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Scapula dyskinesis in medium-sized full-thickness rotator cuff tear after subacromial Lidocaine infiltration and rotator cuff reconstruction
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-02-06 DOI: 10.1002/jeo2.70154
Zoltán Nyőgér, Csenge A. Molnár, Norbert Szakály, Anna Várnagy, Tamás Terebessy, Tibor Gunther, Gábor Skaliczki

Purpose

In rotator cuff tears, scapular dyskinesis is often observed. The aim of our study is to better understand the cause and the role of scapular dyskinesis in rotator cuff tears and evaluate changes in scapulothoracic kinematics after Lidocaine subacromial injection and surgery in patients with medium-sized (1–3 cm) rotator cuff tear.

Methods

The scapular motion during humerus sagittal flexion of nine healthy persons (healthy group, HG) and nine persons with a medium-sized rotator cuff tear (surgery group, SG) was investigated using the VICON motion capture system and upper limb evaluation in movement analysis software. In addition, quality of life and functional outcomes were assessed in the SG group using American Shoulder and Elbow Surgeons, Oxford and Constant-Murley scores and rotator muscle force and Visual Analogue Scale score were evaluated. The SG was further divided into three subgroups: measurements were performed preoperatively (before surgery native subgroup—BSN), then after subacromial Lidocaine injection (before surgery injection subgroup—BSI) and 6 months after rotator cuff reconstruction (after surgery subgroup—AS). Changes observed after injection (BSI) and surgery (AS) were compared to the BSN.

Results

In the BSI, a significant reduction (p < .025) in protraction was observed in the raising phase between 20° and 70° comparing it to the BSN, protraction decreased by 5.3° ± 7.9° (mean ± standard deviation [SD]). In the lowering phase between 80° and 30°, we registered a decrease of protraction by 6.0° ± 8.3° (mean ± SD). In the AS, we observed an approximation of protraction to the HG, but no significant change was detected.

Conclusion

Significant reduction in scapular protraction was demonstrated with Lidocaine subacromial injection during both the arm raising and lowering phases. Six months of rehabilitation treatment in the postoperative period is not enough to fully eliminate scapular dyskinesis.

Level of Evidence

Level II.

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引用次数: 0
Post-operative injection of hydrolyzed collagen peptides shows anti-inflammatory effect in patients with femoroacetabular impingement improving the early recovery
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-31 DOI: 10.1002/jeo2.70158
Enrico Tassinari, Andrea Minerba, Tommaso Basile, Alessio Bucciarelli, Francesco Traina, Brunella Grigolo, Stefano Zaffagnini, Eleonora Olivotto

Purpose

This study aimed to compare the use of cortisone (C), intra-articular injected at the end of hip arthroscopy in patients with femoroacetabular impingement (FAI), to a new Class III medical device based on hydrolyzed collagen peptides ‘PEPTYS’ (P) and, to investigate potential associations among preoperative symptoms and hip function, outcomes after arthroscopic surgery and presence of inflammatory biomarkers in synovial fluids (SFs) at basal condition.

Methods

The two treatments were administrated to patients scheduled for arthroscopy with simple blind randomization sampling. Based on the sample size calculation, the number necessary to recruit was at least 20 patients for the C group and 20 for the P group. SFs, when available, were obtained by aspiration just prior to surgical intervention. At the baseline, osteoarthritis (OA) severity was assessed with a radiographic scoring system (Tönnis classification). Physical examination and clinical assessment using the Hip disability and Osteoarthritis Outcome Score (HOOS) and visual analogue scale (VAS) score for pain were performed at the time of surgery and at 1 and 6 months of follow-up. At the time of surgery, chondral (Outerbridge score) and labral pathology based on direct arthroscopic visualization were also evaluated.

Results

Forty-seven FAI patients were enroled, with a median age of 35 years with a standard deviation (SD) of 10.6 and a body mass index of 24.3kg/m² with an SD of 4.5. 24 patients were treated with C and 23 with P. Both treatments did not show any statistically significant difference in hip function and pain. High expression of inflammatory molecules in SFs was correlated with the worst post-operative articular function.

Conclusions

Our study showed that the use of P was completely comparable to cortisone. Therefore, PEPTYS might be a valuable candidate to improve early recovery, in terms of pain and function, from arthroscopic FAI treatment.

Level of Evidence

Level III, comparative and randomized study.

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引用次数: 0
Genetics, sex and the use of platelet-rich plasma influence the development of arthrofibrosis after anterior cruciate ligament reconstruction 遗传、性别和富血小板血浆的使用会影响前十字韧带重建术后关节纤维化的发展。
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-28 DOI: 10.1002/jeo2.70156
Mikel Sánchez, Izarbe Yarza, Cristina Jorquera, Jose María Aznar, Leonor López de Dicastillo, Cristina Valente, Renato Andrade, João Espregueira-Mendes, David Celorrio, Beatriz Aizpurua, Juan Azofra, Diego Delgado

Purpose

To identify genes and patient factors that are related to the development of arthrofibrosis in patients after anterior cruciate ligament (ACL) reconstruction and to develop a prognostic model.

Methods

The study included patients diagnosed with ACL injury who underwent ACL reconstruction. Patients were enroled consecutively and divided into non-fibrotic (controls) and fibrotic (cases) groups until a balanced sample of matched case–control was achieved. Arthrofibrosis was considered pathological if the range of motion achieved 3 months after surgery decreased by at least 25% compared to its initial full range of motion. Patient variables and saliva samples were collected from each patient to perform a genetic approach by screening a set of candidate genes implicated in arthrofibrosis. Chi-squared was used to analyze the association between the development of arthrofibrosis and different independent variables. Binary logistic regression was used to develop a prognostic algorithm.

Results

A total of 45 controls (non-fibrotic patients) (50.1%) and 44 cases (fibrotic patients) (49.9%) were included for analysis. The median age was 34.0 years (95% confidence interval = 29.0–38.0) and the number of women was 32 (35.9%). Seven genetic polymorphisms showed significant association with the development of arthrofibrosis (p < 0.05). After binary regression analysis, the regression model included the polymorphisms rs4343 (ACE), rs1800947 (CRP), rs8032158 (NEDD4) and rs679620 (MMP3). This analysis also indicated that female gender was a risk factor while the use of platelet-rich plasma (PRP) during surgery was a preventive factor (p < 0.05).

Conclusion

Genetic alterations involved in inflammation and extracellular matrix turnover predispose to the development of arthrofibrosis after ACL reconstruction. Female sex was a risk factor in the development of this condition, while the application of PRP provided a preventive effect. The combination of patient and genetic variants of a patient allows the development of a prognostic algorithm for the risk of post-surgical arthrofibrosis.

Level of Evidence

level III.

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引用次数: 0
Mineralized tissue loss at the femoral ACL enthesis in young male ACL-injured patients
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-28 DOI: 10.1002/jeo2.70106
Mélanie L. Beaulieu, Yuchen Wang, Stephen H. Schlecht, James A. Ashton-Miller, Edward M. Wojtys

Purpose

Primary anterior cruciate ligament (ACL) reconstruction graft failure remains a significant health concern in young patients. Despite the high incidence of poor graft integration in these patients and the resulting high failure rate, little consideration has been given to the quality of the bone into which the graft is anchored at reconstruction. Therefore, we investigated post ACL injury mineralized tissue changes in the ACL femoral entheses of young males and compared them to changes previously reported for young females.

Methods

ACL femoral entheses and adjacent bone specimens were harvested from the injured knees of 51 young males during primary ACL reconstructive surgery and from 10 non-injured male cadaveric donors. The specimens were imaged via nano-computed tomography and analyzed for volumetric bone mineral density (vBMD) and architectural changes.

Results

Male femoral ACL explant specimens had significantly lower cortical vBMD (p < 0.001), lower relative bone volume (BV/TV, p = 0.027) and greater cortical bone porosity (Ct.Po, p = 0.027) but similar trabecular bone parameters (p's > 0.05) to those of control specimens from male cadaveric donors. Cortical and trabecular bone loss increased significantly with time from ACL injury to reconstructive surgery (p's < 0.05). While cortical loss occurred in both males and females, significant trabecular loss occurred only in females (p = 0.009).

Conclusion

Femoral entheseal bone loss occurs in males following ACL injury. This bone loss increases with time following ACL injury, with cortical bone loss occurring sooner after injury than trabecular bone loss. The effects of ACL injury and time from injury to surgery on trabecular bone microarchitecture differed between male and female patients.

Level of Evidence

N/A.

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引用次数: 0
Rapid reduction in surgical time and high level of accuracy in alignment and femoral component size prediction in robotic-assisted total knee arthroplasty with ROSA Knee System
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-27 DOI: 10.1002/jeo2.70148
Stefano Petrillo, Giorgio Moretti, Niccolò Bordignon, Sergio Romagnoli

Purpose

Robotic-assisted total knee arthroplasty (RA-TKA) has gained popularity for its potential ability to improve surgical precision and patient outcomes, despite concerns about its long learning curve and increased operative times. The aim of this study is to evaluate the learning curve of the ROSA® Knee System, the relationship between each phase of the learning curve and the accuracy of the robotic system in femoral component size and knee alignment prediction.

Methods

A single surgeon retrospective analysis of total operative time (TOT) and total robotic time was conducted. The first 60 cases of RA-TKA performed between July 2023 and March 2024 were included. Six (10%) patients were excluded due to incomplete surgical reports. A cumulative sum analysis was used to identify the learning and proficiency phases of the surgeon's learning curve. Moreover, femoral component size prediction accuracy and the difference between planned and achieved knee alignment were analyzed.

Results

The projected learning curve showed a significant reduction in TOT after 10 cases, with mean time decreasing from 62.6 ± 7.92 min in the learning phase to 49.9 ± 8.10 min in the proficiency phase (p = 0.0008). The robotic procedure accounted for 48% and 42% of the TOT in the learning and proficiency phases, respectively. Prediction in femoral component size was accurate in 92.6% of cases. The difference between planned and achieved knee alignment was not statistically significant (1.1° ± 0.9°).

Conclusions

The ROSA® Knee System allows a rapid learning curve in RA-TKA, with a significant reduction in operative time after the first 10 cases. An experienced orthopaedic surgeon specialized in knee arthroplasty can quickly reach a proficiency phase, maintaining high accuracy in alignment and femoral component sizing. These findings suggest that the ROSA® system is an effective and reliable tool for CR RA-TKA, offering precise and reproducible outcomes.

Level of Evidence

IV.

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引用次数: 0
Demographic, anthropometric and intrasubject variations affect platelet-rich plasma formulation
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-26 DOI: 10.1002/jeo2.70024
Luis García-Bordes, Pedro Álvarez-Díaz, Eduard Alentorn-Geli, Alfred Ferré-Aniorte, Patricia Laiz-Boada, Roberto Seijas-Vázquez, Ramon Cugat-Bertomeu

Purpose

The purpose of this study is to describe the inter- and intra-individual differences in the platelet concentration between blood and platelet-rich plasma (PRP) preparation, assess intersubject differences considering demographic and anthropometric variables, describe PRP code distribution and analyse intrasubject variability.

Methods

A retrospective analysis was conducted using a single-centre patient database from November 2021 to November 2023. It included patients with musculoskeletal pathologies treated with PRP injections. Primary variables were demographic characteristics (sex, age, body mass index [BMI]) and platelet concentrations in blood and PRP during treatments. Secondary analysis focused on PRP code frequency distribution and intrasubject variability according to different coding systems.

Results

Here, 686 patients met the inclusion criteria. PRP exhibited significantly higher platelet concentrations compared to blood (378.01 ± 136.25 × 103 platelets/µL vs. 221.97 ± 58.21 × 103 platelets/µL, p < 0.001). Younger patients had higher platelet concentrations in both blood (p = 0.004) and PRP (p = 0.003), whereas female patients showed higher platelet concentrations only in blood (p < 0.001). The platelet concentration ratio was higher in males (p < 0.001) and those with higher BMI (p = 0.023). Significant differences were found between the existing and modified PRP coding systems (p < 0.001). Intrasubject variability was higher in PRP than in blood (coefficient of variance: 21.32 ± 17.36 in blood vs. 27.85 ± 19.10 in PRP, p < 0.001).

Conclusion

Age, gender, BMI and intrasubject variations significantly affect PRP formulation, emphasizing the importance of addressing these variables for a more predictable, personalized and effective therapeutic approach.

Level of Evidence

This is a retrospective study. Level IV.

{"title":"Demographic, anthropometric and intrasubject variations affect platelet-rich plasma formulation","authors":"Luis García-Bordes,&nbsp;Pedro Álvarez-Díaz,&nbsp;Eduard Alentorn-Geli,&nbsp;Alfred Ferré-Aniorte,&nbsp;Patricia Laiz-Boada,&nbsp;Roberto Seijas-Vázquez,&nbsp;Ramon Cugat-Bertomeu","doi":"10.1002/jeo2.70024","DOIUrl":"10.1002/jeo2.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study is to describe the inter- and intra-individual differences in the platelet concentration between blood and platelet-rich plasma (PRP) preparation, assess intersubject differences considering demographic and anthropometric variables, describe PRP code distribution and analyse intrasubject variability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted using a single-centre patient database from November 2021 to November 2023. It included patients with musculoskeletal pathologies treated with PRP injections. Primary variables were demographic characteristics (sex, age, body mass index [BMI]) and platelet concentrations in blood and PRP during treatments. Secondary analysis focused on PRP code frequency distribution and intrasubject variability according to different coding systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Here, 686 patients met the inclusion criteria. PRP exhibited significantly higher platelet concentrations compared to blood (378.01 ± 136.25 × 10<sup>3</sup> platelets/µL vs. 221.97 ± 58.21 × 10<sup>3</sup> platelets/µL, <i>p</i> &lt; 0.001). Younger patients had higher platelet concentrations in both blood (<i>p</i> = 0.004) and PRP (<i>p</i> = 0.003), whereas female patients showed higher platelet concentrations only in blood (<i>p</i> &lt; 0.001). The platelet concentration ratio was higher in males (<i>p</i> &lt; 0.001) and those with higher BMI (<i>p</i> = 0.023). Significant differences were found between the existing and modified PRP coding systems (<i>p</i> &lt; 0.001). Intrasubject variability was higher in PRP than in blood (coefficient of variance: 21.32 ± 17.36 in blood vs. 27.85 ± 19.10 in PRP, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Age, gender, BMI and intrasubject variations significantly affect PRP formulation, emphasizing the importance of addressing these variables for a more predictable, personalized and effective therapeutic approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>This is a retrospective study. Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047857","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
The use of four K-wires does not lead to a reduction of the MPTA in the context of a one-dimensional tibial deflection correction of patients with ACL re-rupture and pathologically increased tibial slope
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-26 DOI: 10.1002/jeo2.70145
Christian Arras, Alexander Korthaus, Jannik Frings, Markus T. Berninger, Hendrik Fahlbusch, Karl-Heinz Frosch, Tobias Drenck, Ralph Akoto, Matthias Krause

Purpose

Anterior tibial closing wedge osteotomy (ATCWO) has been shown to significantly reduce failure rates of revision anterior cruciate ligament (ACL) reconstructions in patients with a posterior tibial slope (PTS) ≥12°. Recent findings suggest a slight but significant reduction of the medial proximal tibial angle (MPTA) resulting in a varus knee where the sagittal osteotomy plane is based on a total of two guide wires defining the osteotomy wedge without respecting the frontal plane. We hypothesize that the placement of a total of four guide wires intraoperatively can reduce the influence on the MPTA.

Methods

This study retrospectively reports on a two-centre series of 42 ATCWOs for PTS correction between January 2022 and December 2023 at two clinical centres. A total of four guide wires were placed based on a true lateral intraoperative view of the tibia, with two positioned each at the cranial and at the caudal pole of the osteotomy wedge, serving as guides for the saw to create the osteotomy, with careful attention to ensuring that the proximal and distal K-Wires were placed parallel to each other. A retrospective analysis was conducted by examining true lateral and anteroposterior radiographs to identify changes in sagittal and coronal plane alignment.

Results

The study included 19 women and 23 men, with a mean age of 29.7 ± 8.6 years with first-time ACL revision surgery and a minimum PTS of ≥12°. PTS decreased significantly from 14.5 ± 2.8° preoperatively to 8.2 ± 1.9° post-operatively (p < 0.001). The aMPTA demonstrated no significant difference between preoperative (mean aMPTA: 86.9 ± 2.1°) and post-operative (mean aMPTA: 86.6 ± 1.9°) measurements (p > 0.05).

Conclusion

With our technique of placing four guide wires to achieve precise guidance during the insertion of the osteotomy wedge, there is no substantial impact on the aMPTA during slope correction.

Level of Evidence

Level IV.

{"title":"The use of four K-wires does not lead to a reduction of the MPTA in the context of a one-dimensional tibial deflection correction of patients with ACL re-rupture and pathologically increased tibial slope","authors":"Christian Arras,&nbsp;Alexander Korthaus,&nbsp;Jannik Frings,&nbsp;Markus T. Berninger,&nbsp;Hendrik Fahlbusch,&nbsp;Karl-Heinz Frosch,&nbsp;Tobias Drenck,&nbsp;Ralph Akoto,&nbsp;Matthias Krause","doi":"10.1002/jeo2.70145","DOIUrl":"10.1002/jeo2.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Anterior tibial closing wedge osteotomy (ATCWO) has been shown to significantly reduce failure rates of revision anterior cruciate ligament (ACL) reconstructions in patients with a posterior tibial slope (PTS) ≥12°. Recent findings suggest a slight but significant reduction of the medial proximal tibial angle (MPTA) resulting in a varus knee where the sagittal osteotomy plane is based on a total of two guide wires defining the osteotomy wedge without respecting the frontal plane. We hypothesize that the placement of a total of four guide wires intraoperatively can reduce the influence on the MPTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study retrospectively reports on a two-centre series of 42 ATCWOs for PTS correction between January 2022 and December 2023 at two clinical centres. A total of four guide wires were placed based on a true lateral intraoperative view of the tibia, with two positioned each at the cranial and at the caudal pole of the osteotomy wedge, serving as guides for the saw to create the osteotomy, with careful attention to ensuring that the proximal and distal K-Wires were placed parallel to each other. A retrospective analysis was conducted by examining true lateral and anteroposterior radiographs to identify changes in sagittal and coronal plane alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 19 women and 23 men, with a mean age of 29.7 ± 8.6 years with first-time ACL revision surgery and a minimum PTS of ≥12°. PTS decreased significantly from 14.5 ± 2.8° preoperatively to 8.2 ± 1.9° post-operatively (<i>p</i> &lt; 0.001). The aMPTA demonstrated no significant difference between preoperative (mean aMPTA: 86.9 ± 2.1°) and post-operative (mean aMPTA: 86.6 ± 1.9°) measurements (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With our technique of placing four guide wires to achieve precise guidance during the insertion of the osteotomy wedge, there is no substantial impact on the aMPTA during slope correction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047873","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
Cartilage thickness can be accurately measured intraoperatively in total knee arthroplasty: A step further in calipered kinematic alignment
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-26 DOI: 10.1002/jeo2.70155
Giancarlo Giurazza, Stefano Campi, Michael T. Hirschmann, Edoardo Franceschetti, Andrea Tanzilli, Pietro Gregori, Michele Paciotti, Biagio Zampogna, Rocco Papalia

Introduction

Kinematic alignment (KA) in total knee arthroplasty (TKA) is by definition a pure femoral resurfacing procedure aiming to restore the individual prearthritic anatomy. However, when a 2 mm compensation is systematically used on the worn side, the variability in cartilage thickness in the unworn compartment might alter the accuracy of the technique. This study aimed to validate two intraoperative femoral cartilage thickness measurement techniques by comparing them to the photographic method, which measures cartilage thickness through pixel analysis of bone-cut images. The study hypothesized that the two intraoperative methods are comparable and similarly accurate within 0.5 mm of the photographic method.

Methods

Seventy cartilage thickness measurements from seventy patients with end-stage knee osteoarthritis were prospectively collected. Two intraoperative techniques were evaluated: the electrocautery tip method (Method A) and the ruler method (Method B), performed before and after distal femoral bone resections, respectively. The postoperative photographic analysis (Method C) served as the reference method. Measurements were rounded to the nearest 0.5 mm for consistency. Data were analyzed using Kruskal–Wallis test, Wilcoxon rank-sum tests, Spearman's rank correlation, percentage of agreement and intraclass correlation coefficients (ICCs).

Results

No significant differences were observed between Method A and Method B in measuring femoral cartilage thickness. Agreement with Method C was 100% for Method B and 85% for Method A. In the 15% of discordant cases, Method A overestimated the measurements by one category of 0.5 mm compared to Method C. Correlation coefficients between the methods were high (ρ = 0.88−1.0). Intra- and interobserver reliability was high for all methods (ICCs 0.91–0.95).

Discussion

Both intraoperative methods are reliable and comparable to the photographic method when rounded to the closest 0.5 mm, with no significant differences among them. The electrocautery method has the added advantage of measuring cartilage thickness before bone cuts are performed.

Level of Evidence

Level IV.

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引用次数: 0
Clinical outcomes and biomechanics in bicruciate-retaining total knee arthroplasty
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-26 DOI: 10.1002/jeo2.70152
Kenichi Kono, Tomofumi Kage, Takaharu Yamazaki, Shuji Taketomi, Ryota Yamagami, Hiroshi Inui, Tetsuya Tomita, Sakae Tanaka

Purpose

To clarify the influence of biomechanics on post-operative clinical outcomes in bicruciate-retaining total knee arthroplasty (BCR-TKA).

Methods

Severe medial osteoarthritis who underwent BCR-TKA were examined. Each patient was asked to perform a squat (weight-bearing [WB]) and active assisted knee flexion (non-WB [NWB]) under single fluoroscopy surveillance. A 2D-to-3D registration technique was used. Patients were divided into two groups based on their 1-year post-operative patient-reported outcome measures (PROMs) using hierarchical cluster analysis. The rotational alignment on computed tomography, anterior stability at 30° of knee flexion, axial rotation of the femur relative to the tibial component and anteroposterior translation of the medial and lateral femorotibial contact points were measured.

Results

Components did not significantly differ between the groups, with 1.6 ± 5.0° and 5.4 ± 4.7° of femoral internal rotation in the low PROM (N = 28) and high PROM (N = 8) groups, respectively. Moreover, anterior stability did not significantly differ (low PROM: 4.9 ± 1.4 mm, high PROM: 5.3 ± 1.0 mm). The knee externally rotated from 0° to 70° and from 50° to 110° of flexion during WB and NWB, respectively. The low-PROM group exhibited more external rotation across all ranges of motion. Medial contact points moved backwards from 0° to 30° of flexion during WB, forward from 30° to 100° of flexion, and backwards from 100° to 110° of flexion. The low-PROM group was positioned more forward throughout the full range of motion during WB. Lateral contact points moved backwards at 0−30° of flexion, forward at 70−100° of flexion, and backwards at 100−110° of flexion during WB, while there was backward movement at 50° of flexion during NWB. Both activities exhibited a more posterior position in the low-PROM group throughout the full range of motion.

Conclusion

The femoral component in the low-PROM group was externally rotated across all ranges of motion, and the lateral contact points were posteriorly located in BCR-TKA.

Level of Evidence

Level II, prospective cohort study.

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引用次数: 0
Biomechanical comparison of all-inside meniscal suture configurations for posterior root tear: Three conventional stitches versus delta-grip stitch
IF 2 Q2 ORTHOPEDICS Pub Date : 2025-01-22 DOI: 10.1002/jeo2.70149
Kyohei Ishibashi, Kyota Ishibashi, Takahiro Tsushima, Eiji Sasaki, Shohei Yamauchi, Yuka Kimura, Yasuyuki Ishibashi

Purpose

This study aimed to compare the biomechanical properties of four meniscal suture configurations—two simple sutures (TSS), two cinch sutures, a locking loop stitch (LLS), and a delta-grip stitch (DGS)—for transtibial pullout repair of medial meniscus posterior root tears (MMPRTs) using porcine menisci.

Methods

Forty porcine menisci were randomly assigned to each suture configuration with all-inside repair. All specimens were subjected to cyclic loading for 1000 cycles, followed by a load-to-failure test. We evaluated displacement after cyclic loading, the ultimate failure load and the mode of failure.

Results

No significant differences in displacement were observed between the configurations (p = 0.709). The DGS exhibited significantly higher ultimate failure loads (281.4 ± 53.5 N) compared to TSS (166.8 ± 84.5 N) and the LLS (119.7 ± 46.7 N) (p = 0.006 and p < 0.001, respectively). Suture breakage was observed in the DGS group, while meniscus cutout was observed in the other suture configuration models.

Conclusion

The results suggest that the DGS provides superior fixation strength and enhances MMPRT repair outcomes.

Level of Evidence

Level IV.

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引用次数: 0
期刊
Journal of Experimental Orthopaedics
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