Journal of Knee Surgery最新文献

The Patient-Reported Outcomes Measurement Information System (PROMIS) is a common patient-reported outcome (PRO) instrument used to evaluate function, pain, satisfaction, and mental health outcomes after surgery. Predictors of 2-year PROMIS physical function (PF) after knee surgery have been previously reported; however, PROMIS PF 2 years after anterior cruciate ligament reconstruction (ACLR) has not been well studied. The aim of this study was to investigate associations and identify predictors of 2-year PROMIS PF after primary ACLR. A prospectively managed orthopaedic registry was queried for patients who underwent primary ACLR between 2015 and 2018. PROs were collected at baseline and 2 years postoperatively, along with self-reported socioeconomic and demographic information. Bivariate analysis was performed to identify associations between baseline characteristics and 2-year PROMIS PF. Multivariate regression analysis was performed to identify predictors of 2-year and 2-year improvement in PROMIS PF. Of 203 eligible patients, 141 patients (70%) completed 2-year surveys and were analyzed. Better 2-year PROMIS PF was associated with student status (p = 0.007), younger age (p = 0.026), lower body mass index (p < 0.001), and lower Charlson Comorbidity Index (p = 0.023). Greater improvement in PROMIS PF at 2 years was associated with private insurance (p = 0.029) and income over $70,000 (p = 0.007). Better baseline PROs were associated with better 2-year PROMIS PF. Younger age (p = 0.003), higher income (p = 0.023), and better baseline PROMIS Fatigue (p < 0.001) were significant predictors of better 2-year PROMIS PF. Additionally, younger age (p = 0.003), higher income (p = 0.029), worse baseline PROMIS PF (p < 0.001), and better baseline PROMIS Fatigue (p < 0.001) were significant predictors of greater 2-year improvement in PROMIS PF. Age, income, and baseline PROMIS Fatigue independently predicted 2-year PROMIS PF and improvement in 2-year PROMIS PF. Though these factors are nonmodifiable, these findings may allow surgeons to more effectively counsel patients preoperatively.

Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) surgeries are often preferred in individuals with medial knee osteoarthritis (OA). The aim of the study was to compare the functional outcomes of patients with UKA and HTO. Seventy-seven individuals were included in the study, of which 39 individuals had undergone HTO surgery (median age = 58.38 ± 7.99, median body mass index [BMI] = 30.93 ± 3.33 kg/m²) and 38 individuals had undergone UKA surgery (median age = 62.95 ± 7.74 years, median BMI = 30.48 ± 3.57 kg/m²). Pain was evaluated before and after surgery. Pain severity, 6-Minute Walk Test (6MWT), 10-Repetition Sitto-Stand Test (10 × STS), stairs test, Timed Up and Go (TUG), and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were used for functional evaluation. There were no differences in demographic characteristics between groups (p > 0.05). The HTO group had lower postoperative pain (p = 0.043) and KOOS pain subscale scores (p = 0.043), better stairs test (p = 0.041), and 10 × STS results (p = 0.007). There were no significant differences between the groups in terms of the 6MWT, TUG, and KOOS total scores (p > 0.05). The results showed that individuals who underwent HTO surgery experienced less postoperative pain and had better functional levels compared with those who underwent UKA surgery. It shows that good functional performance can be achieved with HTO surgery in early medial compartment OA.

Total knee arthroplasty (TKA) is one of the most effective treatment options for patients with end-stage osteoarthritis of the knee. However, one out of five patients remains unhappy with the outcomes. In recent years, more emphasis has been given to knee alignment approaches as a potential solution. The main objective of this study was to compare the clinical and functional outcomes between patients undergoing robot-assisted TKA using mechanical alignment (MA) or functional alignment (FA). This prospective nonrandomized study enrolled 40 patients (20 patients in each group). The procedure was performed by a single surgeon using FA or MA. In addition to other measures, the New Knee Society Score (NKSS) and Oxford Knee Score (OKS), and modified forgotten joint scores (MFJS) were recorded, and the patients were followed up until 18 months. The baseline characteristics, including age, gender, and body mass index, did not differ statistically between the groups. All parameters of the NKSS, the OKS, and the MFJS were improved at 18 months in the FA-TKA group compared with the MA-TKA group. The pain score and time to straight leg raise were better in the FA-TKA versus the MA-TKA group (p < 0.001). This study suggests that robotic TKA with the FA approach could improve patient satisfaction, along with fulfillment of patients' expectations from the surgery, through 18 months of follow-up compared with the MA approach. Due to the small sample size of this study, future studies are needed to confirm these findings.

Anterior cruciate ligament reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, lateral extra-articular procedures such as the modified Lemaire extra-articular tenodesis (LET) have been proposed to decrease failure rates, but knowledge on short-term rehabilitation, stiffness, and isokinetic strength is limited. This study aimed to assess the short-term patient-reported outcome measures (PROMs) and physical performance outcomes following ACLR with and without LET. A prospective study was performed among 152 patients aged ≤25 years undergoing hamstring autograft ACLR with or without modified Lemaire LET between 2019 and 2022 with minimum 1-year follow-up. PROMs (Tegner, International Knee Documentation Committee, Lysholm, NRS for pain, and EQ-5D) were compared between groups preoperatively and at 3, 6, 9, 12, and 24 months, while physical performance (range of motion [ROM], and limb symmetry indices [LSI] of isokinetic testing, single-leg and timed-6m hop) was compared up to 9 months postoperatively. Baseline characteristics and outcomes were similar, except thicker grafts in the LET group (8.9 vs. 8.7 mm, p = 0.047). At 3 months, Lemaire patients reported less pain (NRS pain 17.1 vs. 35.6, p < .001), but at 6 months, Lemaire patients had inferior LSI for timed-6m hop (87% vs. 96%, p = 0.003). At 9 months, Lemaire patients had similar return to sports, PROMs, and ROM, but had lower LSI for flexion endurance strength (88% vs. 97%, p = 0.041). At 12 months, no differences were seen in PROMs. In conclusion, Patients undergoing ACLR with LET had less pain at 3 months, but worse LSI for timed-6m hop at 6 months and worse LSI for flexion endurance strength at 9 months. Both groups showed similar performance on all other outcomes, indicating that ACLR with LET is not associated with increased stiffness, complications, or significant strength deficits. LEVEL OF EVIDENCE: : Level II prospective study.

Revision osteochondral allograft transplantation (OCAT) has historically yielded inferior outcomes compared with primary procedures. This study evaluates outcomes following revision OCAT using high-chondrocyte-viability (HCV) OCAs for functional graft survival. A prospective registry was analyzed for HCV OCAT outcomes. Patients were grouped into primary (n = 182) or revision (n = 70) OCAT cohorts. Demographic, surgical, and follow-up data were collected. Revision cases were further subclassified based on prior cartilage procedures (marrow stimulation, osteochondral, or cell-matrix-based). Functional graft survival and validated patient-reported outcomes were assessed at a mean follow-up of 43 months. At final follow-up (FFU), functional graft survival was 79.1% for primary and 71.4% for revision OCAT. Overall survival at > 2-year follow-up was 84% (primary) and 80% (revision). Patients with failed revision OCAT reported significantly lower Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores at 1-year (mean: 40.8, p = 0.026). Bipolar tibiofemoral revisions conferred increased failure rates (odds ratio: 3.86, p = 0.033). Cell-matrix-based revision cases had significantly higher graft survival (100%) compared with osteochondral revisions (58.6%, p = 0.049). Satisfaction with revision OCAT was high (75.0%), and 84.1% would undergo the procedure again. With evidence-based patient selection, individuals who have failed previous cartilage defect surgical treatments and meet the indication criteria are likely to benefit from revision OCAT with HCV allografts. Optimal candidates for revision OCAT in the knee are patients with a history of marrow stimulation or cell-based matrix procedures who have limited comorbidities, do not require tibiofemoral bipolar OCAT, and strictly adhere to postoperative restriction and rehabilitation protocols.

As patients place higher demand on their implants, mid-flexion instability is increasingly recognized as a contributor to dissatisfaction after total knee arthroplasty (TKA). However, the outcomes of revision surgery to address mid-flexion instability have not been categorized. The study cohort was composed of 52 patients who underwent revision surgery for mid-flexion or combined flexion and mid-flexion instability by a single surgeon between 2015 and 2022. The mean follow-up duration was 2.76 years. Patient characteristics, implants used, and complications were recorded. Range of motion and patient-reported outcomes (collected using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement [KOOS Jr.] and EuroQol-5 Dimensions-5 Levels [EQ-5D-5L] questionnaires) were compared before surgery and at final follow-up. Five patients (9.6%) required an additional operation. Causes of reoperations included component loosening, persistent wound drainage, recurrent instability, and arthrofibrosis. KOOS Jr. scores improved from 46 preoperatively to 60 postoperatively (p < 0.01). EQ-5D-5L scores demonstrated a reduction in pain/discomfort and an improvement in the ability to perform usual activities (p < 0.05). A trend was observed toward increased mobility (p = 0.05). The most common 30-day complications were transfusion (11.5%), readmission (11.5%), renal complications including acute kidney injury (9.6%), and wound complications (5.8%). Patients had improvements in maximum flexion and total arc of motion postoperatively (p < 0.05). This study includes the largest cohort of patients undergoing revision for mid-flexion instability and demonstrates that appropriately selected patients can have improved outcomes while maintaining their range of motion.

Patient-reported outcome measures (PROMs) are crucial in evaluating the success of primary total knee arthroplasty (TKA). This study aimed to determine the individual significance of each question of the Knee Osteoarthritis Outcome Score (KOOS) and the Veterans RAND 12 (VR-12) Mental Composite Score (MCS) in achieving a Patient Acceptable Symptom State (PASS). A prospectively collected cohort of 9,942 unilateral elective TKAs was analyzed. Responses were collected for 17 KOOS questions (KOOS-Pain subscore, KOOS-Physical Function Short form [PS], and KOOS-Joint related [JR]) and 6 MCS questions preoperatively and 1-year postoperatively. Achievement of PASS was assessed through a positive response to a binary satisfaction-related question. The association between responses to questions and outcomes was examined via multivariable logistic regression models. A poorer preoperative response to knee pain frequency (odds ratio [OR] = 0.86 [0.77-0.97], p = 0.017) and knee pain while sitting or lying (OR = 0.88 [0.79-0.99], p = 0.029) was independently associated with reduced odds of achieving PASS at 1-year post-TKA. A more favorable preoperative response in knee pain during full knee straightening was independently associated with an increased odds of PASS attainment (OR = 1.10 [1.01-1.19], p = 0.035). No other metric was independently associated with PASS attainment at 1 year. Individual KOOS questions evaluating knee pain frequency, knee pain while sitting or lying down, and knee pain during full knee straightening were linked to patient satisfaction 1 year following TKA. Patients experiencing frequent or persistent knee pain at rest may represent those with more advanced joint disease or heightened pain sensitivity, contributing to lower postoperative satisfaction. Conversely, patients reporting minimal or no pain during specific movements, such as full knee straightening, likely had a less severe baseline condition, making their postoperative expectations more easily attainable, thereby leading to higher satisfaction.Level of evidence III.

The rate of total knee arthroplasty (TKA) continues to rise, and with it, the need to identify risk factors for reoperation. Additionally, supplemental testosterone use in male patients has increased across the United States. As more patients taking prescription testosterone replacement therapy (TRT) undergo TKA, there is a need to evaluate TRT as it relates to outcomes following TKA. This study aims to evaluate whether the prescription of supplemental testosterone is a risk factor for reoperation and reoperation for infection following TKA. A retrospective cohort study using a nationwide commercial claims database was conducted. About 76,276 male patients who underwent TKA were identified with a 1.9-year mean follow-up. Reoperations and reoperations for infections were identified using the International Classification of Diseases Tenth Edition (ICD-10) and the Current Procedural Terminology (CPT) codes. Patients were matched based on demographic, geographic, and comorbidities data using Mahalanobis nearest neighbor matching. Statistical analysis was conducted on 3,209 male patients prescribed testosterone and 32,090 not prescribed testosterone. Demographic and comorbidities, including age, location of TKA, length of stay, history of diabetes mellitus, hypertension, hyperlipidemia, obesity, smoking, alcohol, and Charlson Comorbidity Index (CCI) score, were similar (p > 0.05) between male patients prescribed testosterone and men who were not. Men prescribed testosterone had a significantly higher cumulative incidence of reoperation for infection than patients not prescribed testosterone at 1 (p = 0.01), 2 (p < 0.001), 3 (p < 0.001), 4 (p < 0.001), and 5 years postoperatively (p < 0.001). Men prescribed testosterone had a significantly higher cumulative incidence for all-cause reoperation than patients not prescribed testosterone at 1 (p = 0.01), 2 (p = 0.003), 3 (p = 0.01), 4 (p < 0.001), and 5 years postoperatively (p < 0.001). Male patients who were prescribed supplemental testosterone within 1 year prior to primary TKA were at an increased risk for both all-cause reoperation and reoperation due to infection. Surgeons should consider the risks and benefits of testosterone cessation in the perioperative period for patients undergoing TKA.

Osteochondral allograft transplantation (OCAT) is an effective treatment option for young, active patients with full-thickness articular cartilage defects, but long-term success is limited by treatment failures often linked to nonadherence to postoperative protocols. Validated methods for preoperative identification of patients at risk for nonadherence and/or poor outcomes following OCAT are limited. This study aimed to characterize the ability of a health behavior psychologist (HBP) to preoperatively delineate patient-specific barriers associated with nonadherence and failure following OCAT. Patients were prospectively enrolled in a lifelong, institutionally approved registry. Patients were eligible for inclusion if they had a preoperative evaluation with an HBP. Demographic, biopsychosocial, patient-reported outcomes surveys, and adherence status were collected. Risk domains (low, medium, high) were assigned by the HBP based on the presence and severity of barriers identified during HBP evaluations. OCAT patients (n = 99) were evaluated and assigned a risk domain: (low-risk [n = 41], medium-risk [n = 44], high-risk [n = 14]). Patients in medium- and high-risk cohorts reported significantly more barriers, including mental health issues, limited social support, and high-demand occupations, compared with low-risk patients. Nonadherence rates were significantly higher in medium- and high-risk cohorts; however, nonadherence was not significantly associated with treatment failure. The low-risk cohort reported better mental health and satisfaction outcomes, whereas medium- and high-risk patients had worse physical health outcomes. Preoperative HBP evaluations effectively identified patient-specific barriers to adherence, enabling targeted interventions to improve OCAT surgery outcomes. Integrating behavioral health support into orthopaedic care may improve adherence, highlighting the need for broader implementation and further studies.Level of Evidence 2, prospective cohort study.

Tibial plateau fractures (TPFs) are common injuries that pose a significant risk of posttraumatic osteoarthritis (PTOA) despite surgical fixation. Though total knee arthroplasty (TKA) has been proven as a viable treatment option for PTOA, there is a higher risk of postoperative complications in patients with prior TPF. This systematic review aimed to evaluate surgical considerations and outcomes of TKA in patients with prior TPF fixation. A search of PubMed MEDLINE, Embase, and Scopus databases from January 2008 to July 2023 was performed according to PRISMA guidelines using the following inclusion criteria: TPF, PTOA, TKA, and conversion TKA. Exclusion criteria included periprosthetic fractures, distal femoral fractures, and patients under 18 years. Two independent reviewers screened each study. For postoperative infection and revision rates, the results were pooled, and random-effects meta-analysis of single proportions was conducted to determine the combined rate of infections and revisions. Nine studies involving a total of 572 patients who underwent TKA following TPF fixation were included. The average patient age ranged from 44.0 to 65.7 years, with mean TPF-to-TKA intervals from 1.7 to 13.6 years. TPF fixation details, implant types, and complication rates, including infection (range 3.2-36.8%) and revision (range 0-20%), were reported in most studies. The meta-analysis pooled estimates for postoperative infection and revision rates were 11% (95% CI 0.06-0.16) at an average of 7.0 years follow-up and 9% (95% CI 0.04-0.15) at an average of 7.4 years follow-up. TKA in patients with previous TPF fixation can be complex and may require augmentation and increased implant constraint. Though the literature reports good functional outcomes in this TKA population, TKA after TPF fixation carries an increased risk of both infection and aseptic revision compared with patients undergoing TKA for osteoarthritis. Further high-quality prospective studies are needed to elucidate risk factors and optimize management strategies for patients undergoing TKA following TPF fixation.