Pub Date : 2023-03-09DOI: 10.1177/22104917231161834
Rohit M Sane, P. Samant
Background/Purpose: The evidence on the influence of body mass index (BMI) on functional outcomes following total knee arthroplasty (TKA) is conflicting. This study assessed and compared the effect of BMI on early mobility and function after TKA. Methods: Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA) who received unilateral TKA were recruited and then divided into normal, overweight and obese groups. The pain and functional outcomes of pre/post-TKA were examined using visual analogue scale (VAS) and Lysholm Knee Scale (LKS), respectively. Results: At 3 and 6 weeks post-TKA, LKS score was significantly higher in normal BMI group compared to overweight and obese. Lower BMI gained early improvement in functional outcome than higher BMI groups. However, patients showed considerable functional improvement at 6 months post-TKA, regardless of BMI category. Conclusion: Although BMI levels influence postoperative early functional improvement in TKA patients, the functional benefits after TKA at 6 months were similar regardless of BMI class.
{"title":"Influence of body mass index on early post-operative functional outcomes after total knee arthroplasty: A prospective, clinical and observational study","authors":"Rohit M Sane, P. Samant","doi":"10.1177/22104917231161834","DOIUrl":"https://doi.org/10.1177/22104917231161834","url":null,"abstract":"Background/Purpose: The evidence on the influence of body mass index (BMI) on functional outcomes following total knee arthroplasty (TKA) is conflicting. This study assessed and compared the effect of BMI on early mobility and function after TKA. Methods: Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA) who received unilateral TKA were recruited and then divided into normal, overweight and obese groups. The pain and functional outcomes of pre/post-TKA were examined using visual analogue scale (VAS) and Lysholm Knee Scale (LKS), respectively. Results: At 3 and 6 weeks post-TKA, LKS score was significantly higher in normal BMI group compared to overweight and obese. Lower BMI gained early improvement in functional outcome than higher BMI groups. However, patients showed considerable functional improvement at 6 months post-TKA, regardless of BMI category. Conclusion: Although BMI levels influence postoperative early functional improvement in TKA patients, the functional benefits after TKA at 6 months were similar regardless of BMI class.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"40 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74471809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1177/22104917221147687
Garibaldi Riccardo, T. Bonanzinga, F. M. Gambaro, Michele Palazzuolo, F. Iacono, M. Marcacci
Background: Recent evidence seems to suggest the effectiveness of distal femur varus osteotomy in the management of patellofemoral instability in the setting of genu valgum. However, literature on this subject remains scarce and consists mostly of small case series. Hypothesis: This study aims to systematically review the literature on varus-producing distal femur osteotomy and critically analyze its implications on patellofemoral kinematics and stability. Results: The statistical analysis revealed that this surgery is able to restore a mechanical angle (mean hip–knee–ankle (HKA): 0.22°) and to improve the main clinical outcomes (Kujala score, Knee injury and Osteoarthritis Outcome Score, visual analog scale) after a mean follow up of 2.5 years. An objective of the present review was to investigate the mechanical implications of femoral osteotomy on the patellofemoral biomechanics. Indeed, the statistical analysis demonstrated changes after surgery in the main patella-femoral radiological angles (modified Insall–Salvati index, Caton–Deschamps index, Blackburne–Peel index). Interestingly the overcorrection of the mechanical axis (HKA), resulting in varus, had similar outcomes compared to studies that obtained a mechanical axis. Level of Evidence: Level II study.
{"title":"Distal femur varus-producing osteotomy: An updated review of patellofemoral implications and clinical outcomes","authors":"Garibaldi Riccardo, T. Bonanzinga, F. M. Gambaro, Michele Palazzuolo, F. Iacono, M. Marcacci","doi":"10.1177/22104917221147687","DOIUrl":"https://doi.org/10.1177/22104917221147687","url":null,"abstract":"Background: Recent evidence seems to suggest the effectiveness of distal femur varus osteotomy in the management of patellofemoral instability in the setting of genu valgum. However, literature on this subject remains scarce and consists mostly of small case series. Hypothesis: This study aims to systematically review the literature on varus-producing distal femur osteotomy and critically analyze its implications on patellofemoral kinematics and stability. Results: The statistical analysis revealed that this surgery is able to restore a mechanical angle (mean hip–knee–ankle (HKA): 0.22°) and to improve the main clinical outcomes (Kujala score, Knee injury and Osteoarthritis Outcome Score, visual analog scale) after a mean follow up of 2.5 years. An objective of the present review was to investigate the mechanical implications of femoral osteotomy on the patellofemoral biomechanics. Indeed, the statistical analysis demonstrated changes after surgery in the main patella-femoral radiological angles (modified Insall–Salvati index, Caton–Deschamps index, Blackburne–Peel index). Interestingly the overcorrection of the mechanical axis (HKA), resulting in varus, had similar outcomes compared to studies that obtained a mechanical axis. Level of Evidence: Level II study.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"139 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76232740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1177/22104917221150533
I. Wayan, Suryanto Dusak, Kartini Ciatawi, Wayan Subawa, P. Eyanoer
Denervation by electrocauterization was proposed to be efficient in preventing anterior knee pain (AKP) following arthroplasty. The purpose of this study was to evaluate the effects of patellar denervation (PD) in primary knee arthroplasty. Systematic search was performed in PubMed, ScienceDirect, Cochrane Library, and ClinicalKey databases until July 2022 for published articles. The quantitative analyses were carried out by Review Manager 5.4 software. Twenty-one studies were included. Overall incidence of AKP, visual analog scale (VAS), and knee society score were significantly superior in PD group. Denervation also showed better outcomes in incidence of AKP at each follow-up time point, and in VAS and range of motion (ROM) at ≤3 months. Subanalyses based on depth of electrocautery showed statistically better results with 2–3 mm depth in VAS and PS compared to ≤1 mm. This study concluded that PD might contribute to lower incidence of knee pain. Patients who expect quicker recovery in pain and ROM may benefit from this procedure.
{"title":"What can we expect from patellar denervation in knee arthroplasty? An updated systematic review and meta-analysis","authors":"I. Wayan, Suryanto Dusak, Kartini Ciatawi, Wayan Subawa, P. Eyanoer","doi":"10.1177/22104917221150533","DOIUrl":"https://doi.org/10.1177/22104917221150533","url":null,"abstract":"Denervation by electrocauterization was proposed to be efficient in preventing anterior knee pain (AKP) following arthroplasty. The purpose of this study was to evaluate the effects of patellar denervation (PD) in primary knee arthroplasty. Systematic search was performed in PubMed, ScienceDirect, Cochrane Library, and ClinicalKey databases until July 2022 for published articles. The quantitative analyses were carried out by Review Manager 5.4 software. Twenty-one studies were included. Overall incidence of AKP, visual analog scale (VAS), and knee society score were significantly superior in PD group. Denervation also showed better outcomes in incidence of AKP at each follow-up time point, and in VAS and range of motion (ROM) at ≤3 months. Subanalyses based on depth of electrocautery showed statistically better results with 2–3 mm depth in VAS and PS compared to ≤1 mm. This study concluded that PD might contribute to lower incidence of knee pain. Patients who expect quicker recovery in pain and ROM may benefit from this procedure.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"96 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83410049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-22DOI: 10.1177/22104917221144723
Gavin Cho wai Lam, Ramon Lo Yiu, Y. Leung
Background/Purpose: To examine clinical and functional outcomes of patients who underwent meniscal repair with a modified accelerated rehabilitation program. Methods: This study represents a case series of patients who underwent meniscal repair from 2017 to 2019. The mean patient age was 26.6 (range: 15–47) years. Of the 28 total patients, 22 had concomitant anterior cruciate ligament tears that were treated with single-bundle hamstring reconstruction at the time of meniscal repair. All patients were enrolled in a standardized rehabilitation program, allowing early-phase protected weight-bearing and knee mobilization. Patient-reported symptoms, the McMurray test, and the International Knee Documentation Committee (IKDC) were used to evaluate outcomes. The mean follow-up period was 13 ± 3.1 (range: 9–20) months. Results: Of the participating patients, 75% (22 of 28) returned to their original sports activities. Most patients displayed satisfactory clinical outcomes with significant improvements in IKDC scores. No re-tears were detected. Conclusion: Early protected weight-bearing with progressive early knee mobilization is a safe rehabilitation option after meniscal repair.
{"title":"Clinical outcomes of a standardized rehabilitation protocol for meniscal repair: A retrospective case series","authors":"Gavin Cho wai Lam, Ramon Lo Yiu, Y. Leung","doi":"10.1177/22104917221144723","DOIUrl":"https://doi.org/10.1177/22104917221144723","url":null,"abstract":"Background/Purpose: To examine clinical and functional outcomes of patients who underwent meniscal repair with a modified accelerated rehabilitation program. Methods: This study represents a case series of patients who underwent meniscal repair from 2017 to 2019. The mean patient age was 26.6 (range: 15–47) years. Of the 28 total patients, 22 had concomitant anterior cruciate ligament tears that were treated with single-bundle hamstring reconstruction at the time of meniscal repair. All patients were enrolled in a standardized rehabilitation program, allowing early-phase protected weight-bearing and knee mobilization. Patient-reported symptoms, the McMurray test, and the International Knee Documentation Committee (IKDC) were used to evaluate outcomes. The mean follow-up period was 13 ± 3.1 (range: 9–20) months. Results: Of the participating patients, 75% (22 of 28) returned to their original sports activities. Most patients displayed satisfactory clinical outcomes with significant improvements in IKDC scores. No re-tears were detected. Conclusion: Early protected weight-bearing with progressive early knee mobilization is a safe rehabilitation option after meniscal repair.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"1076 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76690542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-17DOI: 10.1177/22104917221147688
Marc Koster, Anton D Luzier, O. Temmerman, S. Vos, Joyce L Benner
Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.
背景:全髋关节置换术(THA)有不同的手术入路，当涉及到脱位风险时没有易感性。直接前路入路(DAA)被认为具有较低的风险，因为软组织损伤最小。因此，我们评估了不同手术入路的脱位风险，以及DAA与其他入路相比的相对脱位风险。方法:系统检索6个电子数据库中报道THA术后脱位的前瞻性研究。采用比例荟萃分析来评估手术入路亚组的脱位率。对二元结果进行荟萃分析，以确定与其他方法相比DAA脱位的相对风险。结果:纳入11项研究，共纳入2025例患者(平均年龄64.6岁，男性44%，平均随访10.5个月)，其中4项研究也用于风险比荟萃分析。总体脱位率为0.79% (95% CI 0.37-1.69)。亚组分析显示大多数脱位发生在后路组(1.38%)，但无统计学意义。此外，与其他手术入路相比，DAA出现脱位的风险无显著性降低(RR 0.37, 95% CI 0.05-2.46)。结论:目前的文献显示手术入路对THA脱位风险的影响不显著。患者特征对脱位风险的影响程度尚不清楚。未来的研究应该集中在这一点上，以及外科医生的经验对特定方法的影响。
{"title":"How do dislocation rates differ between different approaches to total hip arthroplasty? A systematic review and meta-analysis","authors":"Marc Koster, Anton D Luzier, O. Temmerman, S. Vos, Joyce L Benner","doi":"10.1177/22104917221147688","DOIUrl":"https://doi.org/10.1177/22104917221147688","url":null,"abstract":"Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"43 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89822507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-12DOI: 10.1177/22104917221150532
Chau Ming Hong, Lee Qunn Jid, Chang Wai Yee Esther
Background: Although we know routine use of continuous passive motion (CPM) has no clinical benefit on patients’ outcome after total knee replacement (TKR), the effect of CPM on patients with poor rehabilitation progress under ERAS (Enhanced Recovery after Surgery) pathway is unclear. We aimed to evaluate the clinical outcomes by using CPM in these patients under ERAS pathway. Methods: We performed a retrospective study for patients who had TKR done between 2017 and 2019 under ERAS pathway. Patients who were not able to reach 45 degrees of active range of movement (ROM) on postoperative day (POD) 3 would be reviewed to see if any CPM was used. Primary outcomes were the length of hospital stay and the active ROM upon discharge. Other outcomes were the active ROM in POD4 and the latest follow-up, pain score, and quadriceps power. Result: After exclusion, total of 68 patients were included in the study, with 30 were given CPM and 38 were not. Both groups had matched demographics. The study (CPM) group had significantly higher mean active ROM upon discharge (76.00 vs 68.42 degrees, p = 0.02) and longer hospital stay (7.3 vs 5.9 days, p =0.01). There were no significant effects on pain score, quadriceps power, and the active ROM in POD4 and the latest follow-up. Conclusion: For post TKR patients with limited rehabilitation progress under ERAS pathway, the use of CPM could attain better active ROM upon discharge with no adverse effect on pain control and quadriceps power, but at the expense of an increase in the length of stay.
背景:虽然我们知道常规使用持续被动运动(CPM)对全膝关节置换术(TKR)后患者的预后没有临床益处，但在ERAS(术后增强恢复)途径下，CPM对康复进展较差的患者的影响尚不清楚。我们的目的是评估这些患者在ERAS途径下使用CPM的临床结果。方法:我们对2017年至2019年在ERAS途径下进行TKR的患者进行了回顾性研究。术后一天(POD) 3不能达到45度活动范围(ROM)的患者将复查是否使用CPM。主要结局是住院时间和出院时的活动度。其他结果包括POD4的活动活动度、最新随访、疼痛评分和股四头肌力量。结果:经排除，共纳入68例患者，其中30例给予CPM治疗，38例未给予CPM治疗。两组的人口统计数据相匹配。CPM组患者出院时平均活动度明显高于对照组(76.00 vs 68.42度，p = 0.02)，住院时间明显延长(7.3 vs 5.9天，p =0.01)。在POD4和最新随访中，疼痛评分、股四头肌力量和活动ROM均无显著影响。结论:对于ERAS途径下康复进展有限的TKR后患者，使用CPM可以在出院时获得更好的活动ROM，对疼痛控制和股四头肌力量无不良影响，但以增加住院时间为代价。
{"title":"Effectiveness of continuous passive motion in total knee replacement patients with slow rehabilitation under ERAS pathway","authors":"Chau Ming Hong, Lee Qunn Jid, Chang Wai Yee Esther","doi":"10.1177/22104917221150532","DOIUrl":"https://doi.org/10.1177/22104917221150532","url":null,"abstract":"Background: Although we know routine use of continuous passive motion (CPM) has no clinical benefit on patients’ outcome after total knee replacement (TKR), the effect of CPM on patients with poor rehabilitation progress under ERAS (Enhanced Recovery after Surgery) pathway is unclear. We aimed to evaluate the clinical outcomes by using CPM in these patients under ERAS pathway. Methods: We performed a retrospective study for patients who had TKR done between 2017 and 2019 under ERAS pathway. Patients who were not able to reach 45 degrees of active range of movement (ROM) on postoperative day (POD) 3 would be reviewed to see if any CPM was used. Primary outcomes were the length of hospital stay and the active ROM upon discharge. Other outcomes were the active ROM in POD4 and the latest follow-up, pain score, and quadriceps power. Result: After exclusion, total of 68 patients were included in the study, with 30 were given CPM and 38 were not. Both groups had matched demographics. The study (CPM) group had significantly higher mean active ROM upon discharge (76.00 vs 68.42 degrees, p = 0.02) and longer hospital stay (7.3 vs 5.9 days, p =0.01). There were no significant effects on pain score, quadriceps power, and the active ROM in POD4 and the latest follow-up. Conclusion: For post TKR patients with limited rehabilitation progress under ERAS pathway, the use of CPM could attain better active ROM upon discharge with no adverse effect on pain control and quadriceps power, but at the expense of an increase in the length of stay.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"19 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85327199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-12DOI: 10.1177/22104917221147690
Tarek Aly
Introduction: Radiographic study plays an important role in diagnosis of acute vertebral injuries and helps in proper management of those patients. Magnetic resonance imaging (MRI) is the modality of choice for evaluation of ligamentous and other soft tissue structures, disc, spinal cord and occult osseous injuries. Due to high cost, it is necessary to detect the best use of this technique in the evaluation of thoracolumbar spinal injuries. The purpose of this study was to evaluate the importance of MRI as indicators for vertebral ligamentous injuries and intervertebral disc injuries or herniation in management of thoracolumbar and lumbar fractures. Methods: Retrospective study using radiological measurements. Seventy-two patients with thoracolumbar and lumbar fractures were included. Radiographic parameters detected were percentage of compression, kyphosis angle, vertebral translation and scoliosis angle. Computed tomography was used to detect the degree of spinal canal narrowing, MRI was used to evaluate the condition of posterior ligamentous complex and intervertebral disc injury or herniation. American Spinal Injury Association score was recorded. Results: There were 83% AO spine type A, 6% AO spine type B and 11% AO spine type C. Correlation between fracture type and neurological status with the posterior ligamentous complex injury was found to be significant: (P = 0.0143 and P = 0.0344, respectively). Degree of vertebral body compression, kyphosis and scoliosis angles, vertebral body translation and spinal canal narrowing were found to be insignificant in correlation with posterior ligamentous complex injuries. Correlation of the above-mentioned parameters with disc injury or herniation was found to be insignificant except for kyphotic angle that was found to be significant in correlation with posttraumatic disc herniation (P = 0.0219). Conclusion: MRI finding is of great value in management plan of thoracolumbar and lumbar fractures. Injury of posterior ligamentous complex is significantly correlated with fracture severity and the neurological function. But the intervertebral disc injury or herniation was not correlated to them except that the disc herniation was significantly correlated to kyphosis angle.
放射学研究在急性椎体损伤的诊断和治疗中起着重要的作用。磁共振成像(MRI)是评估韧带和其他软组织结构、椎间盘、脊髓和隐性骨损伤的首选方式。由于成本高，有必要确定该技术在胸腰椎损伤评估中的最佳应用。本研究的目的是评估MRI作为椎韧带损伤和椎间盘损伤或突出的指标在胸腰椎骨折治疗中的重要性。方法:采用放射学测量进行回顾性研究。纳入72例胸腰椎骨折患者。影像学参数检测为压缩率、后凸角、椎体平移和脊柱侧凸角。ct检查椎管狭窄程度，MRI检查后韧带复合体及椎间盘损伤或突出情况。记录美国脊髓损伤协会评分。结果:A型AO占83%，B型AO占6%，c型AO占11%。骨折类型与神经功能状态与后韧带复合体损伤有显著相关性(P = 0.0143, P = 0.0344)。椎体受压程度、后凸和脊柱侧凸角度、椎体平移和椎管狭窄与后韧带复合体损伤的相关性不显著。除后凸角度与创伤后椎间盘突出相关外，上述参数与椎间盘损伤或椎间盘突出的相关性均不显著(P = 0.0219)。结论:MRI表现对胸腰椎骨折的治疗方案有重要价值。后韧带复合体损伤与骨折严重程度及神经功能显著相关。但椎间盘损伤或突出与它们无关，椎间盘突出与后凸角显著相关。
{"title":"Correlation between presence of traumatic disco-ligamentous injuries as an MRI finding with the results of management of thoracolumbar and lumbar injuries","authors":"Tarek Aly","doi":"10.1177/22104917221147690","DOIUrl":"https://doi.org/10.1177/22104917221147690","url":null,"abstract":"Introduction: Radiographic study plays an important role in diagnosis of acute vertebral injuries and helps in proper management of those patients. Magnetic resonance imaging (MRI) is the modality of choice for evaluation of ligamentous and other soft tissue structures, disc, spinal cord and occult osseous injuries. Due to high cost, it is necessary to detect the best use of this technique in the evaluation of thoracolumbar spinal injuries. The purpose of this study was to evaluate the importance of MRI as indicators for vertebral ligamentous injuries and intervertebral disc injuries or herniation in management of thoracolumbar and lumbar fractures. Methods: Retrospective study using radiological measurements. Seventy-two patients with thoracolumbar and lumbar fractures were included. Radiographic parameters detected were percentage of compression, kyphosis angle, vertebral translation and scoliosis angle. Computed tomography was used to detect the degree of spinal canal narrowing, MRI was used to evaluate the condition of posterior ligamentous complex and intervertebral disc injury or herniation. American Spinal Injury Association score was recorded. Results: There were 83% AO spine type A, 6% AO spine type B and 11% AO spine type C. Correlation between fracture type and neurological status with the posterior ligamentous complex injury was found to be significant: (P = 0.0143 and P = 0.0344, respectively). Degree of vertebral body compression, kyphosis and scoliosis angles, vertebral body translation and spinal canal narrowing were found to be insignificant in correlation with posterior ligamentous complex injuries. Correlation of the above-mentioned parameters with disc injury or herniation was found to be insignificant except for kyphotic angle that was found to be significant in correlation with posttraumatic disc herniation (P = 0.0219). Conclusion: MRI finding is of great value in management plan of thoracolumbar and lumbar fractures. Injury of posterior ligamentous complex is significantly correlated with fracture severity and the neurological function. But the intervertebral disc injury or herniation was not correlated to them except that the disc herniation was significantly correlated to kyphosis angle.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79520521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-10DOI: 10.1177/22104917221144700
Eugene Pak-Lin Ng, H. Wong
Background Hong Kong Chinese exhibits a greater varus lower limb mechanical axis and coronal bowing when compared to Caucasians. This anatomical difference may affect the accuracy of bone cuts in total knee arthroplasty (TKA) using western anatomy-based intramedullary TKA cutting jigs. Use of computer navigation may avoid suboptimal cuts due to altered anatomy. This is the first study evaluating clinical function, radiological alignment and long-term survival of computer-assisted TKA amongst Hong Kong Chinese patients. Methods Retrospective study comparing articular surface mounting computer-assisted TKA (ASM-CATKA) and conventional TKA performed in a single centre from 2008 to 2010. Patients were followed up for assessment of clinical parameters including range of motion, Knee Society Knee score, and radiological parameters such as limb alignment, component alignment, and survival. Results Seventy-five patients were included in this study. Baseline clinical and radiological data were similar between groups. The computer-navigated group had superior radiological mechanical alignment (p < 0.001), tibial component alignment (p = 0.016) and femoral component alignment (p < 0.01) when compared to conventional TKA. There were no differences in knee scores (p = 0.488), range of motion (p = 0.432) and survival at 117 months (p = 0.986) between the two groups. Conclusion This retrospective study showed that ASM-CATKA was more accurate in achieving neutral mechanical axis and component alignment amongst Hong Kong Chinese. Clinical outcomes and implant survival were comparable.
{"title":"A retrospective study of articular surface mounting computer-assisted total knee arthroplasty in alignment, knee function, and survival","authors":"Eugene Pak-Lin Ng, H. Wong","doi":"10.1177/22104917221144700","DOIUrl":"https://doi.org/10.1177/22104917221144700","url":null,"abstract":"Background Hong Kong Chinese exhibits a greater varus lower limb mechanical axis and coronal bowing when compared to Caucasians. This anatomical difference may affect the accuracy of bone cuts in total knee arthroplasty (TKA) using western anatomy-based intramedullary TKA cutting jigs. Use of computer navigation may avoid suboptimal cuts due to altered anatomy. This is the first study evaluating clinical function, radiological alignment and long-term survival of computer-assisted TKA amongst Hong Kong Chinese patients. Methods Retrospective study comparing articular surface mounting computer-assisted TKA (ASM-CATKA) and conventional TKA performed in a single centre from 2008 to 2010. Patients were followed up for assessment of clinical parameters including range of motion, Knee Society Knee score, and radiological parameters such as limb alignment, component alignment, and survival. Results Seventy-five patients were included in this study. Baseline clinical and radiological data were similar between groups. The computer-navigated group had superior radiological mechanical alignment (p < 0.001), tibial component alignment (p = 0.016) and femoral component alignment (p < 0.01) when compared to conventional TKA. There were no differences in knee scores (p = 0.488), range of motion (p = 0.432) and survival at 117 months (p = 0.986) between the two groups. Conclusion This retrospective study showed that ASM-CATKA was more accurate in achieving neutral mechanical axis and component alignment amongst Hong Kong Chinese. Clinical outcomes and implant survival were comparable.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"52 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73870296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-04DOI: 10.1177/22104917221147686
Celleen Rei Setiawan, Made Bramantya Karna, Andrew Sutheno, Febyan Febyan, Dary Gunawan
Objective: The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome. Methods: The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA). Result: The mean of rerupture rate is 3.3% (n = 8) in the combination protocol and 8% (n = 48) in controlled active motion (CAM) protocol. Meta-analysis found no significant difference between Kleinert versus CAM in rerupture rate. Furhtermore, we found no significant difference in Duran versus CAM in rerupture rate. In TSA, the Z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM versus Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture with the range of mean flexion contracture 6.6% (n = 18) in CAM to 23.6% (n = 76) in Kleinert protocol. Conclusion: Current meta-analysis proposed that the combination technique will result less rerupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results in less flexion contracture than others. However, a further meta-analysis with larger sample trials seems to be required to confirm this review's conclusion.
{"title":"Early or delay? The most suitable rehabilitation protocol for “no man's land” injury: Meta-analysis with trial sequential analysis—20 years trends","authors":"Celleen Rei Setiawan, Made Bramantya Karna, Andrew Sutheno, Febyan Febyan, Dary Gunawan","doi":"10.1177/22104917221147686","DOIUrl":"https://doi.org/10.1177/22104917221147686","url":null,"abstract":"Objective: The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome. Methods: The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA). Result: The mean of rerupture rate is 3.3% (n = 8) in the combination protocol and 8% (n = 48) in controlled active motion (CAM) protocol. Meta-analysis found no significant difference between Kleinert versus CAM in rerupture rate. Furhtermore, we found no significant difference in Duran versus CAM in rerupture rate. In TSA, the Z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM versus Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture with the range of mean flexion contracture 6.6% (n = 18) in CAM to 23.6% (n = 76) in Kleinert protocol. Conclusion: Current meta-analysis proposed that the combination technique will result less rerupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results in less flexion contracture than others. However, a further meta-analysis with larger sample trials seems to be required to confirm this review's conclusion.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135500247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.1177/22104917221136285
Changhun Han, Yusuke Hashimoto, Sunao Nakagawa, S. Takahashi, Yohei Nishida, S. Yamasaki, J. Takigami, Hiroaki Nakamura
Background Periarticular multimodal drug injection (PMDI) is a safe and effective pain management technique after anterior cruciate ligament reconstruction (ACLR); however, adding morphine and epinephrine sometimes causes adverse effects. Therefore, we evaluated the efficacy of PMDI without morphine and epinephrine after ACLR. Methods This retrospective matched case-control study included patients who had undergone primary double-bundle ACLR with PMDI and were then matched one-to-one with a control group without PMDI based on sex, age, and body mass index using propensity-matched analysis. The following clinical outcomes were compared between the groups: visual analog scale (VAS) score, C-reactive protein (CRP) concentration, number of times the patients used additional analgesics, complication rate, and postoperative time to achieve straight leg raise (SLR). Results Twenty-nine patients with PMDI and 29 controls were enrolled. The VAS score at 1 day postoperatively was lower in the PMDI than the control group (1.93 ± 1.44 vs. 3.41 ± 1.75, respectively; P < 0.001). The CRP concentration at 1 and 3 days was lower in the PMDI than the control group (0.46 ± 0.47 vs. 1.00 ± 0.69 mg/dL, P < 0.001; and 1.93 ± 1.71 vs. 4.01 ± 2.55 mg/dL, P < 0.001, respectively). The average number of additional analgesics used was significantly lower in the PMDI than the control group. There were no significant differences in the frequency of occurrence of postoperative complications between the two groups. The number of patients who could achieve SLR within 1 day was 27/29 (93%) in PMDI group, which was significantly higher than the control group (12/29, 41%) (P < 0.001). Conclusion PMDI without morphine and epinephrine after ACLR reduced patients’ subjective pain level, objective inflammatory response without complications and enabled patients to achieve early functional recovery.
背景:关节周围多模态药物注射(PMDI)是前交叉韧带重建(ACLR)后安全有效的疼痛管理技术;然而，添加吗啡和肾上腺素有时会引起不良反应。因此，我们评价ACLR术后不加吗啡和肾上腺素的PMDI的疗效。方法本回顾性匹配病例对照研究纳入了行原发性双束ACLR合并PMDI的患者，然后根据性别、年龄和体重指数采用倾向匹配分析与未行PMDI的对照组进行一对一匹配。比较两组间的临床结果:视觉模拟评分(VAS)评分、c反应蛋白(CRP)浓度、患者额外使用镇痛药次数、并发症发生率、术后达到直腿抬高(SLR)时间。结果入选PMDI患者29例，对照组29例。PMDI组术后1 d VAS评分低于对照组(分别为1.93±1.44∶3.41±1.75);p < 0.001)。PMDI组第1天和第3天CRP浓度低于对照组(0.46±0.47 vs 1.00±0.69 mg/dL, P < 0.001;和1.93±1.71和4.01±2.55 mg / dL, P < 0.001,分别)。PMDI组额外使用镇痛药的平均数量明显低于对照组。两组患者术后并发症发生频率差异无统计学意义。PMDI组患者在1 d内达到SLR的人数为27/29(93%)，显著高于对照组(12/29,41%)(P < 0.001)。结论ACLR术后不使用吗啡和肾上腺素的PMDI降低了患者的主观疼痛水平和客观炎症反应，无并发症，使患者早日实现功能恢复。
{"title":"The effect and safety of periarticular multimodal drug injection without morphine and epinephrine in anterior cruciate ligament reconstruction","authors":"Changhun Han, Yusuke Hashimoto, Sunao Nakagawa, S. Takahashi, Yohei Nishida, S. Yamasaki, J. Takigami, Hiroaki Nakamura","doi":"10.1177/22104917221136285","DOIUrl":"https://doi.org/10.1177/22104917221136285","url":null,"abstract":"Background Periarticular multimodal drug injection (PMDI) is a safe and effective pain management technique after anterior cruciate ligament reconstruction (ACLR); however, adding morphine and epinephrine sometimes causes adverse effects. Therefore, we evaluated the efficacy of PMDI without morphine and epinephrine after ACLR. Methods This retrospective matched case-control study included patients who had undergone primary double-bundle ACLR with PMDI and were then matched one-to-one with a control group without PMDI based on sex, age, and body mass index using propensity-matched analysis. The following clinical outcomes were compared between the groups: visual analog scale (VAS) score, C-reactive protein (CRP) concentration, number of times the patients used additional analgesics, complication rate, and postoperative time to achieve straight leg raise (SLR). Results Twenty-nine patients with PMDI and 29 controls were enrolled. The VAS score at 1 day postoperatively was lower in the PMDI than the control group (1.93 ± 1.44 vs. 3.41 ± 1.75, respectively; P < 0.001). The CRP concentration at 1 and 3 days was lower in the PMDI than the control group (0.46 ± 0.47 vs. 1.00 ± 0.69 mg/dL, P < 0.001; and 1.93 ± 1.71 vs. 4.01 ± 2.55 mg/dL, P < 0.001, respectively). The average number of additional analgesics used was significantly lower in the PMDI than the control group. There were no significant differences in the frequency of occurrence of postoperative complications between the two groups. The number of patients who could achieve SLR within 1 day was 27/29 (93%) in PMDI group, which was significantly higher than the control group (12/29, 41%) (P < 0.001). Conclusion PMDI without morphine and epinephrine after ACLR reduced patients’ subjective pain level, objective inflammatory response without complications and enabled patients to achieve early functional recovery.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"133 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89651521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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