Knee最新文献 - Book学术

Accuracy amidst errors: Evaluating a commercially available wearable sensor system and its associated calibration procedures for monitoring sagittal knee motion in patients undergoing total knee arthroplasty

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-01 DOI: 10.1016/j.knee.2025.03.001

Ryan M. Chapman , Kelly B. Taylor , Emily Kaczynski , Shayan Khodabakhsh , Skye Richards , Jayson B. Hutchinson , Robert C. Marchand

Background

Commercially available wearable sensors monitoring knee range of motion (ROM) are gaining traction in orthopaedics, but few studies validate against optical motion capture (MOCAP) in total knee arthroplasty (TKA) patients. Furthermore, wearable calibration is essential for accurate measurements, yet few investigations evaluate calibration and ROM accuracy. This study assessed one commercial wearable sensor system’s calibration (goniometric versus MOCAP) and sagittal knee angle computation accuracy in TKA patients during activities.

Methods

Twenty TKA patients were recruited (5 lost to follow-up). Following a sensor tutorial (MotionSense, Stryker, Mahwah, NJ), participants self-applied sensors for pre-TKA data capture. TKA was then performed by one surgeon followed by identical post-TKA data captures. MOCAP and wearable sensor data were collected during activities. MOCAP sagittal knee angles (θ_MOCAP) were compared to two wearable sensor knee angles: 1) θ_CalGoni = goniometric calibration, 2) θ_CalMOCAP = MOCAP calibration. Two-way ANOVAs evaluated the impact of time (pre-TKA vs. post-TKA) and calibration type (goniometry vs. MOCAP) on calibration angles and wearable sensor error. Variance equality tests compared pre-TKA vs. post-TKA and goniometric vs. MOCAP calibration.

Results

No significant differences were noted pre-TKA vs. post-TKA. Calibration angles differed significantly with goniometry yielding significantly more error than MOCAP. MOCAP calibration reduced error below clinically acceptable levels (<5°) during activities and with significantly less error variance.

Conclusion

MOCAP calibration significant improved accuracy of knee angle computations to acceptable levels (<5°). Accordingly, these wearables are suitable for continuous knee ROM monitoring after calibrating with correct angles, Future studies should investigate specific activities and sensor misplacement on angle measurements.

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引用次数: 0

Comparison of ultrasonography findings of patients with patellofemoral pain and healthy controls

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-01 DOI: 10.1016/j.knee.2025.03.003

Derya Karacif , Onur Karacif , Ayla Cagliyan Turk , Handan Elif Nur Bayraktar

Background

The aim of this study was to compare knee ultrasonography findings in patients with Patellofemoral Pain (PFP) and healthy controls.

Methods

Our cross-sectional study included 54 participants, 27 patients with PFP and 27 healthy controls. Medial and lateral retinaculum thickness, trochlear cartilage thickness and patellofemoral distances were measured by ultrasonography In the PFP group, pain intensity at rest and during activity was assessed by Visual Analogue Scale (VAS, 0–10 cm), functional status was assessed by Kujala Patellofemoral Pain Scoring system. The quality of life of both groups was evaluated with the Short Form-36 (SF-36).

Results

The groups were similar in terms of age, gender, body mass index (BMI), marital status, educational level and dominant extremity. In the PFP group, medial and lateral retinaculum thickness, medial patellofemoral distance were found to be significantly higher (mean difference [MD]:1.08; 95% confidence interval [CI]:0.87–1.28, MD:0.80; 95%CI:0.59–1.01, MD:5.65; 95%CI:4.68–6.61, respectively), while medial and lateral cartilage thickness were found to be significantly lower than the control group (MD:1.32; 95%CI:1.0–1.64, MD:-1.56; 95%CI:-1.86--1.26, respectively). There was no significant difference in lateral patellofemoral distance between the two groups (p = 0.752). No statistically significant correlation was found between ultrasonography measurements and age, BMI, pain duration, Kujala score, VAS scores at rest and during activity and SF-36 subgroup scores in the PFP group.

Conclusion

In our study, medial retinaculum thickness, lateral retinaculum thickness and medial patellofemoral distance were statistically significantly higher and medial and lateral trochlear cartilage thickness were lower in the PFP group compared to the control group.

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引用次数: 0

Synovial D-dimer is a novel and accurate test for diagnosis of chronic knee periprosthetic joint infection

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-19 DOI: 10.1016/j.knee.2025.02.027

Zirvecan Güneş , Mehmet Kürşat Yılmaz , Bahattin Kemah , Ömür Çağlar , Ahmet Mazhar Tokgözoğlu , Javad Parvizi , İbrahim Azboy , Bülent Atilla

Background

Despite numerous tests and guidelines, diagnosing periprosthetic joint infection (PJI) remains challenging. The study aimed to determine the value of synovial D-dimer, rather than serum, in diagnosing PJI.

Methods

This prospective study enrolled 17 patients with chronic knee PJI (the PJI group) and 52 with primary knee osteoarthritis (the control group). PJI was defined using the 2018 International Consensus Meeting Criteria. Synovial D-dimer, plasma D-dimer, serum erythrocyte sedimentation rate, and serum C-reactive protein levels were measured. Synovial fluid D-dimer levels were determined using an enzyme-linked fluorescence assay. The performance of each biomarker in diagnosing PJI was evaluated using receiver operating characteristic (ROC) curves.

Results

The median synovial D-dimer level was significantly higher in the PJI group at (927,095 ng/ml, IQR 566,882–1,215,066) than in the control group (20,954 ng/ml, IQR 10,350–46,493) (P < 0.001). When the synovial D-dimer threshold value was determined to be 236,804 ng/ml, the sensitivity was 100% (CI 93.2–100%), and the specificity was 94.12% (95% CI 71.3–99.9). The area under the curve determined by ROC analysis was 0.992 (95% CI 0.992–1.000, P < 0.0001).

Conclusions

Patients with chronic knee PJI have significantly high synovial D-dimer levels, demonstrating that an increase in fibrinolytic activity coexists with an infection-induced inflammatory response. Synovial D-dimer levels appear to be valuable biomarkers for diagnosing PJI. However, further studies are required to evaluate the role of this novel biomarker.

背景：尽管有许多检查和指南，但诊断假体周围关节感染（PJI）仍具有挑战性。本研究旨在确定滑膜 D-二聚体而非血清在诊断 PJI 中的价值：这项前瞻性研究招募了 17 名慢性膝关节 PJI 患者（PJI 组）和 52 名原发性膝关节骨关节炎患者（对照组）。PJI采用2018年国际共识会议标准进行定义。测定了滑膜D-二聚体、血浆D-二聚体、血清红细胞沉降率和血清C反应蛋白水平。使用酶联荧光测定法测定滑膜液 D-二聚体水平。使用接收器操作特征曲线（ROC）评估了每种生物标记物诊断 PJI 的性能：结果：PJI 组滑膜 D-二聚体水平中位数（927 095 ng/ml，IQR 566 882-1215 066）明显高于对照组（20 954 ng/ml，IQR 10 350-46 493）（P 结论：PJI 组滑膜 D-二聚体水平中位数（927 095 ng/ml，IQR 566 882-1215 066）明显高于对照组（20 954 ng/ml，IQR 10 350-46 493）：慢性膝关节PJI患者的滑膜D-二聚体水平明显偏高，这表明纤溶活性的增加与感染引起的炎症反应同时存在。滑膜 D-二聚体水平似乎是诊断 PJI 的重要生物标志物。然而，还需要进一步的研究来评估这种新型生物标志物的作用。

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引用次数: 0

Restoration of anatomical knee phenotype is associated with improved postoperative clinical outcomes after total knee arthroplasty

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-19 DOI: 10.1016/j.knee.2025.02.028

Hong Yeol Yang, Jae Hyeok Cheon, Jae Yeon Hwang, Jong Keun Seon

Background

A comprehensive assessment of knee phenotypes is crucial for optimizing surgical realignment strategies in total knee arthroplasty (TKA). This study aimed to investigate the relationship between the restoration of preoperative phenotypes, such as joint line orientation (JLO) and alignment, and clinical outcomes following TKA.

Methods

A retrospective review was performed on the records of 1052 primary osteoarthritic knees that underwent mechanically aligned (MA) TKA between March 2016 and October 2021. Patient-reported outcome measures (PROMs) were assessed preoperatively and at 2 years postoperatively. Patients were categorized according to the coronal plane alignment of the knee (CPAK) classification system, which incorporates the arithmetic hip–knee–ankle angle (aHKA) as an indicator of constitutional alignment and JLO. Clinical outcomes were compared between patients whose knee phenotype was maintained and those in whom it was not restored.

Results

Among osteoarthritic knees, the majority (59.4%) were classified as CPAK type I (varus aHKA, apex distal JLO) preoperatively. Using mechanical axis techniques, the native phenotype was restored in 127 (12.1%) of the 1052 cases. These patients demonstrated significantly better postoperative clinical outcomes, as measured by WOMAC function and Forgotten Joint Scores (FJS), compared with the non-restored group (P < 0.05). When alignment was adjusted through detailed analyses of patients with maintained alignment between preoperative and latest follow up assessments, the significant differences in WOMAC function and FJS outcomes between restored JLO and non-restored JLO groups persisted (all P < 0.05). No significant association was observed between the restoration of aHKA and clinical outcomes.

Conclusion

The restoration of the anatomical knee phenotype, particularly JLO, is associated with improved postoperative PROMs, notably in functional outcomes, following TKA. These findings underscore the clinical importance of prioritizing preoperative JLO for optimizing surgical outcomes, rather than focusing exclusively on overall limb alignment.

背景：全面评估膝关节表型对于优化全膝关节置换术（TKA）的手术对位策略至关重要。本研究旨在探讨关节线方向（JLO）和对位等术前表型的恢复与全膝关节置换术后临床疗效之间的关系：对2016年3月至2021年10月期间接受机械对位（MA）TKA的1052个原发性骨关节炎膝关节的记录进行了回顾性审查。对术前和术后两年的患者报告结果指标（PROMs）进行了评估。根据膝关节冠状面对位（CPAK）分类系统对患者进行分类，该系统将算术髋-膝-踝角度（aHKA）作为宪法对位和JLO的指标。对膝关节表型得以保持的患者与膝关节表型未能恢复的患者的临床疗效进行了比较：结果：在骨性关节炎膝关节中，大多数（59.4%）患者术前被归类为 CPAK I 型（aHKA 曲张，JLO 顶端远端）。利用机械轴技术，1052 例病例中有 127 例（12.1%）恢复了原生表型。根据 WOMAC 功能和遗忘关节评分（FJS），与未恢复组相比，这些患者的术后临床疗效明显更好（P 结论：术后临床疗效明显优于未恢复组）：膝关节解剖表型的恢复，尤其是 JLO 的恢复，与 TKA 术后 PROMs 的改善有关，尤其是在功能预后方面。这些发现强调了优先考虑术前 JLO 以优化手术效果的临床重要性，而不是只关注整体肢体对齐情况。

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引用次数: 0

Application of machine learning in the context of reoperation, outcome and management after ACL reconstruction – A systematic review

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-18 DOI: 10.1016/j.knee.2025.02.032

Julius Michael Wolfgart , Ulf Krister Hofmann , Maximilian Praster , Marina Danalache , Filipo Migliorini , Martina Feierabend

Introduction

Machine learning-based tools are becoming increasingly popular in clinical practice. They offer new possibilities but are also limited in their reliability and accuracy.

Objectives

The present systematic review updates and discusses the existing literature regarding machine learning algorithm-based tools to predict outcome and management in patients after ACL reconstruction.

Method

PubMed was searched for articles containing machine learning algorithms related to anterior cruciate ligament reconstruction and its outcome and management. No additional filters or time constraints were used. All eligible studies were accessed by hand.

Results

After screening of 115 articles, 15 were included. Six studies evaluated predictors for reoperation after ACL surgery. Four studies investigated the clinical outcome prediction after ACL reconstruction including prediction of secondary meniscus tear and secondary knee osteoarthritis. Single topics addressed in patients with ACL reconstruction were costs, opioid use, the need for a femoral nerve block, short term complications, hospital admission, and reduction of the burden to complete the Knee Osteoarthritis and Outcome score questionnaire. Predictive power was very heterogeneous, depending on the specific research question and parameters included.

Conclusion

New machine-learning tools offer interesting insights into variables affecting the target outcome and general management of patients with ACL reconstruction. While present machine-learning based prediction models seem to outperform previous existing benchmark regression models, their predictive ability often is still too low to base individual decision making on them. With the rapid progress observed over the last few years, it is conceivable that this might change, however, in the foreseeable future.

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引用次数: 0

Dynamic ultrasound-based determination of the optimal knee position for pullout fixation of medial meniscus posterior root tears

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-14 DOI: 10.1016/j.knee.2025.02.029

Haruhiko Nakamura, Atsuto Hoshikawa, Kei Sato, Ryota Takei, Risa Matsumoto, Hiroshi Inui, Kazuo Saita

Purpose

A larger medial meniscus extrusion (MME) predicts a poorer prognosis after arthroscopic pullout fixation for medial meniscus posterior root tears (MMPRT). However, the optimal knee position in surgery for MMPRT to reduce MME is unclear. We evaluated the MME at various knee positions used for medial fixation.

Methods

We enrolled 20 patients who underwent MMPRT repair and performed ultrasonography preoperatively under anaesthesia, before fixation (both with or without traction), and post-fixation. MMEs were measured in positions A, B, C, and D (supine with the leg dropped from the bed with the knee flexed; valgus stress knee; figure-of-four; and supine with the injured knee flexed over the bed, respectively) at different time points and compared. Surgical fixation was performed in Position B.

Results

The preoperative mean MMEs at positions A, B, C, and D were 1.5, 1.4, 5.8, and 3.6 mm, respectively, and MMEs at A and B were significantly smaller than those at C and D, whereas the MME at C was significantly larger than that at D. The intraoperative mean MMEs, at positions B and C, before traction, with traction, and post-fixation were 1.2 and 5.5 mm, 0.7 and 4.3 mm, and 0.9 and 2.3 mm, respectively.

Conclusion

During MMPRT repair, MMEs increased in the figure-of-four position, but decreased with pullout fixation in the valgus stress knee position. Therefore, the valgus stress knee position is suitable for pullout fixation in MMPRT repair.

Level of Evidence

IV.

{"title":"Dynamic ultrasound-based determination of the optimal knee position for pullout fixation of medial meniscus posterior root tears","authors":"Haruhiko Nakamura, Atsuto Hoshikawa, Kei Sato, Ryota Takei, Risa Matsumoto, Hiroshi Inui, Kazuo Saita","doi":"10.1016/j.knee.2025.02.029","DOIUrl":"10.1016/j.knee.2025.02.029","url":null,"abstract":"<div><h3>Purpose</h3><div>A larger medial meniscus extrusion (MME) predicts a poorer prognosis after arthroscopic pullout fixation for medial meniscus posterior root tears (MMPRT). However, the optimal knee position in surgery for MMPRT to reduce MME is unclear. We evaluated the MME at various knee positions used for medial fixation.</div></div><div><h3>Methods</h3><div>We enrolled 20 patients who underwent MMPRT repair and performed ultrasonography preoperatively under anaesthesia, before fixation (both with or without traction), and post-fixation. MMEs were measured in positions A, B, C, and D (supine with the leg dropped from the bed with the knee flexed; valgus stress knee; figure-of-four; and supine with the injured knee flexed over the bed, respectively) at different time points and compared. Surgical fixation was performed in Position B.</div></div><div><h3>Results</h3><div>The preoperative mean MMEs at positions A, B, C, and D were 1.5, 1.4, 5.8, and 3.6 mm, respectively, and MMEs at A and B were significantly smaller than those at C and D, whereas the MME at C was significantly larger than that at D. The intraoperative mean MMEs, at positions B and C, before traction, with traction, and post-fixation were 1.2 and 5.5 mm, 0.7 and 4.3 mm, and 0.9 and 2.3 mm, respectively.</div></div><div><h3>Conclusion</h3><div>During MMPRT repair, MMEs increased in the figure-of-four position, but decreased with pullout fixation in the valgus stress knee position. Therefore, the valgus stress knee position is suitable for pullout fixation in MMPRT repair.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 275-281"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Influence of pre-operative co-morbidities on pain and function outcomes at 1 year after primary total knee arthroplasty

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-14 DOI: 10.1016/j.knee.2025.02.031

Sean D. Scattergood , Vincent Cheng , Vikki Wylde , Ashley W. Blom , Michael R. Whitehouse , Erik Lenguerrand

Introduction

Multimorbidity has been found to be associated with more pain and poorer function following total knee arthroplasty (TKA). We describe the relationship between both the total number of pre-operative co-morbidities, and individual co-morbidities, with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months after TKR.

Methods

We performed a secondary analysis on 290 participants from the Arthroplasty Pain Experience (APEX) trial, with seventeen imputations by Chained Equations. Using multivariable adjusted linear regression models, we analysed the relationship between total number of pre-operative co-morbidities, followed by individual co-morbidities, with WOMAC score at 12 months after randomisation.

Results

Patients with ≥ 5 co-morbidities have worse outcomes compared to patients with 3 co-morbidities, scoring −9.6 points for function (95% CI −15.3 to −3.8), and −9.8 points for pain (95%CI −15.9 to −3.8). Patients reported worse pain with osteoporosis (−7.8 95%CI −14.1 to −1.6), peripheral vascular disease (−17.8 95%CI −34 to −1.8), depression (−9.8 95%CI −18.1 to −1.4), anxiety (−9.7 95%CI −18 to −1.4) or degenerative disc disease (−7.5 95%CI −13.3 to −1.7). Worse function was associated with osteoporosis (−7.1 95%CI −12.9 to −1.4), diabetes mellitus (−9.1 95%CI −15.6 to −2.6), anxiety (−8.1 95%CI −16 to −0.2) and degenerative disc disease (−8.6 95%CI −14.1 to −3.2).

Conclusion

Pre-operative multimorbidity is associated with worse outcomes after TKA. Patients with pre-operative osteoporosis, anxiety and degenerative disc disease had worse pain and function at 12-months. Surgeons may use these results during discussion with patients about their potential outcome after TKA.

{"title":"Influence of pre-operative co-morbidities on pain and function outcomes at 1 year after primary total knee arthroplasty","authors":"Sean D. Scattergood , Vincent Cheng , Vikki Wylde , Ashley W. Blom , Michael R. Whitehouse , Erik Lenguerrand","doi":"10.1016/j.knee.2025.02.031","DOIUrl":"10.1016/j.knee.2025.02.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Multimorbidity has been found to be associated with more pain and poorer function following total knee arthroplasty (TKA). We describe the relationship between both the total number of pre-operative co-morbidities, and individual co-morbidities, with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 months after TKR.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis on 290 participants from the Arthroplasty Pain Experience (APEX) trial, with seventeen imputations by Chained Equations. Using multivariable adjusted linear regression models, we analysed the relationship between total number of pre-operative co-morbidities, followed by individual co-morbidities, with WOMAC score at 12 months after randomisation.</div></div><div><h3>Results</h3><div>Patients with ≥ 5 co-morbidities have worse outcomes compared to patients with 3 co-morbidities, scoring −9.6 points for function (95% CI −15.3 to −3.8), and −9.8 points for pain (95%CI −15.9 to −3.8). Patients reported worse pain with osteoporosis (−7.8 95%CI −14.1 to −1.6), peripheral vascular disease (−17.8 95%CI −34 to −1.8), depression (−9.8 95%CI −18.1 to −1.4), anxiety (−9.7 95%CI −18 to −1.4) or degenerative disc disease (−7.5 95%CI −13.3 to −1.7). Worse function was associated with osteoporosis (−7.1 95%CI −12.9 to −1.4), diabetes mellitus (−9.1 95%CI −15.6 to −2.6), anxiety (−8.1 95%CI −16 to −0.2) and degenerative disc disease (−8.6 95%CI −14.1 to −3.2).</div></div><div><h3>Conclusion</h3><div>Pre-operative multimorbidity is associated with worse outcomes after TKA. Patients with pre-operative osteoporosis, anxiety and degenerative disc disease had worse pain and function at 12-months. Surgeons may use these results during discussion with patients about their potential outcome after TKA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 263-274"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Helix meniscus − A novel anatomical discovery

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-14 DOI: 10.1016/j.knee.2025.02.030

Tetsuhiro Hagino , Ryosuke Koizumi , Tetsuo Hagino , Satoshi Ochiai , Naoto Furuya , Masanori Wako , Hirotaka Haro

Many anatomical variations of the meniscus have been reported. In this report, we present a case of a novel pattern of meniscal morphology showing a helix structure. A 14-year-old boy presented with knee pain without an apparent cause. Arthroscopic surgery was performed, revealing a helical-shaped meniscus on the lateral side, without injury or degeneration. Partial meniscectomy resulted in symptom improvement. A helix meniscus is very rare and should be recognized as a novel anatomical variant. While arthroscopic meniscectomy improved symptoms, careful consideration is needed when determining surgical indications, as long-term effects remain unknown.

引用次数: 0

Patients aged 80 years and older have an equal improvement in joint-specific outcome health related quality of life and level of satisfaction when compared to those aged 65–75 years old undergoing knee arthroplasty

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-13 DOI: 10.1016/j.knee.2025.02.017

Gregory Hodgson , Samantha Jones , Jad Wehbe , Irrum Afzal , Nick D Clement , Deiary F Kader

Aims

To assess functional outcomes, health-related quality-of-life (HRQoL), and satisfaction at 1-year following knee arthroplasty (KA) in patients aged ≥80 compared to those aged 65–75-years when adjusting for confounding factors.

Methods

A single-centre retrospective cohort study was performed using data from 2010 to 2020. Demographic data, length of stay (LOS), preoperative and 1-year postoperative EuroQol (EQ-5D and EQ-VAS), Oxford Knee Score (OKS) and Outcome Satisfaction (OS) were recorded. Patients aged ≥80 were compared to a control group aged 65–75-years. Regression analyses were performed to assess the independent association of age group after adjusting for confounding factors.

Results

Compared to the 65–75-year group (n = 7525) the ≥80-year group (n = 2966) had greater comorbidity (p < 0.001), worse preoperative OKS (p < 0.001) and EQ-VAS (p = 0.012). Postoperatively both groups had clinically and statistically significant (p < 0.001) improvements in OKS, EQ-5D and EQ-VAS. There was no difference in improvement in OKS (mean difference (p = 0.081) or OS (p = 0.203) between the groups. However, the ≥80-year group had less of an improvement in EQ-5D (p = 0.047) and EQ-VAS (p = 0.007), but these were not clinically meaningful. However, when adjusting for confounding variables there were no differences in improvement in OKS (p = 0.372), EQ-5D (p = 0.703), and EQ-VAS (p = 0.283), or OS (p = 0.829) between the groups. The ≥80-year group was independently associated with a longer LOS (95% CI 0.3–0.8, p < 0.001) when adjusting for confounding factors.

Conclusions

Patients ≥80-years had clinically significant improvements in joint-specific outcome and HRQoL and OS equal to those aged 65–75-years following KA. The ≥80 group had a longer mean LOS of half a day.

目的评估膝关节置换术（KA）后 1 年的功能结果、健康相关生活质量（HRQoL）和满意度，并与 65-75 岁的患者进行比较，同时对混杂因素进行调整。研究记录了人口统计学数据、住院时间（LOS）、术前和术后1年的EuroQol（EQ-5D和EQ-VAS）、牛津膝关节评分（OKS）和结果满意度（OS）。年龄≥80岁的患者与65-75岁的对照组进行了比较。结果与 65-75 岁组（n = 7525）相比，≥80 岁组（n = 2966）的合并症较多（p < 0.001），术前 OKS（p < 0.001）和 EQ-VAS （p = 0.012）较差。术后，两组患者的 OKS、EQ-5D 和 EQ-VAS 均有临床和统计意义上的显著改善（p < 0.001）。两组在 OKS（平均差异（p = 0.081）或 OS（p = 0.203）方面的改善没有差异。然而，≥80 岁组在 EQ-5D（p = 0.047）和 EQ-VAS （p = 0.007）方面的改善较小，但这些改善并无临床意义。然而，在对混杂变量进行调整后，各组之间在 OKS（p = 0.372）、EQ-5D（p = 0.703）和 EQ-VAS （p = 0.283）或 OS（p = 0.829）的改善方面没有差异。结论与 65-75 岁的患者相比，≥80 岁的患者在接受 KA 治疗后，关节特异性结果、HRQoL 和 OS 均有显著的临床改善。≥80岁组患者的平均住院日延长了半天。

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引用次数: 0

Medial meniscus extrusion is associated with acute cartilage deformation after mechanical loading during treadmill walking in older adults

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-13 DOI: 10.1016/j.knee.2025.02.021

Shogo Okada , Masashi Taniguchi , Masahide Yagi , Yoshiki Motomura , Sayaka Okada , Kaede Nakazato , Yoshihiro Fukumoto , Kenta Iwane , Masashi Kobayashi , Kyoseki Kanemitsu , Noriaki Ichihashi

Background

This study aimed to investigate whether the worsening of meniscus function caused by medial meniscus extrusion (MME) was associated with acute cartilage deformation in the medial femur after mechanical loading, which changes depending on the contact force on the cartilage.

Methods

This was a secondary analysis of our previous study investigating acute cartilage deformation after mechanical loading in older women. Fifty-six women, aged ≥50 years, participated in the previous study, 48 of whom (age: 70.3 ± 7.6 years) participated in the meniscus assessment and were included in this analysis. MME was assessed using ultrasonographic B-mode images acquired in the standing position. Acute cartilage deformation was assessed based on the reduction in cartilage thickness after 15 min of treadmill walking. The mechanical cumulative loading was calculated by multiplying the time integrals of the positive values of the knee adduction moment, as assessed by motion analysis with the number of steps taken during treadmill walking. Paired t-tests were performed to compare cartilage thickness in pre- and post-walking. In addition, multiple linear regression analysis was performed to investigate whether MME was associated with acute cartilage deformation after walking.

Results

Significant cartilage deformation occurred after treadmill walking (pre-walking: 1.6 ± 0.3 mm, post-walking: 1.5 ± 0.3 mm, P < 0.001, effect size (r) = 0.760). MME was associated with the amount of acute cartilage deformation after walking, independent of cumulative mechanical loading or cartilage condition (unstandardized regression coefficient B = 0.013, 95% confidence interval: 0.001–0.025, P = 0.033, effect size (R²) = 0.144).

Conclusion

Greater MME is associated with increased acute cartilage deformation after mechanical loading.

{"title":"Medial meniscus extrusion is associated with acute cartilage deformation after mechanical loading during treadmill walking in older adults","authors":"Shogo Okada , Masashi Taniguchi , Masahide Yagi , Yoshiki Motomura , Sayaka Okada , Kaede Nakazato , Yoshihiro Fukumoto , Kenta Iwane , Masashi Kobayashi , Kyoseki Kanemitsu , Noriaki Ichihashi","doi":"10.1016/j.knee.2025.02.021","DOIUrl":"10.1016/j.knee.2025.02.021","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate whether the worsening of meniscus function caused by medial meniscus extrusion (MME) was associated with acute cartilage deformation in the medial femur after mechanical loading, which changes depending on the contact force on the cartilage.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of our previous study investigating acute cartilage deformation after mechanical loading in older women. Fifty-six women, aged ≥50 years, participated in the previous study, 48 of whom (age: 70.3 ± 7.6 years) participated in the meniscus assessment and were included in this analysis. MME was assessed using ultrasonographic B-mode images acquired in the standing position. Acute cartilage deformation was assessed based on the reduction in cartilage thickness after 15 min of treadmill walking. The mechanical cumulative loading was calculated by multiplying the time integrals of the positive values of the knee adduction moment, as assessed by motion analysis with the number of steps taken during treadmill walking. Paired <em>t</em>-tests were performed to compare cartilage thickness in pre- and post-walking. In addition, multiple linear regression analysis was performed to investigate whether MME was associated with acute cartilage deformation after walking.</div></div><div><h3>Results</h3><div>Significant cartilage deformation occurred after treadmill walking (pre-walking: 1.6 ± 0.3 mm, post-walking: 1.5 ± 0.3 mm, <em>P</em> < 0.001, effect size (r) = 0.760). MME was associated with the amount of acute cartilage deformation after walking, independent of cumulative mechanical loading or cartilage condition (unstandardized regression coefficient B = 0.013, 95% confidence interval: 0.001–0.025, <em>P</em> = 0.033, effect size (R<sup>2</sup>) = 0.144).</div></div><div><h3>Conclusion</h3><div>Greater MME is associated with increased acute cartilage deformation after mechanical loading.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 192-198"},"PeriodicalIF":1.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620550","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