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Intra-articular injection of a cross-linked hyaluronic acid combined with triamcinolone hexacetonide improves pain at six months in patients with mild to moderate hip osteoarthritis: A prospective observational study 关节内注射交联透明质酸联合曲安奈德可在 6 个月后改善轻度至中度髋关节骨性关节炎患者的疼痛:一项前瞻性观察研究。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-11-14 DOI: 10.1016/j.jisako.2024.100363
The Prospective Evaluation of the Cingal™ Injection for Hip Osteoarthritis (ECHO) Investigators

Objectives

Joint-preserving interventions, such as intra-articular viscosupplementation injections, are evolving and requiring efficacy and safety evaluations through an evidence-based approach. The objective of this study was to assess the use of a hyaluronic acid and corticosteroid-based injection (Cingal™; Anika Therapeutics, Bedford, MA, USA) in improving pain and functional outcomes for patients aged between 40 and 65 with mild to moderate hip osteoarthritis (OA) six months post-injection.

Methods

This prospective observational study included 100 patients receiving a single ultrasound-guided intra-articular injection of Cingal™. Eligible patients seen in participating orthopaedic, physiatry and sports medicine clinics were evaluated at baseline, one-month, and six-month follow-up. The primary outcome was patient-reported hip pain (Visual Analogue Scale, VAS) at six months post-injection. Secondary outcomes included hip function (Hip Disability and Osteoarthritis Outcome Score, HOOS), quality of life (Short-Form 12, SF-12), pain medication use, range of motion (ROM), physical activity (activity tracker), and adverse events.

Results

Ninety-six patients received the injection; 91 had complete data for primary outcome analysis. Statistically significant improvements were observed in VAS (p ​< ​0.001), HOOS (p ​< ​0.001), and SF-12 scores (Physical Component Summary, p ​= ​0.005; Mental Component Summary, p ​= ​0.022) from baseline to six months post-injection. Pain medication use decreased from 50.0% to 34.0% (p ​= ​0.035). No statistically significant change was observed in ROM or activity level. Adverse events were reported in 9.5% of patients: five (5.3%) experienced hip pain for less than seven days, one for more than seven days but less than one month, and three (3.2%) underwent hip arthroplasty.

Conclusion

Patients receiving an ultrasound-guided Cingal™ injection for hip OA reported statistically significantly reduced hip pain, improved function and quality of life, and reduced pain medication use at six months. The most common adverse event was transient hip pain.

Level of Evidence

Prospective observational study, Level III.
目的:关节内粘弹性补充注射等关节保护干预措施正在不断发展,需要通过循证方法进行疗效和安全性评估。本研究旨在评估透明质酸和皮质类固醇注射剂(Cingal™;Anika Therapeutics,美国马萨诸塞州贝德福德)在改善 40 至 65 岁轻度至中度髋关节骨关节炎(OA)患者注射后 6 个月的疼痛和功能疗效方面的应用:这项前瞻性观察研究包括 100 名接受 Cingal™ 单次超声引导关节内注射的患者。在参与研究的骨科、理疗科和运动医学诊所就诊的合格患者分别在基线、一个月和六个月的随访期间接受了评估。主要结果是注射后六个月患者报告的髋关节疼痛(视觉模拟量表,VAS)。次要结果包括髋关节功能(髋关节残疾和骨关节炎结果评分,HOOS)、生活质量(短表 12,SF-12)、止痛药使用情况、活动范围(ROM)、体力活动(活动追踪器)和不良事件:结果:96 名患者接受了注射,其中 91 人的主要结果分析数据完整。结果:96 名患者接受了注射;91 名患者的主要结果分析数据完整:接受超声引导下 Cingal™ 注射治疗髋关节 OA 的患者在 6 个月后报告称,髋关节疼痛明显减轻,功能和生活质量得到改善,止痛药用量减少。最常见的不良反应是一过性髋关节疼痛:前瞻性观察研究,III 级。
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引用次数: 0
Ligamentous ankle injuries in relation to the morphology of the incisura fibularis: A systematic review 踝关节韧带损伤与腓骨结节形态的关系:系统回顾
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-11-05 DOI: 10.1016/j.jisako.2024.100361
Louise Wittouck , Ruben Vermeir , Matthias Peiffer , Wouter Huysse , Lauren Pringels , Nicolò Martinelli , Emmanuel Audenaert , Arne Burssens

Importance

Ligamentous ankle lesions are among the most frequent sports injuries. One of the key intrinsic stabilizers of the ankle joint is the incisura fibularis (IF), as it interlocks the distal tibia and fibula. Despite an abundant amount of studies related to ligamentous ankle injuries, scant attention has been given to the specific role of the IF morphology.

Objective

We systematically reviewed all literature focused on the relation between ligamentous ankle lesions and IF morphology.

Evidence review

A systematic literature search was conducted on PubMed, Embase, and Web of Science according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021282862). In general, search terms were related to ankle and syndesmosis trauma/instability in combination with morphology parameters of the IF. Studies categorizable as original research (randomized controlled trial or observational) were included. Studies concerning degenerative ankle disease and cadavers were excluded.

Findings

Thirteen studies were confirmed eligible and consisted of a prospective cohort (n ​= ​1), retrospective comparative (n ​= ​10), and observational (n ​= ​2) study design. Several studies have found an increased number of ankle ligament injuries and a higher incidence of chronic ankle instability in association with a shallow IF depth. In addition, statistically significant differences in incisura height and angle were also noted: a shorter incisura and more obtuse angle were more present in patients with ankle ligament injuries.

Conclusion and relevance

Most studies found distinct characteristics of the IF morphology associated with ligamentous ankle lesions, potentially due to lower osseous resistance against tibiofibular displacement. However, not all studies could identify this association and presented a heterogeneous methodological quality. Therefore, further prospective studies are warranted to clarify the relationship between the IF morphology and ligamentous ankle injuries.

Lever of evidence

Level III, systematic review.
重要性:踝关节韧带损伤是最常见的运动损伤之一。腓骨切迹(IF)是踝关节的主要内在稳定器之一,因为它将胫骨远端和腓骨连接在一起。尽管有大量与踝关节韧带损伤相关的研究,但很少有人关注腓骨切迹形态的具体作用:我们系统回顾了所有关于踝关节韧带损伤与 IF 形态之间关系的文献:根据系统性综述和荟萃分析首选报告项目(PRISMA)指南,我们在PubMed、Embase和Web of Science上进行了系统性文献检索,并在国际系统性综述前瞻性注册(PROSPERO)数据库(CRD42021282862)上进行了注册。一般来说,检索词与踝关节和巩膜创伤/不稳定性以及腓骨切迹的形态参数有关。可归类为原创性研究(随机对照试验或观察性研究)的研究均包括在内。有关踝关节退行性疾病和尸体的研究除外:经确认,13 项研究符合条件,包括前瞻性队列研究(1 项)、回顾性比较研究(10 项)和观察性研究(2 项)。多项研究发现,踝关节韧带损伤的数量和慢性踝关节不稳定的发生率与中频深度过浅有关。此外,切口高度和角度也存在统计学意义上的显著差异:踝关节韧带损伤患者的切口更短,角度更钝:大多数研究发现,与踝关节韧带损伤相关的 IF 形态具有明显的特征,这可能是由于胫腓骨移位时骨性阻力较低所致。然而,并非所有研究都能确定这种关联,而且研究方法的质量也参差不齐。因此,有必要进一步开展前瞻性研究,以明确中轴线形态与踝关节韧带损伤之间的关系:证据杠杆:三级,系统综述。
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引用次数: 0
Acute compartment syndrome of the leg following peroneus longus tendon graft harvesting: a case report 腓总肌腱移植术后腿部急性室间隔综合征:病例报告。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1016/j.jisako.2024.100360
Andre Giardino Moreira da Silva , Adriano Marques de Almeida , Camilo Partezani Helito , André Pedrinelli
Acute compartment syndrome is a rare donor-site complication of peroneus longus tendon graft harvesting. A case of leg compartment syndrome following peroneus longus tendon harvest for a revision anterior cruciate ligament reconstruction is described. Symptoms began on the first day after surgery, including intense pain in the lateral aspect of the leg and dorsum of the foot and motor and sensory deficits of the common peroneal nerve. Emergency decompressive fasciotomy was necessary. The patient presented a complete resolution of symptoms and neurological deficit 24 days after surgery. Surgeons harvesting this graft should keep in mind the possibility of this complication in case of unusual pain in the early postoperative period so that they can quickly diagnose and treat this threatening condition.
急性腿室综合征是一种罕见的腓骨肌腱移植术供体部位并发症。本报告描述了一例腓骨长肌腱移植用于前交叉韧带翻修重建术后的腿部室间隔综合征病例。症状始于术后第一天,包括腿部外侧和足背剧烈疼痛以及腓总神经的运动和感觉障碍。必须进行紧急减压筋膜切开术。术后 24 天,患者的症状和神经功能缺损完全消失。采集这种移植物的外科医生应该牢记,如果术后早期出现异常疼痛,就有可能出现这种并发症,以便能够迅速诊断和治疗这种威胁性疾病。
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引用次数: 0
MCL pie crusting for concomitant medial meniscal surgery does not appear to adversely influence primary ACL reconstruction functional outcomes 同时进行内侧半月板手术的 MCL 饼结痂似乎不会对初级前交叉韧带重建的功能结果产生不利影响。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1016/j.jisako.2024.100359
Ayman Gabr , James Robinson

Objectives

Medial collateral ligament “pie-crusting” (MCLPC), selective release of the superficial MCL, has been shown to improve the arthroscopic access to the posterior horn of the medial meniscus without adversely affecting the outcomes of isolated meniscal surgery. However, whether MCL PC, to address concomitant meniscal lesions during anterior cruciate ligament reconstruction (ACLR) surgery, adversely affects ACLR outcomes is unknown. The aim of this study was to assess whether patients who had undergone MCLPC at the time of ACLR had similar post outcomes to patients undergoing isolated ACLR.

Methods

55 consecutive patients (33 male and 22 female), with minimum 2-year follow-up, who had undergone MCLPC with concomitant primary ACLR (PC group) were retrospectively matched on the basis of age, sex and follow-up with 55 patients who underwent isolated primary ACLR. Post-operative outcome measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, Tegner activity score, the EuroQol five-dimension health questionnaire and EuroQol visual analogue scale.

Results

The two groups’ median postoperative EQ 5D-VAS, EQ 5D-index and Tegner scores were similar. The difference between pre-operative and post-operative KOOS scores was similar for the two group for all subscales except the ADL subscale which was higher in the MCLPC group (24, IQR ​= ​6–32) than in the isolated ACLR group (5, IQR ​= ​0–9.74). The median post op IKDC score was 84 in the MCLPC group and compared with 90 in the isolated ACLR group. However, the difference between pre-operative and post-operative IKDC scores was higher in patients in the MCLPC group (40, IQR ​= ​25–49) than in the isolated ACLR group (32, IQR ​= ​19.6–46.8).

Conclusions

MCLPC, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes.

Level of evidence

IV.
目的:内侧副韧带 "饼状壳"(MCLPC),即选择性松解内侧副韧带,已被证明可改善关节镜下内侧半月板后角的入路,而不会对孤立的半月板手术效果产生不利影响。然而,在前交叉韧带重建(ACLR)手术中,MCL PC 用于处理并发的半月板病变是否会对 ACLR 的疗效产生不利影响,目前尚不清楚。本研究的目的是评估在前交叉韧带重建手术时接受 MCLPC 的患者是否与接受孤立前交叉韧带重建手术的患者具有相似的术后效果。方法:根据年龄、性别和随访情况,将 55 名接受 MCLPC 并同时接受原发性前交叉韧带重建手术的连续患者(33 名男性和 22 名女性)(PC 组)与 55 名接受孤立原发性前交叉韧带重建手术的患者进行回顾性配对。术后结果测量指标(PROMs)包括膝关节损伤和骨关节炎结果评分、国际膝关节文献委员会评分、Tegner活动评分、EuroQol五维健康问卷和EuroQol视觉模拟量表:结果:两组患者术后的 EQ 5D-VAS 中位数、EQ 5D 指数和 Tegner 评分相似。两组患者术前和术后的 KOOS 评分在所有分量表中的差异相似,但 ADL 分量表在 MCLPC 组(24,IQR= 6-32)高于孤立 ACLR 组(5,IQR= 0-9.74)。MCLPC 组术后 IKDC 评分中位数为 84 分,而孤立 ACLR 组为 90 分。然而,MCLPC组患者术前和术后IKDC评分的差异(40,IQR= 25-49)高于孤立前交叉韧带重建组(32,IQR=19.6-46.8):结论:在前交叉韧带置换术时进行MCLPC似乎不会对术后功能结果产生不利影响:证据级别:IV。
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引用次数: 0
Oblique or short incisions reduce the risk of saphenous nerve damage during hamstrings harvesting: A model for mapping nerve pathways at the harvest site 斜切口或短切口可降低腘绳肌切除术中隐神经损伤的风险。用于绘制采集部位神经通路的模型。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-11-01 DOI: 10.1016/j.jisako.2024.100358
Pierre-Henri Vermorel , Alban Stordeur , Sylvain Grange , Antonio Klasan , Rémi Philippot , Thomas Neri

Introduction

Hamstring autografts are frequently used for ligament reconstruction surgery. Between 12% and 84% of patients report hypoesthesia or dysaesthesia secondary to injury of the saphenous nerve or one of its branches after hamstring harvesting. Type of incision (orientation and length) is subject of much regarding limiting the risk of nerve damage. A cadaveric study was performed to determine which type of incision limits the risk of injury to the saphenous nerve or one of its branches, based on an anatomic model for mapping nerve pathways at the harvest site.

Methods

An anatomical study was performed on 20 knees from 12 embalmed bodies. Distance between saphenous nerve branches and 4 points of interest along the tibial crest was measured. Based on these measurements, a digital model of the saphenous nerve and its branches was created. A model of three common types of incision (vertical, horizontal and oblique) was overlaid. Each incision was modeled for three lengths (2, 3, and 4 ​cm). Percentage of collision between nerve course model and incision model was then calculated to determine the risk of nerve damage for each type of incision. Based on the nerve course model, a ‘low-collision-risk’ safe zone was identified.

Results

Nerve damage risk after an oblique incision was significantly lower than for a horizontal or vertical incision, for incision lengths of 3 and 4 ​cm (p ​< ​0.05). For a specific incision orientation, the length of the incision did not affect the risk of nerve damage. A trapezoidal space close to the tibial crest and distal to the anterior tibial tuberosity appears to reduce risk of nerve damage.

Conclusion

This cadaveric study suggests that during hamstring harvesting, incisions shorter than 2 ​cm reduce the risk of saphenous nerve's branches injuries. For incisions longer than 2 ​cm, using an oblique incision may reduce the risk compared to vertical or horizontal incisions.

Level of evidence

Level of evidence not applicable: Laboratory experiments.
简介腘绳肌自体移植物常用于韧带重建手术。有 12% 至 84% 的患者在腘绳肌自体移植术后描述了因隐神经或其分支损伤而导致的痛觉减退或失调。为了限制神经损伤的风险,切口类型(方向和长度)一直是争论的焦点。我们进行了一项尸体研究,以根据解剖模型确定哪种切口类型可降低损伤隐神经或其分支的风险,从而绘制切除部位的神经通路图:对来自 12 具防腐尸体的 20 个膝盖进行了解剖研究。测量了隐神经分支与沿胫骨嵴的 4 个兴趣点之间的距离。根据这些测量结果,建立了隐神经及其分支的数字模型。三种常见切口(垂直、水平和斜切)的模型被叠加在一起。每个切口有三种长度(2 厘米、3 厘米和 4 厘米)。然后计算神经走向模型与切口模型之间的碰撞百分比,以确定每种切口的神经损伤风险。根据神经走向模型,确定了 "低碰撞风险 "安全区:结果:在切口长度为 3 厘米和 4 厘米的情况下,斜切口的神经损伤风险明显低于水平切口或垂直切口(pConclusion):这项尸体研究表明,在截取腘绳肌时,短于 2 厘米的切口可降低隐神经分支损伤的风险。对于长于 2 厘米的切口,与垂直或水平切口相比,使用斜切口可降低风险:证据等级不适用:实验室实验。
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引用次数: 0
Trends in lateral extra-articular augmentation use and surgical technique with anterior cruciate ligament reconstruction from 2016 to 2023, an ACL study group survey 前交叉韧带研究小组调查:2016-2023 年前交叉韧带重建中侧向关节外扩创的使用和手术技术趋势。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-10-30 DOI: 10.1016/j.jisako.2024.100356
Ian Hollyer , Connor Sholtis , Galvin Loughran , Yazdan Raji , Muzammil Akhtar , Patrick A. Smith , Volker Musahl , Peter C.M. Verdonk , Bertrand Sonnery-Cottet , Alan Getgood , Seth L. Sherman , ACL Study Group

Purpose

To survey the ACL study group (ACLSG) members to determine the current practice patterns surrounding the use and methodology of lateral extra-articular procedures (LEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) during ACL reconstruction (ACLR).

Methods

A web-based questionnaire was distributed to members of the ACLSG during the 2016, 2018, 2020, and 2023 biennial meetings. Questions explored the indications and techniques when incorporating LEAPs in ACLR.

Results

Analysis of survey responses found that the reported use of LEAPs in both primary and revision ACLR increased between 2016 and 2023 and that surgeons were using lateral augmentation more frequently over time. Surgical techniques were stable across survey years, with most surgeons using iliotibial band (ITB) autograft attached at Gerdy's tubercle, passed under the lateral collateral ligament (LCL), and anchored proximal/posterior to the lateral femoral epicondyle.

Conclusion

Survey responses demonstrate that LEAPs are becoming more common among ACL surgeons in the ACL SG, with the modified Lemaire LET being the predominant technique. This aligns with recent clinical studies showing improved outcomes and reduced risk of failure in ACLR with lateral augmentation compared to ACLR alone.

Level of evidence

Level V, Expert Opinion.
目的:调查前交叉韧带研究小组(ACLSG)成员,以确定当前围绕侧关节外手术(LEAPs)的使用和方法的实践模式,包括前外侧韧带重建(ALLR)或前交叉韧带重建(ACLR)期间的侧关节外腱鞘切除术(LET):在 2016 年、2018 年、2020 年和 2023 年两年一度的会议期间,向 ACLSG 成员分发了一份网络问卷。问题探讨了在 ACLR 中采用 LEAP 的适应症和技术:对调查回复的分析发现,在 2016 年至 2023 年期间,初次和翻修 ACLR 中 LEAPs 的报告使用率显著增加,而且外科医生随着时间的推移更频繁地使用侧向增强。不同调查年份的手术技术保持稳定,大多数外科医生使用的髂胫束(ITB)自体移植物连接在Gerdy结节处,穿过外侧副韧带(LCL)下方,并固定在股骨外上髁近侧/后侧:调查结果显示,前交叉韧带外科医生在前交叉韧带SG中使用LEAP越来越普遍,而改良Lemaire LET是最主要的技术。这与最近的临床研究结果一致,这些研究显示,与单纯前交叉韧带置换术相比,前交叉韧带置换术中的外侧增强术可改善疗效并降低失败风险:证据级别:V 级,专家意见。
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引用次数: 0
Medial center of rotation and 90-degree lateral laxity improve patient-reported outcomes in posterior cruciate retaining total knee arthroplasty 内侧旋转中心和 90 度外侧松弛可改善后交叉韧带保留全膝关节置换术的患者报告结果。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-10-30 DOI: 10.1016/j.jisako.2024.100357
Takahiro Tsushima , Eiji Sasaki , Shizuka Sasaki , Kazuki Oishi , Yuka Kimura , Yukiko Sakamoto , Eiichi Tsuda , Yasuyuki Ishibashi

Objectives

Physiologic knee kinematics is crucial for successful total knee arthroplasty (TKA) but are often not replicated. Using a medial stabilizing technique (MST) minimizes bone resection but results in lateral laxity. This study aimed to investigate the effects of lateral laxity on knee kinematics and symptoms after TKA.

Methods

Mobile-bearing cruciate-retaining MST-TKA was performed on 40 knees using a navigation system. In the kinematic analysis, the anteroposterior (AP) translations of the medial femoral condyle (MFC) and lateral femoral condyle (LFC), femoral rotation angles, and medial and lateral component gaps were recorded every 0.1 ​s. These data were extracted from the software from 0° to 120° flexion in 10° increments. Kinematics was classified as the medial center of rotation (MCR) or non-MCR between 0° to 90° of flexion. Lateral laxity was calculated by subtracting the medial component gap from the lateral component gap. The final follow-up Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated. The relationships between the pre- and post-operative kinematics and between postoperative lateral laxity and kinematics were assessed using Spearman's correlation coefficients. Finally, the correlation between postoperative lateral laxity and KOOS symptoms was evaluated using linear regression analysis.

Results

Preoperative kinematics, including AP translation of the MFC and LFC and femoral rotation, correlated with postoperative kinematics (all P ​< ​0.001). Additionally, postoperative lateral laxity correlated with postoperative AP translation of the MFC, LFC, and femoral rotation (all P ​< ​0.001). Furthermore, the receiver operating characteristic analysis indicated a cutoff value of 0.9 ​mm on postoperative lateral laxity at 90° flexion for postoperative MCR (P ​< ​0.001). Postoperative lateral laxity at 90° flexion was significantly correlated with KOOS symptoms (β ​= ​0.465, P ​= ​0.025).

Conclusion

Preoperative kinematics and postoperative lateral laxity correlated with postoperative kinematics after MST-TKA. Postoperative lateral laxity greater than 0.9 ​mm at 90° flexion was associated with physiological kinematic motion, leading to fewer knee symptoms in the PROMs. The key to successful TKA was considered to be keeping the asymmetric gap balance with physiological lateral laxity, rather than the conventional symmetrical gap balance.

Level of Evidence Level III

Retrospective study.
目的:生理膝关节运动学是成功进行全膝关节置换术(TKA)的关键,但通常无法复制。使用内侧稳定技术(MST)可最大限度地减少骨切除,但会导致外侧松弛。本研究旨在探讨外侧松弛对膝关节运动学和 TKA 术后症状的影响:方法:使用导航系统对 40 个膝关节进行了移动支承十字韧带固定 MST-TKA 手术。在运动学分析中,每 0.1 秒记录一次股骨内侧髁(MFC)和股骨外侧髁(LFC)的前胸(AP)平移、股骨旋转角度以及内侧和外侧组件间隙。在屈曲 0° 至 90° 之间,运动学分为内侧旋转中心 (MCR) 和非 MCR 两类。外侧松弛度的计算方法是将内侧组件间隙减去外侧组件间隙。对最终的膝关节损伤和骨关节炎随访结果评分(KOOS)进行了评估。使用斯皮尔曼相关系数评估了术前和术后运动学之间的关系,以及术后外侧松弛和运动学之间的关系。最后,使用线性回归分析评估了术后侧方松弛与 KOOS 症状之间的相关性:结果:术前运动学(包括 MFC 和 LFC 的 AP 平移以及股骨旋转)与术后运动学相关(所有 P <0.001)。此外,术后外侧松弛与术后MFC、LFC的AP平移和股骨旋转相关(P均<0.001)。此外,接收器操作特征分析表明,术后 MCR 在屈曲 90° 时的侧方松弛度的临界值为 0.9 mm(P < 0.001)。术后90°屈曲时的外侧松弛度与KOOS症状显著相关(β = 0.465,P = 0.025):结论:术前运动学和术后侧向松弛与 MST-TKA 术后运动学相关。术后90°屈曲时侧方松弛度大于0.9毫米与生理性运动学运动相关,导致PROMs中膝关节症状较少。认为TKA成功的关键在于保持非对称间隙平衡和生理性侧向松弛,而非传统的对称间隙平衡:回顾性研究。
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引用次数: 0
Augmented suture pull-out with suture-button(triple fixation) yields less radiological residual laxity than suture pull-out technique-for Arthroscopic reduction and internal fixation of posterior cruciate ligament avulsion fractures. 后交叉韧带撕脱性骨折的关节镜复位和内固定术中,使用缝合扣(三重固定)的增强型缝合拉出技术比缝合拉出技术产生的放射学残留松弛更少。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-10-28 DOI: 10.1016/j.jisako.2024.100354
Rajagopalakrishnan Ramakanth, Sundararajan Silvampatti Ramasamy, Sameer Muhammed, Terence D Souza, Palaniswamy Arumugam, Shanmuganathan Rajasekaran

Objectives: Among numerous arthroscopic reduction and internal fixation (ARIF) techniques for displaced posterior cruciate ligament (PCL) avulsions, residual posterior laxity and non-unions are under reported and the optimal technique is still unclear. The objective of our study is to differentiate the outcomes of arthroscopic suture pull-out(SPO) versus augmented suture pull-out(ASPO) using suture button for acute displaced tibial PCL avulsion fractures.

Methods: Retrospective study of ARIF for displaced tibial PCL avulsion operated between 2015 to 2021.. Chronologically, initial group of patients had underwent SPO(Group I), while the later underwent ASPO(Group II). Assessment included-functional scores (IKDC(International Knee Documentation Committee),Lysholm and KOOS scores(Knee Injury and Osteoarthritis outcome score)), and radiological assessment (union and posterior tibial displacement (PTD)). Student's unpaired t test and Cohen's term d for Effect size was used to compare the groups. Intraclass-correlation-coefficient for assessing inter-observer-reliability.

Results: 64 patients-Group I(n=32),Group II(n=32) were compared. |Mean duration of surgery was 48.06 (±9.52) and 54.3 (± 6.97) in group I and II respectively (p=0.004(s)). At mean follow-up of 39.7months(SD-10.6) in Group I and 35.6months(SD-6.6) in Group II, there was a statistically significant improvement in postoperative-IKDC, Lysholm and KOOS scores(p< 0.001). However, there was no significant difference between the two groups with respect to functional outcomes (P >0.05). Effect size(Cohen's-d) was 0.47(medium for IKDC), 0.78(large for Lysholms), 0.05 (small for KOOS), 1.46 (large for PTD). Mean PTD measuring the residual posterior laxity was greater in Group I (7.25 mm)(SD-1.9) than Group II (4.5mm)(SD-2.1) and was statistically significant(P=0.001). There were two non-unions (6.6%) and one popliteal artery injury in Group I.

Conclusions: Both ASPO and SPO techniques result in comparable functional outcomes for ARIF of PCL avulsion fractures. However, augmented SPO with a suture button provides triple fixation and additional compression during ARIF of PCL avulsion fractures to mitigate residual posterior laxity on follow-up.

Level of evidence: Level III Retrospective cohort study.

目的:在治疗移位的后交叉韧带(PCL)撕脱的众多关节镜复位和内固定(ARIF)技术中,后方残余松弛和不连接的报道较少,最佳技术仍不明确。我们的研究旨在区分关节镜下缝合拉出(SPO)和使用缝合扣的增强缝合拉出(ASPO)治疗急性移位的胫骨 PCL撕脱骨折的效果:方法:对2015年至2021年期间手术治疗的移位性胫骨PCL撕脱骨折的ARIF进行回顾性研究。按照时间顺序,最初的一组患者接受了 SPO(第一组),而后来的患者接受了 ASPO(第二组)。评估包括功能评分(IKDC(国际膝关节文献委员会)、Lysholm评分和KOOS评分(膝关节损伤和骨关节炎结果评分))以及放射学评估(结合部和胫骨后移位(PTD))。采用学生非配对 t 检验和 Cohen's term d(效应大小)对各组进行比较。采用类内相关系数(Intraclass-correlation-coefficient)评估观察者间的可靠性:64例患者--I组(32例)、II组(32例)进行了比较。|第一组和第二组的平均手术时间分别为 48.06 (±9.52) 和 54.3 (±6.97) (P=0.004(s))。第一组平均随访 39.7 个月(SD-10.6),第二组平均随访 35.6 个月(SD-6.6),术后 IKDC、Lysholm 和 KOOS 评分均有显著改善(P< 0.001)。然而,两组在功能结果方面没有明显差异(P>0.05)。效应大小(Cohen's-d)为 0.47(IKDC 为中)、0.78(Lysholms 为大)、0.05(KOOS 为小)、1.46(PTD 为大)。测量残余后方松弛度的 PTD 平均值在第一组(7.25 毫米)(标清-1.9)大于第二组(4.5 毫米)(标清-2.1),具有统计学意义(P=0.001)。结论:ASPO 和 SPO 两种技术均可治疗膝关节损伤:ASPO和SPO技术对PCL撕脱性骨折的ARIF治疗效果相当。结论:ASPO和SPO技术在PCL撕脱性骨折的ARIF治疗中均可获得相当的功能性结果,但在PCL撕脱性骨折的ARIF治疗中,使用缝合扣的增强型SPO可提供三重固定和额外的压迫,以减轻随访时残留的后方松弛:证据级别:III级 回顾性队列研究。
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引用次数: 0
Editorial: Demystifying unicompartmental knee arthroplasty 社论:揭开单关节膝关节置换术的神秘面纱
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1016/j.jisako.2024.100351
Daniel C. Wascher
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引用次数: 0
The outpatient experience in unicompartmental knee arthroplasty: How to perform safely in the ambulatory surgery center 单间室膝关节置换术的门诊体验--如何在非卧床手术中心安全进行手术。
IF 2.7 Q1 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1016/j.jisako.2024.100350
Kevin D. Plancher , Geoffrey E. Braun , Stephanie C. Petterson
The number of outpatient unicompartmental knee arthroplasty (UKA) procedures has increased substantially over the last decade. The ambulatory surgery center (ASC) and hospital outpatient department provide a safe, cost-effective alternative with significant cost savings to the healthcare system. Advancements in technology and perioperative management strategies have expanded the number of eligible patients to optimize outcomes with a focus on safety. Therefore, this review will describe the safety, efficacy, economics, and perioperative protocols for performing UKA in an outpatient setting. Patient selection, risk factors, patient education and expectations, anesthesia, pain management strategies, and outcomes will be discussed.
过去十年间,门诊单间室膝关节置换术(UKA)的数量大幅增加。非卧床手术中心(ASC)和医院门诊部提供了一种安全、经济高效的选择,为医疗系统节省了大量成本。技术和围手术期管理策略的进步扩大了合格患者的数量,从而在注重安全的前提下优化了治疗效果。因此,本综述将介绍在门诊环境下进行 UKA 的安全性、有效性、经济性和围手术期方案。将讨论患者选择、风险因素、患者教育和期望、麻醉、疼痛管理策略和结果。
{"title":"The outpatient experience in unicompartmental knee arthroplasty: How to perform safely in the ambulatory surgery center","authors":"Kevin D. Plancher ,&nbsp;Geoffrey E. Braun ,&nbsp;Stephanie C. Petterson","doi":"10.1016/j.jisako.2024.100350","DOIUrl":"10.1016/j.jisako.2024.100350","url":null,"abstract":"<div><div>The number of outpatient unicompartmental knee arthroplasty (UKA) procedures has increased substantially over the last decade. The ambulatory surgery center (ASC) and hospital outpatient department provide a safe, cost-effective alternative with significant cost savings to the healthcare system. Advancements in technology and perioperative management strategies have expanded the number of eligible patients to optimize outcomes with a focus on safety. Therefore, this review will describe the safety, efficacy, economics, and perioperative protocols for performing UKA in an outpatient setting. Patient selection, risk factors, patient education and expectations, anesthesia, pain management strategies, and outcomes will be discussed.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100350"},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine
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