Knee最新文献 - Book学术

SPECT-CT may aid in determining which side of a revision stemmed implant problematic total knee replacement is loose when planning revision surgery 在计划翻修手术时，SPECT-CT 可帮助确定翻修干式植入物问题全膝关节置换术哪一侧松动

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-25 DOI: 10.1016/j.knee.2024.10.016

Daniel Hill, Patrick Rogers, Jonathan Phillips, Ben Waterson, Andrew D. Toms

Aim

To evaluate SPECT-CT in the diagnosis of single component aseptic loosening in patients with a problematic cemented stemmed TKR (Total Knee Replacement).

Methods

SPECT-CT was performed where aseptic loosening was suspected but was not clear on plain radiography. Demographics, suspected diagnosis and intention to revise were collected prospectively before and after SPECT-CT.

Results

30 patients were investigated. 43% (95% CI: 0.5–0.9) had clear evidence of loosening on SPECT-CT. In 23% (95% CI: 0.1–0.4) intention to perform revision surgery following SPECT-CT changed (7/30) (p = 0.0004, standard error = 42.1, z = 3.5).

Intentions to perform revision surgery according to the radiologist’s overall summary were:

Normal SPECT-CT – 0% (95% CI: 0.0–0.8) intention to revise (0/2).

Possibly abnormal SPECT-CT – 13% (95% CI: 0.0–0.4) intention to revise (2/15).

Definitely abnormal SPECT-CT – 77% (95% CI: 0.5–0.9) intention to revise (10/13).

We report that SPECT-CT had a test sensitivity of 90.9% (95% CI: 0.6–1.0), a specificity of 100% (95% CI: 0.9–1.0), a positive predictive value of 100% and a negative predictive value of 97.7%.

In 70% (95% CI: 0.3–0.9) of cases where revision surgery was performed for aseptic loosening SPECT-CT provided information that guided pre-operative planning with regards single component or both component revision surgery (7/10).

CONCLUSION

When positive SPECT-CT was useful in determining single component revision. A normal SPECT-CT may have a negative predictive value; however, overall half of our series had a possibly abnormal or equivocal investigation.

目的评估SPECT-CT在诊断有问题的骨水泥柄全膝关节置换术（TKR）患者单个组件无菌性松动中的作用。在 SPECT-CT 前后，前瞻性地收集了患者的人口统计学资料、疑似诊断和复查意向。43%（95% CI：0.5-0.9）的患者在 SPECT-CT 上有明确的松动证据。23%（95% CI：0.1-0.4）的患者（7/30）在SPECT-CT检查后进行翻修手术的意向发生了变化（p = 0.0004，标准误差 = 42.1，z = 3.5）。根据放射科医生的总体总结，进行翻修手术的意向为：SPECT-CT检查正常 - 0%（95% CI：0.SPECT-CT可能异常--13%（95% CI：0.0-0.4）有修改意向（2/15）.SPECT-CT肯定异常--77%（95% CI：0.5-0.9）有修改意向（10/13）。我们报告称，SPECT-CT 的检测灵敏度为 90.9%（95% CI：0.6-1.0），特异性为 100%（95% CI：0.9-1.0），阳性预测值为 100%，阴性预测值为 97.7%。在70%（95% CI：0.3-0.9）因无菌性松动而进行翻修手术的病例中，SPECT-CT提供的信息可指导单个组件或两个组件翻修手术的术前计划（7/10）。正常的SPECT-CT可能具有阴性预测价值；但是，在我们的系列研究中，有一半的研究结果可能异常或不明确。

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引用次数: 0

The third gap – The forgotten space in total knee arthroplasty 第三个缺口--全膝关节置换术中被遗忘的空间

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-23 DOI: 10.1016/j.knee.2024.10.011

William Brown , Nicola Gallagher , Dai Roberts , Richard Napier , David Barrett , David Beverland

Aims

Total Knee Arthroplasty (TKA) aims to leave the proximal flange of the femoral component flush with the femoral cortex. Manually, the requisite plane is found using the anterior femoral cortex or the intramedullary canal, whereas navigation uses hip and knee centre. Presently, no system prioritises restoration of the third space or native trochlear groove height (TGH) and there is a deficiency of published data on the variation of TGH with respect to the anterior cortex. This study aims to address this deficit. Hypothetically, restoration of the third space occurs when trochlear component depth equals TGH.

Materials and Methods

Relative to the posterior femoral axis the height of the anterior femoral cortex is higher laterally than centrally. For simplicity, this study reports MRI measurements of TGH relative to the centre in 110 normal subjects.

Results

TGH varied from the anterior femoral cortex by a mean of 2.32 mm (standard deviation, SD 1.77 mm, range −1.50 mm to 6.80 mm). If a femoral component trochlear depth of 2.2 mm is assumed, then 24.5% would be either over- or understuffed by more than 2 mm.

Conclusion

There is significant variation in TGH relative to the anterior femoral cortex. Assuming a femoral component trochlear depth of 2.2 mm, approximately one quarter of patients (24.5%) will be over- or understuffed by more than 2 mm. Variation in femoral component flexion and extension combined with whether or not it is left proud or notched will add further variation. Failure to restore the third space is likely to contribute to unsatisfactory results following TKA. Future surgical workflows should address this.

目的全膝关节置换术（TKA）的目的是使股骨近端凸缘与股骨皮质平齐。人工方法是通过股骨前皮质或髓内管找到必要的平面，而导航则是利用髋关节和膝关节中心。目前，没有任何系统优先考虑恢复第三空间或原生套骨沟高度（TGH），也没有关于TGH相对于股骨前皮质的变化的公开数据。本研究旨在解决这一不足。材料和方法相对于股骨后轴线，股骨前皮质的高度在外侧高于中央。结果TGH与股骨前皮质的差异平均为2.32毫米（标准差，SD 1.77毫米，范围-1.50毫米至6.80毫米）。如果假定股骨组件套管深度为 2.2 mm，那么 24.5% 的患者会出现超过或不足 2 mm 的情况。假设股骨组件套管深度为 2.2 毫米，则约有四分之一的患者（24.5%）会出现超过或不足 2 毫米的情况。股骨组件屈伸的不同，以及是否留有凹槽，都会增加进一步的差异。如果不能恢复第三间隙，很可能会导致 TKA 术后效果不理想。未来的手术流程应解决这一问题。

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引用次数: 0

Non-steroidal anti-inflammatory drugs influence cartilage healing 非甾体抗炎药会影响软骨愈合。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.021

Asma Sajjad Khawaja , Maria Zafar , Rana Muhammad Zeeshan , Muhammad Saad Ilyas , Amer Aziz , Uruj Zehra

Background

Retrograde intramedullary nailing is commonly performed to stabilize distal femoral shaft fractures which may lead to iatrogenic injuries of the knee articular cartilage. The limited regenerative capability of cartilage may further be hindered by intake of non-steroidal anti-inflammatory drugs (NSAIDs) which are usually advised for injuries of the musculoskeletal system. The current study was designed to evaluate the histological changes in the femoral articular cartilage of knee joint after retrograde femoral nailing of rats.

Methods

Retrograde intramedullary nailing was performed in 36 adult male Wistar rats, divided into three groups of 12 each. Groups 1 and 2 were given nonselective and selective COX 2 inhibitors, respectively, while the third group was taken as control. Half of the animals from each group were sacrificed at the second week, and remainder on the seventh week, and samples of the femoral articular cartilage were assessed for cartilage regeneration according to the modified Mankin scoring on histology while BMP-2 expression was evaluated on immunohistochemistry.

Results

Mean modified Mankin scores for cartilage degradation were increased in animals taking NSAIDs at the second and seventh weeks of healing (P = 0.02, P < 0.001 respectively). There was a significant decrease in chondrocytes at the second week (P = 0.001), along with the loss of proteoglycan content in these animals at both time points (P = 0.001). The BMP-2 expression was significantly enhanced in the control group at the second (P = 0.001) and seventh weeks (P = 0.001).

Conclusion

The results reveal that intake of NSAIDs hinders the process of cartilage healing by reducing the number of chondrocytes and loss of proteoglycan content and decreased expression of BMP-2.

背景：逆行髓内钉是稳定股骨远端骨折的常用方法，可能会导致膝关节软骨的先天性损伤。软骨的再生能力有限，摄入非甾体抗炎药（NSAIDs）可能会进一步阻碍软骨的再生，而非甾体抗炎药通常是治疗肌肉骨骼系统损伤的首选药物。本研究旨在评估大鼠股骨逆行钉入后膝关节股骨关节软骨的组织学变化：方法：36 只成年雄性 Wistar 大鼠分为三组，每组 12 只。第一组和第二组分别给予非选择性和选择性 COX 2 抑制剂，第三组为对照组。每组一半动物在第二周处死，其余动物在第七周处死，并根据组织学改良 Mankin 评分法评估股关节软骨样本的软骨再生情况，同时用免疫组化法评估 BMP-2 的表达：结果表明，服用非甾体抗炎药会减少软骨细胞的数量和蛋白多糖的含量，并降低 BMP-2 的表达，从而阻碍软骨愈合的过程。

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引用次数: 0

Three-dimensional models demonstrate differences in correction depending on femoral derotational osteotomy site and may enhance the planning and precision in femoral derotational osteotomy – An observational study in eight femora and two surgeons 三维模型显示股骨截骨部位不同，矫正效果也不同，可提高股骨截骨术的计划性和精确性 - 一项针对 8 个股骨和 2 名外科医生的观察研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.023

Caterina Chiappe , Alejandro Roselló-Añón , Vicente Sanchis-Alfonso , Joan Carles Monllau , Julio Domenech-Fernández

Background

Increased femoral anteversion (FAV) is crucial in the genesis of anterior knee pain (AKP) and a femoral derotational osteotomy (FDO) has demonstrated good clinical results. It remains unclear at what level of the femur the osteotomy should be performed. Resulting degrees of FAV measured by Murphy’s method do not always correspond to the degrees that had been planned after an FDO. The hypothesis of this study is that the femur rotation axis and the osteotomy rotation axis do not coincide. Three-dimensional (3D) technology is used to objectify the discrepancy between these two axes and to find solutions so that the two axes can coincide. The objective is to demonstrate the reliability and reproducibility of the 3D technique for osteotomy adjustment through an intraobserver and interobserver study.

Methods

Images of eight computed tomography scans of the femur, corresponding to seven patients with a diagnosis of AKP and increased FAV, were selected. Two surgeons performed the FAV measurement and simulation of FDO on 3D biomodels. The femoral osteotomies were defined at three levels, at 10°, 20°, 30°. To determine interobserver agreement, measurements were performed independently by two surgeons. To evaluate intraobserver differences each surgeon repeated all measurements after 15 days.

Results

Interobserver and intraobserver agreement: intraclass correlation coefficient 0.930 (95% confidence interval (CI) 0.799–0.975) and 0.986 (95% CI 0.959–0.995). Significant differences between the resulting values were observed when the osteotomy was performed at the intertrochanteric level.

Conclusions

The misalignment of the axes results in hypocorrection when the osteotomy is intertrochanteric. This phenomenon is not observed when the osteotomy is diaphyseal or supracondylar.

背景：股骨外翻（FAV）是导致膝前疼痛（AKP）的关键因素，而股骨外翻截骨术（FDO）具有良好的临床效果。目前仍不清楚应在股骨的哪个水平进行截骨。用 Murphy's 方法测量的 FAV 度数并不总是与 FDO 后计划的度数一致。本研究的假设是股骨旋转轴与截骨旋转轴不一致。三维（3D）技术被用来确定这两个轴线之间的差异，并找到解决方案，使两个轴线能够重合。目的是通过一项观察者内部和观察者之间的研究，证明三维技术在截骨调整方面的可靠性和可重复性：方法：选取七名确诊为 AKP 且 FAV 增高的患者的八张股骨计算机断层扫描图像。两名外科医生在三维生物模型上进行FAV测量和FDO模拟。股骨截骨分为 10°、20° 和 30°三个级别。为确定观察者之间的一致性，由两名外科医生独立进行测量。为评估观察者内部差异，每位外科医生在 15 天后重复所有测量：观察者间和观察者内的一致性：类内相关系数分别为 0.930（95% 置信区间（CI）0.799-0.975）和 0.986（95% 置信区间（CI）0.959-0.995）。在转子间水平进行截骨时，观察到结果值之间存在显著差异：结论：在转子间水平进行截骨时，轴线的错位会导致矫正不足。结论：在转子间进行截骨时，轴线的错位会导致低校正，而在二骺或髁上进行截骨时则不会出现这种现象。

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引用次数: 0

Biomechanical differences of Asian knee osteoarthritis patients during standing and walking using statistical parametric mapping: A cross-sectional study 使用统计参数映射法研究亚洲膝关节骨关节炎患者在站立和行走时的生物力学差异：横断面研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.022

Yi Hu , Phillis Teng , Tsung-Lin Wu , Ross Clark , Yong-Hao Pua , Oliver Roberts , Jia Wei Yong , Amr Alhossary , Lek Syn Lim , Desmond Y.R. Chong , Wei Tech Ang , Bryan Yijia Tan

Background

Biomechanics of knee osteoarthritis (KOA) patients have been extensively studied using motion capture systems, but less have explored standing knee joint angles with the walking parameters, particularly in Asians. We aim to determine gait biomechanical differences between healthy and KOA participants in an Asian population using One-dimensional Statistical Parametric Mapping (SPM1D) and explore if they are associated with standing joint angles.

Methods

A total of 20 KOA and 24 healthy stood upright and walked 10 m at self-selected speeds. The standing angles, walking kinematic and kinetic parameters of the ankle, knee, hip and trunk were analysed. Lower limb muscle excitation was measured via electromyography. SPM1D was used to compare the healthy group with the KOA group, and for further subgroup analysis.

Results

The all KOA group had significantly greater standing knee flexion angles (KFA) (p < 0.001), standing ankle dorsiflexion angles (ADA) (p < 0.001), walking KFA during terminal stance (p = 0.001) and terminal swing (p = 0.02) and walking ADA during terminal stance (p = 0.02) and mid-swing to terminal swing (p = 0.001). Knee adduction moment (p = 0.04) and knee flexion moment (p = 0.03) were higher in severe KOA. A positive correlation was found between standing KFA and initial KFA (R² = 0.579), and mean walking KFA (R² = 0.801) in the KOA group.

Conclusion

The increase in standing KFA was associated with an increase in walking KFA in the KOA group. Static joint angles remain as an essential parameter, although further studies need to be carried out to determine if the increase in standing joint angles can be recommended as an adjunctive measure during gait analysis of KOA using motion capture.

背景：利用运动捕捉系统对膝关节骨性关节炎（KOA）患者的生物力学进行了广泛的研究，但对站立膝关节角度与行走参数，尤其是亚洲人的站立膝关节角度的研究较少。我们的目的是利用一维统计参数映射（SPM1D）确定亚洲人群中健康和 KOA 参与者的步态生物力学差异，并探讨这些差异是否与站立关节角度有关：共有 20 名 KOA 和 24 名健康人直立行走 10 米，速度自定。分析了站立角度、踝关节、膝关节、髋关节和躯干的行走运动学和动力学参数。通过肌电图测量了下肢肌肉的兴奋性。使用 SPM1D 对健康组和 KOA 组进行比较，并进一步进行分组分析：结果：所有 KOA 组的站立膝关节屈曲角 (KFA) 明显更大（P 2 = 0.579），KOA 组的平均行走膝关节屈曲角 (R2 = 0.801)也明显更大：结论：在 KOA 组中，站立膝关节屈曲角的增加与步行膝关节屈曲角的增加相关。静态关节角度仍然是一个重要参数，但还需要进行进一步研究，以确定在使用运动捕捉对 KOA 进行步态分析时，是否可以建议将站立关节角度的增加作为一项辅助测量指标。

{"title":"Biomechanical differences of Asian knee osteoarthritis patients during standing and walking using statistical parametric mapping: A cross-sectional study","authors":"Yi Hu , Phillis Teng , Tsung-Lin Wu , Ross Clark , Yong-Hao Pua , Oliver Roberts , Jia Wei Yong , Amr Alhossary , Lek Syn Lim , Desmond Y.R. Chong , Wei Tech Ang , Bryan Yijia Tan","doi":"10.1016/j.knee.2024.10.022","DOIUrl":"10.1016/j.knee.2024.10.022","url":null,"abstract":"<div><h3>Background</h3><div>Biomechanics of knee osteoarthritis (KOA) patients have been extensively studied using motion capture systems, but less have explored standing knee joint angles with the walking parameters, particularly in Asians. We aim to determine gait biomechanical differences between healthy and KOA participants in an Asian population using One-dimensional Statistical Parametric Mapping (SPM1D) and explore if they are associated with standing joint angles.</div></div><div><h3>Methods</h3><div>A total of 20 KOA and 24 healthy stood upright and walked 10 m at self-selected speeds. The standing angles, walking kinematic and kinetic parameters of the ankle, knee, hip and trunk were analysed. Lower limb muscle excitation was measured via electromyography. SPM1D was used to compare the healthy group with the KOA group, and for further subgroup analysis.</div></div><div><h3>Results</h3><div>The all KOA group had significantly greater standing knee flexion angles (KFA) (<em>p</em> < 0.001), standing ankle dorsiflexion angles (ADA) (<em>p</em> < 0.001), walking KFA during terminal stance (<em>p</em> = 0.001) and terminal swing (<em>p</em> = 0.02) and walking ADA during terminal stance (<em>p</em> = 0.02) and mid-swing to terminal swing (<em>p</em> = 0.001). Knee adduction moment (<em>p</em> = 0.04) and knee flexion moment (<em>p</em> = 0.03) were higher in severe KOA. A positive correlation was found between standing KFA and initial KFA (<em>R</em><sup>2</sup> = 0.579), and mean walking KFA (<em>R</em><sup>2</sup> = 0.801) in the KOA group.</div></div><div><h3>Conclusion</h3><div>The increase in standing KFA was associated with an increase in walking KFA in the KOA group. Static joint angles remain as an essential parameter, although further studies need to be carried out to determine if the increase in standing joint angles can be recommended as an adjunctive measure during gait analysis of KOA using motion capture.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 155-163"},"PeriodicalIF":1.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patients submitted to re-revision ACL reconstruction present more knee laxity, more complications, and a higher failure rate than patients submitted to the first revision ACL reconstruction 与接受首次前交叉韧带翻修重建术的患者相比，接受再次前交叉韧带翻修重建术的患者膝关节更松弛，并发症更多，失败率更高。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.11.004

Camilo Partezani Helito , Andre Giardino Moreira da Silva , Riccardo Cristiani , Anders Stålman , Vitor Barion Castro de Pádua , Riccardo Gomes Gobbi , José Ricardo Pécora

Background

Few comparative studies have evaluated patients who underwent two revision anterior cruciate ligament reconstruction (ACLR) and patients who underwent one revision ACLR, and many of them have a short postoperative follow-up and a relatively small number of patients. The objective of this study is to evaluate the functional results, complications, and failure rates of patients who underwent one revision ACLR and patients who underwent two revision ACLRs.

Methods

This is a retrospective study comparing patients who underwent one revision ACLR (Group 1) with patients who underwent a re-revision ACLR (Group 2). Baseline demographic variables, operative data and post-operative data were evaluated.

Results

Among the 266 patients included, 226 were from Group 1 and 40 from Group 2. Patients in Group 2 had greater rotatory laxity and were more often subjected to associated osteotomy at the time of revision surgery. Postoperatively, patients from Group 2 reported poorer subjective IKDC score and showed greater knee laxity measured with the KT-1000 arthrometer, although both probably not clinically relevant. The complication rate was high in both groups, with a higher incidence in Group 2. Reconstruction failures were also higher in Group 2 (20% vs. 8.8%, p = 0.03).

Conclusion

Patients from Group 2 underwent a higher rate of associated osteotomy procedures, present higher complication rates and a higher failure rate compared with patients from Group 1. However, the functional scores (Lysholm and IKDC score) and the physical examination (KT-1000 and pivot-shift) did not show clinically relevant differences between the groups.

Level of Evidence

III, retrospective comparative therapeutic trial.

背景：很少有比较研究对接受过两次翻修前交叉韧带重建术（ACLR）的患者和接受过一次翻修前交叉韧带重建术的患者进行评估，而且许多研究的术后随访时间较短，患者人数相对较少。本研究旨在评估接受过一次翻修前交叉韧带重建术的患者和接受过两次翻修前交叉韧带重建术的患者的功能效果、并发症和失败率：这是一项回顾性研究，比较了接受过一次前交叉韧带翻修术的患者（第 1 组）和接受过一次前交叉韧带翻修术的患者（第 2 组）。对基线人口统计学变量、手术数据和术后数据进行了评估：在266名患者中，第一组有226人，第二组有40人。第二组患者的旋转松弛度更大，在翻修手术时更常需要进行相关的截骨手术。术后，第2组患者的IKDC主观评分较低，用KT-1000关节测量仪测量的膝关节松弛度较大，但这两点可能与临床无关。两组患者的并发症发生率都很高，其中第 2 组的发生率更高。第二组的重建失败率也更高（20% 对 8.8%，P = 0.03）：结论：与第1组患者相比，第2组患者接受相关截骨手术的比例更高，并发症发生率更高，失败率更高：证据等级：III，回顾性比较治疗试验。

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引用次数: 0

Patellar tendon–Hoffa fat pad interface: From anatomy to high-resolution ultrasound imaging 髌腱-霍法脂肪垫界面：从解剖学到高分辨率超声成像。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.024

Vincenzo Ricci , Giulio Cocco , Kamal Mezian , Ke-Vin Chang , Jorge Barbosa , Ondřej Naňka , Levent Özçakar

Aim

To propose a standardized, high-resolution ultrasound (US) protocol to assess the patellar tendon–Hoffa fat pad interface (PTHFPI) in patients with (proximal) patellar tendinopathy (PPT).

Methods

Using a high-frequency transducer and a high-level machine, we matched the cadaveric and histological microarchitecture of the PTHFPI with multiple sonographic patterns of patients with PPT. Likewise, high-sensitive color/power Doppler assessments were also performed to evaluate the microcirculation of the soft tissues beneath the patellar tendon.

Results

Modern US equipment allows for detailed assessment of the potential pain generators located inside the PTHFPI in patients with PPT. They include anterosuperior portion of the Hoffa body and the loose connective tissue of the deep paratenon with its microvascular plexus.

Conclusions

In patients with PPT, accurate sonographic assessment of the PTHFPI can be performed using adequate technological equipment. Accordingly, tailored ultrasound-guided interventions can also be planned if/when clinically indicated.

目的：提出一种标准化的高分辨率超声（US）方案，用于评估（近端）髌腱病（PPT）患者的髌腱-霍法脂肪垫界面（PTHFPI）：方法：我们使用高频换能器和高级机器，将髌腱-霍法脂肪垫界面（PTHFPI）的尸体和组织学微观结构与 PPT 患者的多种声像图模式相匹配。同样，我们还进行了高灵敏度彩色/功率多普勒评估，以评估髌腱下方软组织的微循环：结果：现代 US 设备可对 PPT 患者 PTHFPI 内部的潜在疼痛发生器进行详细评估。其中包括霍法体的前上部、髌骨旁深层的疏松结缔组织及其微血管丛：结论：使用适当的技术设备可对 PPT 患者的 PTHFPI 进行准确的超声评估。结论：使用适当的技术设备可以对 PTHFPI 患者进行准确的超声波评估，因此，如果/当临床需要时，也可以计划进行有针对性的超声波引导干预。

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引用次数: 0

The effect of frontal plane osteotomy angle on lateral cortex fracture in medial open wedge high tibial osteotomy procedure 额面截骨角度对内侧开放式楔形高胫骨截骨术外侧皮质骨折的影响

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-16 DOI: 10.1016/j.knee.2024.10.007

Alper Kirilmaz , Mustafa Özkaya , Turgut Emre Erdem , Faik Türkmen

Background

Precise high tibial osteotomy is crucial, especially for middle-aged individuals with medial compartment arthritis, aiming to prevent complications like lateral cortex fractures. This study explores how frontal plane osteotomy inclination impacts lateral cortex fractures during medial open-wedge high tibial osteotomy.

Methods

Using finite element analysis, tibia models underwent osteotomies at angles of 10°, 13°, 16°, 19°, and 22°, forming five models. Forces from 5 N to 75 N were applied incrementally, recording bone stresses (MPa) at the lateral hinge, angle changes (°) along the osteotomy line, and gap distances (mm).

Results

Models with higher frontal inclination showed increased gap distances under identical forces. For instance, at 5 N force, the 10° inclination model displayed a correction angle of 0.28° and a 1.43 mm gap, while the 22° model had a correction angle of 0.35° and a 1.37 mm gap. Under 75 N force, the 10° model had a correction angle of 10.81° and a 14.02 mm gap, while the 22° model had a correction angle of 16.86° and a 19.31 mm gap.

Conclusion

The osteotomy starting point’s distance from the joint doesn’t significantly impact final stress on the lateral cortex when the same gap distance is achieved. However, in cases requiring a higher degree of correction, we can say that the surgeon can achieve the result with less resistance by keeping the osteotomy starting point more distal to the joint line.

背景：精确的胫骨高位截骨术至关重要，尤其是对于患有内侧室关节炎的中年人，其目的是防止外侧皮质骨折等并发症。本研究探讨了在内侧开刃高胫骨截骨术中，额平面截骨倾斜度对外侧皮质骨折的影响：通过有限元分析，对胫骨模型进行了角度为 10°、13°、16°、19°和 22°的截骨，形成了五个模型。施加的力从 5 牛到 75 牛不等，记录外侧铰链处的骨应力（兆帕）、沿截骨线的角度变化（°）和间隙距离（毫米）：结果：在相同作用力下，前倾角越大的模型间隙距离越大。例如，在 5 牛顿力的作用下，10°倾角模型的矫正角度为 0.28°，间隙为 1.43 毫米，而 22°倾角模型的矫正角度为 0.35°，间隙为 1.37 毫米。在 75 N 的力作用下，10° 模型的矫正角度为 10.81°，间隙为 14.02 mm，而 22° 模型的矫正角度为 16.86°，间隙为 19.31 mm：结论：当间隙距离相同时，截骨起点与关节的距离对外侧皮质的最终应力影响不大。然而，在需要更高程度矫正的病例中，我们可以说，外科医生可以通过将截骨起点保持在距关节线更远的位置，以更小的阻力达到矫正效果。

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引用次数: 0

The impact of different types of physical activity on the risk of knee osteoarthritis: A Mendelian randomization study 不同类型的体育锻炼对膝关节骨性关节炎风险的影响：孟德尔随机研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-16 DOI: 10.1016/j.knee.2024.10.019

Guiguan Wang , Long Chen , Yancheng Chen , Jie Xu

Background

We aim to evaluate the causal relationship between different types of physical activity and the risk of knee osteoarthritis (KOA) through a two-sample Mendelian randomization study.

Methods

We performed a two-sample Mendelian randomization analysis using publicly available Genome-wide association study associated with physical activity (460 376 individuals) and KOA (403 124 individuals). Two-sample Mendelian randomization analyses were performed to investigate the effects of exposure traits on KOA risk.

Results

In this Mendelian randomization analysis, we investigated the impact of different types of physical activity on the risk of KOA. Light do-it-yourself and walking for pleasure demonstrated a protective effect on the risk of KOA (P = 8.19 × 10−4 and P = 4.24 × 10−6, respectively). No statistically significant differences were observed for heavy do-it-yourself, strenuous sports, other exercises or physical inactivity.

Conclusion

This study has revealed that engaging in light do-it-yourself activities and walking may serve as potential protective factors against KOA. These findings underscore the significance of introducing such activities into public health strategies designed for the prevention and management of KOA. Additional research is warranted to reveal the underlying mechanisms further.

研究背景我们旨在通过一项双样本孟德尔随机研究，评估不同类型的体育锻炼与膝关节骨性关节炎（KOA）风险之间的因果关系：我们利用公开的与体育锻炼（460 376 人）和 KOA（403 124 人）相关的全基因组关联研究进行了双样本孟德尔随机分析。结果表明，暴露特质对KOA风险的影响是双样本孟德尔随机分析的结果：在这项孟德尔随机分析中，我们研究了不同类型的体育锻炼对 KOA 风险的影响。轻度自己动手和为娱乐而步行对 KOA 风险有保护作用（P = 8.19 × 10-4 和 P = 4.24 × 10-6）。重体力劳动、剧烈运动、其他锻炼或缺乏运动在统计学上没有明显差异：本研究揭示了参与轻度动手活动和步行可能是预防 KOA 的潜在保护因素。这些发现强调了在预防和管理 KOA 的公共卫生战略中引入此类活动的重要性。要进一步揭示其潜在机制，还需要进行更多的研究。

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引用次数: 0

In vivo kinematics during step ascent: Changes to the knee associated with osteoarthritis 台阶上升过程中的活体运动学：与骨关节炎相关的膝关节变化。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-16 DOI: 10.1016/j.knee.2024.10.018

Owen J. Rabak , Jacob A Devenish , Diana M Perriman , Jennie M Scarvell , Catherine R Galvin , Paul N Smith , Mark R Pickering , Joseph T Lynch

Background

Stair climbing is a kinematically demanding activity, essential for maintaining independence and quality of life, yet is often impaired in patients with knee osteoarthritis (OA). The purpose of this study was to examine differences in kinematics of a step-up movement between participants with osteoarthritis and asymptomatic controls.

Methods

Thirty participants with end-stage OA awaiting total knee arthroplasty (TKA) and twenty-eight sex and age-similar asymptomatic participants were recruited. Participants performed a step-up task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Kinematic variables of position, displacement, and rate-of-change in six degrees of freedom were compared between the two groups.

Results

OA knees exhibited significantly different kinematics to asymptomatic knees during step-up. Knees with OA demonstrated a reduced terminal extension angle, inferior translation and increased internal rotation throughout the movement compared to asymptomatic. OA participants exhibited more variability in kinematic parameters compared to asymptomatic controls, reflecting the heterogeneity within OA pathology.

Conclusion

The findings of this study indicate that knee kinematics, particularly rotation, differ significantly between OA and asymptomatic knees during step-up. Optimising rotational profiles in OA knee management could help optimise patient function and inform rehabilitation and surgical protocols.

背景：爬楼梯是一项对运动学要求很高的活动，对保持独立性和生活质量至关重要，但膝关节骨性关节炎（OA）患者的爬楼梯能力往往会受到影响。本研究的目的是检查骨关节炎患者与无症状对照组患者在上台阶运动中的运动学差异：方法：招募了 30 名等待进行全膝关节置换术（TKA）的终末期 OA 患者和 28 名性别和年龄相似的无症状患者。参试者通过单平面透视进行上台阶操作。三维假体计算机辅助设计模型与透视成像进行了注册，从而获得了体内运动学数据。对两组的位置、位移和六个自由度的变化率等运动变量进行了比较：结果：在上台阶时，有 OA 的膝关节与无症状膝关节的运动学表现明显不同。与无症状膝关节相比，患有 OA 的膝关节在整个运动过程中表现出末端伸展角度减小、下移和内旋增加。与无症状对照组相比，OA 参与者的运动学参数表现出更大的变异性，这反映了 OA 病理学的异质性：本研究结果表明，膝关节运动学，尤其是旋转，在上台阶时，OA 膝关节和无症状膝关节之间存在显著差异。在膝关节OA治疗中优化旋转曲线有助于优化患者功能，并为康复和手术方案提供参考。

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