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Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review. SARS-CoV-2感染后的膝骨坏死:基于病例的系统性回顾。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-05 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-23-67
Pierangelo Za, Giuseppe Francesco Papalia, Fabrizio Russo, Sebastiano Vasta, Gianluca Vadalà, Rocco Papalia

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19). Patients with COVID-19 manifested symptoms mainly related to the respiratory system, but also the musculoskeletal system can be involved. COVID-19 has been described as a possible cause of knee osteonecrosis (ON). A systematic review was performed to investigate the hypothetical correlation between COVID-19 and knee ON.

Methods: Inclusion criteria were all articles reporting cases of knee ON after a diagnosis of SARS-CoV-2 infection. Considering that COVID-19 is an emerging disease, all levels of evidence studies were included.

Results: Finally, two case series and three case reports were included. We extracted data regarding demographic and clinical characteristics, details of magnetic resonance imaging (MRI), use of corticosteroids (CCS), temporal correlation between ON and COVID-19, treatment of the lesion and its outcomes. A total of seven cases of post-COVID knee ON have been described. Knee pain arose on average 11 weeks after the diagnosis of COVID-19. All patients had knee MRI showing ON. CCS were used to treat COVID-19-related symptoms in four cases. Conservative treatment was successful in five patients.

Conclusions: The correlation between COVID-19 and ON remains unclear. Probably post-COVID-19 ON has a multifactorial origin in which factors related to the patient, consequences of COVID-19 and CCS therapy add up to cause a reduction of blood supply and bone vitality until ON is triggered. A greater number of patients is needed to clarify the role of COVID-19 in the etiopathogenesis of knee ON.

背景:严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)是导致 2019 年冠状病毒病(COVID-19)的病毒。COVID-19 患者的症状主要与呼吸系统有关,但也可能涉及肌肉骨骼系统。COVID-19被描述为膝关节骨坏死(ON)的可能病因。为了研究COVID-19与膝关节骨坏死之间的假设相关性,我们进行了一项系统性综述:方法:纳入标准为所有报道SARS-CoV-2感染后膝关节骨坏死病例的文章。考虑到 COVID-19 是一种新出现的疾病,因此纳入了所有证据级别的研究:结果:最终纳入了两篇系列病例和三篇病例报告。我们提取了有关人口统计学和临床特征、磁共振成像(MRI)细节、皮质类固醇(CCS)的使用、ON与COVID-19的时间相关性、病变治疗及其结果的数据。共描述了七例 COVID 后膝关节 ON 病例。膝关节疼痛平均在确诊COVID-19后11周出现。所有患者的膝关节磁共振成像均显示为ON。四例患者使用CCS治疗COVID-19相关症状。结论:COVID-19与膝关节疼痛之间存在相关性:结论:COVID-19与ON之间的相关性仍不明确。结论:COVID-19与ON之间的相关性仍不明确,COVID-19后ON可能是由多种因素引起的,其中与患者相关的因素、COVID-19的后果和CCS治疗共同导致供血和骨活力下降,直至引发ON。要明确COVID-19在膝关节ON发病机制中的作用,还需要更多患者的参与。
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引用次数: 0
Evolving concepts in the treatment of posterior shoulder instability with glenohumeral bone loss 治疗肩关节后方不稳定并伴有盂肱骨骨质流失的新理念
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.21037/aoj-23-45
Myra Trivellas, Benjamin Hoyt, Steven Bokshan, Jonathan F. Dickens, Brian C. Lau
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引用次数: 0
Interpreting the pharmacological mechanisms of Juanbi recipe on rheumatoid arthritis through network pharmacology, molecular docking 通过网络药理学、分子对接解读娟碧配方对类风湿性关节炎的药理机制
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.21037/aoj-23-72
Ruo-yu Wang, Xiaomin Chen, Song Gong, Bo Wang, Weihua Xu
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引用次数: 0
All-inside suture meniscal repair using suture passer. 使用缝合器进行全内侧缝合半月板修复。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-24-4
Ryohei Uchida, Shuji Horibe, Tomoki Ohori, Konsei Shino

In recent years, to save the meniscus and prevent the progression of knee osteoarthritis, the indications for meniscus repair have been expanding instead of partial menisectomy. Accordingly, various repair techniques for meniscus tears have been developed. The conventional inside-out and outside-in meniscus repair techniques and all-inside repair technique with an implant/anchor can be classified as trans-capsular (TC) repair from the perspective of suture with penetrating capsule. Recently, new suture passers for all-inside meniscus repair have been developed. To distinguish from conventional all-inside repair with implant/anchors, all-inside repair with only suture using these suture passers was described as all-inside suture (AIS) repair. This AIS repair could achieve meniscus-to-meniscus suture across the tear without interposition of soft tissues including the capsule between suture and meniscus, leading direct gap closing of torn edges. In this respect, AIS repair is considered to be "anatomical meniscus repair". Actually, some reports showed biomechanical and clinical advantages of AIS repair. However, there is still limited evidence in clinical practice. Moreover, there are some disadvantages for AIS repair. Not only further studies but also development of new devices and surgical techniques for AIS should be required. This review describes the current status of AIS repair for each type of tear.

近年来,为了挽救半月板并防止膝关节骨性关节炎的发展,半月板修复术的适应症不断扩大,而不再是半月板部分切除术。因此,各种半月板撕裂修复技术应运而生。从缝合穿透囊的角度来看,传统的内向外和外向内半月板修复技术以及带有植入物/锚的全内向修复技术可归类为经囊(TC)修复。近来,用于全内侧半月板修复的新型缝合器得到了发展。为了与传统的植入物/锚全内侧修复术区分开来,使用这种缝合器仅进行缝合的全内侧修复术被称为全内侧缝合(AIS)修复术。这种全内侧缝合修复可实现半月板与半月板之间的缝合,而无需在缝合线与半月板之间插入软组织(包括囊),从而直接缝合撕裂边缘。因此,AIS 修复术被认为是 "解剖半月板修复术"。事实上,一些报告显示了 AIS 修复在生物力学和临床方面的优势。然而,临床实践中的证据仍然有限。此外,AIS 修复术还存在一些缺点。不仅需要进一步研究,还需要开发新的 AIS 设备和手术技术。本综述介绍了每种类型撕裂的 AIS 修复现状。
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引用次数: 0
Postoperative healing and complications based on anterior cruciate ligament reconstruction graft type. 根据前十字韧带重建移植物类型确定术后愈合和并发症。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-06-28 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-24-3
Evan Boyd, Nathan K Endres, Andrew G Geeslin

Injury to the anterior cruciate ligament (ACL) is a devastating injury to athletes of all ages. The current gold standard treatment following complete rupture of the ACL is reconstruction of the torn ligament with autograft or allograft tendon. Commonly used tendon grafts include patellar tendon, hamstring tendon, and quadriceps tendon. Although ligaments and tendons have similar collagen and proteoglycan compositions, they maintain a unique composition and arrangement of cells to serve their unique biomechanical needs. Therefore, following ACL reconstruction (ACLR), the implanted tendon tissue undergoes a process of remodeling which is termed "ligamentization". The process of ligamentization is divided into three main phases, which include the early healing phase, the proliferative phase, and the maturation phase. Following the process of ligamentization, the graft tissue closely mimics the appearance of ligament tissue on an ultrastructural level. Successful outcome following ACLR is contingent upon adequate remodeling of the tissue as well as healing of the graft within the bone tunnels in the femur and tibia. Choice of graft has individual implications regarding their associated risk of complications, failure, and infection. The purpose of this review is to summarize the process of ligamentization and graft healing and to discuss how graft type influences the rate and types of complications, failures, and infections.

前十字韧带(ACL)损伤对所有年龄段的运动员都是一种毁灭性损伤。前十字韧带完全断裂后,目前的金标准治疗方法是用自体或异体肌腱重建撕裂的韧带。常用的肌腱移植包括髌腱、腘绳肌腱和股四头肌腱。虽然韧带和肌腱具有相似的胶原蛋白和蛋白多糖成分,但它们保持着独特的细胞组成和排列,以满足其独特的生物力学需求。因此,在进行前交叉韧带重建(ACLR)后,植入的肌腱组织会经历一个被称为 "韧带化 "的重塑过程。韧带韧化过程分为三个主要阶段,包括早期愈合阶段、增殖阶段和成熟阶段。在韧带化过程之后,移植物组织在超微结构层面上与韧带组织的外观非常相似。前交叉韧带置换术的成功取决于组织的充分重塑以及股骨和胫骨骨隧道内移植物的愈合。移植物的选择对并发症、失败和感染的相关风险具有个体影响。本综述旨在总结结扎和移植物愈合的过程,并讨论移植物类型如何影响并发症、失败和感染的发生率和类型。
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引用次数: 0
The impact of metabolic syndrome on clinical outcomes following total knee arthroplasty in osteoarthritis patients. 代谢综合征对骨关节炎患者全膝关节置换术后临床疗效的影响。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-24-2
Jun Lu, Bing Wei, Jihao Xu, Zhuang Li

Background: Metabolic syndrome (MetS) is a combination of interconnected conditions, including insulin resistance, abdominal obesity, high blood pressure, and abnormal blood lipid levels. The objective of this research was to investigate the impact of MetS on the quality of life and clinical outcomes following total knee arthroplasty (TKA) in patients with osteoarthritis (OA).

Methods: A retrospective descriptive study was conducted to enroll OA patients who underwent primary TKA at Zhongda Hospital, Southeast University from January 2015 to August 2019. A total of 83 OA patients who did and 144 (MetS group) who did not have MetS (non-MetS group) were included. An analysis was conducted on the patient's clinical data.

Results: The two groups had similar results in terms of lengths of stay (P=0.93), hospital costs (P=0.24), and overall complication rates (P=0.99). There was no significant difference in the average erythrocyte sedimentation rate and C-reactive protein levels between the groups. However, the MetS group exhibited notably lower Hospital for Special Surgery knee scores and Short Form [36] health survey (SF-36) scores compared to the non-MetS group (both P>0.05) during the one-year follow-up period.

Conclusions: OA patients who have MetS had significantly worse knee joint function and quality of life after TKA. There are certain constraints in the current research. First, it belongs to a single-center retrospective study. Further study will be necessary to determine the generality of this conclusion. Second, this study is retrospective, and the number of patients included is not large. Third, due to the diverse clinical groups in our hospital, it is challenging to comprehensively document all the clinical data of the patients involved in this study. Forth, this study did not compare the preoperative differences between the two groups, as well as analyze the postoperative improvement changes in depth. We will compare the preoperative and postoperative differences between the two groups in more depth in future large sample studies.

背景:代谢综合征(MetS)是包括胰岛素抵抗、腹部肥胖、高血压和血脂异常在内的一系列相互关联的病症的组合。本研究旨在探讨 MetS 对骨关节炎(OA)患者全膝关节置换术(TKA)后的生活质量和临床疗效的影响:采用回顾性描述性研究方法,招募2015年1月至2019年8月在东南大学附属中大医院接受初次TKA手术的OA患者。共纳入83例接受TKA治疗的OA患者和144例未接受MetS治疗的OA患者(MetS组)(非MetS组)。对患者的临床数据进行了分析:在住院时间(P=0.93)、住院费用(P=0.24)和总体并发症发生率(P=0.99)方面,两组结果相似。两组的平均红细胞沉降率和 C 反应蛋白水平无明显差异。然而,与非 MetS 组相比,MetS 组在一年随访期间的医院特殊外科膝关节评分和短表[36]健康调查(SF-36)评分明显较低(均为 P>0.05):结论:患有 MetS 的 OA 患者在 TKA 术后膝关节功能和生活质量明显较差。目前的研究存在一定的局限性。首先,这是一项单中心回顾性研究。要确定这一结论的普遍性,还需要进一步的研究。第二,本研究为回顾性研究,纳入的患者人数不多。第三,由于本医院的临床群体多种多样,要全面记录本研究中所有患者的临床数据具有挑战性。第四,本研究没有比较两组患者术前的差异,也没有深入分析术后的改善变化。我们将在今后的大样本研究中更深入地比较两组患者术前和术后的差异。
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引用次数: 0
Inflammation of the tibiofemoral joint: inflammatory mediators, treatment, and long-term effects. 胫股关节炎症:炎症介质、治疗和长期影响。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-24-13
Nicholas N DePhillipo
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引用次数: 0
Inflammatory biomarkers and state of the tibiofemoral joint in the osteoarthritic knee: a narrative review. 骨关节炎膝关节的炎症生物标志物和胫股关节状态:综述。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-06-11 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-23-59
Mitchell Iung Kennedy, Conner P Olson, Nicholas N DePhillipo, Adam J Tagliero, Robert F LaPrade, Nicholas I Kennedy

Background: The healing process is initiated by injurious stimuli in response to cellular damage. Upon recruiting proinflammatory biomarkers to the tissue site of injury, the release of additional biomarkers occurs, including the likes of cytokines, matrix molecules, macrophages, neutrophils, and others. This influx of immune system mediators can occur for chronic periods, and though its intention is for healing the original injurious stimuli, it is also suspected of causing long term cartilage impairment following internal structure damage. The objective of this narrative review is to identify which inflammatory factors have the leading roles in the progression of osteoarthritis (OA) following knee injuries and how they fluctuate throughout the healing process, both acutely and chronically.

Methods: This narrative review was performed following a computerized search of the electronic database on PubMed in May 2023. Abstracts related to the inflammatory biomarkers of the post-traumatic knee were included for review.

Key content and findings: The chronic low-level inflammation that leads to OA leads to the destruction of the cartilage extracellular matrix, which new and developing orthopedic research is still attempting to find resolve for. Some of this damage is attributed to the biomechanical alterations that occurs following injury, though with most procedures capable of joint biomechanical restoration, focus has rather been shifted toward the environment of inflammatory biomarkers.

Conclusions: Future studies will be aiming to improve the diagnostics of OA, focusing on a consistent correlation of inflammatory biomarkers with imaging. Additionally, biochemical treatments will need to focus on validating reproducible modulation of signaling molecules, in attempts to lessen the chronic elevations of destructive biomarkers.

背景:愈合过程是由细胞损伤时的损伤性刺激启动的。在损伤组织部位招募到促炎生物标志物后,会释放出更多生物标志物,包括细胞因子、基质分子、巨噬细胞、中性粒细胞等。这种免疫系统介质的涌入可能会长期存在,虽然其目的是为了治愈最初的损伤性刺激,但也被怀疑会在内部结构受损后造成长期的软骨损伤。本综述旨在确定哪些炎症因子在膝关节损伤后骨关节炎(OA)的发展过程中起主导作用,以及这些因子在急性和慢性愈合过程中的波动情况:本综述是在 2023 年 5 月对 PubMed 电子数据库进行计算机检索后完成的。主要内容和研究结果:导致 OA 的慢性低水平炎症会导致软骨细胞外基质的破坏,新的和发展中的骨科研究仍在试图找到解决这一问题的方法。这种破坏的部分原因是损伤后发生的生物力学改变,尽管大多数手术都能恢复关节生物力学,但重点已转向炎症生物标志物的环境:结论:未来的研究将以改善 OA 诊断为目标,重点关注炎症生物标志物与成像的一致性相关性。此外,生化治疗还需要重点验证信号分子调节的可重复性,以减少破坏性生物标志物的长期升高。
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引用次数: 0
Removal of uncemented components: hope for the best, prepare for the worst-technical tips and tricks. 移除非骨水泥组件:希望最好,准备最坏--技术提示和技巧。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-05-22 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-23-34
C Michael Goplen, Jacob Munro

Removing well-fixed uncemented components can be challenging. With thoughtful surgical planning, appropriate surgical instruments, and proper surgical techniques, most implants can be removed expeditiously with little bone loss and minimal impact on the subsequent reconstruction. Preoperative planning is one of the most essential steps to remove uncemented implants. Obtaining previous surgical records, although tedious, should always be attempted preoperatively to determine if specific instruments will be required and to help anticipate which steps may need special attention. These include the presence of ceramic or metal bearings and the presence of acetabular screws or stem collars. Without proper preparation and available tools, the removal of implants can negatively impact the subsequent reconstruction and patient outcomes. We will describe techniques and practical tips for removing uncemented stems from the top (intramedullary) or transfemoral using an extended trochanteric osteotomy. We will also describe techniques and tools to remove uncemented acetabular shells efficiently. Case examples will highlight these clinical situations where careful planning is necessary and potential problems that may be encountered with the recurring theme of preparing for the worst but hoping for the best. We have also included cases such as removing well-fixed cementless collared stems, broken stems, and fully coated stems.

取出固定良好的非骨水泥植入物是一项挑战。通过周密的手术计划、适当的手术器械和正确的手术技巧,大多数种植体都可以快速取出,而且骨量损失小,对后续重建的影响也最小。术前规划是移除非骨水泥植入体的最基本步骤之一。获取以前的手术记录虽然繁琐,但术前应尝试确定是否需要特定的器械,并帮助预测哪些步骤可能需要特别注意。这包括是否存在陶瓷或金属轴承以及是否存在髋臼螺钉或柄环。如果没有适当的准备和可用的工具,植入物的移除可能会对后续重建和患者预后产生负面影响。我们将介绍使用扩展转子截骨术从顶部(髓内)或经股骨移除非骨水泥柄的技术和实用技巧。我们还将介绍有效移除非骨水泥髋臼壳的技术和工具。病例将强调这些需要仔细规划的临床情况,以及可能遇到的潜在问题,并反复强调 "做最坏的打算,抱最好的希望 "这一主题。我们还包括一些病例,如移除固定良好的无骨水泥基台、断裂的基台和完全包覆的基台。
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引用次数: 0
Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review. 前交叉韧带重建术后的全膝关节置换术:综述。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-05-20 eCollection Date: 2024-01-01 DOI: 10.21037/aoj-23-62
Mattia Alessio-Mazzola, Nicolo' Biavardi, Giuseppe Solarino, Giuseppe Marongiu, Vincenzo Salini, Giacomo Placella

Background and objective: Knee replacement following anterior cruciate ligament (ACL) reconstruction can be demanding due to altered anatomy, soft tissue scars, bone loss, extensor mechanism complications, and knee instability. This narrative review summarizes the strategies and approaches to managing operative challenges in total knee arthroplasty (TKA) following ACL reconstruction.

Methods: Studies reporting outcomes of patients who underwent TKA after ACL reconstruction were retrieved and assessed to be included in this review that synthesizes the available evidence highlighting the pitfalls encountered during surgery, the intraoperative challenges posed by ligament balancing and exposure, and the leading role of modular and retained implants.

Key content and findings: TKA following ACL reconstruction has a high rate of intra-operative complications such as instability, bone loss, difficult exposure and demanding soft tissue balancing, representing a revision surgery rather than routine primary knee arthroplasty and a revision-oriented skill set and modular components are recommended to significantly optimize both surgical strategy and patient outcomes. With a rising incidence of ACL injuries and growing reconstructions, anticipating an increase in TKA procedures, this review aims to provide a call for rethinking clinical approaches to ensure effective and patient-centric care.

Conclusions: This narrative review seems to indicate that TKA after ACL reconstruction should be considered as revision surgery and modular components should be used. However, future prospective and high-quality studies are required to better clarify risk factors and give strong recommendations for this complex surgery.

背景和目的:前交叉韧带(ACL)重建术后的膝关节置换术可能会因解剖结构改变、软组织疤痕、骨质流失、伸肌机制并发症和膝关节不稳定而要求较高。本综述总结了前交叉韧带重建术后全膝关节置换术(TKA)中应对手术挑战的策略和方法:方法:检索并评估了前交叉韧带重建术后接受全膝关节置换术患者的疗效报告,并将其纳入本综述,本综述综合了现有证据,强调了手术中遇到的陷阱、韧带平衡和暴露带来的术中挑战,以及模块化和保留植入物的主导作用:前交叉韧带重建后的 TKA 术中并发症发生率较高,如不稳定、骨质流失、难以暴露和要求较高的软组织平衡,是一种翻修手术,而不是常规的初级膝关节置换术,建议采用以翻修为导向的技能组合和模块化组件,以显著优化手术策略和患者预后。随着前交叉韧带损伤发生率的上升和重建手术的增加,预计 TKA 手术也将增加,本综述旨在呼吁重新思考临床方法,以确保有效和以患者为中心的护理:本综述似乎表明,前交叉韧带重建后的 TKA 应视为翻修手术,并应使用模块化组件。然而,未来还需要进行前瞻性和高质量的研究,以更好地阐明风险因素,并为这种复杂的手术提出有力的建议。
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引用次数: 0
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Annals of Joint
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