Knee Surgery and Related Research最新文献

Background: Preoperative templating is an important step for total knee arthroplasty (TKA), facilitating hospital personnel in the anticipation and preparation of necessary surgical resources. Despite its importance, this process currently lacks automation. This study aimed to develop an artificial intelligence (AI) model to automate implant size prediction.

Methods: A total of 13,281 (2938 anteroposterior, 10,343 lateral) knee radiographs obtained from the authors' institute were utilized for model training, with 2302 (1034 anteroposterior, 1268 lateral) images set apart for validation and testing. The templating AI model integrates a pipeline composed of multiple steps for automated implant size estimation. To predict implant size, anterioposterior (AP) and lateral radiograph predictions were merged, selecting the smaller of the predicted sizes to prevent implant overhang. The model's size predictions were validated with 81 real TKA data set apart from the training data, and its accuracy was compared to that of manual templating by an orthopedic specialist. Predictions matching the actual implanted sizes were labeled "exact" and those within one size, "accurate." The influence of patient characteristics on the model's prediction accuracy was also analyzed. The measurement time elapsed for implant sizing was recorded for both the AI model and the orthopedic specialist. Implant position predicted by the model was validated by comparing insert locations with postoperative images.

Results: Compared with data from 81 actual TKA procedures, the model provided exact predictions for 39.5% of femoral and 43.2% of tibial components. Allowing a one-size margin of error, 88.9% of predictions were deemed "accurate" for both components. Interobserver reliability (Cohen's kappa) were 0.60 and 0.70 for femoral and tibial implants, respectively, both classified as "substantial." The orthopedic specialist produced results accurate within one-size margin of error in 95.1% and 100% of cases for femoral and tibial components, respectively. Interobserver reliability between the orthopedic specialist and ground truth was 0.76 and 0.8 for femoral and tibial components, respectively. The measurement time per case was 48.7 s for the AI model, compared with 97.5 s for the orthopedic specialist. Compared with postoperative radiographs, predicted implant position had an error of less than 4 mm on average.

Conclusions: An AI-based templating tool for TKA was successfully developed, demonstrating satisfactory accuracy and efficiency. Its application could significantly reduce the clinical workload in TKA preparation.

Background: Research on factors influencing the outcomes of revision anterior cruciate ligament (ACL) reconstruction is relatively scarce and mostly relies even on reports from a single group. Understanding the factors contributing to the failure of revision ACL reconstruction can provide valuable information for achieving better clinical outcomes and assist in patient counseling before surgery. Therefore, this study aimed to analyze the factors contributing to surgical failure after revision ACL reconstruction.

Methods: The medical records of consecutive patients who underwent single-bundle revision ACL reconstruction using the transportal technique between 2010 and 2020 and had a minimum follow-up of 2 years were retrospectively reviewed. Eligible patients were classified into two groups on the basis of the presence of surgical failure during the follow-up period (group NF, patients who did not experience surgical failure; group F, patients who experienced surgical failure). In this study, surgical failure after revision ACL reconstruction was defined as meeting any of the following conditions during follow-up: the presence of graft re-tear confirmed by magnetic resonance imaging (MRI), anterior-posterior laxity graded ≥ 2, or rotational laxity graded ≥ 2. A comparative analysis was conducted on demographic data, as well as peri-, intra-, and postoperative data between the groups. Additionally, a regression analysis was performed to investigate factors influencing surgical failure after revision ACL reconstruction.

Results: A total of 58 patients were included (group NF, 40 patients; group F, 18 patients). In between-group comparisons of demographic, peri-, and intra-operative data, group F exhibited a higher frequency of multiple revision surgeries (P = 0.001), increased preoperative osteoarthritis grade (P = 0.001), and shallower femoral tunnel depth (P = 0.002) compared with group NF. At the final follow-up, group F demonstrated relatively poor clinical outcomes, both subjectively and objectively. Multivariate regression analysis revealed that all variables that showed differences in the preceding comparisons were independent factors affecting surgical failure after revision ACL reconstruction.

Conclusions: Surgical failure after revision ACL reconstruction can occur in a substantial number of patients, influenced by non-modifiable factors, such as cases corresponding to multiple revision surgery and preoperative osteoarthritis grade, and modifiable factors, such as femoral tunnel depth.

Purpose: This retrospective single-center study aimed to investigate incidence and risk factors influencing tibial periprosthetic fractures (TPF) in Oxford unicompartmental knee arthroplasty (UKA), with a specific focus on tibial component positioning and sizing.

Methods: A total of 2063 patients with medial UKA using the Oxford® mobile partial knee implant were analyzed between July 2014 and September 2022. Various preoperative and postoperative radiographic parameters determining pre- and postoperative alignment and implant positioning, incidence and characteristics of periprosthetic fractures, and patient demographics were assessed. Statistical analyses, including Mann-Whitney U test and logistic regression, were conducted to identify significant associations and predictors of tibial fractures.

Results: Of the 1853 cases that were finally included in the study, 19 (1%) patients experienced TPF. The fracture group presented with a significantly shorter relative mediolateral and posteroanterior distance between the keel and cortex [mediolateral: 23.3% (23.2-24.8%) versus 27.1% (25.7-28.3%), p < 0.001; posteroanterior: 8.4% (6.3-10.3%) versus 10.0% (9.8-10.1%), p = 0.004]. Additionally, an increased posterior tibial slope in pre- and postoperative radiographs [preoperative: 10.4° (8.6-11.1°) versus 7.7° (5.4-10.0°), p < 0.001; postoperative 9.1° ± 3.1° versus 7.5° (5.9-9.0°), p = 0.030] was observed in the fracture group. Furthermore, the use of smaller-sized implants (AA) was associated with higher fracture rates (p < 0.001). Anatomical variants, such as a medial overhanging tibial plateau, were not observed.

Conclusions: In UKA, type Oxford TPF are linked to shorter mediolateral and posteroanterior keel-cortex distances, increased pre- and postoperative PTS, and small implant sizes (AA). Fracture lines often extend from the distal keel to the medial tibial cortex. These findings emphasize the importance of precise implant positioning and sizing to minimize fracture risk. Level of evidence Retrospective single-center study, III.

Background: The ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model.

Methods: Thirteen 3D computer models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 to 12 mm (in 1-mm intervals). Multibody simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation, and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion.

Results: The main effects of an ascending compared with a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters.

Conclusions: Significant differences in the changes in patellofemoral shift, tilt, rotation, and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.

Background: This study aimed to compare clinical and radiographic outcomes for a new tibial component (Attune S +) and the previous design (Attune S) in total knee arthroplasty (TKA) patients using ATTUNE® posterior stabilized (PS) prosthesis and also assessed related factors for the development of tibial radiolucent line(RLL).

Methods: This retrospective study included 362 knees (179 Attune S, 183 Attune S +) with an average 4 years (range, 2-8) follow-up. Clinical outcomes, radiologic parameters and the incidence of RLL around the tibial component were compared through the serial assessment. For the subgroup analysis, radiologic parameters were compared between patients with and without RLL.

Results: There was no significant difference in terms of clinical outcomes and radiologic parameters between two designs. The incidence of RLL was not different through the serial follow-up (P > 0.05). In the subgroup analysis, the preoperative medial proximal tibial angle (83.7° versus 85.0°, P = 0.01) was smaller and preoperative hip-knee-ankle angle (169.1° versus 171.8°, P = 0.01) has more varus in the group with RLL than those without.

Conclusions: The clinical and radiologic outcomes including the incidence of tibial RLL between new design and predecessor were not significantly different at average 4 years follow-up. The development of tibial RLL was associated with preoperative varus deformity of tibia and lower limb alignment.

Background: Magnetic resonance imaging (MRI) is the imaging of choice for meniscal extrusion (ME). However, they may underappreciate the load-dependent changes of the meniscus. There is growing evidence that weight-bearing ultrasound (WB US) is more suitable, particularly in revealing occult extrusion. We therefore perform a systematic review and meta-analysis on the validity and reliability of US in diagnosing extrusion. Furthermore, we explored whether it detects differences in extrusion between loaded and unloaded positions and those with pathological (osteoarthritis and meniscal injury) and healthy knees.

Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Data pertaining to intra- and interrater reliability of US in measuring meniscal extrusion (ME), its correlation with magnetic resonance imaging (MRI), and head-to-head comparison of potential factors to influence ME were included [loading versus unloading position; osteoarthritis (OA) or pathological menisci (PM) versus healthy knees; mild versus moderate-severe knee OA]. Pooled data were analyzed by random or fixed-effects models.

Results: A total of 31 studies were included. Intraclass correlation coefficients (ICC) for intra- and interrater reliability were minimum 0.94 and 0.91, respectively. The correlation between US and MRI was (r = 0.76). US detected ME to be greater in the loaded position in all knees (healthy, p < 0.00001; OA, p < 0.00001; PM, p = 0.02). In all positions, US detected greater extrusion in OA (p < 0.0003) and PM knees (p = 0.006) compared with healthy controls. Furthermore, US revealed greater extrusion in moderate-severe OA knees (p < 0.00001).

Conclusions: This systematic review suggests ultrasonography can play an important role in the measurement of meniscal extrusion, with results comparable to that of MRI. However, to what extent it can differentiate between physiological and pathological extrusion requires further investigation, with an absolute cutoff value yet to be determined. Nevertheless, it is an appropriate investigation to track the progression of disease in those with meniscal pathologies or osteoarthritis. Furthermore, it is a feasible investigation to evaluate the meniscal function following surgery.

Level of evidence: IV, Systematic review of level III-IV evidence.

Background: There is a lack of evidence of the diagnosis and treatment-related epidemiological studies of symptomatic discoid meniscus. This study analyzed the national epidemiological data for discoid meniscus in South Korea.

Methods: From 2011 to 2019, data related to the diagnosis and procedure codes of discoid meniscus were obtained from the Korean Health Insurance Review and Assessment Service database. All patients encoded as discoid meniscus were included. Data were extracted and further analyzed as follows: (1) the total number and the incidence (cases per 100,000) of discoid meniscus diagnosis per year, (2) sex distribution, (3) age distribution, (4) discoid meniscus ratio (total discoid meniscus coding per total meniscus injury coding), and (5) surgical procedures after discoid meniscus injury.

Results: The total number of discoid meniscus diagnosed was 4576 in 2011 and increased to 6639 in 2019, representing a 45.1% increase. The incidence was 9.5 in 2011 and increased to 13.0 in 2019. Concerning sex, discoid meniscus was more common in females (55%) than in males (45%) over the study period. Regarding age, the peak age of discoid meniscus in 2011 was "under 19," whereas in 2019, the peak age was observed in the 50s. The discoid meniscus ratio range was 2.12-2.60% from 2011 to 2019. The total number of meniscectomy increased by 20% from 2000 in 2011 to 2475 in 2014. However, the total number of meniscus repairs was 318 in 2011 and increased to 502 in 2019, indicating an increase of 58%.

Conclusions: The total number and incidence of symptomatic discoid as well as the discoid meniscus ratio and the incidence of total discoid meniscus repair steadily increased from 2011 to 2019. The number of meniscus repair procedures increased more rapidly than that of meniscectomy. The current study helps understand the epidemiology of symptomatic discoid meniscus, its prevention, and cost-saving measures in South Korea.

Purpose: Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, and achieving optimal outcomes can be challenging due to various influencing factors. Previous research has focused on identifying factors that affect postoperative functional outcomes. However, there is a paucity of studies predicting individual postoperative improvement following TKA. Therefore, a quantitative prediction model for individual patient outcomes is necessary.

Materials and methods: Demographic data, radiologic variables, intraoperative variables, and physical examination findings were collected from 976 patients undergoing TKA. Preoperative and 1-year postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed, and multivariate regression analysis was conducted to identify significant factors influencing one-year WOMAC scores and changes in WOMAC scores. A predictive model was developed on the basis of the findings.

Results: The predictive accuracy of the model for 1-year WOMAC scores was poor (all adjusted R² < 0.08), whereas the model for changes in WOMAC scores demonstrated strong predictability (all adjusted R² > 0.75). Preoperative WOMAC scores, sex, and postoperative knee range of motion significantly affected all pain, stiffness, and physical function aspects of the WOMAC scores (all P < 0.05). Age, cerebrovascular disease, and patellar resurfacing were associated with changes in physical function (all P < 0.05).

Conclusions: The developed quantitative model demonstrated high accuracy in predicting changes in WOMAC scores after TKA. The identified factors influencing postoperative improvement in WOMAC scores can assist in optimizing patient outcomes after TKA.

Background: This study aimed to evaluate the predictive value of anthropometric measurements for two-stranded peroneus longus tendon (PLT) graft thickness using ultrasonography MATERIALS AND METHODS: A prospective study was conducted on 204 healthy volunteers (102 males and 102 females) aged 18-40 years. Anthropometric measurements were recorded, including height, weight, body mass index (BMI), fibular length, calf circumference, and ankle circumference. The Tegner Activity Scale (TAS) was used to assess activity levels. PLT cross-sectional area (CSA) was measured using ultrasonography. Two-stranded PLT graft thickness was calculated using the previously reported formula by Luo et al. A thickness of less than 8 mm of PLT graft was accepted as an insufficient autograft for anterior cruciate ligament reconstruction (ACLR). Correlation and regression analyses were performed to identify predictors of two-stranded PLT graft thickness. Receiver operating characteristic (ROC) analysis was performed to establish the best threshold values.

Results: Males had a significantly greater PLT CSA (0.17 ± 0.03 cm²) and predicted two-stranded PLT graft thickness (8.1 ± 0.6 mm) compared with females (0.15 ± 0.03 cm² and 7.5 ± 0.6 mm, respectively; p < 0.001 for both). Correlation analysis revealed that two-stranded PLT graft thickness positively correlated with height, weight, BMI, fibular length, calf circumference, ankle circumference, and Tegner Activity Scale in both genders, with stronger correlations observed in females. The logistic regression model identified height and calf circumference as significant predictors of sufficient two-stranded PLT graft thickness (≥ 8 mm) in males, while calf circumference and the TAS were significant predictors in females. ROC analysis demonstrated that calf circumference and the TAS had acceptable discriminatory abilities in females, with 36.25 cm and ≥ 4 cutoff points, respectively. However, no anthropometric variables in males exhibited strong discriminatory abilities for predicting two-stranded PLT graft thickness CONCLUSIONS: Calf circumference and the TAS are significant predictors for two-stranded PLT autograft thickness in females. However, no anthropometric variables in males could be used strongly for prediction. These anthropometric measurements can assist in preoperative planning and decision-making, potentially improving ACLR outcomes by ensuring adequate graft thickness in females.

Level of evidence: Level II prospective study.