Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose: The influence of polyethylene insert conformity on the outcomes of cruciate-retaining (CR) total knee arthroplasty (TKA) with a medial pivot design remains uncertain. Therefore, this study aimed to evaluate the effects of polyethylene insert conformity in CR-TKA on patient-reported outcomes.

Methods: The data of 255 knees (FINE Total Knee System) from 255 patients were retrospectively analysed to compare outcomes for high- or low-constraint medial pivot inserts, as determined through historical controls, over an average follow-up period of 2.2 years (range, 2.0-5.5 years). Multivariate logistic regression analysis was used to identify predictors of achieving the patient-acceptable symptom state (PASS) for the Forgotten Joint Score-12 (FJS-12). Propensity score-matched cohorts for age, sex, body mass index, Kellgren-Lawrence grade, Charlson Comorbidity Index, knee flexion contracture, FJS-12 and follow-up duration were created for between-group comparison (n = 50 in each group).

Results: Low-constraint insert (p = 0.031) and age (p = 0.043) were independent predictors of achieving the PASS for the FJS-12 (>33, 153/255). After successful matching, compared to the high-constraint insert, the low-constraint insert improved patient satisfaction (p = 0.029 for pain on going up or downstairs, and p = 0.047 for the function of going upstairs) and increased the likelihood of achieving the minimal clinically important difference (p = 0.019) and PASS (p = 0.025) for the FJS-12. A significant correlation was observed between the posterior tibial slope and the FJS-12 in the low-constraint insert group (p < 0.001), indicating that a greater posterior tibial slope was associated with better functional outcomes in this group.

Conclusions: Compared with high-constraint inserts, low-constraint medial pivot inserts yielded higher functional outcomes and patient satisfaction. Therefore, insert conformity may play a crucial role in CR-TKA outcomes.

Level of evidence: Level III.

Purpose: Recurrent shoulder instability, a common musculoskeletal disorder, often involves glenoid bone loss and Hill-Sachs lesions. However, the optimal imaging modality for accurately and reliably quantifying bipolar bone loss remains uncertain. This systematic review aims to evaluate the accuracy and reliability of various imaging modalities in assessing bipolar bone loss in anterior shoulder instability.

Methods: Major electronic databases were searched for English-language studies reporting the measurement of glenoid track width and/or determination of on/off track HSL through imaging. Studies reporting statistical measures such as area under the curve, sensitivity, specificity, positive predictive value, NPV, intraobserver reliability and interobserver reliability were included. Data extraction and risk of bias assessment were performed independently by two reviewers.

Results: The systematic review included 19 studies comprising 1567 shoulders. Overall, studies could be divided into those looking at the accuracy or reliability of determining glenoid track width, on- or off-track Hill-Sachs lesions and near-track lesions. Three-dimensional images of computed tomography (3D-CT) was the most reliable and accurate imaging modality to measure the glenoid track width. On the opposite, two-dimensional magnetic resonance imaging (2D-MRI) did not provide enough evidence of accuracy and reliability in the determination of On/Off track lesions and near-track lesions.

Conclusion: 3D-CT demonstrated excellent reliability for measuring glenoid track width. However, the reliability of 2D-MRI for determining on/off track Hill-Sachs lesions is still controversial.

Level of evidence: Level III.

Purpose: Blood flow restriction training (BFRT) has been found to reduce quadriceps atrophy and weakness after anterior cruciate ligament (ACL) surgery. However, the clinical benefit of BFRT as compared to general rehabilitation exercise (GRE) alone remains uncertain. This study aimed to compare the effects of BFRT and GRE on ACL reconstruction rehabilitation through a meta-analysis of randomized controlled trials.

Methods: PubMed, Web of Science, EMBASE, Elsevier and Biosis were searched for randomized controlled trials comparing BFRT and GRE following ACL reconstruction. Primary outcomes included muscle strength (extensor and flexor muscle general strength), Lysholm score, the International Knee Documentation Committee (IKDC) score, extensor muscle torque (peak torque and average torque) and muscle cross-sectional area (CSA). The secondary outcomes included a range of motion (ROM), pain, Y-balance and the Patient-Reported Outcomes Measurement Information System (PROMIS).

Results: Thirteen randomized controlled trials involving 376 participants were included. The change in muscle strength (Mean difference, MD: 12.96, 95% confidence interval, [95% CI]: 7.02-18.91, heterogeneity, I² = 39%), Lysholm score (MD: 9.41, 95% CI: 8.93-9.88, I² = 40%) and IKDC score (MD: 9.88, 95% CI: 0.57-19.19, I² = 87%) of the BFRT group were superior to that of the GRE group at the time of last follow-up. However, no significant difference was found between the BFRT and the GRE groups regarding the change in muscle CSA, ROM, extensor muscle torque, pain score, Y-balance and PROMIS.

Conclusion: BFRT seems to perform better than GRE in terms of functional improvement and muscle strength following ACL reconstruction, but there seems to be no significant difference between them in terms of joint mobility, pain relief, stability improvement and patient's perception of their disease and treatment.

Level of evidence: Level II.

Purpose: Addressing grade 2 and 3 medial-sided instabilities during anterior cruciate ligament (ACL) reconstruction is crucial to reduce the risk of ACL graft failure. This study introduced a minimally invasive, medial collateral ligament (MCL) augmentation technique using a peroneus longus split tendon autograft, which was fixed to the femoral deep MCL insertion and tibial superficial MCL insertion.

Methods: This prospective, longitudinal, single-centre case series included patients who underwent MCL augmentation concurrent with primary or revision ACL reconstruction due to anteromedial instability. Preoperatively and at 1-year follow-up, clinical examinations, such as rolimeter test of anterior tibial translation and medial instability, knee (International Knee Documentation Committee subjective knee form [IKDC], Lsyholm, Knee Injury and Osteoarthritis Outcome Score [KOOS]) and foot function scores (American Orthopaedic Foot and Ankle Society score [AOFAS]) and complications, were analyzed.

Results: Thirty-one patients with a mean follow-up of 13.5 ± 2.6 months and a mean age of 27.8 ± 9.6 years were included. The side-to-side difference for anterior tibial translation significantly improved from preoperative to 1-year follow-up with an ACL reconstruction failure rate of 6.5%. No patient retained a grade 2 or 3 medial instability on valgus stress testing with 30° flexion. Significant improvements from preoperative to 1-year postoperative follow-up were observed in knee function scores: IKDC (48.9 ± 26.9- 71.3 ± 11.5, p < 0.001) and Lysholm (59.9 ± 28.5-80.5 ± 11.2, p = 0.002) as well as KOOS pain, ADL, sport and QoL, each reaching the respective minimal clinically important difference values. The foot function score AOFAS showed no significant impairment (100 ± 0-99.3 ± 2.5, p = 0.250). Complications included cyclops lesions of ACL reconstruction in three patients.

Conclusion: At 1-year follow-up, MCL augmentation using a peroneus longus split tendon autograft for patients simultaneously undergoing ACL reconstruction satisfactorily restores knee stability, has a low ACL reconstruction failure rate and does not significantly impair foot function.

Level of evidence: Level IV therapeutic study; case series.

Purpose: The purpose of this study is to assess whether early surgical intervention for first-time patellar dislocations in paediatric patients is superior to conservative management. We hypothesized that surgical intervention would lead to lower redislocation rates compared to conservative treatment.

Methods: Three online databases (PubMed, MEDLINE and EMBASE) were searched from inception to 14 March 2024 to identify studies investigating the management options for acute first-time patellar dislocations in paediatric patients. Data pertaining to patient demographics, patient management, redislocation rates and Kujala scores, evaluating function, were abstracted. Weighted means and meta-analyses were conducted to compare rates of redislocation, as well as Kujala scores. The quality of included studies was assessed using the methodological index for non-randomized studies criteria for non-randomized studies and the ROB2 tool for randomized controlled trials (RCTs).

Results: A total of 11 studies and 761 patients were included in this review. The weighted mean post-operative combined rates of redislocation in the surgical group was 25.1%, compared to 46.4% in the conservative group at a mean follow-up of 53.2 months (12-168). The relative risk (RR) of redislocation was 0.82 (95% confidence interval [CI]: 0.65-1.04, I² = 0%, p = 0.11), favouring surgery compared to conservative management. A subgroup meta-analysis of two recent RCTs with 110 patients demonstrated an RR of redislocation of 0.53 (95% CI: 0.31-0.91, I² = 0%, p = 0.02), favouring surgery. Kujala scores among three comparative studies showed a mean difference of -2.7 (95% CI: -6.1 to 0.68, I² = 0%, p = 0.12), favouring conservative treatment. The weighted mean redislocation rate in 131 patients undergoing medial patellofemoral ligament reconstruction (MPFLR) was 3.1%, compared to 39.4% in 203 patients undergoing other surgical procedures, such as lateral release and medial imbrication, Roux-Goldwaith and MPFL repair. Furthermore, the conservative groups experienced a complication rate of 0.9% compared to 2.9% across the surgical groups.

Conclusion: Surgical management for first-time patellar dislocations in a paediatric population, particularly MPFLR, may be more beneficial in lowering redislocation rates than conservative management. No significant differences in Kujala scores were found.

Level of evidence: Level IV.

Purpose: In total knee arthroplasty (TKA), valgus deformities require special approaches to achieve precise mechanical axis correction and joint stability. This study aimed to determine whether the lateral approach without tibial tubercle osteotomy allows mechanical axis correction in valgus knee osteoarthritis (OA), which is at least as effective as the medial approach, while also assessing whether it provides clinically comparable results and complications.

Methods: A total of 204 patients undergoing TKA for valgus knee OA were included in this retrospective comparative study, with 131 patients in the lateral approach group and 73 patients in the medial approach group. The surgical goal was to achieve stability with a neutral axis based on mechanical alignment. Detailed pre- and postoperative clinical and radiographic data were obtained, including measurements of the hip-knee-ankle angle (HKAA) and patella tilt angle. Functional status was determined based on the Oxford Knee Score (OKS). Age, body mass index, sex and preoperative HKAA were adjusted between both groups using propensity score matching (n = 45 per group).

Results: In the propensity score-matched cohort, the postoperative HKAA did not show differences when comparing the lateral and the medial approach at a mean follow-up of 19.7 months (p = 0.385). The achieved correction of the patella tilt angle was higher in the lateral approach group in the overall (p < 0.001) and matched cohort (p < 0.001). No differences were detected regarding the postoperative OKS and complications. However, wound healing disorders showed a tendency to be more prevalent in patients who underwent the lateral approach in the overall cohort (6.1%, n = 8 vs. 0.0%, n = 0, p = 0.053) but not in the propensity score-matched cohort (p = 0.494).

Conclusion: This study demonstrated that for pronounced valgus OA, the lateral approach achieves favourable results in HKAA correction, patellar tilt and complications comparable to the medial approach. However, the risk of wound healing disorders appears higher with severe valgus deformity.

Level of evidence: Level III therapeutic study.

Purpose: To evaluate 5-year postoperative clinical outcomes of autologous matrix-induced chondrogenesis (AMIC) for isolated ICRS grade 3-4 patellar cartilage defects and correlate outcomes with magnetic resonance imaging (MRI). The hypothesis was that AMIC would improve clinical symptoms and induce neocartilage formation, visible on MRI, making it a safe and effective option for repairing focal patellar cartilage defects.

Methods: The cohort comprised 13 focal patellar lesions in 12 patients. Pain visual analogue scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala score, EuroQol-5D Health Survey questionnaire and MRI data were assessed preoperatively and at 2 and 5 years postoperatively. All MRI scans were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue System. Descriptive statistics were calculated on all data. Inferential analysis comparing outcome scores before and after surgery employed the nonparametric Wilcoxon signed-rank test, with the nonparametric Friedman test used to detect differences across multiple test attempts. p < 0.05 was considered statistically significant.

Results: Twelve patients (23-52 years old) with patellofemoral chondral full-thickness defects (2-4 cm²) were treated. At a 5-year follow-up, eleven knees showed MRI improvement. Two were asymptomatic and nine showed clear clinical improvement. Only one knee showed no clinical improvement. MRI revealed a defect filling with newly formed cartilage characterized by a less compact and heterogeneous signal. Cartilage degradation or joint damage was observed in two knees, and bone formation within the plate was identified in four. AMIC significantly improved patients' VAS pain, KOOS, EuroQol-5D and Kujala scores compared to preoperative baseline for up to 5 years postoperatively.

Conclusions: Satisfactory clinical outcomes and new cartilage formation, as observed by MRI, are achieved with AMIC at mid-term follow-up for ICRS grade 3-4 in small-to-medium-sized patellar defects in patients under 52 years of age, with improvements maintained for up to 5 years.

Level of evidence: Level III.

Purpose: To compare the load distributed to the medial tibial articular cartilage after refixation of posterior medial meniscus root tears between the suture anchor and transtibial pullout techniques in posterior medial meniscus root tears.

Methods: Twelve Thiel's embalmed human cadaveric knees are used and divided into three groups (four knees in each group): (1) intact meniscus (IM), (2) fixation with suture anchor technique (SA) and (3) fixation with transtibial pullout technique (TP). Each group applies an axial compression load up to 1500 N by Instron E 10000 at two knee flexion angles (0° and 60°). A Tekscan 4000 pressure sensor is used to record the contact pressure and the contact area for each testing condition.

Results: The contact pressure and the contact area between the three conditions are not significantly different at 0° and 60° knee flexion angles. The peak contact pressure and contact area are 3734.8 ± 2642.2 kPa, 288.2 ± 115.0 mm², 4510 ± 2930.5 kPa, 204.4 ± 36.8 mm² and 5328.8 ± 2607.7 kPa, 219.2 ± 84.7 mm² in IM, SA and TP, respectively.

Conclusion: Both suture anchor and transtibial pullout refixation of PMMRT can restore contact pressure and contact area similar to the intact meniscus. This finding suggests that either technique can be reliably used in clinical practice to preserve joint function and potentially reduce the risk of osteoarthritis progression following posterior medial meniscus root tear repairs.

Level of evidence: Level III.