IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-08 DOI: 10.1016/j.knee.2024.12.015

Takaya Watabe , Takuya Sengoku , Masafumi Kubota , Goro Sakurai , Shinya Yoshida , Yuta Taniguchi

Background

This study investigated changes in the Knee Injury and Osteoarthritis Outcome Score (KOOS), 2011 Knee Society Score (KSS), and minimal clinically important differences (MCIDs) of these scores preoperatively to 2 years after total knee arthroplasty (TKA).

Methods

This single-center retrospective study included 168 patients who underwent primary cruciate-retaining (CR) TKA using the subvastus approach. The KOOS and KSS were assessed preoperatively and during the 3-month, 6-month, 1-year, and 2-year follow ups. The MCIDs of the KOOS and KSS were calculated using distribution-based methods with standard deviation.

Results

All patient-reported outcome measures improved considerably from preoperatively to 3 months postoperatively. KOOS pain and symptom scores considerably improved at approximately 2 years postoperatively, with KOOS activities of daily living (ADL) and sports/recreation subscale scores showing rapid improvement within 3 months, followed by smaller gains. MCID thresholds for KOOS subscales were as follows: pain, 14.3–15.3; symptoms, 14.1–15.6; ADL, 15.2–16.0; sport/recreation, 11.7–11.8; and quality of life, 13.6–14.4. KSS objective knee indicators and satisfaction improved considerably approximately 2 years postoperatively; however, scores on the expectation and functional activity subscales did not improve after 1 year. MCID thresholds for KSS subscales were as follows: objective knee indicators, 4.6–4.7; satisfaction, 4.9–5.0; expectation, 2.4; and functional activities, 12.0–12.3.

Conclusions

Improvements in the KSS objective knee indicators and KOOS subjective pain and symptom scores were similar over the 2-year follow up. These findings may help better understand the expected outcomes of CR-type TKA, especially in severe osteoarthritis cases, thereby informing patient counseling.

背景：本研究调查了膝关节损伤和骨关节炎结局评分（oos）、2011年膝关节社会评分（KSS）的变化，以及这些评分在术前至全膝关节置换术（TKA）后2年的最小临床重要差异（MCIDs）。方法：这项单中心回顾性研究纳入了168例采用股下入路行原发性椎体保留（CR）全椎体置换术的患者。术前、随访3个月、6个月、1年和2年分别评估KOOS和KSS。采用基于分布的方法计算kos和KSS的MCIDs，并伴有标准差。结果：从术前到术后3个月，所有患者报告的预后指标均有显著改善。kos疼痛和症状评分在术后约2年显著改善，kos日常生活活动（ADL）和运动/娱乐亚量表评分在3个月内快速改善，随后小幅改善。oos亚量表的MCID阈值为：疼痛，14.3-15.3；症状,14.1 - -15.6;ADL, 15.2 - -16.0;运动/休闲,11.7 - -11.8;生活质量，13.6-14.4。术后约2年，KSS客观膝关节指标和满意度显著提高；然而，期望和功能活动亚量表的得分在1年后没有改善。KSS亚量表的MCID阈值为：膝关节客观指标4.6-4.7；满意,4.9 - -5.0;期望,2.4;功能活动，12.0-12.3。结论：在2年的随访中，KSS客观膝关节指标和KOOS主观疼痛和症状评分的改善相似。这些发现可能有助于更好地了解cr型TKA的预期结果，特别是在严重骨关节炎病例中，从而为患者咨询提供信息。

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引用次数: 0

The impact of implant design consistency in staged bilateral total knee arthroplasty on gait patterns and functional outcomes: A comparative analysis 分阶段双侧全膝关节置换术中植入物设计一致性对步态模式和功能结果的影响：一项比较分析。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-04 DOI: 10.1016/j.knee.2024.12.011

Olgun Bingol , Taner Karlidag , Enejd Veizi , Burak Kulakoglu , Guzelali Ozdemir , Ahmet Firat , Bulent Ozkurt

Background

The aim of this study was to assess whether there are any differences in plantar pressure distribution and gait cycle between patients with the same implant design and patients with different designs in staged bilateral TKA and to examine the impact of these differences on clinical and functional outcomes.

Methods

A retrospective review was conducted of all patients who underwent staged bilateral TKA. The patients were divided into two groups based on the prosthesis design used in both knees. A comparison was made between the two groups regarding various factors, including demographic data, radiological measurements, functional scores, gait analysis, and plantar pressure mapping.

Results

Patients with the same implant design were found to have statistically significantly higher functional scores (p = 0.001). Furthermore, the difference in pre-swing phase plantar distribution for both extremities in patients with different implant designs was found to be greater than in those with the same implant design (p = 0.031). Similarly, the difference in initial contact phase load distribution between the different implant design groups was found to be significantly higher than that observed in the same implant design group (p = 0.014).

Conclusion

In conclusion, individuals with two different implant designs in staged bilateral TKA showed a substantial imbalance in gait cycle and plantar pressure distribution. This may result in various consequences, including impairment in movement, patient dissatisfaction, and even early implant failure. Therefore, the same implant design should be used as much as possible to achieve balanced knee kinematics and favorable outcomes.

背景：本研究的目的是评估在分阶段双侧TKA中，相同植入物设计的患者和不同设计的患者在足底压力分布和步态周期方面是否存在差异，并研究这些差异对临床和功能结果的影响。方法：对所有接受分阶段双侧TKA的患者进行回顾性分析。根据双膝假体设计将患者分为两组。比较两组之间的各种因素，包括人口统计数据、放射学测量、功能评分、步态分析和足底压力制图。结果：采用相同种植体设计的患者功能评分有统计学意义上显著提高（p = 0.001）。此外，不同种植体设计的患者摆动前双下肢足底分布差异大于相同种植体设计的患者（p = 0.031）。同样，不同种植体设计组之间的初始接触相负荷分布差异明显高于相同种植体设计组（p = 0.014）。结论：两种不同种植体设计的个体在分阶段双侧TKA中表现出步态周期和足底压力分布的明显不平衡。这可能导致各种后果，包括运动障碍，患者不满，甚至早期种植体失败。因此，应尽可能使用相同的植入物设计，以达到平衡的膝关节运动学和良好的预后。

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引用次数: 0

Posterior cruciate ligament injuries managed with internal bracing 后交叉韧带损伤用内支治疗。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-01 DOI: 10.1016/j.knee.2024.11.019

Ashley Arakkal, Waldo Scheepers, Michael Held

Background

Synthetic augmentation in the form of an internal brace is increasingly used to stabilize injured knee ligaments. This study aimed to evaluate the clinical and radiological outcome of patients with knee dislocations treated with a posterior cruciate ligament (PCL) internal brace.

Methods

Synthetic suture tape drilled into the femoral and tibial PCL footprints was performed in patients with multiple knee ligament injuries. PCL tears were either repaired or left in situ if not repairable. Patients with chronic injuries, contraindications to magnetic resonance imaging (MRI) scans, or cognitive impairment were excluded. Patient-reported outcome measures (PROMs), range of motion, stress X-Rays, and MRI scans were assessed. An acceptable outcome was defined as a Lysholm score of 84 or more, grade II laxity or less on stress radiographs and a range of motion from full extension to 90° or more of flexion.

Results

Eight patients were included with a median age of 38 years, five were female. No patients had knee flexion less than 90° or an extension deficit of more than 10°. PROMs showed a median Lysholm score of 87. Stress radiographs showed less than 7 mm (Grade I) of posterior translation laxity in all patients. In six patients a follow up MRI scan was obtained, which revealed no healing of the PCL in one patient and only partial healing in three patients.

Conclusion

All patients had stable knees and acceptable PROMs, despite tunnel widening or reaction to synthetic material on MRI in five of the six patients. Factors such as anisometric tunnel position and the absence of PCL tear repair may have contributed to the tunnel widening.

背景：内支架形式的合成增强物越来越多地用于稳定受伤的膝关节韧带。本研究旨在评估后交叉韧带（PCL）内支架治疗膝关节脱位患者的临床和影像学结果。方法：对膝关节多发韧带损伤患者采用人工缝合带钻入股骨、胫骨PCL足部。对PCL撕裂进行修复，如果无法修复则留在原位。排除有慢性损伤、磁共振成像（MRI）扫描禁忌症或认知障碍的患者。评估患者报告的结果测量（PROMs）、活动范围、应力x射线和MRI扫描。可接受的结果定义为Lysholm评分为84或以上，应力x线片上的II级或以下松弛，活动范围从完全伸展到90°或以上屈曲。结果：8例患者入组，中位年龄38岁，5例女性。没有患者膝关节屈曲小于90°或伸直不足超过10°。prom的Lysholm分数中位数为87。应力x线片显示所有患者的后平移松弛小于7mm （I级）。在6例患者中，随访MRI扫描显示1例患者PCL未愈合，3例患者仅部分愈合。结论：6例患者中有5例在MRI上出现隧道拓宽或合成材料反应，但所有患者膝关节稳定，PROMs可接受。隧道位置不均匀和未进行PCL撕裂修复等因素可能导致隧道变宽。

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引用次数: 0

The pathoanatomy of medial ligamentous disruption in the dislocated and multiple ligament injured knee 膝关节脱位及多发韧带损伤中内侧韧带断裂的病理解剖。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-01 DOI: 10.1016/j.knee.2024.11.002

Nancy Park , Jay Moran , Logan Petit , Joseph Kahan , William McLaughlin , Peter Joo , Michael Lee , Joshua Green , Kinjal Vasavada , Isabel Chalem , Peter Jokl , Michael J. Alaia , Michael J. Medvecky

Purpose

To describe the medial-sided pathoanatomy and ligament injuries in acute MLKIs with medial-sided involvement and look for associated injury patterns based upon location of ligamentous injury.

Methods

Patients who underwent treatment for MLKI at two level-1 trauma centers were identified between January 2001 and May 2023. Only cases involving complete disruption of the superficial medial collateral ligament (sMCL) were included. Zone of injury to the sMCL, the posterior oblique ligament (POL), the medial patellofemoral ligament (MPFL), the vastus medialis oblique (VMO) was recorded, as well as demographics, injury details, neurovascular status, and mechanism of injury. Data was summarized using descriptive statistics.

Results

A total of 92 patients were included, with a mean age of 37.8 ± 12.7 years. Forty-four (47.8%) patients had a high velocity injury. Within sMCL tears, 39% were proximal avulsions, 29% were midsubstance tears, and 32% were distal avulsions. The medial-sided injury patterns were: 31 (33.7%) isolated sMCL tears, 24 (27.3%) combined sMCL, POL, and MPFL tears, 23 (25%) combined sMCL and MPFL tears, and 11 (12%) combined sMCL and POL tears. Most common location of sMCL injury varied based upon the number of associated medial knee ligaments injured: isolated sMCL (even distribution), sMCL & POL (distal), sMCL-MPFL (proximal), sMCL-POL-MPFL (proximal).

Conclusion

Medial-sided ligament injuries seen MLKIs were found to occur in four injury patterns ranging from isolated sMCL or combined injury patterns of the adjacent medial structures. Additionally, location of sMCL injury varied based upon the number of medial-sided ligaments injured.

目的：描述伴有内侧受累的急性mlki的内侧病理解剖和韧带损伤，并根据韧带损伤的位置寻找相关的损伤模式。方法：选取2001年1月至2023年5月在两个一级创伤中心接受MLKI治疗的患者。我们只包括了涉及浅内侧副韧带（sMCL）完全断裂的病例。记录sMCL、后斜韧带（POL）、髌股内侧韧带（MPFL）、股内侧斜肌（VMO）的损伤区域，以及人口统计学、损伤细节、神经血管状况和损伤机制。数据采用描述性统计进行汇总。结果：共纳入92例患者，平均年龄37.8±12.7岁。44例（47.8%）为高速损伤。在sMCL撕裂中，39%为近端撕脱，29%为中端撕脱，32%为远端撕脱。内侧损伤类型为：单纯sMCL撕裂31例（33.7%），sMCL、POL和MPFL联合撕裂24例（27.3%），sMCL和MPFL联合撕裂23例（25%），sMCL和POL联合撕裂11例（12%）。最常见的sMCL损伤位置因相关膝关节内侧韧带损伤的数量而异：孤立性sMCL（均匀分布）、sMCL & POL（远端）、sMCL- mpfl（近端）、sMCL-POL- mpfl（近端）。结论：内侧韧带损伤可发生在四种损伤类型中，包括单纯性小韧带损伤或相邻内侧结构的联合损伤。此外，sMCL损伤的位置根据内侧韧带损伤的数量而变化。

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引用次数: 0

Posterior capsular release around the intercondylar notch increases extension gap without affecting flexion gap in posterior-stabilized total knee arthroplasty 后稳定全膝关节置换术中，髁间切迹周围的后囊膜释放可增加伸展间隙而不影响屈曲间隙。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-01 DOI: 10.1016/j.knee.2024.11.014

Yutaka Suetomi , Patricio Ⅲ Espinoza Dumlao , Atsunori Tokushige , Venkata Vinay Atluri , Takashi Sakai , Hiroshi Fujii

Background

In posterior-stabilized (PS) total knee arthroplasty (TKA), joint extension gap decreases after placement of a femoral trial component which causes imbalance between the extension and flexion gaps. Previous studies have demonstrated that capsular release around the intercondylar notch can enlarge the extension gap; however, its impact on the flexion gap is unknown. This study assessed the effect of capsular release around the intercondylar notch on both extension and flexion gaps.

Methods

This study included 100 patients who underwent PS-TKA, and capsular release was performed intraoperatively to avoid flexion contracture and to balance the extension–flexion gap. We measured the gap and tilting angle with a femoral trial using FuZion™ tensor, applying a joint distraction force of 40 lbs. The differences in gap and tilting angle were assessed before and after capsular release.

Results

The mean center component gap (CG) before and after capsular release was 10.0 mm and 12.5 mm in extension (P < 0.001), 14.1 mm and 14.2 mm in flexion (P = 0.58), respectively. Calculated medial CG before and after capsular release was 9.2 mm and 11.4 mm in extension (P < 0.001), 12.6 mm and 12.7 mm in flexion (P = 0.20), respectively. The average medial CG difference significantly decreased from 3.4 mm to 1.3 mm after release.

Conclusion

This study confirmed that capsular release around the intercondylar notch significantly enlarges the extension component gap, while having an insignificant effect on the flexion component gap in PS-TKA.

背景：在后路稳定（PS）全膝关节置换术（TKA）中，放置股骨试验假体后，关节伸展间隙减小，导致伸展和屈曲间隙不平衡。先前的研究表明，髁间切迹周围囊膜的释放可以扩大髁间延伸间隙；然而，其对屈曲间隙的影响尚不清楚。本研究评估了髁间切迹周围囊膜释放对伸展和屈曲间隙的影响。方法：本研究纳入100例PS-TKA患者，术中进行囊膜释放以避免屈曲挛缩并平衡伸屈间隙。我们使用FuZion™张量仪通过股骨试验测量间隙和倾斜角度，施加40磅的关节牵引力。评估胶囊释放前后间隙和倾斜角度的差异。结果：囊膜释放前后的平均中心构件间隙（CG）为10.0 mm，伸展时为12.5 mm (P)。结论：本研究证实，在PS-TKA中，髁间切迹周围的囊膜释放显著增大伸展构件间隙，而对屈曲构件间隙的影响不显著。

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引用次数: 0

What is the evidence? Who can you trust? 证据是什么？你能信任谁？

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-01 DOI: 10.1016/j.knee.2024.12.012

Caroline Hing, Oday Al-Dadah

引用次数: 0

Effect of surgical treatment on relative tibial external rotation in patients with recurrent patellar dislocation

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-31 DOI: 10.1016/j.knee.2024.12.006

Kangning Tang , Xianming Wang , Yan Jin , Tao Zhang , Qing Wang

Background

In the knee joints of patients with recurrent patellar dislocation (RPD), an increased relative tibial external rotation (rTER) is often observed. However, the changes in this parameter pre- and postoperatively remain unclear.

Purpose

The purpose of this study was to reveal preoperative and postoperative changes in rTER in patients with RPD.

Methods

A total of 48 cases with RPD in the knee joint were included in the study group, while 50 cases with normal knee joints were included in the control group. The measured parameters included tibial tubercle–trochlear groove distance (TT-TG) and rTER. Measurements were recorded for RPD patients both pre-and postoperatively. Analysis of variance was used to assess the intergroup differences in TT-TG and rTER, and a t-test was employed to evaluate differences among various surgical procedures.

Results

In the RPD group, rTER was significantly higher than in the control group (P＜0.001), with no statistically significant difference in postoperative rTER (P = 0.366). There was no significant difference in postoperative rTER between the RPD group and the control group (P = 0.057). The difference in TT-TG distance before and after operation in RPD patients was statistically significant (P < 0.001). Within the subgroups, there was a significant difference in rTER between pre − and post-operation in the tibial tuberosity osteotomy combined with medial patellofemoral ligament reconstruction (MPFLR) group (P = 0.043). Multivariate analysis showed that age and body mass index had no correlation with rTER.

Conclusions

Compared with MPFLR alone, tibial tuberosity osteotomy combined with MPFLR can significantly reduce postoperative rTER and make rTER tend to be normal. For patients with elevated TT-TG and abnormal rTER, tibial tuberosity osteotomy combined with MPFLR may be a better choice.

{"title":"Effect of surgical treatment on relative tibial external rotation in patients with recurrent patellar dislocation","authors":"Kangning Tang , Xianming Wang , Yan Jin , Tao Zhang , Qing Wang","doi":"10.1016/j.knee.2024.12.006","DOIUrl":"10.1016/j.knee.2024.12.006","url":null,"abstract":"<div><h3>Background</h3><div>In the knee joints of patients with recurrent patellar dislocation (RPD), an increased relative tibial external rotation (rTER) is often observed. However, the changes in this parameter pre- and postoperatively remain unclear.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to reveal preoperative and postoperative changes in rTER in patients with RPD.</div></div><div><h3>Methods</h3><div>A total of 48 cases with RPD in the knee joint were included in the study group, while 50 cases with normal knee joints were included in the control group. The measured parameters included tibial tubercle–trochlear groove distance (TT-TG) and rTER. Measurements were recorded for RPD patients both pre-and postoperatively. Analysis of variance was used to assess the intergroup differences in TT-TG and rTER, and a <em>t</em>-test was employed to evaluate differences among various surgical procedures.</div></div><div><h3>Results</h3><div>In the RPD group, rTER was significantly higher than in the control group (<em>P</em>＜0.001), with no statistically significant difference in postoperative rTER (<em>P</em> = 0.366). There was no significant difference in postoperative rTER between the RPD group and the control group (<em>P</em> = 0.057). The difference in TT-TG distance before and after operation in RPD patients was statistically significant (<em>P</em> < 0.001). Within the subgroups, there was a significant difference in rTER between pre − and post-operation in the tibial tuberosity osteotomy combined with medial patellofemoral ligament reconstruction (MPFLR) group (<em>P</em> = 0.043). Multivariate analysis showed that age and body mass index had no correlation with rTER.</div></div><div><h3>Conclusions</h3><div>Compared with MPFLR alone, tibial tuberosity osteotomy combined with MPFLR can significantly reduce postoperative rTER and make rTER tend to be normal. For patients with elevated TT-TG and abnormal rTER, tibial tuberosity osteotomy combined with MPFLR may be a better choice.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 147-153"},"PeriodicalIF":1.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061382","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

Using three-zone flexible cones at the metaphyseal–diaphyseal junction may avoid the need for distal femoral replacement: The floating cone technique

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-31 DOI: 10.1016/j.knee.2024.12.004

Marc Ferrer-Banús, Montserrat Monfort-Mira, Marta Sabater-Martos, Laia Boadas-Gironès, Clara Chimeno-Pigrau, Juan Carlos Martínez-Pastor

Distal femoral replacement (DFR) with megaprostheses is a salvage revision total knee arthroplasty (rTKA) procedure indicated in cases with massive bone defects in the distal femur. As long as these implants achieve fixation only in the diaphysis, the high aseptic loosening rate reported in some series is probably related to a lack of rotational stability. Two patients with extensive distal femoral bone defects with preservation of the metaphyseal–diaphyseal junction underwent rTKA. Instead of performing a DFR with megaprostheses, partially impacted three-zone cones and standard cemented hinged implants were used with the aim of achieving better rotational stability. Both patients showed good evolution after a 12-month follow up. Clinical findings included a normal range of motion (0–100°) without any instability and preserved ability for full weight-bearing ambulation. No signs of prosthetic loosening appeared in the X-rays during follow up. To our knowledge, this was the first time a single partially anchored three-zone cone was used in massive metaphyseal femoral defects. It is an implant-dependent technique that additionally requires the preservation of the metaphyseal–diaphyseal junction, but may avoid the use of megaprostheses in some cases.

{"title":"Using three-zone flexible cones at the metaphyseal–diaphyseal junction may avoid the need for distal femoral replacement: The floating cone technique","authors":"Marc Ferrer-Banús, Montserrat Monfort-Mira, Marta Sabater-Martos, Laia Boadas-Gironès, Clara Chimeno-Pigrau, Juan Carlos Martínez-Pastor","doi":"10.1016/j.knee.2024.12.004","DOIUrl":"10.1016/j.knee.2024.12.004","url":null,"abstract":"<div><div>Distal femoral replacement (DFR) with megaprostheses is a salvage revision total knee arthroplasty (rTKA) procedure indicated in cases with massive bone defects in the distal femur. As long as these implants achieve fixation only in the diaphysis, the high aseptic loosening rate reported in some series is probably related to a lack of rotational stability. Two patients with extensive distal femoral bone defects with preservation of the metaphyseal–diaphyseal junction underwent rTKA. Instead of performing a DFR with megaprostheses, partially impacted three-zone cones and standard cemented hinged implants were used with the aim of achieving better rotational stability. Both patients showed good evolution after a 12-month follow up. Clinical findings included a normal range of motion (0–100°) without any instability and preserved ability for full weight-bearing ambulation. No signs of prosthetic loosening appeared in the X-rays during follow up. To our knowledge, this was the first time a single partially anchored three-zone cone was used in massive metaphyseal femoral defects. It is an implant-dependent technique that additionally requires the preservation of the metaphyseal–diaphyseal junction, but may avoid the use of megaprostheses in some cases.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 154-159"},"PeriodicalIF":1.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061394","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

An isolated extra-articular procedure can be indicated for patients with minor instabilities and intact graft after anterior cruciate ligament reconstruction

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-31 DOI: 10.1016/j.knee.2024.12.007

Camilo Partezani Helito , Andre Giardino Moreira da Silva , Matt Daggett , Sergio Marinho de Gusmão Canuto , Carlo Leekninh Paione , Hernan Galan , Riccardo Cristiani

Background

Some patients submitted to isolated ACL reconstruction may have symptomatic postoperative rotational instability. The objective of this study was to evaluate a population with mild rotatory instability after ACL reconstruction, which was submitted to an isolated extra-articular procedure.

Methods

Patients submitted to an isolated extra-articular procedure after ACL reconstruction were retrospectively evaluated. Only patients presenting anterior knee instability of less than 5 mm, pivot-shift of a maximum of 1+, and ACL graft intact were included. Demographic data, physical examination and subjective functional scales were evaluated.

Results

Twenty patients were included. The mean age was 27.0 ± 7.3 years. The follow up time after the extra-articular procedure was 27.5 ± 6.2 months. The KT-1000 decreased from 3.0 mm ± 0.7 mm to 2 mm ± 0.4 mm (P = 0.00016). The pivot-shift improved from 100% of grade 1 positivity to 30% (6/20 patients) of grade 1 positivity (P < 0.0001). The IKDC showed no difference (74.4 ± 11.8 vs. 87.6 ± 5.8; P = 0.087), but the percentage of patients who passed the PASS IKDC cut-off value increased from 45% (9/20) to 95% (19/20) (P = 0.0012). The Lysholm increased from 81.1 ± 7.3 to 91.2 ± 5.7 (P = 0.0001).

Conclusions

Patients submitted to an isolated extra-articular procedure due to residual instability after ACL reconstruction showed improvement in physical examination (KT-1000 and pivot-shift) and subjective functional scales. This procedure can be considered for a specific population with minor instabilities and intact ACL graft, avoiding a complete ACL revision.

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引用次数: 0

Correction of severe varus deformity in total knee arthroplasty with the technique of tibial plateau reduction 胫骨平台复位技术矫正全膝关节置换术中严重内翻畸形。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-30 DOI: 10.1016/j.knee.2024.12.005

Guo-Chun Zha, Gang Bao, Hao Wu, He-Ping Wang, An-Dong Wang, Zhi-Jun Shen

Background

The optimal soft tissue release technique for severe varus total knee arthroplasty (TKA) remains controversial. The technique of tibial plateau reduction was suggested for severe varus deformity during TKA. The purpose of this study was to evaluate the clinical and radiological outcomes of the technique of tibial plateau reduction.

Methods

Fifty-one knees (39 patients) with a mechanical femoro-tibial angle (MFTA) greater than 15° treated with TKA was presented. The clinical and radiographic data were gathered prospectively. The patients were divided into two groups according to the preoperative angle: Group A comprised patients with a preoperative MFTA less than or equal to 20°, while Group B included patients with a preoperative MFTA greater than 20°.

Results

Among the 51 knees, 46 knees (90.2%) had femoro-tibial component size mismatch. The KSS-KS improved from preoperative 39.9 ± 11.3 points (range:18–68 points) to 92.3 ± 5.2 points (range: 83–100 points) at the final follow up (t = 30.141, P < 0.001); the KSS-FS improved from preoperative 48.0 ± 11.5 points (range: 31–71 points) to 87.2 ± 8.7 points (range: 63–100 points) at the final follow up (t = 19.413, P < 0.001). The mean MFTA was corrected from 21.0 ± 4.7° preoperatively to 2.9 ± 1.8° at the latest follow up (P < 0.001). The preoperative MFTA was less than or equal to 20° in 27 knees (Group A), and greater than 20° in 24 knees (Group B). The mean postoperative MFTA was 1.9 ± 0.9° in Group A, and 4.1 ± 1.7° in Group B (P < 0.001). The neutral limb alignment was reached in 26 knees (96.3%) in group A, which was significantly higher than that in group B (29.7%) (P = 0.019).

Conclusions

The technique of tibial plateau reduction provided satisfactory clinical and radiological outcomes without instability for severe varus TKA. However, surgeons should remain aware that the greater the preoperative varus deformity, the greater the postoperative residual varus deformity, and that there is a high incidence of femoro-tibial component size mismatch using the technique.

背景：重度内翻全膝关节置换术（TKA）的最佳软组织释放技术仍然存在争议。对于TKA中严重的内翻畸形，建议采用胫骨平台复位技术。本研究的目的是评估胫骨平台复位技术的临床和放射学结果。方法：对39例机械股胫角（MFTA）大于15°的51例膝关节进行TKA治疗。前瞻性地收集临床和影像学资料。根据术前角度将患者分为两组：A组为术前MFTA小于等于20°的患者，B组为术前MFTA大于20°的患者。结果：51个膝关节中，46个膝关节（90.2%）存在股胫骨假体尺寸不匹配。KSS-KS评分由术前的39.9±11.3分（范围：18-68分）提高到最后随访时的92.3±5.2分（范围：83-100分）（t = 30.141， P）。结论：胫骨平台复位技术治疗严重内翻TKA临床及影像学结果满意，无不稳定性。然而，外科医生应该意识到，术前内翻畸形越大，术后残留的内翻畸形也越大，并且使用该技术时，股骨-胫骨部件尺寸不匹配的发生率很高。

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引用次数: 0

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