Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose: The treatment of patellar dislocation is tailored based on the presence or absence of osseous risk factors. The purpose of this scoping review was to investigate whether existing research addresses patient differences by mapping the use of osseous risk factors and patient-reported outcome measures (PROMs) in studies investigating the treatment of patellar dislocation.

Methods: This study was a scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Studies published between 1 January 2013 and 3 April 2023 were included if they investigated the treatment of patellar dislocation and registered osseous risk factor(s). Case series with fewer than 10 patients, reviews and meta-analyses were excluded.

Results: A total of 8923 records were identified, of which 1007 articles underwent full-text screening, and 300 met the inclusion criteria. A twofold increase in articles investigating patellar dislocation treatment was observed between the years 2013 and 2022. This review identified 176 osseous risk factors and 56 PROMs. Among the included articles, 131 (44%) utilized osseous risk factors as in- or exclusion criteria, and 26 (9%) employed a PROM specifically developed for patellar instability evaluation. The most frequently investigated treatment was medial patellofemoral ligament reconstruction (231 articles, 77%), followed by tibial tubercle osteotomies (87 articles, 29%).

Conclusion: There is considerable heterogeneity among studies investigating the treatment of patellar dislocation. Less than half of studies define the patient population according to osseous risk factors, and only 1 in 10 studies use a PROM designed for patellar dislocation. This complicates the evaluation of treatment effects in relation to osseous risk factors.

Level of evidence: Level III.

Purpose: Functional alignment (FA) in total knee arthroplasty (TKA) prioritizes soft tissue balancing and anatomical restoration without systematic correction to neutral alignment. Most studies have focused on varus deformity, with little evidence available about FA in valgus deformity. The hypothesis of the present study was that FA in robotic-assisted TKA for valgus deformity would demonstrate correction of the coronal alignment and yield satisfactory short-term outcomes.

Methods: This retrospective study included 58 patients with valgus coronal alignment (hip-knee-angle [HKA] ≥ 183°) who underwent robotic-assisted TKA using the FA technique with a minimum of 1-year follow-up. Outcomes were assessed through the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and radiographic measurements of alignment and phenotypes. Complication and revision rates were also analyzed.

Results: The cohort included 39 females and 19 males with a median age of 70. Post-operatively, 86.2% of cases achieved coronal alignment within the safe zone (HKA 177-183°). Significant improvements were observed in KSS (part 1: 69.5-95, part 2: 65-94, p < 0.001), while OKS and FJS exhibited optimal outcomes. Two complications were recorded: one aseptic loosening (1.7%) and one early infection (1.7%). Kaplan-Meier survival analysis indicated favourable implant survivorship at a median follow-up of 18 months.

Conclusion: FA in image-based robotic TKA is a safe and effective approach for patients with valgus deformity. This procedure resulted in a modest correction of the coronal alignment, where no soft tissue releases were needed. The majority of the cases fell within the target coronal alignment boundaries by only accommodating the individual laxities, suggesting the aim of FA to restore each knee's pre-pathological alignment.

Level of evidence: Level IV.

Purpose: To investigate return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR), differences based on sex and concomitant meniscal repair, and identify reasons why patients do not RTS.

Methods: Overall, 232 patients undergoing ACLR, with or without concomitant meniscal repair, that were actively participating in pivoting sports at the time of injury, were prospectively recruited. At 2 years, return to preinjury pivoting sport was investigated and, if they had returned, whether they felt their performance was at (or better) or below preinjury status. Specific reasons for not returning were identified. RTS rates and reasons for not returning were compared based on sex and meniscal repair.

Results: Overall, 140 patients (60.3%) had returned to their preinjury pivoting sport, of which 98 (70.0%) felt they were performing at (or beyond) preinjury status. While a significantly greater (p = 0.024) percentage of males (66.9%) versus females (52.4%) had returned to pivoting sports by 2 years, no differences (p = 0.708) were seen based on concomitant meniscal repair. Overall, 92 patients (39.7%) had not RTS, with primary reasons being loss of interest (21.7%), too busy due to their work and/or family environment (22.8%), or fear of reinjury or lacking confidence (17.4%). Other less-reported reasons included ongoing knee issues (6.5%) or not feeling physically ready (5.4%).

Conclusions: This study outlined specific reasons why community-level patients do not RTS, with RTS status (and reasons for not returning to preinjury pivoting sports) differing between males and females, with the latter returning at a significantly lower rate overall.

Level of evidence: Level IV.

Purpose: The dynamic alignment of the lumbar spine, pelvis and femur is increasingly studied in hip preservation surgery. However, the interaction between lumbopelvic alignment, acetabular and femoral morphology and its influence on patients' preoperative symptom burden remains poorly understood. The aim of this study was to evaluate whether lumbopelvic malalignment affects osseous hip morphology and exacerbates preoperative patient-reported joint functionality in patients undergoing periacetabular osteotomy (PAO).

Methods: One hundred thirteen patients were prospectively enroled in this single-centre study. Sagittal lumbopelvic radiographs were used to divide the patients in accordance with their lumbopelvic alignment (pelvic incidence [PI]-lumbar lordosis [LL] mismatch) into a balanced (PI-LL: 10° and 10°/n = 60) and unbalanced alignment (PI-LL: <10° and >10°/n = 53) group. Intergroup analyses were performed for acetabular and femoral morphology as well as various patient-reported outcome measures (PROMs) scores (modified Harris-Hip, Hip Osteoarthritis Outcome, International Hip Outcome tool-12 and University of California Los Angeles activity scale).

Results: Patients with concomitant unbalanced lumbopelvic alignment due to hyperlordosis showed higher femoral head coverage and lower femoral anteversion (lateral centre-edge angle 20.2° vs. 15.8°, p = 0.012/anterior wall index 0.47 vs. 0.36, p = 0.001/acetabular inclination 10.2° vs. 13.6°, p = 0.008/Femoral anteversion 21.3° vs. 28.2°, p = 0.041). Furthermore, these patients were significantly younger at the time of PAO (28.7 vs. 32.4 years, p = 0.020), even when there were no intergroup differences in all analyzed PROMs.

Conclusion: Concomitant lumbopelvic deformity affecting the hip joint morphology could aggravate clinical symptoms leading to earlier presentation in patients undergoing PAO. Thus, the lumbopelvic balance needs to be carefully evaluated in clinical decision-making in PAO patients and future research should focus on long-term outcomes of patients with concomitant unbalanced lumbopelvic alignment.

Level of evidence: Level III, prognostic study.

Purpose: Arthrogenic muscle inhibition (AMI) is a reflexive shutdown of the quadriceps muscles following a knee injury or surgery that presents with or without hamstring contracture. This complication can be classified according to the SANTI classification, but the reproducibility of this clinical classification has not yet been demonstrated.

Methods: This single-centre longitudinal observational study included 140 patients who were within 6 weeks of an ACL rupture. The presence of AMI was assessed separately and blindly during the preoperative consultation and at 3 weeks post-operative by an Orthopaedic Surgeon, an Orthopaedic Resident, a Sports Medicine Physician and a Physiotherapist. AMI was also assessed a second time by the physiotherapist, 10 days after the first assessment, before and after reconstruction surgery, in order to measure intra-rater reliability. The inter-rater and intra-rater reliability of the AMI classification was determined by calculating the intraclass correlation coefficient (ICC).

Results: Agreement for the AMI classification between different examiners was excellent pre-operatively (ICC = 0.99 [95% confidence interval, CI: 0.99-0.99]) and post-operatively (ICC = 0.98 [95% CI: 0.98-0.99]). Agreement in the AMI classification, when determined repeatedly by the same assessor (physiotherapist), was excellent pre-operatively (ICC = 0.92 [95% CI: 0.89-0.94]) and post-operatively (ICC = 0.98 [95% CI: 0.97-0.99]).

Conclusion: Excellent intra-rater and inter-rater reliability of the AMI classification system was found in patients with recent ACL rupture and post-operatively.

Level of evidence: Level II, diagnostic study prospective cohort study.

Purpose: >The aim of this multicenter study was to analyze the potential impact of patient demographics and cementation technique towards the development of radiolucent lines (RLLs) in primary total knee arthroplasty (TKA). It was hypothesized that cementation techniques, including higher cement volume, double-layer cementation technique and hardening in full extension, reduce RLL incidence by improving stability, whereas demographic factors such as age, BMI and smoking may increase RLL risk by affecting bone quality and mechanical loading.

Methods: Altogether, 776 patients (median age: 70.7 years; 39.2% males) underwent TKA at five tertiary orthopaedic centres between 11/2013 and 04/2023. X-rays were analyzed retrospectively for the evaluation of RLLs taken between 6 and 36 months from surgery. RLLs on anterior-posterior and lateral X-rays taken at a median of 14 months (range: 6-36) from primary surgery were evaluated using the Knee Society roentgenographic evaluation and scoring system. Potential associations of demographics and cementation technique on the occurrence of RLLs during follow-up were analyzed with uni- and multivariate logistic regression models.

Results: The overall incidence of RLLs around the TKA amounted to 37.4% (n = 290), with the tibial component (29.4%) being more commonly affected than the femoral component (15.0%). Patient age, gender, BMI and smoking habits were not significantly associated with higher incidence of RLLs (p > 0.05). The amount of cement used (odds ratio: 0.99; 95% confidence interval: 0.98-0.99; p = 0.028) was independently associated with a lower incidence of RLLs, irrespective of the double- versus single-layer cementation technique, cement hardening in full extension and time required for the X-ray.

Conclusions: No influence of demographic data on the incidence of RLL was found, yet specific cementation techniques appeared beneficial. Future studies with longer follow-up periods are required to provide further insight into the herein-made preliminary findings and to assess potential associations with long-term aseptic loosening rates.

Level of evidence: Level III, retrospective observational study.

Purpose: To investigate kneeling tolerance in patients undergoing hamstring (HT) versus quadriceps (QT) anterior cruciate ligament reconstruction (ACLR) and investigate correlation with patient-reported outcome measures (PROMs).

Methods: After recruitment and randomisation, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed at 6, 12 and 24 months using the Kneeling Tolerance Test, which evaluates patient-reported pain in a position of both 90 (KT90) and 110 (KT110) degrees of knee flexion. PROMs collected included the International Knee Documentation Committee (IKDC) questionnaire and the ACL Return to Sport after Injury (ACL-RSI) questionnaire.

Results: Kneeling tolerance at KT90 and KT110 improved (p < 0.05) for both graft types across all time points. There was no difference in KT90 scores between groups at 6 or 12 months. At 24 months, kneeling tolerance was superior in the QT group (mean HT 93 ± 9 vs. QT 98 ± 5; p = 0.003). For KT110 scores, a statistically significant difference was noted at 6 (mean HT 80 ± 25 vs. QT 89 ± 12; p = 0.027), 12 (mean HT 90 ± 13 vs. QT 95 ± 10; p = 0.040) and 24 months (mean HT 92 ± 10 vs. QT 97 ± 5; p = 0.003). The ACL-RSI was significantly correlated with KT90 and KT110 at 24 months (r = 0.40, p < 0.001; r = 0.40, p < 0.001). Other PROMs demonstrated significant weak-to-moderate correlations with kneeling tolerance.

Conclusion: Patients undergoing ACLR with a QT versus HT autograft report superior kneeling tolerance up to 2 years postsurgery, more prominent in deeper (110°) knee flexion. A strong correlation with ACL-RSI was demonstrated at 2 years.

Registration: ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry).

Level of evidence: Level 1.