Journal of Experimental Orthopaedics最新文献

Purpose

The purpose of the study was to compare time to return to sport between patients undergoing isolated medial patellofemoral ligament reconstruction (MPFL-R) and patients undergoing MPFL-R and concomitant TTO (MPFL-TTO) for recurrent patellofemoral instability.

Methods

A retrospective chart review of prospectively collected data was conducted to identify consecutive patients who underwent primary isolated MPFL-R or MPFL-TTO. Exclusion criteria included concomitant cruciate ligament surgery, multi-ligament surgery, failed previous surgery and <1 year follow-up. Patient demographic information, surgical data, radiographic data, return to sport, and re-dislocation rates were recorded. Pre-operative and post-operative functional outcome scores (Kujala, IKDC), activity level (Pedi-FABS), and health-related quality of life (KOOS-PS, KOOS-QOL) were compared.

Results

One hundred and seventy-eight patients were included in the study. One hundred and nineteen patients (74% female) underwent isolated MPFL-R, and 59 patients (85% female) underwent MPFL-TTO. Patients who underwent MPFL-R returned to sport at 9.5 ± 3.9 months, and patients who underwent MPFL-TTO returned to sport at 12.9 ± 11.0 months (p = 0.011). Patients who underwent isolated MPFL-R had a significantly higher return to the same or higher level of sport compared to MPFL-TTO (85% vs. 66%, p = 0.018). Both cohorts showed significant improvement in KOOS, IKDC, and Kujala scores at all follow-ups (p < 0.001).

Conclusion

Patients who underwent both isolated MPFL-R and MPFL-TTO had excellent return to sport rates, with isolated MPFL-R patients reporting significantly higher rates of return to the same or higher level of sport. The MPFL-R group returned to sport faster than those who had a concomitant TTO, with no difference in rates of recurrent instability. Patient-reported outcomes for both groups were significantly improved at 5 years postoperatively. The results of this study contribute to the growing body of literature supporting excellent long-term functional recovery with low rates of recurrent instability after isolated MPFL-R or MPFL-TTO.

Level of Evidence

Level III, cohort study.

Purpose

Metal detectors in airports are designed to identify metallic objects on passengers, which can inadvertently trigger alarms for patients with total knee arthroplasty (TKA) implants. The main goal of this study was to compare the prevalence of metal detection at security airport between a cohort of patient who sustained a TKA and another group free of any metallic implants. The hypothesis was that patients with TKA would trigger metal detectors more frequently than those without TKA and this would have a detrimental impact on their whole postsurgical experience.

Methods

A continuous, nonrandomised, case-control, cross-sectional study was carried out. Patients who underwent a TKA between 2020 and 2021 at the same hospital were included in this study. A control group was included to compare the results and improve the level of evidence. This cohort was recruited via patient fellows who accompanied them in clinics.

Results

A total of 101 patients were included, 51 patients in the TKA group (over 64 patients) set off the metal detector (79.7%, 95% confidence interval [CI]: 68.3–87.7) versus 5 in the control group (over 37 patients), (13.5%, 95% CI: 5.9–28.0). This difference was statistically significant (p < 0.0001). For those who triggered the alarm (51 patients in the TKA group), this event occurred at all security checkpoints they went through for 42 (82.4%) of them whereas in the control group it occurred 20% of the time. This difference was also statistically significant (p < 0.05). Additionally, 28 out of the 51 TKA patients who triggered alarms (54.9%) reported that the experience was bothersome and had a negative impact on their mood.

Conclusion

TKA patients more frequently trigger metal detector alarms at airport security checkpoints than patients free of any prosthesis, which cause unnecessary stress and discomfort. As the global number of TKA procedures continues to rise, it is crucial to implement strategies that acknowledge the unique needs of patients with TKA, ensuring both security and comfort during air travel.

Level of Evidence

Level III, retrospective comparative study (cross sectional).

Purpose

The geometry of the Notch within the knee joint is highly discussed to influence the overall knee stability and can predict the rupture of the cruciate ligaments. Therefore, associations between anthropometric measurements and notch geometry may help to identify patients at risk for soft tissue knee trauma or inferior surgical outcome. To better describe the normal anatomy of the notch geometry, the primary objective of this study was to examine the notch geometry in a large general population cohort and to define reference values. Furthermore, associations of anthropometric parameters on the notch geometry were examined.

Methods

Notch Depth, Notch Angle, Notch Width and Notch Width Index were measured on bilateral knee magnetic resonance imaging (MRI) of 1043 participants of the Study of Health in Pomerania (SHIP), aged 28–89 years. SHIP drew a sample of the adult general population of Northeastern Germany. Reference values for Notch parameters were assessed by quantile regression models. Associations of sex, age, body height and body weight with the Notch parameters were calculated by linear regression models.

Results

Significantly higher values for men were present for all Notch parameters (p = <0.001–0.037) as well as a positive association with age (p = 0.001–0.025). Increasing body height was positively associated with Notch Depth and Notch Width (p = <0.001), whereas Notch Angle showed an inverse relation to body height (p = 0.001). Additionally, Notch Depth showed a significant association with body weight (p = 0.009). Based on these associations, adjusted reference values were calculated.

Conclusion

Knee notch geometry is influenced by sex and anthropometric factors. Therefore, individual reference values were provided to enable patient-specific diagnostics.

Level of Evidence

Level II

Purpose

The purpose is to investigate whether the graft of single-bundle anterior cruciate ligament reconstruction with concomitant anterolateral ligament surgery (SBACLR-ALLR) has a healing advantage over that of double-bundle ACLR (DBACLR). It is hypothesised that there is no difference in the signal-to-noise quotient (SNQ) of the ACLR graft between SBACLR-ALLR and DBACLR.

Methods

A retrospective case-control study was conducted from 2010 to 2019, comparing patients who received SBACLR-ALLR and DBACLR. The primary outcome was the SNQ of the ACLR graft. The secondary outcomes were the clinical results assessed at 2 years postoperation.

Results

Forty-eight SBACLR-ALLRs and sixty DBACLRs with a mean follow-up of 53 months were identified. The SNQ of the ACLR graft in SBACLR-ALLR was comparable to that in DBACLR (6.9 ± 5.3 and 6.4 ± 5.0, respectively; p = 0.31). The graft rupture rates were 2.1% and 5%, respectively (p = 0.43). There was no statistically significant difference in the rate of return to previous sport at 2 years postoperation (SBACLR-ALLR = 79%, DBACLR = 60%; p = 0.05). The 2-year International Knee Documentation Committee (IKDC) subjective scores were 89.3 ± 9.2 and 87.6 ± 9.6, respectively (p = 0.21). Eighty-four per cent of SBACLR-ALLRs compared to 90% of DBACLRs achieved MCID in IKDC at 2-year follow-up (p = 0.33). There was no difference between the two groups in terms of the results of 2-year Lachman, anterior drawer and pivot shift tests.

Conclusion

When comparing SBACLR-ALLR and DBACLR, no difference was found in the postoperative SNQ, the 2-year graft rupture rate, the rate of return to sport, the proportion of patients achieving MCID in IKDC at 2-year follow-up, and the 2-year clinical outcomes. These results suggest that adding an ALLR to SBACLR yields outcomes comparable to the more technically demanding DBACLR.

Level of Evidence

Level III.

Purpose

To determine the biomechanical effects of a lateral hinge screw on postoperative fracture after medial closing wedge distal femoral osteotomy (MCWDFO). It was hypothesized that adding a lateral hinge screw would significantly increase the failure strength of the hinge.

Methods

Twelve Sawbone femurs were used for the study. A biplanar cut was made, a protective lateral hinge pin was placed, and a 5 mm-closing wedge osteotomy was performed in each specimen. After osteotomy, the hinge pin was removed in six specimens, and in the remaining six specimens, the hinge pin was replaced with a lateral hinge screw. A varus load was then applied utilizing a load frame in a single load-to-failure test. Failure was defined as the point just before a substantial drop in the force versus displacement curve. Nonparametric Wilcoxon rank-sum test was performed to compare maximum load and stiffness between the hinge screw and no hinge screw groups with p < 0.05 considered the threshold of statistical significance.

Results

The maximum load to failure was significantly higher in the hinge screw group versus the control group, 440 ± 70 N versus 256 ± 107 N (mean ± standard deviation), respectively. Load to failure was 72% higher in the hinge screw group versus the no hinge screw group. No significant difference in stiffness was found between the groups.

Conclusion

Using a Sawbone model, the current data showed that placement of a lateral hinge screw significantly increased resistance to varus stress following MCWDFO compared with a construct having no screw. Additionally, no significant difference in stiffness was observed between the group with the hinge screw and the group without the screw. Further investigation should assess the clinical benefit of a hinge screw in reducing surgical morbidity during the postoperative period for patients undergoing a distal femoral osteotomy.

Level of Evidence

N/A.

Purpose

The purpose of the study was to determine the prevalence of proximal tibiofibular joint (PTFJ) dislocations in knee dislocations classified as Schenck type ≥III and to compare with uninjured contralateral knees, which served as control cohort.

Methods

Patients treated at Cologne Merheim Medical Center with knee dislocation ≥III between 2015 and 2022 were included, while one control group consisted of uninjured contralateral knees. In addition to established PTFJ-specific parameters, two novel computed tomography-based PTFJ parameters were implemented on scans obtained a mean of 5 days post-trauma. The fibula lateralisation quantifies the lateral shift of the proximal fibula joint line in relation to the tibial PTFJ joint line. The posterior fibula area quantifies the fibula position in the sagittal plane with reference to the posterior tibial margin.

Results

A total of 107 knee joints were included, comprising 40 with knee dislocation ≥III, 24 uninjured contralateral knees and 43 chronically isolated anterior cruciate ligament insufficient knees. The overall cohort had a median posterior fibula area of 92.7% and a fibula lateralisation of 0.0%. Complete PTFJ dislocation was observed in 5.4% of knee dislocation cases, all in type IV injuries. Fibula lateralisation analysis indicated PTFJ subluxation in an additional 21.6% of cases. No PTFJ dislocations were present in the contralateral knee group. The knee dislocation group differed significantly from the matched contralateral knee group with regard to fibula lateralisation (r = 0.43; p = 0.007), whereas no differences were observed for inclination-horizontal (p = 0.620), inclination-fibular axis (p = 0.082) and obliquity (p = 0.602).

Conclusions

This study demonstrates a 5.4% prevalence of PTFJ dislocation in knee dislocations ≥III, which is lower than previously reported. The incidence of PTFJ dislocation in knee dislocations type IV is high at 33.3%. Fibula lateralisation and posterior fibula area are suitable parameters for assessing anterolateral dislocation of the proximal fibula. Inclination-horizontal, inclination-fibular axis and obliquity show no relevant side-to-side differences in individuals.

Level of Evidence

Level III.

Purpose

Young athletes undergoing anterior cruciate ligament reconstruction (ACLR) are at high risk of graft failure and contralateral anterior cruciate ligament (CACL) injury, despite advances in surgical technique. Lateral extra-articular tenodesis (LET) has emerged as a potential adjunct to improve graft survivability in high-risk young populations. The study aimed to describe graft survival, CACL rates, patient-reported outcome measures (PROMs) and return-to-sport (RTS) outcomes in high-risk under-20 athletes undergoing ACLR and LET.

Methods

This retrospective cohort study analysed U20 athletes who underwent primary ACLR with hamstring tendon autografts and concurrent LET between 2017 and 2023. All surgeries were performed by a single surgeon using a standardized technique. Outcomes included graft survivability, CACL injury incidence, and RTS level, with functional recovery assessed via the Marx Activity Scale and Tegner–Lysholm Score. Kaplan–Meier survival analysis, independent t-tests, χ² tests, and multivariate logistic regression were used to evaluate outcomes and identify predictors, with significance set at p < 0.05.

Results

One hundred fifty-nine patients (mean age 17.6 ± 1.9 years) were included, with a mean follow-up of 49.7 ± 18.8 months. Graft rerupture occurred in 2.5% of patients, all within 40 months postoperatively. CACL injury was observed in 12.6% of patients. Over 60% of athletes returned to their pre-injury level of sport, with higher PROMs in those achieving same-level RTS. A smaller graft diameter was significantly associated with increased risk of CACL injury (p < 0.05). LET was not associated with adverse effects on functional recovery.

Conclusions

This cohort showed low graft rerupture rates, favourable functional outcomes and encouraging RTS levels following ACLR and LET. However, CACL injury remained a substantial concern. LET may be considered in adolescent athletes participating in pivoting sports to potentially reduce graft failure, although further comparative studies are needed.

Level of Evidence

Level IV.

The incidence of anterior cruciate ligament (ACL) injuries in paediatric and skeletally immature patients is rising, proportionally to the worldwide spread of sport participation. However, differently from adults, injuries in young patients pose serious challenges regarding their management, especially when surgery is required. To date, controversies remain regarding the indications, timing of surgery and techniques for ACL reconstruction. This current concept provides a deep and detailed theoretical background of ACL injury and management in patients with open physis. Moreover, a practical algorithm of treatment is provided based on authors' experience and research and current evidence-based medicine (EBM). To optimise management and reduce the risks of either conservative or surgical treatment, a deep knowledge of the specific concepts related to paediatric patients is required.

Level of Evidence

Level V.