Journal of Experimental Orthopaedics最新文献_第8页

Repair of bucket handle meniscus tears improves patient outcomes versus partial meniscectomy at the time of ACL reconstruction 修复斗柄半月板撕裂与在前交叉韧带重建时进行部分半月板切除术相比，可改善患者的预后

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-28 DOI: 10.1002/jeo2.70004

Gregory T. Perraut, Rachel E. Cherelstein, Alexandra M. Galel, Laura E. Keeling, Christopher M. Kuenze, Andrew J. Curley, David X. Wang, Kaitlin A. Malekzadeh, Edward S. Chang

Purpose

The aim of this study was to examine demographic and surgical factors that influence patient-reported knee function in patients who undergo anterior crucial ligament reconstruction (ACLR) with concurrent bucket-handle meniscal tear (BHMT) procedures. We hypothesized that repair of BHMT in the setting of concomitant ACLR and shorter time from injury to surgery would lead to improved patient-reported outcomes.

Methods

Forty-one patients (mean age: 28.0 ± 9.8 years, 72% male) with BHMT at the time of ACLR completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) via online survey at an average of 15.2 months postop. Patient demographics and surgical characteristics, including time from injury to surgery, were compared between repair (n = 22) and meniscectomy (n = 19) groups using one-way analysis of variances; distributions of sex, graft source, BHMT compartment and zone were compared between groups using χ² tests. The association between IKDC-SKF score, demographics and surgical characteristics was evaluated using multivariable linear regression. A priori alpha level was p < 0.05.

Results

Meniscal repair and meniscectomy groups differed based on graft source and BHMT zone but not IKDC-SKF score (p = 0.085). Patients undergoing ACLR with autograft (p = 0.003) and with red–red zone BHMT (p < 0.001) more often underwent meniscal repair. The regression model demonstrated longer time from injury to surgery (p = 0.049), red–red tear zone (p = 0.04) and meniscectomy (p = 0.008); these were predictive of poorer IKDC-SKF scores.

Conclusion

BHMT repair was more likely performed in ACL autograft and on red–red zone tears. Longer time from injury to surgery is an indicator of poorer IKDC-SKF score, as this may increase the risk of concomitant pathologies. White–white zone BHMTs are associated with better IKDC-SKF scores than red–red zone BHMTs, which may be due to the smaller volume of tissue removed during meniscectomy of white–white zone tears and the avoidance of iatrogenic complications of meniscal repair.

Level of Evidence

Level III, therapeutic study.

目的本研究旨在对接受前关键韧带重建（ACLR）并同时接受桶柄半月板撕裂（BHMT）手术的患者进行人口统计学和手术因素分析，以了解这些因素对患者膝关节功能报告的影响。我们假设，在同时进行前交叉韧带重建的情况下进行 BHMT 修复，并缩短从受伤到手术的时间，将改善患者报告的结果。方法 41 名在进行前交叉韧带损伤（ACLR）时患有 BHMT 的患者（平均年龄：28.0 ± 9.8 岁，72% 为男性）在术后平均 15.2 个月时通过在线调查完成了国际膝关节文献委员会主观膝关节表格（IKDC-SKF）。采用单因素方差分析比较了修复组（22 例）和半月板切除术组（19 例）的患者人口统计学特征和手术特征，包括从受伤到手术的时间；采用χ2 检验比较了组间性别、移植物来源、BHMT 区和区域的分布。采用多变量线性回归评估了IKDC-SKF评分、人口统计学特征和手术特征之间的关联。先验α水平为 p <0.05。结果半月板修复组和半月板切除术组在移植物来源和 BHMT 区方面存在差异，但在 IKDC-SKF 评分方面没有差异（p = 0.085）。接受自体移植物 ACLR（p = 0.003）和红-红区 BHMT（p < 0.001）的患者更常接受半月板修复术。回归模型显示，从受伤到手术的时间更长（p = 0.049）、红色撕裂区（p = 0.04）和半月板切除术（p = 0.008）；这些都是IKDC-SKF评分较差的预测因素。结论前交叉韧带自体移植和红色撕裂区更有可能进行 BHMT 修复。从受伤到手术的时间较长是IKDC-SKF评分较差的一个指标，因为这可能会增加并发病症的风险。与红-红区BHMT相比，白-白区BHMT的IKDC-SKF评分较高，这可能是由于白-白区撕裂的半月板切除术中切除的组织量较小，避免了半月板修复的先天性并发症。证据等级 III 级，治疗性研究。

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引用次数: 0

Delayed anterior cruciate ligament reconstruction and risk of meniscus injury: Exploring the safest delay interval 延迟前十字韧带重建与半月板损伤风险：探索最安全的延迟时间间隔

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-27 DOI: 10.1002/jeo2.70006

Ghuna Arioharjo Utoyo, Dliyauddin Fachri, Calvin

Purpose

The duration for which anterior cruciate ligament reconstruction (ACLR) can be delayed without resulting in a risk of subsequent meniscus injury has remained a debatable topic. The main purpose of this study was to determine the safest delay interval for a delayed ACLR.

Methods

This retrospective study included all patients who underwent ACLR between January 2020 and January 2022. The patients were divided into four groups based on the delay interval: <3 months, 3–6 months, 6–12 months and >12 months. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1-year postoperatively.

Results

A total of 95 patients were included in this study. ACLR delay of 3–6 months was not associated with the risk of meniscus injury, while a delay of 6–12 months (odds ratio [OR] = 4.35; 95% confidence interval [CI] = 1.13–16.79; p = 0.031) and >12 months (OR = 10.68; 95% CI = 2.55–42.22; p = 0.001) was associated with a likelihood of developing meniscus injury. Meniscus injury risk increased by 12% for each month of ACLR delay (OR = 1.12; 95% CI = 1.04–1.22; p = 0.003). Regarding clinical outcomes at 1-year postoperatively, all groups exhibit the same clinical results.

Conclusion

ACLR can be safely delayed up to 6 months after the initial injury. However, a delay for >6 months must be avoided, as it was found to significantly increase the likelihood of developing a meniscus injury.

Level of Evidence

Level III, retrospective comparative study.

目的前交叉韧带重建术（ACLR）可以延迟多长时间而不会导致随后半月板损伤的风险，这一直是一个有争议的话题。本研究的主要目的是确定延迟前交叉韧带重建最安全的延迟时间间隔。方法这项回顾性研究纳入了 2020 年 1 月至 2022 年 1 月期间接受 ACLR 的所有患者。根据延迟时间将患者分为四组：3 个月、3-6 个月、6-12 个月和 12 个月。术后1年使用国际膝关节文献委员会（IKDC）评分和膝关节损伤与骨关节炎结果评分（KOOS）评估临床结果。结果本研究共纳入 95 名患者。ACLR 延迟 3-6 个月与半月板损伤的风险无关，而延迟 6-12 个月（几率比 [OR] = 4.35；95% 置信区间 [CI] = 1.13-16.79；p = 0.031）和 12 个月（OR = 10.68；95% CI = 2.55-42.22；p = 0.001）与发生半月板损伤的可能性有关。前交叉韧带重建每延迟一个月，半月板损伤风险就增加12%（OR = 1.12; 95% CI = 1.04-1.22; p = 0.003）。关于术后 1 年的临床结果，所有组别均表现出相同的临床结果。结论 ACLR 可以安全地延迟到初次损伤后 6 个月。但是，必须避免延迟 6 个月，因为这将显著增加半月板损伤的可能性。证据等级 III 级，回顾性比较研究。

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引用次数: 0

The association of the medial meniscus covering ratio with knee cartilage thickness at 15 medial compartment subregions as found by three-dimensional analysis using MRI 利用核磁共振成像进行三维分析，发现内侧半月板覆盖率与膝关节软骨厚度在 15 个内侧隔亚区域的相关性

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-27 DOI: 10.1002/jeo2.70005

Nobutake Ozeki, Hideyuki Koga, Tomomasa Nakamura, Hiroki Katagiri, Yusuke Nakagawa, Takashi Hoshino, Mai Katakura, Masaki Amemiya, Aritoshi Yoshihara, Hisako Katano, Mitsuru Mizuno, Kentaro Endo, Jun Masumoto, Ichiro Sekiya

Purpose

The correlation of cartilage thickness measured by three-dimensional (3D) magnetic resonance imaging (MRI) and the medial meniscal coverage ratio (MMCR), which presented pathology of the medial meniscus extrusion (MME) in 3D MRI, has not yet been elucidated. The study's purpose was to retrospectively verify whether the average cartilage thickness calculated by the automatic MRI 3D analysis system for each subregion was correlated with MMCR.

Methods

A total of 60 patients underwent medial meniscus repair or high tibial osteotomy to treat their medial knee osteoarthritis. Cartilage thickness and MMCR were automatically calculated using 3D MRI software. The MMCR was defined as the ratio of the area covered by the meniscus within the medial tibial cartilage area to the total medial tibial cartilage area. The association between MMCR and the average cartilage thickness at 15 subregions in the medial femoral condyle (MFC) and medial tibial plateau (MTP) was evaluated using Spearman's rank correlation coefficient.

Results

Kellgren–Lawrence grade exhibited a negative correlation with MMCR and a positive correlation with MME width. Cartilage thickness in the MTP had a moderately positive correlation with MMCR at four subregions and a weakly positive correlation at another subregion. Cartilage thickness in the MFC showed a moderately positive correlation with MMCR at five subregions and a weakly positive correlation at one subregion.

Conclusions

Cartilage thickness calculated by automatic MRI 3D analysis system had a positive correlation with MMCR for all subregions of the anterior and middle subregions in the MFC and for five regions of nine subregions of the anterior and middle subregions in the MTP.

Level of evidence

Level II, cross-sectional study (diagnosis).

目的通过三维（3D）磁共振成像（MRI）测量的软骨厚度与内侧半月板覆盖率（MMCR）之间的相关性尚未阐明，而内侧半月板覆盖率在三维磁共振成像中呈现出内侧半月板挤压（MME）的病理特征。本研究的目的是回顾性验证核磁共振成像三维自动分析系统计算出的每个亚区域的平均软骨厚度是否与MMCR相关。方法共有 60 名患者接受了内侧半月板修复术或胫骨高位截骨术，以治疗膝关节内侧骨关节炎。使用三维核磁共振成像软件自动计算软骨厚度和MMCR。MMCR定义为胫骨内侧软骨区域内半月板覆盖面积与胫骨内侧软骨总面积之比。使用斯皮尔曼等级相关系数评估了MMCR与股骨内侧髁（MFC）和胫骨内侧平台（MTP）15个亚区域平均软骨厚度之间的关系。结果 Kellgren-Lawrence 分级与 MMCR 呈负相关，与 MME 宽度呈正相关。MTP软骨厚度在四个亚区与MMCR呈中度正相关，在另一个亚区呈弱正相关。MFC 的软骨厚度在五个亚区与 MMCR 呈中度正相关，在一个亚区呈弱正相关。结论核磁共振成像三维自动分析系统计算出的软骨厚度与 MFC 前区和中区所有亚区的 MMCR 呈正相关，与 MTP 前区和中区九个亚区中五个亚区的 MMCR 呈正相关。证据级别 II 级，横断面研究（诊断）。

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引用次数: 0

Cross-cultural adaptation and measurement properties of the Persian version of the modified Cincinnati knee rating system 改良辛辛那提膝关节评分系统波斯语版的跨文化适应性和测量特性

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-27 DOI: 10.1002/jeo2.70003

Nasim Eshraghi, Peyman Mirghaderi, Reza Omid, Mohamad Sajadi, Amirreza Pashapour-Yeganeh, S. M. Javad Mortazavi

Purpose

To validate and assess the cross-sectional adaptation of the modified Cincinnati knee rating system (MCRKS) Persian translation.

Methods

To assess test-pretest reliability, 102 participants were asked to fill out the MCRKS (Per) scale after anterior cruciate ligament (ACL) reconstruction surgery. Internal consistency (Cronbach's α), reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patients completed other relevant measures as the ACL return to sports after injury (ACL-RSI) survey, hospital for special surgery ACL satisfaction survey (HSS ACL-SS), visual analogue scale (VAS) of pain and patient's satisfaction, Tegner activity score (TAS), single assessment numeric evaluation, and Lysholm score.

Results

Using MCRKS (Per), the internal consistency (Cronbach's α) was 0.9 (if item deleted: 0.81–0.86); the construct validity (Pearson's r) varied between –0.50 (for VAS pain scale) and 0.79 (for Lysholm score); the reliability (ICC value) varied between 0.82 and 0.97; furthermore, no ceiling or floor effect was present.

Conclusion

The MCRKS (Per) has adequate measurement properties and is considered a valid, reliable and sensitive instrument which can identify clinical outcomes after ACLR surgery.

Level of Evidence

Level IV.

目的验证和评估改良辛辛那提膝关节评分系统（MCRKS）波斯语翻译的横断面适应性。方法为了评估测试后的可靠性，要求 102 名参与者在前交叉韧带（ACL）重建手术后填写 MCRKS（波斯语）量表。测定了量表的内部一致性（Cronbach's α）、可靠性（类内相关系数）、建构效度（Pearson's r）和灵敏度（地板/天花板效应）。此外，患者还完成了前交叉韧带损伤后运动恢复调查（ACL-RSI）、特殊外科医院前交叉韧带满意度调查（HSS ACL-SS）、疼痛和患者满意度视觉模拟量表（VAS）、Tegner活动评分（TAS）、单一评估数字评价和Lysholm评分等其他相关测量。结果使用 MCRKS (Per)，其内部一致性（Cronbach's α）为 0.9（如果删除项目：0.81-0.86）；结构效度（Pearson's r）在-0.50（VAS 疼痛量表）和 0.79（Lysholm 评分）之间变化；可靠性（ICC 值）在 0.82 和 0.97 之间变化；此外，不存在上限或下限效应。结论 MCRKS（Per）具有充分的测量特性，被认为是一种有效、可靠和灵敏的工具，可以确定前交叉韧带重建手术后的临床结果。证据等级 IV 级。

{"title":"Cross-cultural adaptation and measurement properties of the Persian version of the modified Cincinnati knee rating system","authors":"Nasim Eshraghi, Peyman Mirghaderi, Reza Omid, Mohamad Sajadi, Amirreza Pashapour-Yeganeh, S. M. Javad Mortazavi","doi":"10.1002/jeo2.70003","DOIUrl":"https://doi.org/10.1002/jeo2.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To validate and assess the cross-sectional adaptation of the modified Cincinnati knee rating system (MCRKS) Persian translation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To assess test-pretest reliability, 102 participants were asked to fill out the MCRKS (Per) scale after anterior cruciate ligament (ACL) reconstruction surgery. Internal consistency (Cronbach's <i>α</i>), reliability (intraclass correlation coefficients), construct validity (Pearson's <i>r</i>) and sensitivity (floor/ceiling effect) were determined. In addition, patients completed other relevant measures as the ACL return to sports after injury (ACL-RSI) survey, hospital for special surgery ACL satisfaction survey (HSS ACL-SS), visual analogue scale (VAS) of pain and patient's satisfaction, Tegner activity score (TAS), single assessment numeric evaluation, and Lysholm score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using MCRKS (Per), the internal consistency (Cronbach's <i>α</i>) was 0.9 (if item deleted: 0.81–0.86); the construct validity (Pearson's <i>r</i>) varied between –0.50 (for VAS pain scale) and 0.79 (for Lysholm score); the reliability (ICC value) varied between 0.82 and 0.97; furthermore, no ceiling or floor effect was present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The MCRKS (Per) has adequate measurement properties and is considered a valid, reliable and sensitive instrument which can identify clinical outcomes after ACLR surgery.</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":"11 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077847","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

Joint line convergence angle is the most associated alignment factor with the severity of medial knee osteoarthritis 关节线会聚角是与膝关节内侧骨关节炎严重程度最相关的对齐因素。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-22 DOI: 10.1002/jeo2.70007

Takahiro Tsushima, Eiji Sasaki, Yukiko Sakamoto, Yuka Kimura, Eiichi Tsuda, Yasuyuki Ishibashi

Purpose

The purpose of this study was to evaluate the relationship between the joint line convergence angle (JLCA) and the severity of medial knee osteoarthritis (OA). We hypothesise that JLCA is the most associated factor with the severity of medial knee OA.

Methods

This retrospective study included a total of 202 knees that underwent either high tibial osteotomy or medial meniscus repair/partial resection. Kellgren–Lawrence grade and hip–knee–ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and JLCA were assessed from preoperative radiographs. Medial meniscus extrusion (MME) was measured using preoperative magnetic resonance imaging. The International Cartilage Research Society (ICRS) grade on the medial femoral condyle and medial tibial plateau were also assessed. The relationships between JLCA and Kellgren–Lawrence grades and MME and ICRS grades were analysed using Spearman's correlation test and regression analysis.

Results

The JLCA was correlated with the Kellgren–Lawrence grade (R = 0.765, p < 0.001), MME (R = 0.638, p < 0.001), ICRS grade on the MFC (R = 0.586, p < 0.001) and the MTP (R = 0.586, p < 0.001). Regression analysis showed that age (p = 0.002) and JLCA (p < 0.001) were associated with Kellgren–Lawrence grade. Furthermore, JLCA was related to ICRS grade on the MFC (p < 0.001) and MTP (p < 0.001).

Conclusion

The JLCA, reflecting radiological severity, meniscus status, and cartilage lesion, was the most associated alignment parameter in the severity of medial knee OA. The JLCA may be beneficial for quantitative assessment of medial knee OA.

Level of Evidence

Level III, retrospective cohort study.

目的：本研究旨在评估关节线收敛角（JLCA）与膝关节内侧骨关节炎（OA）严重程度之间的关系。我们假设关节线会聚角是与膝关节内侧骨性关节炎严重程度最相关的因素：这项回顾性研究共纳入了 202 个接受胫骨高位截骨术或内侧半月板修复/部分切除术的膝关节。根据术前X光片评估了Kellgren-Lawrence等级和髋膝踝角度（HKAA）、机械外侧股骨远端角度（mLDFA）、内侧胫骨近端角度（MPTA）和JLCA。内侧半月板挤压（MME）通过术前磁共振成像进行测量。此外，还评估了国际软骨研究学会（ICRS）对股骨内侧髁和胫骨内侧平台的分级。采用斯皮尔曼相关性检验和回归分析法分析了JLCA和Kellgren-Lawrence分级与MME和ICRS分级之间的关系：结果：JLCA与Kellgren-Lawrence分级（R = 0.765，p R = 0.638，p R = 0.586，p R = 0.586，p p = 0.002）和JLCA（p p p 结论）相关：JLCA反映了放射学严重程度、半月板状态和软骨病变，是与膝关节内侧OA严重程度最相关的对齐参数。JLCA可能有利于膝关节内侧OA的定量评估：证据等级：三级，回顾性队列研究。

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引用次数: 0

Artificial intelligence-assisted ultrasound-guided regional anaesthesia: An explorative scoping review 人工智能辅助超声引导区域麻醉：探索性范围综述

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-14 DOI: 10.1002/jeo2.12104

Martina Marino, Rebecca Hagh, Eric Hamrin Senorski, Umile Giuseppe Longo, Jacob F. Oeding, Bengt Nellgard, Anita Szell, Kristian Samuelsson

Purpose

The present study reviews the available scientific literature on artificial intelligence (AI)-assisted ultrasound-guided regional anaesthesia (UGRA) and evaluates the reported intraprocedural parameters and postprocedural outcomes.

Methods

A literature search was performed on 19 September 2023, using the Medline, EMBASE, CINAHL, Cochrane Library and Google Scholar databases by experts in electronic searching. All study designs were considered with no restrictions regarding patient characteristics or cohort size. Outcomes assessed included the accuracy of AI-model tracking, success at the first attempt, differences in outcomes between AI-assisted and unassisted UGRA, operator feedback and case-report data.

Results

A joint adaptive median binary pattern (JAMBP) has been applied to improve the tracking procedure, while a particle filter (PF) is involved in feature extraction. JAMBP combined with PF was most accurate on all images for landmark identification, with accuracy scores of 0.83, 0.93 and 0.93 on original, preprocessed and filtered images, respectively. Evaluation of first-attempt success of spinal needle insertion revealed first-attempt success in most patients. When comparing AI application versus UGRA alone, a significant statistical difference (p < 0.05) was found for correct block view, correct structure identification and decrease in mean injection time, needle track adjustments and bone encounters in favour of having AI assistance. Assessment of operator feedback revealed that expert and nonexpert operator feedback was overall positive.

Conclusion

AI appears promising to enhance UGRA as well as to positively influence operator training. AI application of UGRA may improve the identification of anatomical structures and provide guidance for needle placement, reducing the risk of complications and improving patient outcomes.

Level of Evidence

Level IV.

目的本研究回顾了有关人工智能（AI）辅助超声引导区域麻醉（UGRA）的现有科学文献，并评估了所报道的术中参数和术后结果。方法 2023 年 9 月 19 日，电子检索专家利用 Medline、EMBASE、CINAHL、Cochrane Library 和 Google Scholar 数据库进行了文献检索。所有研究设计均在考虑之列，对患者特征或队列规模没有限制。评估的结果包括人工智能模型跟踪的准确性、首次尝试的成功率、人工智能辅助和非辅助 UGRA 的结果差异、操作者反馈和病例报告数据。结果采用了联合自适应中值二元模式（JAMBP）来改进跟踪程序，而粒子滤波器（PF）则参与了特征提取。在所有图像上，JAMBP 与粒子滤波器相结合的地标识别准确率最高，在原始图像、预处理图像和滤波图像上的准确率分别为 0.83、0.93 和 0.93。对脊柱针插入的首次尝试成功率进行的评估显示，大多数患者的首次尝试成功率都很高。在比较人工智能应用和单独使用 UGRA 时，发现在正确的区块视图、正确的结构识别以及平均注射时间减少、针轨调整和骨接触方面，人工智能辅助有显著的统计学差异（p < 0.05）。对操作员反馈的评估显示，专家和非专家操作员的反馈总体上是积极的。结论人工智能似乎有望增强 UGRA，并对操作员培训产生积极影响。人工智能在 UGRA 中的应用可改善解剖结构的识别，并为穿刺针的放置提供指导，从而降低并发症风险并改善患者预后。证据等级 IV 级。

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引用次数: 0

The ‘forgotten’ lateral patellofemoral ligament: The known unknown 被 "遗忘 "的髌股外侧韧带：已知的未知

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-14 DOI: 10.1002/jeo2.12109

Angelo V. Vasiliadis, Theodorakys Marín Fermín, Emmanouil Papakostas

Level of Evidence

Level V.

证据等级 V 级。

引用次数: 0

Large angular correction of arithmetic coronal alignment is associated with residual lateral laxity after total knee arthroplasty in varus knees for Japanese patients 算术冠状线的大角度校正与日本患者膝关节外翻全膝关节置换术后的残余外侧松弛有关

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-13 DOI: 10.1002/jeo2.12100

Junya Itou, Umito Kuwashima, Masafumi Itoh, Ken Okazaki

Purpose

One of the most common types of coronal plane alignment of the knee (CPAK) is type I, which is characterised by varus alignment and apex distal joint line obliquity. The purpose of this study was to evaluate the association of changes in arithmetic hip–knee–ankle angle (aHKA) with both postoperative joint laxity and patient-reported outcome measures (PROMs) in patients with CPAK type I following mechanical alignment (MA) total knee arthroplasty (TKA).

Methods

Of 111 consecutive knees in 92 patients with osteoarthritis who underwent primary TKA, 80 knees (72.0%) with CPAK type I phenotype preoperatively were evaluated. All TKAs were performed to achieve neutral MA by a medial stabilising gap balancing technique. Pre- to postoperative change in aHKA was defined as ΔaHKA. The 80 CPAK type I knees were divided into a larger ΔaHKA group (>7°) and a smaller ΔaHKA group (≤7°). PROMs, including the Knee Society Score and Forgotten Joint Score-12, were assessed before and 2 years after surgery. Pre- and postoperative joint laxity was assessed using a Telos arthrometer.

Results

Twenty-two knees showed a larger ΔaHKA, and postoperative lateral joint laxity in varus stress was significantly greater in these patients than in those with a smaller ΔaHKA (6.8° vs. 4.5°, p = 0.006). There were no significant differences between the groups in PROMs (p = n.s.).

Conclusions

Postoperative lateral laxity was associated with larger aHKA changes than smaller aHKA changes in CPAK type I knees after TKA. However, no statistically significant differences in PROMs were found according to the amount of change in aHKA.

Level of Evidence

Level III.

目的膝关节冠状面对位（CPAK）最常见的类型之一是 I 型，其特点是膝关节屈曲对位和关节顶远端线偏斜。本研究旨在评估机械对位（MA）全膝关节置换术（TKA）后 CPAK I 型患者的算术髋-膝-踝角度（aHKA）变化与术后关节松弛和患者报告结果指标（PROMs）之间的关系。方法对 92 名骨关节炎患者的 111 个连续膝关节进行初次 TKA 评估，其中 80 个膝关节（72.0%）术前表型为 CPAK I 型。所有 TKA 都是通过内侧稳定间隙平衡技术实现中性 MA 的。术前到术后aHKA的变化被定义为ΔaHKA。80个CPAK I型膝关节被分为ΔaKA较大组（>7°）和ΔaKA较小组（≤7°）。术前和术后两年评估了PROMs，包括膝关节社会评分和Forgotten Joint Score-12。术前和术后关节松弛情况由泰罗斯关节测量仪进行评估。结果有22个膝关节的ΔaKA较大，这些患者术后外侧关节松弛度在屈曲应力下明显大于ΔaKA较小的患者（6.8° vs. 4.5°，p = 0.006）。两组患者的 PROMs 无明显差异（p = n.s.）。结论 CPAK I型膝关节TKA术后外侧松弛与较大的aHKA变化相关，而与较小的aHKA变化相关。然而，根据 aHKA 的变化量，PROMs 没有统计学意义上的显著差异。证据等级 III 级。

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引用次数: 0

Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis 三维打印手术导板在创伤学和骨科手术中的应用和准确性：系统综述与荟萃分析。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-12 DOI: 10.1002/jeo2.12096

Silvan Hess, Julius Husarek, Martin Müller, Sophie C. Eberlein, Frank M. Klenke, Andreas Hecker

Background

Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers.

Methods

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The ‘Quality Assessment Tool for Quantitative Studies’ was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee).

Results

Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA.

Conclusion

Accuracy of PSSGs depends on the type of surgery but averages around 2–3° deviation from the plan. The use of PSSGs might be considered for selected complex cases.

Level of Evidence

Level 3 (meta-analysis including Level 3 studies).

背景：患者特异性手术指南（PSSG）被认为可以减少手术辐射、缩短手术时间并提高手术精度。然而，现有的准确性评估仅限于特定的手术，对于不同解剖部位、三维（3D）打印技术和制造商（传统与在护理点打印）之间的准确性差异还存在不确定性。本研究旨在评估 PSSGs 在创伤学和骨科手术中的准确性，同时考虑到解剖区域、打印方法和制造商：方法：按照《系统综述和元分析首选报告项目》指南进行了系统综述。符合以下条件的研究均可：（1）通过比较至少两个不同平面的术前计划和术后结果来评估 PSSG 的准确性；（2）使用计算机断层扫描或磁共振成像；（3）涵盖矫形外科或创伤学领域；（4）使用英语或德语。方法学质量评估采用 "定量研究质量评估工具"。报告中提供了描述性统计数字，包括平均值、标准差和范围。随机效应荟萃分析确定了每个解剖区域（肩部、髋部、脊柱和膝部）术前计划与术后结果之间的汇总平均绝对偏差：在 4212 项初步符合条件的研究中，有 33 项被纳入最终分析（肩关节 8 项、髋关节 5 项、脊柱 5 项、膝关节 14 项、创伤 1 项）。全膝关节置换术（TKA）、全肩关节置换术（TSA）、全髋关节置换术（THA）和脊柱手术（脊柱切除术中椎弓根螺钉置入）的汇总平均偏差（95% 置信区间）分别为 1.82°（1.48, 2.15）、2.52°（1.9, 3.13）、3.49°（3.04, 3.93）和 2.67°（1.64, 3.69）。TKA和THA之间以及TKA和TSA之间的准确性各不相同：结论：PSSG 的准确性取决于手术类型，但平均偏离计划约 2-3°。某些复杂病例可考虑使用PSSG：3级（包括3级研究的荟萃分析）。

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引用次数: 0

Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis 通过动态放射性立体测量分析评估桡骨头关节置换术直径对肘关节运动学的影响。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-08 DOI: 10.1002/jeo2.12092

Johanne F. Teilmann, Emil T. Petersen, Theis M. Thillemann, Chalotte K. Hemmingsen, Josephine O. Kipp, Maiken Stilling

Purpose

Radial head arthroplasty (RHA) reestablishes elbow stability after complex radial head fracture, but complication rates are high, possibly due to inappropriate implant sizing. Knowledge of impact of radial head implant diameter on elbow kinematics is limited and warranted. This study evaluated elbow kinematics of different radial head implant diameters after RHA using dynamic radiostereometric analysis (dRSA).

Methods

Eight human donor arms were examined with dRSA during elbow flexion with the forearm in unloaded neutral position, and in supinated- and pronated position without and with 10N either varus or valgus load, respectively. Elbow kinematics were examined before and after RHA with head diameters of anatomical size, −2 mm (undersized), and +2 mm (oversized). The ligaments were kept intact by use of step-cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from CT, and by AutoRSA software bone models were matched with dRSA recordings. The elbow kinematics were described using anatomical coordinate systems.

Results

Compared to the native radial head during elbow flexion, the anatomical sized RHA shifted 2.0 mm in ulnar direction during unloaded pronated forearm position. The undersized RHA shifted 1.5 mm in posterior direction and 2.1 mm in ulnar direction during unloaded pronated forearm position and increased the varus angle by 2.4° during supinated loaded forearm position. The oversized RHA shifted 1.6 mm in radial direction during loaded supinated forearm position.

Conclusions

The anatomically sized RHA should be preferred as it maintained native elbow kinematics the best. The kinematic changes with oversized and undersized RHA diameters were small, suggesting forgiveness for the RHA diameter size.

Level of Evidence

Level III.

目的：桡骨头关节置换术（RHA）可重建复杂桡骨头骨折后的肘关节稳定性，但并发症发生率较高，这可能是由于植入物尺寸不当造成的。有关桡骨头植入物直径对肘关节运动学影响的知识十分有限，因此有必要进行研究。本研究使用动态放射性立体计量分析（dRSA）评估了RHA后不同桡骨头植入物直径对肘关节运动学的影响：方法：在前臂处于无负荷中立位、上举位和前伸位时，分别在无10N或10N内翻或外翻负荷的情况下，使用dRSA对8个人体供体手臂进行肘关节屈曲检查。在肘关节头直径为解剖学大小、-2 毫米（过小）和 +2 毫米（过大）的情况下，对 RHA 前后的肘关节运动学进行了检查。通过阶梯式肱骨截骨术保持韧带完整，以重复交换 RHA。骨骼模型由 CT 获得，并通过 AutoRSA 软件将骨骼模型与 dRSA 记录进行匹配。使用解剖坐标系描述肘关节运动学：结果：在肘关节屈曲时，与原生桡骨头相比，解剖大小的桡骨头在前臂无负荷代偿位时向尺侧移动了2.0毫米。过小的 RHA 在前臂无负荷代偿位时向后方偏移 1.5 毫米，向尺侧偏移 2.1 毫米，在前臂负荷上举位时使屈曲角度增加 2.4°。在前臂上举负重姿势时，过大的RHA在桡侧方向移动了1.6毫米：结论：应首选符合解剖学尺寸的 RHA，因为它能最好地保持原生肘关节运动学特性。RHA直径过大和过小的运动学变化都很小，这表明RHA直径的大小是可以原谅的：证据等级：三级。

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引用次数: 0