Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose: The purpose of this study was to evaluate the radiographic and clinical outcomes of sulcus-deepening trochleoplasty at a minimum follow-up of 23 years.

Methods: The authors evaluated a retrospective series of 10 patients (11 knees) who underwent trochleoplasty between 1993 and 2000. All patients were assessed at a minimum follow-up of 23 years by an independent clinician who noted any patellar redislocations and collected the International Knee Documentation Committee (IKDC), Kujala scores and range of motion. Radiographic examination was performed to assess patellofemoral arthritis using the Iwano classification.

Results: A total of 11 knees, from five women and five men aged 25.6 ± 6.9 years (range, 15-47 years) underwent trochleoplasty during the inclusion period. All 11 knees underwent adjuvant procedures during trochleoplasty (100%): 10 had tibial tuberosity osteotomy (TTO) and vastus medialis plasty and 1 had only vastus medialis plasty (had prior TTO). At a follow-up of 24.4 ± 2.1 years (range, 23-30 years), two patients were lost to follow-up (18%). The Iwano classification was Grade 1 in three patients (33%), Grade 2 in four patients (44%) and Grade 4 in two patients (22%). The flexion range was 130 ± 8.7° and satisfaction was 9.2 ± 0.7, Kujala was 76.9 ± 8.5 and IKDC was 65.5 ± 13.8.

Conclusion: At 23-30 years following sulcus-deepening trochleoplasty in this small series of 10 patients (11 knees), patients had satisfactory clinical scores, only 1 patient reported an episode of traumatic patellar dislocation, and two knees had patellofemoral arthritis of Iwano Grade >2 (22%).

Level of evidence: Level IV.

Purpose: The aim of this study was to conduct a systematic review and meta-analysis on the reliability and applicability of artificial intelligence (AI)-based analysis of leg axis parameters. We hypothesized that AI-based leg axis measurements would be less time-consuming and as accurate as those performed by human raters.

Methods: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Epistemonikos, and Web of Science were searched up to 24 February 2024, using a BOOLEAN search strategy. Titles and abstracts of identified records were screened through a stepwise process. Data extraction and quality assessment of the included papers were followed by a frequentist meta-analysis employing a common effect/random effects model with inverse variance and the Sidik-Jonkman heterogeneity estimator.

Results: A total of 13 studies encompassing 3192 patients were included in this meta-analysis. All studies compared AI-based leg axis measurements on long-leg radiographs (LLR) with those performed by human raters. The parameters hip knee ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA) showed excellent agreement between AI and human raters. The AI system was approximately 3 min faster in reading standing long-leg anteroposterior radiographs (LLRs) compared with human raters.

Conclusion: AI-based assessment of leg axis parameters is an efficient, accurate, and time-saving procedure. The quality of AI-based assessment of the investigated parameters does not appear to be affected by the presence of implants or pathological conditions.

Level of evidence: Level I.

Purpose: An arthroscopic partial meniscectomy (APM) for degenerative meniscus lesions and traumatic meniscus tears are two distinct entities and their long-term outcomes are rarely reported. The aim of this review was to compare the long-term (clinical and radiological) results of APM performed on stable knees for traumatic tears (TT) or degenerative lesions (DL).

Methods: Pubmed, Scopus and Embase databases were searched to identify relevant studies published between 2010 and 2023 using the keywords 'meniscectomy' OR 'meniscectomies' OR 'meniscal resection'. English-language, Levels I-IV evidence studies reporting either radiographic or clinical outcome measures with a minimum of 6 years' follow-up after APM were included. Studies including discoid meniscus, open meniscectomy, unstable knee and combination with other procedures were excluded. To rate the quality of evidence, the methodological index for non-randomized studies was used.

Results: Thirty-two studies were included, with follow-up periods ranging from 6 to 22 years. Eleven studies dealt with TT with a mean age of 31.5 ± 6.6 years and a mean follow-up of 11.6 ± 6.9 years. At the last follow-up, radiographic osteoarthritis (OA) ranged from 36% to 76%, with an average rate of 48 ± 19%; functional scores ranged from 71 to 97, with a mean of 90 ± 4 for the Lysholm score, 86 ± 10 for the International Knee Documentation Committee (IKDC) and 94 ± 16 for the knee injury and osteoarthritis outcome (KOOS). Twenty-one studies dealt with DL with a mean age of 49.9 ± 7.2 years and a mean follow-up of 14.9 ± 6.3 years. At the last follow-up, radiographic OA ranged from 23% to 97%, with an average rate of 77 ± 28%; functional scores ranged from 40 to 87, with a mean of 79 ± 10 for the Lysholm score and 71 ± 16 for the IKDC.

Conclusion: Ten-year clinical outcomes of APM are better for TTs when compared to DLs. Rates of OA are difficult to compare but lower for TTs.

Level of evidence: Level IV.

Purpose: The purpose of this study was to analyse the impact on peri-prosthetic joint infection (PJI) rate and prosthetic survival using antibiotic-loaded bone cement (ALBC) versus plain cement during total knee arthroplasty (TKA).

Methods: A retrospective cohort study was conducted. The main data source was the Catalan Arthroplasty Register (RACat). TKAs with surgery date between 1 January 2011 and 31 December 2020 were analysed and followed up until 31 December 2023. The main variable of interest was the type of cement (ALBC vs. plain cement), and several endpoints (septic revision, aseptic revision, and all-cause revision) were considered. The analysed outcomes were revision rates, survival rates and risk factors' hazard ratios (HR).

Results: A total of 22,781 TKAs were analysed, 13,125 (57.6%) of them with plain cement and 9656 (42.4%) with ALBC. The septic revision rate was lower in the ALBC group after 3 months of follow-up (0.52% vs. 0.78%, p value = 0.04). Prosthetic survival with respect to the aseptic revision endpoint was also higher for the ALBC group during the whole follow-up period (~158 months). Regarding risk factors for infection, ALBC showed a protective effect, HR: 0.53 (0.44, 0.63), while sex (being male) and the analysed comorbidities increased the risk.

Conclusions: ALBC is associated with a reduction in both the septic revision and the aseptic revision rate after TKA, and thus with higher prosthetic survival.

Level of evidence: Level III, Therapeutic, retrospective.

Purpose: This study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra-articular knee ligament reconstructions in elite athletes by reporting return-to-play (RTP) rates and levels, career longevity and complications.

Methods: A consecutive series of all extra-articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy-six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTP was defined as competing at professional level or national/international level in amateur sport.

Results: There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty-two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty-six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP.

Conclusion: Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications.

Level of evidence: Level IV.

Purpose: Aseptic loosening often requires major, expensive and invasive revision surgery. Current diagnostic modalities merely show indirect signs of loosening. A recent proof of concept study proposed a non-invasive technique for the quantitative and visual assessment of implant movement as a diagnostic aid for tibial component loosening. The primary research question addressed is whether this novel diagnostic modality can safely and effectively aid the diagnosis of aseptic loosening.

Methods: This clinical study included patients suspected of aseptic total knee arthroplasty (TKA) loosening listed for revision surgery and asymptomatic patients. Safety was evaluated using a numerical rating scale (NRS) for discomfort and by registration of adverse events. Feasibility was assessed by recording the duration and ease of the procedure. Intra- and interrater reliability were evaluated. In symptomatic patients, diagnostic accuracy metrics were evaluated with intra-operative assessment as a reference test.

Results: In total, 34 symptomatic and 38 asymptomatic knees with a TKA were analysed. The median NRS for discomfort during loading was 6 (interquartile range [IQR]: 3.75-7.00) in symptomatic patients and 2 (IQR: 1.00-3.00) in asymptomatic patients. No adverse events were reported. The majority of users found the use of the loading device easy. The median time spent in the computed tomography room was 9 min (IQR: 8.00-11.00). Excellent to good intra- and interrater reliabilities were achieved. Diagnostic accuracy analysis resulted in a sensitivity of 0.91 (95% confidence interval [CI]: 0.72-0.97) and a specificity of 0.72 (95% CI: 0.43-0.90).

Conclusions: The proposed diagnostic method is safe, feasible, reliable and accurate in aiding the diagnosis of aseptic tibial component loosening.

Level of evidence: Level II.

Purpose: This study aims to assess the functional outcomes based on restoring the anterior compartment after total knee arthroplasty (TKA).

Methods: This retrospective study included 96 primary TKAs performed between 2021 and 2022. Functional positioning principles were applied using an image-based robotic-assisted system. The mean age was 69.2 ± 7.9 years. Knee Society Score (KSS), Kujala score, Forgotten Joint Score (FJS) and knee flexion were collected preoperatively and at 1 year. The depth difference between native and prosthetic trochlea was measured to assess anterior compartment restoration at full extension, 30°, 70° and 90° flexion. The global anterior compartment restoration combined the anterior compartment restoration and the patellar thickness restoration.

Results: The trochlear offset was mostly understuffed after TKA compared to the native anatomy, mainly for medial and lateral condyles at 30° and 70° of flexion. The global anterior compartment restoration was understuffed in full extension (-0.7 mm ± 2), at 30° (-4.4 mm ± 2) and 70° of flexion (-3.6 mm ± 2.5). At 90°, the global anterior compartment restoration was overstuffed (2.2 mm ± 1.8). Functional scores were not significantly influenced by the anterior compartment stuffing at 0° and 30° (n.s.). The anterior compartment overstuffing at 70° and 90° was associated with decreased KSS function score (p = 0.009) and flexion (p = 0.04).

Conclusion: Moderate anterior understuffing was frequently observed after TKA performed with functional positioning and an image-based robotic-assisted system. This understuffing did not influence the functional outcomes. The overstuffing of the anterior compartment led to a reduction in KSS function score and flexion measurements at 1 year.

Level of evidence: Level III, retrospective cohort study.

Purpose: The aim of this study was to investigate the influence of preoperative anxiety and depression on subjective function, pain and revision rates following total knee arthroplasty (TKA).

Methods: A prospective comparative study was conducted, including 349 patients undergoing TKA surgery between January 2019 and April 2021. Patients completed the Hospital Anxiety and Depression Scale (HADS) questionnaire preoperatively, and a set of Patient-Reported Outcome Measures (PROMs) preoperatively and at 6, 12 and 24 months postoperatively. Patients were categorized into anxiety and depression groups based on HADS scores. PROMs included the Knee injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), Oxford Knee Score (OKS) and NRS-Pain. Differences in PROM scores between the anxiety/depression group and, respectively, nonanxiety/nondepression group were assessed, as well as differences in minimal clinical important difference (MCID) and attainment of Patient Acceptable Symptom State (PASS). Lastly, revision rates were compared.

Results: Anxiety and depression groups exhibited inferior subjective function preoperatively and postoperatively compared to nonanxiety and nondepression groups (all p < 0.05), experienced more pain preoperatively (p < 0.001) and also postoperatively for depression patients (all p < 0.05). Significantly fewer patients with anxiety and depression reached the PASS for KOOS-PS, OKS and NRS-Pain (all p < 0.05). There were no differences in the proportion of patients reaching the MCID for all PROMs (all p > 0.060), and revision rates did not differ between groups (both p > 0.96).

Conclusion: Preoperative anxiety and depression negatively influence subjective function and pain preoperatively and up to 2-year follow-up in patients undergoing TKA. Revision rates did not differ between groups, and there were no relevant differences in clinical improvement of subjective function and pain.

Level of evidence: Level II, prospective comparative study.

Introduction: This study compares postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) versus navigation-guided total knee arthroplasty (NG-TKA). Using Nationwide Inpatient Sample (NIS) data, it provides an analysis of postoperative complications, mortality, hospital costs and duration of stay.

Methods: The study analysed 217,715 patients (81,830 RA-TKA; 135,885 NG-TKA) using NIS data from 2016 to 2019. Elective TKA patients were identified through the International Classification of Diseases, 10th Revision codes. Statistical analyses, including logistic regression modelling, were performed using Statistical Package for the Social Sciences and MATLAB.

Results: RA-TKA patients were younger (66.1 vs. 67.1 years, p < 0.0001) and had similar mortality rates (0.024% vs. 0.018%, p = 0.342) but shorter length of stay (LOS) (1.89 vs. 2.1 days, p < 0.0001). Mean total charges were comparable between RA-TKA ($66,180) and NG-TKA ($66,251, p = 0.669). RA-TKA demonstrated lower incidences of blood-related complications (11.67% vs. 14.19%, p < 0.0001), pulmonary oedema (0.0306% vs. 0.066%, p < 0.0001), deep vein thrombosis (0.196% vs. 0.254%, p = 0.006) and acute kidney injury (AKI) (1.356% vs. 1.483%, p = 0.016).

Conclusion: RA-TKA reduces postoperative complications and LOS without increasing costs, highlighting the relevance of this technology in patient care.

Level of evidence: Level III.

Purpose: Glenohumeral instability with combined bone lesion in contact and overhead athletes with subcritical bone loss is challenging to treat with high recurrent instability. Treatment options are arthroscopic Bankart repair with remplissage and Latarjet operations. However, there is no consensus on their effectiveness. This study aims to compare the clinical outcomes and return to sports after both operations and whether evaluating the glenoid bone loss and Hill-Sachs width to calculate the total bone loss can help determine the appropriate operation.

Methods: In this retrospective comparative analysis, 30 athletes who underwent index arthroscopic Bankart repair with remplissage (n = 16) or Latarjet procedure (n = 14) between 2017 and 2020 were included. Computed tomography (CT) and magnetic resonance imaging (MRI) were routinely performed. The quick Disabilities of the Arm, Shoulder and Hand (qDASH), American Shoulder and Elbow Surgeons (ASES), instability severity index (ISI) scores and range of motion (ROM) were recorded preoperatively and at a mean follow-up of 53 months (SD = 12). Follow-up included time-to-return sports, self-perceived sports performance level and complications/recurrent dislocations.

Results: Preoperative qDASH, ASES, ISI scores, ages and genders were similar. The Latarjet group had significantly larger glenoid bone loss, Hill-Sachs width and total bone loss (p < 0.01). Both groups had significant improvement in patient-reported outcomes (PROs) after the operations (p < 0.01). Athletes with a total bone loss <25% underwent arthroscopic Bankart repair with remplissage and total bone loss ≥25% underwent Latarjet procedure, and there were no differences between the groups in terms of postoperative PROs, ROM, time-to-return sports and performance. There were no re-dislocations.

Conclusion: Arthroscopic Bankart repair with remplissage or Latarjet procedure can adequately address glenohumeral instability with combined bone lesions. Patients with total bone loss scores greater than or equal to 25 may particularly benefit from the Latarjet procedure, while the minimally invasive arthroscopic Bankart repair with remplissage can yield equally satisfying scores for total bone loss less than 25.

Level of evidence: Level III.