Journal of Knee Surgery最新文献

Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. Cohort study. Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.

Prolonged and incomplete osteochondral allograft (OCA) osteointegration is consistently cited as a major mechanism for OCA treatment failure. Subrejection immune responses may play roles in this mode of failure. Preimplantation OCA preparation techniques, including subchondral bone drilling, thorough irrigation, and autogenous bone marrow aspirate concentrate saturation, may dampen immune responses and improve OCA osteointegration. This study sought to further characterize potential immune system contributions to OCA transplantation treatment failures by analyzing donor-recipient ABO and Rh-factor mismatches and histological and immunohistochemical assessments of transplanted OCA tissues recovered from revision surgeries. Using a dedicated registry, OCA transplant recipients with documented treatment failures who met inclusion criteria (n = 33) as well as age-, body mass index-, and joint-matched patients with successful outcomes (n = 70) were analyzed to compare matched cohorts of patients with successful versus failed OCA transplantation outcomes. Tissues recovered from 18 failed OCA transplants and portions of 7 nonimplanted OCA controls were further analyzed to provide contributing evidence for potential immune response mechanisms. For patients analyzed, no statistically significant differences in proportions for treatment success versus failure based on mismatches for ABO type, Rh factor, or both were noted. Further, no statistically significant differences in proportions for histological immune response presence or absence based on mismatches for ABO type, Rh factor, or both were noted. Twelve (67%) of the failed OCA tissues contained lymphocyte aggregations in the subchondral bone, which were comprised of combinations of CD3 + , CD4 + , CD8 + , and CD20+ lymphocytes. The mechanisms of failure for these 12 OCA transplants involved insufficient OCA osteointegration. Results of this study suggest that T- and B-cell-mediated subrejection immune responses may play roles in OCA transplant treatment failures independent of donor-recipient blood type mismatch effects.

Periprosthetic patella fractures are a rare complication that can lead to severe disability following total knee arthroplasty (TKA). There are several factors that increase the risk of this injury, including patient comorbidities, anatomic considerations, and surgical technique. With these factors limiting healing ability in the area, periprosthetic patellar fractures can pose a major challenge to treat, with potentially lasting morbidity for affected patients. These fractures can occur at any time following TKA and are classified based on their associated implant stability and disruption of the extensor mechanism using the Ortiguera and Berry classification system. Each of the three types of fractures can be managed in their own unique way; however, outcomes remain poor, and the complication rates remain high regardless of fracture type. This article provides an overview of the current literature and the recommended management of periprosthetic patella fractures.

This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR)-derived hip-knee-ankle angle (HKAA) and intraoperative supine computer-assisted surgery (CAS)-derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if WB alignment could be mimicked or inferred based on intraoperative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single center by a single surgeon. The HKAA was recorded using the CAS navigation system immediately postregistration of navigation data and after implantation of the prosthesis. The intraoperative HKAA was recorded in both the supine "resting" position of the knee and also while the knee was manipulated in an effort to replicate the patient's WB alignment. These measurements were compared with the HKAA recorded on pre- and postoperative WB LLRs. There was a strong correlation between the preoperative WB LLR HKAA and the intraoperative preimplant CAS-derived stressed HKAA (R = 0.946). However, there was no correlation between the postoperative WB LLR HKAA and the postimplant insertion HKAA as measured intraoperatively via CAS for either a "resting" or "stressed" position of the operated knee (R = 0.165 and R = 0.041, respectively). Thus, the interpretation of intraoperative alignment data is potentially problematic. Despite technological advances in the development and utilization of computer navigation and robotics in arthroplasty to help obtain the optimal alignment, it would seem apparent from our study that this alignment does not correlate to upright stance postoperatively. Surgeons should apply caution to the strength of assumptions they place on intraoperative coronal plane alignment findings.

The purpose of this study is to evaluate the effect of patient demographics and injury characteristics on post-arthroscopic partial meniscectomy (post-APM) patient-reported outcomes (PROs). We hypothesize that the presence of high-grade (Kellgren-Lawrence grades 3-4) arthritis at any location of the knee (medial and lateral compartments, patella, trochlea), comorbidities (psychiatric history, chronic pain, diabetes, smoking, body mass index [BMI] ≥ 30), and lower scores on preoperative patient-reported measures (36-Item Short Form Health Survey [SF-36]) would predict poor outcomes after APM. We conducted a single-center prospective study of 92 patients who underwent APM surgery for associated knee pain. General demographic information and PROs were prospectively collected using SF-12, SF-36, and International Knee Documentation Committee (IKDC) surveys presurgery and at 6-month follow-up. Postsurgery outcomes were patient-reported satisfaction (yes/no) and obtaining a patient-acceptable symptom state (PASS) on IKDC. Data were analyzed with odds ratios (ORs), binomial logistic regression, and Mann-Whitney U test using IBM SPSS software. Demographic and injury characteristics that were poor prognostic indicators (had a decreased likelihood of obtaining PASS on IKDC postsurgery) included having Medicaid insurance (OR: 0.056; 0.003-1.00), chronic pain (OR: 0.106; 0.013-0.873), acute injury (OR: 0.387; 0.164-0.914), and high-grade (KL grades 3-4) medial compartment arthritis (OR: 0.412; 0.174-0.980), and preoperative SF-36 physical health score (PHS; p = 0.023) and mental health score (MHS; p = 0.006) values less than 47 and 48, respectively. Additionally, former smoking history (OR: 0.271; 0.079-0.928) showed a lower likelihood of being satisfied postsurgery. Not having psychiatric history (OR: 14.925; p < 0.001; increased likelihood of obtaining PASS on IKDC score postsurgery) and not having patellar arthritis (OR: 4.082; p = 0.025; increased likelihood of PASS on IKDC) were positive prognostic indicators. This study identifies predictive factors of poor outcomes post-APM; particularly, it highlights the usefulness of SF-36 surveys prior to APM surgery. Patients with low SF-36 score preoperatively may not find APM acceptable. Additional attention should be put on patient demographics (such as psychiatric history, chronic pain, and insurance type) and injury characteristics (presence of arthritis and acute injury) prior to performing APM. LEVEL OF EVIDENCE:  II.

Meniscus allograft transplantation (MAT) is a proven treatment option for patients with symptomatic irreparable meniscus deficiency. When patients are adherent to prescribed postoperative restriction and rehabilitation protocols, outcomes after MAT are considered good to excellent. However, nonadherence to standard protocols is common and can be associated with undesirable outcomes and patient dissatisfaction. Based on demonstrated safety for early weight-bearing following MAT in conjunction with significant advances in graft preservation and surgical techniques, our joint preservation center implemented a shift in practice toward accelerated weight-bearing following MAT and designed this study to test the hypothesis that accelerated rehabilitation would be associated with superior adherence, patient-reported outcomes, and patient satisfaction, without diminishing patient safety, when compared with standard rehabilitation. Patients were included for analyses when they had undergone fresh or fresh-frozen MAT using a double bone plug technique for treatment of medial or lateral meniscus deficiency and had at least 1-year treatment outcomes recorded. The results of this study revealed that patients who were prescribed accelerated rehabilitation after MAT were significantly more adherent than patients who were prescribed standard rehabilitation and reported statistically significant and clinically meaningful improvements in knee pain and function for at least 1-year following MAT, whereas those in the standard cohort did not. While not statistically different, treatment failure rate was lower in the accelerated rehabilitation cohort when compared with the standard rehabilitation cohort (11 vs. 29%). Importantly, initial outcomes for revision MAT were associated with short-term success in all the patients who opted for this option in the study population. These data suggest that accelerated weight-bearing after MAT is safe, promotes patient adherence, and is associated with statistically significant and clinically meaningful improvements in patient-reported knee pain and function at early and mid-term follow-up.

Improvement after knee arthroplasty (KA) is often measured using patient-reported outcome measures (PROMs). However, PROMs are limited due to their subjectivity. Therefore, wearable technology is becoming commonly utilized to objectively assess physical activity and function. We assessed the correlation between PROMs and step/stair flight counts in total (TKA) and partial knee arthroplasty (PKA) patients.Analysis of a multicenter, prospective, longitudinal cohort study investigating the collection of average daily step and stair flight counts, was performed. Subjects (N = 1,844 TKA patients and N = 489 PKA patients) completed the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and provided numerical rating scale pain scores pre- and postoperatively. Only patients who reported living in a multilevel home environment (N = 896 TKA patients and N = 258 PKA patients) were included in analysis of stair flight counts. Pearson correlation coefficients were calculated to determine correlations between variables.Among TKA patients, pain scores demonstrated a negative correlation to mean step counts at preoperative (r = -0.14, p < 0.0001) and 1-month follow-up (r = -0.14, p < 0.0001). Similar negative correlations were true for pain and stair flight counts at preoperative (r = -0.16, p < 0.0001) and 1-month follow-up (r = -0.11, p = 0.006). KOOS JR scores demonstrated weak positive correlations with mean step counts at preoperative (r = 0.19, p < 0.0001) and 1-month postoperative (r = 0.17, p < 0.0001). Similar positive correlations were true for KOOS JR scores and stair flight counts preoperatively (r = 0.13, p = 0.0002) and at 1-month postoperatively (r = 0.10, p = 0.0048). For PKA patients, correlations between pain and KOOS JR with step/stair counts demonstrated similar directionality.Given the correlation between wearable-generated data and PROMs, wearable technology may be beneficial in evaluating patient outcomes following KA. By combining subjective feedback with the objective data, health care providers can gain a holistic view of patients' progress and tailor treatment plans accordingly.

The spacer block technique is widely used in medial fixed-bearing unicompartmental knee arthroplasty (UKA) for osteoarthritis (OA) and osteonecrosis (ON), while it is still unclear if there is any difference in the extension gap between UKAs for the two conditions. To clarify the question, the data from 87 consecutive patients (OA: 57 patients and ON: 30 patients) who underwent medial fixed-bearing UKA with the spacer block technique were retrospectively collected and analyzed. The component gap between the medial tibial osteotomy surface and the femoral trial prosthesis in extension was measured using a UKA tensor, and the preosteotomy gap was calculated in each condition. Also, pre- and postoperative coronal hip-knee-ankle (HKA) angles, the thickness of the insert, and the amount of distal femoral and proximal tibial osteotomy were measured and compared between the two groups. As a result, the mean preosteotomy gap in Group OA and Group ON was 5.4 and 3.7 mm, respectively (p < 0.001). The amount of change in HKA angle following UKA in Group OA and Group ON was 4.4and 3.8 degrees, respectively (p = 0.044), while no significant difference was found regarding pre- and postoperative HKA angle between them. Also, thinner inserts tended to be used in Group ON than in Group OA, while no significant difference in the amount of osteotomies was found between them. Since knees with OA and ON showed different biomechanical conditions at medial fixed-bearing UKA probably for the difference in the amount of remaining cartilage, the surgical technique should be carefully considered for each condition.

The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent studies have shown that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure nonsurgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests. This is a case-control study with a 2-year follow-up. The case group consisted of patients who had provided written consent and completed their 2-year follow-up, and the control group was made up of healthy people who did not have any knee medical conditions and were matched by age, gender, and activity level. Physical examinations, Tegner and International Knee Documentation Committee questionnaires, and knee magnetic resonance imaging were conducted, and functional performance tests were performed after a 10-minute warm-up. Lody's index (the ratio of injured-to-uninjured knee results) was calculated. The data were analyzed using independent t-test, one-way analysis of variance, chi-squared test, and Fisher's exact test. The study involved 11 patients in each concomitant ACL and MCL injury cases and healthy control groups with a mean age of 32.4 and 28 years, respectively. None of the patients reported knee instability symptoms in the 2-year follow-up. More than half of the patients continued their sports field without reinjury, with no significant difference in activity levels between case and control groups. The 6-meter hop test and single-leg hop test showed no significant difference between case and control groups (p-value: 0.326, 0.859), and no significant difference was observed in the three Carioca, cocontraction, and Shuttle tests in the 2-year follow-up. Functional tests in ACL and MCL injuries revealed normal outcomes, implying a nonsurgical approach for patients with proximal ACL tears, better knee stability, and no significant differences between the injured and control groups.

Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the midterm clinical performance of cementless TKA using a highly porous tibial baseplate compared with its cemented counterpart of the same system. We conducted a retrospective case-control study of 400 patients undergoing primary TKA that included 200 patients with cementless components matched for age and body mass index (BMI) to 200 patients with cemented implants of the same implant design with a 5-year follow-up. We evaluated clinical results, complications, revisions, and overall survivorship between the cohorts. Statistical analysis was performed using student t-test and chi-square analysis. There was no statistical difference in age (64.3 vs. 64.3 p = 0.81), BMI (34 vs. 33.1 p = 0.19), preoperative Knee Society Score (KSS) function (41 vs. 32.3 p = 0.22), and preoperative KSS knee score (39.2 vs. 38.3 p = 0.54) between the cementless and cemented cohorts, respectively. The cementless group had seven revisions, while the cemented group had nine revisions (p = 0.609). The cementless group had one revision due to aseptic loosening versus five in the cemented group (p = 0.09). Postoperative 5-year KSS knee scores were 92.84 versus 91.75 (p = 0.386) and function scores were 81.81 versus 69.65 (p = 0.00004) in the cementless and cemented groups, respectively. The cementless group had survivorship of 96.5% for all-cause revision compared with 95.5% in the cemented group at 5-year follow-up (p = 0.60). Cementless TKA using a highly porous tibial baseplate showed excellent midterm results with one case of aseptic loosening at 5-year follow-up and with similar Knee Society outcome scores and survivorship compared with the cemented group. Cementless TKA demonstrated noninferiority to cemented TKA and could be used as an alternative mode of fixation in patients opting for primary TKA. Additional long-term follow-up is needed to determine if cementless TKA can demonstrate improved survivorship over cemented TKA.