Journal of Knee Surgery最新文献

Varus mechanical alignment of the knee is a recognized contributor to medial compartment osteoarthritis (OA). Medial meniscus tears (MMT) frequently occur with knee OA. The present study aimed to analyze the association between mechanical alignment and MMT. We retrospectively analyzed 201 knee joints from patients with knee pain who underwent whole-leg weight-bearing radiographs and magnetic resonance imaging (MRI). Mechanical alignment was quantified using the hip-knee-ankle angle (HKAA), measured independently by two radiologists with excellent interrater reliability (intraclass correlation coefficient = 0.93). MMTs were assessed on MRI with high diagnostic agreement (κ = 0.87). Based on MRI findings, participants were classified into two groups: those with MMT (n = 104) and those without MMT (n = 97). Group comparisons were performed using t-tests and chi-square tests. Patients with MMT had greater varus alignment (HKAA: -6.2 ± 3.4 vs. -2.4 ± 1.4 degrees, p < 0.001), were older (53.7 ± 8.3 vs. 49.3 ± 9.0 years, p < 0.001), and had higher body mass index (26.6 ± 3.0 vs. 25.2 ± 2.4 kg/m², p = 0.001). Sex distribution did not differ between groups (p = 0.479). Logistic regression identified HKAA as the only independent predictor of MMT. When entered as a continuous variable, each additional degree of varus increased the odds of MMT nearly 2-fold (adjusted OR = 2.01, 95% confidence interval [CI]: 1.64-2.47, p < 0.001). The complementary binary analysis showed that patients with varus alignment had over a 3-fold higher risk of MMT compared with those with neutral or valgus alignment (OR = 3.25, 95% CI: 1.85-5.72, p < 0.001). Posterior horn tears were the most common subtype (47.1%), followed by multisite tears (33.7%). MMTs are strongly associated with varus mechanical alignment. Each incremental degree of varus increased the likelihood of MMT, and posterior horn tears were the most prevalent subtype. These findings highlight the pivotal role of mechanical alignment in the prevention, early detection, and management of MMT.

The main aim of this study was to analyze whether revision of medial unicompartmental knee arthroplasty (rUKA) has better clinical outcomes than primary total knee arthroplasty (TKA) or revision of total knee arthroplasty (rTKA). The study reference group (rUKA) was identified and matched with two control groups: primary TKA and revision rTKA. Patients were matched according to five preoperative factors: follow-up (minimum of 60 months), age, sex, body mass index (BMI), and operation side at a ratio of 1:1:1. The Knee Society score (KSS) and the forgotten joint score (FJS) were used for the clinical assessment. The pain was measured via the visual analog scale (VAS) for pain. The following complications were also recorded: postoperative anemia, infection, and revision surgeries. Forty-five patients were included in each group. The three groups did not differ in terms of age, sex, operation side, BMI, or follow-up (p > 0.05). At the final follow-up, the rTKA group had lower values than did the rUKA and TKA groups in terms of the KSS (rUKA = 95; TKA = 100; rTKA = 87.5) and FJS (rUKA = 95; TKA = 100; rTKA = 90; p < 0.05). For the KSS, no difference was found between the rUKA and TKA groups (p > 0.05). Regarding pain, the rTKA group had a lower value than the TKA group did (p = 0.001; rUKA = 3; TKA = 2; rTKA = 3), whereas in terms of FJS, there was also a difference between the rUKA and TKA groups (p = 0.038). The rates of complications in terms of postoperative anemia and aseptic loosening were similar among the three groups (p > 0.05). Revised UKA has comparable clinical and patient-reported outcomes to those of primary TKA and better outcomes than those of revised TKA, whereas medical complications of revised UKA are similar to those of primary TKA. These findings serve to inform discussions with patients requiring revision of a UKA regarding clinical outcomes and complications following this procedure. The level of evidence is a level III match cohort study.

Patient satisfaction following primary total knee arthroplasty (TKA) is of great importance to practitioners, and as many as one in five patients report postoperative dissatisfaction. The purpose of this study was to assess patient-specific factors that may have a correlation with being unsatisfied following primary TKA. A comprehensive literature review of four electronic databases was considered for inclusion in this meta-analysis. Upon review, 12 studies were included for analysis. Patient-specific factors for dissatisfaction without failure etiology were evaluated. The final cohort consisted of 27,496 patients who underwent primary TKA, and 2,815 (10.2%) were dissatisfied with their TKA. There was an association found between dissatisfaction and mild osteoarthritis (relative ratio [RR]: 1.86; 95% confidence interval [CI]: 1.41-2.45; p = 0.0001), female gender (RR: 1.06; 95% CI: 1.02-1.10; p = 0.004), and a diagnosis of depression and/or anxiety (RR: 1.46; 95% CI: 1.30-1.64; p = 0.0001). There was substantial heterogeneity among the studies. Those who may be at higher risk for dissatisfaction include those with mild arthritis, female gender, and depression/anxiety. Future research should focus on the role of any preoperative interventions and possible surgery-specific factors that may increase the chances of patient satisfaction.

Lateral extra-articular tenodesis (LET) is indicated to decrease the pivot shift and to restore rotational control in anterior cruciate ligament (ACL) surgery. However, there are still concerns regarding the patellofemoral joint, as with increased tension on the iliotibial band, there is a hypothetical increase of lateralizing forces on the lateral patellar surface. To compare clinical and radiographic patellofemoral outcomes of professional soccer players who underwent LET and ACL revision with a control group of professional soccer players who underwent primary ACL reconstruction. Retrospective comparative study. Inclusion criteria were professional or elite soccer players with failed ACL reconstruction who underwent ACL revision and LET for anterior laxity >5 mm and a pivot-shift test >2. Exclusion criteria were a two-stage procedure, injuries to the contralateral knee, multi-ligament injuries, and patients with less than 3 years of follow-up. The control group was selected as standard ACL reconstruction with autograft in elite or professional soccer players. All included patients were assessed with a Tegner Lysholm, IKDC, and Kujala score. Patients recalled for radiographic patellofemoral assessment with bilateral skyline Merchant view which was compared with the contralateral unaffected knee. Sixty-four consecutive patients (30 in the study group and 34 in the control group) treated from 2015 to 2018 have been included in the study. All patients had a minimum 3-year follow-up, and the mean follow-up was 4.9 ± 2.8 (range: 3-7) years. Overall, patients demonstrated significant improvement in measured outcome measures from baseline to final follow-up. There were no significant differences between groups in Kujala, Tegner and Lysholm, and IKDC scores (p > 0.05). In the study group, no significant differences in lateral patellar tilt (p > 0.05) between treated and unaffected knees were found. LET represents a reliable solution to increase anteroposterior and rotational stability in revision ACL reconstruction with severe pivot shift. Clinical and radiographical results showed favorable patellofemoral outcomes, with clinical scores comparable to primary surgery and no significant patellar lateralization and degenerative changes.

There is a lack of consensus on the effects of prior colectomy on health outcomes, particularly those that involve orthopedic procedures. We sought to characterize the association between prior colectomy and outcomes following primary total knee arthroplasty (TKA). We hypothesized that compared with patients without, those with prior colectomy who undergo primary TKA have higher odds of same-admission postoperative complication and reoperation. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS) database to identify patients who underwent primary TKA. Patients with prior colectomy were propensity-score matched to patients without prior colectomy at a ratio of 1:50 by age, gender, race/ethnicity, Charlson-Deyo Comorbidity index, history of osteoporosis, history of smoking, insurance status, hospital size, hospital location and teaching status, and hospital ownership. Adjusted logistic regression analyses were used to determine the relationship between colectomy and the same-admission outcomes, postoperative complication, and reoperation. Overall, 894,911 patients underwent primary TKA during the study period. After propensity score matching (PSM), 2,625 (1.96%) patients were assigned to the cohort with prior colectomy, while 131,250 (98.04%) patients were assigned to the cohort without prior colectomy. Compared with patients without prior colectomy, those with prior colectomy who underwent primary TKA had no significantly higher odds of same-admission postoperative complication; however, they had 2.12 times higher odds (95% confidence interval: 1.04-4.31; p = 0.038) of same-admission reoperation. Compared with patients with no prior colectomy, those with prior colectomy who underwent primary TKA had no higher odds of postoperative complication but had over twice the odds of reoperation during the same admission for surgery. Further studies examining the role of the colon and microbiota may help to better understand outcomes associated with the history of prior colectomy in the setting of primary TKA. This study is a level III retrospective cohort study.

Degenerative meniscal injuries are a common occurrence in orthopedic practice. However, there is currently no consensus regarding the optimal treatment algorithm and the efficacy of different treatment modalities. Therefore, this study aimed to analyze the clinical reflections of arthroscopic partial meniscectomy (APM) and physical therapy (PT) methods, as well as the potential development of osteoarthritis (OA) following treatment. The study group comprised patients diagnosed with degenerative meniscal tears who were treated with either conservative or APM methods at a center between March 2021 and January 2022. The radiographs of these patients prior to the commencement of treatment were classified according to the Kelgren-Lawrence system, and clinical and pain scores were recorded. Following a 2-year period of treatment, the radiographs and scores at the conclusion of the third, 12th, and 24th months were analyzed. Among 213 patients followed up with a diagnosis of degenerative meniscal damage, at the 3-month follow-up, the APM group demonstrated significantly better pain relief and functional outcomes compared with the PT group, with notable improvements in WOMAC (between score difference: -15.96; 95% confidence interval [CI]: -17.08 to -14.83), Lysholm (23.43; 95% CI: 22.15-24.71), and VAS (-6.98; 95% CI: -7.25 to -6.71) scores (p < 0.001). However, by the 12th and 24th months, both groups showed comparable long-term improvements. Radiographic assessments over 2 years revealed no significant differences in OA progression. These findings suggest that APM provides superior short-term benefits, but both APM and PT are equally effective in the long-term management of degenerative meniscus tears. A comparison of the APM and PT groups revealed that patients under 50 years of age who underwent APM demonstrated superior outcomes in terms of pain and functional scores at the 3-month follow-up. At the 2-year mark, the efficacy of the treatment methods was established, yet no significant differences were observed in their capacity to prevent OA.The level of evidence is III.

Insurance status has been shown to impact clinical outcomes after several orthopaedic procedures. Current evidence examining the role of insurance provider on outcomes following anterior cruciate ligament (ACL) reconstruction is limited. Therefore, the purpose of this investigation was to explore the effect that insurance carrier had on physical therapy (PT) access, knee range of motion (ROM), and Knee Outcome Survey (KOS) scores. A retrospective cohort study identified patients who underwent ACL reconstruction at an academic health system from January 1, 2019 to December 31, 2021. Patients were partitioned into two cohorts based on their insurance provider: Managed care (MC) or commercial (COM). Outcomes recorded change in knee active range of motion (AROM), passive ROM (PROM), KOS score, and reason for conclusion of PT. Univariate and multivariate analyses were performed by chi-squared tests, Welch's t-tests, as well as multivariable logistic and linear regression with Bonferroni corrections applied to control the family-wise error rate. The study cohort included 149 patients who underwent ACL reconstruction and completed rehabilitation within affiliated PT locations. The MC cohort experienced a longer time until the first PT visit, shorter duration of PT, fewer total PT visits as well as insurance-authorized visits, and a smaller maximum number of visits per patient's benefit. However, there was no difference between cohorts in the number of visits divided over the treatment duration or the number of visits attended over the total number authorized. Both the groups displayed statistically similar improvements in AROM, PROM, and KOS in addition to comparable reasons for concluding PT. Furthermore, regression demonstrated that no insurance parameter predicted changes in AROM, PROM, KOS, or reason for concluding PT. MC-provided patients who underwent ACL reconstruction had inferior access to PT compared with those insured by COM. However, MC and COM yielded a similar percentage utilization of authorized PT visits and number of insurance denials leading to early PT termination. Both the cohorts also demonstrated similar improvements in AROM, PROM, and KOS.

Patellar tendon shortening (PTS) following primary total knee arthroplasty (TKA) is thought to occur because of excessive soft tissue tensioning during wound closure. Few studies have examined the incidence of acute PTS in TKA patients. The purpose of this prospective study was to evaluate the incidence and clinical implications of acute PTS after primary TKA. All patients undergoing primary TKA for osteoarthritis (OA) from January 2024 through April 2024 by a single, fellowship-trained surgeon were included. Patient demographics and range of motion (ROM) were recorded preoperatively. Range of motion and physical therapy (PT) requirements were recorded at 6-week follow-up. Patellar tendon length was determined by the Insall-Salvati ratio (ISR) and measured preoperatively, on postoperative day (POD) 0, and at 6 weeks following surgery. Significant PTS was defined as a decrease in the ISR of ≥10%. In total, 89 patients were included in the analysis. Of these, 54 (60.7%) patients experienced significant PTS and 35 (39.3%) did not experience significant PTS immediately following TKA. Preoperative ISR and ROM was similar between cohorts; however, on POD 0, the ISR decreased by 21.9 ± 8.7% in the significant PTS cohort versus 0.8 ± 10.9% (p < 0.001) in the insignificant PTS cohort. From POD 0 to 6 weeks postoperatively, ISR increased by 25.0 ± 15.8% in the significant PTS cohort versus 7.6 ± 12.0% in the insignificant PTS cohort (p < 0.001). The ISR decreased by 2.9 ± 10.9% for patients in the significant PTS cohort and increased by 5.7 ± 7.9% for patients in the insignificant PTS cohort (p < 0.001). There was no significant difference in PT requirements or ROM between cohorts at 6-week follow-up. Patellar tendon shortening following TKA resolved by 6 weeks postoperatively; no ROM deficits or additional PT requirements were found to exist between cohorts.

Consequences of ACL reconstruction (ACLR) utilizing the patellar tendon (PT) autograft include a residual defect in the PT and the potential for donor site morbidity, such as anterior knee pain and difficulty kneeling. The purpose of this study was (1) to evaluate the presence and size of PT defects following ACLR and (2) to determine if there is an association with knee pain and function. Patients who underwent ACLR with PT autograft by two surgeons between 2011 and 2023 were identified. One surgeon routinely reapproximated the PT harvest site with suture, and the other left the tendon open while closing the overlying paratenon. Included patients were at least 1 year postoperative and 13 years or older at the time of surgery. Patients underwent ultrasound evaluation of the operative knee by an independent sonographer, measuring residual PT defect width and depth. International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, and Single Assessment Numeric Evaluation surveys were collected. Regression analysis determined correlations between defect size and knee outcomes. Eighty-one subjects met the criteria and completed the ultrasound and surveys. A PT defect was present in all patients at a mean follow-up of 2.97 years (1.0-9.6 years). Mean percent residual defect was 36.5 ± 17.5% of the original harvest width (mean: 10.3 mm), with a mean defect width of 3.8 ± 1.8 mm. Mean percent residual defect was significantly greater in the 57 patients who had the graft site left open (41.4 ± 13.5%) compared to the 24 patients who had the graft site reapproximated (26.1 ± 21.1%; p < 0.001). While 44.4% of patients reported moderate to extreme difficulty kneeling, it was not correlated with defect size. Patient-reported outcome scores were not correlated with defect size. A PT defect was present in 100% of patients even up to 9 years postoperatively. Defect width did not correlate with knee pain or the ability to kneel. Repeat harvesting of the PT for subsequent ACLR should be considered with caution.

Local delivery of high-dose antibiotics via absorbable calcium sulfate beads has been investigated as a treatment of prosthetic joint infection (PJI). We investigate this strategy as a prophylactic measure for high-risk patients undergoing primary total knee arthroplasty (TKA). A retrospective review of a single-surgeon consecutive series of primary TKA patients with identified risk factors for PJI development was performed. These patients were treated with calcium sulfate beads containing 1 g of vancomycin and 1.2 g of tobramycin per 10 cc, with 10 cc placed intraarticularly. Outcomes included PJI, wound complications, revision surgery, and medical complications. There were 114 knees in 103 patients, with 76 women (66.7%), a mean age of 66.8 years (range: 21-91), and a mean follow-up of 16 months (range: 3-55). The mean preoperative lifetime PJI risk based on the 2018 International Consensus Meeting on the PJI calculator was 11.3% (standard deviation: 16.3%, range: 0.9-94.3%). Risk factors included medical comorbidities, homelessness, chronic urinary tract infection, other PJI or septic arthritis history, or prior ipsilateral knee surgeries. One delayed PJI occurred 1 year postoperatively from presumed hematogenous seeding following dialysis. There were no other known deep infections. There were nine patients who had delayed wound healing with marginal skin necrosis-six resolved with wound care and three underwent superficial extraarticular surgical debridement. There was one patient who underwent aseptic revision for patellar instability and nine patients required manipulation under anesthesia for stiffness. There was one patient who died after readmission for cardiac arrhythmia and one patient had bilateral DVT. No cases of chronic PJI, persistent wound drainage, or postoperative hypercalcemia were identified. Prophylactic use of antibiotic-eluting calcium sulfate beads in primary TKA has resulted in low rates of early PJI in a high-risk cohort, warranting further prospective studies and investigation.