Knee最新文献

Background: Meniscal tears are common intra-articular knee injuries that cause pain, swelling, and impaired mobility. Although magnetic resonance imaging (MRI) remains the diagnostic gold standard, interest is increasing in hematological and inflammatory indices as potential adjunctive biomarkers reflecting inflammatory activity.

Purpose: To examine the relationship between meniscal tears and systemic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), neutrophil-to-platelet ratio (NPR), and systemic immune-inflammation index (SII), and to assess their diagnostic performance.

Methods: A retrospective case-control study was conducted at Tepecik Training and Research Hospital, comprising 286 participants 143 patients with MRI-confirmed meniscal tears and 143 age- and sex-matched healthy controls. Hematological indices were derived from complete blood counts. Between-group comparisons were performed using the Mann-Whitney U and chi-square tests, correlations were evaluated by Spearman's analysis, and receiver operating characteristic (ROC) curves assessed discriminative ability.

Results: Meniscal tear patients showed significantly lower MPV (p < 0.001) and NLR (p < 0.001), but higher NPR (p = 0.023) compared to controls. No significant difference was observed for SII (p = 0.740). Smoking was associated with higher MPV-to-lymphocyte ratio (p = 0.007). ROC analysis indicated weak discrimination for NPR (AUC = 0.578, p = 0.023) and poor performance for SII (AUC = 0.511).

Conclusion: Inflammatory indices, particularly NPR, may reflect systemic inflammatory changes related to meniscal tears. While their diagnostic utility alone is limited, they may serve as supportive tools alongside imaging in evaluating meniscal pathology.

Purpose: Lower limb torsion affects the accuracy of knee coronal alignment measurements, which has an impact on the planning for surgical management of knee osteoarthritis (KOA). Current computed tomography (CT) scans for evaluating torsion are costly and cannot be performed for every case. This study aimed to investigate the relationship between distal and proximal tibio-fibular overlap ratio measured on long-limb radiographs with femoral and tibial torsion quantified by CT scan in an Asian population with KOA.

Methods: A retrospective analysis was performed on patients who were planned for robotic total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) between September 2018 and April 2024 in a single tertiary institution. Proximal and distal tibio-fibular overlap was defined as the longest overlapping length between the medial cortex of the fibula and the lateral cortex of the tibia, measured on weight-bearing long-leg radiographs. Femoral and tibial torsion were assessed on CT images using the Lee and bimalleolar method, respectively. Spearman's rank correlation coefficient was used to examine associations between the tibio-fibular overlap ratio and tibial and femoral torsion. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the overlap ratio to discriminate between increased and decreased torsion, with area under the curve (AUC), sensitivity, and specificity reported. Inter- and intra-observer reliability were assessed using intraclass correlation coefficients (ICCs) in a random sample of 30 patients.

Results: A total of 217 patients were included (74 males and 143 females; 66.3 ± 8.8 years old). The median tibio-fibular overlap ratio and femoral torsion was 0.9 (0.7-0.8) and 26.9° (-10.7° to 7°), respectively. The mean tibial torsion was 20.7° + 8.55°. Overall, a moderate positive Spearman correlation of tibio-fibular overlap ratio with tibial torsion (ρ = 0.54, P < 0.001) was observed. ROC analysis for tibio-fibular overlap ratio in predicting both decreased (AUC 0.91 ± 0.05; 95%, CI 0.81-0.99) and increased tibial torsion (AUC 0.77 ± 0.07; 95%, CI 0.64-0.90) was excellent and acceptable, respectively. For predicting low tibial torsion, the optimal cut-off was <0.5 (sensitivity 99%, specificity 82%). For predicting high tibial torsion, the optimal cutoff was >0.8 (sensitivity 76%, specificity 71%). Reliability analysis revealed excellent intra-observer and interobserver reliability.

Conclusion: This study suggests the utility of the tibio-fibular overlap ratio as a potential screening tool for underlying tibia torsional deformity. Further evaluation of tibial torsion is recommended for knees with tibio-fibular overlap ratio of <0.5 or >0.8.

Aim: To define the Patient-Acceptable Symptom State (PASS) in the Oxford Knee Score (OKS) following total knee arthroplasty (TKA) and identify independent preoperative factors associated with failure to achieve this threshold.

Methods: A retrospective cohort of 3304 patients undergoing primary TKA who completed preoperative and 6-month OKS was identified from an arthroplasty registry. The PASS was defined using receiver operating curve analysis, using patient satisfaction at 6 months as the anchor. Regression analysis was used to identify independent preoperative predictors of achieving the PASS.

Results: The PASS was defined as OKS ≥31 (area under the curve [AUC] 0.865, 95% CI 0.850-0.881) with 2333 (70.6%) patients achieving this. Patients not achieving a PASS were younger, had a higher BMI, and worse baseline PROMs (all p < 0.001). Higher preoperative OKS (odds ratio [OR] 1.09 per point) and EQ-VAS (OR 1.01 per point) were independently associated with achieving a PASS (both p < 0.001). A preoperative OKS ≤19 was associated with achieving a PASS (AUC 0.707). PASS achievers were more likely to be satisfied (OR 15.3, p < 0.001), though 54.4% of non-achievers were also satisfied.

Conclusion: The PASS was defined as ≥31 points in the OKS at 6 months following TKA. Lower preoperative OKS and EQ-VAS scores were associated with failure to achieve this threshold. While PASS attainment was associated with patient satisfaction, 54% of those not achieving a PASS were still satisfied, highlighting a limitation of this PROM threshold in isolation.

Level of evidence: Retrospective study, Level III.

Introduction: Knee arthroplasty is an effective treatment option for managing advanced osteoarthritis and rheumatoid arthritis, even in elderly patients. However, super-elderly patients face increased risks of postoperative complications such as in-hospital mortality, deep vein thrombosis, pneumonia, cerebrovascular events, and cognitive dysfunction. This study aims to analyze postoperative complications in super-elderly patients (aged 85 years and older) and elderly patients (aged 70-84 years) who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) using Japan's nationwide DPC database. The analysis was conducted after adjusting for confounding factors through propensity score matching.

Methods: We conducted a retrospective study of 200,925 patients who underwent TKA or UKA between 2016 and 2023. After propensity score matching (1:1) based on age, sex, body mass index, surgical method, and comorbidities, 21,117 patients were included in each group. Postoperative complications, including in-hospital mortality, deep vein thrombosis, pneumonia, cerebrovascular events, and cognitive dysfunction, were analyzed. Multivariate logistic regression identified independent risk factors for postoperative complications.

Results: The super-elderly group exhibited higher odds ratios for pneumonia (2.227, 95% CI: 1.494-3.319), cerebrovascular events (1.720, 95% CI: 1.305-2.266), and cognitive dysfunction (1.767, 95% CI: 1.485-2.103). They also had more extended hospital stays and higher blood transfusion requirements. However, no significant differences were observed for deep vein thrombosis, pulmonary embolism, or in-hospital mortality.

Conclusion: Super-elderly patients exhibit increased risks for certain complications, though not for mortality. When clinically appropriate, performing knee arthroplasty before the age of 85 may help reduce these risks.

Background: Total knee arthroplasty (TKA) and distal femoral replacement (DFR) can be used in limb-salvage after resection of bony tumors, but few reports have examined patient-reported outcome measurements (PROMs) with survival data in young patients. This study analyzed individuals who underwent TKA/DFR for neoplasm at a young (≤40) age, to report outcomes and survival experience.

Methods: A retrospective study on 12 TKAs/23 DFRs was conducted between January 1990-2020 in 35 patients ≤40 years old. Electronic medical records were reviewed to identify patients with neoplasm, and collect data. Patients were contacted to obtain PROMs.

Results: The median age (interquartile range) at surgery for TKAs and DFRs was 26.7 (22.7-34.0) and 24.6 years (20.9-28.4), respectively. Median follow-up was 3.95 (0.33-8.14) and 3.01 years (1.72-6.07). TKAs were more commonly due to complications after allograft reconstruction (75.0% vs. 0.00%, p < 0.0001), had lower blood loss (250 vs. 800 ml, p = 0.01) and a higher rate of tourniquet use (75.0% vs. 34.8%, p = 0.04). Revision-free survival (8-year) was 54.7% (95% confidence interval (CI): 13.7%-83.3%) for TKAs and 37.9% (95% CI: 10.4%-66.0%, p = 0.12) for DFRs. For TKAs, median KOOS Jr. was 76.3 (76.3-79.9), VR-12-Physical was 50.0 (40.5-51.7), VR-12-Mental was 40.8 (32.6-45.8), LEAS was 12.0 (12.0-13.0), and FJS was 23.0 (19.0-25.0), without statistical difference from the DFR group.

Conclusion: Patients ≤40 years old who underwent TKAs/DFRs for neoplastic disease demonstrated a similarly high postoperative complication rate and poor long-term survival. Almost all PROMs were favorable, reflecting a more promising postoperative experience than survival curves might demonstrate.

Background: There are several orthotic treatment options for knee osteoarthritis. Ankle-foot orthosis (AFO) is a new approach in this regard; it is designed to reduce knee joint loading and consequently reduce the joint cartilage degeneration process. Previous studies considered the knee adduction moment as a surrogate marker for knee joint loading and knee joint contact force was not measured precisely. Moreover, the effect of this orthosis on joint kinematic and ground reaction force was not evaluated in previous studies. Thus, the aim of this study was to evaluate the gait kinetic parameters including joint moment and joint contact force and kinematic parameters of patients with medial knee compartment osteoarthritis using AFO.

Methods: Ten women with knee osteoarthritis participated in this study. Patients were assessed in two conditions: walking with and without AFO (Agilium Freestep®, Ottobock, Duderstadt, Germany). Thirty-six reflective markers were attached on lower limb anatomical landmarks of patients and a motion analysis system and a Kistler force plate were used to monitor the markers' motion and collect the forces applied on the legs, respectively. OpenSim software was used to measure knee joint kinematic, moments and estimate knee joint contact force.

Results: The current study showed that immediately after wearing AFO, stride length significantly decreased (1.141 ± 0.103 vs. 1.101 ± 0.095 m, P = 0.02). Moreover, the second peak of vertical ground reaction force decreased significantly (1.034 ± 0.035 vs. 1.013 ± 0.030, P = 0.02). Immediately after wearing the AFO, no statistically significant changes were observed in the knee joint contact force components or in the ankle and knee ranges of motion.

Conclusion: No statistically significant difference was observed immediately after wearing Agilium AFO regarding its effect on reducing knee joint contact force and sagittal knee moment. It is important to note that due to the small sample size and the short-term nature of this study, the generalizability of these findings is limited. Further research with larger cohorts and longer follow up periods is recommended to clarify and confirm these preliminary findings. However, therapists could consider recommending this AFO for osteoarthritic knee patients to potentially decrease knee joint loading, especially for those who cannot tolerate knee orthoses.

Purpose: The Knee Self-Efficacy Scale (K-SES) is widely used to assess patients' confidence after knee injury, but no validated Persian version exists, limiting its use in Persian-speaking populations. This study aimed to translate, adapt, and evaluate the psychometric properties of the Persian-language versions of the K-SES (K-SES-Persian).

Methods: One hundred and six Persian patients with knee injuries were recruited from orthopedic and physiotherapy centers. Construct validity was examined using confirmatory factor analysis and Pearson correlations. Reliability was assessed by Cronbach's alpha and intraclass correlation coefficients (ICC). Convergent validity was tested with the Oxford Knee Score (OKS) and Knee outcome survey activities for daily living (KOS-ADL). Test-retest reliability was assessed in 53 patients after 7-8 days.

Results: The K-SES-Persian showed excellent internal consistency for total score (α = 0.965). An excellent internal consistency (α = 0.953) was shown for present score and good internal consistency (α = 0.898) for the future score. The factor loading for each item was greater than 0.70. The K-SES-Persian showed significant correlations with the OKS (r = 0.37, 95% CI: 0.19-0.53, p < 0.001) and the KOS-ADL (r = 0.33, 95% CI: 0.15-0.49, p = 0.001). A significant but weak correlation was found between the OKS and KOS-ADL (r = 0.219 p = 0.024), indicating limited consistency between the comparator measures used for evaluating the convergent validity of the K-SES-Persian. No floor or ceiling effects were observed.

Conclusions: The K-SES-Persian was successfully adapted and demonstrated sound psychometric properties, including construct validity, internal consistency, and test-retest reliability, with internal consistency varying across subscales, supporting its use among Persian-speaking patients with knee injuries.