Knee最新文献

英文中文

The tensile strength of different methods of anterior cruciate ligament graft end stitches in an animal model

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-02-07 DOI: 10.1016/j.knee.2025.01.012

Marcin Dembski , Patryk Kawa , Jakub Tarnawski , Marcin Ceynowa , Krzysztof Żerdzicki , Paweł Kłosowski

Background

There are several methods for stitching graft ends in anterior cruciate ligament reconstructive surgery. The tendon-suture construct should be able to withstand tensioning until the graft is stabilized with an implant.

Methods

In this biomechanical study, 40 porcine lower extremity tendons ends were stitched with No. 2 suture, secured to the grips of the Zwick-Roell testing machine and tested for load at failure and type of failure (tendon v/s suture thread). The applied force was linear, the results are given in Newtons (N) as a mean. The Mann-Whitney U test was used for statistical analysis. The following constructs were compared: a whipstitch of each tendon end individually with 3, 4, and 5 passes through the tendon, a whipstitch of both tendon ends folded together and a tendon end knot without stitching.

Results

All specimens survived the minimum tensile load of 80 N. The load at failure for whipstitch with 3,4 and 5 passes were 175 N, 211 N and 254 N respectively. The load at failure was greater for individual whipstitch than for both ends folded together (261 N v/s 152 N). The mean load at failure for braided graft was 209 N. The braided graft slips off the tendon before failure leading to uneven strength distribution during tensioning.

Conclusion

Increasing number of suture passes resulted in higher load at failure. Individual tendon ends whipstitched with 5 passes was the strongest construct. All of the investigated techniques are sufficient to withstand the suggested optimal graft tension of 80 N.

{"title":"The tensile strength of different methods of anterior cruciate ligament graft end stitches in an animal model","authors":"Marcin Dembski , Patryk Kawa , Jakub Tarnawski , Marcin Ceynowa , Krzysztof Żerdzicki , Paweł Kłosowski","doi":"10.1016/j.knee.2025.01.012","DOIUrl":"10.1016/j.knee.2025.01.012","url":null,"abstract":"<div><h3>Background</h3><div>There are several methods for stitching graft ends in anterior cruciate ligament reconstructive surgery. The tendon-suture construct should be able to withstand tensioning until the graft is stabilized with an implant.</div></div><div><h3>Methods</h3><div>In this biomechanical study, 40 porcine lower extremity tendons ends were stitched with No. 2 suture, secured to the grips of the Zwick-Roell testing machine and tested for load at failure and type of failure (tendon v/s suture thread). The applied force was linear, the results are given in Newtons (N) as a mean. The Mann-Whitney <em>U</em> test was used for statistical analysis. The following constructs were compared: a whipstitch of each tendon end individually with 3, 4, and 5 passes through the tendon, a whipstitch of both tendon ends folded together and a tendon end knot without stitching.</div></div><div><h3>Results</h3><div>All specimens survived the minimum tensile load of 80 N. The load at failure for whipstitch with 3,4 and 5 passes were 175 N, 211 N and 254 N respectively. The load at failure was greater for individual whipstitch than for both ends folded together (261 N v/s 152 N). The mean load at failure for braided graft was 209 N. The braided graft slips off the tendon before failure leading to uneven strength distribution during tensioning.</div></div><div><h3>Conclusion</h3><div>Increasing number of suture passes resulted in higher load at failure. Individual tendon ends whipstitched with 5 passes was the strongest construct. All of the investigated techniques are sufficient to withstand the suggested optimal graft tension of 80 N.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 293-301"},"PeriodicalIF":1.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143360570","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

Clinical outcomes of repaired radial meniscal tears: A retrospective study with minimum 2-year follow-up

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-02-07 DOI: 10.1016/j.knee.2025.01.009

Camilo Partezani Helito , Andre Giardino Moreira da Silva , Filippo Familiari , Roberto Simonetta , Mateus Carlos Andrade , Daniel Esperante Gomes , Christoffer von Essen , Riccardo Cristiani

Background

The management of meniscal radial tears has changed significantly in recent years in favor of meniscus repair. However, there is still limited published data on the outcomes and risk factors associated with repair failure. The objective of this study is to evaluate the clinical success rate of repaired meniscal radial tears and identify potential risk factors for failure.

Methods

Patients who underwent repair of meniscal radial tears between 2016 and 2022 were reviewed retrospectively. The following parameters were collected: demographic data, pre-operative Kellgren-Lawrence grading, history of previous knee surgeries, time from injury to surgery, injury location, number of sutures used, use of transtibial tunnel augmentation, associated procedures, postoperative functional scores, and clinical failure rates.

Results

81 patients were included, with a mean age of 29.9 ± 12.3 years. The mean follow-up time was 36.7 ± 17.0 months. Postoperatively, the mean IKDC was 81 ± 18.1, and the mean Lysholm score was 82 ± 18.4. The clinical failure rate was 19.8%. In the univariate analysis, the factors associated with failure included increased age, female gender, medial meniscus repair, isolated repairs (without ACL reconstruction), a Kellgren-Lawrence scale greater than 0, and repairs without a transtibial tunnel. However, none of these variables were statistically significant in the multivariate analysis adjusted for age and gender.

Conclusion

The clinical success rate of repaired meniscal radial tears was about 80% after a minimum 2-year follow-up. Increased age, female gender, repair of medial meniscus, isolated repair without ACL reconstruction, mild preoperative osteoarthritic signs, and repair without a transtibial tunnel augmentation are possible risk factors for failure.

Level of evidence

Level IV, retrospective case series.

{"title":"Clinical outcomes of repaired radial meniscal tears: A retrospective study with minimum 2-year follow-up","authors":"Camilo Partezani Helito , Andre Giardino Moreira da Silva , Filippo Familiari , Roberto Simonetta , Mateus Carlos Andrade , Daniel Esperante Gomes , Christoffer von Essen , Riccardo Cristiani","doi":"10.1016/j.knee.2025.01.009","DOIUrl":"10.1016/j.knee.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>The management of meniscal radial tears has changed significantly in recent years in favor of meniscus repair. However, there is still limited published data on the outcomes and risk factors associated with repair failure. The objective of this study is to evaluate the clinical success rate of repaired meniscal radial tears and identify potential risk factors for failure.</div></div><div><h3>Methods</h3><div>Patients who underwent repair of meniscal radial tears between 2016 and 2022 were reviewed retrospectively. The following parameters were collected: demographic data, pre-operative Kellgren-Lawrence grading, history of previous knee surgeries, time from injury to surgery, injury location, number of sutures used, use of transtibial tunnel augmentation, associated procedures, postoperative functional scores, and clinical failure rates.</div></div><div><h3>Results</h3><div>81 patients were included, with a mean age of 29.9 ± 12.3 years. The mean follow-up time was 36.7 ± 17.0 months. Postoperatively, the mean IKDC was 81 ± 18.1, and the mean Lysholm score was 82 ± 18.4. The clinical failure rate was 19.8%. In the univariate analysis, the factors associated with failure included increased age, female gender, medial meniscus repair, isolated repairs (without ACL reconstruction), a Kellgren-Lawrence scale greater than 0, and repairs without a transtibial tunnel. However, none of these variables were statistically significant in the multivariate analysis adjusted for age and gender.</div></div><div><h3>Conclusion</h3><div>The clinical success rate of repaired meniscal radial tears was about 80% after a minimum 2-year follow-up. Increased age, female gender, repair of medial meniscus, isolated repair without ACL reconstruction, mild preoperative osteoarthritic signs, and repair without a transtibial tunnel augmentation are possible risk factors for failure.</div></div><div><h3>Level of evidence</h3><div>Level IV, retrospective case series.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 285-292"},"PeriodicalIF":1.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348393","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

Similarities in the kinematics of autografts and hybrid grafts for anterior cruciate ligament reconstruction: Minimum 2 years of follow-up

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-02-07 DOI: 10.1016/j.knee.2025.01.014

Shaozheng Yang , Guangyuan Dong , Jianying Pan , Yongqiang Liu , Hua Zhong , Chun Zeng

Objective

To compare the clinical results of anterior cruciate ligament reconstruction (ACLR) with autografts and that with hybrid grafts of the same diameter.

Methods

This study retrospectively included 102 patients who underwent ACLR from August 2017 to July 2019. According to graft type, the patients were divided into an autograft group (58 patients) and a hybrid graft group (44 patients). All grafts were 8.0 mm in diameter. The failure rate, knee kinematics with 6 degrees of freedom (DOFs), signal/noise quotient (SNQ), the Lachman test, pivot-shift test, Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score were compared in each group after a minimum 2-year follow-up.

Results

There was no significant difference in the failure rate between the autograft group (1.72%) and the hybrid graft group (2.27%) (P > 0.999). The SNQ values of the autograft group (16.42 ± 5.29 and 18.52 ± 5.30) at the middle and proximal sites were lower than those of the hybrid graft group (12.13 ± 5.62 and 16.35 ± 4.64; P = 0.020 and P < 0.001, respectively). In the autograft group, the results of range of motion at 6 DOFs and tibiofemoral kinematics at 5 DOFs (except internal-external rotation) were similar to those of the hybrid graft group (P > 0.05). The Lysholm score, Tegner activity score, IKDC score, Lachman test, and pivot-shift test showed no differences between the two groups (P > 0.05).

Conclusions

Autograft in ACLR has better graft maturity than hybrid grafts, but their kinematic characteristics are similar.

Clinical trial registration

ChiCTR2000037869.

{"title":"Similarities in the kinematics of autografts and hybrid grafts for anterior cruciate ligament reconstruction: Minimum 2 years of follow-up","authors":"Shaozheng Yang , Guangyuan Dong , Jianying Pan , Yongqiang Liu , Hua Zhong , Chun Zeng","doi":"10.1016/j.knee.2025.01.014","DOIUrl":"10.1016/j.knee.2025.01.014","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the clinical results of anterior cruciate ligament reconstruction (ACLR) with autografts and that with hybrid grafts of the same diameter.</div></div><div><h3>Methods</h3><div>This study retrospectively included 102 patients who underwent ACLR from August 2017 to July 2019. According to graft type, the patients were divided into an autograft group (58 patients) and a hybrid graft group (44 patients). All grafts were 8.0 mm in diameter. The failure rate, knee kinematics with 6 degrees of freedom (DOFs), signal/noise quotient (SNQ), the Lachman test, pivot-shift test, Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score were compared in each group after a minimum 2-year follow-up.</div></div><div><h3>Results</h3><div>There was no significant difference in the failure rate between the autograft group (1.72%) and the hybrid graft group (2.27%) (<em>P</em> > 0.999). The SNQ values of the autograft group (16.42 ± 5.29 and 18.52 ± 5.30) at the middle and proximal sites were lower than those of the hybrid graft group (12.13 ± 5.62 and 16.35 ± 4.64; <em>P</em> = 0.020 and <em>P</em> < 0.001, respectively). In the autograft group, the results of range of motion at 6 DOFs and tibiofemoral kinematics at 5 DOFs (except internal-external rotation) were similar to those of the hybrid graft group (<em>P</em> > 0.05). The Lysholm score, Tegner activity score, IKDC score, Lachman test, and pivot-shift test showed no differences between the two groups (<em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Autograft in ACLR has better graft maturity than hybrid grafts, but their kinematic characteristics are similar.</div></div><div><h3>Clinical trial registration</h3><div>ChiCTR2000037869.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 273-284"},"PeriodicalIF":1.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348391","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

Early radiographic evaluation of an anatomic porous tantalum tibia: A prospective, multi-center, non-randomized clinical study

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-02-07 DOI: 10.1016/j.knee.2025.01.010

Cass Nakasone , Ian Weber , Craig Israelite , Jason Cholewa

Background

Excellent survival rates have been reported for total knee arthroplasty (TKA) performed with cementless porous metal tibial components. More data, however, is necessary to assess the survival and radiographic results of modular implants with anatomic designs. The purpose of this study was to investigate the early radiographic, survival, and clinical outcomes of a cementless tantalum metal tibial implant with a modular anatomic component.

Methods

An early follow-up of a prospective, multi-center, non-randomized outcomes study of patients who received cementless tibial implants in primary TKA between 2018 and 2020 was performed. A total of 148 implants were available for review. Radiographs, the Forgotten Joint Score (FJS-12), Oxford Knee Score (OKS), patient satisfaction, and adverse events were collected for at least two-years post-operative. A minimum of two-years follow-up was available for 119 patients and evaluated for progressive radiolucent lines (RLLs).

Results

The mean follow-up was 2.2 ± 0.6 years, and the two-year implant survival rate was 98.59% (95% C.I.: 94.46, 99.64) with no aseptic revisions during the follow-up period. Progressive tibial RLLs were present in 3.4% of patients at two-years follow-up, but were all less than 2 mm with all combined RLLs less than 4 mm. The FJS-12 and OKS all significantly (p < 0.0001) increased and exceeded their respective minimal clinical important differences, and 93% of patients were satisfied at two-years follow-up.

Conclusion

This study supports excellent survivorship, clinical and patient reported outcomes using cementless, fixed bearing TKA with minimal complications at early follow-up. Further follow-up is necessary to confirm the sustainability of the clinical outcomes and to evaluate mid- to long-term survivorship.

{"title":"Early radiographic evaluation of an anatomic porous tantalum tibia: A prospective, multi-center, non-randomized clinical study","authors":"Cass Nakasone , Ian Weber , Craig Israelite , Jason Cholewa","doi":"10.1016/j.knee.2025.01.010","DOIUrl":"10.1016/j.knee.2025.01.010","url":null,"abstract":"<div><h3>Background</h3><div>Excellent survival rates have been reported for total knee arthroplasty (TKA) performed with cementless porous metal tibial components. More data, however, is necessary to assess the survival and radiographic results of modular implants with anatomic designs. The purpose of this study was to investigate the early radiographic, survival, and clinical outcomes of a cementless tantalum metal tibial implant with a modular anatomic component.</div></div><div><h3>Methods</h3><div>An early follow-up of a prospective, multi-center, non-randomized outcomes study of patients who received cementless tibial implants in primary TKA between 2018 and 2020 was performed. A total of 148 implants were available for review. Radiographs, the Forgotten Joint Score (FJS-12), Oxford Knee Score (OKS), patient satisfaction, and adverse events were collected for at least two-years post-operative. A minimum of two-years follow-up was available for 119 patients and evaluated for progressive radiolucent lines (RLLs).</div></div><div><h3>Results</h3><div>The mean follow-up was 2.2 ± 0.6 years, and the two-year implant survival rate was 98.59% (95% C.I.: 94.46, 99.64) with no aseptic revisions during the follow-up period. Progressive tibial RLLs were present in 3.4% of patients at two-years follow-up, but were all less than 2 mm with all combined RLLs less than 4 mm. The FJS-12 and OKS all significantly (p < 0.0001) increased and exceeded their respective minimal clinical important differences, and 93% of patients were satisfied at two-years follow-up.</div></div><div><h3>Conclusion</h3><div>This study supports excellent survivorship, clinical and patient reported outcomes using cementless, fixed bearing TKA with minimal complications at early follow-up. Further follow-up is necessary to confirm the sustainability of the clinical outcomes and to evaluate mid- to long-term survivorship.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 264-272"},"PeriodicalIF":1.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143360571","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

Effect of specialized pro-resolving mediators on knee joint inflammation 专门的促进缓解介质对膝关节炎症的影响

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-02-04 DOI: 10.1016/j.knee.2025.01.005

Chilan Bou Ghosson Leite , Alexander Bumberger , Domenico Franco , Marco Tulio Di Stefano , Christian Lattermann

Background

Chronic inflammation following knee injuries often results in persistent knee pain and post-traumatic osteoarthritis (PTOA). Understanding the inflammatory processes that follow a joint injury is crucial to effectively mitigate PTOA progression. While inflammation is an integral part of any healing response, unresolved, long-lasting inflammation can be detrimental to the joint. The resolution of inflammation is an active process coordinated by pro-resolving molecules, including specialized pro-resolving mediators (SPMs). While SPMs have been primarily studied in chronic inflammatory diseases, their role in degenerative knee conditions such as PTOA remains underexplored.

Methods

This review examines the process of inflammation and its resolution following knee joint injuries and subsequent PTOA, with a focus on the impact of SPMs.

Conclusions

SPMs play a key role in the resolution of inflammation and may offer potential benefits in the management of knee injuries to improve pain and prevent PTOA.

{"title":"Effect of specialized pro-resolving mediators on knee joint inflammation","authors":"Chilan Bou Ghosson Leite , Alexander Bumberger , Domenico Franco , Marco Tulio Di Stefano , Christian Lattermann","doi":"10.1016/j.knee.2025.01.005","DOIUrl":"10.1016/j.knee.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Chronic inflammation following knee injuries often results in persistent knee pain and post-traumatic osteoarthritis (PTOA). Understanding the inflammatory processes that follow a joint injury is crucial to effectively mitigate PTOA progression. While inflammation is an integral part of any healing response, unresolved, long-lasting inflammation can be detrimental to the joint. The resolution of inflammation is an active process coordinated by pro-resolving molecules, including specialized pro-resolving mediators (SPMs). While SPMs have been primarily studied in chronic inflammatory diseases, their role in degenerative knee conditions such as PTOA remains underexplored.</div></div><div><h3>Methods</h3><div>This review examines the process of inflammation and its resolution following knee joint injuries and subsequent PTOA, with a focus on the impact of SPMs.</div></div><div><h3>Conclusions</h3><div>SPMs play a key role in the resolution of inflammation and may offer potential benefits in the management of knee injuries to improve pain and prevent PTOA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 257-263"},"PeriodicalIF":1.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181807","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

Letter to the Editors: Quadriceps tendon versus hamstring tendon graft for primary anterior cruciate ligament reconstruction: Is there any difference? Knee 2024;49:226–40

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-30 DOI: 10.1016/j.knee.2025.01.004

Pedro Felipe Austregésilo de Alencar , Guilherme Sávio Lima Frota , Guilherme Nobre Nogueira , Larissa Amorim Teixeira

引用次数: 0

Individualized total knee arthroplasty achieves better functional results than off-the-shelf implants in patients undergoing personalized coronal alignment

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-25 DOI: 10.1016/j.knee.2024.12.009

Bernard de Geofroy , Tristan Fauchille , Michael Djian , Marc-Olivier Gauci , Jean-Yves Bohic , Xavier Pocquet , Grégoire Micicoi

Background

Several studies have demonstrated the interest in patient-specific custom cutting guides in total knee arthroplasty (TKA), but clinical improvement remains debated. The purpose of this study was to evaluate the functional outcomes (Forgotten Joint Score, FJS) of patients undergoing individualized TKA compared with those receiving off-the-shelf (OTS) implants, both using patient-specific cutting guides with personalized alignment over a minimum follow up period of 12 months. We hypothesized that individualized TKA demonstrates significantly better functional outcomes than OTS TKA (FJS and percentage of patients reaching the minimum clinically important difference).

Methods

A continuous single-surgeon retrospective series was analyzed from September 2018 to June 2020. The inclusion criterion was primary TKA for osteoarthritis. The series compared 58 individualized TKAs to 54 standard implants, with personalized alignment, at a mean follow up of 25 (12–40) months. The two groups were comparable in gender, age, BMI, and preoperative deformity. Complications and revision procedures were recorded. The FJS, New IKS, and Oxford Knee Score were assessed at the last follow up, and the sensation of a forgotten knee was evaluated.

Results

One patient in each group required TKA revision. At last follow up, the individualized TKA group showed significantly better FJS (91 ± 14 vs. 81 ± 23, P = 0.01), satisfaction category in the IKS (36 ± 5 vs. 32 ± 8, P = 0.002), IKS function (83 ± 11 vs. 72 ± 21, P = 0.003) and Oxford scores (44 ± 5 vs. 39 ± 10, P = 0.005. There was no significant difference in the IKS objective score (88 ± 16 vs. 82 ± 2, P = 0.34). The sensation of a forgotten knee rate did not differ significantly between the groups.

Conclusion

Individualized TKA leads to improved clinical outcomes significantly compared with OTS TKA, utilizing personalized alignment and patient-specific cutting guides. This combination of personalized factors and individualized TKA enhances the potential to tackle the challenges associated with TKA and improve functional results.

{"title":"Individualized total knee arthroplasty achieves better functional results than off-the-shelf implants in patients undergoing personalized coronal alignment","authors":"Bernard de Geofroy , Tristan Fauchille , Michael Djian , Marc-Olivier Gauci , Jean-Yves Bohic , Xavier Pocquet , Grégoire Micicoi","doi":"10.1016/j.knee.2024.12.009","DOIUrl":"10.1016/j.knee.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Several studies have demonstrated the interest in patient-specific custom cutting guides in total knee arthroplasty (TKA), but clinical improvement remains debated. The purpose of this study was to evaluate the functional outcomes (Forgotten Joint Score, FJS) of patients undergoing individualized TKA compared with those receiving off-the-shelf (OTS) implants, both using patient-specific cutting guides with personalized alignment over a minimum follow up period of 12 months. We hypothesized that individualized TKA demonstrates significantly better functional outcomes than OTS TKA (FJS and percentage of patients reaching the minimum clinically important difference).</div></div><div><h3>Methods</h3><div>A continuous single-surgeon retrospective series was analyzed from September 2018 to June 2020. The inclusion criterion was primary TKA for osteoarthritis. The series compared 58 individualized TKAs to 54 standard implants, with personalized alignment, at a mean follow up of 25 (12–40) months. The two groups were comparable in gender, age, BMI, and preoperative deformity. Complications and revision procedures were recorded. The FJS, New IKS, and Oxford Knee Score were assessed at the last follow up, and the sensation of a forgotten knee was evaluated.</div></div><div><h3>Results</h3><div>One patient in each group required TKA revision. At last follow up, the individualized TKA group showed significantly better FJS (91 ± 14 vs. 81 ± 23, <em>P</em> = 0.01), satisfaction category in the IKS (36 ± 5 vs. 32 ± 8, <em>P</em> = 0.002), IKS function (83 ± 11 vs. 72 ± 21, <em>P</em> = 0.003) and Oxford scores (44 ± 5 vs. 39 ± 10, <em>P</em> = 0.005. There was no significant difference in the IKS objective score (88 ± 16 vs. 82 ± 2, <em>P</em> = 0.34). The sensation of a forgotten knee rate did not differ significantly between the groups.</div></div><div><h3>Conclusion</h3><div>Individualized TKA leads to improved clinical outcomes significantly compared with OTS TKA, utilizing personalized alignment and patient-specific cutting guides. This combination of personalized factors and individualized TKA enhances the potential to tackle the challenges associated with TKA and improve functional results.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 228-235"},"PeriodicalIF":1.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048661","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

Corrigendum to “Soft tissue flap reconstruction in infected or exposed total knee arthroplasty: A systematic review and network meta-analysis” [The Knee 52 (2025) 9–21]

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-25 DOI: 10.1016/j.knee.2024.12.014

Mario Alessandri-Bonetti , Riccardo Giorgino , Andrea Costantino , Francesco Amendola , Armando De Virgilio , Laura Mangiavini , Giuseppe M. Peretti , Luca Vaienti , Saïd C. Azoury , Francesco M. Egro

引用次数: 0

Discrepancies in long-leg alignment and knee joint line obliquity between two- and three-dimensional measurements under weight-bearing conditions: Effects on coronal plane alignment of the knee classification

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-25 DOI: 10.1016/j.knee.2024.12.008

Ryo Sasaki , Yasuo Niki , Kazuya Kaneda , Yoshitake Yamada , Shu Kobayashi , Kengo Harato , Takeo Nagura , Masaya Nakamura , Masahiro Jinzaki

Background

Long-leg alignment and joint line obliquity have traditionally been assessed using two-dimensional (2D) radiography, but the accuracy of this measurement has remained unclear. This study aimed to evaluate the accuracy of 2D measurements of lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) using upright three-dimensional (3D) computed tomography (CT).

Methods

This study involved 66 knees from 38 patients (34 women, four men) with knee osteoarthritis (OA), categorized by Kellgren–Lawrence (KL) grade. Patients underwent standing long-leg radiography (LLR) and upright CT. Flexion and rotation angles of the femur and tibia were measured from upright CT data, and knees were classified by coronal plane alignment of the knee (CPAK) according to 2D- and 3D-LDFA/MPTA.

Results

Overall, as KL grade increased, femoral external rotation and flexion increased significantly (P < 0.05). Regarding the tibia, flexion increased (P < 0.05) while rotation remained unchanged with increasing KL grade. In mild OA (KL1 or KL2), 2D-LDFA (86.5 ± 1.8°) was significantly larger than 3D-LDFA (85.0 ± 2.5°; P < 0.05), and this difference was also observed in severe OA (KL3 or KL4) (88.7 ± 2.5° vs. 87.7 ± 3.2°; P < 0.05). However, MPTA was comparable between 2D and 3D. The consistency between 2D and 3D CPAK classifications was 48.5% for the entire sample, 25.0% for mild OA, and 61.9% for severe OA.

Conclusion

Based on 3D-LDFA/MPTA data gained from upright CT, 2D radiographic LDFA tended to be inaccurate, which may significantly affect the CPAK classification.

背景：长腿对齐和关节线斜度传统上使用二维（2D）射线摄影进行评估，但这种测量方法的准确性仍不明确。本研究旨在评估使用直立三维计算机断层扫描（CT）对股骨外侧远端角度（LDFA）和胫骨内侧近端角度（MPTA）进行二维测量的准确性：这项研究涉及 38 名膝关节骨性关节炎（OA）患者（34 名女性，4 名男性）的 66 个膝关节，按 Kellgren-Lawrence (KL) 等级分类。患者接受了站立长腿放射摄影（LLR）和直立 CT 检查。根据直立 CT 数据测量股骨和胫骨的屈伸和旋转角度，并根据 2D 和 3D-LDFA/MPTA 按膝关节冠状面排列（CPAK）对膝关节进行分类：总体而言，随着 KL 等级的增加，股骨外旋和屈曲显著增加（P根据直立 CT 获得的 3D-LDFA/MPTA 数据，二维射线 LDFA 往往不准确，这可能会严重影响 CPAK 分级。

{"title":"Discrepancies in long-leg alignment and knee joint line obliquity between two- and three-dimensional measurements under weight-bearing conditions: Effects on coronal plane alignment of the knee classification","authors":"Ryo Sasaki , Yasuo Niki , Kazuya Kaneda , Yoshitake Yamada , Shu Kobayashi , Kengo Harato , Takeo Nagura , Masaya Nakamura , Masahiro Jinzaki","doi":"10.1016/j.knee.2024.12.008","DOIUrl":"10.1016/j.knee.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Long-leg alignment and joint line obliquity have traditionally been assessed using two-dimensional (2D) radiography, but the accuracy of this measurement has remained unclear. This study aimed to evaluate the accuracy of 2D measurements of lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) using upright three-dimensional (3D) computed tomography (CT).</div></div><div><h3>Methods</h3><div>This study involved 66 knees from 38 patients (34 women, four men) with knee osteoarthritis (OA), categorized by Kellgren–Lawrence (KL) grade. Patients underwent standing long-leg radiography (LLR) and upright CT. Flexion and rotation angles of the femur and tibia were measured from upright CT data, and knees were classified by coronal plane alignment of the knee (CPAK) according to 2D- and 3D-LDFA/MPTA.</div></div><div><h3>Results</h3><div>Overall, as KL grade increased, femoral external rotation and flexion increased significantly (<em>P</em> < 0.05). Regarding the tibia, flexion increased (<em>P</em> < 0.05) while rotation remained unchanged with increasing KL grade. In mild OA (KL1 or KL2), 2D-LDFA (86.5 ± 1.8°) was significantly larger than 3D-LDFA (85.0 ± 2.5°; <em>P</em> < 0.05), and this difference was also observed in severe OA (KL3 or KL4) (88.7 ± 2.5° vs. 87.7 ± 3.2°; <em>P</em> < 0.05). However, MPTA was comparable between 2D and 3D. The consistency between 2D and 3D CPAK classifications was 48.5% for the entire sample, 25.0% for mild OA, and 61.9% for severe OA.</div></div><div><h3>Conclusion</h3><div>Based on 3D-LDFA/MPTA data gained from upright CT, 2D radiographic LDFA tended to be inaccurate, which may significantly affect the CPAK classification.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 237-245"},"PeriodicalIF":1.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048719","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

The coronal plane alignment of the knee classification of a Japanese population indicates more varus deformity tendency compared with European countries

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-01-25 DOI: 10.1016/j.knee.2024.12.010

Mitsuaki Kubota , Haruka Kaneko , Keiichi Yoshida , Shinnosuke Hada , Youngji Kim , Jun Shiozawa , Jun Tomura , Mayuko Kinoshita , Takaya Otaki , Keiji Kobayashi , Yoshitomo Saita , Masashi Nagao , Yuji Takazawa , Muneaki Ishijima

Purpose

The purpose of this study was to compare the distribution of the coronal plane alignment of the knee (CPAK) phenotype between the healthy population and the arthritic population in Japan.

Methods

The retrospective cross-sectional study included 1049 knees. There were 256 healthy individuals with a total of 512 knees and 310 individuals with a total of 537 arthritic knees who underwent around-knee osteotomy between June 2010 and January 2024. The CPAK phenotype was compared between the healthy population and the arthritic population. Furthermore, the CPAK phenotype rates were compared between Japan and the other countries.

Results

The most common type of CPAK was type II (51.2%), followed by type III (26.4%) and type I (16.6%) in the healthy population, and type I (63.4%), followed by type II (22.9%) and type IV (6.3%) in the arthritic population. There were significant differences in CPAK types I, II, III, IV, VI between the healthy and arthritic populations. The rates of CPAK phenotype in Japan were significantly different from those in the other countries. The rates of apex distal joint line obliquity in the healthy and arthritic population (94.2%, 88.9%) were significantly higher than in the other countries.

Conclusions

There were significant differences in distribution of the CPAK phenotype between the healthy and arthritic populations. Furthermore, the Japanese distribution of the CPAK phenotype was different from other countries. Japanese CPAK types were highly involved in distal joint line apex obliquity, which indicates varus deformity in the future.

{"title":"The coronal plane alignment of the knee classification of a Japanese population indicates more varus deformity tendency compared with European countries","authors":"Mitsuaki Kubota , Haruka Kaneko , Keiichi Yoshida , Shinnosuke Hada , Youngji Kim , Jun Shiozawa , Jun Tomura , Mayuko Kinoshita , Takaya Otaki , Keiji Kobayashi , Yoshitomo Saita , Masashi Nagao , Yuji Takazawa , Muneaki Ishijima","doi":"10.1016/j.knee.2024.12.010","DOIUrl":"10.1016/j.knee.2024.12.010","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to compare the distribution of the coronal plane alignment of the knee (CPAK) phenotype between the healthy population and the arthritic population in Japan.</div></div><div><h3>Methods</h3><div>The retrospective cross-sectional study included 1049 knees. There were 256 healthy individuals with a total of 512 knees and 310 individuals with a total of 537 arthritic knees who underwent around-knee osteotomy between June 2010 and January 2024. The CPAK phenotype was compared between the healthy population and the arthritic population. Furthermore, the CPAK phenotype rates were compared between Japan and the other countries.</div></div><div><h3>Results</h3><div>The most common type of CPAK was type II (51.2%), followed by type III (26.4%) and type I (16.6%) in the healthy population, and type I (63.4%), followed by type II (22.9%) and type IV (6.3%) in the arthritic population. There were significant differences in CPAK types I, II, III, IV, VI between the healthy and arthritic populations. The rates of CPAK phenotype in Japan were significantly different from those in the other countries. The rates of apex distal joint line obliquity in the healthy and arthritic population (94.2%, 88.9%) were significantly higher than in the other countries.</div></div><div><h3>Conclusions</h3><div>There were significant differences in distribution of the CPAK phenotype between the healthy and arthritic populations. Furthermore, the Japanese distribution of the CPAK phenotype was different from other countries. Japanese CPAK types were highly involved in distal joint line apex obliquity, which indicates varus deformity in the future<em>.</em></div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 246-254"},"PeriodicalIF":1.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048731","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

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