Journal of Joint Surgery and Research最新文献

英文中文

Anterior cruciate ligament reconstruction: Recent evolution and technical improvement 前交叉韧带重建：最新进展和技术改进

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.02.002

Kiminari Kataoka, Yuichi Hoshino, Koji Nukuto

Purpose

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries in young and active patients. ACL reconstruction has been usually recommended to restore anterior-posterior as well as rotatory knee stability. However, there are still some issues to be addressed in ACL reconstruction. Therefore, the purpose of this review was to summarize the current literature regarding recent evolution and technical improvement of ACL reconstruction.

Methods

We performed a comprehensive review of the literature regarding graft selection in ACL reconstruction, surgical technique (especially double-bundle ACL reconstruction), and additional procedures.

Results

There is still no gold standard for graft selection, while it should be individualized for each patient. Hamstrings tendon autograft and bone-patellar tendon-bone autograft are often chosen, although quadriceps tendon autograft has increased in popularity. Double-bundle ACL reconstruction was introduced to restore normal knee kinematics by closely mimicking the native anatomy. Although clinical advantages of double-bundle ACL reconstruction such as improved clinical outcome and better anteroposterior and rotatory stability have been reported, current global trend of ACL reconstruction technique is unfavourable due to technical difficulty and surgical complications. Further evolution and technical improvement are required to achieve “true” double-bundle ACL reconstruction. An additional procedure such as lateral extra-articular tenodesis, anterolateral ligament reconstruction, and anterior closing wedge osteotomy, may be considered for ACL reconstruction, especially for revision ACL reconstruction, to prevent a graft re-rupture.

Conclusion

ACL reconstruction has evolved over time in terms of technique, graft selection, and additional procedures. However, there is still room for improvement.

目的前交叉韧带（ACL）损伤是年轻活动期最常见的膝关节损伤之一。ACL重建通常被推荐用于恢复膝关节前后和旋转稳定性。然而，在ACL重建中仍有一些问题需要解决。因此，本综述的目的是总结当前关于ACL重建的最新进展和技术改进的文献。方法我们对ACL重建中移植物的选择、手术技术（尤其是双束ACL重建）和附加手术的文献进行了全面的回顾。结果目前还没有选择移植物的金标准，但应该针对每个患者进行个性化选择。自体腘绳肌腱和自体骨-髌腱-骨通常被选择，尽管自体股四头肌肌腱移植越来越受欢迎。双束前交叉韧带重建被引入，通过密切模拟本地解剖结构来恢复正常的膝关节运动学。尽管双束ACL重建的临床优势已被报道，如改善临床结果、更好的前后和旋转稳定性，但由于技术难度和手术并发症，当前ACL重建技术的全球趋势是不利的。需要进一步的进化和技术改进才能实现“真正”的双束ACL重建。ACL重建，尤其是翻修ACL重建，可以考虑采用额外的手术，如外侧关节外肌腱固定、前外侧韧带重建和前闭合楔形截骨，以防止移植物复发。结论ACL重建在技术、移植物选择和额外手术方面随着时间的推移而发展。然而，仍有改进的余地。

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引用次数: 0

Clinical evaluation of knee joint diseases 膝关节疾病的临床评价

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2022.12.003

Kohei Nishitani, Shinichiro Nakamura, Shinichi Kuriyama

Purpose

This article aimed to comprehensively introduce clinical scoring of pathological conditions of the knee.

Methods

Review articles on the clinical scores of knee joints were searched. The frequency of the clinical scores used in said articles are presented as whole-knee pathological conditions or according to specific knee diseases. Frequently used scoring systems are separately explained in terms of validity and clinically important values.

Results

Of 132 review articles, 95 were included in this review. Among these 95, the top five frequently used scoring systems were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC subjective score), Knee Society Score (KSS), and Lysholm Knee Scoring Scale. Patient-reported outcome measures to evaluate patients’ health-related quality of life, such as the EuroQol 5 dimensions (EQ5D), MOS 36-Item Short-Form Health Survey (SF-36), and SF-12 Health Survey (SF-12), were frequently used. Activity and functional ratings, such as the Tegner activity score and University of California Los Angeles (UCLA) Activity Scale, were also frequently used. Usage trends of scoring systems differed according to the pathological conditions of the knee, and some disease-specific scoring systems, such as the Kujala score for patellofemoral problems or Forgotten Joint Score for arthroplasty, have been reported.

Conclusions

Various scoring systems are used for pathological conditions of the knee. Even for knee diseases, trends in scoring systems differ according to pathological conditions, necessitating the selection of appropriate scoring systems.

目的全面介绍膝关节病变的临床评分。方法查阅有关膝关节临床评分的综述性文章。在所述文章中使用的临床评分的频率被表示为整个膝关节的病理状况或根据特定的膝关节疾病。常用的评分系统分别根据有效性和临床重要价值进行解释。结果132篇综述文章中，95篇被纳入本综述。在这95人中，最常用的五种评分系统是西安大略大学和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节损伤和骨关节炎结果评分（KOOS）、国际膝关节文献委员会主观膝关节表（IKDC主观评分）、膝协会评分（KSS）和Lysholm膝关节评分量表。经常使用患者报告的评估患者健康相关生活质量的结果指标，如EuroQol 5维度（EQ5D）、MOS 36项简式健康调查（SF-36）和SF-12健康调查（SF-12）。活动和功能评分，如Tegner活动评分和加州大学洛杉矶分校（UCLA）活动量表，也经常使用。评分系统的使用趋势因膝关节的病理状况而异，一些疾病特异性评分系统，如髌股问题的Kujala评分或关节成形术的遗忘关节评分，已有报道。结论各种评分系统可用于膝关节的病理状况。即使对于膝关节疾病，评分系统的趋势也因病理状况而异，因此必须选择适当的评分系统。

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引用次数: 2

A plain radiography may underestimate the steep posterior tibial slope of the medial condyle in elderly Japanese with varus knee osteoarthritis undergoing arthroplasties 在接受关节置换术的老年日本人膝内翻性骨关节炎患者中，平片可能低估了内侧髁的胫骨后斜坡

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.06.002

Kohei Nishitani, Shinichi Kuriyama, Shinichiro Nakamura, Taisuke Yabe, Young-Dong Song, Hiromu Ito, Shuichi Matsuda

Purpose

Understanding the native posterior tibial slope (PTS) is important especially in cruciate ligament retaining total knee arthroplasty (TKA) and uni-compartmental knee arthroplasty (UKA). This study investigated the efficacy of PTS with lateral knee radiograph (radiographic PTS) by comparing it with PTS of medial and lateral tibial condyles (MPTS and LPTS) by computed tomography (CT).

Methods

In patients who underwent TKA and UKA on varus knee osteoarthritis, radiographic PTS, MPTS, and LPTS were measured. Spearman's correlation was used to compare the radiographic PTS and PTS on CT. More than 3° delta PTS (CT PTS - radiographic PTS) were defined as positive outliers.

Results

Three-hundred and twenty-six osteoarthritic knees (278 TKAs and 48 UKAs) were evaluated. The mean radiographic PTS, MPTS, LPTS was 8.0 ± 2.9°, 10.2 ± 4.2°, and 8.3 ± 3.3°, respectively. Plain radiograph tended to underestimate steep MPTS, and its correlations to LPTS (ρ = 0.65, p < 0.001) and MPTS (ρ = 0.54, p < 0.001) were moderate. The positive outliers were observed in 136/326 (42%) and 36/326 (12%) knees in medial and lateral condyles, respectively. Even in UKA, the positive outliers were observed in 13/48 (28%) knees in medial condyle.

Conclusions

Radiographic PTS better reproduced LPTS, but did not accurately reproduce MPTS in varus knee osteoarthritis. Radiographic PTS may not detect steep medial PTS. Surgeons should be cautious because the actual PTS of the medial tibial condyle may be different from that preoperatively measured on plain radiographs.

目的了解天然胫骨后斜坡（PTS）在保留交叉韧带的全膝关节置换术（TKA）和单室膝关节置换手术（UKA）中具有重要意义。本研究通过膝关节外侧位片与胫骨内侧髁突和外侧髁突的计算机断层扫描（CT）进行比较，探讨膝外侧位片PTS的疗效。Spearman相关性用于比较影像学PTS和CT上的PTS。超过3°delta PTS（CT PTS-影像学PTS）被定义为阳性异常值。结果对326个骨关节炎膝关节（278个TKA和48个UKA）进行了评估。平均影像学PTS、MPTS、LPTS为8.0±2.9°，10.2±4.2°和8.3±分别为3.3°。平片倾向于低估陡峭的MPTS及其与LPTS的相关性（ρ=0.65，p<；0.001）和MPTS（ρ=0.54，p<；0.001）为中等。内侧髁突和外侧髁突的阳性异常值分别为136/326（42%）和36/326（12%）。即使在UKA中，在内侧髁的13/48（28%）膝关节中也观察到阳性异常值。结论影像学PTS能较好地再现膝内翻骨关节炎患者的LPTS，但不能准确地再现MPTS。射线照相PTS可能无法检测到陡峭的内侧PTS。外科医生应该谨慎，因为胫骨内侧髁的实际PTS可能与术前在平片上测量的PTS不同。

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引用次数: 0

Does lateral incision reduce perceptual deficits and improve postoperative kneeling ability after total knee arthroplasty? 外侧切口是否能减少全膝关节置换术后的知觉缺陷并提高术后跪下能力？

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.05.003

Yutaka Suetomi , Hiroshi Fujii , Atsunori Tokushige , Patricio Ⅲ Dumlao , Takashi Sakai

Purpose

Kneeling is often difficult after a total knee arthroplasty. However, the reasons behind kneeling difficulties are not yet fully understood. According to several studies, a lateral incision reduces perceptual deficits and improves kneeling performance. This study compared two different skin incisions (lateral and midline) as they relate to postoperative perceptual deficits, as well as kneeling on a mat or in daily life following TKA, and demonstrates the advantage of the lateral incision in postoperative kneeling ability.

Methods

This study included 99 patients with lateral incisions and 104 patients with midline incisions. Sensory disturbance was evaluated with a brush on the nine subdivisions of the kneeling area. Patients were tested in the outpatient clinic to determine whether they could kneel on a mat. The level of discomfort in the kneeling area was assessed using a visual analog scale. Questionnaires were used to assess kneeling ability.

Results

Compared to a midline incision, a lateral incision significantly reduced the perceptual deficits in the center of the kneeling area and the discomfort associated with kneeling on a mat. There was no significant difference between the two groups in kneeling on a mat in the clinic or kneeling in daily activities. However, less than 30% of patients in both groups could kneel in daily living. The reasons for being unable to kneel were mainly anxiety and pain, rather than numbness.

Conclusion

Lateral incisions alone did not improve kneeling in patients' daily living following TKA.

目的全膝关节置换术后跪地通常很困难。然而，下跪困难背后的原因尚不完全清楚。根据几项研究，横向切口可以减少知觉缺陷，改善跪姿表现。本研究比较了两种不同的皮肤切口（侧切口和中线切口），因为它们与术后感知缺陷、TKA后跪在垫子上或日常生活有关，并证明了侧切口在术后跪下能力方面的优势。方法本研究包括99例侧切口患者和104例中线切口患者。用刷子在跪区的九个分区上评估感觉障碍。在门诊部对患者进行测试，以确定他们是否可以跪在垫子上。使用视觉模拟量表评估跪着区域的不适程度。问卷被用来评估下跪的能力。结果与中线切口相比，外侧切口能显著减少跪区中心的知觉缺陷和与跪垫相关的不适感，两组在临床跪垫和日常活动跪垫方面无显著差异。然而，两组患者中只有不到30%的人能够在日常生活中下跪。不能下跪的原因主要是焦虑和疼痛，而不是麻木。结论TKA术后患者的日常生活中单用侧切口并不能改善跪姿。

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引用次数: 0

Contemporary posterior surgical approach with standard cemented total hip arthroplasty for femoral neck fracture in patients of age 60 years and older: Still a safe option? 标准骨水泥全髋关节置换术治疗60岁及以上患者股骨颈骨折的现代后路手术方法：仍然是一种安全的选择？

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.08.002

Kevin Syam , P Nithin Unnikrishnan , Akmal Turaev , Jeremy Oakley , Henry Wynn Jones , Nikhil Shah

Purpose

The ideal operative treatment of displaced intracapsular femoral neck fractures in the active elderly is contentious. Recent literature favours a better outcome with the use of total hip arthroplasty (THA). Dislocation remains a major concern with THA, especially when a posterior approach is used. More recently, the concept of dual mobility cups is being promoted to avoid dislocations. The aim of the present study was to look at the outcomes of cemented THA utilising the posterior approach for these patients using a 28 mm (mm) femoral head.

Methods

This study retrospectively analysed the outcome of 108 primary cemented THA, performed by specialist hip surgeons, using a posterior approach with robust soft tissue repair in patients of age 60 years and older presenting with displaced intra capsular femoral neck fractures using a 28 mm head.

Result

At mean follow-up of 5.2 years (2.0–10.5 years), there were 2 dislocations (1.9%). One underwent manipulation under anaesthesia and the other had application of a posterior lip augmentation device. No other revisions were performed during the follow up period. The 30 day mortality was nil and no post-operative deep infections. Hundred patients (93%) at 1 year follow-up were independently mobilising.

Conclusions

With optimal patient selection, an excellent outcome can be achieved for patients with displaced femoral neck fractures using the standard cemented THA via the posterior approach with 28 mm head. A robust soft tissue repair and a specialist hip surgeon is recommended for this cohort of patients.

目的老年活动期移位性股骨颈囊内骨折的理想手术治疗存在争议。最近的文献支持使用全髋关节置换术（THA）获得更好的结果。脱位仍然是THA的一个主要问题，尤其是当使用后部入路时。最近，双迁移率杯的概念正在被推广，以避免错位。本研究的目的是观察使用28mm（mm）股骨头。方法本研究回顾性分析了由专业髋关节外科医生在60岁及以上患有移位性囊内股骨颈骨折的患者中采用后部入路和坚固的软组织修复术进行的108例原发性骨水泥THA的疗效mm水头。结果平均随访5.2年（2.0-10.5年），有2例脱位（1.9%），一例在麻醉下进行了手法治疗，另一例使用了后唇部隆凸装置。随访期间未进行其他修订。30天死亡率为零，术后无深部感染。100名患者（93%）在1年的随访中独立动员。结论选择合适的患者，采用标准骨水泥THA经后入路治疗移位性股骨颈骨折可获得良好的疗效mm水头。对于这群患者，建议进行强有力的软组织修复和专业的髋关节外科医生。

{"title":"Contemporary posterior surgical approach with standard cemented total hip arthroplasty for femoral neck fracture in patients of age 60 years and older: Still a safe option?","authors":"Kevin Syam , P Nithin Unnikrishnan , Akmal Turaev , Jeremy Oakley , Henry Wynn Jones , Nikhil Shah","doi":"10.1016/j.jjoisr.2023.08.002","DOIUrl":"10.1016/j.jjoisr.2023.08.002","url":null,"abstract":"<div><h3>Purpose</h3><p>The ideal operative treatment of displaced intracapsular femoral neck fractures in the active elderly is contentious. Recent literature favours a better outcome with the use of total hip arthroplasty (THA). Dislocation remains a major concern with THA, especially when a posterior approach is used. More recently, the concept of dual mobility cups is being promoted to avoid dislocations. The aim of the present study was to look at the outcomes of cemented THA utilising the posterior approach for these patients using a 28 mm (mm) femoral head.</p></div><div><h3>Methods</h3><p>This study retrospectively analysed the outcome of 108 primary cemented THA, performed by specialist hip surgeons, using a posterior approach with robust soft tissue repair in patients of age 60 years and older presenting with displaced intra capsular femoral neck fractures using a 28 mm head.</p></div><div><h3>Result</h3><p>At mean follow-up of 5.2 years (2.0–10.5 years), there were 2 dislocations (1.9%). One underwent manipulation under anaesthesia and the other had application of a posterior lip augmentation device. No other revisions were performed during the follow up period. The 30 day mortality was nil and no post-operative deep infections. Hundred patients (93%) at 1 year follow-up were independently mobilising.</p></div><div><h3>Conclusions</h3><p>With optimal patient selection, an excellent outcome can be achieved for patients with displaced femoral neck fractures using the standard cemented THA via the posterior approach with 28 mm head. A robust soft tissue repair and a specialist hip surgeon is recommended for this cohort of patients.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 ","pages":"Pages 192-196"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705123000270/pdfft?md5=39a27efc17a44aecadcb1461425d8f87&pid=1-s2.0-S2949705123000270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50195378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness of single leg standing up exercise for recovery of knee muscle strength and lower extremity motion function following anterior cruciate ligament reconstruction 单腿站立运动对前交叉韧带重建后膝关节肌力和下肢运动功能恢复的效果

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.07.006

Koichi Kamiike , Takahisa Mori , Shinichi Yoshiya , Kotaro Kawaguchi , Shigeo Fukunishi

Purpose

We investigated the effectiveness of single-leg standing exercise (SLSE) as a home-based self-exercise for the recovery of knee joint muscle strength and lower limb motor function after anterior cruciate ligament (ACL) reconstruction.

Methods

In addition to postoperative rehabilitation, 55 patients who underwent ACL repair were asked to begin SLSE as a home-based self-exercise 50 times per day using a platform elevated at 40 cm for 2 months, 30 cm at 3 months, 20 cm at 4 months, and 10 cm at 5 months (intervention group). Sixty-four patients who underwent ACL reconstruction and followed the existing rehabilitation protocol were included in the control group. Isokinetic knee extension and flexion at 60° angular velocity at 3, 8, and 10 months after surgery and lower limb motor function performance at 8 and 10 months after surgery were compared within and between the two groups.

Results

Knee extension and flexion muscle strength and lower-extremity motor function recovered over time in both groups. There were no significant differences in knee extension and flexion muscle strength between the two groups at 3 months after surgery. However, knee extension strength, flexion strength, and triple hop test (THT) results were significantly higher in the intervention group (p < 0.01) 8 months after surgery. In addition, knee flexion strength and THT were significantly higher in the intervention group (p < 0.01) 10 months after surgery.

Conclusions

The results of this study suggest that SLSE can be an effective exercise for recovering knee joint muscle strength and lower limb motor function.

目的研究单腿站立运动（SLSE）作为一种基于家庭的自我锻炼对前交叉韧带（ACL）重建后膝关节肌力和下肢运动功能恢复的有效性。方法除了术后康复外，55名接受ACL修复的患者被要求开始SLSE，这是一种基于家庭的自我锻炼，每天50次，使用40cm，持续2个月，303个月时为cm，204个月时为cm，10cm（干预组）。64名接受ACL重建并遵循现有康复方案的患者被纳入对照组。比较两组患者术后3个月、8个月和10个月以60°角速度进行等速膝关节伸展和屈曲，以及术后8个月、10个月的下肢运动功能表现。结果两组患者膝关节屈伸肌力和下肢运动功能均随时间恢复。术后3个月，两组的膝关节伸展和屈曲肌力没有显著差异。然而，干预组的伸膝力量、屈曲力量和三跳测试（THT）结果显著高于对照组（p<；0.01）术后8个月。此外，干预组的膝关节屈曲强度和THT显著高于对照组（p<；0.01）术后10个月。结论SLSE是恢复膝关节肌力和下肢运动功能的有效运动。

{"title":"Effectiveness of single leg standing up exercise for recovery of knee muscle strength and lower extremity motion function following anterior cruciate ligament reconstruction","authors":"Koichi Kamiike , Takahisa Mori , Shinichi Yoshiya , Kotaro Kawaguchi , Shigeo Fukunishi","doi":"10.1016/j.jjoisr.2023.07.006","DOIUrl":"10.1016/j.jjoisr.2023.07.006","url":null,"abstract":"<div><h3>Purpose</h3><p>We investigated the effectiveness of single-leg standing exercise (SLSE) as a home-based self-exercise for the recovery of knee joint muscle strength and lower limb motor function after anterior cruciate ligament (ACL) reconstruction.</p></div><div><h3>Methods</h3><p>In addition to postoperative rehabilitation, 55 patients who underwent ACL repair were asked to begin SLSE as a home-based self-exercise 50 times per day using a platform elevated at 40 cm for 2 months, 30 cm at 3 months, 20 cm at 4 months, and 10 cm at 5 months (intervention group). Sixty-four patients who underwent ACL reconstruction and followed the existing rehabilitation protocol were included in the control group. Isokinetic knee extension and flexion at 60° angular velocity at 3, 8, and 10 months after surgery and lower limb motor function performance at 8 and 10 months after surgery were compared within and between the two groups.</p></div><div><h3>Results</h3><p>Knee extension and flexion muscle strength and lower-extremity motor function recovered over time in both groups. There were no significant differences in knee extension and flexion muscle strength between the two groups at 3 months after surgery. However, knee extension strength, flexion strength, and triple hop test (THT) results were significantly higher in the intervention group (<em>p</em> < 0.01) 8 months after surgery. In addition, knee flexion strength and THT were significantly higher in the intervention group (<em>p</em> < 0.01) 10 months after surgery.</p></div><div><h3>Conclusions</h3><p>The results of this study suggest that SLSE can be an effective exercise for recovering knee joint muscle strength and lower limb motor function.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 ","pages":"Pages 179-185"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705123000257/pdfft?md5=bb1fcd5352697d56ec09e8438f6094c8&pid=1-s2.0-S2949705123000257-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50195379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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