IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.012

Nirav Mungalpara , Cadence F. Lee , Yvon M. Bogdonoff , Jared M. Rubin , Asheesh Bedi , Mark Hutchinson , Jason Koh , Farid Amirouche

Introduction

Utilizing large animal model like male pig for biomechanical studies offers a cost-effective approach to understanding human joint and tissue mechanics. Our study explores the osteology and meniscus anatomy of the male porcine stifle joint and compares it to human knee joint parameters, aiming to provide a valuable reference for orthopaedic research and surgical training.

Methods

We examined 60 male porcine stifle joints and analyzed their menisci and bones. Dissections were meticulously performed, with measurements taken using digital Vernier calipers and ImageJ software. These dimensions included bone morphology and meniscal width, height, and volume, followed by statistical analysis using unpaired Student’s t-tests.

Results

The various measurements of bones and menisci indicated a high degree of anatomical similarity to human knees. The anterior width of the medial meniscus was 12.545 ± 1.763 mm, while the lateral meniscus was 14.99 ± 1.720 mm. The middle width of the medial meniscus was 12.065 ± 1.691 mm, compared to the lateral meniscus at 14.375 ± 1.732 mm. The posterior width was 15.25 ± 1.741 mm for the medial meniscus and 16.39 ± 1.662 mm for the lateral meniscus. The femoral intercondylar notch dimensions widened and became shallower with age, resembling the maturation patterns seen in human knee development. The average volume of the medial meniscus was 4.30 ± 0.13 ml, while the lateral meniscus was 5.9 ± 0.29 ml. The aspect ratio of the femoral condyles was 1.04 ± 0.04 (0.95–1.11), while the aspect ratio of the tibial condyles was 0.65 ± 0.02 (0.61–0.70), measured via digital Vernier calipers. These findings were statistically significant, showcasing the male porcine model’s relevance in replicating human knee mechanics (p < 0.05).

Conclusion

Male porcine stifle joints present a valid and accessible model for knee anatomy research. Our study underscores the value of the male porcine model in understanding human knee joint biomechanics and supports its continued use in orthopaedic research and training. These findings have significant implications for advancing orthopaedic research methodologies and enhancing surgical training practices by providing a reliable and anatomically comparable model.

引言利用雄猪等大型动物模型进行生物力学研究，是了解人体关节和组织力学的一种经济有效的方法。我们的研究探讨了雄性猪跗关节的骨学和半月板解剖，并将其与人类膝关节参数进行了比较，旨在为骨科研究和外科培训提供有价值的参考。解剖过程一丝不苟，并使用数字游标卡尺和 ImageJ 软件进行测量。结果骨骼和半月板的各种测量结果表明其解剖结构与人类膝关节高度相似。内侧半月板前部宽度为 12.545 ± 1.763 毫米，外侧半月板为 14.99 ± 1.720 毫米。内侧半月板的中间宽度为 12.065 ± 1.691 毫米，而外侧半月板为 14.375 ± 1.732 毫米。内侧半月板的后部宽度为 15.25 ± 1.741 毫米，外侧半月板的后部宽度为 16.39 ± 1.662 毫米。股骨髁间凹槽的尺寸随着年龄的增长而变宽变浅，这与人类膝关节发育的成熟模式相似。内侧半月板的平均体积为 4.30 ± 0.13 毫升，外侧半月板为 5.9 ± 0.29 毫升。通过数字游标卡尺测量，股骨髁的长宽比为 1.04 ± 0.04（0.95-1.11），而胫骨髁的长宽比为 0.65 ± 0.02（0.61-0.70）。结论雄性猪跗关节为膝关节解剖学研究提供了一个有效且易于使用的模型。我们的研究强调了雄猪模型在理解人类膝关节生物力学方面的价值，并支持在骨科研究和培训中继续使用该模型。这些研究结果提供了一个可靠的解剖学可比模型，对推进骨科研究方法和加强外科培训实践具有重要意义。

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引用次数: 0

A systematic review on Autologous Matrix Induced Chondrogenesis (AMIC) for chondral knee defects 关于自体基质诱导软骨生成（AMIC）治疗膝关节软骨缺损的系统性综述。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.003

Jason Jia Shyan Ong , Sue Fen Tan , Thomas Kurien

Background

Chondral defects of the knee can be identified in up to 60% of patients undergoing knee arthroscopy. The use of Autologous Matrix Induced Chondrogenesis (AMIC), which combines subchondral microfracture with a collagen membrane, has been increasingly used to treat these defects.

Aims

This review assesses the clinical, functional, and radiological outcomes of patients undergoing the AMIC procedure and reports any associated complications.

Methods

Studies with a minimum of 10 patients and fulfilled at least a 12-month follow up period with more than 70% follow up rate were included. Methodological quality was assessed using MINORS (Methodological Index for Non-Randomised Studies) criteria. The meta-analysis compared Lysholm, VAS (Visual Analog Scale), IKDC (International Knee Documentation Committee), KOOS (Knee Injury and Osteoarthritis Outcome Score) Pain, and Tegner clinical outcome measures at baseline and follow up.

Results

18 studies (n = 490 patients) were included. The mean age was 35.2 [SD = 5.0] years and the mean defect size was 3.47 [SD = 0.96] cm². There was a clinically significant improvement in Lysholm, IKDC, and KOOS scores of 30.36 [95% CI (25.80, 34.93)], 34.05 [95% CI (4.16, 43.95)], and 30.63 [95% CI (24.78, 36.47)] respectively; and reduction in VAS pain score of −4.10 [95%CI (−4.50, −3.71) at follow up. Improvement in Tegner score at follow up was not statistically significant: 0.21 [95% CI (−0.88, 1.30)],(p > 0.05).

Conclusion

AMIC is a safe, effective, and reliable technique to treat knee chondral defects which can provide significant clinical, functional, and radiological improvements to patients.

背景：在接受膝关节镜检查的患者中，多达 60% 的人可发现膝关节软骨缺损。目的：本综述评估了接受自体基质诱导软骨生成术（AMIC）的患者的临床、功能和放射学结果，并报告了相关并发症：方法：纳入至少有 10 名患者、随访期至少 12 个月、随访率超过 70% 的研究。方法学质量采用 MINORS（非随机研究方法学指数）标准进行评估。荟萃分析比较了基线和随访时的 Lysholm、VAS（视觉模拟量表）、IKDC（国际膝关节文献委员会）、KOOS（膝关节损伤和骨关节炎结果评分）疼痛和 Tegner 临床结果指标：结果：共纳入 18 项研究（n = 490 名患者）。平均年龄为 35.2 [SD = 5.0]岁，平均缺损面积为 3.47 [SD = 0.96] 平方厘米。随访时，Lysholm、IKDC 和 KOOS 评分分别为 30.36 [95% CI (25.80, 34.93)]、34.05 [95% CI (4.16, 43.95)]和 30.63 [95% CI (24.78, 36.47)]，均有明显改善；VAS 疼痛评分降低了 -4.10 [95%CI (-4.50, -3.71)]。随访时 Tegner 评分的改善无统计学意义：0.21 [95%CI (-0.88, 1.30)]，（P > 0.05）：AMIC是一种安全、有效、可靠的治疗膝关节软骨缺损的技术，能显著改善患者的临床、功能和影像学状况。

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引用次数: 0

Association of intraoperative medial joint gap laxity in the flexion position with subjective knee instability after fixed-bearing posterior-stabilised total knee arthroplasty 术中屈曲位内侧关节间隙松弛与固定支座后稳定型全膝关节置换术后膝关节主观不稳定性的关系。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.005

Hideki Ueyama , Shigeru Nakagawa , Yukihide Minoda , Kenji Fukunaga , Susumu Takemura , Junichiro Koyanagi , Mitsuyoshi Yamamura

Background

Postoperative subjective knee instability is an important clinical outcome after total knee arthroplasty (TKA), however the association with intraoperative soft tissue balance remains unclear. This study aimed to assess the association between intraoperative soft tissue balance and postoperative subjective knee instability in fixed-bearing posterior-stabilised (PS) TKA.

Methods

This retrospective case-control study included 457 patients who underwent fixed-bearing PS TKA. Intra-articular distraction force was quantitatively applied to measure the gap parameters (length and angle) during surgery. The intraoperative joint gap parameters and postoperative clinical outcomes between the patients with (n = 90) and without (n = 367) subjective knee instability were compared. The risk factors for subjective postoperative knee instability were analysed using multivariate logistic regression analysis.

Results

The patients with subjective knee instability demonstrated a medially wider intra-articular gap angle and worse Knee Society Score 2011 symptoms (18 vs. 21; p < 0.01), satisfaction (27 vs. 30; p < 0.01), functional activity (55 vs. 65; p < 0.01), and Forgotten Joint Score 12 items (51 vs. 65; p < 0.01) than those in the patients without subjective knee instability. The use of measured resection technique (odds ratio, 2.3; 95% CI, 1.1–4.8; p = 0.02) and the medial laxity of joint gap balance in the flexion position (odds ratio, 1.2; 95% CI, 1.0–1.4; p = 0.04) were detected as risk factors for postoperative subjective knee instability.

Conclusion

In fixed-bearing PS TKA, intraoperative medial joint laxity in the flexion position was associated with postoperative subjective knee instability, and surgical techniques to achieve sufficient soft tissue balance contributed to improve postoperative subjective clinical outcomes.

Level of evidence

Ⅲ (case-control study).

背景：术后主观膝关节不稳是全膝关节置换术（TKA）后的一个重要临床结果，但其与术中软组织平衡的关系仍不清楚。本研究旨在评估固定支座后稳定（PS）TKA术中软组织平衡与术后主观膝关节不稳之间的关系：这项回顾性病例对照研究纳入了457名接受固定支座PS TKA的患者。在手术过程中定量施加关节内牵引力以测量间隙参数（长度和角度）。比较了有主观膝关节不稳（90 例）和无主观膝关节不稳（367 例）患者的术中关节间隙参数和术后临床结果。采用多变量逻辑回归分析法对术后膝关节主观不稳的风险因素进行了分析：结果：主观膝关节不稳患者的关节内侧间隙角更宽，2011 年膝关节协会评分症状更严重（18 分 vs. 21 分；P 结论：主观膝关节不稳患者的膝关节内侧间隙角更宽，2011 年膝关节协会评分症状更严重（18 分 vs. 21 分）：在固定支座PS TKA中，术中屈曲位的关节内侧松弛与术后主观膝关节不稳定有关，而实现充分软组织平衡的手术技术有助于改善术后主观临床结果：证据等级：Ⅲ（病例对照研究）。

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引用次数: 0

Surgically treated acute knee dislocations with knee stiffness perform equally as well as non-stiff knees when treated with arthroscopic arthrolysis 经手术治疗的急性膝关节脱位伴有膝关节僵硬者，在接受关节镜关节切除术治疗时，其表现与非僵硬膝关节相同。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.017

Hendrik Fahlbusch, Markus Neumann, Jannik Frings, Karl-Heinz Frosch, Matthias Krause

Purpose

Postoperative knee stiffness is a common issue in multiligament knee injuries (MLKIs). This study aims to compare outcomes between MLKI patients who underwent postoperative arthroscopic lysis of arthrofibrosis (LOA) for limited range of motion (ROM) and those who did not.

Methods

Thirty-one patients (10 IIIM, nine IIIL and 12 IV) were included in this retrospective clinical study with acute type III or IV knee dislocations, while two patients were lost to follow up. Thirteen patients underwent LOA at a mean of 18.7 ± 8.4 weeks (Group A), while 18 did not require this intervention (Group B). Patient-reported outcome measures (IKDC, Lysholm, VAS) and ROM were evaluated.

Results

The average follow up period was 31.0 ± 10.2 months. The mean time to LOA was 19.4 ± 7.6 weeks and a significant increase in ROM was observed after LOA (flexion: before LOA: 83.8° ± 19.2, after LOA: 119.6° ± 9.9; P < 0.0001). There were no significant differences between groups regarding clinical scores (Lysholm: Group A 85.0 ± 13.4, Group B 84.6 ± 14.5; IKDC: Group A 74.3 ± 10.8, Group B 76.7 ± 14.7) and ROM (flexion: Group A 118.6° ± 9.8, Group B 124.3° ± 12.8). There were no complications regarding LOA.

Conclusions

Patients, whether undergoing LOA or not, performed equally well in terms of ROM and clinical scores at final follow up, while timing of LOA appears less critical. LOA is a simple, durable and safe method of treating ROM deficits in patients treated for acute knee dislocation, with very good results.

目的：术后膝关节僵硬是多韧带膝关节损伤（MLKI）的常见问题。本研究旨在比较因活动范围（ROM）受限而在术后接受关节镜下关节纤维化溶解术（LOA）的膝关节多韧带损伤（MLKI）患者与未接受该手术的患者的治疗效果：这项回顾性临床研究共纳入了31例急性III型或IV型膝关节脱位患者（10例IIIM、9例IIIL和12例IV型），其中2例患者失去了随访机会。13名患者接受了LOA治疗，平均时间为18.7周±8.4周（A组），18名患者无需接受该治疗（B组）。对患者报告的结果指标（IKDC、Lysholm、VAS）和ROM进行了评估：平均随访时间为（31.0 ± 10.2）个月。结果：平均随访时间为（31.0±10.2）个月，LOA的平均时间为（19.4±7.6）周，LOA后观察到ROM显著增加（屈曲：LOA前：83.8°±19.2，LOA后：119.6°±9.9；P 结论：LOA的平均时间为（19.4±7.6）周：无论患者是否接受了LOA，他们在最终随访时的ROM和临床评分方面表现同样出色，而LOA的时机似乎并不那么重要。LOA是治疗急性膝关节脱位患者ROM缺损的一种简单、持久和安全的方法，效果非常好。

{"title":"Surgically treated acute knee dislocations with knee stiffness perform equally as well as non-stiff knees when treated with arthroscopic arthrolysis","authors":"Hendrik Fahlbusch, Markus Neumann, Jannik Frings, Karl-Heinz Frosch, Matthias Krause","doi":"10.1016/j.knee.2024.08.017","DOIUrl":"10.1016/j.knee.2024.08.017","url":null,"abstract":"<div><h3>Purpose</h3><p>Postoperative knee stiffness is a common issue in multiligament knee injuries (MLKIs). This study aims to compare outcomes between MLKI patients who underwent postoperative arthroscopic lysis of arthrofibrosis (LOA) for limited range of motion (ROM) and those who did not.</p></div><div><h3>Methods</h3><p>Thirty-one patients (10 IIIM, nine IIIL and 12 IV) were included in this retrospective clinical study with acute type III or IV knee dislocations, while two patients were lost to follow up. Thirteen patients underwent LOA at a mean of 18.7 ± 8.4 weeks (Group A), while 18 did not require this intervention (Group B). Patient-reported outcome measures (IKDC, Lysholm, VAS) and ROM were evaluated.</p></div><div><h3>Results</h3><p>The average follow up period was 31.0 ± 10.2 months. The mean time to LOA was 19.4 ± 7.6 weeks and a significant increase in ROM was observed after LOA (flexion: before LOA: 83.8° ± 19.2, after LOA: 119.6° ± 9.9; <em>P</em> < 0.0001). There were no significant differences between groups regarding clinical scores (Lysholm: Group A 85.0 ± 13.4, Group B 84.6 ± 14.5; IKDC: Group A 74.3 ± 10.8, Group B 76.7 ± 14.7) and ROM (flexion: Group A 118.6° ± 9.8, Group B 124.3° ± 12.8). There were no complications regarding LOA.</p></div><div><h3>Conclusions</h3><p>Patients, whether undergoing LOA or not, performed equally well in terms of ROM and clinical scores at final follow up, while timing of LOA appears less critical. LOA is a simple, durable and safe method of treating ROM deficits in patients treated for acute knee dislocation, with very good results.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 114-119"},"PeriodicalIF":1.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0968016024001510/pdfft?md5=e8d1eb89f0c9025204123d34579153ca&pid=1-s2.0-S0968016024001510-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147006","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

Donor-recipient age- or sex-mismatched osteochondral allografts do not adversely affect cumulative graft survival rates after transplantation in the knee 供体与受体年龄或性别不匹配的骨软骨异体移植物不会对膝关节移植后的累积移植物存活率产生不利影响

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.008

Jonathan Williams , Kylee Rucinski , James P. Stannard , Josh Pridemore , Aaron M. Stoker , Cory Crecelius , Clayton W. Nuelle , James L. Cook

Background

Osteochondral allograft transplantation (OCAT) can be performed without the need for blood-type matching or anti-rejection medications. However, other donor-recipient mismatch variables could influence outcomes. Therefore, it is critical to examine the impacts of sex and age mismatching on functional OCA survival.

Methods

Prospectively collected data for patients undergoing primary knee OCAT enrolled in a lifelong outcomes registry were analyzed for functional OCA survival based on sex- and age-matched and −mismatched cohorts. Treatment failure was defined as the need for OCAT revision surgery or knee arthroplasty.

Results

162 donor-recipient pairs were analyzed; 57 (35.2%) were sex-mismatched and 89 (54.9%) were age-mismatched. Sex-mismatched OCATs were not associated with a significantly different cumulative graft survival rate when compared to sex-matched OCATs (78.9% vs 75.2% p = 0.324). Age-mismatched OCATs were not associated with a significantly different cumulative graft survival rate when compared to age-matched OCATs (71.6% vs 81.5% p = 0.398). When adjusting for sex, BMI, concomitant procedures, and surgery type, age-mismatched and sex-mismatched OCATs were not significantly associated with higher likelihood for treatment failure.

Conclusion

By analyzing functional graft survival rates for donor-recipient sex- or age-mismatched OCAs following primary OCAT, the results of the present study support current donor-recipient matching protocols for OCA transplantation in the knee. Based on current evidence, donor-recipient blood-type, sex-, and age-matching are not required for safe and effective primary OCAT in the knee. However, further studies are imperative for defining modifiable variables that further optimize safety and outcomes while maximizing donor tissue quality, availability, access, and use.

背景骨软骨异体移植（OCAT）无需血型匹配或抗排斥药物即可进行。然而，其他供体-受体不匹配变量可能会影响移植结果。因此，研究性别和年龄不匹配对功能性OCA存活率的影响至关重要。方法根据性别和年龄匹配及不匹配队列，分析了终生结果登记处前瞻性收集的接受初级膝关节OCAT患者的数据，以分析功能性OCA存活率。结果分析了162对供体和受体，其中57对（35.2%）性别不匹配，89对（54.9%）年龄不匹配。与性别不匹配的 OCAT 相比，性别不匹配的 OCAT 的累积移植物存活率没有明显差异（78.9% vs 75.2% p = 0.324）。与年龄匹配的 OCAT 相比，年龄不匹配的 OCAT 与累积移植物存活率无明显差异（71.6% vs 81.5% p = 0.398）。结论通过分析初级 OCAT 后供体-受体性别或年龄不匹配的 OCA 的功能性移植物存活率，本研究结果支持目前膝关节 OCA 移植的供体-受体匹配方案。根据目前的证据，供体与受体的血型、性别和年龄不匹配并不是安全有效的膝关节原发性 OCAT 的必要条件。然而，进一步的研究势在必行，以确定可修改的变量，从而进一步优化安全性和疗效，同时最大限度地提高供体组织的质量、可用性、可及性和使用率。

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引用次数: 0

Characterization of bone marrow edema patterns among patients with Segond fracture in the setting of acute anterior cruciate ligament injury: A comparative MRI study 急性前十字韧带损伤时 Segond 骨折患者骨髓水肿模式的特征：磁共振成像对比研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.007

Sharif Garra , Zachary I. Li , Michael R. Moore , Naina Rao , Jordan Eskenazi , Erin F. Alaia , Michael J. Alaia , Eric J. Strauss , Laith M. Jazrawi

Purpose

The purpose of this study is to investigate the anatomic distribution of bone marrow edema on MRI among patients who sustained a Segond fracture compared to those with an isolated ACL tear.

Methods

A retrospective cohort study was performed of patients aged 18–40 years old who presented with an acute isolated ACL tear between January 2012 and May 2022. Two blinded readers reviewed all knee MRIs to assess bone marrow edema using the Whole-Organ Magnetic Resonance Imaging Score and the area of each sub-compartment was scored.

Results

There were 522 patients in the final analysis, of which 28 patients (5.4%) were identified to have a Segond fracture. The Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central lateral femoral condyle, as well as the anterior, central, and posterior lateral tibial plateau. Furthermore, the Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central medial femoral condyle and the anterior medial tibial plateau. Bone edema at the central lateral femoral condyle (R = 0.034, p = 0.019) and central tibial plateau (R = 0.093, p = 0.033) were significantly correlated with lateral meniscus tears, while the edema in the posterior medial femoral condyle was correlated with medial meniscus tears (R = 0.127, p = 0.004).

Conclusion

Patients who present with ACL tear and a concomitant Segond fracture demonstrate significantly more extensive bone marrow edema in both the medial and lateral compartments of the knee compared to patients with an isolated ACL tear.

目的本研究旨在调查与孤立性前交叉韧带撕裂患者相比，Segond骨折患者在核磁共振成像上骨髓水肿的解剖分布情况。方法对2012年1月至2022年5月期间出现急性孤立性前交叉韧带撕裂的18-40岁患者进行回顾性队列研究。结果最终分析中有522名患者，其中28名患者（5.4%）被确定为塞贡骨折。在股骨外侧髁中部、胫骨平台前部、中部和后部，Segond 组的 WORMS 2 级和 3 级率明显更高。此外，Segond 组股骨内侧中央髁和胫骨内侧前平台的 WORMS 2 级和 3 级发生率明显更高。股骨外侧髁中部（R = 0.034，p = 0.019）和胫骨平台中部（R = 0.093，p = 0.033）的骨水肿与外侧半月板撕裂明显相关，而股骨内侧髁后部的水肿与内侧半月板撕裂相关（R = 0.结论与前交叉韧带单独撕裂的患者相比，前交叉韧带撕裂同时伴有塞贡骨折的患者膝关节内侧和外侧的骨髓水肿明显更广泛。

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引用次数: 0

Letter to the Editor: "Prognostic factors of knee pain and function 12 months after total knee arthroplasty: A prospective cohort study of 798 patients". 致编辑的信："全膝关节置换术后 12 个月膝关节疼痛和功能的预后因素：798名患者的前瞻性队列研究"。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.004

Elena Tchetina

引用次数: 0

Episode-of-care costs of total knee arthroplasty: Outpatient versus inpatient postoperative care protocol 全膝关节置换术的护理成本：门诊病人与住院病人术后护理方案对比

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.010

Philippe Moisan , Simon Martel , Julien Montreuil , Mitchell Bernstein , Michael Tanzer , Adam Hart

Background

Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in North America. Few studies have successfully evaluated the episode-of-care cost (EOCC) of common elective orthopedic procedures using an activity-based costing (ABC) framework. The objective of this study is to compare the EOCC of same-day discharge versus inpatient TKA using an activity-based costing methodology.

Methods

An observational case-control study was conducted comparing the EOCC of 25 consecutive patients who underwent same-day discharge (SDD) TKA and 25 consecutive patients who underwent same-day admission (SDA) TKA at an academic center. The EOCC was generated using an ABC framework.

Results

The median total EOCC for outpatient TKA was $7,243.26 CAD (IQR=614.12), while the median EOCC in the inpatient group was $8,303.94 CAD (IQR=1,157.77). The costs incurred secondary to the hospital admission were the main driver of the increased cost for inpatients. The mean length of stay for admitted patients was 2.45 days (SD=1,52). Patients in the outpatient group were younger (p < 0.01) and had a lower mean Charlson Comorbidity Index group (p = 0.01). There was no significant difference in gender, BMI, ASA scores, and complication rates between the two groups.

Conclusion

Through the application of an ABC framework, this value-based healthcare study demonstrates that outpatient procedures are a cost-effective approach to knee arthroplasty. Our findings demonstrate that the total cost of outpatient TKA was on average 15% ($1,060 CAD) lower than the cost of TKA with the standard inpatient postoperative care protocol.

背景全膝关节置换术（TKA）是北美最常见的关节置换手术。很少有研究采用基于活动的成本计算（ABC）框架成功地评估了常见骨科择期手术的护理发作成本（EOCC）。本研究的目的是采用基于活动的成本计算方法，比较当日出院与住院 TKA 的 EOCC。方法在一家学术中心进行了一项观察性病例对照研究，比较了 25 名连续接受当日出院 (SDD) TKA 的患者和 25 名连续接受当日入院 (SDA) TKA 的患者的 EOCC。结果门诊 TKA 患者的 EOCC 中位数为 7,243.26 加元（IQR=614.12），而住院患者组的 EOCC 中位数为 8,303.94 加元（IQR=1,157.77）。住院患者费用增加的主要原因是入院后产生的二次费用。入院患者的平均住院时间为 2.45 天（SD=1,52）。门诊病人组的病人更年轻（p < 0.01），夏尔森综合指数组的平均值更低（p = 0.01）。结论通过应用 ABC 框架，这项以价值为基础的医疗保健研究表明，门诊手术是一种具有成本效益的膝关节置换术方法。我们的研究结果表明，门诊 TKA 的总费用比采用标准住院术后护理方案的 TKA 费用平均低 15%（1,060 加元）。

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引用次数: 0

Offloading effect in the unoperated contralateral knee after unilateral medial open wedge high tibial osteotomy: A SPECT/CT analysis 单侧内侧开放式楔形高胫骨截骨术后未手术对侧膝关节的卸载效应：SPECT/CT分析

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.009

Jae Ang Sim, Jigang Jeun, Byung Hoon Lee

Background

An open wedge high tibial osteotomy (OWHTO) may lead to gait alteration, which change the contact loading in the contralateral knee, while clear evidence about the impact on contralateral knee still lacks. The purpose of the current study was to evaluate the change in scintigraphic uptake using SPECT-CT in the medial compartment of the contralateral knee following OWHTO.

Methods

Contralateral radiographic measurements were performed for patients with medial osteoarthritis and varus malalignment of >5° treated with OWHTO in this retrospective analysis. The medial compartmental changes according to SPECT/CT analysis before and 1-year after OWHTO were evaluated on the contralateral side.

Results

The study comprised 72 patients. The mean preoperative mechanical femorotibial angle was a mean varus of 7.6° (range, 5.1° – 13.0°), corrected to a mean valgus of 2.5° (range, 1.9° – −8.5°) postoperatively. The average grading of the scintigraphic uptakes in the medial compartment of the contralateral knee was significantly decreased 1 year postoperatively than after the surgery (from 2.8 ± 0.4 to 2.1 ± 0.6, p < 0.001). Measurable differences in varus alignment on radiographs of the contralateral limb were identified. The preoperative mechanical axis value decreased from 8.0° ± 2.4° to 6.7° ± 2.6° at the 3-month postoperative visit (p = 0.011). The overall decrease in varus alignment remained at the 2-year final postoperative follow-up.

Conclusion

Alignment correction by OWHTO results in reducing scintigraphy uptakes in medial compartment and improvement in mechanical alignment of the contralateral knee.

Level of evidence

Therapeutic Level IV.

背景开放性楔形胫骨高位截骨术（OWHTO）可能会导致步态改变，从而改变对侧膝关节的接触负荷，但目前仍缺乏有关其对对侧膝关节影响的明确证据。本研究旨在通过 SPECT-CT 评估 OWHTO 术后对侧膝关节内侧间室闪烁摄取的变化。根据 SPECT/CT 分析，评估了 OWHTO 术前和术后 1 年对侧内侧间室的变化。术前机械股胫夹角平均为7.6°（范围为5.1° - 13.0°），术后矫正为平均2.5°（范围为1.9° - 8.5°）。术后一年，对侧膝关节内侧间室的闪烁摄取平均分级比术后明显降低（从 2.8 ± 0.4 降至 2.1 ± 0.6，p <0.001）。在对侧肢体的 X 光片上发现了可测量的屈曲对位差异。术前的机械轴值从 8.0° ± 2.4° 降至术后 3 个月时的 6.7° ± 2.6°（p = 0.011）。结论通过 OWHTO 矫正对位可减少内侧间室的闪烁照相摄取，并改善对侧膝关节的机械对位。

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引用次数: 0

Accuracy assessment of ChatGPT responses to frequently asked questions regarding anterior cruciate ligament surgery 对有关前十字韧带手术常见问题的 ChatGPT 回答进行准确性评估。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-09-05 DOI: 10.1016/j.knee.2024.08.014

Juan Bernardo Villarreal-Espinosa , Rodrigo Saad Berreta , Felicitas Allende , José Rafael Garcia , Salvador Ayala , Filippo Familiari , Jorge Chahla

Background

The emergence of artificial intelligence (AI) has allowed users to have access to large sources of information in a chat-like manner. Thereby, we sought to evaluate ChatGPT-4 response’s accuracy to the 10 patient most frequently asked questions (FAQs) regarding anterior cruciate ligament (ACL) surgery.

Methods

A list of the top 10 FAQs pertaining to ACL surgery was created after conducting a search through all Sports Medicine Fellowship Institutions listed on the Arthroscopy Association of North America (AANA) and American Orthopaedic Society of Sports Medicine (AOSSM) websites. A Likert scale was used to grade response accuracy by two sports medicine fellowship-trained surgeons. Cohen’s kappa was used to assess inter-rater agreement. Reproducibility of the responses over time was also assessed.

Results

Five of the 10 responses received a ‘completely accurate’ grade by two-fellowship trained surgeons with three additional replies receiving a ‘completely accurate’ status by at least one. Moreover, inter-rater reliability accuracy assessment revealed a moderate agreement between fellowship-trained attending physicians (weighted kappa = 0.57, 95% confidence interval 0.15–0.99). Additionally, 80% of the responses were reproducible over time.

Conclusion

ChatGPT can be considered an accurate additional tool to answer general patient questions regarding ACL surgery. None the less, patient–surgeon interaction should not be deferred and must continue to be the driving force for information retrieval. Thus, the general recommendation is to address any questions in the presence of a qualified specialist.

背景：人工智能（AI）的出现使用户能够以类似聊天的方式获取大量信息。因此，我们试图评估 ChatGPT-4 对有关前交叉韧带（ACL）手术的 10 个患者最常见问题（FAQ）的回复准确性：在对北美关节镜协会（AANA）和美国运动医学矫形学会（AOSSM）网站上列出的所有运动医学研究机构进行搜索后，创建了一份有关前交叉韧带手术的 10 大常见问题清单。两名受过运动医学研究员培训的外科医生采用李克特量表对回答的准确性进行评分。Cohen's kappa 用于评估评分者之间的一致性。此外，还评估了回复在一段时间内的可重复性：结果：在 10 份答复中，有 5 份被两名受过研究培训的外科医生评为 "完全正确"，另有 3 份答复被至少一名外科医生评为 "完全正确"。此外，评分者之间的可靠性准确性评估显示，接受过研究员培训的主治医生之间的评分结果基本一致（加权卡帕 = 0.57，95% 置信区间为 0.15-0.99）。此外，80%的回答在一段时间内具有可重复性：结论：ChatGPT 可被视为回答患者有关前交叉韧带手术一般问题的准确补充工具。尽管如此，患者与医生之间的互动不应被推迟，必须继续成为信息检索的驱动力。因此，一般建议在合格的专科医生在场的情况下解决任何问题。

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引用次数: 0

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