Journal of Experimental Orthopaedics最新文献

Radiographic acceptable zone of endobutton placement in ACL reconstruction: A prospective study 前交叉韧带重建术中内侧钮扣放置的X光片可接受区域：前瞻性研究

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-20 DOI: 10.1002/jeo2.70082

Arash Sharafatvaziri, Mohammad Tahami, Maryam Salimi, Hamid Rabie, Fardis Vosoughi, Morad Karimpour, Ghazaleh Moradkhani, Mosayeb Soleymani

Purpose

During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values.

Methods

Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards.

Results

Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X-ray, while body mass index had a significant relation with D3 (p < 0.05).

Conclusion

In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical.

Level of Evidence

Level III.

目的在前交叉韧带（ACL）重建的搬运技术中，隧道出口的位置可能因某些解剖和技术特征而有所不同。因此，我们旨在通过引入几种影像学数值来找出可接受的内疝位置区域。方法对 72 名患者的术后侧位X光片进行评估，测量从按钮中心到股骨后皮质（D1）和外侧髁最远点（D2）的距离。此外，还根据前胸（AP）X 光片，评估了从按钮中心到股骨外侧皮质（D3）的距离，以及从按钮中心到股骨内侧髁和外侧髁最远点连线（D4）的距离。为了测量每个放射学值（D1、D2、D3 和 D4）的敏感性和特异性，计算了接收者操作特征曲线下的面积。α角和股骨隧道长度值被视为金标准。结果分析表明，D1、D2、D3 和 D4 的平均值分别为 13.20 ± 0.54、39.44 ± 0.31、1.65 ± 0.15 和 42.66 ± 0.47 毫米。平均角度为 38.6 ± 0.3°，平均股骨隧道长度为 38.6 ± 0.2 mm。年龄与 D2 和 AP X 光股骨直径有明显关系，而体重指数与 D3 有明显关系（p < 0.05）。结论本研究提出了一种新方法，用于评估前交叉韧带重建手术术后解剖隧道放置的准确性。对测量变量的统计分析显示，D1、D2 和 D4 的平均比率分别为 21.79 ± 0.87、65.65 ± 0.63 和 51.90 ± 0.73。结果表明，如果术后放射影像中的隧道出口位置和内扣位置在建议的区域内，就可以有意义地断定隧道在关节内的位置正确，韧带重建符合解剖学原理。证据等级 III 级。

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引用次数: 0

Preoperative tibiofemoral contact point on standing lateral radiograph predicts anteroposterior knee kinematics in total knee arthroplasty 立位侧位片上的术前胫股关节接触点可预测全膝关节置换术的膝关节前后运动学特性

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-14 DOI: 10.1002/jeo2.70093

Yusuke Tominaga, Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Yusuke Horita, Masaki Takao

Purpose

This study investigated the tibiofemoral contact point (CP) on standing lateral radiographs in knee osteoarthritis and assessed the relationship between CP and pre- and postoperative knee kinematics in total knee arthroplasty (TKA).

Methods

The intraoperative knee status of 46 knees with varus deformity that underwent bicruciate stabilized TKA using a navigation system was investigated. The intraoperative anteroposterior (AP) position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60° and 90° was evaluated by the navigation system before and after TKA. The CP, defined as the CP between the femur and tibia, was assessed on standing lateral radiographs at the maximum extension of the knee before and 1 year after TKA. CP was expressed as the ratio of tibial plateau distance on a scale of 0–1, with 0 indicating the most anterior position of the femur relative to the tibia.

Results

The mean CP on standing lateral radiographs was 0.54 ± 0.12 and 0.46 ± 0.08 before and after TKA, respectively. The postoperative CP was significantly more anterior than the preoperative CP (p = 0.0002). The mean AP position of the femur relative to the tibia moved anteriorly during early knee flexion both before and after TKA, representing nonanatomical AP movement. The preoperative posterior CP group (CP > 0.54) showed more nonanatomical AP movement from 15° to 60° before and after TKA compared with the preoperative anterior CP group (CP < 0.54).

Conclusion

Preoperative posterior deviation of the femur relative to the tibia in the standing position was a predictive factor for nonanatomical AP knee kinematics. Biomechanical analysis of postoperative knees will be necessary; however, surgeons should focus on preoperative tibiofemoral CP on standing lateral radiographs to predict knee kinematics.

Level of Evidence

Level Ⅲ.

目的本研究调查了膝关节骨性关节炎患者站立侧位片上的胫股关节接触点（CP），并评估了CP与全膝关节置换术（TKA）术前和术后膝关节运动学之间的关系。方法对使用导航系统进行双叉稳定 TKA 手术的 46 个膝关节外翻畸形患者的术中膝关节状态进行了调查。在最大伸展角度、15°、30°、45°、60°和90°时，术中股骨相对于胫骨的前后（AP）位置由导航系统在 TKA 手术前后进行评估。CP 定义为股骨和胫骨之间的 CP，在 TKA 手术前和手术后 1 年，通过膝关节最大伸展时的立位侧位片进行评估。CP以胫骨平台距离的比率表示，0表示股骨相对于胫骨的最前位置，1表示股骨相对于胫骨的最前位置。结果 TKA前后立位侧位片上的平均CP分别为0.54 ± 0.12和0.46 ± 0.08。术后 CP 明显比术前 CP 更前（p = 0.0002）。在 TKA 手术前后，股骨相对于胫骨的平均 AP 位置在膝关节早期屈曲时均向前方移动，代表非解剖 AP 移动。与术前CP前组（CP <0.54）相比，术前CP后组（CP >0.54）在TKA前后的15°至60°之间表现出更多的非解剖性AP移动。结论在站立位时，术前股骨相对于胫骨的后方偏差是膝关节非解剖AP运动学的一个预测因素。有必要对术后膝关节进行生物力学分析；然而，外科医生应关注术前站立位侧位片上的胫股骨CP，以预测膝关节运动学。证据等级Ⅲ级。

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引用次数: 0

Daily physical activity following unicompartmental knee arthroplasty: A pilot study 单关节膝关节置换术后的日常体育锻炼：试点研究

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-14 DOI: 10.1002/jeo2.70048

Kevin A. Wu, Eric S. Dilbone, David N. Kugelman, Rahul K. Goel, Sean P. Ryan, Samuel S. Wellman, Michael P. Bolognesi, Thorsten M. Seyler

Purpose

The purpose of this study was to understand how objective measures of daily activity change following unicompartmental knee arthroplasty (UKA). Objective data on post-operative changes in daily physical activity following UKA are limited, highlighting the need for studies using wearable technologies to provide real-time assessments of recovery.

Methods

This pilot study included a secondary analysis of a prospective study of 33 consecutive UKA patients, with data collected using an Apple Watch and a digital care management application. Objective metrics, including step count, steadiness, standing duration and performance on the six-minute walk test, were analyzed at different post-operative time points. Descriptive statistics and the Wilcoxon signed-rank test were used for analysis.

Results

Post-operatively, there was a significant increase in daily step count at 6 weeks (p = 0.017), 6 months (p < 0.001) and 12 months (p = 0.0018). Steadiness improved significantly at 6 months (p = 0.049) and 12 months (p = 0.039) post-operatively. Standing duration increased significantly at all the post-operative time points (p < 0.001). Gait speed did not show significant changes post-operatively. The estimated six-minute walk test distance improved significantly at 6 months (p = 0.027) and 12 months (p = 0.031) post-operatively.

Conclusion

The study findings suggest that UKA improves daily physical activity levels, reflected by enhanced mobility and function. While gait speed did not significantly change, improvements in step count, steadiness, standing duration and the six-minute walk test distance indicate enhanced functional capacity and endurance post-operatively. The study highlights the benefits of UKA in improving functional outcomes in patients with knee osteoarthritis. Further research with larger sample sizes and longer follow-ups is warranted to confirm these findings.

Levels of Evidence

II.

目的本研究旨在了解单间室膝关节置换术（UKA）后日常活动的客观指标是如何变化的。有关单关节膝关节置换术（UKA）术后日常体力活动变化的客观数据非常有限，因此需要使用可穿戴技术对恢复情况进行实时评估。方法这项试验性研究包括对一项前瞻性研究的二次分析，研究对象为 33 名连续的 UKA 患者，使用 Apple Watch 和数字护理管理应用程序收集数据。分析了术后不同时间点的客观指标，包括步数、稳定性、站立时间和六分钟步行测试成绩。分析采用了描述性统计和 Wilcoxon 符号秩检验。结果术后 6 周（p = 0.017）、6 个月（p < 0.001）和 12 个月（p = 0.0018）时，每日步数显著增加。术后 6 个月（p = 0.049）和 12 个月（p = 0.039）时，稳健性明显改善。站立时间在术后所有时间点都有明显增加（p < 0.001）。步速在术后没有明显变化。估计的六分钟步行测试距离在术后 6 个月（p = 0.027）和 12 个月（p = 0.031）有明显改善。结论研究结果表明，UKA 可以改善日常体力活动水平，这体现在活动能力和功能的增强上。虽然步速没有明显变化，但步数、稳定性、站立时间和六分钟步行测试距离都有所改善，这表明术后患者的功能能力和耐力得到了增强。这项研究强调了UKA在改善膝关节骨性关节炎患者功能方面的益处。为证实这些研究结果，有必要进行样本量更大、随访时间更长的进一步研究。证据等级 II。

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引用次数: 0

Does free tendon length influence the injury risk of the Achilles tendon? A finite element study 游离肌腱的长度会影响跟腱的损伤风险吗？有限元研究。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-14 DOI: 10.1002/jeo2.70036

Pedro Diniz, Carlos Quental, Hélder Pereira, André Soares Ferreira, Gino M. M. J. Kerkhoffs, Frederico Castelo Ferreira, João Folgado

Purpose

The Achilles tendon is a common injury site, but anatomical risk factors for injury are relatively unexplored in the literature. This study aimed to evaluate whether changes in free tendon length would influence the results of a simulated rupture of the Achilles tendon.

Methods

Using a previously validated 3D finite element model of the free and aponeurotic Achilles tendon as a basis, two additional finite element models with 25% decreased and increased free tendon lengths were created. The finite element models were sequentially loaded from 2500 to 3500N in 100N increments, and the total volume of elements exhibiting a maximal principal strain above 10% was recorded. An Achilles tendon rupture was considered to have occurred when a continuous group of elements with a volume of at least 3 mm³ exhibited a maximum principal strain above 10%. Models were compared regarding the smallest load that met the rupture criterion and plots of the percentage of elements exhibiting maximum principal strains above 10% across the loading range. Sensitivity analyses assessed the influence of subtendon division variations and subtendon sliding restriction on the results.

Results

Rupture loads and plots of the percentage of elements with maximum principal strains above 10% were similar between models, regardless of the free tendon length. No models met the rupture criterion when simulations were run without subtendon sliding. Rupture loads in the subtendon division variation models were correlated with the subtendon cross-sectional areas.

Conclusions

The simulated rupture results of the Achilles tendon were sensitive to variations in subtendon cross-sectional areas but not in free tendon length.

Level of Evidence

Level V.

目的：跟腱是常见的损伤部位，但文献中对其损伤的解剖学风险因素的研究相对较少。本研究旨在评估游离肌腱长度的变化是否会影响跟腱模拟断裂的结果：方法：以之前验证过的跟腱游离和肌腱三维有限元模型为基础，创建了游离肌腱长度减少 25% 和增加 25% 的两个额外有限元模型。以 100N 为增量，从 2500N 到 3500N 依次对有限元模型进行加载，并记录显示最大主应变超过 10% 的元素的总体积。当体积至少为 3 立方毫米的连续元素组的最大主应变超过 10%时，即认为跟腱断裂发生。我们比较了符合断裂标准的最小载荷模型，并绘制了在整个载荷范围内最大主应变超过 10% 的元素百分比图。敏感性分析评估了副腱划分变化和副腱滑动限制对结果的影响：结果：无论自由肌腱长度如何，不同模型的断裂荷载和最大主应变超过 10%的元素百分比图相似。在没有副肌滑动的情况下进行模拟时，没有任何模型符合断裂标准。副腱分裂变化模型的断裂荷载与副腱横截面积相关：结论：跟腱的模拟断裂结果对亚腱横截面积的变化敏感，但对自由肌腱长度的变化不敏感：证据等级：V 级。

{"title":"Does free tendon length influence the injury risk of the Achilles tendon? A finite element study","authors":"Pedro Diniz, Carlos Quental, Hélder Pereira, André Soares Ferreira, Gino M. M. J. Kerkhoffs, Frederico Castelo Ferreira, João Folgado","doi":"10.1002/jeo2.70036","DOIUrl":"10.1002/jeo2.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Achilles tendon is a common injury site, but anatomical risk factors for injury are relatively unexplored in the literature. This study aimed to evaluate whether changes in free tendon length would influence the results of a simulated rupture of the Achilles tendon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a previously validated 3D finite element model of the free and aponeurotic Achilles tendon as a basis, two additional finite element models with 25% decreased and increased free tendon lengths were created. The finite element models were sequentially loaded from 2500 to 3500N in 100N increments, and the total volume of elements exhibiting a maximal principal strain above 10% was recorded. An Achilles tendon rupture was considered to have occurred when a continuous group of elements with a volume of at least 3 mm<sup>3</sup> exhibited a maximum principal strain above 10%. Models were compared regarding the smallest load that met the rupture criterion and plots of the percentage of elements exhibiting maximum principal strains above 10% across the loading range. Sensitivity analyses assessed the influence of subtendon division variations and subtendon sliding restriction on the results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rupture loads and plots of the percentage of elements with maximum principal strains above 10% were similar between models, regardless of the free tendon length. No models met the rupture criterion when simulations were run without subtendon sliding. Rupture loads in the subtendon division variation models were correlated with the subtendon cross-sectional areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The simulated rupture results of the Achilles tendon were sensitive to variations in subtendon cross-sectional areas but not in free tendon length.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628646","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

Assessment of trochanteric vascularity using quantitative magnetic resonance imaging in a cadaveric model 在尸体模型中使用定量磁共振成像评估转子血管情况

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-14 DOI: 10.1002/jeo2.70092

Craig E. Klinger, Burak Altintas, Kathryn A. Barth, Kenneth M. Lin, David C. Dewar, Lionel E. Lazaro, Jonathan P. Dyke, David S. Wellman, David L. Helfet

Purpose

Few studies have assessed trochanteric vascularity despite its implications for bone healing and surgical approaches. This study aimed to assess the regional arterial contributions of the medial femoral circumflex artery (MFCA) versus the lateral femoral circumflex artery (LFCA) to trochanteric vascularity.

Methods

Ten adult human cadaveric pelvises to mid-femur specimens were obtained. One hip was randomly assigned experimental (either MFCA or LFCA MRI-contrast infusion) and contralateral as control (MFCA and LFCA magnetic resonance imaging [MRI]-contrast infusion). Vascular dissection was performed for MFCA and LFCA cannulation. Pre- and post-contrast 3T MRI was completed, and intra-osseous contributions were quantified by region: greater trochanter (GT), intertrochanteric (IT), lesser trochanter (LT) and subtrochanteric (ST). A polyurethane compound mixed with barium sulfate was injected into the LFCA cannula, and into the MFCA cannula for the contralateral hip. Computed tomography (CT) imaging was completed to assess terminal branch locations.

Results

MFCA provided the majority of arterial contributions to the full trochanteric region (68.5% MFCA, 31.5% LFCA; standard deviation [SD]: 10.7%, p < 0.001). Over 70% of arterial contributions to ST, LT and IT regions are derived from MFCA. GT contributions were more balanced (52.5% MFCA, 47.5% LFCA; SD: 33.7%; p = 0.853). Significant differences were found between MFCA and LFCA contributions in all regions except for the GT. CT revealed multiple consistent MFCA and LFCA trochanteric terminal branches.

Conclusions

MFCA provided the dominant trochanteric arterial supply, which highlights MFCA's importance to overall hip vascularity. LFCA's trochanteric contribution was smaller but still provided trochanteric contributions, especially the GT region. Knowledge of trochanteric arterial contributions can be beneficial for optimizing surgical approaches and fixation to protect terminal branches during trochanteric fracture, nonunion treatment and trochanteric osteotomies.

Level of Evidence

Not applicable.

目的尽管转子血管对骨愈合和手术方法有影响，但很少有研究对其进行评估。本研究旨在评估股内侧周动脉（MFCA）和股外侧周动脉（LFCA）对转子血管的区域贡献。方法取来十个成年人类尸体骨盆到股骨中段标本。随机分配一个髋关节为实验组（MFCA 或 LFCA 磁共振成像对比输注），对侧为对照组（MFCA 和 LFCA 磁共振成像对比输注）。在 MFCA 和 LFCA 插管时进行血管解剖。完成对比前和对比后 3T 磁共振成像，并按区域量化骨内贡献：大转子（GT）、转子间（IT）、小转子（LT）和转子下（ST）。在 LFCA 插管和对侧髋关节的 MFCA 插管中分别注入与硫酸钡混合的聚氨酯化合物。完成计算机断层扫描（CT）成像以评估终末分支位置。结果 MFCA 为全转子区域提供了大部分动脉供血（68.5% MFCA，31.5% LFCA；标准差 [SD]：10.7%，P < 0.001）。超过 70% 的 ST、LT 和 IT 区域动脉供血来自 MFCA。GT 的贡献更为均衡（52.5% MFCA，47.5% LFCA；SD：33.7%；P = 0.853）。除 GT 外，MFCA 和 LFCA 对所有区域的贡献均存在显著差异。CT 显示多个一致的 MFCA 和 LFCA 转子末端分支。结论 MFCA 提供了主要的转子动脉供应，这凸显了 MFCA 对整个髋部血管的重要性。LFCA 对转子的贡献较小，但仍能提供转子，尤其是 GT 区域。了解转子动脉的贡献有助于优化手术方法和固定方式，从而在转子骨折、不愈合治疗和转子截骨时保护末端分支。证据级别不适用。

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引用次数: 0

The location of the centre of the proximal quadriceps tendon in kinematically aligned total knee arthroplasty is not associated with poor outcome scores or symptomatic patellar instability 在运动学排列的全膝关节置换术中，股四头肌腱近端中心的位置与不良结果评分或症状性髌骨不稳无关。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-13 DOI: 10.1002/jeo2.70075

Daniel Razick, Muzammil Akhtar, Stephen M. Howell, Alexander J. Nedopil, Maury L. Hull

Purpose

A previous study on osteoarthritic knees found that the average position of the centre of the proximal quadriceps tendon (PQT) was 9 mm lateral from the native trochlear groove. In patients with lateral patellar facet osteoarthritis, which indicates patellofemoral instability, the average location was 21 mm. The researchers suggested that a position more lateral than 20 mm might lead to poor outcomes after kinematically aligned total knee arthroplasty (KA TKA)—the current study aimed to test this hypothesis.

Methods

The study involved all patients (n = 302) who underwent KA TKA (n = 313) in 2019, had a post-operative long-leg scanogram and knee computed tomography scan, and completed a 2-year questionnaire. An evaluator measured the location of the PQT relative to the centre of the distal prosthetic trochlear groove. A Spearman's rank correlation coefficient analysis determined whether there was an association between the location of the PQT and the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) at 2 years.

Results

The mean location of the PQT was 11 ± 8 mm (range, −2 medial to 36 mm lateral), with 16% (N = 46) of the KA TKAs having a more lateral location than 20 mm. The location of the PQT was not associated with the FJS (r = −0.0349, p = 0.7281) and OKS (r = −0.0641, p = 0.9009)—no patient response indicated symptoms or operative treatment for patellofemoral instability.

Conclusion

Even though 16% of patients with a KA TKA had a more lateral location than 20 mm, there is no reason to measure the centre of the PQT relative to the distal prosthetic groove. This is because the location did not show any association with the 2-year FJS and OKS nor had any patient experienced patellofemoral instability.

Level of Evidence

IV.

目的：之前一项针对骨关节炎膝关节的研究发现，股四头肌腱近端（PQT）中心的平均位置距原生蹄状沟外侧 9 毫米。在患有髌骨外侧面骨性关节炎（表明髌骨股骨不稳定）的患者中，平均位置为 21 毫米。研究人员认为，超过20毫米的外侧位置可能会导致运动学配准全膝关节置换术（KA TKA）后的效果不佳--本研究旨在验证这一假设：研究涉及2019年接受KA TKA（n = 313）的所有患者（n = 302），他们接受了术后长腿扫描和膝关节计算机断层扫描，并填写了一份为期2年的调查问卷。一名评估人员测量了PQT相对于假体远端套骨沟中心的位置。斯皮尔曼等级相关系数分析确定了PQT位置与2年后的Forgotten关节评分（FJS）和牛津膝关节评分（OKS）之间是否存在关联：PQT的平均位置为11 ± 8 mm（范围：内侧-2 mm至外侧36 mm），16%的KA TKAs（N = 46）的外侧位置超过20 mm。PQT的位置与FJS（r = -0.0349，p = 0.7281）和OKS（r = -0.0641，p = 0.9009）无关--没有患者反应显示髌骨不稳的症状或手术治疗：尽管16%的KA TKA患者的PQT位置超过20毫米，但没有理由测量PQT中心相对于假体远端凹槽的位置。这是因为该位置与2年的FJS和OKS没有任何关联，也没有患者出现髌骨股骨不稳定：证据等级：IV。

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引用次数: 0

Leveraging digital twins for improved orthopaedic evaluation and treatment 利用数字双胞胎改进骨科评估和治疗。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-10 DOI: 10.1002/jeo2.70084

Michael C. Dean, Jacob F. Oeding, Pedro Diniz, Romain Seil, Kristian Samuelsson, ESSKA Artificial Intelligence Working Group

Purpose

The purpose of this article is to explore the potential of digital twin technologies in orthopaedics and to evaluate how their integration with artificial intelligence (AI) and deep learning (DL) can improve orthopaedic evaluation and treatment. This review addresses key applications of digital twins, including surgical planning, patient-specific outcome prediction, augmented reality-assisted surgery and simulation-based surgical training.

Methods

Existing studies on digital twins in various domains, including engineering, biomedical and orthopaedics are reviewed. We also reviewed advancements in AI and DL relevant to digital twins. We focused on identifying key benefits, challenges and future directions for the implementation of digital twins in orthopaedic practice.

Results

The review highlights that digital twins offer significant potential to revolutionise orthopaedic care by enabling precise surgical planning, real-time outcome prediction and enhanced training. Digital twins can model patient-specific anatomy using advanced imaging techniques and dynamically update with real-time data, providing valuable insights during surgery and postoperative care. However, challenges such as the need for large-scale data sets, technological limitations and integration issues must be addressed to fully realise these benefits.

Conclusion

Digital twins represent a promising frontier in orthopaedic research and practice, with the potential to improve patient outcomes and enhance surgical precision. To enable widespread adoption, future research must focus on overcoming current challenges and further refining the integration of digital twins with AI and DL technologies.

Level of Evidence

Level V.

目的：本文旨在探讨数字孪生技术在骨科领域的潜力，并评估其与人工智能（AI）和深度学习（DL）的整合如何改善骨科评估和治疗。这篇综述探讨了数字孪生的主要应用，包括手术规划、患者特定结果预测、增强现实辅助手术和基于模拟的手术培训：方法：综述了数字双胞胎在工程、生物医学和骨科等不同领域的现有研究。我们还回顾了与数字孪生相关的人工智能和 DL 方面的进展。我们重点确定了在骨科实践中实施数字孪生的主要优势、挑战和未来方向：综述强调，数字孪生通过实现精确的手术规划、实时结果预测和强化培训，为骨科护理的变革提供了巨大的潜力。数字孪生可以利用先进的成像技术建立特定患者的解剖模型，并根据实时数据进行动态更新，从而在手术和术后护理过程中提供有价值的见解。然而，要充分实现这些优势，必须解决诸如需要大规模数据集、技术限制和集成问题等挑战：数字孪生代表了骨科研究和实践中一个前景广阔的前沿领域，具有改善患者预后和提高手术精准度的潜力。为实现广泛应用，未来的研究必须侧重于克服当前的挑战，并进一步完善数字孪生与人工智能和 DL 技术的整合：证据等级：V 级。

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引用次数: 0

Inside-out tibial tunnel drilling technique is a reliable approach for all-inside ACL reconstruction: A longitudinal MRI assessment 胫骨内侧隧道钻孔技术是全内侧前交叉韧带重建的可靠方法：核磁共振成像纵向评估

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-10 DOI: 10.1002/jeo2.70068

João Pedro Oliveira, Otília C. d'Almeida, Ricardo Sampaio, José Carlos Noronha

Purpose

To longitudinally evaluate sockets localization, tunnel morphological changes and graft maturation after the inside-out tibial tunnel drilling technique for all-inside Anterior Cruciate Ligament Reconstruction (ACLR). We hypothesized that due the necessary angle for the inside-out reaming procedure, the described technique could input changes in the tibial socket.

Methods

Fourteen knees treated with the same all-inside ACLR technique were randomly assigned for a magnetic resonance evaluation. All patients were operated by the same surgeon and performed the same follow-up rehabilitation protocol. Socket's localization, shape and widening, as well as graft maturation and integration, were evaluated intraoperatively at 6 months and 4 years after surgery.

Results

Both femoral and tibial tunnels had an expected increase at 6 months follow-up. The widening was larger in the tibial tunnel (12.6 ± 10.0% vs. 9.1 ± 8.5%), yet this difference was not statistically different. Tibial tunnel was well centred in the tibial plateau and the integration of the graft was higher in the tibial socket. Four years after surgery, there was a general reduction of diameter in both tunnels. The tunnel occlusion rate was 33.3% for tibia and 16.7% for femur.

Conclusions

Overall, our results show that within a 4-year follow-up period, the inside-out tibial tunnel drilling technique for all-inside ACLR represents a safe technique that did not influence the tibial socket position nor tunnel widening or graft maturation in the long term.

Level of Evidence

Level IV.

目的：纵向评估全内侧前交叉韧带重建术（ACLR）中胫骨隧道内向外钻孔技术后的关节窝定位、隧道形态变化和移植物成熟度。我们假设，由于内向外扩孔手术需要一定的角度，所述技术可能会导致胫骨窝发生变化：方法：我们随机分配了 14 个采用相同的全内侧 ACLR 技术治疗的膝关节进行磁共振评估。所有患者均由同一外科医生进行手术，并执行相同的后续康复方案。分别在术后6个月和4年对韧带臼的定位、形状和增宽以及移植物的成熟和整合情况进行术中评估：结果：股骨和胫骨隧道在术后 6 个月时都出现了预期的增大。胫骨隧道的增宽更大（12.6 ± 10.0% 对 9.1 ± 8.5%），但这一差异在统计学上没有差异。胫骨隧道在胫骨平台的中心位置良好，移植物在胫骨窝的整合度较高。术后四年，两条隧道的直径普遍缩小。胫骨隧道闭塞率为33.3%，股骨隧道闭塞率为16.7%：总之，我们的研究结果表明，在4年的随访期内，用于全内交叉韧带置换术的胫骨隧道内向外钻孔技术是一种安全的技术，不会影响胫骨臼的位置，也不会影响隧道增宽或移植物的长期成熟：证据等级：IV 级。

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引用次数: 0

Diagnostic performance of deep learning for leg length measurements on radiographs in leg length discrepancy: A systematic review 深度学习在腿长不一致的 X 光片腿长测量中的诊断性能：系统综述。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-10 DOI: 10.1002/jeo2.70080

Bradley A. Lezak, James A. Pruneski, Jacob F. Oeding, Kyle N. Kunze, Riley J. Williams III, Michael J. Alaia, Andrew D. Pearle, Joshua S. Dines, Kristian Samuelsson, Ayoosh Pareek

Purpose

To systematically review the literature regarding machine learning in leg length discrepancy (LLD) and to provide insight into the most relevant manuscripts on this topic in order to highlight the importance and future clinical implications of machine learning in the diagnosis and treatment of LLD.

Methods

A systematic electronic search was conducted using PubMed, OVID/Medline and Cochrane libraries in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Two observers independently screened the abstracts and titles of potential articles.

Results

A total of six studies were identified in the search. All measurements were calculated using standardized anterior-posterior long-leg radiographs. Five (83.3%) of the studies used measurements of the femoral length, tibial length and leg length to assess LLD, whereas one (16.6%) study used the iliac crest height difference to quantify LLD. The deep learning models showed excellent reliability in predicting all length measurements with intraclass correlation coefficients ranging from 0.98 to 1.0 and mean absolute error (MAE) values ranging from 0.11 to 0.45 cm. Three studies reported measurements of LLD, and the convolutional neural network model showed the lowest MAE of 0.13 cm in predicting LLD.

Conclusions

Machine learning models are effective and efficient in determining LLD. Implementation of these models may reduce cost, improve efficiency and lead to better overall patient outcomes.

Clinical Relevance

This review highlights the potential of deep learning (DL) algorithms for accurate and reliable measurement of lower limb length and leg length discrepancy (LLD) on long-leg radiographs. The reported mean absolute error and intraclass correlation coefficient values indicate that the performance of the DL models was comparable to that of radiologists, suggesting that DL-based assessments could potentially be used to automate the measurement of lower limb length and LLD in clinical practice.

Level of Evidence

Level IV.

目的：系统综述有关机器学习在腿长不一致（LLD）方面的应用的文献，并深入分析与该主题最相关的手稿，以强调机器学习在诊断和治疗腿长不一致方面的重要性和未来的临床意义：根据《系统综述和元分析首选报告项目》指南，使用 PubMed、OVID/Medline 和 Cochrane 图书馆进行了系统的电子检索。两名观察员独立筛选了潜在文章的摘要和标题：结果：检索共发现六项研究。所有测量值均采用标准化前后长腿X光片进行计算。其中五项研究（83.3%）使用股骨长度、胫骨长度和腿长的测量值来评估LLD，一项研究（16.6%）使用髂嵴高度差来量化LLD。深度学习模型在预测所有长度测量值方面表现出极佳的可靠性，类内相关系数在 0.98 到 1.0 之间，平均绝对误差 (MAE) 值在 0.11 到 0.45 厘米之间。三项研究报告了 LLD 的测量结果，其中卷积神经网络模型预测 LLD 的 MAE 最低，为 0.13 厘米：机器学习模型在确定 LLD 方面有效且高效。临床意义：本综述强调了深度学习（DL）算法在准确可靠地测量长腿X光片上的下肢长度和腿长差异（LLD）方面的潜力。报告的平均绝对误差和类内相关系数值表明，DL模型的性能与放射科医生的性能相当，这表明基于DL的评估有可能在临床实践中用于自动测量下肢长度和LLD：证据等级：IV 级。

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引用次数: 0

Old but gold: Is the Judet procedure still a viable option for posttraumatic knee stiffness in 2024? A comprehensive systematic review and meta-analysis 老而弥坚：2024 年，Judet 术是否仍是治疗创伤后膝关节僵硬的可行方案？一项全面的系统回顾和荟萃分析。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-11-07 DOI: 10.1002/jeo2.70079

Vito Gaetano Rinaldi, Iacopo Sassoli, Alberto Fogacci, Antongiulio Favero, Giada Lullini, Massimiliano Mosca, Mattia Morri, Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli

Background

Posttraumatic extension contracture of the knee (PECK) is common after knee injury. Initial management is conservative to improve the range of motion; if it fails, surgery may be necessary. This systematic review analyses existing literature on Judet quadricepsplasty for PECK. We will assess clinical outcomes, complications, patient satisfaction and factors that may influence its success.

Methods

A search was conducted on 25 November 2023, adhering to preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Embase and Google Scholar were used. Search strings were ([Judet] OR [quadricepsplasty]) AND (knee) AND (stiffness) and ([Judet] OR [quadricepsplasty]) AND (knee). Inclusion criteria: English articles focused on PECK, published between 2003 and 2023, and a minimum follow-up of 24 months. Exclusion criteria: case reports, alternative techniques, knee stiffness cases not only due to trauma, a sample size of <10 patients and articles not reporting functional outcomes.

Results

Among selected studies, 239 patients were considered. The average time between injury and Judet was 27 months. The population was predominantly male; the mean follow-up was 33 months. An average intraoperative knee range of motion improvement of 79.1 degrees (confidence interval 76.9; 81.3) compared to the average preoperative starting value of 30.7 degrees was observed. This improvement decreased by 13.5 degrees at the first postoperative check and by an additional 2.4 degrees at the follow-up, while maintaining an average value of bending above 90 degrees.

Conclusion

Judet quadricepsplasty appears an effective technique for the management of PECK. The heterogeneity of included studies and the absence of standardized outcome measures limit the ability to draw definitive conclusions.

Level of Evidence

Level III.

背景：膝关节外伤后伸展挛缩（PECK）是膝关节损伤后的常见病。最初的治疗方法是保守治疗，以改善活动范围；如果治疗无效，则可能需要手术治疗。这篇系统性综述分析了现有的朱代特股四头肌成形术治疗 PECK 的文献。我们将评估临床效果、并发症、患者满意度以及可能影响手术成功的因素：根据系统综述和荟萃分析指南的首选报告项目，于2023年11月25日进行了检索。使用了 PubMed、Embase 和 Google Scholar。搜索字符串为（[Judet] OR [股四头肌成形术]）和（膝关节）和（僵硬）以及（[Judet] OR [股四头肌成形术]）和（膝关节）。纳入标准：2003年至2023年间发表的以PECK为主题的英文文章，且随访时间至少为24个月。排除标准：病例报告、替代技术、非外伤导致的膝关节僵硬病例、样本量小于结果：在选定的研究中，有 239 名患者被考虑在内。从受伤到 Judet 的平均时间为 27 个月。研究对象以男性为主，平均随访时间为 33 个月。与术前平均 30.7 度的起始值相比，术中膝关节活动范围平均改善了 79.1 度（置信区间 76.9；81.3）。在术后第一次检查时，这一改善幅度减少了 13.5 度，在随访时又增加了 2.4 度，但膝关节弯曲的平均值仍保持在 90 度以上：结论：Judet 股四头肌成形术似乎是治疗 PECK 的有效技术。由于纳入研究的异质性和缺乏标准化的结果测量，因此无法得出明确的结论：证据等级：三级。

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引用次数: 0