Journal of Knee Surgery最新文献

As robotic systems become increasingly utilized in total knee arthroplasty (TKA), structured certification programs are necessary to ensure that surgeons are proficiently trained for safe and effective use. This review examines the certification requirements for six major robotic TKA systems: Zimmer Biomet's ROSA, Stryker's Mako, Smith and Nephew's CORI, Depuy Synthes' Velys, Corin's ApolloKnee, and Think Surgical's TSolution One and TMINI. However, variation in certification structures and training requirements between each system is evident. This variability in training programs points to a need for standardized protocols across robotic platforms to ease the learning curve for surgeons and promote transferable skills and consistent outcomes. Establishing evidence-based guidelines for robotic TKA certification could facilitate broader adoption and improve clinical results, contributing to the advancement of robotic technology in orthopedic surgical practices.

Predicting hamstring graft size before anterior cruciate ligament (ACL) reconstruction is crucial to avoid subsequent graft failure. Our study aims to (1) develop a generalized algorithm to predict final ACL graft diameter for single- and double-tendon hamstring grafts consisting of any number of folds, (2) evaluate our algorithm with a regression model adjusting for patient and surgical factors, and (3) assess algorithm's specificity, sensitivity, and discriminative ability, defining adequate graft size as ≥9 mm.We conducted a retrospective review of 105 patients who underwent primary ACL reconstruction with either single- (semitendinosus or gracilis only) or double-tendon (both semitendinosus and gracilis) hamstring grafts from January 2023 to June 2024 at a tertiary institution. Magnetic resonance imaging (MRI) scans were independently measured by two junior members. The average of the measurements was taken. Predicted graft diameter is √(x·AB + y·CD), where A and B are the semitendinosus cross-sectional length and breadth, C and D are the gracilis cross-sectional length and breadth, and x and y are the number of semitendinosus and gracilis folds, respectively.Pearson correlation shows moderate correlation between predicted and actual graft diameters (R = 0.602, p < 0.01). Univariate and multivariate linear regression, adjusted for age, gender, body mass index (BMI), and graft type, indicate that males, overweight individuals, and those with single-tendon grafts are more likely to have larger actual graft diameters (p < 0.05). Our algorithm has a sensitivity of 95.8%, specificity of 69.7%, with excellent discriminative ability (AUC = 0.889). A high 82.9% agreement rate was achieved, with Cohen's kappa of 0.578 (p < 0.05).This study has demonstrated a practical generalized algorithm with high sensitivity (95.8%) to predict the final ACL graft diameter for single- and double-tendon hamstring grafts consisting of any number of folds using preoperative MRI measurements.

This retrospective study investigates whether the degree of infrapatellar fat pad (IFP) fibrosis influences postoperative pain 6 months following patellofemoral arthroplasty (PFA). Furthermore, this study explores whether sex and patellar height are impacted by the degree of IFP fibrosis. A total of 64 patients who underwent PFA from 2010 to 2023 were included, all of whom had a preoperative knee MRI and at least 1 year of follow-up. Patients were categorized into low (grades 0-1) and increased (grades 2-5) IFP fibrosis groups based on defined MRI findings. Pain outcome was assessed via a numeric rating scale. Demographic data, imaging parameters (e.g., preoperative Insall-Salvati index (IS), pre- and postoperative Caton-Deschamps index (CD), and patella morphology), and implant survivorship were analyzed. Contrary to the hypothesis, no significant association was found between IFP fibrosis degree and postoperative pain levels 6 months following PFA. Notably, the low IFP fibrosis group had a significantly higher prevalence of females (p = 0.02) and a higher preoperative IS index (p < 0.05), suggesting a connection among IFP fibrosis status, sex, and patellar height. No differences between groups were observed in age, body mass index, delta CD index, patella type, or implant survivorship. The lack of association between IFP fibrosis and postoperative pain suggests that IFP fibrosis may not be a determinant of PFA outcomes, potentially guiding surgeons to focus on other factors for optimizing postoperative pain management and implant success. Further studies are needed to elucidate the roles of sex and patellar height in the development of IFP fibrosis. The study provides level III evidence.

Anterior tibial subluxation (ATS) in knee extension is observed in knees with anterior cruciate ligament (ACL) injuries. Preoperative ATS adversely affects the postoperative anterior stability and increases the risk of early graft failure. To investigate the factors associated with preoperative ATS in knees with ACL injury. A total of 191 patients who underwent primary ACL reconstruction between 2017 and 2022 were included. Preoperatively, all patients underwent lateral radiography with full extension of both knees to evaluate the ATS. These 191 patients were divided into two groups based on ATS positivity. Positive ATS was defined as a side-to-side difference (SSD) in ATS > SD from the average SSD in ATS. The evaluation items included age, sex, height, weight, time from injury to surgery, mechanism of injury, posterior tibial slope, knee hyperextension angle, anterior tibial translation (ATT), meniscal tear on arthroscopy, and intraoperative pivot shift grade. There were 32 patients in the ATS-positive group. The overall average SSD in ATS was 1.7 ± 1.9 mm. Therefore, ATS > 3.6 mm was regarded as positive ATS. A logistic regression analysis indicated that positive ATS predictors were the ATT (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.13-1.44; p < 0.001), >6 months from injury to surgery (OR: 2.89; 95% CI: 1.19-7.06; p = 0.02), and the contralateral hyper-extension angle (OR: 1.10; 95% CI: 1.00-1.21; p = 0.049). No significant difference was observed between the groups regarding meniscal tears. Anterior knee laxity, chronicity of ACL-deficiency, and hyperextension affect preoperative ATS in knees with ACL injuries. This study is a cross-sectional study providing level III evidence.

Infection is a leading cause of primary total knee arthroplasty failure. Numerous strategies for infection prevention have been devised; however, the vast number of variables has made it difficult to isolate impactful factors. This study aims to narrow the scope by parsing the surgical procedure into stages to determine when the contamination risk is elevated. Twenty-six primary knee arthroplasties were divided into six stages: draping, skin incision, bone cuts, trial placement/balancing, implanting of components, and wound closure. Samples were taken at the end of each stage by swabbing surgical instruments and blotting the surgeon's fingertips. An active particle counter was also in operation during the procedure. A viable contaminant was detected during at least one surgical stage in 54% of the cases. The balancing (19%) and implanting (23%) stages tended to have the most occurrences. Of the contaminated cases, 42% had positive cultures transferred from the surgeon's gloves and 12% from the overhead light handle. A positive correlation was seen between the number of staff present and the occurrence of contamination (p = 0.008). The level of airborne particles 10 μm and larger also correlated with the number of staff present (p = 0.025). Limiting the number of personnel being trained per case and changing the surgical team's gloves after balancing may help to reduce the risk of contamination.

Several studies have demonstrated the importance of patient expectation management following surgery, as this is a crucial factor influencing postoperative outcomes. Informing patients on the likelihood on return to sport (RTS) following a knee arthroplasty is therefore important. This systematic review aimed to compare RTS rates and RTS rates per sport-impact level for primary total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or patellofemoral knee arthroplasty (PFA). A literature search was conducted in PubMed, Embase, and Cochrane up to June 1, 2024. Studies reporting on RTS rate following TKA, medial UKA, or PFA were included. RTS rates per sport impact level, Tegner-Lysholm, and University of California and Los Angeles (UCLA) activity scores were extracted. Outcomes were compared with meta-analysis using random-effect models. Thirty-eight studies were included for qualitative assessment, of which eight for meta-analysis, comprising 7,634 patients. Meta-analysis demonstrated a significantly greater likelihood for UKA patients (80.7% [18.4-100%]) to RTS than TKA patients (69.0% [4.1-100%]; odds ratio: 1.87 [1.23-2.85], p = 0.004). In high-impact sports, UKA patients (65.4% [18.4-100%]) were able to RTS at a higher rate than TKA patients (TKA 4.4% [4.1-12.5%]). RTS to low- and moderate-impact sports were similar. Postoperative UCLA activity score was superior for UKA patients and postoperative Tegner scores between UKA and TKA were similar. PFA patients returned to sports at a low rate (low-impact 42.4% [41.2-43.5%]; moderate-impact 35.0% [34.8-41.2%]; high-impact 20.5% [17.4-35.3%]). UKA Patients had a significantly higher overall RTS rate than TKA patients. Over 50% of UKA patients were able to return to high-impact sports, whereas only 5% of TKA patients achieved this outcome. The likelihood of RTS appeared lowest among patients who underwent PFA. A more liberal counseling regarding return to high-impact sports following UKA may be justified.

New total knee replacement designs aim to improve patient outcomes through restoration of normal knee joint movements. This study uses in vivo fluoroscopic analysis to quantify the kinematic characteristics of the Physica KR system. Twenty-one patients underwent kinematic fluoroscopic analysis 1 year following implantation of the Physica KR knee using three defined activities (step-up, kneel, and lunge). Assessments were made of initial rollback, maximum flexion, axial rotation, anteroposterior (AP) translation, and the presence or absence of condylar lift-off. A mean maximum passive flexion of 115.8 degrees (standard deviation ± 10.8) was achieved. All joints were congruent throughout range of movement in all three activities. During the step-up activity, the medial femoral condyle exhibited some initial rollback, the lateral condyle moved slightly posteriorly during initial flexion, then back toward its initial alignment with increased flexion. The combined effect produced tibial internal rotation of approximately 5 degrees during the first 90 degrees of flexion with a smooth progression toward slight varus alignment in maximal flexion, with minimal condylar lift-off. During maximal kneeling, both the medial and lateral femoral condyle contact points were just posterior to the AP midline and lift-off of both condyles was noted. During maximal lunge, the medial contact point was slightly anterior to the AP midpoint, with the lateral contact point slightly posterior, resulting in tibial internal rotation. There was no appreciable lift-off of the lateral condyle, although medial condylar lift-off increased from mid-flexion. These in vivo data demonstrate congruent kinematics throughout range of movement, with some initial femoral rollback during early flexion. Our study has shown that the Physica KR knee implant behaved similarly to other established cruciate-retaining implants.

The purpose of this study is to examine the effect of age on outcomes following repair of acute displaced patella fractures. A total of 248 patients who sustained a displaced patella fracture and underwent open reduction and internal fixation were identified. Patients included underwent a similar operative protocol, were prescribed a standard postoperative protocol of therapy, and were seen at standard follow-up intervals. Patients were divided into groups of <65 years old (young) and ≥65 years old (older). Statistical analysis was run to determine if there was a significant difference in range of knee motion and rate of major complications. Of the 248 patients, 149 were young and 99 were older. The mean age of the old group was 74.5 ± 6.7 and the mean age of the young group was 50 ± 12. Fracture pattern and BMI were the same across the groups. However, the old group had a higher average Charlson Comorbitiy Index (CCI) (p < 0.001). Additionally, the groups had similar length of follow-up (p = 0.693) and similar mean time to radiographic healing (p = 0.533). Older patients had limited knee extension at 6 months compared with young patients (p = 0.031). Finally, old patients had a higher rate of all complications compared with young patients. About 2% of old patients developed a fracture-related infection (FRI), 4% developed a symptomatic nonunion, and 11% were underwent reoperation including removal of hardware, total knee replacement, irrigation and debridement, and manipulation under anesthesia. Complication rates following patella fracture fixation in older patients were worse than young patients, despite having similar injury patterns, surgical treatment, and follow-up. These findings can better inform treating physicians during surgical intervention of older patients with patella fractures.

Quadriceps tendon ruptures (QTR) lead to significant lower extremity weakness, gait abnormalities, and disability. Outcomes following surgical management of chronic QTR remain largely unknown. This study aimed to systematically review the management of chronic QTR to better understand the incidence, indications for repair versus reconstruction, complications, and outcomes. Studies published in PubMed, EMBASE, and the Cochrane Library reporting on patients with chronic QTR were identified. Inclusion criteria consisted of patients with chronic QTR (injuries ≥6 weeks) undergoing operative management, with reported injury mechanism, tear characteristics, surgical repair versus reconstruction, graft type (if used), postoperative complications, and outcomes. A total of 26 studies, consisting of 44 patients undergoing repair or reconstruction for chronic QTR, were identified. The mean patient age was 48.5 (range, 15-80) years, with 83% (n = 33/40) of patients being male. The mean interval between injury and surgery was 17.2 months (range, 6 weeks-303 months). Falls were the most frequently reported injury mechanism (59%, n = 16/27). Patient-related factors-primarily patient delay in seeking treatment-accounted for delayed management in 55% (n = 11/20) of patients. Tendon reconstruction using graft augmentation was performed in 46% (n = 20/44), most frequently with hamstring autograft (40%; n = 8/20). Quadriceps atrophy (n = 3) and superficial wound infection (n = 3) were the most commonly reported adverse outcomes, while no subsequent re-ruptures, revisions, or additional surgeries were reported. Postoperative active range of motion (ROM) was comparable in patients undergoing repair versus reconstruction (mean ROM = 0.0-124.4 degrees vs. 4.3-120.5 degrees, respectively). Chronic QTR was identified in 44 patients undergoing operative management, an average of 17.2 months following injury. The majority of patients were males, with a mean age of 48.5 years. Falls comprised the majority of injuries, while patient deferral in seeking treatment represented the most common reason for delay. Reconstruction was performed in 46% of cases, most commonly utilizing hamstring autograft. ROM was comparable irrespective of surgical management. Quadriceps atrophy and wound infection were the most commonly reported adverse outcomes, with no reported re-ruptures or revision procedures.

There has been significant exploration into anterior cruciate ligament (ACL) reconstruction with lateral extra-articular augmentation, with a marked increase in research output over the past 10 years. This study aims to conduct a thorough bibliometric analysis of the most influential publications on ACL reconstruction combined with lateral extra-articular augmentation. This research is a cross-sectional study, classified as level 4 evidence. In July 2024, a thorough search was conducted utilizing the Web of Science Core Collection and Google Scholar databases to identify studies related to ACL reconstruction with lateral extra-articular augmentation. The 100 most cited articles that met the established inclusion criteria were carefully selected and subjected to an in-depth bibliometric analysis. The top 100 cited articles were published between 1976 and 2020, with a notable concentration during the 2010s. Citation counts for these articles ranged from 125 to 1,000, with citation density varying between 3.32 and 113.00. The United States led in both the number of publications and citations, followed by France and Italy. The majority of the studies focused on anatomical and biomechanical topics, with a growing presence of high-level evidence studies, including 15 classified as levels 1 or 2 evidence. The period from 2010 to 2020 witnessed a significant surge in the publication of the top 100 most cited articles, highlighting their scientific relevance in specialized areas. The diversity of study types, predominantly anatomical and biomechanical, reflects the substantial interest in this field, coupled with an increase in high-evidence-level research, with 15 articles classified as levels 1 or 2. The United States stands out, contributing 31% of these articles, with notable input from France and Italy. This review provides valuable insights into global research trends and outlines potential directions for future research.