Journal of Experimental Orthopaedics最新文献

Purpose

The aim of this study was to determine the influence of preoperative psychological factors on clinical outcomes of fresh osteochondral allograft (FOCA) transplantation of the knee. The hypothesis was that patients with preoperative pathological scores on psychological factors would show worsen functional outcomes after FOCA transplantation of the knee.

Methods

A prospective data collection study was performed from patients undergoing FOCA transplantation for osteochondral lesions of the knee. All patients were followed up for 30 months. Psychological factors of anxiety, depression, kinesiophobia and catastrophizing were assessed by means of self-administered Hospital Anxiety and Depression Subscale (HADS), Tampa Scale for Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS) questionnaires one week prior to surgery. Clinical outcomes were evaluated preoperatively and at 3, 6, 9, 12, 15 and 30 months postoperatively using the Kujala score, the Western Ontario Meniscal Evaluation Tool (WOMET) score, the International Knee Documentation Committee (IKDC) score and the Tegner Activity Scale. Participants were classified as pathological or non-pathological scores for each psychological parameter in accordance with the cut-off point proposed by the authors of each questionnaire. The interaction between clinical outcome's evolution and pathological scores was analysed using two-way ANOVA tests with Greenhouse–Geisser correction to avoid non-sphericity errors.

Results

Forty-one cases were included (mean age 37.1 years old, 41% female). In the postoperative clinical outcome's evolution, no differences were observed between preoperative pathological and non-pathological scores (p > 0.05) regarding anxiety, depression, kinesiophobia and catastrophizing factors.

Conclusions

No significant differences were observed in the evolution of postoperative clinical outcomes between patients with pathological and non-pathological psychological scores.

Level of Evidence

Level III, case series.

Purpose

Clinical evidence indicates that an unintended increase in the medial proximal tibial angle (MPTA) can occur during slope-reducing tibial osteotomies, which is most relevant in anterior cruciate ligament (ACL) deficient knees. Therefore, the purpose of this three-dimensional (3D) simulation study is to assess how axial or coronal hinge axis rotation affect alignment parameters in anterior tibial closing wedge osteotomies (ACWO). The hypothesis states that a neutral hinge axis (NHA) in ACWO prevents changes in coronal and axial alignment.

Methods

A 3D surgical simulation was used to perform ACWO with a stepwise increment of one-degree (1°–5°) rotation around thirteen different hinge axes. Surface models were created from CT scans of 49 individuals (mean PTS 11.5° ± 3.8°) resulting in 3185 simulations. A NHA not changing the coronal or axial alignment was defined as oriented parallel to the posterior tibial plateau 1 cm underneath the articular surface. Anatomical landmarks were determined for each simulation to measure the PTS, MPTA, hip-knee-ankle angle (HKA), and tibial torsion (TT). The effects of the initial MPTA or PTS on the resulting alignment parameters and the effects of axial and sagittal rotation of the joint axis were analysed for their effects on postsimulation PTS, MPTA and TT.

Results

Clinically relevant hinge axis rotation in the coronal or axial plane below 20° did not significantly influence PTS correction (p > 0.05). Axial rotation of the hinge axis exceeding 10° led to significant MPTA changes (> +1.7° ± 0.03°) compared to the NHA (p < 0.001). Pre-simulation MPTA had no influence on post-simulation MPTA changes (p > 0.05).

Conclusion

NHA aligned parallel to the posterior tibial plateau below the articular surface prevents significant changes in MPTA during ATCWO. This 3D simulation suggest, that hinge axis orientation requires meticulous consideration during slope-reducing osteotomies to preserve alignment integrity.

Level of Evidence

Level V, retrospective simulation study.

Purpose

The aim of this study is to evaluate the impact of graft size and time between injury to surgery (TBIS) on static anterior tibial translation (SATT) and dynamic anterior tibial translation (DATT) after anterior cruciate ligament (ACL) reconstruction.

Methods

A consecutive series of patients treated with primary ACL reconstruction using hamstring autograft was reviewed. Preoperative SATT, DATT and posterior tibial slope (PTS) were measured with a previously validated technique by two independent reviewers on lateral weight-bearing knee radiographs. Regression analysis was performed to assess the relationship between postoperative—preoperative SATT difference (Δ SATT) and postoperative—preoperative DATT difference (Δ DATT) with graft size and TBIS.

Results

In total, 66 patients were included in this study. The mean preoperative SATT and DATT were 2.41 (standard deviation [SD] 2.98) and 9.09 (SD 3.19), respectively. The mean postoperative SATT and DATT were 2.14 (SD 2.47) and 5.28 (SD 2.55), respectively. The mean graft size was 8.4 mm (SD 8.4; range 7.75–10), and the median TBIS was 3 months (range 1–275). Linear regression analysis showed no correlation between graft size and Δ SATT (p = 0.060) and Δ DATT (p = 0.979) and no correlation between TBIS and Δ SATT (p = 0.817) and Δ DATT (p = 0.811).

Conclusion

Our results suggest that larger graft sizes or shorter times between injury and reconstruction do not impact the reduction of SATT or DATT following ACL reconstruction.

Level of Evidence

Level IV, retrospective cohort study.

Purpose

This study aims to describe a novel minimally invasive technique for the treatment of acute tibial posterior cruciate ligament (PCL) avulsion fracture.

Methods

This retrospective study included seven patients who underwent ultrasound-guided fixation for acute PCL tibial avulsion fractures by using an adjustable-loop device between January 2021 and January 2023. Before the surgery, the maximum diameter, area and displacement distance of the fragments were measured using computed tomography examination. All patients were followed up for at least 12 months, and clinical outcomes were assessed on the basis of range of motion, the International Knee Documentation Committee Score and the Lysholm score.

Results

For the seven patients, the mean maximum diameter, area and displacement distance of preoperative avulsion fragments were 12.7 mm (range, 9.0–48.3), 128 mm² (range, 63–256.2) and 5.9 mm (range, 3.8–7.2), respectively. These fractures were fixed using an adjustable-loop suspensory device under ultrasound guidance. Based on x-ray examination during the post-operative follow-up period, all patients had no fracture displacement and fracture unions were confirmed, with a mean union time of 10.28 ± 2.13 weeks (range, 8–14). Based on the knee function assessment at 12-month post-operative follow-up visit, all patients demonstrated excellent clinical outcomes.

Conclusions

Ultrasound-assisted internal fixation using an adjustable-loop device demonstrated satisfactory clinical and radiographic results. This technique has the advantages of being minimally invasive, safe, stable, convenient to operate and thus could be considered as a feasible alternative for the treatment of acute tibial PCL avulsion fractures.

Level of Evidence

Level III.

Purpose

Surgical options for end-stage knee osteoarthritis (OA) include total and medial unicompartmental knee replacement (TKR and UKR). Deciding which surgery to perform is complex and ill-defined, yet it has important implications for patients and the health service. The study aimed to identify clinical and surgeon factors predicting surgeons' preferences.

Methods

Based on a preliminary survey of 162 UK surgeons, we identified clinical features frequently considered when deciding between TKR and UKR. By systematically varying patient age, obesity, site of pain, anaesthetic risk and anterior cruciate ligament (ACL) integrity, we constructed 32 clinical vignettes. We used these in a new survey, where surgeons indicated which surgery they would recommend on an 11-point rating scale with end points anchored at ‘definitely TKR’ and ‘definitely medial UKR’. Data were analysed with mixed-effects linear regressions.

Results

Eighty-three UK arthroplasty surgeons completed the vignettes. Preference for UKR over TKR was significantly lower for patients over 50 years (b = −0.57 [−0.82 to −0.33], p < 0.001) with abnormal ACL (b = −1.93 [−2.17 to −1.68], p < 0.001) and severe systemic disease (b = −0.46 [−0.70 to −0.21], p < 0.001). Obesity was a weak and unreliable predictor, and we did not detect any influence of site of pain. The surgeons' habitual practice (proportion of UKRs over all knee replacements performed in a typical year) was the second strongest predictor after ACL (b = 1.26 [0.54–1.99], p = 0.001).

Conclusions

ACL integrity was the most important determinant of surgeons' preferences between TKR and UKR. Their habitual practice was also a strong predictor, outweighing most clinical factors in the vignettes.

Level of Evidence

Level II, prospective cohort study.

Purpose

Previous investigations have associated weakness of neck muscles with a higher likelihood of developing neck pain. However, no previous investigation has examined the influence of neck stabilization exercise (NSE) and dynamic neuromuscular stabilization (DNS) on pain intensity, forward head angle (FHA) and muscle activity.

Methods

A total of 45 female employees with chronic non-specific neck pain (CNNP) underwent measurements of pain intensity, FHA and electrical activity of muscles in a slump posture, before and after either NSE or DNS.

Results

After both stabilization exercise (SE) and DNS the Numeric Pain Rating Scale (NPRS) (F (2,39) = 17.61, p = 0.001, partial η² = 0.475) and forward head posture (FHP), (F (2,39) = 5.509, p = 0.008, partial η² = 0.220), had decreased. Both interventions also decreased the activity in the cervical erector spinae muscle (F (2,39) = 5.31, p = 0.009, partial η² = 0.214), the upper trapezius muscle (F (2,39) = 5.41, p = 0.008, partial η² = 0.217) in slump typing posture, but there was no significant effect on the activity in the sternocleidomastoid muscle (F (2,39) = 2.65, p = 0.083, partial η² = 0.120).

Conclusion

Both DNS and SE exercises diminished pain intensity, forward head and muscle activity after 6 weeks in patients with CNSNP.

Level of Evidence

Level I, randomized controlled trials with adequate statistical power.

Purpose

The aim of the present study was to compare clinical and radiological outcomes between the all-inside single bundle (SB) and a modified double-bundle (DB) anterior cruciate ligament reconstructions (ACLR) at over 5-year follow-up.

Methods

This is an observational, retrospective comparative, two-centre study. Clinical outcomes were evaluated using Lysholm and International Knee Documentation Committee (IKDC) scores, and anterior tibial translation (ATT) was assessed using the KT-1000 arthrometer. Knee x-ray images were recorded, classified according to the KL grading and compared with radiographs of the same patient before surgery. Inclusion criteria were patients undergoing ACLR, age between 18 and 45 years and negative knee history of major traumatic events after surgery. Exclusion criteria were congenital laxity, combined multiple knee ligament injuries, patients undergoing ACL revision surgery, history of infection, lower limb coronal axial deviation >5°, patients undergoing lateral extra-articular tenodesis or anterolateral ligament reconstruction, patients with chondral damage Outerbridge grade >2, patients with meniscal tears undergoing subtotal meniscectomy or meniscal repair and patients with knee OA Kellgren–Lawrance (KL) grade >3.

Results

One hundred and fifty-two patients were included in the study. Patients were divided into two groups according to surgical technique: Group A—ACLR with all-inside technique, and Group B—ACLR with modified DB technique. There were no statistical differences between groups for age, side, gender or time since surgery.

There were no statistically significant differences between groups for Lysholm scores (p = 0.43), IKDC (p = 0.88), ATT (p = 0.105) and KL grade (p = 0.93 before surgery, 0.99 at the fu). KL grade increased significantly since pre-op.

Conclusions

Our data show significant improvements in all clinical outcome measures, along with excellent KT-1000 arthrometer values and low clinical failure rates for both the SB all-inside and modified DB techniques at a mean follow-up of over 6 years. There were no significant differences in arthritic progression according to KL grade between groups.

Level of Evidence

Level III.

Background

Dual mobility cup in total hip arthroplasties has gained popularity worldwide as it reduces instability providing greater range of motion. However, increased polyethylene wear remains debated. This in vitro study aimed to measure and qualitatively analyse the wear of ultra-high molecular weight polyethylene in contemporary dual mobility cup compared to conventional single mobility acetabular component.

Methods

Hip simulator was used to compare ultra-high molecular weight polyethylene wear in dual mobility and single mobility acetabular component The specimens were tested at an in vitro angle of 30° relative to the ISO standard fixated position. Flexion/extension, abduction/adduction, and internal/external rotation were simulated. Testing was stopped every 0.5 million cycles until 5.0 million cycles were reached and the liners were disassembled and weighted to assess mass loss. The test fluid was sent for scanning electron microscopy analysis and wear particles were characterized for mean equivalent circle diameter, form factor, maximum Feret diameter, minimum Feret diameter, area, perimeter and aspect ratio.

Results

Dual mobility hip reported a lower wear respect to single mobility (20.4 and 39.6 mg/Mcy, p < 0.01). Moreover, conventional acetabular component produced wear particles with higher equivalent circle diameter, area, perimeter, minimum and maximum Feret diameter, while aspect ratio and form factor resulted higher in dual mobility polyethylene wear. No cases of ultra-high molecular weight polyethylene rupture have been reported.

Conclusion

Dual mobility cup produces less wear than conventional single mobility acetabular component ensuring lower risk of instability and greater range of motion. Further studies are needed to definitively clarify the issue of wear in the dual mobility prosthesis.

Purpose

To evaluate the incidence of anterior cruciate ligament (ACL) reconstructions in athletes who participated in the men's 2022 and women's 2023 Federation Internationale de Football Association (FIFA®) World Cups, comparing the incidence between genders, positions and the stages reached by the teams during the competition.

Methods

This is a media analysis study, and data were collected from official club and FIFA® websites: a list of athletes who played during the men's 2022 and women's 2023 FIFA® World Cup, a list of athletes who already did an ACL reconstruction (ACLR) and rehabilitation before the competition, and stages from each team during the competition.

Results

12.5% of the athletes in the women's competition (92 athletes) and 7.7% in the men's competition (64 athletes) underwent ACLR surgery before. When comparing positions (goalkeeper, defence, midfield and forwards), there were no statistical differences between men (p = 0.97) and women (p = 0.26). According to the competition stage, the prevalence increased from 12.5% in the group stage to 17.4% in the finals (p = 0.05) for women and ranged from 6.8% to 7.9% (p = 0.87) among men. The number of ACL revision surgeries was 18 in women players (2.4% of total, 19.4% of those operated) and 5 in men players (0.6% of total, 7.5% of those operated). No statistical difference in revision rates between men and women (p = 0.16).

Conclusion

In the highest football level competition in the world (FIFA® World Cup), there was no statistical difference between the number of men and women called up and who participated after ACLR, rehabilitation and return to sport (12.5% vs. 7.7%; p > 0.05). Furthermore, the incidence of ACL-operated players belonging to each team that played in the World Cup increased from the stage of groups to the final in the female category (p = 0.05), but remained stable in the male category (p = 0.87).

Level of Evidence

Not applicable.