Joni Nunes, Bruno Direito-Santos, André Costa, N. Tavares, Pedro Varanda, Rui M. Duarte
Proximal tibiofibular joint (PTFJ) dislocation is a rare injury, accounting for less than 1% of all knee injuries. The mechanism of this injury is usually sports related. Diagnosis is largely clinical, but the findings may be subtle. This condition may be easily missed. There is no larger series described in the literature but only several cases of dislocation of the PTFJ treated by different methods. We present two different antero-lateral dislocation cases successfully treated with different approaches.
{"title":"Acute proximal tibiofibular joint dislocation: a sports related injury?—two different cases","authors":"Joni Nunes, Bruno Direito-Santos, André Costa, N. Tavares, Pedro Varanda, Rui M. Duarte","doi":"10.21037/AOJ.2019.01.07","DOIUrl":"https://doi.org/10.21037/AOJ.2019.01.07","url":null,"abstract":"Proximal tibiofibular joint (PTFJ) dislocation is a rare injury, accounting for less than 1% of all knee injuries. The mechanism of this injury is usually sports related. Diagnosis is largely clinical, but the findings may be subtle. This condition may be easily missed. There is no larger series described in the literature but only several cases of dislocation of the PTFJ treated by different methods. We present two different antero-lateral dislocation cases successfully treated with different approaches.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.01.07","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43950001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Application of the CARE guideline as reporting standard in the Annals of Joint","authors":"","doi":"10.21037/aoj.2019.10.04","DOIUrl":"https://doi.org/10.21037/aoj.2019.10.04","url":null,"abstract":"","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47643449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eiji Kondo, Zenta Joutoku, S. Matsubara, Koji Iwasaki, T. Onodera, K. Yasuda, T. Yagi, N. Iwasaki
Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries results in severe functional knee disability. The posterolateral structure (PLS) injuries are commonly associated with PCL and/or ACL injuries by traffic accident or high energy trauma. The PCL is the primary restraint structure to posterior tibial translation of the knee. The PLS injury promote the functional disability of the PCL insufficiency. However, the treatment strategy for combined ligamentous injuries of the knee with the PLS insufficiency remains controversial. The authors have been performed PLS reconstruction using an autogenous biceps femoris tendon (BFT) for the chronic posterolateral (PL) instability of the knee. In this article, the surgical technique, and clinical outcomes of PLS reconstruction for the chronic PLS insufficiency with PCL and/or ACL ruptures.
{"title":"Posterolateral structure reconstruction for the chronic multiple ligament injuries of the knee","authors":"Eiji Kondo, Zenta Joutoku, S. Matsubara, Koji Iwasaki, T. Onodera, K. Yasuda, T. Yagi, N. Iwasaki","doi":"10.21037/aoj.2019.08.04","DOIUrl":"https://doi.org/10.21037/aoj.2019.08.04","url":null,"abstract":"Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries results in severe functional knee disability. The posterolateral structure (PLS) injuries are commonly associated with PCL and/or ACL injuries by traffic accident or high energy trauma. The PCL is the primary restraint structure to posterior tibial translation of the knee. The PLS injury promote the functional disability of the PCL insufficiency. However, the treatment strategy for combined ligamentous injuries of the knee with the PLS insufficiency remains controversial. The authors have been performed PLS reconstruction using an autogenous biceps femoris tendon (BFT) for the chronic posterolateral (PL) instability of the knee. In this article, the surgical technique, and clinical outcomes of PLS reconstruction for the chronic PLS insufficiency with PCL and/or ACL ruptures.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.08.04","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44494883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Metallic implants are an integral part of the practice of orthopaedic surgery. Metal hypersensitivity is reported to be from 10−17% of the general population. No consensus exists on how to screen or what changes in treatment plans should be implemented when reported sensitivities to metals exist. Literature review suggests that preoperative testing may influence surgical practice. This study was designed to gain insight to the experience of orthopaedic surgeons as it relates to metal allergies to metallic orthopaedic implants and to examine the trends in screening and evaluating patients who have sensitivities to metals to determine how this data influences treatment. Methods: An online survey of orthopaedic surgeons’ experiences and opinions on the prevalence, screening protocols, and treatment adjustments made when metal hypersensitivity is suspected was performed. A 35-question survey was distributed via orthopaedic surgery specialty societies, orthopaedic surgery departments, and state orthopaedic societies’ email lists. The survey was performed by a commercially available online survey company, which provided data acquisition and analysis. Results: A total of 230 responses were obtained from May 15, 2015 through December 31, 2015. Respondents were primarily from the United States with a small contribution from Canada and other countries. All regions of the United States and all orthopedic specialties were represented. A quarter of respondents have experience with metal allergy to an implant. Most orthopaedic surgeons (69%) believed that metal allergies occur with orthopedic implants, while 18% did not believe that metal allergies occur. Nickel, cobalt, and chromium allergies were most commonly seen. Consultation with an allergist/dermatologist was primarily used for diagnosis. Revision was listed as the first choice of treatment in 47% of respondents, while observation was listed as first choice by 33%. Most surgeons (59%) did not ask patients about metal allergy history. Only a quarter of patient questionnaires inquired about metal allergy. The majority (59%) altered their implant choice with a mild reaction to testing, whereas 29% did not. With a moderate reaction, 72% altered their implant. When the reaction was severe, 64% altered their implant, 12% obtained a second opinion, and 6% did not alter their implant. Conclusions: Orthopaedic surgeons vary in their level of confidence on whether metal allergy to orthopaedic implants exist. Most surgeons believe in metal allergy, but a sizable number do not believe. The prevalence of reported metal allergy to an implant was low. Surgeons tend to alter their choice of implant more frequently as the reaction becomes more severe. Observation and revision surgery are frequently used to treat an allergic reaction. Allergy/dermatology consults are used to diagnose metal allergy, yet a minority of orthopaedic surgeons inquire about metal hypersensitivity in their patients. Greater awarene
{"title":"Does metal allergy have relevance in patients undergoing arthroplasty—an electronic survey of surgeon attitudes","authors":"K. Scheidt, M. Schultzel, J. Itamura","doi":"10.21037/AOJ.2019.04.01","DOIUrl":"https://doi.org/10.21037/AOJ.2019.04.01","url":null,"abstract":"Background: Metallic implants are an integral part of the practice of orthopaedic surgery. Metal hypersensitivity is reported to be from 10−17% of the general population. No consensus exists on how to screen or what changes in treatment plans should be implemented when reported sensitivities to metals exist. Literature review suggests that preoperative testing may influence surgical practice. This study was designed to gain insight to the experience of orthopaedic surgeons as it relates to metal allergies to metallic orthopaedic implants and to examine the trends in screening and evaluating patients who have sensitivities to metals to determine how this data influences treatment. \u0000 Methods: An online survey of orthopaedic surgeons’ experiences and opinions on the prevalence, screening protocols, and treatment adjustments made when metal hypersensitivity is suspected was performed. A 35-question survey was distributed via orthopaedic surgery specialty societies, orthopaedic surgery departments, and state orthopaedic societies’ email lists. The survey was performed by a commercially available online survey company, which provided data acquisition and analysis. Results: A total of 230 responses were obtained from May 15, 2015 through December 31, 2015. Respondents were primarily from the United States with a small contribution from Canada and other countries. All regions of the United States and all orthopedic specialties were represented. A quarter of respondents have experience with metal allergy to an implant. Most orthopaedic surgeons (69%) believed that metal allergies occur with orthopedic implants, while 18% did not believe that metal allergies occur. Nickel, cobalt, and chromium allergies were most commonly seen. Consultation with an allergist/dermatologist was primarily used for diagnosis. Revision was listed as the first choice of treatment in 47% of respondents, while observation was listed as first choice by 33%. Most surgeons (59%) did not ask patients about metal allergy history. Only a quarter of patient questionnaires inquired about metal allergy. The majority (59%) altered their implant choice with a mild reaction to testing, whereas 29% did not. With a moderate reaction, 72% altered their implant. When the reaction was severe, 64% altered their implant, 12% obtained a second opinion, and 6% did not alter their implant. Conclusions: Orthopaedic surgeons vary in their level of confidence on whether metal allergy to orthopaedic implants exist. Most surgeons believe in metal allergy, but a sizable number do not believe. The prevalence of reported metal allergy to an implant was low. Surgeons tend to alter their choice of implant more frequently as the reaction becomes more severe. Observation and revision surgery are frequently used to treat an allergic reaction. Allergy/dermatology consults are used to diagnose metal allergy, yet a minority of orthopaedic surgeons inquire about metal hypersensitivity in their patients. Greater awarene","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2019.04.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49631628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
José A. Rodriguez, V. Entezari, J. Iannotti, E. Ricchetti
With the increasing use of reverse shoulder arthroplasty and its expanding indications, surgeons today are facing tougher reconstructive challenges while still providing the patient with a good clinical outcome. There are a greater number of primary and revision cases where glenoid vault deformity is encountered. This presents a challenge to the surgeon during glenoid component positioning. He or she must place the implants in a location and orientation that optimizes range of motion and stability while minimizing impingement. In order to address this, surgeons can look to the use of 3D imaging in order to better understand each patient’s pathology. With the use of virtual planning the surgeon has the ability to arrive in the operating room with an established surgical plan in order to better address the deformity present. This can help in determining if glenoid bone grafting, eccentric reaming, or the use of augmented/lateralized components is the best choice in addressing bony deformity and maximizing impingement-free range-of-motion. Furthermore, with the advent of patient specific instrumentation and navigation the surgeon has the means to translate the preoperative plan into the operating room with increased accuracy, thus, decreasing the likelihood of component malposition and its associated complications. In the future, custom implants may grant the surgeon the means to address severe glenoid bone loss that would otherwise not be reconstructable and potentially give the patient improved function.
{"title":"Pre-operative planning for reverse shoulder replacement: the surgical benefits and their clinical translation","authors":"José A. Rodriguez, V. Entezari, J. Iannotti, E. Ricchetti","doi":"10.21037/AOJ.2018.12.09","DOIUrl":"https://doi.org/10.21037/AOJ.2018.12.09","url":null,"abstract":"With the increasing use of reverse shoulder arthroplasty and its expanding indications, surgeons today are facing tougher reconstructive challenges while still providing the patient with a good clinical outcome. There are a greater number of primary and revision cases where glenoid vault deformity is encountered. This presents a challenge to the surgeon during glenoid component positioning. He or she must place the implants in a location and orientation that optimizes range of motion and stability while minimizing impingement. In order to address this, surgeons can look to the use of 3D imaging in order to better understand each patient’s pathology. With the use of virtual planning the surgeon has the ability to arrive in the operating room with an established surgical plan in order to better address the deformity present. This can help in determining if glenoid bone grafting, eccentric reaming, or the use of augmented/lateralized components is the best choice in addressing bony deformity and maximizing impingement-free range-of-motion. Furthermore, with the advent of patient specific instrumentation and navigation the surgeon has the means to translate the preoperative plan into the operating room with increased accuracy, thus, decreasing the likelihood of component malposition and its associated complications. In the future, custom implants may grant the surgeon the means to address severe glenoid bone loss that would otherwise not be reconstructable and potentially give the patient improved function.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/AOJ.2018.12.09","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46960970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The recent focused issue of Annals of Joint ( AOJ ) deals with “Anatomic reconstruction of anterior cruciate ligament—concept, indication and its efficacy”. I worked as an invited editor. Professor Freddie Fu, an Editor-in-Chief of AOJ, kindly and unexpectedly asked me to do so. It is an extraordinarily honorable invitation to me.
{"title":"Anatomic reconstruction of anterior cruciate ligament—concept, indication and its efficacy","authors":"T. Muneta","doi":"10.21037/aoj.2019.09.04","DOIUrl":"https://doi.org/10.21037/aoj.2019.09.04","url":null,"abstract":"The recent focused issue of Annals of Joint ( AOJ ) deals with “Anatomic reconstruction of anterior cruciate ligament—concept, indication and its efficacy”. I worked as an invited editor. Professor Freddie Fu, an Editor-in-Chief of AOJ, kindly and unexpectedly asked me to do so. It is an extraordinarily honorable invitation to me.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.09.04","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43464576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Bar-Ziv, Konstantin Lamykin, N. Shohat, Ahmad Jurban, G. Agar, E. Ner
Kinematic total knee arthroplasty (TKA) has gained much attention in recent years. While most surgeons agree on how to adjust the femoral component, cutting the tibia and restoring it to its pre-arthritic state while maintaining the native laxity of the soft tissue envelope remains an unsolved issue. In this study we present a novel, easy and reproducible technique for cutting the tibia when performing a kinematic TKA. A novel technique for kinematic TKA (“linked soft tissue guided technique”) was developed for planning and executing the tibia cut, without the use of patient specific instrumentations nor navigation. Patient reported outcomes 6 months post op suggested a learning curve of approximately 20 patients. In 26 patients who had undergone a previous mechanical knee arthroplasty, a comparison was made between the two knees in regards to pain and function. Our preliminary results show an advantage for the novel technique regarding patient satisfaction. In conclusion, the “linked soft tissue guided technique” is a simple, comfortable, and a reproducible technique, and may aid surgeons in their transition to kinematic alignment arthroplasties.
{"title":"The “linked soft tissue guided technique”: a novel method for cutting the tibia while performing a kinematic femoral alignment in total knee arthroplasty","authors":"Y. Bar-Ziv, Konstantin Lamykin, N. Shohat, Ahmad Jurban, G. Agar, E. Ner","doi":"10.21037/aoj.2019.08.03","DOIUrl":"https://doi.org/10.21037/aoj.2019.08.03","url":null,"abstract":"Kinematic total knee arthroplasty (TKA) has gained much attention in recent years. While most surgeons agree on how to adjust the femoral component, cutting the tibia and restoring it to its pre-arthritic state while maintaining the native laxity of the soft tissue envelope remains an unsolved issue. In this study we present a novel, easy and reproducible technique for cutting the tibia when performing a kinematic TKA. A novel technique for kinematic TKA (“linked soft tissue guided technique”) was developed for planning and executing the tibia cut, without the use of patient specific instrumentations nor navigation. Patient reported outcomes 6 months post op suggested a learning curve of approximately 20 patients. In 26 patients who had undergone a previous mechanical knee arthroplasty, a comparison was made between the two knees in regards to pain and function. Our preliminary results show an advantage for the novel technique regarding patient satisfaction. In conclusion, the “linked soft tissue guided technique” is a simple, comfortable, and a reproducible technique, and may aid surgeons in their transition to kinematic alignment arthroplasties.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.08.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47360241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metal-on-metal (MoM) bearings with a cemented femoral component and a cementless acetabular shell has historically been the gold standard for fixation in surface arthroplasty (SA) of the hip. Lately, there has been an increase in the availability of cementless femoral fixation. Since there is a paucity of literature on the clinical performance of modern generation cementless designs in SA, we aimed to perform a review of the literature on this type of fixation, as well as to report our institutional mid-term survival with a MoM cementless hip design. A comprehensive literature search provided information on joint arthroplasty registries, case-series, case-controlled studies and randomized controlled-trials reporting on the performance of hip resurfacings with cementless femoral fixation and its comparison with cemented fixation. Even though initial attempts of cementless femoral fixation showed high failure rates in the early 1990s, modern cementless porous-coated designs have proven to be non-inferior, with excellent mid- and long-term results in terms of survival and clinical outcomes. Our experience showed a two-, five-, and eight-year survivorships of 99.6% (95% CI: 98.8–100%), 98.3% (95% CI: 96.3–100%), and 98.3% (95% CI: 96.3–100%), respectively; with only 2 aseptic femoral failures. In SA of the hip, cementless femoral fixation has evolved in such a fashion that is the fixation of choice for SA in many centers. Modern implants have similar outcomes to that of cemented fixation in the early to mid-term. However, long-term clinical outcomes are still necessary to determine whether these results will continue or surpass that of cemented femoral fixation in SA.
{"title":"Then and now, design matters: significant improvements in the clinical and radiological performance of cementless hip resurfacing","authors":"P. Slullitel, Nicholas Tubin, P. Kim","doi":"10.21037/aoj.2019.09.01","DOIUrl":"https://doi.org/10.21037/aoj.2019.09.01","url":null,"abstract":"Metal-on-metal (MoM) bearings with a cemented femoral component and a cementless acetabular shell has historically been the gold standard for fixation in surface arthroplasty (SA) of the hip. Lately, there has been an increase in the availability of cementless femoral fixation. Since there is a paucity of literature on the clinical performance of modern generation cementless designs in SA, we aimed to perform a review of the literature on this type of fixation, as well as to report our institutional mid-term survival with a MoM cementless hip design. A comprehensive literature search provided information on joint arthroplasty registries, case-series, case-controlled studies and randomized controlled-trials reporting on the performance of hip resurfacings with cementless femoral fixation and its comparison with cemented fixation. Even though initial attempts of cementless femoral fixation showed high failure rates in the early 1990s, modern cementless porous-coated designs have proven to be non-inferior, with excellent mid- and long-term results in terms of survival and clinical outcomes. Our experience showed a two-, five-, and eight-year survivorships of 99.6% (95% CI: 98.8–100%), 98.3% (95% CI: 96.3–100%), and 98.3% (95% CI: 96.3–100%), respectively; with only 2 aseptic femoral failures. In SA of the hip, cementless femoral fixation has evolved in such a fashion that is the fixation of choice for SA in many centers. Modern implants have similar outcomes to that of cemented fixation in the early to mid-term. However, long-term clinical outcomes are still necessary to determine whether these results will continue or surpass that of cemented femoral fixation in SA.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.09.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47223160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eiji Kondo, T. Masuda, Junki Shiota, Koji Iwasaki, T. Onodera, K. Yasuda, T. Yagi, N. Iwasaki
Residual remnant tissue preservation of the anterior cruciate ligament (ACL) has attracted notice in ACL reconstruction. There is a possibility that residual remnant tissue preserving technique has several potential advantages to accelerate the graft remodeling, such as improved anterior knee laxity, accelerated cell infiltration and revascularization, increased mechanoreceptors, and reduction of bone tunnel enlargement. Recently, the authors reported a new remnant tissue preserved procedure for anatomic double-bundle (DB) ACL reconstruction using the transtibial tunnel technique. The anterior and rotational knee laxities were significantly less in the remnant-preserved group than in the remnant-resected group. The 2 nd look observation showed that the remnant-preserved group was significantly better than the remnant-resected group. In this article, the authors described the surgical technique and clinical outcomes of the residual remnant preserving DB ACL reconstruction.
{"title":"Residual remnant preserving anatomic double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts","authors":"Eiji Kondo, T. Masuda, Junki Shiota, Koji Iwasaki, T. Onodera, K. Yasuda, T. Yagi, N. Iwasaki","doi":"10.21037/aoj.2019.09.03","DOIUrl":"https://doi.org/10.21037/aoj.2019.09.03","url":null,"abstract":"Residual remnant tissue preservation of the anterior cruciate ligament (ACL) has attracted notice in ACL reconstruction. There is a possibility that residual remnant tissue preserving technique has several potential advantages to accelerate the graft remodeling, such as improved anterior knee laxity, accelerated cell infiltration and revascularization, increased mechanoreceptors, and reduction of bone tunnel enlargement. Recently, the authors reported a new remnant tissue preserved procedure for anatomic double-bundle (DB) ACL reconstruction using the transtibial tunnel technique. The anterior and rotational knee laxities were significantly less in the remnant-preserved group than in the remnant-resected group. The 2 nd look observation showed that the remnant-preserved group was significantly better than the remnant-resected group. In this article, the authors described the surgical technique and clinical outcomes of the residual remnant preserving DB ACL reconstruction.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.09.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42515642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Conrad, Antionette W. Lindberg, J. White, R. Ching
Background: Despite a proposed lower incidence of aseptic loosening, uncemented distal femoral implants present challenges with the intra-operative assessment of the adequacy of stem fixation within the femoral canal. Our biomechanical study was intended to assess the adequacy of oncologic implant press-fit stem fixation within the reamed canal of the distal femur for the Stryker GMRS oncologic distal femoral implant. We hoped to answer the following: #1 Does the initial stem placement in the femoral canal using a standardized force (50 N) (i.e., “Scratch Fit”) predict the (adequacy)stability of the final stem placement (and implant fixation) within the femoral canal? #2 Is there a difference in the uncemented stem fixation and stability within the femur for different stem (Stryker GMRS) diameters (13, 14, and 15 mm) for the Stryker GMRS uncemented press-fit stems/(Stryker Global Orthopaedics) Methods: Femoral cadaveric specimens were thawed and cut at the distal end of the femur, at 13 cm from the distal joint line, to e represent a distal femoral tumor resection. Stryker GMRS uncemented stems were placed, after femoral reaming, into the distal femoral canal with firm, hand pressure applied via a customized, spring-based insertion tool positioned over the standard Stryker insertion tool and calibrated to apply a standard stem insertion force of 50 N (11.2 lbs). Initial stem placement, utilizing this method, resulted in a stem that was only partially implanted into the femur with a recorded distance (defined as “Scratch Fit”) between the stem collar and the cut surface of the femoral shaft. After completing final stem impaction into the femur, stem torsional testing was performed on a multi-axis biomechanical test frame with a 3-D Vicon motion-capture system with axial torsion applied to the stems with the proximal femur fixed to a potted base. Kinematics of both the implant and the distal femur were captured using the Vicon system which tracked reflective infrared targets at a 60 Hz sampling rate. The peak torsional moment at failure was compared to “Scratch Fit” metrics for each implant diameter to address the proposed research questions. Results: Scratch fit distances ranged from 7–46 mm with a mean of 29.1±12.7 mm. Peak torques ranged from 11.5 to 57.5 Nm with a mean of 33.6±17.0 Nm. Figure shows peak (max.) torque plotted against scratch fit for all stems/specimens with good correlation (r 2 =0.6404). When separated by stem diameters, figure shows strong correlations between peak torque and scratch fit. Conclusions: while there may be multiple metrics that affect uncemented stem implant placement and stability (i.e., femoral canal size, femoral reaming, and implant type/size (diameter), there appears to be some correlation between initial stem placement (i.e., “Scratch Fit”) after femoral reaming to implant torsional (rotational) stability; this correlation is stronger when controlled for stem diameter. This suggests that a greater initial
{"title":"Uncemented megaprosthesis stem fixation using “Scratch Fit” to achieve improved implant fixation","authors":"E. Conrad, Antionette W. Lindberg, J. White, R. Ching","doi":"10.21037/aoj.2019.08.05","DOIUrl":"https://doi.org/10.21037/aoj.2019.08.05","url":null,"abstract":"Background: Despite a proposed lower incidence of aseptic loosening, uncemented distal femoral implants present challenges with the intra-operative assessment of the adequacy of stem fixation within the femoral canal. Our biomechanical study was intended to assess the adequacy of oncologic implant press-fit stem fixation within the reamed canal of the distal femur for the Stryker GMRS oncologic distal femoral implant. We hoped to answer the following: #1 Does the initial stem placement in the femoral canal using a standardized force (50 N) (i.e., “Scratch Fit”) predict the (adequacy)stability of the final stem placement (and implant fixation) within the femoral canal? #2 Is there a difference in the uncemented stem fixation and stability within the femur for different stem (Stryker GMRS) diameters (13, 14, and 15 mm) for the Stryker GMRS uncemented press-fit stems/(Stryker Global Orthopaedics) Methods: Femoral cadaveric specimens were thawed and cut at the distal end of the femur, at 13 cm from the distal joint line, to e represent a distal femoral tumor resection. Stryker GMRS uncemented stems were placed, after femoral reaming, into the distal femoral canal with firm, hand pressure applied via a customized, spring-based insertion tool positioned over the standard Stryker insertion tool and calibrated to apply a standard stem insertion force of 50 N (11.2 lbs). Initial stem placement, utilizing this method, resulted in a stem that was only partially implanted into the femur with a recorded distance (defined as “Scratch Fit”) between the stem collar and the cut surface of the femoral shaft. After completing final stem impaction into the femur, stem torsional testing was performed on a multi-axis biomechanical test frame with a 3-D Vicon motion-capture system with axial torsion applied to the stems with the proximal femur fixed to a potted base. Kinematics of both the implant and the distal femur were captured using the Vicon system which tracked reflective infrared targets at a 60 Hz sampling rate. The peak torsional moment at failure was compared to “Scratch Fit” metrics for each implant diameter to address the proposed research questions. Results: Scratch fit distances ranged from 7–46 mm with a mean of 29.1±12.7 mm. Peak torques ranged from 11.5 to 57.5 Nm with a mean of 33.6±17.0 Nm. Figure shows peak (max.) torque plotted against scratch fit for all stems/specimens with good correlation (r 2 =0.6404). When separated by stem diameters, figure shows strong correlations between peak torque and scratch fit. \u0000 Conclusions: while there may be multiple metrics that affect uncemented stem implant placement and stability (i.e., femoral canal size, femoral reaming, and implant type/size (diameter), there appears to be some correlation between initial stem placement (i.e., “Scratch Fit”) after femoral reaming to implant torsional (rotational) stability; this correlation is stronger when controlled for stem diameter. This suggests that a greater initial","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/aoj.2019.08.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41535482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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