Journal of Knee Surgery最新文献

In most previous studies investigating return to preinjury level of sport (RTPS) after anterior cruciate ligament reconstruction (ACLR), whether patients continue aiming for RTPS not only before but also after ACLR was unclear because environmental and social factors were not considered. Herein, we aimed to evaluate factors associated with RTPS among athletes who desired to achieve RTPS even after ACLR, excluding patients who no longer desire this goal owing to environmental and social factors. Ninety-two patients who underwent primary double-bundle ACLR with a minimum 2-year follow-up and desired to achieve RTPS before surgery were retrospectively enrolled. Twelve (13%) patients who no longer desired to achieve RTPS after ACLR owing to environmental and social factors were excluded. Sixty-nine patients were included in the final cohort. At the final follow-up, the patients were split into two groups: those who achieved (R group) or did not achieve (N group) RTPS based on patient self-assessment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores were also determined. The anterior tibial translation in the Lachman test and acceleration and external rotational angular velocity (ERAV) in the pivot shift test were measured at the hardware removal operation. Significant differences were observed for preinjury level of sports between the groups (p < 0.05). The rate of RTPS in competitive athletes was lower than that in recreational athletes (20/46: 43% vs. 16/22: 73%; p =.037). Lysholm score, KOOS symptom, pain, and quality of life showed higher values in the R group than in the N group (p < 0.050). Acceleration was significantly lower in the R group than in the N group (p = 0.028). Competitive level of sports is a risk factor for failure to achieve RTPS. The postoperative functional outcomes in the group that achieved RTPS showed more favorable results. These results provide important information to enable the surgeons to consider the appropriate surgical plan for competitive athletes who desire to achieve RTPS after ACLR.

Rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) face infection risk. The study evaluates vancomycin-loaded calcium sulfate bone as infection prevention. Patients with RA treated with TKA who had their femoral canal filled using either vancomycin-loaded calcium sulfate bone (experimental group [n = 35]) or the patient's own excised autologous bone (control group [n = 30]) at the Qingdao University Affiliated Hospital, Qingdao, China from January 1, 2017, to March 1, 2023, were retrospectively enrolled in this study. An experienced surgeon used midvastus approach. Surgeries included disinfection, antibiotics, and femoral filling. The age, gender, body mass index (BMI), comorbidities, and intraoperative details were extracted from the patient's medical records. Preoperation and postoperation markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), pain scale (Visual Analog Scale [VAS]), infection rate, and Knee Society Score (KSS) were collected. Groups matched in age, gender, and BMI. No preoperative inflammatory marker differences were observed. However, compared to the control group, the postoperative inflammatory markers were significantly lower in the experimental group at 1-week postsurgery (CRP: 40.80 ± 23.17 vs. 60.80 ± 43.12 mg/L, p = 0.021; ESR: 72.06 ± 17.52 vs. 83.87 ± 21.52 mm/h, p = 0.012) and at 1-month postsurgery (CRP: 15.63 ± 6.56 vs. 21.17 ± 13.16 mg/L, p = 0.032; ESR: 25.25 ± 20.44 vs. 38.40 ± 25.26 mm/h, p = 0.024). There were no significant differences in the VAS (2.79 ± 0.90 vs. 2.70 ± 0.84 score, p = 0.689) and KSS (64.31 ± 17.88 vs. 66.57 ± 12.36) at 1-month postsurgery. Experimental group: zero infections; control group: only one infection. Administering vancomycin and calcium sulfate during TKA in RA patients reduces postoperative inflammation, but does not significantly affect infection risk; further research may be necessary for validation.

When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11-23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to -14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (p ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL. LEVEL OF EVIDENCE::  IV.

This study aimed to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n = 9) with either PCL preservation (n = 264) or sacrifice (n = 134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90-day complications, and patient-reported outcomes were recorded for each patient. There were no differences in preoperative baseline function or patient-reported outcome measures, Charlson Comorbidity Index, or American Society of Anesthesiologists class among patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12-week postoperative Knee Injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p < 0.05). Yet, no complications within the 90-day period were associated with PCL status and other patient-reported outcomes. This study comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores, and complication rates, which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared with the PCL-preserving at early follow-up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.

Knee range of motion (ROM) is an important indicator of knee function. Outside the clinical setting, patients may not be able to accurately assess knee ROM, which may impair recovery following trauma or surgery. This study aims to validate a smartphone mobile application developed to measure knee ROM compared to visual and goniometer ROM measurements. A knee ROM Android mobile application was developed to measure knee ROM. Patients ≥ 18 years old presenting to an orthopaedic clinic with native knee complaints were approached to participate. Knee ROM was measured bilaterally by an arthroplasty-trained surgeon using (1) vision, (2) goniometer, and (3) the mobile application. Measurements were compared in flexion and extension using a one-way analysis of variance with post hoc Tukey test (alpha = 0.05). Eighty-four knee ROM measurements (40 left, 44 right) were obtained in 47 patients. Median Kellgren-Lawrence grade from available radiographs was grade 3. In flexion, mobile application (117.6 ± 14.7 degrees) measurements were not significantly different from visual (116.1 ± 13.6 degrees) or goniometer (116.2 ± 13.6 degrees) measurements. In extension, mobile application (4.8 ± 7.3 degrees) measurements were significantly different from visual (1.9 ± 4.1 degrees) measurements on post hoc analysis (p < 0.01), while no differences were present compared to goniometer (3.1 ± 5.8 degrees) measurements. Our study found that a mobile application for evaluating knee ROM was noninferior to goniometer-based measurements performed by an arthroplasty-trained surgeon. Future studies will investigate this application's utility in (1) remote patient care, (2) accelerating recovery during rehabilitation, (3) detecting early postoperative complications including arthrofibrosis, and (4) adding additional functionalities to the application to provide more detail-oriented descriptive analyses of patient knee function.

The use of alternative alignments in total knee arthroplasty (TKA) has recently been increasing in popularity: many of these alignments have been included in the broad spectrum of "kinematic alignment." This alternative approach was recommended to increase patients' satisfaction since many studies based on patient-reported outcome measures (PROMs) showed that every fifth patient is not satisfied with the surgical outcome. In fact, the original kinematic alignment technique was designed as a "pure resurfacing" technique, maintaining the preoperative axes (flexion-extension and axial rotation) of the knee. In adjunct, many new classifications of the preoperative limb deformity have been proposed to include a large range of knee anatomies, few of them very atypical. Following those classifications, many surgeons aimed for a reproduction of unusual anatomies putting in jeopardy the survivorship of the implant according to the classical "dogma" of a poor knee kinematics and TKA biomechanics if the final hip-knee-ankle (HKA) axis was not kept within 5 degrees from neutral. This article reviews the literature supporting the choice of setting alignment boundaries in TKA when surgeons are interested in reproducing the constitutional knee anatomy of the patient within a safe range.

The purpose of this study was to report on the treatment, results, and longer-term outcomes of patients who sustained a tibial plateau fracture with an associated leg compartment syndrome (CS). A total of 766 patients who sustained 766 tibial plateau fractures met inclusion criteria. Fourteen patients (1.8%) were diagnosed with CS in association with a tibial plateau fracture during their initial hospitalization, 13 at the time of presentation and 1 delayed. The treatment protocol consisted of initial external fixation and fasciotomy, followed by irrigation and debridement, and eventual closure. Fasciotomy cases included 2/14 (14.3%) single incision approaches and 12/14 (85.7%) dual incision approaches. Operative treatment of the tibial plateau fracture was performed at the time of final closure or once soft tissues were permitted. One case of CS that developed following definitive fixation was treated with fasciotomy and delayed primary closure after initial stabilization. Ten (71.4%) were available at 1-year follow-up. We compared these 10 cases to the patients with operative tibial plateau fractures without CS to assess for surgical, radiographic, clinical, and functional outcomes. We used a propensity match based on age, body mass index, sex, Charleson comorbidity index, and fracture type to reduce the presence of confounding biases. Standard statistical methods were employed. Those in the CS cohort were younger males (p < 0.05). At latest follow-up, function did not differ between those in the CS group compared with the non-CS cohort (p > 0.05). Clinically, knee flexion (130.7 vs. 126; p = 0.548), residual depression (0.5 vs. 0.2; p = 0.365), knee alignment (87.7 vs. 88.3; p = 0.470), and visual analog scale pain scores (3.0 vs. 2.4; p = 0.763) did not differ between the cohorts. Although infection was higher in the CS cohort, the overall complication rates did not differ between the CS patients and non-CS cohort (p > 0.05). Early identification and standardized treatment protocols for the management of CS that develops in association with a tibial plateau fracture lead to outcome scores that were not significantly different from patients who did not develop CS.

Based on recent evidence-based advances in meniscus allograft transplantation (MAT), fresh (viable) meniscus allografts have potential for mitigating key risk factors associated with MAT failure, and preclinical and clinical data have verified the safety of fresh meniscus allografts as well as possible efficacy advantages compared with fresh-frozen meniscus allografts. The objective of this study was to prospectively assess clinical outcomes for the initial cohort of patients undergoing MAT using fresh meniscus allografts at our center. Patients who were prospectively enrolled in a dedicated registry were included for analyses when they had undergone primary MAT using a fresh meniscus allograft for treatment of medial and/or lateral meniscus deficiency with at least 1-year follow-up data recorded. Forty-five patients with a mean final follow-up of 47.8 months (range = 12-90 months) were analyzed. The mean patient age was 30.7 years (range = 15-60 years), mean body mass index (BMI) was 29.7 kg/m² (range = 19-48 kg/m²), and 14 patients (31%) were females. In total, 28 medial, 13 lateral, and 4 combined medial and lateral MATs with 23 concurrent ligament reconstructions and 2 concurrent osteotomies were included. No local or systemic adverse events or complications related to MAT were reported for any patient in the study. Treatment success rate for all patients combined was 91.1% with three patients requiring MAT revision and one patient requiring arthroplasty. Treatment failures occurred 8 to 34 months after MAT and all involved the medial meniscus. None of the variables assessed were significantly different between treatment success and treatment failure cohorts. Taken together, the data suggest that the use of fresh (viable) meniscus allografts can be considered a safe and effective option for medial and lateral MAT. When transplanted using double bone plug suspensory fixation with meniscotibial ligament reconstruction, fresh MATs were associated with a 91% success rate, absence of local or systemic adverse events or complications, and statistically significant and clinically meaningful improvements in patient-reported measures of pain and function at a mean of 4 years postoperatively.