Knee Surgery and Related Research最新文献

Knee cysts are a common finding in orthopedic practice, with diagnoses that range from benign fluid collections to more complex lesions requiring intervention. This comprehensive review explores the types of cysts around the knee, including popliteal (Baker's) cysts, meniscal cysts, proximal tibiofibular joint cysts, and ganglion cysts within the cruciate ligaments. The review highlights the mechanisms of formation, clinical presentations, diagnostic methods, differential diagnoses, and treatments for each cyst type. Imaging, particularly MRI, plays a critical role in accurate diagnosis, helping differentiate cysts from other pathologies, such as tumors and vascular lesions. Treatment options vary, from conservative management for asymptomatic cases to surgical interventions, such as arthroscopic cyst removal, for symptomatic cysts or those associated with intra-articular pathologies. Emerging biological treatments, including platelet-rich plasma (PRP) and mesenchymal stem cell (MSC) therapies, show promise for addressing underlying joint degeneration and inflammation associated with certain cysts, particularly those linked to osteoarthritis. This review underscores the importance of tailored, evidence-based approaches in managing knee cysts to optimize patient outcomes. Keywords: Knee Cysts, Popliteal Cyst, Meniscal Cyst, Proximal Tibiofibular Joint Cyst, Joint Pathology.

Background: This study aims to evaluate research trends, key contributors, and thematic focuses in research of the anterolateral ligament (ALL) of the knee. It seeks to identify future direction for studies related to long-term clinical outcomes regarding ALL's role in rotational stability, especially in the context of anterior cruciate ligament (ACL) injuries.

Methods: A bibliometric analysis was conducted using the Web of Science (WoS) database, covering publications from 2012 to 2024 with the search term "anterolateral ligament". A total of 942 studies were identified. Descriptive statistics summarized publication trends, authorship, institutional contributions, and citation metrics. VOSviewer software was used to analyze co-authorship network analysis, keyword co-occurrence mapping, and total citation analysis. Yearly publication and citation trends were analyzed using WoS data. Studies addressing the ALL in other body regions were excluded. Additionally, only authors with at least one publication and one citation were considered, and documents with more than 25 authors were excluded. A total citation analysis was conducted, and 24 relevant keywords with more than 5 occurrences were identified using VOSviewer.

Results: Among 942 publications, 707 were original articles. Research output peaked in 2017 (125 articles). Sonnery-Cottet was the leading author (75 publications), while Universidade De São-Paulo emerged as the top institution (57 publications). Key journals included Arthroscopy: Journal of Arthroscopic and Related Surgery (143 articles) and The American Journal of Sports Medicine (131 articles). Keywords such as "anterior cruciate ligament", "reconstruction", and "rotational stability" dominated, reflecting a focus on ACL injury management. The top ten cited studies accrued 3,86 citations, with Claes et al.'s anatomical study leading (621 citations). Of the 942 ALL-related articles in WoS, 381 focused on anatomy (11,278 citations) while 814 addressed reconstruction (17,048 citations). Keyword trends shifted from anatomical to clinical terms, with anatomy declining and stability, injury, and outcomes gaining prominence from 2021 to 2024.

Conclusions: This bibliometric analysis underscores the growing interest in ALL research, peaking between 2016 and 2017. While foundational studies on ALL anatomy and biomechanics appear saturated, future research should prioritize clinical outcomes in terms of failure rate, reoperation, the long-term efficacy of ACL-ALL reconstruction, and advancements in imaging techniques.

Introduction: Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are widely used to treat knee osteoarthritis. TKA significantly contributes to long-term pain relief and joint function improvement, while UKA offers faster recovery and reduced early complications. However, TKA and UKA complication risks, aside from conditions such as deep vein thrombosis, have not been thoroughly investigated. This study compares the in-hospital complication risks of TKA and UKA using a nationwide Japanese database.

Methods: A retrospective cohort study was conducted using data from the Japanese Diagnosis Procedure Combination (DPC) database, spanning from April 2016 to March 2023. A total of 259,319 knee arthroplasty cases (TKA: 228,595; UKA: 30,724) were analyzed. Propensity score matching (1:1) was used to adjust for age, sex, comorbidities, and surgical factors, resulting in 30,591 matched pairs. Multivariable logistic regression analyses assessed the risks of complications, including deep vein thrombosis, pulmonary embolism, and surgical site infections.

Results: Deep vein thrombosis is frequently observed as a complication with a high incidence rate. Even after propensity score matching, the incidence remained significantly higher in the TKA group (8.8%) compared with the UKA group (6.1%) (p < 0.0001). TKA was associated with significantly higher risks of deep vein thrombosis (odds ratio (OR): 1.467, 95% confidence interval (CI) 1.380-1.560, p < 0.0001), pulmonary embolism (OR: 1.709, 95% CI 1.182-2.470, p = 0.0044), and surgical site infection (OR: 1.512, 95% CI 1.277-1.790, p < 0.0001) compared with UKA. UKA showed lower risks of cognitive dysfunction, pneumonia, transfusion requirements, and shorter hospital stays. However, patients who underwent UKA had a higher risk of periprosthetic fractures.

Conclusions: This study highlights the distinct risk profiles of TKA and UKA, emphasizing the need for tailored surgical decision-making. UKA offers advantages in reducing complications for specific patient populations. Strengthening prophylactic measures is crucial for effectively managing thromboembolic and infectious complications in patients undergoing TKA.

Background: Total knee arthroplasty (TKA) alters the lower extremity alignment, potentially affecting adjacent joints such as the ankle and subtalar joints. However, the relationship between changes in hindfoot alignment and ankle osteoarthritis (OA) after TKA remains incompletely understood. The purpose of this study was to clarify whether ankle and subtalar alignment normalizes after TKA and to identify factors associated with persistent malalignment.

Methods: We retrospectively analyzed 331 patients who underwent unilateral mechanical alignment (MA) TKA for knee osteoarthritis. A control group of 40 healthy subjects was used to define normal alignment ranges. Whole-leg anteroposterior weight-bearing radiographs were obtained preoperatively and 2 months postoperatively. Alignment parameters included the hip-knee-ankle angle (HKA), tibiotalar tilt angle (TTA), tibial plafond inclination angle (TPIA), talar inclination angle (TIA), and hindfoot alignment angle (HAA). Pre- and postoperative values were compared using the Wilcoxon signed-rank test, and changes in the proportion of patients within the normal range were determined. Wilcoxon rank-sum tests and chi-squared tests were used for group comparisons, and multivariate logistic regression identified independent predictors of persistent malalignment.

Results: HKA improved after TKA (-12° to -2.0°), with corresponding improvements in TPIA (99° to 94°) and TIA (99° to 95°) (all p < 0.001), indicating a significant correction toward neutral alignment. The proportion of patients within normal range increased postoperatively from 16% to 85% for HKA, 26% to 67% for TPIA, 24% to 64% for TIA, and 65% to 73% for HAA. Multivariate analysis identified ankle OA (odds ratio [OR] = 6.62 for TTA), female sex (OR = 2.32 for TPIA; OR = 3.19 for TIA), and varus knee alignment (OR = 2.81 for TIA) as independent predictors of persistent malalignment.

Conclusions: MA-TKA facilitates partial normalization of coronal hindfoot alignment, particularly at the tibial plafond and talus. However, female sex, varus knee deformity, and pre-existing ankle OA independently limit full correction. These findings highlight the biomechanical interdependence between the knee and hindfoot and may guide surgical decision-making and patient-specific alignment strategies.

Background: Multiligamentous knee injuries (MLKIs), defined as injuries involving at least two of the four primary knee ligaments, are rare but severe, with potentially limb- or life-threatening complications. Despite numerous publications, the low incidence and heterogeneity of injury patterns limit high-level evidence for optimal surgical timing, technique, and management of complications. This systematic review aims to consolidate the available evidence on MLKI surgery complications, with a particular focus on arthrofibrosis as the underlying cause of stiffness, infection, and graft failure.

Methods: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (no. CRD42024618025). A comprehensive search of PubMed, EMBASE, and MEDLINE from January 2013 to November 2024 identified studies reporting complications in surgically treated MLKIs with at least a 12-month follow-up. The studies were screened independently by two reviewers. Data on demographics, injury mechanisms, surgical techniques, and complication outcomes were extracted. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS).

Results: A total of 33 studies with 2863 patients met the inclusion criteria. The mean age was 32.4 years (standard deviation, SD ± 5.37), with males constituting 69.4% of the sample. Arthrofibrosis was the most common complication, requiring surgical management in 8.4% of cases. Graft failure was reported in 5%, while infection, the third most common complication, occurred in 2.86% of cases. Management of lack of range of motion varied, with manipulation under anesthesia and arthroscopic arthrolysis utilized. Surgical timing also influenced outcomes; 54.2% of patients underwent acute surgery (< 21 days), which seems to be associated with increased stiffness rates.

Conclusions: This systematic review highlights the complexity of managing MLKIs, with a 19.2% overall complication rate. Stiffness demanding reoperation remains a rare but a significant challenge, underscoring the need for standardized treatment protocols. However, the included studies demonstrate heterogeneity and lack high methodological rigor, highlighting the need to account for these limitations.

Background: We investigated whether the preoperative flexion tear gap (FTG) observed in open magnetic resonance imaging (MRI) affects meniscus stability after medial meniscus (MM) posterior root (MMPR) repairs. Furthermore, time-correlated MRI findings from MMPR tear occurrence were evaluated.

Methods: This retrospective observational study included 54 patients (mean age, 64.6 years; 13 males and 41 females) who underwent pullout repair for radial degenerative MMPR tear. Meniscus stability (scored 0-4 points) was assessed using a semi-quantitative arthroscopic scoring system during second-look arthroscopy 1 year postoperatively. The FTG was evaluated on preoperative axial MRI at 90° knee flexion. Other MRI measurements included MM extrusion (MME) at 10° knee flexion, MM posterior extrusion (MMPE) at 90° knee flexion, and MM posteromedial extrusion (MMpmE) at 90° knee flexion preoperatively and 1 year postoperatively. The correlation between the arthroscopic stability score and MRI findings was investigated. A receiver-operating characteristic curve was calculated to predict a good meniscus healing score (3-4 points). The correlation between the FTG and patient demographics, including time from injury to MRI, was analyzed.

Results: At 1 year postoperatively, MME increased by 1.1 mm, while MMpmE and MMPE decreased by 0.4 mm and 1.0 mm, respectively. The meniscus stability score was negatively correlated with the preoperative FTG (r = -0.61, p < 0.01). The time from injury to MRI was significantly correlated with the preoperative FTG. The receiver-operating characteristic curve identified an FTG cut-off value of 8.7 mm for predicting good postoperative stability, with sensitivity and specificity of 67% and 85%, respectively.

Conclusions: FTG evaluated with open MRI at 90° knee flexion was associated with time from injury and affected meniscus stability following pullout repair. MMPR tears should be treated in the early phase to increase meniscus healing stability.

Purpose: We aim to compare the clinical effects of intraarticular leukocyte-poor platelet-rich plasma (LP-PRP) injection with those of intraarticular hyaluronic acid (HA) injection in adult patients with knee osteoarthritis.

Methods: Two authors independently reviewed databases, including PubMed, Web of Science, and the Cochrane Library. Only randomized controlled trials (RCTs) were included in our meta-analysis. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC total, pain, stiffness, and physical function scores), visual analog scale (VAS) scores, EQ-VAS scores, International Knee Documentation Committee (IKDC) scores, and adverse events were used as outcome measurements to evaluate the efficacy of LP-PRP and HA treatment.

Results: After screening 377 potential articles, 12 RCTs were included in this systemic review and meta-analysis. The WOMAC total scores and WOMAC physical function scores of the LP-PRP group were better than those of the HA group at 6 and 12 months. VAS scores of the LP-PRP group were better than those of the HA group at 3, 6, and 12 months. The LP-PRP group showed a better outcome of IKDC scores than the HA group at 6 months. There was no significant difference in adverse events between the LP-PRP and HA groups.

Conclusion: Intraarticular injections of LP-PRP showed better overall outcomes, such as WOMAC total scores, WOMAC physical function scores, VAS scores, and IKDC scores, compared with HA for adult patients with knee osteoarthritis at 6- and 12-month follow-up periods. Also, LP-PRP showed better pain relief compared with HA at 3-, 6-, and 12-month follow-up periods. Intraarticular LP-PRP improves pain relief and overall outcomes in patients with knee osteoarthritis.

Background: The need for total knee arthroplasty (TKA) and spinal fusion (SF) for degenerative spine disease (DSD) is increasing. However, it is still unknown if prior SF for DSD impacts outcomes following TKA. This study aims to fill this gap by comparing the risk of complications and revisions in patients undergoing TKA with DSD between patients with and without SF.

Methods: This study is a retrospective review of the PearlDiver Mariner Database between 2010 and 2020. On the basis of whether or not patients had had prior SF, the patients undergoing TKA were divided into two groups: patients with DSD and SF and patients with DSD and without SF. The two groups were matched on the basis of age, gender, the Charlson Comorbidity Index (CCI), and obesity. Surgical complications (mechanical loosening, prosthetic dislocation, periprosthetic fractures, and stiffness) and revisions at 1, 2, and 3 years were compared between the groups.

Results: The patients in the TKA with DSD and no SF cohort were older (64.9 ± 8.4 versus 63.3 ± 8.1 years, p < .001), had higher CCI (2.0 ± 2.2 versus 1.6 ± 2.0, p < .001), and had a lower rate of obesity (58.7% versus 61.7%, p < .001). After being matched, 8887 patients remained in each group. There was a higher rate of stiffness and manipulation under anesthesia (MUA) in the no-fusion cohort at 1 year (0.7% versus 0.1%, p < .001; and 0.5% versus 0.2%, p < .001, respectively), 2 years (1.2% versus 0.5%, p < .001; and 1.1% versus 0.6%, p < .001, respectively), and 3 years (1.7% versus 0.7%, p < .001; and 1.6% versus 0.9%, p < .001, respectively).

Conclusions: This study shows no increase in risk of surgical complications and revisions after TKA in patients with DSD and SF compared with patients without SF. Notably, SF was shown to be protective of stiffness and MUA after TKA in patients with DSD.