Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

Introduction: This study aimed to assess the feasibility of using mobile application (app) technology for monitoring recovery after knee osteotomy and to determine the time required for patients to return to their preoperative step counts.

Methods: This retrospective study included 329 patients who underwent coronal realignment surgery, including high tibial osteotomy (HTO) or distal femoral osteotomy (DFO) with a minimum follow-up of 1 year. The patients were grouped based on the type of osteotomy performed, i.e., HTO and DFO groups. Step count data were collected using the MyRecovery app and analyzed preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. Statistical analyses included univariate linear regression models to assess the relationship between step counts at each time point and the duration required to return to their preoperative step counts.

Results: Of the 329 patients included in the study, a total of 62 patients (19%) downloaded the app and 24 patients (7%) had complete step count data. Of the 24 patients with complete data, 18 were included in the HTO group and 6 were included in the DFO group. It took patients an average of 153 ± 112 days to return to their preoperative step counts, with the patients in the HTO group taking 174 ± 121 days and those in the DFO group taking 113 ± 77 days. Step counts increased significantly over time, with percentages of preoperative step counts reaching 108% at 12 months postoperatively. A significant correlation was found between step counts at 3 months postoperatively and the time to return to preoperative step counts (R² = 0.240, P = 0.015).

Discussion: This study found that patients took approximately 5 months to return to their preoperative step counts after knee osteotomy. However, the adoption of the app was limited, with only 19% of patients downloading the app and just 7% providing complete data, posing a significant barrier to the feasibility of mobile apps for tracking recovery.

Conclusion: The mobile app is effective for tracking recovery progress following knee osteotomy, but strategies to increase patient adoption are essential for enhancing its practical application.

Level of evidence: Level IV, Retrospective Case Series.

Introduction: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure in alleviating pain and restoring function. However, there is limited published literature of the outcomes of this procedure and the ability to return to sport in elite athletes. This study aims to assess the outcomes of first MTPJ arthrodesis in the elite athlete population and their ability to return to professional sport.

Methods: A single-center prospective case series of elite athletes undergoing first MTPJ arthrodesis between 2004 and 2016 was conducted. Patients were assessed a minimum of 2, 6, 12 weeks and 1-year post-operation and at final follow-up. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Visual Analogue Scale (VAS) scores and assessing satisfaction.

Results: 16 elite athletes with a mean age of 27 years (range 19-32, 81%) and mean follow-up of 81 months (range 60-121 months) were included. At 1-year post-operation, 12 (75%) athletes returned to their original level of sport. Of the 4 unable to return, two soccer players dropped a division, an ATP tennis player never regained his original ranking, and a badminton player was unable to return to the same level of competition. Mean VAS scores improved from pre-operation to final follow-up (5.6 to 0.4, p < 0.001). All FAOS subscores showed significant improvement from pre-operation to final follow-up (all p < 0.05). All (100%) athletes were either very satisfied or satisfied at final follow-up.

Conclusion: To our knowledge this is the first study investigating return to elite level sport post first MTPJ arthrodesis. Our results confirm that a significant majority will return to their elite level of sport post operatively. Improved clinical outcomes and pain reduction was achieved in all patients.

Level of evidence: IV LEVEL OF EVIDENCE: V.

Importance: Osteochondral lesions of the talus (OLT) with an osteochondral fragment are amendable for fixation. Fixation aims to stabilize the osteochondral fragment while retaining the native cartilage. Though fixation for OLT is a promising treatment, no systematic overview of the literature on its efficacy and safety exists.

Aim: The primary aim of the present study is to assess the clinical success rate of fixation for OLT. The secondary outcomes concern the union rate and adverse events.

Evidence review: A systematic literature search of PubMed, Embase (Ovid), and Cochrane Library was performed up to December 2023. The methodological quality of the included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. The primary outcome the clinical success rate following fixation was pooled using a random effects model with 95% confidence interval (95%-CI). Success was predefined based on cut-off values for commonly used patient- or physician-reported outcome measures. Secondary outcomes concerned the union rate, complication rate, and revision rate.

Findings: A total of 10 studies with 241 ankles were included at a mean follow-up of 40 months. 88% of lesions were chronic in nature, and 12% acute. In total, 9 non-comparative studies had a mean MINRORS score of 10.3 (range: 6 - 14) out of 16 points and 1 comparative study had and a MINRORS score of 20 of 24 points. The pooled clinical success rate was 91% [95%-CI: 81% - 96%]. The pooled union rate was 91% [95%-CI: 87% - 94%]. The addition of biological adjuncts in the form of autologous bone-grafting did not show a statistically superior success rate. The pooled complication and revision rate were 1% [95%-CI: 0 - 4] and 6% [95%-CI: 0% - 4%], respectively.

Conclusion and relevance: Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients. Moreover, fragment union is achieved in 9 out of 10 patients, with a low reported complication rate. These findings show that when a symptomatic OLT is fixable physicians should consider fixation.

Level of evidence: IV.

Purpose: To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction.

Methods: Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores.

Results: 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up.

Conclusions: At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis.

Level of evidence: IV, Case Series.

Objectives: To compare the biomechanical strength and stiffness of the native posteromedial and posterolateral meniscotibial ligament complex (MTLC) to suture anchor repair of the MTLC.

Methods: Biomechanical testing was performed on 24 fresh-frozen pediatric human knees. Four conditions were tested: native posteromedial MTLC (n=14), native posterolateral MTLC (n=14), posteromedial MTLC repair (n=5), and posterolateral MTLC repair (n=5). Load-to-failure and stiffness were measured for all conditions.

Results: The load-to-failure for the posteromedial suture anchor construct was significantly higher than the native MTLC (p < 0.01). The posterolateral suture anchor construct had a significantly greater stiffness than the native MTLC (p = 0.03). Posterolateral MTLC load-to-failure and posteromedial MTLC stiffness were similar between native tissue and suture-anchor repair. All native MTLC failed at the meniscus-MTLC interface. The suture anchor groups had various failure modes, including suture pullout and breakage.

Conclusion: Suture anchor fixation can match or exceed the native tissue's load-to-failure. This study supports the viability of suture anchor-based posterior MTLC repairs of the medial and lateral meniscus in pediatric bone.

Objectives: We have previously shown that ultrasound-guided repair results in an accurate anchor placement and restores ankle joint stability using cadaveric models. The objective is to assess the safety and clinical outcomes of ultrasound-guided ATFL repair with or without augmentation.

Methods: Forty-nine patients with chronic lateral ankle instability underwent ultrasound-guided ATFL repair with or without augmentation. Following the procedure, patients completed a standardized post-operative rehabilitation protocol. The primary outcome was the complication rate in 49 subjects. The clinical outcomes were analyzed as a secondary outcome for 28 patients (20 athletes and 8 non-athletes) after excluding 21 subjects with such concomitant injuries that could affect clinical course. These included (1) Numerical Rating Scale (NRS) for pain, (2) Foot and Ankle Outcome Score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale (a Japanese equivalent of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot score), and (4) Self-Administered Foot Evaluation Questionnaire Sports (SAFE-Q Sports) score at baseline, 3 months, and 6 months.

Results: The overall complication rate was 2.0% with one superficial peroneal nerve irritation out of 49 cases, which was improving at 6 months. All 4 clinical outcome scores resulted in statistically significant improvement at 6 months. NRS decreased from 3.6 ± 2.1 at baseline to 1.3 ± 1.6 (p < 0.001, student's t-test). FAOS increased from 74.7 ± 11.9 to 93.4 ± 8.1 (p < 0.001). JSSF scale increased from 56.9 ± 15.1 to 90.9 ± 10.2 (p < 0.001). All 20 athletes returned to sports at a pre-injury level, and their SAFE-Q sports activity scores increased from 40.7 ± 17.6 to 90.6 ± 0.2 (p < 0.001).

Conclusion: Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months.

Evidence level: V.

Introduction: Chondromalacia patella (CMP) is characterized by cartilage degeneration, affects young adults, more women (2:1) and is responsible for 75% of knee pain complaints in the active population. The etiology is multifactorial and may be related to extrinsic factors (trauma and burden) and intrinsic factors (patellar malalignment and quadriceps weakness). Isokinetic dynamometry (ID) can aid in the detection of the causal factors of knee pain related to CMP.

Objectives: To evaluate and compare the parameters of the ID of individuals with and without CMP and correlate them with the clinical aspects of individuals with CMP.

Methods: This is a study retrospective that analyzed ID of the knee flexors and extensors, performed between 2013 and 2019 in the isokinetic dynamometry sector of the hospital. Six hundred ninety dynamometers tests were included, both sexes, aged between 14-59 years, divided into Chondromalacia Group (342) tests and Control Group (348) tests. All performed ID in concentric mode for knee extension and flexion, with five maximum repetitions at an angular speed of 60º/s and 180º/s and 20 repetitions at an angular speed of 300º/s, with 30-second intervals between each. After completing the test, the patient points out a number from 0 - 10 on the visual analog scale, regarding the presence and intensity of pain during and after the isokinetic assessment.

Results: The groups similar distribution from sex (P=0.071); age (P=0.99), but were different about pain (P<0.001). CMP had greater levels of pain. In most of the muscle parameters of the extensors and flexors at 60°/s were lower in the CMP Group (P<0.001).

Conclusion: The main predictor of chondromalacia is pain. The greater coeffcient of variability and time to reach peak torque on the involved side, the average power and morphology of the extensor curve can also be predictor of chondromalacia.

Level of evidence: III.