Journal of Knee Surgery最新文献

This study investigated isokinetic muscle strength deficits in patients with advanced knee osteoarthritis (KOA) scheduled for total knee arthroplasty (TKA) to explore the relationship between objective strength measures and subjective symptoms such as pain and functional limitations. By analyzing muscle function using isokinetic dynamometry, the study aimed to provide insights into how strength deficits relate to patient-reported outcomes and whether these assessments could inform surgical decision-making. A total of 52 patients (mean age: 66.96 years, 53.85% female) with advanced KOA awaiting TKA were included. Isokinetic muscle strength of the knee, measured in peak torque (Newton-meters), work (Joules), and power (Watts), was assessed bilaterally before surgery using a Biodex dynamometer at angular velocities of 180 degrees/s and 60 degrees/s. Subjective symptoms were evaluated using standardized assessments, including the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short Form-12 (SF-12), Hospital Anxiety and Depression Scale (HADS-D), and EuroQol 5-Dimension 3-Level questionnaire. Findings revealed a significant strength deficit on the affected side scheduled for surgery (p < 0.050). However, correlations between isokinetic knee parameters and symptom scores were weak (|r| ≤0.5), suggesting that subjective complaints do not necessarily align with objective strength measurements. Notably, isokinetic parameters were significantly intercorrelated (p < 0.050). These results indicate that isokinetic dynamometry effectively quantifies muscle strength differences in KOA patients, yet its findings should be considered alongside clinical assessments and patient-reported symptoms to form a comprehensive evaluation of disease severity and surgical necessity.

Patellar instability following total knee arthroplasty (TKA) is a rare, yet serious complication, potentially requiring revision surgery or resulting in chronic dysfunction. When encountered, it is paramount to understand the etiologies, diagnostic approaches, treatment options, and outcomes of the selected treatment. The most common cause of patella instability is improper positioning of components, leading to lateral maltracking of the patella. Factors such as internal rotation and/or medialization of femoral or tibial components and lateralization of the patellar button have been identified as factors that contribute to instability. Additionally, a longstanding valgus deformity of the knee may exacerbate patella maltracking. Patients typically present with anterior knee pain, worsened by activities like stair climbing, and may report sensations of giving way. Radiographs and computed tomography scans aid in evaluating component positioning and rotation. Operative intervention is often necessary, with options ranging from soft tissue realignment to component revision. Lateral retinacular release is a common approach, although it is associated with complications such as osteonecrosis of the patella. Proximal or distal realignment procedures may be required if instability persists. Some recent case reports have also described medial patellofemoral ligament reconstruction as a treatment modality, but more investigation on the topic is still pending. It is important that the treatment strategy address the underlying cause, as failure to do so may result in recurrent instability. The best way to avoid patella instability is to pay attention to all the details of component position and soft tissue balance during the index procedure.

It is still controversial whether anteroposterior laxity or posterior tibial slope (PTS) after total knee arthroplasty (TKA) affects maximum flexion angle. The purpose of this study was to evaluate the relationship between PTS and tibial anteroposterior laxity after TKA and to examine the effect of these factors on knee flexion angle after TKA. This study enrolled 96 knees in 80 patients undergoing cruciate-retaining TKA (CR-TKA). Anterior translation (AT) and posterior translation (PT) were measured separately at a flexion of 90 degrees using stress radiographs. Total anteroposterior translation (APT) was defined as the sum of AT and PT. PTS was measured in a lateral view. In univariate analysis, postoperative flexion angle was positively correlated with preoperative flexion (R = 0.51; p < 0.01), PT (R = 0.48; p < 0.01), and APT (R = 0.48; p < 0.01), whereas it was negatively correlated with body mass index (BMI; R = - 0.43; p < 0.01) and PTS (R = - 0.24; p = 0.02). In multivariate analysis, postoperative flexion angle was negatively correlated with BMI (β = - 0.243; p < 0.01), whereas it was positively correlated with preoperative flexion (β = 0.406; p < 0.01) and PT (β = 0.279; p < 0.01). A negative correlation was found between PTS and PT (R = - 0.39, p < 0.01). An increase in posterior laxity at 90 degrees of flexion significantly increased postoperative flexion. An increase in PTS was associated with decreased posterior laxity; however, it had no effect on postoperative flexion.

Cementless total knee arthroplasty (TKA) has become a viable option in recent years, and there has been an increase in robotic-assisted technology. Although institutions may monitor their implant usage, the evolution of their use and complication rates have not been well described at a national level in the United States. Therefore, we sought to characterize the use and compare complications between cemented, cementless, manual, and robotic-assisted TKA across the United States.We retrospectively reviewed a commercial claims database and found 94,603 inpatient primary TKAs that were performed with cemented or cementless components between January 1, 2016 and December 31, 2022. Records were reviewed for demographics, use of robotics, complications, and readmissions up to 90 days postoperatively.More cementless TKAs were performed each year, from 4.1% in 2016 to 12.3% in 2022 (odds ratio [OR] = 1.3, p < 0.001). The use of robotic technology increased each year from 7.7% in 2016 to 25.0% in 2022 (OR = 1.3, p < 0.001) and was more commonly used with cementless TKA (OR = 1.3, p < 0.001). Patient factors associated with cementless TKA included younger age (OR = 1.0, p < 0.001) and male sex (OR = 1.3, p < 0.001). Cementless TKA was a risk factor for explantation within 90 days postoperatively (OR = 1.5, p = 0.008), but not aseptic loosening (OR = 0.8, p = 0.6), periprosthetic fracture (OR = 0.2, p = 0.2), infection (OR = 1.3, p = 0.1), revision TKA (OR = 1.4, p = 0.1), manipulation under anesthesia (OR = 1.0, p = 0.9), deep vein thrombosis (OR = 0.9, p = 0.5), pulmonary embolism (OR = 1.2, p = 0.3), or blood transfusion (OR = 0.3, p = 0.1).The use of cementless and robotic TKA is increasing each year, although most inpatient primary TKAs are still performed with manual cemented technique. Although cementless TKA was found to be a risk factor for revision and explanation within 90 days, it was not associated with a specific cause of revision. Further research is needed to better understand why cementless TKA increases these risks.

Total knee arthroplasty systems are continually being updated. Evaluating these new systems for their effectiveness, and potential complications is vital, and is closely monitored by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The ATTUNE Knee System was released in 2013, and some early studies reported on an increase in rates of aseptic loosening. This study aims to investigate the revision rates of the ATTUNE Knee System and its predecessor the PFC Sigma utilizing registry data. Data were collected from AOANJRR. All ATTUNE and PFC Sigma primary total knee replacements (TKR) performed between September 1999 until 2021 were included. The primary outcome measures were revision rates and indications for revision. A total of 38,407 primary TKRs were included in the study (24,863 ATTUNE, 13,544 PFC Sigma). The cumulative percentage revision (CPR) at 8 years was 3.3% (95% confidence interval [CI]: 2.6, 4.1) for the ATTUNE Knee System and 3.2% (95% CI: 2.9, 3.5) for the PFC Sigma Knee System (p = 0.144). The proportion of revisions due to aseptic loosening was 20.5% for the ATTUNE Knee System and 21.5% for the PFC Sigma Knee System. Midterm revision rates of the ATTUNE and PFC Sigma Knee Systems are not significantly different. Additionally, the percentage of revisions due to aseptic loosening of the implant were not significantly different between the two knee systems.

During anterior cruciate ligament (ACL) reconstruction, intraoperative graft contamination or postoperative infection remains a notable clinical concern. While antiseptic solutions are increasingly employed for graft decontamination and infection prophylaxis, the potential impact of these agents on the biomechanical integrity of tendon grafts has not been fully elucidated. This experimental study aimed to evaluate the biomechanical effects of soaking tendon grafts in vancomycin, chlorhexidine, and povidone-iodine solutions. Fresh bovine deep digital flexor tendons were used to simulate ACL autografts and randomly assigned to four groups (n = 6): 4% chlorhexidine, 10% povidone-iodine, 5 mg/mL vancomycin, and 0.9% isotonic saline (control). After 30-minute soaking, tendons were sutured using a four-rip-stop technique and biomechanically tested using a servohydraulic tensile system. Failure load, stiffness, and cyclic elongation were measured. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction. Vancomycin and chlorhexidine groups exhibited significantly lower cyclic elongation compared to control and povidone-iodine groups. Failure load was also significantly higher in these groups, particularly compared to povidone-iodine, which demonstrated the weakest biomechanical performance. No significant differences in stiffness were observed across groups. Vancomycin and chlorhexidine can be safely used for short-term antiseptic soaking without compromising graft mechanical integrity. In contrast, povidone-iodine may weaken tendon structure. These findings may guide antiseptic use during ACL reconstruction and in managing contaminated tendons in open injuries.

Anatomic research has demonstrated significant differences in native knee morphology between genders and ethnicities. These studies have traditionally evaluated femoral morphology. However, no studies have yet investigated possible relationships between the posterior femoral condyles and the tibial plateau. Our study sought to demonstrate this relationship and evaluate its strength when stratified by gender and race. An international database of CT scans of non-arthritic knees was accessed, and, using computer software, length measurements of regions of interest were recorded. Measurements included medial-lateral width of the posterior femoral condyles and width of the tibial plateau (TW). These measurements were compared. Statistical analysis was performed for the entire population, and subsequently for the population stratified by gender and ethnic groupings. The review included 373 non-arthritic knees, each from a unique patient. The cohort consisted of 184 males (49.3%) and 189 females (50.6%). About 117 patients were from Japan (31.4%), 100 were from India (26.8%), 87 were from South Korea (23.3%), 43 were from China (11.5%), and 26 were from North America (7.0%). The average age was 57.6 ± 8.6 years. The width of the proximal tibia was positively correlated to posterior femoral condylar width, R ² = 0.83. Gender stratification weakened the correlation, with female patients demonstrating an R ² of 0.64 and male patients an R ² of 0.60. Ethnic stratification strengthened relationships in Japanese (R ² = 0.87), North American (R ² = 0.89), and South Korean (R ² = 0.88) patients; and weakened them in Indian (R ² = 0.72) and Chinese (R ² = 0.82) patients. This study is the first to use CT to demonstrate the strength of tibiofemoral relationships for individual demographic groups. These findings highlight important differences in morphology and may be used to inform implant design, selection, stocking, and supply. Further, these data may help identify patients who require different-sized tibial and femoral components preoperatively.

Surgical reconstruction of the anterior cruciate ligament (ACL) has historically been the only method by which knee stability is restored following ACL rupture. Following ACL rupture, the torn ends of the ligament are exposed to the synovial environment, containing hyaluronan (HA), which has been implicated in the poor migratory function of ACL fibroblasts (ACLF). We hypothesize that the HA in synovial fluid attenuates the wound healing response of the ACL by inhibition of new focal adhesions between ACLF and the surrounding environment. Juvenile bovine ACLF were isolated and cultured in the presence of endogenous and exogenous high molecular weight HA (HMWHA) to monitor in vitro wound closure. Concurrently, cells were assayed for focal adhesion formation and adhesion strength. Next, human ACLF were cast into tissue-engineered constructs to assess their ability to contract within a 3D matrix after treatment with HA. A cellular viability assay was used to determine the cytotoxicity of HMWHA. Co-culture of synoviocytes with ACLF wounds demonstrated that HMWHA was the primary cause for attenuated wound healing. When exogenous HMWHA was cultured with ACLF, a dose-dependent negative correlation (r = -0.65, p < 0.001) in cell migration was observed. A significant decrease in the number and strength of focal adhesions was found to mirror the dose-dependent pattern. Collagen gel contraction was inhibited in the presence of HMWHA. Direct exposure of ACLF to HMWHA was shown to inhibit ACLF wound healing and contraction. As cytotoxicity remained unchanged, this decreased healing capacity is attributed to reduced focal adhesion formation and weakened adhesion strength of ACLF in the presence of HMWHA. This study identifies HMWHA exclusion as a potential therapeutic strategy and provides insight into the mechanism by which traditional primary repair of the ACL, as well as graft reconstructions, may fail.

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.