was assessed using the SEBT in the anterior and medial directions in addition to hip and knee muscle strength, pain, and function. Results Fourteen participants completed the study. Dynamic balance on the affected side demonstrated significant improvements in the anterior and medial directions (p=0.02 and p=0.01, respectively). The contralateral side demonstrated significant improvements in dynamic balance in the anterior direction (p<0.001). However, balance in the medial direction did not change significantly (p=0.07). Hip and knee muscle strength, pain, and function significantly improved (p<0.05) after the exercise programme. Conclusions This is the first study to explore the effect of an exercise programme on dynamic balance using the SEBT in knee OA. The exercise programme was effective in improving dynamic balance which is required in different activities of daily living where the patients might experience the risk of falling. This might be attributed to the improvement in muscle strength and pain after the exercise programme.

      PubDate: 2016-06-18T18:48:13Z
      DOI: 10.1016/j.knee.2016.05.006
      Issue No: Vol. 23, No. 5 (2016)
  • Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by
           the 2010 ACR/EULAR criteria
    • Authors: Pierfranco Triolo; Roberto Rossi; Federica Rosso; Davide Blonna; Filippo Castoldi; Davide Edoardo Bonasia
      Pages: 862 - 866
      Abstract: Publication date: Available online 16 June 2016
      Source:The Knee
      Author(s): Pierfranco Triolo, Roberto Rossi, Federica Rosso, Davide Blonna, Filippo Castoldi, Davide Edoardo Bonasia
      Background The aims of this study were: (1) to evaluate the mid-term results and survivorship of arthroscopic synovectomy (AS) of the knee in rheumatoid arthritis (RA) defined with the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria; and (2) to identify prognostic factors. Methods Patients matching the 2010 ACR/EULAR criteria, with symptomatic knee synovitis for at least six months, treated with arthroscopic synovectomy of the knee at a minimum of three year followup were included. Pre-operative evaluation included Larsen, HAQ, DAS28, and Laurin scores. Post-operatively, Laurin, WOMAC, and patient satisfaction scores were evaluated. Different variables were investigated to find associations with the outcomes. Kaplan–Meier survival analysis was performed. Results Sixty-four patients met the inclusion criteria. Seven patients (9.6%) were lost to followup, leaving 57 patients (66 knees) for the present study. The average followup was 96.3months (SD 41). The pre-operative Laurin score was 3.91 points (SD 1.3) and significantly (P <0.001) improved after surgery (mean 8.2, SD 2). The post-operative average WOMAC score was 73.9 points (SD 45.9). Eighteen knees (27.3%) underwent revision procedures at an average of 48.6 months (SD 39.8). Joint degeneration (Larsen grade III) and range of movement (ROM) reduction (>10%) were identified as negative prognostic factors. Kaplan–Meier survivorship with total knee replacement as endpoint was: 78% at one year, 28% at four years, and six percent at 10 years. Conclusions Although AS of the knee has still a role as a salvage procedure in the treatment of RA synovitis with initial joint degeneration (less than Larsen grade III) and good ROM, high revision rates and limited survivorship are reported.

      PubDate: 2016-06-18T18:48:13Z
      DOI: 10.1016/j.knee.2016.05.010
      Issue No: Vol. 23, No. 5 (2016)
  • Psychiatric disorders increase complication rate after primary total knee
    • Authors: Mitchell R. Klement; Brian T. Nickel; Colin T. Penrose; Abiram Bala; Cynthia L. Green; Samuel S. Wellman; Michael P. Bolognesi; Thorsten M. Seyler
      Pages: 883 - 886
      Abstract: Publication date: Available online 7 June 2016
      Source:The Knee
      Author(s): Mitchell R. Klement, Brian T. Nickel, Colin T. Penrose, Abiram Bala, Cynthia L. Green, Samuel S. Wellman, Michael P. Bolognesi, Thorsten M. Seyler
      Background Psychiatric disease is difficult to screen preoperatively and the incidence of mental health disorders in patients undergoing total knee arthroplasty (TKA) may be underappreciated. The purpose of this study is to evaluate the perioperative complication profile in patients with psychiatric disorders. Methods A search of the entire Medicare database from 2005 to 2011 was performed to identify patients who underwent primary TKA with bipolar disorder (20,972), depression (187,448), and schizophrenia (7607). A cohort of 1,271,464 patients as controls with minimum 2.5-year follow-up. Medial and surgical complications at 30-days, 90-days, and overall were compared between the two cohorts. Results Patients with any psychiatric disease were more likely to be younger (age<65 OR 5.5, p<0.001), female (OR 2.61, p<0.001), and more medically complex (significant increase in 28/28 Elixhauser medical comorbidities, p<0.05). There was a significant increase (p<0.001) in 11/14 (78.5%) of recorded postoperative medical complication rates at 90-days. There was a statistically significant increase in periprosthetic infection (OR 2.17 p<0.001), periprosthetic fracture (OR 2.40, p<0.001), revision TKA (OR 2.06, p<0.001), and extensor mechanism rupture (OR 2.41, p<0.001) at 90day and overall time points. Conclusions Patients with psychiatric disorders who undergo elective primary TKA have significantly increased medical and surgical complication rates in the global period and short term follow-up. An ideal screening tool is yet to be determined and these patients need to be counseled appropriately regarding the increased complication rates before proceeding with TKA.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.05.007
      Issue No: Vol. 23, No. 5 (2016)
  • Intra-articular osteoid osteoma in the proximal tibia and its imaging
    • Authors: Matthias Krause; Ralf Oheim; Norbert M. Meenen; Karl-Heinz Frosch; Michael Amling
      Pages: 915 - 919
      Abstract: Publication date: Available online 7 June 2016
      Source:The Knee
      Author(s): Matthias Krause, Ralf Oheim, Norbert M. Meenen, Karl-Heinz Frosch, Michael Amling
      Due to mostly non-specific clinical symptoms and variable appearance on magnetic resonance imaging (MRI), the diagnosis of an intra-articular osteoid osteoma (iaOO) is often delayed. We report the case of a 26-year-old male with an atypical clinical manifestation of an iaOO in the proximal tibia and its MRI specific characteristics of tumor progression. The patient presented to our clinic after receiving multiple unsuccessful conservative and surgical interventions due to anterior knee pain, which persisted for 12months. Prior to the correct diagnosis of iaOO manifestation, the patient was subjected to multiple steroid infiltrations and two arthroscopies including partial meniscal resection. Due to increasing complaints, meniscal transplantation, bone decompression and/or ACL reconstruction were recommended. Subsequent computer tomography (CT) scanning and successful test medication with salicylates (ASS) confirmed iaOO presentation. Only after arthroscopic tumor resection was the patient symptom free at three months of follow-up. The present description of MRI specific characteristics of iaOO progression has the potential to accelerate correct tumor detection in the future.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.05.005
      Issue No: Vol. 23, No. 5 (2016)
  • Editorial
    • Authors: Oday Al-Dadah; Caroline Hing
      First page: 565
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Oday Al-Dadah, Caroline Hing

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.06.011
  • Correlation between histological outcome and surgical cartilage repair
           technique in the knee: A meta-analysis
    • Authors: Alex C. DiBartola; Joshua S. Everhart; Robert A. Magnussen; James L. Carey; Robert H. Brophy; Laura C. Schmitt; David C. Flanigan
      Pages: 344 - 349
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Alex C. DiBartola, Joshua S. Everhart, Robert A. Magnussen, James L. Carey, Robert H. Brophy, Laura C. Schmitt, David C. Flanigan
      Background Compare histological outcomes after microfracture (MF), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OATS). Methods Literature review using PubMed MEDLINE, SCOPUS, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Cochrane Collaboration Library. Inclusion criteria limited to English language studies International Cartilage Repair Society (ICRS) grading criteria for cartilage analysis after ACI (autologous chondrocyte implantation), MF (microfracture), or OATS (osteochondral autografting) repair techniques. Results Thirty-three studies investigating 1511 patients were identified. Thirty evaluated ACI or one of its subtypes, six evaluated MF, and seven evaluated OATS. There was no evidence of publication bias (Begg’s p=0.48). No statistically significant correlation was found between percent change in clinical outcome and percent biopsies showing ICRS Excellent scores (R2 =0.05, p=0.38). Percent change in clinical outcome and percent of biopsies showing only hyaline cartilage were significantly associated (R2 =0.24, p=0.024). Mean lesion size and histological outcome were not correlated based either on percent ICRS Excellent (R2 =0.03, p=0.50) or percent hyaline cartilage only (R2 =0.01, p=0.67). Most common lesion location and histological outcome were not correlated based either on percent ICRS Excellent (R2 =0.03, p=0.50) or percent hyaline cartilage only (R2 =0.01, p=0.67). Conclusions Microfracture has poorer histologic outcomes than other cartilage repair techniques. OATS repairs primarily are comprised of hyaline cartilage, followed closely by cell-based techniques, but no significant difference was found cartilage quality using ICRS grading criteria among OATS, ACI-C, MACI, and ACI-P. Level of evidence IV, meta-analysis

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.017
  • A cadaveric investigation into the demographic and bony alignment
           properties associated with osteoarthritis of the patellofemoral joint
    • Authors: Douglas S. Weinberg; Braden J. Tucker; Joseph P. Drain; David M. Wang; Allison Gilmore; Raymond W. Liu
      Pages: 350 - 356
      Abstract: Publication date: Available online 14 April 2016
      Source:The Knee
      Author(s): Douglas S. Weinberg, Braden J. Tucker, Joseph P. Drain, David M. Wang, Allison Gilmore, Raymond W. Liu
      Background Patellofemoral joint osteoarthritis is common, although circumstances dictating its evolution and pathogenesis remain unclear. Advances in surgical technique have improved the ability to modify long-bone alignment in the coronal, sagittal, and axial planes. However, to our knowledge, there is no significant long-term data available in regard to the relationship between anatomic alignment parameters most amenable to surgical modification and patellofemoral joint osteoarthritis. Methods Five-hundred and seventy-one cadaveric skeletons were obtained from the Hamann–Todd osteological collection. Mechanical lateral distal femoral angle, medial proximal tibial angle, tibial slope, femoral version, tibial torsion, the position of the tibial tubercle relative to the width of the tibial plateau, trochlear depth, and patellar size were measured using validated techniques. A previously published grading system for patellofemoral joint arthritis was used to quantify macroscopic signs of degenerative joint disease. Results Increasing age (standardized beta 0.532, p<0.001), female gender (standardized beta 0.201, p=0.002), and decreasing mechanical lateral distal femoral angle (standardized beta −0.128, p=0.025) were independent correlates of increased patellofemoral joint osteoarthritis. A relatively more laterally positioned tibial tubercle trended towards predicting patellofemoral joint osteoarthritis (standardized beta 0.080, p=0.089). Conclusions These findings confirm that patellofemoral joint osteoarthritis is strongly associated with increasing age and female gender. Valgus alignment of the distal femur, a relatively more lateral location of the tibial tubercle, and a shallower trochlear grove appear to have modest effects on the development of patellofemoral joint osteoarthritis.

      PubDate: 2016-06-05T06:24:58Z
      DOI: 10.1016/j.knee.2016.02.016
  • Association between ADAM12 polymorphism and knee osteoarthritis in Thai
    • Authors: Thitiya Poonpet; Rachaneekorn Tammachote; Nattapol Tammachote; Supakit Kanitnate; Sittisak Honsawek
      Pages: 357 - 361
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Thitiya Poonpet, Rachaneekorn Tammachote, Nattapol Tammachote, Supakit Kanitnate, Sittisak Honsawek
      Background Osteoarthritis (OA), a common degenerative joint disorder in the elderly, is characterized by the destruction of articular cartilage, bony outgrowths at joint margins, and synovitis. The objective of this study was to evaluate whether there is an association between the ADAM12 (rs3740199) polymorphism and susceptibility to knee OA in a Thai population. Methods Genomic deoxyribonucleic acid (DNA) was isolated from 200 Thai knee OA patients and 200 healthy controls. High resolution melting analysis was used to detect ADAM12 polymorphisms. The melt profile of all DNA samples was generated on the CFX96™ real-time polymerase chain reaction system and analyzed by Precision Melt Analysis™ software. The genotype distributions and allele frequencies of ADAM12 were compared between groups using the StatCalc program. Results The significant associations were shown from the C allele (OR=2.10, 95% CI=1.16–3.79, P =0.008) and the CC genotype (OR=4.28, 95% CI=1.21–15.72, P =0.01) in male knee OA patients. No significant association was observed in female patients. Conclusion The rs3740199 in ADAM12 was associated with knee OA susceptibility in Thai male patients, and individuals with the CC genotype carried the highest risk when compared with the GG and GC genotypes. Clinical relevance The rs3740199 polymorphism of the ADAM12 gene can potentially be used to determine genetically high-risk subgroup of knee osteoarthritis and to better understand the pathogenesis of knee osteoarthritis.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.007
  • A comparison of hamstring muscle activity during different screening tests
           for non-contact ACL injury
    • Authors: Rasmus S. Husted; Jesper Bencke; Lars L. Andersen; Grethe Myklebust; Thomas Kallemose; Hanne B. Lauridsen; Per Hölmich; Per Aagaard; Mette K. Zebis
      Pages: 362 - 366
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Rasmus S. Husted, Jesper Bencke, Lars L. Andersen, Grethe Myklebust, Thomas Kallemose, Hanne B. Lauridsen, Per Hölmich, Per Aagaard, Mette K. Zebis
      Background Reduced ability to activate the medial hamstring muscles during a sports-specific sidecutting movement has been found to be a potential risk factor for non-contact ACL injury. However, whether a reduced ability to activate the medial hamstring muscle is a general neuromuscular phenomenon and thereby observable independently of the type of clinical screening tests used is not known. This cross sectional study investigated the rank correlation of knee joint neuromuscular activity between three different ACL injury risk screening tests. Methods Sixty-two adolescent female elite football and handball players (16.7±1.3years) participated in the study. Using surface electromyography (EMG) assessment, the neuromuscular activity of medial hamstring muscle (semitendinosus, ST), lateral hamstring muscle (biceps femoris, BF) and quadriceps muscle (vastus lateralis, VL) were monitored during three standardized screening tests — i.e. one-legged horizontal hop (OLH), drop vertical jump (DJ) and sidecutting (SC). Neuromuscular pre-activity was measured in the time interval 10ms prior to initial contact on a force plate. Results For neuromuscular hamstring muscle pre-activity, correlation analysis (Spearman correlation coefficient) showed low-to-moderate correlations between SC and 1) DJ (rs =0.34–0.36, P<0.05) and 2) OLH (rs =0.40–0.41, P<0.05), respectively. Conclusions In conclusion, the present data suggest that hamstring pre-activity share some common variance during the examined tests. However, a lack of strong correlation suggests that we cannot generalize one risk factor during one test to another test. Clinical relevance The present data demonstrate that one-legged horizontal hop and drop vertical jump testing that are commonly used in the clinical setting does not resemble the specific neuromuscular activity patterns known to exist during sidecutting, a well known high risk movement for non-contact ACL injury.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.02.004
  • Biomechanical and neuromuscular adaptations during the landing phase of a
           stepping-down task in patients with early or established knee
    • Authors: Diana C. Sanchez-Ramirez; Bart Malfait; Isabel Baert; Marike van der Leeden; Jaap van Dieën; Willem F. Lems; Joost Dekker; Frank P. Luyten; Sabine Verschueren
      Pages: 367 - 375
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Diana C. Sanchez-Ramirez, Bart Malfait, Isabel Baert, Marike van der Leeden, Jaap van Dieën, Willem F. Lems, Joost Dekker, Frank P. Luyten, Sabine Verschueren
      Background To compare the knee joint kinematics, kinetics and EMG activity patterns during a stepping-down task in patients with knee osteoarthritis (OA) with control subjects. Methods 33 women with knee OA (early OA, n =14; established OA n =19) and 14 female control subjects performed a stepping-down task from a 20cm step. Knee joint kinematics, kinetics and EMG activity were recorded on the stepping-down leg during the loading phase. Results During the stepping-down task patients with established knee OA showed greater normalized medial hamstrings activity (p=0.034) and greater vastus lateralis-medial hamstrings co-contraction (p=0.012) than controls. Greater vastus medialis-medial hamstrings co-contraction was found in patients with established OA compared to control subjects (p=0.040) and to patients with early OA (p=0.023). Self-reported knee instability was reported in 7% and 32% of the patients with early and established OA, respectively. Conclusions The greater EMG co-activity found in established OA might suggest a less efficient use of knee muscles or an attempt to compensate for greater knee laxity usually present in patients with established OA. In the early stage of the disease, the biomechanical and neuromuscular control of stepping-down is not altered compared to healthy controls.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.02.002
  • Contribution of altered hip, knee and foot kinematics to dynamic postural
           impairments in females with patellofemoral pain during stair ascent
    • Authors: Danilo de Oliveira Silva; Fernando Henrique Magalhães; Marcella Ferraz Pazzinatto; Ronaldo Valdir Briani; Amanda Schenatto Ferreira; Fernando Amâncio Aragão; Fábio Mícolis de Azevedo
      Pages: 376 - 381
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Danilo de Oliveira Silva, Fernando Henrique Magalhães, Marcella Ferraz Pazzinatto, Ronaldo Valdir Briani, Amanda Schenatto Ferreira, Fernando Amâncio Aragão, Fábio Mícolis de Azevedo
      Background Altered hip, knee and foot kinematics have been systematically observed in individuals with patellofemoral pain (PFP). However, less attention has been given to the altered dynamic postural control associated with PFP. Additionally, the relative contribution of kinematic impairments to the postural behavior of subjects with PFP remains an open question that warrants investigation. The aims of this study were: i) to investigate possible differences in hip adduction, rearfoot eversion, knee flexion and displacement area of the center of pressure (COP) in individuals with PFP in comparison to controls during stair ascent; and (ii) to determine which kinematic parameter is the best predictor of the displacement area of the COP measured during the stance phase of the stair ascent. Methods Twenty-nine females with PFP and 25 asymptomatic pain-free females underwent three-dimensional kinematic and COP analyses during stair ascent. Between-group comparisons were made using independent t-tests. Regression models were performed to identify the capability of each kinematic factor in predicting the displacement area of the COP. Results Reduced knee flexion and displacement area of the COP as well as increased peak hip adduction and peak rearfoot eversion were observed in individuals with PFP as compared to controls. Peak hip adduction was the best predictor of the displacement area of the COP (r2 =23.4%). Conclusions The excessive hip adduction was the biggest predictor of the displacement area of the COP. Clinical relevance Based on our findings, proximally targeted interventions may be of major importance for the functional reestablishment of females with PFP.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.014
  • Core muscle recruitment pattern during voluntary heel raises is different
           between patients with patellofemoral pain and healthy individuals
    • Authors: Mana Biabanimoghadam; Alireza Motealleh; Sallie Melissa Cowan
      Pages: 382 - 386
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Mana Biabanimoghadam, Alireza Motealleh, Sallie Melissa Cowan
      Background Recent studies suggest that the inconsistent outcomes of patellofemoral pain (PFP) treatment may result from the unclear understanding of changes in the structures remote from the knee joint. Due to the crucial influence of core stability on the knee function, this study aimed to evaluate the recruitment pattern of core muscles in individuals with and without PFP. Methods Sixty women aged 18 to 40years, including 30 subjects diagnosed with PFP and 30 healthy controls rose on to their toes as quickly and strongly as possible in response to a sound alarm in standing position. Electromyographic onsets of the transversus abdominis (TrA)/internal oblique (IO), erector spinae (ES), and gluteus medius (GM) muscles were expressed relative to the electromyographic onset of the prime mover (i.e. soleus). Independent t-tests were performed to compare the onsets of each muscle between the groups. The nonparametric Friedman test and the post-hoc of Wilcoxon signed-rank test were used to describe the muscle activation pattern within the groups. Results The results revealed different recruitment patterns of the core muscles between the groups. In the healthy group the GM and TrA/IO contracted, almost simultaneously, in anticipation of the prime mover contraction (sol). However, in PFP subjects a significant delay in the contraction of TrA/IO changed the pattern of muscle activation. Conclusion The findings demonstrate that muscular stabilization of spine is altered in the presence of PFP and suggest that treatment techniques aimed at improving core stability could be appropriate in the management of PFP.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.008
  • Primary and coupled motions of the native knee in response to applied
           varus and valgus load
    • Authors: Brian P. Gladnick; James Boorman-Padgett; Kyle Stone; Robert N. Kent; Michael B. Cross; David J. Mayman; Andrew D. Pearle; Carl W. Imhauser
      Pages: 387 - 392
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Brian P. Gladnick, James Boorman-Padgett, Kyle Stone, Robert N. Kent, Michael B. Cross, David J. Mayman, Andrew D. Pearle, Carl W. Imhauser
      Background Knowledge of the complex kinematics of the native knee is a prerequisite for a successful reconstructive procedure. The aim of this study is to describe the primary and coupled motions of the native knee throughout the range of knee flexion, in response to applied varus and valgus loads. Methods Twenty fresh-frozen cadaver knees were affixed to a six degree of freedom robotic arm with a universal force-moment sensor, and loaded with a 4Nm moment in varus and valgus at 0, 15, 30, 45, and 90° of knee flexion. The resulting tibiofemoral angulation, displacement, and rotation were recorded. Results For each parameter investigated, the knee joint demonstrated more laxity at higher flexion angles. Varus angulation increased progressively from zero (2.0° varus) to 90 (5.2° varus) degrees of knee flexion (p<0.001). Valgus angulation also increased progressively, from zero (1.5° valgus) to 90 (3.9° valgus) degrees of knee flexion (p<0.001). At all flexion angles, the magnitude of tibiofemoral angle deviation was larger with varus than with valgus loading (p<0.05). Conclusions We conclude that the native knee exhibits small increases in coronal plane laxity as the flexion angle increases, and that the knee has generally more laxity under varus load than with valgus load throughout the Range of Motion (ROM). Larger differences in laxity of more than 2 to 3°, or peak laxity specifically during the range of mid-flexion, were not found in our cadaver model and are not likely to represent normal coronal plane kinematics. Level of Evidence Level V, biomechanical cadaveric study.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.006
  • The effects of knee direction, physical activity and age on knee joint
           position sense
    • Authors: Nicola Relph; Lee Herrington
      Pages: 393 - 398
      Abstract: Publication date: Available online 21 March 2016
      Source:The Knee
      Author(s): Nicola Relph, Lee Herrington
      Background Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18–82years to evaluate the effects of age, physical activity and knee direction. Methods A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results. Results Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15–29, 30–44, 45–59, 60–74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension. Conclusions The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability.

      PubDate: 2016-03-22T14:52:58Z
      DOI: 10.1016/j.knee.2016.02.018
  • Does a new implant design with more physiological kinematics provide
           better results after knee arthroplasty?
    • Authors: Pablo Sanz-Ruiz; Esther Carbo-Laso; Berta Alonso-Polo; Jose Antonio Matas-Diez; Javier Vaquero-Martín
      Pages: 399 - 405
      Abstract: Publication date: Available online 15 March 2016
      Source:The Knee
      Author(s): Pablo Sanz-Ruiz, Esther Carbo-Laso, Berta Alonso-Polo, Jose Antonio Matas-Diez, Javier Vaquero-Martín
      Background Improved knee kinematics is one of the major goals to obtain better satisfaction after total knee arthroplasty. This study examined whether a guided motion knee design improves functional outcome and satisfaction as compared to a conventional design. Methods In a retrospective manner, from January 2005 to December 2008, patients with two different kinematic TKA designs were enrolled. The 150 patients were divided into two groups: guided motion group (77) with kinematic design (Journey) and control group (73) with no kinematic design (LCS). All the patients had the same surgical technique and postoperative protocols. The functional and radiographic results were interpreted with the Hospital for Special Surgery (HSS) knee score and WOMAC score. Results After a mean follow-up of 84.2months, the guided motion group had higher mean postoperative range of motion (p=0.022), functional status in the WOMAC function subscale (p=0.002), but had higher residual pain in the WOMAC pain subscale (p=0.018 and p=0.013) and higher iliotibial band syndrome incidence (6.6% vs 0%; p=0.02). There were no significant differences in HSS score between the two groups. No differences were seen between groups in patient satisfaction in the WOMAC total score (p=0.46) and survival rate. Conclusion The guided motion design can improve functional status according to WOMAC but not to HSS knee scores. Poorer pain scores and no higher patient satisfaction were observed with this kinematic design.

      PubDate: 2016-03-17T13:56:14Z
      DOI: 10.1016/j.knee.2016.02.017
  • What are the bias, imprecision, and limits of agreement for finding the
           flexion–extension plane of the knee with five tibial reference
    • Authors: Abheetinder S. Brar; Stephen M. Howell; Maury L. Hull
      Pages: 406 - 411
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Abheetinder S. Brar, Stephen M. Howell, Maury L. Hull
      Background Internal–external (I–E) malrotation of the tibial component is associated with poor function after total knee arthroplasty (TKA). Kinematically aligned (KA) TKA uses a functionally defined flexion–extension (F–E) tibial reference line, which is parallel to the F–E plane of the extended knee, to set I–E rotation of the tibial component. Methods Sixty-two, three-dimensional bone models of normal knees were analyzed. We computed the bias (mean), imprecision (±standard deviation), and limits of agreement (mean±2 standard deviations) of the angle between five anatomically defined tibial reference lines used in mechanically aligned (MA) TKA and the F–E tibial reference line (+external). Results The following are the bias, imprecision, and limits of agreement of the angle between the F–E tibial reference line and 1) the tibial reference lines connecting the medial border (−2°±6°, −14° to 10°), medial 1/3 (6°±6°, −6° to 18°), and the most anterior point of the tibial tubercle (9°±4°, −1° to 17°) with the center of the posterior cruciate ligament, and 2) the tibial reference lines perpendicular to the posterior condylar axis of the tibia (−3°±4°, −11° to 5°), and a line connecting the centers of the tibial condyles (1°±4°, −7° to 9°). Clinical relevance Based on these in vitro findings, it might be prudent to reconsider setting the I–E rotation of the tibial component to tibial reference lines that have bias, imprecision, and limits of agreement that fall outside the −7° to 10° range associated with high function after KA TKA.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.005
  • Transportal femoral drilling creates more horizontal ACL graft orientation
           compared to transtibial drilling: A 3D CT imaging study
    • Authors: S. Clockaerts; A. Van Haver; J. Verhaegen; K. Vuylsteke; T. Leenders; K.C. Lagae; P. Verdonk
      Pages: 412 - 419
      Abstract: Publication date: Available online 21 March 2016
      Source:The Knee
      Author(s): S. Clockaerts, A. Van Haver, J. Verhaegen, K. Vuylsteke, T. Leenders, K.C. Lagae, P. Verdonk
      Background The principle of anatomic anterior cruciate ligament (ACL) reconstruction is to create a femoral and tibial tunnel that resembles the insertion of the native ACL. Anatomic reconstruction leads to a more horizontal graft orientation that provides more rotational stability. The aim of this study is to investigate the best method to achieve anatomical reconstruction of femoral insertion of the ACL and thus, a more horizontal orientation of the ACL. We compared tunnel position and orientation between transportal femoral drilling technique and transtibial technique. Methods Thirty-two patients were included. Post-operative CT scans were obtained and femur, tibia and ACL tunnels were reconstructed. The position and orientation of tibial and femoral tunnels were quantified using the quadrant method, and femoral tunnel length, ellipticity and posterior wall breakage were assessed. We also investigated clinical outcome. Results Analyses show that transportal drilled femoral tunnels were situated significantly lower than transtibial drilled tunnels (p<0.0001), resulting in a significantly more horizontal oriented ACL in the transportal group in coronal (p<0.0001) and sagittal plane (p=0.01). No differences were observed in depth of femoral tunnel position (p=0.44). Femoral tunnel length was shorter in the transportal group (p=0.01) with a more ellipsoidal femoral aperture (p=0.01). There were no differences between both groups in tibial position. There were no differences in clinical outcome measure between the transportal and transtibial groups. Conclusion This study indicates that transportal drilling of the femoral tunnel leads to a more horizontal graft orientation of the ACL, without differences in clinical outcome.

      PubDate: 2016-03-22T14:52:58Z
      DOI: 10.1016/j.knee.2016.02.014
  • A new method for the evaluation of the end-to-end distance of the knee
           ligaments and popliteal complex during passive knee flexion
    • Authors: G. Rochcongar; H. Pillet; E. Bergamini; S. Moreau; P. Thoreux; W. Skalli; P. Rouch
      Pages: 420 - 425
      Abstract: Publication date: Available online 10 March 2016
      Source:The Knee
      Author(s): G. Rochcongar, H. Pillet, E. Bergamini, S. Moreau, P. Thoreux, W. Skalli, P. Rouch
      Background Accurate knowledge about the length variation of the knee ligaments (ACL, PCL, MCL and LCL) and the popliteal complex during knee flexion/extension is essential for modelling and clinical applications. The aim of the present study is to provide this information by using an original technique able to faithfully reproduce the continuous passive knee flexion–extension kinematics and to reliably identify each ligament/tendon attachment site. Methods Twelve lower limbs (femur, tibia, fibula, patella) were tested and set in motion (0–120°) using an ad hoc rig. Tibio-femoral kinematics was obtained using an optoelectronic system. A 3D digital model of each bone was obtained using low-dosage stereoradiography. Knee specimens were dissected and the insertion of each ligament and popliteal complex were marked with radio opaque paint. ACL, PCL and MCL were separated into two bundles. Bone epiphyses were CT-scanned to obtain a digital model of each ligament insertion. Bones and attachment site models were registered and the end-to-end distance variation of each ligament/tendon was computed over knee flexion. Results A tibial internal rotation of 18°±4° with respect to the femur was observed. The different bundles of the ACL, MCL and LCL shortened, whereas all bundles of the PCL lengthened. The popliteal complex was found to shorten until 30° of knee flexion and then to lengthen. Conclusion The end-to-end distance variation of the knee ligaments and popliteal complex can be estimated during knee flexion using a robust and reliable method based on marking the ligaments/tendon insertions with radiopaque paint. Level of evidence Level IV

      PubDate: 2016-03-13T13:51:22Z
      DOI: 10.1016/j.knee.2016.02.003
  • Autologous chondrocyte implantation (ACI) for cartilage defects of the
           knee: A guideline by the working group “Clinical Tissue Regeneration”
           of the German Society of Orthopaedics and Trauma (DGOU)
    • Authors: P. Niemeyer; D. Albrecht; S. Andereya; P. Angele; A. Ateschrang; M. Aurich; M. Baumann; U. Bosch; C. Erggelet; S. Fickert; H. Gebhard; K. Gelse; D. Günther; A. Hoburg; P. Kasten; T. Kolombe; H. Madry; S. Marlovits; N.M. Meenen; P.E. Müller; U. Nöth; J.P. Petersen; M. Pietschmann; W. Richter; B. Rolauffs; K. Rhunau; B. Schewe; A. Steinert; M.R. Steinwachs; G.H. Welsch; W. Zinser; J. Fritz
      Pages: 426 - 435
      Abstract: Publication date: Available online 3 March 2016
      Source:The Knee
      Author(s): P. Niemeyer, D. Albrecht, S. Andereya, P. Angele, A. Ateschrang, M. Aurich, M. Baumann, U. Bosch, C. Erggelet, S. Fickert, H. Gebhard, K. Gelse, D. Günther, A. Hoburg, P. Kasten, T. Kolombe, H. Madry, S. Marlovits, N.M. Meenen, P.E. Müller, U. Nöth, J.P. Petersen, M. Pietschmann, W. Richter, B. Rolauffs, K. Rhunau, B. Schewe, A. Steinert, M.R. Steinwachs, G.H. Welsch, W. Zinser, J. Fritz
      Background Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. Methods The present review of the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning therapeutic consequences of primary cartilage lesions and the suitable indication for ACI. Results Based on best available scientific evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than three to four square centimetres; in the case of young and active sports patients at 2.5cm2, while advanced degenerative joint disease needs to be considered as the most important contraindication. Conclusion The present review gives a concise overview on important scientific background and the results of clinical studies and discusses the advantages and disadvantages of ACI. Level of Evidence Non-systematic Review

      PubDate: 2016-03-04T15:05:24Z
      DOI: 10.1016/j.knee.2016.02.001
  • Large osteochondral lesions of the femoral condyles: Treatment with fresh
           frozen and irradiated allograft using the Mega OATS technique
    • Authors: Erik Hohmann; Kevin Tetsworth
      Pages: 436 - 441
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Erik Hohmann, Kevin Tetsworth
      Background The purpose of this study was to review the clinical results of irradiated fresh frozen osteochondral allografts for large osteochondral defects of the knee using the Mega-OATS technique. Methods Nine patients with a mean age of 32.1±6.6 (18 to 44) underwent Mega-OATS transplantation with irradiated (2.5Mrad), fresh frozen distal femur allograft. Three patients also underwent ACL-reconstruction; one patient a high tibial osteotomy. The underlying indication was osteochondrosis dissecans in four and trauma in five patients. The defect size was 25×25mm in three patients and 30×30 in six patients and the depth ranged from eight to 14mm. All OCD lesions were located on the medial femoral condyle; two of the traumatic lesions were located on the lateral femoral condyle. Clinical outcome was assessed using the Lysholm and IKDC scores. Radiographic incorporation was evaluated using serial radiographs and MR imaging at one year post surgery. All patients were reviewed at three, six, 12, and 24months following surgery. Results The Lysholm (IKDC) score improved significantly (p =0.02 resp. p =0.007) within and between patients during the follow-up period from 40.9 (37) to 90.9 (87.1) at 2years. Radiographic union was observed in all patients at three months; on MR imaging at one year osseous integration was observed in eight patients. Graft subsidence with loss of the overlying cartilage was observed in one and subchondral cystic changes at the implantation side were seen in another patient. Conclusion The results of this case series suggest that irradiated osteochondral allograft provides significant medium-term clinical improvement in patients treated for large osteochondral lesions of the femoral condyles. Level of evidence IV, case series

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.020
  • Can chondral healing be improved following microfracture' The effect
           of adipocyte tissue derived stem cell therapy
    • Authors: Hasan H. Ceylan; Kerem Bilsel; Nur Buyukpinarbasili; Hamid Ceylan; Mehmet Erdil; Ibrahim Tuncay; Cengiz Sen
      Pages: 442 - 449
      Abstract: Publication date: Available online 6 April 2016
      Source:The Knee
      Author(s): Hasan H. Ceylan, Kerem Bilsel, Nur Buyukpinarbasili, Hamid Ceylan, Mehmet Erdil, Ibrahim Tuncay, Cengiz Sen
      Background We aimed to investigate the effect of adipose tissue-derived mesenchymal stem cells (ADSCs) on chondral healing using the microfracture (MF) technique. Methods Thirty male rabbits were randomly divided into three groups. Standard cylindrical osteochondral defects (OCDs) were created in the weight-bearing areas of the medial condyles of all the right knees; the defects were four millimeters in diameter and two millimeters in depth. The control group (group A) was restricted to spontaneous healing. For group B, we performed MF with a 1.5-mm drill. For group C, we applied MF using the same method and then applied 3×106 ADSCs to the defect area. At eight weeks post-operation, the subjects were sacrificed, and the distal femoral joint surfaces were evaluated histopathologically for chondral healing. The samples were scored according to the International Cartilage Repair Society (ICRS) scale. Results The results for group C were significantly better than those for group A in terms of the surface properties (p=0.003). The matrix evaluation was better for group A than for group C (p=0.01). The cell distribution, cell viability and subchondral bone parameters were similar between the groups (p=0.198, p=0.387 and p=0.699). The cartilage mineralization parameter was better for group C than for group A (p=0.001). The signs of healing were better for group C than for group B, but the differences were not significant (p=0.185). Conclusions Improvements with additional ADSC treatments were not statistically significant in cases in which ADSC treatment was compared with isolated MF treatment. Clinical Relevance Additional ADSCs treatment may have positive effect on chondral healing but it doesn’t seem significant.

      PubDate: 2016-04-08T03:47:40Z
      DOI: 10.1016/j.knee.2015.11.008
  • Dynamic tracking influenced by anatomy in patellar instability
    • Authors: John J. Elias; Neil T. Soehnlen; Loredana M. Guseila; Andrew J. Cosgarea
      Pages: 450 - 455
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): John J. Elias, Neil T. Soehnlen, Loredana M. Guseila, Andrew J. Cosgarea
      Background The current study was performed to correlate anatomical parameters related to trochlear dysplasia, tibial tuberosity position, and patella alta with in vivo patellar tracking for subjects with recurrent patellar instability. Methods Eight subjects with recurrent patellar instability that failed conservative treatment were evaluated using computational reconstruction of in vivo knee motion. Computational models were created from dynamic CT scans of the knee during extension against gravity. Shape matching techniques were utilized to position a single model of each bone (femur, patella and tibia) to represent multiple positions of knee extension. Patellar tracking was characterized by the bisect offset index (lateral shift) and lateral tilt. Anatomical parameters were characterized by the inclination of the lateral ridge of the trochlear groove, the lateral distance from the tibial tuberosity to the posterior cruciate ligament attachment (lateral TT–PCL distance), and the Caton–Deschamps index. Stepwise multivariable linear regression analysis was used to relate patellar tracking to the anatomical parameters at low (<20°) and high flexion angles. Results At low flexion angles, both lateral trochlear inclination and lateral TT–PCL distance were significantly correlated with bisect offset index (p=0.02). Only lateral trochlear inclination was significantly correlated with lateral tilt (p<0.001). At high flexion angles, bisect offset index and lateral tilt were correlated with only lateral TT–PCL distance (p≤0.02). Conclusion Parameters related to trochlear dysplasia and tibial tuberosity position were both related to patellar tracking, but the relationship changed with the flexion angle. Clinical relevance The anatomical parameters related to patellar tracking can be used to evaluate the risk of continued instability and guide surgical treatment.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.021
  • Femoral insertion site in medial patellofemoral ligament reconstruction
    • Authors: Samuel C. Blatter; Philipp Fürnstahl; Anna Hirschmann; Matthias Graf; Sandro F. Fucentese
      Pages: 456 - 459
      Abstract: Publication date: Available online 17 March 2016
      Source:The Knee
      Author(s): Samuel C. Blatter, Philipp Fürnstahl, Anna Hirschmann, Matthias Graf, Sandro F. Fucentese
      Background The optimal femoral insertion point in MPFL (medial patellofemoral ligament)-reconstruction still remains ambiguous. Three-dimensional knee simulations based on computerized tomography (CT) images acquired under physiological loading conditions give further insights to predict the optimal femoral insertion site of the MPFL. The hypothesis of the present study is that the optimal insertion point is not as reliable as thought and is dependent on subject-specific anatomical factors. Methods High-resolution 3D images of the knee were acquired in ten weight-bearing knees of healthy subjects in five flexion angles (0 to 120°). The distance between different femoral insertion points and two defined patellar points was computed in each position to quantify length of respective bundles and isometry of the femoral insertion site. Results The median length of both bundles was maximal in full extension (proximal bundle: 62.2mm and distal bundle: 59.9mm). The shortest ligament length was obtained in the flexion position 90° for bundle I (57.3mm) and 30° for bundle II (85.3mm). The calculated most isometric femoral attachment point showed a non-uniform distribution pattern related to anatomic landmarks. The radiographic landmark showed the worst isometric score value compared to virtually defined spots by surgeons and the computed most isometric point. Conclusions This study provides results on the MPFL path length under physiological loading conditions using high-resolution bone geometry. The most important finding of this study was that the computed, best isometric femoral insertion point showed a variable anatomical distribution. This suggests that the optimal position for femoral MPFL-graft fixation is patient specific.

      PubDate: 2016-03-22T14:52:58Z
      DOI: 10.1016/j.knee.2015.11.021
  • Accuracy of MRI evaluation of meniscus tears in the setting of ACL
    • Authors: Faustine L. Dufka; Drew A. Lansdown; Alan L. Zhang; Christina R. Allen; C. Benjamin Ma; Brian T. Feeley
      Pages: 460 - 464
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Faustine L. Dufka, Drew A. Lansdown, Alan L. Zhang, Christina R. Allen, C. Benjamin Ma, Brian T. Feeley
      Background Our purpose was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for the pre-operative detection of meniscus tears requiring operative intervention, and identify factors that determined accuracy of diagnosing meniscus tears, in the setting of anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent primary ACL reconstruction were retrospectively reviewed. A meniscus tear was classified as requiring treatment if it was debrided or repaired at the time of ACL reconstruction. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of pre-operative MRIs were determined for medial and lateral meniscus tears. Results Sensitivity, specificity, PPV, and NPV of MRI were 0.90, 0.75, 0.58, and 0.95 for medial meniscus tears, respectively, and 0.67, 0.81, 0.65, and 0.82 for lateral meniscus tears. MRI-diagnosed medial meniscus tears were associated with a longer time interval between initial injury and imaging compared to ACL tears without concomitant meniscus injury on MRI (p=0.038). Vertical medial meniscus tears were less likely than other tear patterns to require treatment at the time of ACL reconstruction (p=0.03). MRI showed a higher diagnostic performance for lateral meniscus tears when surgery was performed within 30days of imaging. Conclusions This study demonstrates only moderate sensitivity and specificity of pre-operative MRI in the detection of meniscus tears requiring operative treatment in the setting of ACL injury. High rates of false diagnoses were observed, suggesting MRI may not be as accurate in predicting positive or negative meniscus findings at the time of ACL reconstruction as previously reported. Level of Evidence Level III

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.018
  • Extension deficit after ACL reconstruction: Is open posterior release a
           safe and efficient procedure'
    • Authors: Nicolas Tardy; Mathieu Thaunat; Bertrand Sonnery-Cottet; Colin Murphy; Pierre Chambat; Jean-Marie Fayard
      Pages: 465 - 471
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Nicolas Tardy, Mathieu Thaunat, Bertrand Sonnery-Cottet, Colin Murphy, Pierre Chambat, Jean-Marie Fayard
      Background Extension loss is a potentially devastating consequence of anterior cruciate ligament reconstruction (ACLR). It can often be treated by anterior arthroscopic release. In rare cases, a chronic flexion contracture requires an additional posterior open release. To our knowledge, no study analysing the results of both posteromedial and posterolateral approaches has been performed so far. The purposes of this study were (1) to analyse the midterm outcome and complications of a combined procedure, anterior arthroscopic debridement and posterior open capsulotomy — for the treatment of chronic extension deficits after ACLR and (2) to describe the surgical technique of posterior open release with both posteromedial and posterolateral approaches. Material and methods This is a retrospective clinical cohort study. Twelve patients presenting a chronic flexion contracture of 10° or more after ACLR treated by open posterior arthrolysis with an average follow-up time of 38months (range six to 90) were included. At last follow-up, they underwent both a clinical examination with range of motion analysis, International Knee Documentation Committee (IKDC) and KOOS scores. Results At follow-up, all patients except one (93%) achieved complete extension. Only one patient (7%) had a residual post-operative flexion deformity of five degrees. The range of motion (ROM) improved significantly after arthrolysis from 96°±14.3° (SD) to 14.3°±7°(SD)(p<0.001). No post-operative complications were recorded. No patients required further open debridement. The post-operative objective IKDC score was grade A for five patients, B for seven versus C for five patients and D for seven preoperatively. The mean post-operative subjective IKDC score was 86.4±9.7. The post-operative Knee injury and Osteoarthritis Outcome Score (KOOS) distribution was as follows: pain 93.8±5 (SD); symptoms 88±8.6 (SD); ADL 96.8±3.7 (SD); sports activities 83.6±12.3 (SD); and quality of life 82.9±8.8 (SD). Mean patients' satisfaction was 9.25±0.6 (SD) out of 10 after arthrolysis. Conclusions Open posterior release with both posteromedial and posterolateral approaches is a safe and efficient additional procedure in case of persistent flexion contracture after ACLR with good ROM gain, functional scores and patients' satisfaction. Level of evidence Therapeutic study — Level IV

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.001
  • Single-leaf partial meniscectomy in extensive horizontal tears of the
           discoid lateral meniscus: Does decreased peripheral meniscal thickness
           affect outcomes' (Mean four-year follow-up)
    • Authors: Se-Won Lee; Yong-Min Chun; Chong-Hyuk Choi; Sung-Jae Kim; Min Jung; Joon-Woo Han; Sung-Hwan Kim
      Pages: 472 - 477
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Se-Won Lee, Yong-Min Chun, Chong-Hyuk Choi, Sung-Jae Kim, Min Jung, Joon-Woo Han, Sung-Hwan Kim
      Background To evaluate whether single-leaf partial meniscectomy in horizontal tears along the entire discoid lateral meniscus has any advantages in clinical and radiological results compared with other meniscectomies in discoid lateral meniscus. Methods A total of 145 patients with a horizontal tear pattern in symptomatic lateral discoid meniscus were retrospectively reviewed. Twenty-seven patients had undergone full-extent single-leaf partial meniscectomy (group A), 60 had undergone conventional partial meniscectomy (saucerization) maintaining peripheral meniscal height (group B), and 58 patients had undergone total meniscectomy (group C). Each patient was evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective grading, and modified Kellgren–Lawrence grade in plain radiography at their last follow-up. Results Group C had inferior functional results to groups A and B on the Lysholm knee score and IKDC subjective score. There was no significant difference between groups A and B. Group C fared significantly worse than groups A and B (p=0.003, p<0.001) by modified Kellgren–Lawrence grade. Conclusion With regard to clinical and radiological evaluations in lateral discoid meniscus tears, the full-extent single-leaf partial meniscectomy group had no adverse results compared with the total meniscectomy group and was not significantly different compared to the conventional partial meniscectomy group. Study design Cohort study. Level of evidence Level III, therapeutic study. See Guidelines for
      Authors for a complete description of levels of evidence

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2015.11.019
  • A prospective evaluation of the anterior horn of the lateral meniscus as a
           landmark for tibial tunnel placement in anterior cruciate ligament (ACL)
    • Authors: Brian C. Werner; M. Tyrrell Burrus; F. Winston Gwathmey; Mark D. Miller
      Pages: 478 - 481
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Brian C. Werner, M. Tyrrell Burrus, F. Winston Gwathmey, Mark D. Miller
      Background The goal of this study was to prospectively evaluate the accuracy and consistency of the anterior horn of the lateral meniscus as a landmark in achieving the desired tibial tunnel location during primary anterior cruciate ligament (ACL) reconstruction. Methods One hundred consecutive adult patients undergoing primary ACL reconstruction were enrolled in the study. One sports-fellowship trained surgeon performed all ACL reconstructions using independent tunnel drilling with an accessory anteromedial portal for the femoral tunnel. All guide pins for the tibial tunnel were placed using a 55-degree guide using the posterior border of the anterior horn of the lateral meniscus as a landmark. Following pin placement, a true lateral fluoroscopic image was obtained. These were digitally analyzed to measure the location of the pin along the length of the tibial plateau. Results The average anteroposterior (A–P) distance achieved using the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement was 37.0%±5.2% (mean±standard deviation) [range 26.4%–49.2%]. 66% of tibial tunnels were located between 30.0% and 39.9% of the A–P tibial distance. Only 18% of tibial tunnels localized between 40.0% and 44.9%, the area of the anatomic footprint described by Staubli and Rauschning [9] 16% of patients were significant outliers, with tunnels localizing to 25.0%–29.9% (6 patients) or 45.0%–49.9% (10 patients). Conclusions Use of the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel placement during anatomic ACL reconstruction yields an inconsistent tunnel location. Level of Evidence II, Prospective study.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2015.10.009
  • Focal intratendinous radiolucency: A new radiographic method for
           diagnosing patellar tendon ruptures
    • Authors: Jonathan P. Ng; Derek T. Cawley; Suzanne M. Beecher; Matthew J. Lee; Diane Bergin; Fintan J. Shannon
      Pages: 482 - 486
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Jonathan P. Ng, Derek T. Cawley, Suzanne M. Beecher, Matthew J. Lee, Diane Bergin, Fintan J. Shannon
      Background Diagnosis of patellar tendon rupture is usually based on clinical history and examination. In equivocal cases, imaging may be required. Lateral radiograph is a simple and cost-effective method for prompt diagnosis. However, no specific radiological sign has been described. Rather than utilising patella alta as an indirect measure of patellar tendon rupture, we hypothesise that a focal intratendinous radiolucency is another reliable and accurate radiological sign for diagnosis. Sensitivity and specificity analysis was undertaken to evaluate the diagnostic value of this radiographic sign. Methods Lateral radiographs of mid-substance patellar tendon ruptures from 19 patients were analysed. These were then randomised with another 19 normal knee radiographs from age-matched patients to create a pool of 38 radiographs for interpretation. Six independent interpreters who were blinded to the diagnosis were requested to indicate whether rupture was present or absent based on the visualisation of a focal intratendinous radiolucency in the patellar tendon. The Insall–Salvati (IS), Caton–Deschamps (CD) and Blackburne–Peel (BP) ratios were measured in the same radiographs. Sensitivity and specificity for each of the radiographic measurements were calculated. Inter- and intraobserver correlations were reported in kappa statistics. Results The average sensitivity and specificity for focal radiolucency in the patellar tendon substance were 82.5% and 95.2%, respectively. Sensitivity and specificity for the IS ratio were 84.2% and 78.9%, for CD was 68.4% and 84.2% and for BP was 68.4% and 89.4% respectively. Conclusion The presence of a focal intratendinous radiolucency in the patellar tendon is both accurate and reliable in diagnosing patellar tendon ruptures.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2015.09.021
  • Early evolving joint degeneration by cartilage trauma is primarily
           mechanically controlled
    • Authors: K. Wiegant; M. Beekhuizen; S.C. Mastbergen; N.O. Kuchuk; A.D. Barten-van Rijbroek; R.J.H. Custers; D.B.F. Saris; L.B. Creemers; F.P.J.G. Lafeber
      Pages: 487 - 494
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): K. Wiegant, M. Beekhuizen, S.C. Mastbergen, N.O. Kuchuk, A.D. Barten-van Rijbroek, R.J.H. Custers, D.B.F. Saris, L.B. Creemers, F.P.J.G. Lafeber
      Background Mechanical and inflammatory processes add to osteoarthritis (OA). To what extent both processes contribute during the onset of OA after a cartilage trauma is unknown. This study evaluates whether local cartilage damage leads to focally confined or more generalized cartilage damage with synovial inflammation in the early development of joint tissue degeneration. Methods In nine goats, cartilage damage was surgically induced on the weight bearing area of exclusively the medial femoral condyle of the right knee joint. The other tibio-femoral compartments, lateral femoral condyle and lateral medial tibial plateau, were left untouched. The contralateral left knee joint of each animal served as an intra-animal control. Twenty weeks post-surgery changes in cartilage matrix integrity in each of the four compartments, medial and lateral synovial tissue inflammation, and synovial fluid IL-1β and TNFα were evaluated. Results In the experimental medial femoral plateau, significant macroscopic, histologic, and biochemical cartilage damage was observed versus the contralateral control compartments. Also the articulating cartilage of the experimental medial tibial plateau was significantly more damaged. Whereas, no differences were seen between the lateral compartments of experimental and contralateral control joints. Synovial tissue inflammation was mild and only macroscopically (not histologically) significantly increased in the experimental medial compartments. Synovial fluid IL-1β level was not different between experimental and contralateral control joints, and TNFα was overall beneath the detection limit. Conclusions Local cartilage damage is a trigger for development of OA, which in early onset seems primarily mechanically driven. Early treatment of traumatic cartilage damage should take this mechanical component into consideration.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.004
  • Outcomes following impaction bone grafting for treatment of unstable
           osteochondritis dissecans
    • Authors: Robert A. Gallo; Michael Plakke; Timothy Mosher; Kevin P. Black
      Pages: 495 - 500
      Abstract: Publication date: Available online 2 March 2016
      Source:The Knee
      Author(s): Robert A. Gallo, Michael Plakke, Timothy Mosher, Kevin P. Black
      Background Many methods have been proposed to treat unstable osteochondritis dissecans (OCD). Our purpose is to report outcomes in a cohort of patients undergoing impaction bone grafting for treatment of knee OCD. Methods Patients undergoing impaction bone grafting for knee OCD between 1998 and 2011 were contacted and stratified into (a) those who have undergone subsequent surgery on the affected knee and (b) those who have not had revision surgery performed on the affected knee since the impaction bone grafting procedure. For those not undergoing another procedure, physical examination, radiographs, MRI, and functional outcomes (SF12, Tegner, Activity Rating Scale, and IKDC) were obtained. Results Of nine patients (10 knees) undergoing the procedure, seven (eight knees) were available for follow-up. Three had revision surgery. One had debridement due to surface overgrowth and had no symptoms 43months following debridement, while two had osteochondral allograft and autograft procedures at three and 10years after initial surgery, respectively. Four patients did not require a revision surgical procedure at average follow-up of 55.4months (range, 21–116months). All had complete MRI fill of the cartilaginous defect with less than 50% of surface irregularity and redeveloped the tidemark and a heterogeneous cartilaginous surface. Follow-up Tegner, ARS, and SF12-PCS averaged 6.8, 67.5, and 56.6, respectively. All four had good/excellent IKDC results. Conclusion Impaction bone grafting can reliably restore osteocartilaginous defect produced by OCD and is a readily available and less-expensive option in treating OCD lesions. Further investigation is necessary to determine the long-term durability of the results. Level IV – Case series

      PubDate: 2016-03-04T15:05:24Z
      DOI: 10.1016/j.knee.2015.11.016
  • Medial unicompartmental knee arthroplasty improves congruence and restores
           joint space width of the lateral compartment
    • Authors: Saker Khamaisy; Hendrik A. Zuiderbaan; Jelle P. van der List; Denis Nam; Andrew D. Pearle
      Pages: 501 - 505
      Abstract: Publication date: Available online 16 March 2016
      Source:The Knee
      Author(s): Saker Khamaisy, Hendrik A. Zuiderbaan, Jelle P. van der List, Denis Nam, Andrew D. Pearle
      Background Osteoarthritic progression of the lateral compartment remains a leading indication for medial unicompartmental knee arthroplasty (UKA) revision. Therefore, the purpose of this study was to evaluate the alterations of the lateral compartment congruence and joint space width (JSW) following medial UKA. Methods Retrospectively, lateral compartment congruence and JSW were evaluated in 174 knees (74 females, 85 males, mean age 65.5years; SD±10.1) preoperatively and six weeks postoperatively, and compared to 41 healthy knees (26 men, 15 women, mean age 33.7years; SD±6.4). Congruence (CI) was calculated using validated software that evaluates the geometric relationship between surfaces and calculates a congruence index (CI). JSW was measured on three sides (inner, middle, outer) by subdividing the lateral compartment into four quarters. Results The CI of the control group was 0.98 (SD±0.01). The preoperative CI was 0.88 (SD±0.01), which improved significantly to 0.93 (SD±0.03) postoperatively (p<0.001). In 82% of knees, CI improved after surgery, while in 18% it decreased. The preoperative significant JSW differences of the inner (p<0.001) and outer JSW (p<0.001) were absent postoperatively. Conclusion Our data suggests that a well-conducted medial UKA not only resurfaces the medial compartment but also improves congruence and restores the JSW of the lateral compartment.

      PubDate: 2016-03-17T13:56:14Z
      DOI: 10.1016/j.knee.2016.02.012
  • Unicompartmental knee replacement: Does the macroscopic status of the
           anterior cruciate ligament affect outcome'
    • Authors: T.W. Hamilton; C. Pistritto; C. Jenkins; S.J. Mellon; C.A.F. Dodd; H.G. Pandit; D.W. Murray
      Pages: 506 - 510
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): T.W. Hamilton, C. Pistritto, C. Jenkins, S.J. Mellon, C.A.F. Dodd, H.G. Pandit, D.W. Murray
      Purpose ACL damage is associated with progression of arthritis and whilst in the population undergoing joint replacement in the majority of cases the ACL is intact there is a wide spectrum of ACL disease. This study investigated whether the macroscopic status of the ACL affected functional outcome or survival following UKR. Methods The macroscopic status of the ACL was recorded in 820 cemented Oxford UKRs implanted by two surgeons for the recommended indications. The ACL was considered functionally normal in the setting of anteromedial tibial wear and macroscopically the ACL visually appeared normal or had synovial damage or longitudinal splits. The patients were followed up independently with a mean follow-up of 10.3years (range 5.3 to 16.6). Results More marked ACL macroscopic damage was significantly associated with increasing age, male gender and a more extensive anteromedial tibial defect. Patients with more ACL damage had a significantly lower pre-operative AKSS Objective Score, however no difference in AKSS-Functional or OKS was detected between groups. At 10years no difference in functional outcome or activity level was found between groups. Compared to those with a macroscopically normal ACL at 10years a significantly greater improvement from baseline OKS score was seen in patients with macroscopic ACL abnormalities. At 15years no difference in implant survival, or failure mechanism, was detected between groups. Conclusion The macroscopic status of the ACL does not affect long term functional outcomes or implant survival and in the setting of an intact ACL macroscopic status is not a contraindication to mobile bearing UKR. Level of evidence Level IV.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.013
  • Range of movement correlates with the Oxford knee score after total knee
           replacement: A prediction model and validation
    • Authors: Julian F. Maempel; Nicholas D. Clement; Ivan J. Brenkel; Phil J. Walmsley
      Pages: 511 - 516
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Julian F. Maempel, Nicholas D. Clement, Ivan J. Brenkel, Phil J. Walmsley
      Background Patient reported outcome measures are widely used in the evaluation of outcomes after Total Knee Replacement (TKR) in joint registries and large studies. The aim of this study was to assess the relationship between the Oxford knee score (OKS) and range of motion (ROM) after TKR, and to construct and validate prediction models of ROM from the measured OKS. Methods Eight hundred sixty patients reviewed five years postoperatively and 273 patients reviewed nine to 10 years postoperatively completed an OKS. Of these, 808 (94%) and 226 (83%) patients, respectively, had a complete dataset (knee extension and ROM) and formed the study cohort. Results Regression analysis demonstrated a significant correlation between the OKS and ROM (r=0.38, p<0.001) after adjusting for other confounding variables (age, sex, body mass index, and knee extension). A prediction model was constructed and validated using a second cohort of 226 patients at nine to 10 years after their TKR. Intraclass correlation demonstrated good reliability (r=0.60, 95% CI 0.47 to 0.69) between predicted and actual measured ROM for this group. However, when the OKS is used in isolation the reliability of the predicted ROM is diminished (intraclass correlation r=0.41, 95% CI 0.24 to 0.55). Conclusions The OKS is an independent predictor of ROM after TKR. It is also possible to predict ROM from the OKS, but the reliability of this is improved when other independent predictors such as age, gender, body mass index (BMI) and degree of knee extension are also acknowledged.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.009
  • The influence of posterior tibial slope changes on joint gap and range of
           motion in unicompartmental knee arthroplasty
    • Authors: Koji Takayama; Tomoyuki Matsumoto; Hirotsugu Muratsu; Kazunari Ishida; Daisuke Araki; Takehiko Matsushita; Ryosuke Kuroda; Masahiro Kurosaka
      Pages: 517 - 522
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Koji Takayama, Tomoyuki Matsumoto, Hirotsugu Muratsu, Kazunari Ishida, Daisuke Araki, Takehiko Matsushita, Ryosuke Kuroda, Masahiro Kurosaka
      Background The effect of posterior slope on joint gap in unicompartmental knee arthroplasty (UKA) has yet to be quantified. The purpose of this study was to quantify the effect of the tibial slope on the joint component gap and postoperative range of motion in UKA. Methods Forty consecutive patients were prospectively enrolled. The correlation between the tibial slope changes and the component gap, the component gap difference between flexion angles, the postoperative extension or flexion angles was examined. The correlation of joint looseness with tibial slope changes and postoperative extension angle was also examined. Results Increased tibial slope positively correlated with the differences between the component gap at 90° and 10°, 120° and 10°, or 135° and 10° knee flexion angle. Although tibial slope change did not affect postoperative flexion angle, increased tibial slope reduced postoperative extension angle. Moreover, increased tibial slope resulted in decreased joint looseness during 10° of knee flexion and decreased joint looseness during 10° of knee flexion resulted in reduced postoperative extension angle. Conclusions Increased tibial slope resulted in tight component gap at knee extension compared with that at knee flexion. Furthermore, tight component gap at extension lead to decreased postoperative extension angle. These results indicate that an individual anatomical tibial slope should be considered when tibial sagittal osteotomy was performed and increasing tibial slope should be avoided to achieve full extension angle after UKA. Level of evidence II.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.003
  • Percutaneous freezing of sensory nerves prior to total knee arthroplasty
    • Authors: Vinod Dasa; Gabriel Lensing; Miles Parsons; Justin Harris; Julia Volaufova; Ryan Bliss
      Pages: 523 - 528
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Vinod Dasa, Gabriel Lensing, Miles Parsons, Justin Harris, Julia Volaufova, Ryan Bliss
      Background Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction. Methods A retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function. Results A significantly lower proportion of patients in the treatment group had a LOS of ≥2days compared with the control group (6% vs. 67%, p<0.0001) and required 45% less opioids during the first 12weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively. Conclusions Perioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials. Level of evidence III

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.011
  • The “midsulcus line” as a landmark for tibial resection during
           total knee arthroplasty
    • Authors: David F. Dalury; Luke J. Aram
      Pages: 529 - 531
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): David F. Dalury, Luke J. Aram
      Background Proper tibial alignment is an important goal of total knee arthroplasty. Most surgeons agree that tibial coronal alignment should be within three degrees of neutral mechanical alignment. The “midsulcus line” is a line drawn along the sulcus of the tibial spines, and then the line is continued in the sagittal plane and extended onto the anterior tibia where it intersects the tibial tubercle approximately 3 to 4mm lateral to the tubercle's medial border. The tibial cut was then made perpendicular to this line. The aim of our study was to assess, using CT scans, whether this line provided a consistent guide for planning the tibial cut in total knee arthroplasty. Methods We reviewed the CT scans of the knees of 107 patients with osteoarthritis who had undergone a CT scan for planning of custom cutting guides. The midsulcus line was drawn on all scans. Results We found that in 105 of 107 knees, a perpendicular cut to this tibial landmark would have delivered a cut surface within three degrees of neutral mechanical alignment. Conclusions The midsulcus line is a reliable landmark for planning the tibial resection in total knee arthroplasty. Level of Evidence III

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.019
  • Effect of femoro-tibial component size mismatch on outcome in primary
           total knee replacement
    • Authors: Steven Heylen; Knud Foubert; Annemieke Van Haver; Paul Nicolai
      Pages: 532 - 534
      Abstract: Publication date: Available online 12 April 2016
      Source:The Knee
      Author(s): Steven Heylen, Knud Foubert, Annemieke Van Haver, Paul Nicolai
      Background Most total knee arthroplasty systems allow a degree of femoro-tibial component size mismatch. We aim to investigate the influence of size mismatch on outcome after primary total knee arthroplasty. Methods We reviewed 332 patients with cruciate-retaining Genesis II total knee arthroplasty with regard to femoro-tibial component size mismatch and Oxford Knee Score (OKS). We evaluated effects of Body Mass Index, gender and patellar procedure. Minimum follow-up is five years. We divided patients into four groups (tibial component larger than femoral component, no mismatch, femoral component one size larger and femoral component two sizes larger than tibial component). Results There was no statistically significant difference in OKS between the four groups. Size mismatch did not have a statistical significant effect on OKS in a multivariate analysis. Women had mismatched components in 66% of all cases and men in 40% of all cases. Conclusions Our study showed no statistically significant effect of femoro-tibial size mismatch on outcome after total knee replacement. Compared to men, women tend to have more component size mismatch. Level of evidence Level III, retrospective comparative study.

      PubDate: 2016-06-05T06:24:58Z
      DOI: 10.1016/j.knee.2016.03.003
  • Prosthetic alignment after total knee replacement is not associated with
           dissatisfaction or change in Oxford Knee Score
    • Authors: Henricus J.T.A.M. Huijbregts; Riaz J.K. Khan; Daniel P. Fick; Olivia M. Jarrett; Samantha Haebich
      Pages: 535 - 539
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Henricus J.T.A.M. Huijbregts, Riaz J.K. Khan, Daniel P. Fick, Olivia M. Jarrett, Samantha Haebich
      Background Approximately 18% of the patients are dissatisfied with the result of total knee replacement. However, the relation between dissatisfaction and prosthetic alignment has not been investigated before. Methods We retrospectively analysed prospectively gathered data of all patients who had a primary TKR, preoperative and one-year postoperative Oxford Knee Scores (OKS) and postoperative computed tomography (CT). The CT protocol measures hip–knee–ankle (HKA) angle, and coronal, sagittal and axial component alignment. Satisfaction was defined using a five-item Likert scale. We dichotomised dissatisfaction by combining ‘(very) dissatisfied’ and ‘neutral/not sure’. Associations with dissatisfaction and change in OKS were calculated using multivariable logistic and linear regression models. Results 230 TKRs were implanted in 105 men and 106 women. At one year, 12% were (very) dissatisfied and 10% neutral. Coronal alignment of the femoral component was 0.5 degrees more accurate in patients who were satisfied at one year. The other alignment measurements were not different between satisfied and dissatisfied patients. All radiographic measurements had a P-value>0.10 on univariate analyses. At one year, dissatisfaction was associated with the three-months OKS. Change in OKS was associated with three-months OKS, preoperative physical SF-12, preoperative pain and cruciate retaining design. Discussion Neither mechanical axis, nor component alignment, is associated with dissatisfaction at one year following TKR. Patients get the best outcome when pain reduction and function improvement are optimal during the first three months and when the indication to embark on surgery is based on physical limitations rather than on a high pain score. Level of evidence 2

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2015.12.007
  • The influence of intraoperative soft tissue balance on patellar pressure
           in posterior-stabilized total knee arthroplasty
    • Authors: Tomoyuki Matsumoto; Nao Shibanuma; Koji Takayama; Hiroshi Sasaki; Kazunari Ishida; Takehiko Matsushita; Ryosuke Kuroda; Masahiro Kurosaka
      Pages: 540 - 544
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Tomoyuki Matsumoto, Nao Shibanuma, Koji Takayama, Hiroshi Sasaki, Kazunari Ishida, Takehiko Matsushita, Ryosuke Kuroda, Masahiro Kurosaka
      Background Appropriate soft tissue balance is essential for the success of total knee arthroplasty (TKA), and assessment with an offset-type tensor provides useful information about the femorotibial (FT) joint. The purpose of the study was to investigate the relationship between intraoperative soft tissue balance and patellar pressure at both medial and lateral sides. Methods Thirty varus-type osteoarthritis patients who received mobile-bearing posterior-stabilized TKAs were enrolled in the study. Using the tensor, soft tissue balance, including joint component gap and varus ligament balance, was recorded at 0°, 10°, 30°, 60°, 90°, 120°, and 135° with patellofemoral (PF) joint reduction and femoral component placement. Following final prostheses implanted with appropriate insert, the medial and lateral patellar pressures were measured at each flexion angle. A simple regression analysis was performed between each patellar pressure, parameter of soft tissue balance, and postoperative flexion angle. Results Both lateral and medial patellar pressures increased with flexion. The lateral patellar pressure was significantly higher than the medial patellar pressure at 60°, 90°, and 135° of flexion (p<0.05). The lateral patellar pressure inversely correlated with the varus ligament balance at 60° and 90° of flexion (p<0.05). The lateral patellar pressure at 120° and 135° of flexion inversely correlated with the postoperative flexion angle (p<0.05). Conclusion Soft tissue balance influenced patellar pressure. In particular, a reduced lateral patellar pressure was found at the lateral laxity at flexion, leading to high postoperative flexion angle. Level of evidence III.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2015.11.020
  • The use of metaphyseal sleeves in revision total knee arthroplasty
    • Authors: David F. Dalury; William P. Barrett
      Pages: 545 - 548
      Abstract: Publication date: Available online 2 March 2016
      Source:The Knee
      Author(s): David F. Dalury, William P. Barrett
      Background Bone loss in revision total knee arthroplasty is common. Various reconstruction options are available. The purpose of our study is to report on one such reconstruction option, titanium metaphyseal sleeves. Methods We describe a series of 45 patients (46 knees) who underwent revision total knee arthroplasty and were treated with a porous metaphyseal sleeve between August 2000 and September 2009 at two centers. Patients were followed for a minimum of four years, and at final follow-up, 40 patients (40 knees) were available for review. Patients were evaluated using The Knee Society's Knee Scoring System at each follow-up. Radiographs (standing anteroposterior, lateral, and sunrise views) were taken at six weeks, three months, and final evaluations. Results Mean Knee Society Scores increased from 36 (range 10 to 69) pre-operatively to 90 (range 38 to 100) at final follow-up. Mean alignment on final radiographic evaluation was 5° (range 3° to 8° valgus). Mean pre-operative alignment was 6° (range 15° varus to 18° valgus). Mean range of motion was 125° (range 80° to 140°) pre-operatively and 115° (range 95° to 130°) postoperatively. One device failed to achieve ingrowth and was revised at two years. All other knees were radiographically stable and ingrown. Conclusions Metaphyseal sleeves provide an alternative for bone loss reconstruction in revision total knee arthroplasty. Level of Evidence III

      PubDate: 2016-03-04T15:05:24Z
      DOI: 10.1016/j.knee.2016.02.005
  • Functional recovery following primary ACL repair with dynamic
           intraligamentary stabilization
    • Authors: Lorenz Büchler; Dorina Regli; Dimitrios Stergios Evangelopoulos; Kathrin Bieri; Sufian S. Ahmad; Anna Krismer; Thorsten Muller; Sandro Kohl
      Pages: 549 - 553
      Abstract: Publication date: Available online 10 March 2016
      Source:The Knee
      Author(s): Lorenz Büchler, Dorina Regli, Dimitrios Stergios Evangelopoulos, Kathrin Bieri, Sufian S. Ahmad, Anna Krismer, Thorsten Muller, Sandro Kohl
      Background Recently, a new technique, dynamic intraligamentary stabilization (DIS) was introduced for the acute repair of ACL ruptures. The purpose of this study was to report the functional recovery for patients undergoing acute anterior cruciate ligament (ACL) repair alongside DIS. Methods Forty five patients sustaining acute ACL rupture and treated with DIS repair were retrospectively evaluated. Limb symmetry index of the hop test as well as knee function by means of range of motion, knee swelling, pain and maximum strength were evaluated. Following completion of the rehabilitation program, the difference in anterior–posterior translation (Δ-AP Translation), IKDC, Tegner score (TAS) was additionally analyzed. Results Forty five (13 females, 32 males) patients were included in the study. Mean age was 26years (range 18 to 54years). Median time to successfully complete hop test was 22.0weeks (range 11 to 32weeks) postoperatively. Median limb symmetry index 91.6%±8.3%. Median delta anterior-posterior translation compared to the healthy side was plus 0.0mm±1.6mm. Median IKDC was 89.5±6.5. Mean Tegner score (TAS) at 12months of follow-up was seven (range four to nine). Three patients suffered a rerupture during the first 12 postoperative months. Conclusions DIS technique with proper rehabilitation following acute ACL rupture provides successful functional recovery and low rerupture rate at one-year follow-up.

      PubDate: 2016-03-13T13:51:22Z
      DOI: 10.1016/j.knee.2016.01.012
  • Remnant-preserving, selective single-bundle augmentation of the anterior
           cruciate ligament using a bone–patellar tendon–bone autograft: A
           technical note
    • Authors: Takuya Tajima; Etsuo Chosa; Nami Yamaguchi; Noboru Taniguchi; Yasuyuki Ishida
      Pages: 554 - 558
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Takuya Tajima, Etsuo Chosa, Nami Yamaguchi, Noboru Taniguchi, Yasuyuki Ishida
      Background To the best of our knowledge, there has been no detailed study on bone–patellar tendon–bone (BTB) grafts for remnant-preserving, selective-bundle anterior cruciate ligament (ACL) augmentation. Therefore, we aimed to develop such a technique using a BTB graft. Method A total of five patients underwent surgery using the presented procedure. These patients were young, male, and with high body mass index, and hence required very high durability of reconstructed ACL. A femoral bone tunnel was created using the inside-out technique via an accessory far-medial portal, protecting the remnant using a probe, regardless of the presence of an anteromedial (AM) or posterolateral (PL) tunnel. A single tibial tunnel was drilled at the center of the AM or PL attachment and two transverse skin incisions were made in the ipsilateral knee. The central third of the patellar tendon attached to a patellar and tibial bone plug autograft with a width of seven millimeters was harvested by subcutaneous tunneling. The femoral side was fixed using a cortical fixation device for BTB and the tibial bone plug was fixed using an interference screw with the knee at an angle of 20° of flexion by applying maximal manual traction. Results Bone tunnel enlargement, which was measured by computed digital radiography, was not observed in all cases. A BTB autograft for remnant-preserving, selective-bundle ACL augmentation offers reduced risk of tunnel enlargement. Conclusion The presented procedure might be considered one of the potentially available options for patients with ACL partial tear who require very high durability of reconstructed ACL. Level of evidence 5

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2015.11.024
  • Monthly swelling of the knee — Case report and review of the
    • Authors: Jetse Jelsma; Alistair Mayne; Bjorn Steffanie
      Pages: 559 - 560
      Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3
      Author(s): Jetse Jelsma, Alistair Mayne, Bjorn Steffanie
      Introduction We report a 17-year old with monthly swelling of her knee. The complaints are associated with the menstrual cycle. After physical examination, radiographs, MRI and an arthroscopy with biopsies, a diagnosis of intra-articular endometriosis and menstrual arthritis was made. Discussion Both an intra-articular manifestation of endometriosis and menstrual arthritis are very rare diagnoses. Extraperitoneal lesions of endometriosis are rare and the mechanism for spreading outside the retroperitoneal space is unknown. A similar situation exists for menstrual arthritis, it is thought that cytokines, which are produced as a reaction to retrograde menstruation, are the trigger for menstrual arthritis. A review of literature is given. Conclusion A monthly recurrent, painful swelling of a joint, can and should give rise to thorough investigation. Differential diagnostic one should think of intra-articular manifestation of endometriosis and menstrual arthritis. We give a proposal for treatment.

      PubDate: 2016-06-10T06:50:15Z
      DOI: 10.1016/j.knee.2016.01.010
  • Contents List
    • Abstract: Publication date: June 2016
      Source:The Knee, Volume 23, Issue 3

      PubDate: 2016-06-10T06:50:15Z
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