Journal of Knee Surgery最新文献

Osteochondral allograft transplantation (OCAT) is safe and effective for the treatment of large articular defects in the knee. Yet, there are no quantitative methods for predicting OCAT outcomes. This study was designed to analyze serum and urine biomarkers collected prior to OCAT to determine their capabilities for predicting outcomes with respect to functional graft survival. Prospectively collected data for patients undergoing primary multisurface knee OCAT, enrolled in an outcomes registry, were analyzed for graft survival. Blood and urine samples were collected prior to surgery for biomarker analyses. Biomarker concentrations were analyzed for the capability to predict OCAT failures (revision or arthroplasty) that occurred within the first 2 years. Fifty consecutive patients were included for analysis; the 2-year graft survival (success) rate was 80%. In samples obtained prior to OCAT, concentrations of serum hyaluronan (HA) and urine cross-linked C-telopeptide of type II collagen (CTX-II) were significantly higher for failure patients. A urinary biomarker panel containing cross-linked C-telopeptide of type I collagen (CTX-I), CTX-II, HA, IL-8, MMP-2, MMP-3, MMP-13, osteoprotegrin (OPG), and osteopontin (OPN) was able to predict the likelihood of treatment failure with an area under the curve (AUC) of 0.895, sensitivity of 85.3%, and specificity of 93.8%. Preoperative concentrations of urine CTX-II and urine MMP-3 were significantly associated with a higher risk for OCAT treatment failure. Serum and urine protein biomarkers analyzed prior to surgery have the potential to predict functional graft survival at 2 years following complex multisurface OCAT surgery in the knee. With further validation, these biomarkers may be useful as a component of the shared decision-making process for patients and health care teams to evaluate this treatment option. Level of Evidence 2, prospective cohort study.

The impact of preoperative patellofemoral malalignment (PFM) on the prognosis of patients who underwent total knee arthroplasty (TKA) remains unknown. This study aimed to explore the effect of preoperative PFM on the prognosis of patients who underwent TKA. This retrospective observational study included patients who underwent TKA at the Second Hospital Affiliated to Fujian Medical University between February 2018 and July 2020. The primary outcome measure was the Hospital for Special Surgery Knee-Rating Scale (HSS) score. The secondary outcomes included postoperative radiographic parameters (X-rays) and the occurrence of complications. A total of 94 patients (107 knees) who underwent TKA were included in the study. Of these, 37 knees had PFM and 70 had normal patellofemoral alignment (PFA). Patients with preoperative PFM showed a change in patellar outward displacement from 7.01 ± 3.91 mm preoperatively to -0.31 ± 2.86 mm postoperatively (p < 0.001), and the lateral patellar tilt angle changed from 9.45 ± 7.47 degrees to 6.06 ± 3.61 degrees (P = 0.009). Postoperative radiographic parameters between the PFM and PFA groups did not show any significant difference (p > 0.05), but the postoperative HSS score in the PFM group was lower than in the PFA group (total score: 70.35 ± 8.39 vs. 80.47 ± 5.44, p < 0.001). In addition, 13 (35.14%) knees in the PFM group experienced postoperative anterior knee pain compared to 10 (14.29%) knees in the PFA group (P = 0.013). Preoperative PFM may have an impact on the HSS score and the occurrence of anterior knee pain in patients after TKA. These findings suggest that surgeons should carefully evaluate preoperative PFA in patients undergoing TKA. Furthermore, patients with PFM may require additional monitoring and management of postoperative anterior knee pain, as well as special considerations for optimizing functional outcomes.

Quadricep tendon (QT) ruptures following total knee arthroplasty (TKA) represent a challenging complication with potentially severe consequences, including impaired function and the need for additional surgical intervention. This article reviews the relevant anatomic features, etiology, and risk factors of QT ruptures after TKA. The different treatment options and indications for nonoperative management, direct repair, augmented repair, extensor reconstruction with mesh, and complete extensor allograft reconstruction are reviewed.

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.