Journal of Experimental Orthopaedics最新文献_第9页

Fragility analysis and systematic review of patellar resurfacing versus non-patellar resurfacing in total knee arthroplasty 全膝关节置换术中髌骨重置与非髌骨重置的脆性分析和系统回顾。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-08-06 DOI: 10.1002/jeo2.12113

Teja Polisetty, Alexandra L. Hohmann, Eric DiDomenico, Jess H. Lonner

Introduction

Fragility analysis is a method of further characterising the robustness of statistical outcomes. This study evaluates the statistical fragility of randomised controlled trials (RCTs) comparing patellar resurfacing versus non-patellar surfacing in total knee arthroplasty (TKA).

Methods

PubMed, MEDLINE and EMBASE were searched for RCTs comparing outcomes in TKA based on patellar resurfacing. Fragility index (FI) and reverse FI (collectively, “FI”) were calculated for dichotomous outcomes as the number of outcome reversals needed to change statistical significance. Fragility quotient (FQ) was calculated by dividing the FI by the sample size for that outcome. Median FI and FQ were calculated for each individual outcome and for the overall study. Subanalyses were performed to assess FI and FQ based on outcome type, statistical significance and loss to follow-up.

Results

Twenty-one RCTs were included in the analysis, capturing 3910 subjects. The overall median FI was 5.0 (interquartile range, [IQR] 4.0−6.0), and the overall median FQ was 0.048 (IQR 0.022−0.065). The outcome of anterior knee pain has a median FI of 6.0 (IQR 4.0−6.0) and a median FQ of 0.057 (IQR 0.025−0.065). Only five (7%) outcomes were significant. The loss to follow-up was greater than the FI in 12 of 19 studies (63%) with available data.

Conclusion

RCTs comparing patellar resurfacing in TKAs show significant statistical fragility; a few outcome reversals can alter findings. The majority of outcomes were nonsignificant, indicating that the choice to resurface the patella may not affect most clinical outcomes; however, clinical conclusions are limited by the statistical fragility of the analysed outcomes. Larger RCTs for this comparison are necessary, and we suggest adding FI and FQ to RCT reports with p values to improve the interpretability of results.

Level of Evidence

Level II.

导言脆性分析是进一步描述统计结果稳健性的一种方法。本研究评估了在全膝关节置换术（TKA）中比较髌骨表面与非髌骨表面的随机对照试验（RCT）的统计脆性：方法：在 PubMed、MEDLINE 和 EMBASE 中检索比较基于髌骨表面重铺的 TKA 结果的 RCT。脆性指数（FI）和反向 FI（统称为 "FI"）被计算为改变统计显著性所需的结果反转数。脆性商（FQ）的计算方法是将 FI 除以该结果的样本量。计算每个结果和整个研究的 FI 和 FQ 中位数。根据结果类型、统计显著性和随访损失进行子分析，以评估 FI 和 FQ：共有 21 项研究纳入分析，涉及 3910 名受试者。总体FI中位数为5.0（四分位数间距[IQR] 4.0-6.0），总体FQ中位数为0.048（IQR 0.022-0.065）。膝关节前侧疼痛结果的 FI 中位数为 6.0（IQR 4.0-6.0），FQ 中位数为 0.057（IQR 0.025-0.065）。只有五项（7%）结果具有显著性。在19项有可用数据的研究中，12项（63%）的随访损失大于FI：结论：比较 TKAs 中髌骨重置的 RCT 显示出显著的统计学脆弱性；少数结果的逆转会改变研究结果。大多数结果并不显著，这表明选择髌骨表面翻修可能不会影响大多数临床结果；但是，临床结论受到所分析结果的统计学脆弱性的限制。我们建议在RCT报告中加入FI和FQ的p值，以提高结果的可解释性：证据等级：二级。

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引用次数: 0

Blood and urine biomarkers for the diagnosis of early stages of knee osteoarthritis: A systematic review 用于诊断早期膝骨关节炎的血液和尿液生物标记物：系统综述。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-29 DOI: 10.1002/jeo2.12105

Marko Ostojic, Joao Pedro Oliveira, David Kordic, Caroline Mouton, Robert Prill, Roland Becker

Purpose

To identify biomarkers in human blood or urine at an early stage of knee osteoarthritis (OA) and to elucidate if any can accurately differentiate between healthy controls and early knee OA patients and be considered as a candidate for widespread clinical use for early diagnosis of the disease.

Methods

Medline, Embase and Web of Science were screened to identify comparative studies measuring differences in blood or urine biomarkers between healthy controls and knee OA patients at an early stage (grade 1 or 2 Kellgren–Laurence). Two independent reviewers screened the abstracts for eligibility, reviewed the full texts, assessed the methodological quality and extracted the data. The Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies was used to assess the quality of the included studies. Due to relevant heterogeneity, meta-analysis was not appropriate.

Results

Five studies met the eligibility criteria. The examined biomarkers were adropin, collagen type II metabolite, C-terminal cross-linked telopeptide of type II collagen, C-terminal cross-linked telopeptide of type I collagen, cartilage oligomeric matrix protein, matrix metalloproteinase 3, N-terminal propeptide of procollagen type IIA, type I procollagen N-terminal propeptides, N-terminal osteocalcin, angiopoietin-2, follistatin, granulocyte colony-stimulating factor, hepatocyte growth factor, interleukin-8, leptin, platelet-derived growth factor-BB, platelet endothelial cell adhesion molecule-1, vascular endothelial growth factor and calprotectin and totalling 19 biomarkers. All of the biomarkers were studied only once in the selected papers.

Conclusions

There is no reliable biomarker available to differentiate between early knee OA in patients and healthy controls, but a potential role of a cluster of biomarkers to close this gap. There are several limitations, including inappropriate study designs, small sample sizes, nonconsecutive patient groups and inadequate statistical methods for evaluating biomarker performance in studies included.

Level of Evidence

Level III.

目的：确定膝关节骨性关节炎（OA）早期人体血液或尿液中的生物标志物，并阐明是否有生物标志物能准确区分健康对照组和早期膝关节OA患者，并考虑将其作为临床广泛应用于疾病早期诊断的候选标志物：对 Medline、Embase 和 Web of Science 进行筛选，以确定测量健康对照组和早期膝关节 OA 患者（1 级或 2 级 Kellgren-Laurence）血液或尿液生物标志物差异的比较研究。两名独立审稿人筛选了摘要的合格性，审阅了全文，评估了方法学质量并提取了数据。乔安娜-布里格斯研究所（Joanna Briggs Institute）的诊断测试准确性研究关键评估工具用于评估纳入研究的质量。由于存在相关异质性，因此不适合进行荟萃分析：结果：五项研究符合资格标准。受检的生物标志物包括阿托品、II型胶原代谢物、II型胶原C端交联端肽、I型胶原C端交联端肽、软骨低聚基质蛋白、基质金属蛋白酶3、IIA型胶原N端肽和I型胶原N端肽、N-末端骨钙素、血管生成素-2、软骨素、粒细胞集落刺激因子、肝细胞生长因子、白细胞介素-8、瘦素、血小板衍生生长因子-BB、血小板内皮细胞粘附分子-1、血管内皮生长因子和钙蛋白，共 19 种生物标记物。所有生物标志物在所选论文中都只研究过一次：结论：目前还没有可靠的生物标志物可用于区分早期膝关节 OA 患者和健康对照组，但一组生物标志物的潜在作用可缩小这一差距。研究还存在一些局限性，包括研究设计不当、样本量较小、非连续性患者群体以及所纳入研究中评估生物标志物性能的统计方法不足：证据等级：三级。

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引用次数: 0

Defining the minimal clinically important difference for IKDC and KOOS scores for patients undergoing tibial tubercle osteotomy for patellofemoral pain or instability 确定因髌骨疼痛或不稳定而接受胫骨结节截骨术的患者的 IKDC 和 KOOS 评分的最小临床重要差异。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-29 DOI: 10.1002/jeo2.12115

Julia S. Retzky, Aakash K. Shah, Ava G. Neijna, Morgan E. Rizy, Andreas H. Gomoll, Sabrina M. Strickland

Purpose

The aim of the present study is to define the minimal clinically important difference (MCID) for International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) for patients undergoing tibial tubercle osteotomy (TTO) for either (1) patellofemoral pain or (2) patellar instability.

Methods

Patients undergoing TTO for either patellofemoral pain or patellar instability by one of two sports medicine fellowship-trained surgeons at a single institution between September 2014 and May 2023 were included in the study. IKDC and KOOS scores were collected preoperatively and minimum 1 year postoperatively. Distribution-based methods were used to calculate the MCID.

Results

Seventy-seven patients (82 knees) were included, with a median age of 29.3 years (interquartile range [IQR]: 22.2−36.3 years) and a median BMI of 24.5 kg/m² [IQR: 22.3−28.3 kg/m²]. Fifty-seven patients (74%) were female, and there were 40 right knees (49%). The median time to IKDC and KOOS score was 1.8 and 1.7 years, respectively. Forty-five patients (46 knees) underwent TTO for patellofemoral instability, and 32 patients (36 knees) underwent TTO for patellofemoral pain. The MCID was 11.5 for IKDC, 10.2 for KOOS pain, 10.1 for KOOS symptoms, 9.9 for KOOS ADL, 14.2 for KOOS sport and 14.2 for KOOS QoL for patients undergoing TTO for patellofemoral pain. The MCID was 11.2 for IKDC, 10.1 for KOOS pain, 10.6 for KOOS symptoms, 10.2 for KOOS ADL, 16.0 for KOOS sport and 13.2 for KOOS QoL for patients undergoing TTO for patellar instability.

Conclusion

We define the MCIDs for commonly used patient-reported outcome measures for patients undergoing TTO for either patellofemoral pain or patellar instability.

Level of Evidence

Level II.

目的：本研究旨在确定因(1)髌骨疼痛或(2)髌骨不稳而接受胫骨结节截骨术(TTO)的患者在国际膝关节文献委员会(IKDC)和膝关节损伤与骨关节炎结果评分(KOOS)中的最小临床重要差异(MCID)：研究对象包括 2014 年 9 月至 2023 年 5 月期间在一家医疗机构接受胫骨结节截骨术（TTO）治疗的髌骨股骨疼痛或髌骨不稳的患者，由两名接受过运动医学研究培训的外科医生中的一位负责。术前和术后至少 1 年收集 IKDC 和 KOOS 评分。采用基于分布的方法计算MCID：共纳入了 77 名患者（82 个膝关节），中位年龄为 29.3 岁（四分位间距 [IQR]：22.2-36.3 岁），中位体重指数为 24.5 kg/m2 [IQR：22.3-28.3 kg/m2]。57例患者（74%）为女性，40例为右膝（49%）。获得IKDC和KOOS评分的中位时间分别为1.8年和1.7年。45名患者（46个膝关节）因髌骨股骨不稳接受了TTO治疗，32名患者（36个膝关节）因髌骨股骨疼痛接受了TTO治疗。接受 TTO 治疗髌骨股骨疼痛的患者，IKDC 的 MCID 为 11.5，KOOS 疼痛为 10.2，KOOS 症状为 10.1，KOOS 日常活动为 9.9，KOOS 运动为 14.2，KOOS QoL 为 14.2。对于因髌骨不稳而接受 TTO 的患者，IKDC 的 MCID 为 11.2，KOOS 疼痛的 MCID 为 10.1，KOOS 症状的 MCID 为 10.6，KOOS ADL 的 MCID 为 10.2，KOOS 运动的 MCID 为 16.0，KOOS QoL 的 MCID 为 13.2：我们确定了因髌骨股骨痛或髌骨不稳而接受TTO治疗的患者常用的患者报告结果测量指标的MCID：证据等级：二级。

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引用次数: 0

A surface registration-based approach for assessment of 3D angles in guided growth interventions in the growing femur 一种基于表面注册的方法，用于评估股骨生长介入中的三维角度。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-29 DOI: 10.1002/jeo2.12111

Shima Gholinezhad, John Rasmussen, Ahmed Halloum, Søren Kold, Ole Rahbek

Purpose

Postoperative assessment of surgical interventions for correcting femoral rotational deformities necessitates a comparative analysis of femoral rotation pre- and post-surgery. While 2D assessment methods are commonly employed, ongoing debate surrounds their accuracy and reliability. To address the limitations associated with 2D analysis, we introduced and validated a 3D model-based analysis method for quantifying the angular and rotational impact of corrective rotational osteotomy in the growing femur.

Methods

The method is based on surface registration of the pre- and post-intervention 3D femoral models. To this end, 3D triangulated surface models were generated using CT images for the right femurs of 11 skeletally immature pigs, each scanned at two distinct time points with a 12-week interval between scans. In our validation procedures, femoral corrective rotational osteotomy of the post-12-week femur was simulated at varying angles of 5, 10, 15 and 20 degrees in three dimensions. Subsequently, a surface 3D/3D registration-based approach was applied to determine the 3D femoral angulation and rotation between the two models to assess the method's detection accuracy of the predefined twist angles as ground truth references.

Results

The results document the precision and accuracy of the registration-based method in evaluating rotation angles. Consistently high accuracy was observed across all angles, with an accuracy rate of 92.97% and a coefficient of variance of 8.14%.

Conclusion

This study has showcased the potential for improving post-operative assessments with significant implications for experimental studies evaluating the effects of correcting rotational deformities in the growing femur.

Level of Evidence

Not applicable.

目的：要对矫正股骨旋转畸形的手术干预进行术后评估，就必须对手术前后的股骨旋转情况进行比较分析。虽然二维评估方法已被普遍采用，但围绕其准确性和可靠性的争论仍在继续。为了解决二维分析的局限性，我们引入并验证了一种基于三维模型的分析方法，用于量化股骨生长期旋转截骨矫正术的角度和旋转影响：该方法基于干预前和干预后三维股骨模型的表面注册。为此，我们使用 11 头骨骼尚未发育成熟的猪的右股骨 CT 图像生成了三维三角表面模型，每个模型在两个不同的时间点扫描，扫描间隔为 12 周。在我们的验证程序中，以 5 度、10 度、15 度和 20 度等不同角度对 12 周后的股骨进行三维模拟股骨矫正旋转截骨。随后，采用基于表面三维/三维配准的方法确定两个模型之间的股骨三维角度和旋转，以评估该方法对作为地面实况参考的预定扭转角度的检测准确性：结果：结果证明了基于配准的方法在评估旋转角度方面的精确性和准确性。所有角度的准确率都很高，准确率为 92.97%，方差系数为 8.14%：本研究展示了改进术后评估的潜力，对评估股骨生长期旋转畸形矫正效果的实验研究具有重要意义：证据等级：不适用。

{"title":"A surface registration-based approach for assessment of 3D angles in guided growth interventions in the growing femur","authors":"Shima Gholinezhad, John Rasmussen, Ahmed Halloum, Søren Kold, Ole Rahbek","doi":"10.1002/jeo2.12111","DOIUrl":"10.1002/jeo2.12111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Postoperative assessment of surgical interventions for correcting femoral rotational deformities necessitates a comparative analysis of femoral rotation pre- and post-surgery. While 2D assessment methods are commonly employed, ongoing debate surrounds their accuracy and reliability. To address the limitations associated with 2D analysis, we introduced and validated a 3D model-based analysis method for quantifying the angular and rotational impact of corrective rotational osteotomy in the growing femur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The method is based on surface registration of the pre- and post-intervention 3D femoral models. To this end, 3D triangulated surface models were generated using CT images for the right femurs of 11 skeletally immature pigs, each scanned at two distinct time points with a 12-week interval between scans. In our validation procedures, femoral corrective rotational osteotomy of the post-12-week femur was simulated at varying angles of 5, 10, 15 and 20 degrees in three dimensions. Subsequently, a surface 3D/3D registration-based approach was applied to determine the 3D femoral angulation and rotation between the two models to assess the method's detection accuracy of the predefined twist angles as ground truth references.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results document the precision and accuracy of the registration-based method in evaluating rotation angles. Consistently high accuracy was observed across all angles, with an accuracy rate of 92.97% and a coefficient of variance of 8.14%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study has showcased the potential for improving post-operative assessments with significant implications for experimental studies evaluating the effects of correcting rotational deformities in the growing femur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11284963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793741","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

Accuracy of patient-specific instrumentation for implant positioning in custom-made total ankle arthroplasty 在定制全踝关节置换术中，用于植入物定位的患者专用器械的准确性。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-26 DOI: 10.1002/jeo2.12026

Antonio Mazzotti, Simone Ottavio Zielli, Alberto Arceri, Elena Artioli, Laura Langone, Federico Sgubbi, Giuseppe Geraci, Cesare Faldini

Purpose

This retrospective radiological analysis aimed to assess the accuracy of implant positioning in patients with ankle arthritis undergoing custom-made total ankle arthroplasty (TAA) with patient-specific instrumentation (PSI) compared with preoperative planning.

Methods

Patients who underwent custom-made TAA with PSI from January 2018 to March 2023 were retrospectively evaluated, focusing on the tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle and tibiotalar ratio (TTR). Additionally, data regarding the time from the preoperative computed tomography (CT) scan to surgery, associated procedures and complications were recorded.

Results

No associated procedures were performed, and only one intraoperative complication, an iatrogenic lateral malleolar fracture, was recorded. In the coronal plane, custom-made TAA with PSI consistently achieved precise positioning of prosthetic components, even in cases with significant preoperative deformities or bone deficits. However, a statistically significant deviation from the planned values was observed in the sagittal plane (p = 0.007). A notable correlation was identified between the time elapsed from the preoperative CT scan to surgery and the deviation from the planned to the actual postoperative TAS angle (p < 0.001).

Conclusion

This study underscores the efficacy of PSI systems in achieving precise positioning in the coronal plane, in accordance with preoperative planning. In contrast, sagittal plane positioning did not demonstrate the same level of accuracy, as evidenced by a statistically significant difference between the planned and postoperative TLS values. Nevertheless, all measurements remained within the recommended range according to the existing literature.

Level of Evidence

Level IV.

目的：这项回顾性放射学分析旨在评估与术前规划相比，接受定制全踝关节置换术（TAA）并使用患者特异性器械（PSI）的踝关节炎患者植入物定位的准确性：回顾性评估了2018年1月至2023年3月期间接受定制全踝关节置换术（TAA）的患者，重点关注胫骨前表面（TAS）角度、胫骨外侧表面（TLS）角度和胫腓骨比（TTR）。此外，还记录了从术前计算机断层扫描（CT）到手术的时间、相关手术和并发症的数据：结果：未进行任何相关手术，仅记录了一起术中并发症，即先天性外侧踝骨骨折。在冠状面上，即使术前存在明显畸形或骨质缺损的病例，使用 PSI 定制 TAA 也能始终实现假体组件的精确定位。然而，在矢状面上观察到与计划值有明显的统计学偏差（p = 0.007）。从术前 CT 扫描到手术的时间与术后 TAS 角度从计划值到实际值的偏差之间存在明显的相关性（p 结论：术后 TAS 角度从计划值到实际值的偏差之间存在明显的相关性（p 结论：术后 TAS 角度从计划值到实际值的偏差之间存在明显的相关性（p）：本研究强调了 PSI 系统在按照术前计划实现冠状面精确定位方面的功效。与此相反，矢状面定位并没有表现出同样的准确性，这体现在计划值与术后 TLS 值之间存在显著的统计学差异。尽管如此，根据现有文献，所有测量值仍在推荐范围内：证据等级：IV 级。

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引用次数: 0

Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta-analysis 影响主动膝关节角度再现测试中角度误差的因素：系统回顾与荟萃分析。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12091

Juliane Wieber, Leon Müller-Rahmel, Rüdiger Reer, Robert Rein, Bjoern Braunstein

Purpose

The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests.

Methods

Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18–60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool.

Results

Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = −0.56; 95% CI = −1.00 to −0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18–1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04–1.75).

Conclusion

Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting.

Level of Evidence

Level III, systematic review with meta-analysis.

目的：该系统综述和荟萃分析研究了影响主动膝关节角度再现测试绝对角度误差的受试者无关测试因素：检索了五个电子数据库，以确定 2023 年 12 月 20 日之前发表的相关研究。所纳入的研究均以英语或德语发表，并调查了健康膝关节的关节本体感觉。纳入的研究还要求参与者年龄在 18-60 岁之间，没有下肢损伤、神经系统疾病和影响关节位置感的疾病。使用 Cochrane 偏倚风险工具对偏倚风险进行了评估：在已确定的 2023 篇文章中，有 26 项研究（1082 名参与者）被纳入荟萃分析。荟萃分析表明，身体方位、运动方向和疲劳的绝对角度误差存在显著的集合标准平均差。研究发现，与俯卧位相比，坐位进行主动膝关节角度再现测试时，绝对角度误差较小（SMD = -0.56；95% CI = -1.00 至 -0.12）。与膝关节伸展相比，膝关节屈曲时的绝对角度误差更大（SMD = 0.71；95% CI = 0.18-1.24）。全身和局部肌肉疲劳会导致更大的绝对角度误差（SMD = 1.39；95% CI = 1.04-1.75）：因此，疲劳、身体方向和运动方向会影响主动膝关节角度再现测试中绝对角度误差的程度。从业人员应注意，测试条件和患者的疲劳程度会影响此类测试的结果，直接比较不同测试方案得出的结果可能并不合适。测试方案应妥善记录，并在临床环境中一致应用：证据等级：III级，系统综述与荟萃分析。

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引用次数: 0

The accuracy of preoperative implant size prediction achieved by digital templating in total knee arthroplasty is not affected by the quality of lateral knee radiographs 在全膝关节置换术中，通过数字模板实现的术前植入物尺寸预测的准确性不受膝关节侧位X光片质量的影响。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12102

Lorenz Pichler, Leonhard Klein, Carsten F. Perka, Clemens Gwinner, Moses K. D. El Kayali

Background

Digital templating software can be used for preoperative implant size prediction in total knee arthroplasty (TKA). However, the accuracy of its prediction is reported to be low, and the impact of radiograph quality is unclear.

Purpose

To investigate on the application of lateral knee radiograph quality criteria for knee rotation (KR) and knee abduction/adduction (KA) and their impact on the accuracy of final implant size prediction achieved by preoperative digital templating for TKA.

Methods

A total of 191 radiographs of patients undergoing TKA were allocated into four groups according to their KR as measured at the posterior femoral condyles and their KA as measured at the distal femoral condyles on lateral knee radiographs: group A (KR ≤ 5 mm, KA ≤ 5 mm), B1 (KR > 5 mm, KA ≤ 5 mm), B2 (KR ≤ 5 mm, KA > 5 mm) and B3 (KR > 5 mm, KA > 5 mm). Preoperative templating of femoral and tibial implant size using digital templating software was carried out by two observers. Correlation coefficients (CCs) between planned and final implant size, percentage of cases with planned to final size match as well as percentage of cases within ±1 and ±2 of planned to final size were reported according to groups.

Results

Group A showed the highest percentage of cases with matching planned to final femoral implant size (45%) and the highest percentage of cases with ±1 planned to final implant size (86%) as compared to B1 (match 28%, ±1 84%), B2 (match 41%, ±1 84%) and B3 (match 35%, ±1 78%). CCs for planned to final implant size were reported at >0.75 in all groups. No statistically significant difference in the CCs of planned to final implant size amongst groups was found.

Conclusion

The accuracy of implant size prediction achieved by preoperative digital templating for TKA is neither affected by KR nor KA on lateral knee radiographs.

Level of evidence

Level III.

背景：数字模板软件可用于全膝关节置换术（TKA）的术前假体尺寸预测。目的：研究膝关节旋转（KR）和膝关节外展/内收（KA）的膝关节侧位片质量标准的应用及其对通过 TKA 术前数字模板预测最终植入物大小的准确性的影响：根据膝关节侧位片上股骨后髁处测量的KR和股骨远髁处测量的KA，将接受TKA手术的191名患者分成四组：A组（KR≤5毫米，KA≤5毫米）、B1组（KR>5毫米，KA≤5毫米）、B2组（KR≤5毫米，KA>5毫米）和B3组（KR>5毫米，KA>5毫米）。术前由两名观察员使用数字模板软件对股骨和胫骨植入物的尺寸进行模板化。各组报告了计划植入尺寸与最终植入尺寸的相关系数（CC）、计划植入尺寸与最终植入尺寸匹配的病例百分比以及计划植入尺寸与最终植入尺寸在±1和±2范围内的病例百分比：与 B1（匹配率 28%，±1 84%）、B2（匹配率 41%，±1 84%）和 B3（匹配率 35%，±1 78%）相比，A 组股骨种植体计划尺寸与最终尺寸匹配的病例比例最高（45%），计划尺寸与最终尺寸±1 的病例比例最高（86%）。所有组的计划种植体大小与最终种植体大小的 CC 值均大于 0.75。各组间计划种植体大小与最终种植体大小的 CCs 差异无统计学意义：结论：通过 TKA 术前数字模板预测植入物尺寸的准确性不受膝关节侧位片 KR 或 KA 的影响：证据等级：三级。

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引用次数: 0

Addressing meniscal deficiency part 2: An umbrella review of systematic reviews and meta-analyses on meniscal scaffold-based approaches 解决半月板缺损问题第二部分：基于半月板支架方法的系统综述和荟萃分析。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12108

Kevin A. Wu, Aaron D. Therien, Lulla V. Kiwinda, Christian J. Castillo, Stephanie Hendren, Jason S. Long, Annunziato Amendola, Brian C. Lau

<div> <section> <h3> Purpose</h3> <p>Meniscal injuries are common in knee surgery and often require preservation techniques to prevent secondary osteoarthritis. Despite advancements in repair techniques, some patients undergo partial meniscectomy, which can lead to postmeniscectomy syndrome. To address these challenges, meniscal substitution techniques like scaffolds have been developed. However, a comprehensive synthesis of the existing evidence through an umbrella review is lacking.</p> </section> <section> <h3> Methods</h3> <p>A comprehensive search was conducted in the MEDLINE, Embase and Scopus databases to identify relevant systematic reviews and meta-analyses. Studies were screened based on predefined inclusion and exclusion criteria. The quality of included studies was assessed using the AMSTAR-2 tool.</p> </section> <section> <h3> Results</h3> <p>A total of 17 studies met the inclusion criteria and were included in the review. Most studies focused on the use of collagen-based scaffolds, with fewer studies evaluating synthetic scaffolds. The majority of studies (52.9%) were rated as having ‘Critically Low’ overall confidence, with only one study (5.9%) rated as ‘High’ confidence and most studies exhibiting methodological limitations, such as small sample sizes and lack of long-term follow-up. Despite these limitations, the majority of studies reported positive short-term outcomes, including pain relief and functional improvement, following scaffold implantation. However, some studies noted a relatively high failure rate. Radiographically, outcomes also varied, with some studies reporting morphological deterioration of the implant seen on MRI, while others noted possible chondroprotective effects.</p> </section> <section> <h3> Conclusions</h3> <p>Meniscal scaffold-based approaches show promise in the management of meniscal deficiency; however, the current evidence is limited by methodological shortcomings. One notable gap in the literature is the lack of clear guidelines for patient selection and surgical technique. Future research should focus on conducting well-designed randomized controlled trials with long-term follow-up to further elucidate the benefits and indications of these techniques in clinical practice. Additionally, efforts should be made to develop consensus guidelines to standardize the use of meniscal scaffolds and improve patient outcomes. Despite limited availability, synthesizing the literature on meniscal scaffold-based approaches is crucial for understanding research, guiding clinical decisions and informing future direc

目的：半月板损伤在膝关节手术中很常见，通常需要采用保留技术来预防继发性骨关节炎。尽管修复技术不断进步，但仍有一些患者接受了半月板部分切除术，这可能导致半月板切除术后综合征。为了应对这些挑战，人们开发了半月板替代技术，如支架。然而，目前还缺乏通过综述对现有证据进行全面总结的方法：方法：在 MEDLINE、Embase 和 Scopus 数据库中进行了全面检索，以确定相关的系统综述和荟萃分析。根据预先确定的纳入和排除标准对研究进行筛选。使用 AMSTAR-2 工具对纳入研究的质量进行评估：共有 17 项研究符合纳入标准并被纳入综述。大多数研究侧重于胶原支架的使用，而对合成支架进行评估的研究较少。大多数研究（52.9%）的总体可信度被评为 "极低"，只有一项研究（5.9%）的可信度被评为 "高"，而且大多数研究在方法上存在局限性，如样本量小和缺乏长期随访。尽管存在这些局限性，但大多数研究都报告了支架植入后的积极短期效果，包括疼痛缓解和功能改善。然而，一些研究指出失败率相对较高。影像学结果也不尽相同，一些研究报告称核磁共振成像显示植入物形态恶化，而另一些研究则指出可能存在软骨保护作用：结论：基于半月板支架的方法在治疗半月板缺损方面前景广阔，但由于方法上的缺陷，目前的证据还很有限。文献中一个明显的缺陷是缺乏关于患者选择和手术技巧的明确指南。未来的研究应侧重于开展设计良好的随机对照试验和长期随访，以进一步阐明这些技术在临床实践中的益处和适应症。此外，还应努力制定共识指南，规范半月板支架的使用，改善患者预后。尽管文献资料有限，但对基于半月板支架方法的文献进行综合分析，对于理解研究、指导临床决策和指明未来方向至关重要：证据等级：IV 级。

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引用次数: 0

Superior load-to-failure in an all-suture anchor system for all-inside meniscal repair compared to a PEEK-cage anchor system in an experimental cadaveric test setting 在实验性尸体测试环境中，用于全内侧半月板修复的全缝合锚系统与 PEEK 笼锚系统相比具有更高的负载-失效率。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12110

Lorenz Pichler, Gyula Kiss, Thomas Sator, Andrea Schuller, Sam A. Kandathil, Marcus Hofbauer, Thomas Koch, Lena Hirtler, Thomas Tiefenboeck

Purpose

The purpose of this study was to compare the biomechanical properties of a latest generation all-suture anchor repair device (ASARD) for meniscal repair with that of a latest generation PEEK-cage anchor repair device (PCARD) in an experimental setting using cadaveric menisci.

Methods

Twenty-six menisci were obtained from the knees of fresh body donors. Artificially created meniscal lesions were treated randomly, using a single stitch with either an ASARD or a PCARD. Cyclic biomechanical testing, utilising a universal material testing machine and following an established protocol, was carried out and load-to-failure (LTF), displacement, stiffness, and mode-of-failure (MOF) reported.

Results

Mean LTF was found to be 61% higher in the ASARD group at 107.10 N (standard deviation [SD], 42.34), compared to 65.86 N (SD, 27.42) in the PCARD group with statistical significance (p = 0.022). The ASARD exhibited a trend towards higher stiffness (10.35 N; SD, 3.92 versus 7.78 N; SD; 3.59) and higher displacement at cycles one, 100, and 499 (1.64, 3.27, and 4.17 mm versus 0.93, 2.19, and 2.83 mm) compared to the PCARD. Cheese wiring was the most common mode-of-failure in both groups (76.9%).

Conclusions

This study demonstrates that an ASARD shows a higher mean LTF than a PCARD when compared in an experimental biomechanical setting.

Level of evidence

Level III

目的：本研究旨在使用尸体半月板，在实验环境中比较用于半月板修复的最新一代全缝合锚修复装置（ASARD）与最新一代 PEEK 笼锚修复装置（PCARD）的生物力学特性：方法：从新鲜尸体捐献者的膝盖上获取 26 个半月板。方法：从新鲜尸体捐献者的膝盖上获取了 26 个半月板，对人工制造的半月板损伤进行随机处理，使用 ASARD 或 PCARD 进行单针缝合。利用通用材料试验机并按照既定方案进行了循环生物力学测试，并报告了破坏荷载（LTF）、位移、硬度和破坏模式（MOF）：ASARD组的平均LTF为107.10牛顿（标准差[SD]，42.34），比PCARD组的65.86牛顿（标准差，27.42）高61%，具有统计学意义（P = 0.022）。与 PCARD 相比，ASARD 表现出更高的硬度（10.35 N；SD，3.92 对 7.78 N；SD；3.59）和更高的位移（1.64、3.27 和 4.17 mm 对 0.93、2.19 和 2.83 mm）。奶酪接线是两组中最常见的故障模式（76.9%）：本研究表明，在生物力学实验环境中进行比较时，ASARD显示出比PCARD更高的平均LTF：证据等级：三级。

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引用次数: 0

Diagnosing popliteofibular ligament injuries in anterior cruciate ligament-injured knees: A prospective magnetic resonance imaging study investigating the inter- and intraobserver reliability of identification of the popliteofibular ligament 诊断前交叉韧带损伤膝关节的腘绳肌韧带损伤：一项前瞻性磁共振成像研究，调查腘绳肌韧带识别的观察者间和观察者内可靠性。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2024-07-24 DOI: 10.1002/jeo2.12112

Steven Heylen, Thomas Braeckevelt, Peter Verdonk, Matthias Krause, Jozef Michielsen

Purpose

The aim of our study was to investigate the intra- and interobserver reliability for the identification of the popliteofibular ligament (PFL) in magnetic resonance imaging (MRI) scans in patients with an anterior cruciate ligament (ACL) injury and ascertain the prevalence of PFL tears in ACL-injured knees without clinically high-grade posterolateral corner injury.

Methods

MRI readings were performed retrospectively by two surgeons on 84 patients who underwent ACL reconstruction in our department. The presence of the PFL on both sagittal and coronal images as well as the presence of PFL tears was noted. Readings were repeated 6 weeks later for one observer. The κ value was calculated to determine the intra- and interobserver reliability for identification of the PFL and the prevalence of PFL tears was ascertained.

Results

The PFL was visualized in 90.5%−91.7% of MRI scans. The intra- and interobserver reliability of visualizing the PFL on MRI had an κ value of 0.63 and 0.66 (substantially reliable), respectively. The intraobserver reliability for identification of PFL tears had an κ value of 0.26 (fair reliability). We found a 4.8% prevalence of PFL tears in ACL-injured knees.

Conclusions

There is substantially reliable intra- and interobserver reliability for the identification of the PFL on MRI scans but only fair reliability for the identification of PFL tears. A 4.8% prevalence of PFL tears in ACL-injured knees without clinically confirmed high-grade posterolateral corner injury can be observed in our series.

Level of Evidence

Level IV.

目的：我们的研究旨在探讨在前交叉韧带（ACL）损伤患者的磁共振成像（MRI）扫描中识别腘绳肌韧带（PFL）的观察者内部和观察者之间的可靠性，并确定在临床上无高级别后外侧角损伤的前交叉韧带损伤膝关节中PFL撕裂的发生率：方法：两名外科医生对在我科接受前交叉韧带重建术的 84 名患者进行了 MRI 回顾性扫描。矢状面和冠状面图像上是否存在 PFL 以及是否存在 PFL 撕裂。一名观察者在 6 周后重复读数。计算κ值以确定观察者内部和观察者之间识别PFL的可靠性，并确定PFL撕裂的发生率：结果：90.5%-91.7%的核磁共振扫描可观察到PFL。在核磁共振成像上观察 PFL 的观察者内和观察者间可靠性κ值分别为 0.63 和 0.66（基本可靠）。鉴别PFL撕裂的观察者内可靠性κ值为0.26（可靠性一般）。我们发现在前交叉韧带损伤的膝关节中，PFL撕裂的发生率为4.8%：结论：在核磁共振成像扫描中识别PFL的观察者内部和观察者之间的可靠性非常可靠，但识别PFL撕裂的可靠性一般。在我们的系列研究中可以观察到，在前交叉韧带损伤的膝关节中，PFL撕裂的发生率为4.8%，但没有临床确诊的高级别后外侧角损伤：证据级别：IV级

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引用次数: 0