Knee最新文献

Background: Medial stability has been considered a key determinant of favorable outcomes after total knee arthroplasty (TKA). This study aimed to investigate the association between postoperative medial joint stability and clinical outcomes and to identify factors influencing medial joint stability.

Methods: One hundred and sixty-five primary cruciate-sacrificing TKAs were analyzed. Three implant designs were used: bicruciate-stabilized (BCS), posterior-stabilized (PS), and cruciate-sacrificing (CS) implants. Surgeries were performed by two surgical teams, with Surgical Team A characterized by a strategy of minimal medial soft-tissue release. Medial joint stability was assessed using stress radiographs under a 150-N varus or valgus load in extension. Knees with a medial opening angle (MOA) <3° were included in the medial tight group, and those with an MOA ≥3° were included in the medial loose group. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to evaluate clinical outcomes 1 year after surgery. Multivariate regression analysis was performed to identify factors influencing medial stability.

Results: The medial tight group demonstrated significantly higher KOOS activities of daily living, sports, and quality of life scores than the loose group. Among the implant designs, BCS TKA knees demonstrated significantly superior medial stability compared with PS TKA knees. Multivariate analysis revealed that BCS prosthesis (P = 0.033) and Surgical Team A (P = 0.006) were identified as independent predictors of medial stability.

Conclusions: Postoperative medial stability in extension was associated with improved clinical outcomes after cruciate-sacrificing TKA. Implant design and surgical technique were factors significantly influencing medial stability.

Objective: The purpose of this study was to prompt GPT-4 to analyze qualitative data used in a published scientific article where qualitative content analysis was performed by human researchers, and to qualitatively compare results from the published article with the results generated by GPT-4.

Methods: This study was conducted using the full interview dataset from a published qualitative study that aimed to explore experiences of patients treated with rehabilitation alone after an anterior cruciate ligament (ACL) injury. Interview transcripts were analyzed by GPT-4 through iterative prompting to replicate the original six-step content analysis process. Different attempts were conducted to improve GPT-4's output. GPT-4's final output was qualitatively compared with the human-generated results.

Results: While the human-made analysis produced one overarching theme supported by three main categories and nine sub-categories, GPT-4's analysis resulted in four themes, six main categories, and 15 sub-categories. Both analyses captured uncertainty and the impact of knee-related symptoms. GPT-4's results showed a suspiciously equal distribution of codes across sub-categories, and introduced a theme not grounded in the source data. Multiple prompts were required to produce and organize the material.

Conclusion: The analysis performed by humans and GPT-4 had similarities and differences. The use of GPT-4 for qualitative analysis in its present form is challenging and needs to be performed across several steps. Currently, GPT-4 should not be used as the only tool in a qualitative analysis of interview data.

Background: Gushu pills (GSW), a traditional Chinese medicine formulation, have demonstrated clinical efficacy in treating bone metabolic disorders, including osteoarthritis (OA). However, the underlying molecular mechanisms remain poorly understood. This study aimed to investigate the therapeutic effects of GSW on IL-1β-induced osteoblast injury and OA in rats, focusing on the potential involvement of the OPG/RANKL/RANK signaling pathway.

Methods: A rat OA model was established by anterior cruciate ligament transection and medial meniscus resection (ACLT + MMx). After 8 weeks of GSW treatment, cartilage integrity was evaluated by histology (H&E and Safranin O-Fast Green staining), and inflammation (TNF-α, IL-1β) and apoptosis (TUNEL) were assessed. In IL-1β-stimulated human osteoblasts (hFOB1.19), GSW's effects on proliferation (CCK-8), apoptosis (flow cytometry), differentiation (ALP activity), and mineralization (Alizarin Red S) were examined. Key signaling molecules (OPG, RANKL, NF-κB, β-catenin) were analyzed by RT-qPCR, western blot, and ELISA.

Results: GSW ameliorated cartilage degradation, inflammation, and apoptosis in OA rats. In IL-1β-injured osteoblasts, GSW promoted proliferation, differentiation, and mineralization while reducing apoptosis. Mechanistically, GSW increased the OPG/RANKL ratio and inhibited NF-κB activation, while promoting β-catenin signaling. The protective effects of GSW were reversed by exogenous RANKL and enhanced by OPG.

Conclusion: GSW mitigates osteoblast injury and OA progression. The mechanism is associated with the restoration of the OPG/RANKL balance, potentially via suppression of NF-κB.

Background: Isolated posterolateral corner (PLC) injuries classified as grade I/II or type B (Fanelli-Larson) may coexist with a hypermobile lateral meniscus (LM). Although lesions are often managed conservatively, residual rotational instability from LM hypermobility can persist, warranting surgery in patients. We evaluated outcomes of open repair for isolated PLC injury with hypermobile LM at a minimum 2-year follow up.

Methods: Twenty-eight consecutive patients undergoing open repair were retrospectively evaluated at a minimum 2-year follow up (median, 2.8 years; interquartile range (IQR), 2.2-3.9). Conservative treatment was initiated in all patients, and surgery was considered after at least 3 months of persistent symptoms. Patient-reported outcomes (PROs) included the Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. Rotational laxity was assessed with the dial test (30°/90°) and quantified bilaterally with the Rotameter.

Results: Ninety-six per cent of patients were satisfied or very satisfied. Median postoperative Lysholm and subjective IKDC scores were 85 (IQR, 73-94 and 77-91, respectively); median KOOS was 85 (IQR, 71-93). The Tegner activity scale was unchanged (6 (IQR, 5-7) preinjury vs. 5 (IQR, 4-6) postoperatively). No side-to-side differences were detected on dial testing at 30° or 90°. Rotameter side-to-side differences were 0.6 ± 2.4° (internal rotation), 1.1 ± 4.5° (external rotation), and 1.7 ± 4.6° (total rotational laxity).

Conclusions: Open repair for isolated PLC injury with a hypermobile LM yielded high patient satisfaction and favorable PROs, and restored rotational stability at mid-term follow up.