Knee Surgery and Related Research最新文献

Background: Nonanatomical anterior cruciate ligament (ACL) reconstruction occasionally induces ACL failure without an evident injury episode, necessitating revision surgery. Although the in vivo kinematics of ACL deficiency before primary ACL reconstruction are well documented, the kinematics of ACL failure after nonanatomical reconstruction remain unexplored. The aim of this study is to investigate ACL failure kinematics following nonanatomical reconstruction.

Patients and methods: This study enrolled three patients with ACL failure after nonanatomical reconstruction, 20 normal and 16 ACL-deficient knees. The anteroposterior (AP) translation of the medial and lateral femoral condyles and center of the femur and femoral rotation relative to the tibia during squatting were evaluated using a two- to three-dimensional registration technique under fluoroscopy.

Results: Medial AP translation of the nonanatomically reconstructed knee in one patient showed posterior location and abnormal kinematics compared with the ACL-deficient knees. In contrast, the lateral AP position of the nonanatomically reconstructed knees in two patients were more posteriorly located and showed more abnormal kinematics than the ACL-deficient knees. Central AP translation of the nonanatomically reconstructed knees in two patients was located more posteriorly throughout the range of midflexion. Femoral rotation of the nonanatomically reconstructed knees showed abnormal kinematics compared with that of the normal and ACL-deficient knees.

Conclusions: By independently assessing the medial and lateral aspects of the femur, the medial or lateral condyle of the femur of nonanatomically reconstructed knees exhibited a more pronounced abnormality compared with ACL-deficient knees. The femur of the nonanatomically reconstructed knees showed abnormal rotational kinematics. Considering the kinematic aspect, nonanatomical ACL reconstruction should be avoided.

Background: Patellar tendinopathy, also known as jumper's knee, can significantly impact the quality of daily life for patients due to the associated pain. A randomized controlled trial was investigated the clinical, sonographic, and serum cytokine markers in patellar tendinopathy of athletes following platelet-rich plasma (PRP) or PRP with extracorporeal shockwave therapy (ESWT) treatments. Our aims to investigate and compare therapeutic effects of PRP versus a combination of PRP with ESWT for treating patellar tendinopathy.

Methods: A total of 33 athletes with patellar tendinopathy were randomized into two groups. PRP + Sham (PS) group received intraarticular injection of autologous PRP (5 mL) once and sham ESWT. PRP + ESWT (PE) group received intraarticular injection of autologous PRP once and after 1 week ESWT (0.2 mJ/mm² energy flux density, 1350 impulses, 4 Hz) once. All patients were followed up for 1 year.

Results: Autologous PRP injection and its combination with ESWT are both effective treatments for chronic patellar tendinopathy in athletes. PRP combined with ESWT resulted in faster reduction of knee pain than PRP alone at the 1-month follow-up. Serum IL-33 showed no significant difference at the 12-month follow-up. Levels of interleukin (IL)-6, IL-15, and IL-17 increased at the 12-month follow-up, potentially due to the additional training. However, the athletes did not report any discomfort or injuries, and no abnormalities were detected by ultrasonography after study. We demonstrated improvements in pain and functional scores, as well as knee injury protection in athletes, following 12 months of PRP and PRP with ESWT treatments.

Conclusions: The study analyzed the therapeutic effect of PRP injection alone and combining PRP injection with ESWT for chronic patellar tendinopathy. Our results showed that combined treatment can facilitate the pain relief early than PRP alone and is a safety treatment modality. No adverse effect was noted in our study. Trial registration Research registry and the registration number is researchregistry9518. Registered 14 September 2023. https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650263e4f549fd00282a338c/ . The level of evidence is level II.

Background: Body fluid retention after major surgeries, including total knee arthroplasty (TKA), is well documented in the literature. Currently, multimodal pain control protocols consisting of several medications together with early discharge protocol may magnify this adverse event after a patient's discharge. However, no study has focused on the quantitative and chronological changes in body fluids following modern pain management protocols for TKA. The aim of this study was to investigate the perioperative total body water (TBW) change in patient undergoing TKA.

Patients and methods: A consecutive series of 85 patients undergoing primary unilateral TKA, with uniform hospital admission, multimodal pain control, and rehabilitation protocol, had five consecutive multifrequency bioelectrical impedance analysis (BIA) scans; baseline, postoperative day 1 (POD 1), postoperative day 3 (POD 3), 2 weeks, and 6 weeks. Changes in TBW, body weight, corticosteroid-fluid retention dose-response relationship, and complications were evaluated.

Results: Seventy patients completed all five scans and follow-ups. Female patients were dominant, with a mean age of 69.5 years. There were no perioperative complications. At 24 h, the mean total fluid input and output were 3695.14 mL and 1983.43 mL, respectively, with 1711.71 mL increments and a mean accumulative dosage of dexamethasone of 15.14 mg. The mean TBW increased by 2.61 L on POD 1 and continued to peak at 3.2 L on POD 3, then gradually decreased at 2 weeks and reached the baseline level at 6 weeks postoperatively. Similarly, the mean body weight increased to 2.8 kg on POD 1, reached the maximum point at 3.42 kg on POD 3, and returned to baseline at 6 weeks.

Conclusions: Fluid retention following multimodal pain control in TKA increased from POD 1, peaked on POD 3, and gradually returned to the baseline at 6 weeks. With early discharge protocol, patient education regarding fluid retention after discharge should be considered.

Background: Septic arthritis is a rare but devastating complication after anterior cruciate ligament reconstruction (ACLR). While early treatment can prevent significant graft complications, outcomes are often inferior to those in uncomplicated ACLR. Furthermore, whether to retain or remove the graft after infection remains debatable. Therefore, we sought to compare the outcomes of septic arthritis post ACLR with uncomplicated ACLR and evaluate graft retention versus removal in infected patients.

Methods: We conducted a systematic review and meta-analysis in which PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they compared patient-reported, clinician-reported, or radiographic outcomes (minimum follow-up of 12 months) between patients with post-ACLR septic arthritis and those with uncomplicated ACLR or that compared graft retention and removal in patients with post-ACLR septic arthritis.

Results: Thirteen studies were retrieved. Patients with post-ACLR septic arthritis reported inferior Lysholm Knee Scoring Scale scores (mean difference (MD) 7.53; 95% confidence interval (CI) 3.20-11.86; P = 0.0006), Tegner Activity Scale scores (MD, 1.42; 95% CI 1.07-1.76; P < .00001), and return to sports rates (53% versus 76%, respectively) to those of patients with uncomplicated ACLR. Patients with post-ACLR septic arthritis and those with uncomplicated ACLR did not differ in terms of the pooled estimate of various clinician-reported outcomes, such as the objective International Knee Documentation Committee score, anterior-posterior laxity, pivot shift, and Lachman test results. Furthermore, no significant difference was noted between the aforementioned patient groups regarding osteoarthritis (detected radiographically). Graft retention led to better patient- and clinician-reported outcomes than graft removal.

Conclusions: Despite similar clinician-reported outcomes and osteoarthritis rates, patients with post-ACLR septic arthritis reported worse outcomes than those with uncomplicated ACLR. Graft retention leads to improved patient- and clinician-reported outcomes compared with the outcomes of graft removal. Our findings may help develop realistic expectations and management strategies for this rare complication.

Background: Knee arthroscopy is one of the most common procedures performed by orthopedic surgeons. A potentially life-threatening complication following this procedure is deep vein thrombosis (DVT). DVT prophylaxis can be obtained both mechanically (e.g., compression stockings) and chemically (e.g., aspirin, anticoagulants, and factor Xa inhibitors). Currently, there is no standardized guideline for DVT prophylaxis following knee arthroscopy. The purpose of this systematic review was to summarize how DVT prophylaxis is employed for patients who undergo knee arthroscopy.

Methods: PubMed, Embase, and Cochrane Library were searched for studies published after 1998 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated DVT prophylaxis regimens in patients of any age who underwent knee arthroscopy. Studies not written in English, that analyzed animals or cadavers, that did not directly evaluate patients undergoing knee arthroscopy, or that did not address DVT prophylaxis were excluded.

Results: The initial search identified 300 studies, 15 of which were included. These 15 studies examined methods of DVT prophylaxis, including compression stockings (2 of 18; 11%), aspirin (1 of 18; 6%), factor Xa inhibitors (2 of 18; 11%), low-molecular-weight heparin (12 of 18; 67%), and neuromuscular electrical stimulation (1 of 18; 6%). Overall, 7 of 15 (47%) studies recommended DVT prophylaxis in all patients, and 3 (20%) studies supported its use for high-risk patients. Five (33%) studies did not support DVT prophylaxis, citing low incidence of postoperative DVT.

Conclusions: Compression stockings, aspirin, factor Xa inhibitors, and low-molecular-weight heparin (LMWH) were identified as possible options for DVT prophylaxis in patients undergoing knee arthroscopy. For high-risk knee arthroscopy patients, factor Xa inhibitors and LMWH drugs are appropriate for DVT prophylaxis. Level of evidence Level III, systematic review of level I-III studies.

Purpose: This study aimed to investigate the sequential changes in patient-reported outcome measures (PROMs) and the satisfaction rate during long-term follow-up after total knee arthroplasty (TKA).

Methods: Studies published until December 2023 were searched in MEDLINE, EMBASE, SCOPUS and Cochrane Library. The inclusion criteria were TKA as the primary procedure, a final post-operative follow-up period of at least seven years and reporting of PROMs data. The exclusion criteria were studies not reporting serial data of the same patient cohort, studies without mid-term data, comparative studies and reviews, comments or practice guidelines. Heterogeneity was assessed with the I² and tau² statistics. The quality of each study was evaluated using the methodological index for non-randomized studies (MINORS) criteria. The follow-up periods were divided into short-term, mid-term and long-term. Data were synthesised by narrative reviews and random-effects meta-analysis using standardised mean difference.

Results: Among the 13 studies included in the review, six were included in the meta-analysis. The overall PROMs were maintained until the mid-term (0.14; 95% CI [confidence interval], -0.05 to 0.34; I² = 96%; tau² = 0.10; P = 0.16), but declined in the long-term (-0.23; 95% CI -0.34 to -0.13; I² = 88%; tau² = 0.04; P < 0.0001). According to the subgroup analysis, pain improved from the short-term to mid-term (0.21; 95% CI 0.14 to 0.29; I² = 0%; tau² = 0). Subscales including function (-0.28; 95% CI -0.52 to -0.03; I² = 94%; tau² = 0.09) and objective measure (-0.23; 95% CI -0.31 to -0.15; I² = 62%; tau² = 0.01) declined from the mid-term to long-term. The patient satisfaction rate remained consistent throughout the study period.

Conclusions: The overall PROMs after TKA were maintained, with improvement observed in the pain subscale until the mid-term follow-up. However, in the long-term, overall PROMs, including function and objective measure, declined compared with those in the mid-term. Despite the decline in the physical aspects of PROMs over the long-term follow-up period, the patient satisfaction rate remained consistently high throughout the study period. Providing this information to patient pre-operatively may assist in establishing realistic expectations. Trial Registration This research was registered at PROSPERO (registration number: CRD42024578579).

Background: Due to non-vascularized and aneural structure, articular cartilage has limited self-repairing capacity. The aim of this study was to investigate the revitalization of inflammatory injured articular cartilage matrices by human nasal chondrocytes (hNC).

Materials and methods: Cartilage matrix was prepared by devitalization of articular cartilage samples obtained intraoperatively from an adult patient undergoing knee joint replacement. hNC were obtained from native tissues by enzymatic digestion with further expansion over two passages. The obtained nasal chondrocytes were used to seed decellularized scaffolds, which were then cultured in vitro for 7, 14, or 21 days in chondrogenic medium. Migration was observed by histologic staining with fast green, safranin-O, and hematoxylin and scanning electron microscopy. Biochemical analysis was performed to determine the glycosaminoglycan (GAG) and DNA content of the cartilage using dimethylmethylene blue and CyQuant Cell Proliferation Assay Kit.

Results: We seeded healthy and inflamed cartilage with nasal chondrocytes and found that the cells actively invade mainly pathologically altered cartilage. The results of biochemical quantitative analysis showed that the amount of DNA significantly increased by day 7 and decreased by day 14, while the quantitative values of GAGs had the opposite trend. Histological staining showed that cartilage formation occurred on day 7, intercellular spaces were filled with de novo synthesized cartilage matrix with significantly low GAG content on day 14, and newly formed GAG-rich cartilage was observed on day 21. The obtained data on cartilage regeneration were confirmed by scanning electron microscopy.

Conclusions: Our preliminary results showed that human nasal chondrocytes are capable of infiltrating the pathologically altered extracellular matrix of articular cartilage damaged by arthritis, thereby promoting its repair to a physiologically relevant state.

Background: The aim of this study was to compare the clinical and radiologic results of the arthroscopic and the open trochleoplasty techniques.

Methods: A total of 83 trochleoplasties in 83 patients were performed between 2014 and 2021 in one institution. Surgical indications for trochleoplasty were recurrent patellofemoral instability and a lateral trochlear inclination angle (LTI) ≤ 11˚ and a trochlear depth ≤ 6 mm. Of the trochleoplasties, 40 were done by open technique (OT) and 43 by arthroscopic technique (AT). In every case an additional medial patellofemoral ligament (MPFL) reconstruction was performed. Additional tuberosity tibia transfer and/or de-rotation of the femur were done when indicated. Pre- and postoperative magnetic resonance imaging (MRI) were analyzed in respect to LTI, trochlear depth, and lateralization of the patella. Postoperative subjective clinical assessment was done using the Kujala Score, Banff II Score, Tegner Score, and Marx Score.

Results: Of the patients, 15 with OT and 20 with AT were available for follow-up. The mean follow-up was 29.9 months in the OT group and 12.7 months in the AT group. No re-dislocation was observed in either groups. A significant reduction of LTI, increase of trochlear depth, and a reduction of lateralization of the patella was observed between the pre- and postoperative MRI scans in both groups. No significant difference in the observed MRI parameters was found between the two groups. Neither was there a difference in the postoperative Kujala Score, Banff II Score, Tegner Score, and Marx Score between the two groups. Length of stay was on average 6.2 days in the AT group and 8.1 days in the OT group. The surgical time was on average 141 min in the OT group and 160 min in the AT group.

Conclusion: We found that patients undergoing an arthroscopic trochleoplasty had a comparable outcome with respect to clinical and radiological parameters compared with patients treated by open trochleoplasty.

Background: Precise lower limb measurements are crucial for assessing musculoskeletal health; fully automated solutions have the potential to enhance standardization and reproducibility of these measurements. This study compared the measurements performed by BoneMetrics (Gleamer, Paris, France), a commercial artificial intelligence (AI)-based software, to expert manual measurements on anteroposterior full-leg standing radiographs.

Methods: A retrospective analysis was conducted on a dataset comprising consecutive anteroposterior full-leg standing radiographs obtained from four imaging institutions. Key anatomical landmarks to define the hip-knee-ankle angle, pelvic obliquity, leg length, femoral length, and tibial length were annotated independently by two expert musculoskeletal radiologists and served as the ground truth. The performance of the AI was compared against these reference measurements using the mean absolute error, Bland-Altman analyses, and intraclass correlation coefficients.

Results: A total of 175 anteroposterior full-leg standing radiographs from 167 patients were included in the final dataset (mean age = 49.9 ± 23.6 years old; 103 women and 64 men). Mean absolute error values were 0.30° (95% confidence interval [CI] [0.28, 0.32]) for the hip-knee-ankle angle, 0.75 mm (95% CI [0.60, 0.88]) for pelvic obliquity, 1.03 mm (95% CI [0.91,1.14]) for leg length from the top of the femoral head, 1.45 mm (95% CI [1.33, 1.60]) for leg length from the center of the femoral head, 0.95 mm (95% CI [0.85, 1.04]) for femoral length from the top of the femoral head, 1.23 mm (95% CI [1.12, 1.32]) for femoral length from the center of the femoral head, and 1.38 mm (95% CI [1.21, 1.52]) for tibial length. The Bland-Altman analyses revealed no systematic bias across all measurements. Additionally, the software exhibited excellent agreement with the gold-standard measurements with intraclass correlation coefficient (ICC) values above 0.97 for all parameters.

Conclusions: Automated measurements on anteroposterior full-leg standing radiographs offer a reliable alternative to manual assessments. The use of AI in musculoskeletal radiology has the potential to support physicians in their daily practice without compromising patient care standards.

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.