Knee最新文献

英文中文

Exam Corner Q September 2024 考试角 Q 2024 年 9 月

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-01 DOI: 10.1016/S0968-0160(24)00172-8

引用次数: 0

Exam Corner A September 2024 考试角 A 2024 年 9 月

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-01 DOI: 10.1016/S0968-0160(24)00173-X

引用次数: 0

Advancing indications for total knee arthroplasty 推进全膝关节置换术的适应症。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-01 DOI: 10.1016/j.knee.2024.09.001

Oday Al-Dadah (Editors-in-Chief), Caroline Hing

引用次数: 0

Masterclass in Research 研究大师班

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-01 DOI: 10.1016/S0968-0160(24)00174-1

引用次数: 0

The difference in bone mineral density between femur and tibia is related to tibia deformation in endstage knee osteoarthritis 股骨和胫骨骨矿密度的差异与膝关节骨性关节炎晚期患者的胫骨变形有关

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-30 DOI: 10.1016/j.knee.2024.09.008

Yun Seong Choi, Jung-Ro Yoon, Young-Bin Shin, Seung Hoon Lee

Background

This study investigated bone mineral density (BMD) around the knee joint to clarify the mechanism by which tibia deformation exceeds that of the femur in patients with end-stage knee osteoarthritis (KOA).

Methods

We retrospectively analyzed 193 patients who underwent total knee arthroplasty for end-stage KOA with varus alignment. Preoperative T-score of the femur neck and femur total using dual-energy X-ray absorptiometry (DXA) and hounsfield units (HU) of the distal femur and proximal tibia using computed tomography (CT) were measured to asess the BMD. HU was measured by dividing the femur and tibia into medial, lateral, and total parts, respectively. Patients with medial proximal tibial angle (MPTA) ≥ 85° were considered ‘group 1′, and MPTA < 85° were ‘group 2′. The HU between femur and tibia were compared in group 1. T-score, HU, and HU difference between group 1 and group 2 were compared.

Results

The HU of the proximal tibia was lower than that of the distal femur (femur lateral > femur medial > tibia medial > tibia lateral). T-score (femur neck, femur total) and HU (femur lateral, femur total, tibia lateral) were lower in group 2 than in group 1. There was no difference in femur-tibia HU difference between groups.

Conclusion

The medial tibia collapse more than the medial femur in varus endstage KOA was associated with the lower BMD of the proximal tibia than that of the distal femur, and the MPTA collapse was affected by the absolute value of BMD rather than by the femur-tibia BMD difference.

背景本研究调查了膝关节周围的骨矿密度（BMD），以明确终末期膝骨关节炎（KOA）患者胫骨变形超过股骨变形的机制。术前使用双能 X 射线吸收仪（DXA）测量股骨颈和股骨总的 T 值，并使用计算机断层扫描（CT）测量股骨远端和胫骨近端的 hounsfield 单位（HU），以评估 BMD。HU的测量方法是将股骨和胫骨分别分为内侧、外侧和总段。胫骨近端内侧角（MPTA）≥85°的患者被视为 "第1组"，MPTA < 85°的患者被视为 "第2组"。结果胫骨近端 HU 低于股骨远端（股骨外侧；股骨内侧；胫骨内侧；胫骨外侧）。第 2 组的 T 评分（股骨颈、股骨全长）和 HU（股骨外侧、股骨全长、胫骨外侧）均低于第 1 组。结论 KOA曲位终末期的胫骨内侧塌陷比股骨内侧塌陷严重，这与胫骨近端 BMD 低于股骨远端 BMD 有关，而且 MPTA 塌陷受 BMD 绝对值的影响，而不是受股骨-胫骨 BMD 差异的影响。

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引用次数: 0

Percutaneous isometric reconstruction of medial collateral and posterior oblique ligaments offers similar outcomes to open techniques with reduced complication rates at a medium-term follow-up: A retrospective comparative study 经皮等长重建内侧副韧带和后斜韧带的效果与开放技术相似，中期随访时并发症发生率降低：一项回顾性比较研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-25 DOI: 10.1016/j.knee.2024.09.004

E. Ortiz, S. Fornell, P. Barrena

Background

Knee Injuries involving the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) can cause severe instability. The open surgical technique involves larger incisions. A percutaneous technique may offer similar outcomes with reduced morbidity and a shorter recovery time. The purpose of this study was to compare the clinical and functional outcomes of percutaneous and open reconstruction using isometric allografts.

Methods

A retrospective comparative analysis was conducted on 21 patients between 2010 and 2021. Eleven patients underwent open surgery, while 10 underwent percutaneous surgery. The subjective IKDC, Lysholm, and Tegner scores, and valgus laxity were evaluated. Complications were also recorded.

Results

Both the groups demonstrated significant improvements in functional scores and a reduction in valgus laxity postoperatively, with no significant differences. The mean improvements were 32.3 for the IKDC score and 37.9 for the Lysholm score. The average reduction in the Tegner score was 1.1 points. Postoperative radiographic measurements of medial joint opening were < 2 mm in all patients. The percutaneous group had fewer complications, with arthrofibrosis being significantly less frequent (0 vs. 4 in the open group). The mean follow-up was 3.5 years.

Conclusion

Percutaneous reconstruction of the medial side of the knee with an isometric technique is a safe and effective procedure that provides results similar to those of open reconstruction. The advantages of percutaneous reconstruction include smaller incisions, less pain and scarring, shorter recovery time, and lower risk of complications. Allografts are preferred over autografts to avoid donor site morbidity and weakening of the medial stabilizers.

背景涉及浅内侧副韧带（sMCL）和后斜韧带（POL）的膝关节损伤可导致严重的不稳定性。开放手术技术的切口较大。经皮技术可提供类似的效果，同时降低发病率并缩短恢复时间。本研究的目的是比较使用等距异体移植的经皮重建和开放重建的临床和功能效果。方法对2010年至2021年间的21例患者进行了回顾性比较分析。11名患者接受了开放手术，10名患者接受了经皮手术。对主观的 IKDC、Lysholm 和 Tegner 评分以及外翻松弛度进行了评估。结果两组患者术后的功能评分均有显著改善，外翻松弛程度也有所减轻，无明显差异。IKDC 评分平均提高了 32.3 分，Lysholm 评分平均提高了 37.9 分。Tegner 评分平均降低了 1.1 分。所有患者术后内侧关节开口的影像学测量值均为 2 毫米。经皮手术组的并发症较少，关节纤维化的发生率明显较低（开放手术组为 0 例，经皮手术组为 4 例）。结论采用等长技术经皮重建膝关节内侧是一种安全有效的手术，其效果与开放重建相似。经皮重建的优点包括切口更小、疼痛和疤痕更少、恢复时间更短、并发症风险更低。与自体移植物相比，异体移植物更受青睐，可避免供体部位发病和内侧稳定器受损。

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引用次数: 0

MCP-1 in synovial fluid as a predictor of inferior clinical outcomes after meniscectomy 滑液中的 MCP-1 可预测半月板切除术后的不良临床结果

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-25 DOI: 10.1016/j.knee.2024.09.002

Isabel Wolfe, Alexander J. Egol, Michael R. Moore, Ryan Isber, Daniel J. Kaplan, Thorsten Kirsch, Eric J. Strauss

Purpose

To evaluate knee intra-articular cytokine concentrations in patients undergoing isolated meniscectomy and determine if these concentrations are associated with clinical outcomes.

Methods

Concentrations of ten biomarkers were quantified in synovial fluid aspirated from the operative knees of patients who underwent isolated meniscectomy from 10/2011-12/2019. Patients completed a survey at final follow-up including VAS, Lysholm, Tegner, and KOOS Physical Function Short Form (KOOS-PS). Failure was defined as subsequent TKA or non-achievement of the Patient Acceptable Symptom State (PASS) for knee pain defined as VAS > 27/100. Regression analysis investigating the relationship between cytokine concentrations and failure was performed.

Results

The study consisted of 100 patients, including 50 males (50.0%) with a mean age of 51.1 ± 11.7 years, a median BMI of 28.9 kg/m² [25.5, 32.4], and a mean follow-up of 8.0 ± 2.2 years. There were no demographic or clinical differences between failures (n = 41) and non-failures (n = 59) at baseline. Monocyte Chemotactic Protein 1 (MCP-1) concentration was significantly higher in failures than in non-failures (344.3 pg/ml vs. 268.6 pg/ml, p = 0.016). In a regression analysis controlling for age, sex, BMI, symptom duration, length of follow-up, and ICRS grade, increased MCP-1 was associated with increased odds of failure (p = 0.002).

Conclusions

The concentration of MCP-1 on the day of arthroscopic meniscectomy was predictive of failure as defined by an unacceptable pain level at intermediate- to long-term follow-up. This finding may help identify patients at high risk for poor postoperative outcomes following isolated meniscectomy and serve as a target for future postoperative immunomodulation research.

目的评估接受孤立性半月板切除术的患者膝关节内细胞因子的浓度，并确定这些浓度是否与临床结果相关。方法对 2011 年 10 月至 2019 年 12 月期间接受孤立性半月板切除术的患者从手术膝关节抽取的滑液中的十种生物标志物的浓度进行量化。患者在最终随访时完成了一项调查，包括 VAS、Lysholm、Tegner 和 KOOS Physical Function Short Form (KOOS-PS)。失败定义为后续TKA或膝关节疼痛未达到患者可接受症状状态（PASS），定义为VAS > 27/100。研究对细胞因子浓度与失败之间的关系进行了回归分析。结果该研究共有 100 例患者，其中男性 50 例（50.0%），平均年龄（51.1 ± 11.7）岁，中位体重指数（BMI）为 28.9 kg/m2 [25.5, 32.4]，平均随访时间（8.0 ± 2.2）年。失败者（41 人）和非失败者（59 人）在基线时没有人口统计学或临床差异。失败者的单核细胞趋化蛋白 1 (MCP-1) 浓度明显高于非失败者（344.3 pg/ml vs. 268.6 pg/ml，p = 0.016）。结论关节镜下半月板切除术当天的 MCP-1 浓度可预测中长期随访时无法接受的疼痛程度所定义的手术失败。这一发现可能有助于识别孤立半月板切除术后术后效果不佳的高风险患者，并作为未来术后免疫调节研究的目标。

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引用次数: 0

Tibial contact points cannot be used to determine internal-external axial rotation of the native tibiofemoral joint 胫骨接触点不能用于确定原生胫股关节的内外轴向旋转。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-19 DOI: 10.1016/j.knee.2024.08.019

Alexander Simileysky , M.L. Hull

Background

In the study of tibiofemoral kinematics of the native knee, internal-external (IE) axial rotation is a motion of interest. Locations of contact by the femur on the tibia (termed tibial contact points) have been used to determine IE rotations but such rotations might not be useful due to large error. Hence, our objective was to determine whether tibial contact points are useful in quantifying IE rotations of the native knee.

Method

Fluoroscopic images of the native knee were analyzed from 25 subjects who performed a weight-bearing deep knee bend. For each subject, 3D bone + cartilage models were created. Following 3D model-to-2D image registration, anterior-posterior (AP) positions of the lowest points and the tibial contact points were computed for each femoral condyle at 0°, 30°, 60°, and 90° of flexion. IE rotations were the angles between lines connecting points in the medial and lateral tibial compartments at different flexion angles.

Results

Based on the lowest points, the tibia rotated internally on the femur primarily during the first 30° of flexion. In this range, mean internal tibial rotation based on tibial contact points was negligible but internal tibial rotation was significantly greater based on lowest points (0° vs 7°, p = 0.0002). At 90° of flexion, the difference was maintained (1.8° vs 8.3°, p = 0.0007).

Conclusion

While tibial contact points are useful in the study of wear of tibial inserts in total knee arthroplasty (TKA), tibial contact points considerably underestimate internal tibial rotation during flexion in the native knee and should not be used to quantify tibiofemoral kinematics.

背景：在研究原生膝关节的胫股关节运动学时，内-外（IE）轴向旋转是一个值得关注的运动。股骨与胫骨的接触位置（称为胫骨接触点）已被用于确定内-外旋转，但由于误差较大，这种旋转可能并无用处。因此，我们的目标是确定胫骨接触点是否有助于量化原生膝关节的 IE 旋转：方法：我们分析了 25 名进行负重膝关节深屈的受试者的原生膝关节透视图像。为每个受试者创建了三维骨骼+软骨模型。在三维模型与二维图像配准后，计算出每个股骨髁在屈曲 0°、30°、60° 和 90°时的最低点和胫骨接触点的前后（AP）位置。IE旋转是指在不同屈曲角度下，胫骨内侧和外侧各点连线之间的夹角：根据最低点，胫骨在股骨上的内旋转主要发生在屈曲的前 30°。在这一范围内，根据胫骨接触点计算的平均胫骨内旋可以忽略不计，但根据最低点计算的胫骨内旋明显更大（0° vs 7°，p = 0.0002）。在屈曲 90° 时，差异保持不变（1.8° vs 8.3°，p = 0.0007）：结论：虽然胫骨接触点有助于研究全膝关节置换术（TKA）中胫骨假体的磨损情况，但胫骨接触点大大低估了原生膝关节屈曲时的胫骨内旋，因此不应被用于量化胫骨-股骨运动学。

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引用次数: 0

Unicompartmental knee arthroplasty in octogenarians: An analysis of 1,466 patients with 2-year follow-up 八旬老人的单间室膝关节置换术：对 1 466 名患者进行的 2 年随访分析

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-10 DOI: 10.1016/j.knee.2024.08.016

Alexander J. Acuña, Enrico M. Forlenza, Joseph Serino III, Vince K. Morgan, Tad L. Gerlinger, Craig J. Della Valle

Introduction

Unicompartmental knee arthroplasty (UKA) has been shown to improve pain and function in appropriately selected patients. Limited data exists regarding outcomes and complication rates following UKA among octogenarians.

Methods

The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2010–2022. Patients < 80 years old were matched 4:1 to the octogenarian cohort (≥80 years old) by sex, year, Elixhauser Comorbidity Index (ECI), tobacco use, obesity, and diabetes. A total of 1,334 octogenarians and 5,313 controls were included in our analysis. Multivariate logistic regression was utilized to compare medical complications at 90-days post-operatively and surgical complications at 1- and 2-years post-operatively. Our regression analysis controlled for sex, ECI, tobacco use, obesity, and diabetes.

Results

Octogenarians had an increased risk of acute kidney injury (OR: 2.306, 95% CI: 1.393–3.749; p < 0.001), pneumonia (OR: 2.367, 95% CI: 1.301–4.189; p = 0.003), UTI (OR: 1.846, 95% CI: 1.304–2.583; p < 0.001), ED visits (OR: 2.229, 95% CI: 1.586–3.105; p < 0.001), and any complication (OR: 1.575, 95% CI: 1.304–1.895; p < 0.001) at 90-days post-operatively. Octogenarians had lower odds of all-cause revision at 2-years (OR: 0.607, 95% CI: 0.382–0.923; p = 0.026). No differences were demonstrated between cohorts in rates of PJI (OR: 0.832, 95% CI: 0.334–1.796; p = 0.664), periprosthetic fracture (OR: 0.516, 95% CI: 0.120–1.520; p = 0.289), or aseptic loosening (OR: 0.285, 95% CI: 0.045–1.203; p = 0.088) at 2-years.

Discussion

These findings suggest that despite an increased risk of certain medical complications within the acute post-operative period, octogenarians undergoing UKA experienced similar rates of surgical complications to younger matched controls at 2-year follow-up.

导言事实证明，在经过适当选择的患者中，膝关节非髁置换术（UKA）可改善疼痛和功能。有关八旬老人接受UKA后的疗效和并发症发生率的数据有限。方法在PearlDiver Mariner数据库中查询了2010-2022年间接受初级UKA的患者。根据性别、年份、Elixhauser 合并症指数 (ECI)、吸烟、肥胖和糖尿病，将 80 岁以上的患者与八旬老人队列（≥80 岁）进行 4:1 匹配。我们的分析共纳入了 1,334 名八旬老人和 5,313 名对照组。我们利用多变量逻辑回归对术后 90 天的内科并发症和术后 1 年和 2 年的外科并发症进行了比较。我们的回归分析对性别、ECI、吸烟、肥胖和糖尿病进行了控制。结果外科医生发生急性肾损伤（OR：2.306，95% CI：1.393-3.749；P <；0.001）、肺炎（OR：2.367，95% CI：1.301-4.189；p = 0.003）、UTI（OR：1.846，95% CI：1.304-2.583；p <；0.001）、术后 90 天的急诊就诊（OR：2.229，95% CI：1.586-3.105；p <；0.001）和任何并发症（OR：1.575，95% CI：1.304-1.895；p <；0.001）。八旬老人在 2 年后发生全因翻修的几率较低（OR：0.607，95% CI：0.382-0.923；P = 0.026）。2年后PJI（OR：0.832，95% CI：0.334-1.796；P = 0.664）、假体周围骨折（OR：0.516，95% CI：0.120-1.520；P = 0.289）或无菌性松动（OR：0.285，95% CI：0.045-1.203；P = 0.088）的发生率在不同队列之间没有差异。讨论这些研究结果表明，尽管术后急性期发生某些内科并发症的风险增加，但接受UKA手术的八旬老人在2年随访时的手术并发症发生率与年轻的匹配对照组相似。

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引用次数: 0

Morphology of the popliteomeniscal fascicles around the popliteal hiatus on three-dimensional images reconstructed from 7 T magnetic resonance imaging: A cadaveric study 从 7 T 磁共振成像重建的三维图像上观察腘窝周围的腘绳肌筋膜形态：尸体研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-10 DOI: 10.1016/j.knee.2024.08.018

Goro Tajima , Hiroki Kaneko , Ryunosuke Oikawa , Moritaka Maruyama , Atsushi Sugawara , Shinya Oikawa , Ken Hayashi , Minoru Doita

Background

This study aimed to clarify the characteristic features of the anteroinferior and posterosuperior popliteomeniscal fascicles (aiPMF and psPMF, respectively) and popliteal hiatus using three-dimensional (3D) reconstructions of 7 T magnetic resonance imaging (MRI) arthrography.

Methods

Six knees from human cadavers fixed using the Thiel embalming method were examined using 7 T MRI arthrography. 3D Images of the structures around the popliteal hiatus were reconstructed. Morphologies of the psPMF, aiPMF, and popliteal hiatus were investigated and their positional relationships analyzed.

Results

The PMFs attached to the periphery of the lateral meniscus (LM) to form the popliteal hiatus. Each coursed in an oblique direction. The mean length of the psPMF and aiPMF attachments to the LM were 6.8 and 21.6 mm, respectively; mean popliteal hiatus length was 12.8 mm. These lengths corresponded to 7.5%, 24.3%, and 14.5% of the total length of the LM, respectively. The aiPMF was thick near the lateral aspect of the articular capsule and became thinner towards the posteromedial aspect of the LM. The psPMF was thick near the posterior aspect of the articular capsule and became thinner towards the posterolateral aspect of the LM.

Conclusion

Morphological properties of the aiPMF, psPMF, their attachments to the LM, and the popliteal hiatus were consistent across the cadaver specimens examined. Each PMF was thin near the popliteal hiatus and became thicker towards its attachment to the articular capsule. These findings may be useful for anatomical repair for the LM hypermobility.

背景本研究旨在利用 7 T 磁共振成像（MRI）关节造影的三维（3D）重建，阐明腘窝前筋膜束（aiPMF）和腘窝后筋膜束（psPMF）以及腘窝裂隙的特征。重建了腘窝周围结构的三维图像。结果PMF附着在外侧半月板（LM）外围，形成腘窝。每条PMF的走向均为斜向。psPMF和aiPMF附着到LM的平均长度分别为6.8毫米和21.6毫米；腘窝裂隙的平均长度为12.8毫米。这些长度分别相当于 LM 总长度的 7.5%、24.3% 和 14.5%。aiPMF在关节囊外侧附近较厚，向LM后内侧变薄。结论在所检查的尸体标本中，aiPMF、psPMF、它们与 LM 的连接处以及腘窝的形态特性是一致的。每个 PMF 在腘窝附近都很薄，而在其与关节囊的附着处则变厚。这些发现可能有助于对腘绳肌过度活动进行解剖修复。

{"title":"Morphology of the popliteomeniscal fascicles around the popliteal hiatus on three-dimensional images reconstructed from 7 T magnetic resonance imaging: A cadaveric study","authors":"Goro Tajima , Hiroki Kaneko , Ryunosuke Oikawa , Moritaka Maruyama , Atsushi Sugawara , Shinya Oikawa , Ken Hayashi , Minoru Doita","doi":"10.1016/j.knee.2024.08.018","DOIUrl":"10.1016/j.knee.2024.08.018","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to clarify the characteristic features of the anteroinferior and posterosuperior popliteomeniscal fascicles (aiPMF and psPMF, respectively) and popliteal hiatus using three-dimensional (3D) reconstructions of 7 T magnetic resonance imaging (MRI) arthrography.</p></div><div><h3>Methods</h3><p>Six knees from human cadavers fixed using the Thiel embalming method were examined using 7 T MRI arthrography. 3D Images of the structures around the popliteal hiatus were reconstructed. Morphologies of the psPMF, aiPMF, and popliteal hiatus were investigated and their positional relationships analyzed.</p></div><div><h3>Results</h3><p>The PMFs attached to the periphery of the lateral meniscus (LM) to form the popliteal hiatus. Each coursed in an oblique direction. The mean length of the psPMF and aiPMF attachments to the LM were 6.8 and 21.6 mm, respectively; mean popliteal hiatus length was 12.8 mm. These lengths corresponded to 7.5%, 24.3%, and 14.5% of the total length of the LM, respectively. The aiPMF was thick near the lateral aspect of the articular capsule and became thinner towards the posteromedial aspect of the LM. The psPMF was thick near the posterior aspect of the articular capsule and became thinner towards the posterolateral aspect of the LM.</p></div><div><h3>Conclusion</h3><p>Morphological properties of the aiPMF, psPMF, their attachments to the LM, and the popliteal hiatus were consistent across the cadaver specimens examined. Each PMF was thin near the popliteal hiatus and became thicker towards its attachment to the articular capsule. These findings may be useful for anatomical repair for the LM hypermobility.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 136-144"},"PeriodicalIF":1.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0968016024001546/pdfft?md5=6cd546cdb6adaee240f1d5f9f18fd5c3&pid=1-s2.0-S0968016024001546-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164744","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

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