Journal of Clinical Orthopaedics and Trauma最新文献

Purpose: To review outcomes of medial patellofemoral ligament reconstruction (MPFLR) using synthetic suture tape in biomechanical and clinical studies.

Methods: A comprehensive literature search was performed in three databases. Studies reporting biomechanical and/or clinical outcomes of MPFLR using synthetic suture tape were included. For clinical studies, the primary outcome measures included patient-reported outcomes (PROs) and adverse events.

Results: Three biomechanical studies were included. One study reported stronger integrity of fixation with suture tape versus semitendinosus autografts. One study reported similar integrity of MPFLR with knotless anchor versus soft tissue fixation. Another study found suture tape fixation between 60° and 90° of knee flexion to avoid excessive medial patellofemoral joint contact pressure after MPFLR. Eight clinical studies with 287 patients and 317 knees (36.1 % male, pooled mean age: 23.2 years old, pooled mean follow-up: 41.6 months) were included. All studies reported significant preoperative to postoperative improvement for all PROs except for the Tegner score in one study. The range of PROs were as follows (preoperative and postoperative): Lysholm (32.8-72.0 and 78.0 to 96.7), Kujala (36.0-75.2 and 78.8 to 97.7), International Knee Documentation Committee (IKDC) (48.6-69.8 and 71.3 to 91.3), and Tegner (1.0-4.6 and 4.0 to 6.5). Two studies comparing suture tape with autografts (quadriceps and gracillis tendons) reported similar postoperative PROs. The pooled rate of adverse postoperative events was 8.2 %. The pooled rate of positive patellar apprehension tests at follow-up was 3.2 %.

Conclusions: Patients undergoing MPFLR with suture tape fixation achieved significant improvements in PROs and demonstrated low rates of postoperative complications. Compared to autograft fixation, suture tape fixation provided comparable or superior clinical and biomechanical outcomes.

Background: There has been an increasing interest in elbow hemiarthroplasty to circumvent the problems with total elbow arthroplasty for comminuted distal humerus fractures in the elderly. The primary aim of the study is to assess the mid-term clinical and radiological outcomes of patients undergoing TEA and hemiarthroplasty for distal humerus fractures.

Methods: Retrospective analysis of data for patients undergoing hemiarthroplasty for distal humerus fractures (OTA- C3 Comminuted total articular fractures) was done. This is a non-randomized consecutive series from a single centre. A minimum follow-up of 3 years was required for inclusion. Patients with delayed/neglected presentation (>3 weeks), those needing total elbow arthroplasty and conservatively managed fractures needing delayed arthroplasty were excluded.

Results: A total of 12 patients were operated in the period between 2016 and 2021(mean follow-up-59.4 months). The mean age of the patients undergoing hemiarthroplasty was 68.4 years. The mean arc of flexion extension was 21-115°. The mean range of supination was 75° while pronation was 86° (p > 0.05). The mean QuickDASH score was 8.7. There were no cases of infection, dislocations, intra-operative fractures or revision surgery. Two patients had transient weakness in the ulnar nerve distribution that recovered on follow-up.Evidence of heterotrophic ossification was seen in 8 patients. None of the patients showed radiological evidence of loosening but trochlear cartilage wear was seen in 2 patients. None of the radiographs showed migration of the condyles. There were 5 cases where the medial condyle though approximated had not healed.

Conclusions: Elbow hemiarthroplasty provides predictably good clinical and radiological outcomes on mid-term follow-up. Longer follow-up is necessary to determine the survival of these prostheses in the long term.

Background: Lisfranc injuries describe a spectrum of midfoot and tarsometatarsal joint (TMTJ) trauma ranging from purely ligamentous to multiple fracture-dislocations. Lisfranc injuries represent 0.2 % of all fractures and are seen predictably, with mechanisms involving a fall from height, crushing, or torsion. Diagnosis can be challenging, with approximately 20 % of cases being missed, and relies upon clinical acumen and proficient image interpretation. Whilst multiple classification systems have described Lisfranc injuries using a 3-column concept, these add zero prognostic value and are therefore rarely used clinically. Furthermore, existing literature on diagnosis and management is limited to retrospective small series.

Methods: We present a review of 161 midfoot injuries, with the aim of highlighting characteristics of radiological instability and indication for operative management. CT scans and weight-bearing and non-weight-bearing X-rays were reviewed for features of joint instability. These features included metatarsal base, cuneiform and cuboid fractures, tarsometatarsal joint subluxation or dislocation and C1-MT2 diastasis. The subsequent "stable" and "unstable" injury groups were then compared to identify statistically significant indicators for instability.

Results: Avulsion and intra-articular fractures of the medial, middle, or lateral column were all suggestive of instability. Although these appeared in multiple combinations, 95 % involved the middle column. Concomitant inter-cuneiform and cuboid fractures were additional indicators of instability. In cases of uncertain midfoot instability, weight-bearing radiographs were of value with 14.2 % demonstrating a diastasis of C1-MT2 >2 mm.

Conclusion: We propose the need for a new classification of midfoot injuries which emphasises the diagnosis of instability and guides surgical management. We propose that, based on non-weight-bearing X-ray and CT scans, these injuries can be initially classified as "stable", "unstable", or "stability uncertain". Weight-bearing X-rays are a safe and reliable method of detecting instability in the "stability uncertain" group. Fractures of the medial column and cuneiform on initial imaging were suggestive of midfoot instability.

Introduction: After total knee arthroplasty (TKA), dissatisfaction rates are described up to 30 %. Optimal alignment of the prosthesis in TKA is believed to improve clinical outcome and survival rates. Radiological outliers after TKA are used to define this alignment. Limited evidence is available on the cumulative effect of these outliers on survival or clinical outcome. The purpose of this study is to assess whether the amount of postoperative femoral and/or tibial radiological outliers, measured in different planes, influences the survival and clinical outcome after TKA.

Methods: Prospective data were used from a previously published randomized trial, with a mean follow-up of 5-years after surgery. Data of 168 patients who received TKA were assessed. Patients were divided into four groups: 0, 1, 2 or ≥3 postoperative radiological outliers of the femoral and/or tibial component in different planes (e.g. frontal, sagittal). Revision rates were analysed and clinical outcome was assessed using PROMs. The study used a general linear model for repeated measures to compare the difference of each questionnaire over time between the groups.

Results: No statistically significant differences were found between patients with 0, 1, 2 or ≥3 outliers regarding improvement of postoperative PROMs. Data was underpowered to detect a possible relationship between the number of outliers and the survival of the prosthesis.

Conclusion: The number of postoperative radiological outliers did not influence clinical outcome after TKA. High-powered studies are needed to examine the influence of these outliers on survival rates.

Introduction: Neck of femur (NOF) fractures constitute a significant proportion of the workload of orthopaedic departments, with approximately 65 000 admissions across the UK annually. There are various surgical procedures available to repair NOF fractures and each is associated with numerous intraoperative and perioperative risks. Informed consent is an essential part of the workup when planning to undertake any surgical procedure, whereby the risks and benefits of surgery are discussed with the patient, so they are able to make decisions about their care. It is therefore important that consent forms are sufficiently detailed and accurate to ensure consent is fully informed.

Method: We performed a multi-loop audit of consent forms for patients admitted to the Royal Oldham Hospital (United Kingdom) with NOF fracture. The frequency that different risks were included on consent forms was compared to the British Orthopaedic Association (BOA)-produced standardised list of risks for NOF fracture procedures.

Results: We found that on each consent form an average of only 56.6 % of risks were included before intervention. Some significant risks such as mortality were frequently missed. Following this, we implemented changes to the consent process including the use of stickers to use on consent forms and team education sessions. We subsequently performed a second audit cycle and found that compliance had increased to 87.9 %.

Conclusion: Overall, there was poor documentation of surgical risks on consent forms, however this was improved with basic interventions. A further audit cycle should be recommended to investigate if this improvement is sustained.

Aim: This randomized controlled trial aimed to evaluate the impact of different incision types (oblique, vertical, and horizontal) for hamstring graft harvest on sensory disturbances and functional outcomes after anterior cruciate ligament (ACL) reconstruction.

Methods: A total of 118 patients were randomized into three groups: oblique incision (n = 40), vertical incision (n = 40), and horizontal incision (n = 38). Sensory deficits were assessed using Von Frey Filaments at three weeks, three months, and six months postoperatively. Functional outcomes were measured using the International Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation score at the 6-month mark. Statistical analyses included ANOVA and post-hoc tests to compare sensory disturbances across groups.

Results: At 6 months, the oblique incision group demonstrated significantly less sensory disturbance (34.7 mm² ± 38.6) than the vertical (43.8 mm² ± 39.1) and horizontal (63.4 mm² ± 42.4) incision groups (p = 0.031). No significant differences were found between the oblique and vertical incisions. The functional outcomes were comparable across all groups (P > 0.05).

Conclusion: Compared with vertical and horizontal incisions, oblique incisions for hamstring graft harvesting significantly reduced sensory disturbances without compromising functional outcomes. These findings suggest that careful selection of incision type can improve postoperative sensory outcomes in ACL reconstruction.

Introduction: Mobile-bearing (MB) inserts, designed to minimize aseptic loosening and to reduce contact stresses leading to polyethylene wear, are an alternative to fixed-bearing (FB) inserts. Most studies have shown no significant difference between MB and FB constructs, and there is limited long-term data comparing the two constructs [1,2,3,4]. The purpose of this study was to report the outcomes of a randomized controlled trial comparing MB versus FB inserts on patients with minimum 20-year follow-up.

Methods: Between 2002 and 2003, 132 patients were randomized intra-operatively to the rotating-platform (RP) prosthesis group or the FB prosthesis group. 40 patients from the previous minimum 12-year follow-up were evaluated to obtain information on implant survival and satisfaction. Basic univariate statistics were used.

Results: 26 patients were deceased, and 4 patients were lost to follow-up. This left 10 remaining knees (FB = 5, RP = 5) for inclusion. The mean age at surgery was 56.8 years, and the mean follow-up was 21 years overall for both groups. There were four failures and two revisions in total for each group 12. The RP revisions were for patellar component loosening and deep infections. The revisions on FB knees were for patella fracture and dislocation, pain from an oversized femoral component, and a loose tibial baseplate. The remaining patients expressed satisfaction with their replaced knees. No additional revisions were reported in this follow-up study. With the numbers available for study, there was no difference in ROM at 122° ± 12.5° for RP knees and 119° ± 6.5° for FB knees (p = 0.92).

Conclusions: There were few revisions, and most patients, in both RP and FB groups, expressed satisfaction and limited wear with their knees. While a safe, viable option for TKA, RP inserts did not result in long-term clinical benefit compared to FB.

The rotator cuff, a vital group of tendons and muscles in the shoulder, is essential for stabilizing the joint and enabling a wide range of arm movements. Rotator cuff tears, common across all age groups, often cause significant pain and functional limitations. Rotator cuff repair surgery aims to alleviate pain, restore function, and improve quality of life. Recent advances, particularly in arthroscopic techniques, have enhanced surgical outcomes and shortened recovery times. Nevertheless, risks remain, including surgical site infections, tendon retears, stiffness, severe postoperative pain, and nerve injuries. This article explores the complexities of rotator cuff repair, dividing complications into intraoperative and postoperative categories. Key challenges in arthroscopic techniques include ensuring optimal visualization, preventing anchor pullout, and managing chondral damage. Postoperative concerns such as infections, stiffness, and retears are also discussed, with an emphasis on preoperative skin preparation and emerging interventions like benzoyl peroxide application and platelet-rich plasma. By incorporating surgical innovations, evidence-based protocols, and comprehensive patient management, clinicians can enhance outcomes and recovery rates. The ongoing exploration of new treatments and collaborative research efforts are crucial for refining treatment protocols and advancing orthopedic patient care.

Introduction: Osteoporosis is a silent disease that is more prevalent among postmenopausal women (PMW) due to hormonal transition. Various toolkits, including the Osteoporosis Knowledge Assessment Tool (OKAT), were available for the knowledge assessment. The Osteoporosis-related knowledge is crucial for preventing osteoporosis, but there is no validated, reliable questionnaire in Tamil to measure this knowledge.

Aim: To validate the Tamil version of the OKAT (OKAT-T) and its psychometric properties to measure the knowledge of osteoporosis for use in postmenopausal women.

Methodology: This cross-sectional study was done in two phases, as translation of OKAT in Tamil and validation of OKAT-T among 430 postmenopausal women in both rural and urban regions. Reliability was examined by the Flesch reading ease (FKRE&G) and McNemar's test, along with difficulty index, item discrimination and item-total correlations, inter-item consistency (Cronbach's alpha coefficient).

Result: The overall mean age of the 430 PMW was 59.53 ± 9.83 years. The results showed a good and satisfactory face validity and FKRE&G score (55.9). The Cronbach's alpha for the overall scale was calculated as 0.85 and considered to be good and satisfactory. As per the difficulty index, 19 items had a 0.3 to 0.7, implying that the questionnaire was easy to understand and satisfactory. Similarly, a test-retest was assessed, which was statistically significant for only six items out of 26, showing that the tool has stable reliability.

Conclusion: The management of chronic disorders such as osteoporosis has become more challenging for patients especially among PMW and healthcare professionals due to the increasing life expectancy and urbanization. The use of an Osteoporosis Knowledge Assessment tool that has been tailored to people's understanding and developed in the local language can raise awareness levels about osteoporosis, encourage the adoption of osteoprotective strategies, and provide guidance on treatment options.