Journal of Experimental Orthopaedics最新文献

Purpose

This study aimed to analyse the clinical outcomes and survival of patellofemoral arthroplasty (PFA) in treating isolated patellofemoral osteoarthritis (IPFOA) at our centre. The secondary objective was to compare these results with a historical cohort treated with partial lateral facetectomy plus Insall realignment (PLFIR). We hypothesised that clinical outcomes and survival with PFA are superior to PLFIR and comparable to the literature.

Methods

A retrospective analysis of 120 patients with IPFOA was conducted. The PFA series included 33 patients treated between 2012 and 2019 with a minimum follow-up of 5 years (range 1.2–12.1 years). The PLFIR historical cohort treated between 1995 and 2002 (range 4.1–15.7 years) consisted of 87 patients. Preoperative and post-operative clinical outcomes were assessed using the Knee Society Score (KSS) and Kujala score, and survivorship was evaluated via Kaplan–Meier analysis. Cox regression analysis was used to identify factors influencing surgical failure.

Results

The PFA group demonstrated a 75.8% survival rate at 10 years, with a 24.2% failure rate requiring conversion to total knee arthroplasty (TKA). In the PLFIR group, the 10-year survival rate was 79.3%, although 26.4% required TKA. Both groups exhibited significant improvements in KSS and Kujala score, with PFA showing superior Kujala score improvement (p = 0.012). No statistically significant difference in survival between the two groups was observed at 10 years (p = 0.056), but PFA showed better long-term clinical outcomes.

Conclusions

PFA demonstrated comparable survival rates to PLFIR in the treatment of IPFOA. Despite a higher initial failure rate, PFA showed a potential for greater improvement in the long term, particularly in terms of anterior knee pain.

Level of Evidence

Level IV, retrospective case series analysis compared with a historical cohort.

Purpose

To translate and adapt the Norwich Patellar Instability (NPI) score into Norwegian, and second, to examine the psychometric properties of the Norwegian version (NPI-No).

Methods

NPI was translated according to international guidelines. A cohort of 107 patients surgically treated for recurrent patellofemoral instability completed NPI-No, related questionnaires and functional tests prior to and six months post-surgery. Validity (face, content and construct validity), internal consistency (Cronbach's alpha [α]), test–retest reliability (intraclass correlation coefficient [ICC]], measurement error (standard error of measurement [SEM] and smallest detectable change at individual [SDC_ind] and group level [SDC_group]) and construct validity (hypotheses testing; independent t tests, Pearson's r) were examined.

Results

NPI-No had good face and content validity. Internal consistency was satisfactory (α = 0.88), test–retest reliability was moderate ICC_2.1 0.65 (95% confidence interval = 0.47–0.77) and measurement error low (SEM = 7.8). SDC_ind was 21.7 points and SDC_group was 2.8. Seven of the 10 hypotheses about construct validity were confirmed. While there was no ceiling effect pre- or post-operatively, a substantial floor effect (28%) was observed at the 6-month follow-up.

Conclusion

The NPI-No is valid for assessment of self-perceived patellar instability before and after surgery in Norwegian patients. However, reproducibility was found to be only moderate. This study adds further knowledge about the measurement properties of the NPI.

Level of Evidence

Level II.

Purpose

This systematic review and meta-analysis aimed to compare the clinical and radiological outcomes of patients undergoing revision total knee arthroplasty (rTKA) using uncemented press-fit stems (hybrid fixation) versus cemented stems (cemented fixation). It is also examined whether cemented fixation offers any superiority over hybrid fixation regarding implant survival, clinical function, imaging analysis and complication rates.

Methods

Following the PRISMA guidelines, a systematic review and meta-analysis were conducted on five databases (Pubmed, Scopus, Embase, Medline and Cochrane). Articles were evaluated according to levels of evidence (LoE). Retrospective studies were analysed with risk of bias in nonrandomised studies of interventions (Robins-I) and randomised controlled trials with risk of bias 2 (RoB-2). This review was registered in the International Prospective Register of Systematic Reviews database. Meta-analysis was performed using R software, with p < 0.05 considered statistically significant.

Results

Data from 12 comparative studies with 1303 patients (1352 rTKAs) were analysed. Survival rates of hybrid and cemented fixations were comparable, with a significant trend favouring hybrid fixation (p = 0.04). Infection and aseptic loosening were the most common causes of failure. Radiographic failure rates showed no significant differences between fixation methods (p = 0.4). Meta-analysis indicated better results with hybrid fixation, although not statistically significant (KSS functional p = 0.15; KSS clinical p = 0.5). High heterogeneity was observed due to variations in patient characteristics and surgical strategies.

Conclusion

Both hybrid and cemented fixation techniques achieve satisfactory clinical results in rTKA, with hybrid fixation demonstrating an overall lower failure rate. The choice of fixation method must be tailored to individual patient characteristics and surgical considerations. Further high-quality randomised trials are needed to refine these results and optimise fixation strategies to improve patient outcomes.

Level of Evidence

Level IV.

Purpose

Double-level osteotomies (DLOs) have shown promising results for knee joint preservation, however, most ultimately progress in terms of degenerative disease resulting in conversion to total knee arthroplasty (TKA). Therefore, the purpose of this study was to examine the time to TKA conversion, long-term clinical outcomes and revision rates of patients who have undergone TKA after prior ipsilateral DLO.

Methods

Patients who underwent simultaneous or staged DLO and subsequently underwent conversion to TKA at a single academic institution from 1997 to 2022 were evaluated. The type of osteotomy performed (opening- vs. closing-wedge), osteotomy hardware fixation, when and if osteotomy hardware was removed, implanted TKA components and revision rates were recorded. Postoperative outcomes, including Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score and subjective knee preference were also obtained.

Results

A total of 22 patients (24 knees) underwent TKA following DLO and were followed for an average of 26.1 ± 7.7 years. The average time from DLO to TKA conversion was 14.1 ± 6.5 years, with 70.8% of knees converting to TKA more than 10 years after DLO. The mean follow-up after conversion to TKA was 12.0 ± 7.7 years. Only 12.5% of patients received a varus-valgus or hinged-constrained TKA. At the final follow-up, the mean FJS-12 was 75.8 ± 23.1, while the mean Tegner Activity Scale score was 2.5 ± 1.1. Seventy-seven percent of patients had no subjective knee preference or preferred their DLO-TKA knee. Only two knees (7.4%) underwent subsequent revision after index arthroplasty at a mean of 9.3 years postoperatively.

Conclusions

A majority of DLOs (70.8%) converted to TKA after more than a decade. Subsequent TKA function was favorable as most patients had either no subjective knee preference or preferred their DLO-TKA knee. This study demonstrates both long-term joint preservation and uncompromised TKA function after prior DLO.

Level of Evidence

Level IV.

The official medical journals of scientific societies advocate for high-quality standards. It's important to assess whether randomized controlled trials (RCTs) in influential journals, such as the hybrid journal of the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), adhere to reporting guidelines and best practices. Therefore, the present scoping review aimed to explore and map the reporting practices and methodological quality in recent RCTs published in the Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) journal, focusing on identifying gaps in adherence to reporting guidelines and transparency. The study was preregistered and followed the PRISMA-ScR checklist. RCTs published in KSSTA between 2022 and 2023 were included. The search was conducted via PubMed. A two-stage selection process was employed, with two independent reviewers conducting study selection and data extraction. Data collected included study characteristics, intervention details, sample size calculation reporting, data transparency, and adherence to Consolidated Standards of Reporting Trials (CONSORT) guidelines. Critical appraisal was conducted using the JBI tool for RCTs. All included RCTs (n = 25) reported a predetermined minimum sample size. Study protocol preregistration was reported in 52% of the RCTs, while only 24% provided data availability statements. Most RCTs offering data availability indicated data would be shared upon request. Adherence to CONSORT guidelines was reported in 96% of studies, with only one RCT not adhering to recognized reporting standards. All the included studies adequately addressed statistical conclusion validity. However, internal validity was less consistently addressed across the studies.

Conclusions

While most recently published RCTs in KSSTA adhered to CONSORT guidelines, there is potential for improvement in the reporting of protocol preregistration and data availability statements. Although all studies reported sample size calculations, transparency in data sharing remains limited.

Level of Evidence

Level I.

Purpose

This study aimed to compare the return to sports, return to competition, Tegner score and anterior cruciate ligament-return to sports injury (ACL-RSI) scores between patients who underwent ACL reconstruction (ACLR) combined with anterolateral ligament reconstruction (ALLR) and those who underwent ACLR alone.

Methods

Two independent reviewers conducted a literature search in PubMed (MEDLINE), EMBASE, Google Scholar and the Cochrane Library in July 2024, followed by data extraction and quality assessment. This study followed the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. The return to sports rate, return to competition rate, Tegner score and ACL-RSI score were compared between patients who underwent primary ACLR with ALLR and those who underwent isolated primary or revision ACLR. The methodological quality of the included studies was assessed via the Cochrane risk-of-bias tool and methodological items for nonrandomized studies.

Results

In total, 12,139 studies were screened, and 14 (four randomized controlled trials and 10 nonrandomized studies) studies were ultimately evaluated. Compared with isolated ACLR, ACLR combined with ALLR resulted in a higher rate of return to sports and competition. Nevertheless, no significant differences were found in the Tegner score or ACL-RSI score between the two groups.

Conclusion

Patients who underwent ACLR in combination with ALLR had higher rates of return to sports and competition, but their Tegner activity and ACL-RSI scores were similar to those of patients who underwent ACLR alone. This finding may assist surgeons in making decisions when treating patients undergoing ACLR, especially athletes.

Level of Evidence

Level III.

Purpose

The purpose of this study was to examine the outcomes following opening-wedge high tibial osteotomy (HTO) focusing on return to sports in a consecutive series of highly active patients who underwent a unilateral osteotomy procedure.

Methods

Sixty-three consecutive patients with preoperative Tegner's activity score of five or more who underwent unilateral HTO for varus osteoarthritic knees were included in this study. The clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) Subjective Score. In radiological assessment, the following parameters were measured in full-length weight-bearing radiographs both pre- and postoperatively; mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibial angle (mMPTA) and joint-line convergence angle. As regard postoperative functional recovery, inability to return to sports activities and reduction in the activity level on the Tegner scale were considered as failure to return to sports. Potential prognostic factors examined with logistic regression analysis were as follows: age ≥ 70, body mass index > 25, postoperative mTFA > 3° valgus or <0° varus, postoperative mMPTA > 90°, opening gap > 10 mm and Kellgren–Laurence classification (KL) grade 4.

Results

At 2 years after surgery, the KOOS and the IKDC score improved from 231 to 437 and from 34 to 72, respectively, with significant improvements in both scores. As for functional recovery, 50 patients (79.4%) could return to high-impact sports activities at the presymptomatic level with a mean time period of 8.0 months. Statistical analysis of the prognostic factors showed that postoperative mTFA > 3° valgus, opening gap >10 mm and KL grade 4 were the factors significantly affecting the postoperative return to sports.

Conclusions

Presence of postoperative mTFA > 3° valgus, opening gap >10 mm and KL grade 4 were identified as risk factors impairing postoperative return to high-impact sports.

Level of Evidence

Level Ⅳ.

Purpose

Effective rehabilitation after orthopaedic surgery is critical. The early post-operative phase is increasingly managed in outpatient settings, necessitating objective measures such as step counts to monitor rehabilitation progress. However, it remains unclear if commercially available wearables or accelerometers using simple algorithms can accurately count steps in early post-operative conditions. We hypothesised that only accelerometers could accurately determine the number of steps under these conditions.

Methods

This case series involved 20 healthy subjects, 7 female and 13 males, walking in a circle at varying speeds under partial loading with three different walking aids (forearm crutches, walking frame and rolling walker) and four wearables (Vivofit 4, Fenix 3HR, Fitbit Charge 3 and Omron HJ-325) and one accelerometer (AX6) worn on the wrist, hip and ankle. The two-point and modified three-point gait patterns commonly used post-operatively were simulated. The primary end point was the relative error (RE), defined as RE = (manual count − automated count)/manual count, of each wearable measurement compared to visual and video step counting, the gold standard.

Results

The RE of AX6 and Fitbit was less than 0.1 for all walking aids except the rolling walker, with AX6 showing the lowest standard deviation (SD) compared to other wearables. Other wearables had significantly higher RE. Increased gait speed generally improved accuracy, reducing RE in most devices, except for the AX6, which showed the opposite trend. At 0.6 m/s, only AX6 achieved an RE below 0.1. The ankle was identified as the best measuring location.

Conclusion

During the early post-operative period, commercial wearables can only accurately count steps under specific conditions and should be used cautiously for monitoring steps in the early post-operative phase. However, accelerometers with appropriate coding appear suitable for this purpose.

Level of Evidence

Level III diagnostic study.

Purpose

To clarify the femoral tunnel location for a virtual anterior cruciate ligament (ACL) graft to simulate the native ACL.

Methods

Three-dimensional (3D) computed tomography (CT) and magnetic resonance imaging (MRI) were obtained in 14 normal knees in full extension. Two types of virtual triple bundle ACL grafts (VACLG) were created. In one type, the femoral tunnels for anteromedial bundle (AM = AMM/anteromedial bundle medial part + AML/anteromedial bundle lateral part) and posterolateral bundle (PL) were positioned behind the resident's ridge (RR) based on the bone landmark strategy (BR-VACLG group). In the other type, the tunnels were placed on the RR (OR-VACLG group). VACLG was displayed as three straight lines by connecting the two centres of the femoral attachment areas of AM and PL to those of the three tibial footprints of AMM, AML and PL attachments on 3D CT, and then superimposed on MRI. The ACL/ACL graft-the tibial plateau (ACL-TP) angles were compared among normal ACL (N-ACL), BR-VACLG and OR-VACLG.

Results

The mean ACL-TP angles of N-ACL, BR-VACLG and OR-VACLG were 74.4 ± 3.4°, 75.2 ± 4.5° and 68.7 ± 5.0° for AMM, 81.9 ± 3.8°, 82.9 ± 5.1° and 76.3 ± 4.0° and for AML, 71.1 ± 6.4°, 70.0 ± 7.2° and 61.0 ± 4.7° for PL on the oblique-coronal slices; 55.3 ± 4.9° 53.9 ± 4.4° and 50.5 ± 4.3° for AMM; 54.9 ± 4.5°, 54.7 ± 2.6° and 50.7 ± 3.2° for AML; 51.4 ± 3.3°, 51.2 ± 2.4° and 48.1 ± 2.0° for PL on the oblique-sagittal slices. There was no significant difference in the angles between N-ACL and BR-VACLG, while those of AMM and PL in OR-VACLG were significantly lower compared to N-ACL.

Conclusion

The virtual triple bundle ACL graft via femoral tunnels behind the RR on 3D CT shows equivalent orientation to the native ACL on MRI in full extension.

Level of Evidence

Level III.

Purpose

This biomechanical study aimed to investigate the effectiveness of a hinged elbow orthosis in reducing passive valgus forces following medial ulnar collateral ligament (UCL) injuries of the elbow joint. The hypothesis tested was that a hinged elbow orthosis reduces these passive valgus forces.

Methods

Eight fresh frozen cadaveric elbow specimens were prepared and tested under three scenarios: intact ligaments, simulated UCL rupture and application of a hinged elbow brace after simulated UCL rupture. Valgus instability was assessed using a custom testing set-up and the Optotrak motion capture system. Statistical analysis was conducted to compare the results across scenarios.

Results

Intraclass correlation (ICC) calculation showed that the testing set-up was reliable in investigating valgus deflection across all levels of applied force. The hinged elbow brace reduced passive valgus forces after UCL rupture. The reduction in valgus instability was consistent with close approximation to the native state, although not reaching its level.

Conclusion

The hypothesis—that a hinged elbow orthosis significantly reduces passive valgus forces in the elbow following UCL injuries—is not supported by the data and therefore has to be rejected. Nevertheless, the study demonstrates a tendency that a hinged elbow brace could mitigate these forces, at least in an experimental cadaveric model with static study conditions.

Level of Evidence

The level of evidence of this study is level IV.