The aim of the present study was to evaluate the morphology of the distal medial femoral surface during coronal osteotomy in medial closed wedge distal femoral varus osteotomy (MCWDFO) using plain CT.
Methods
Twenty knees (mean age, 55.3 years) were included. Preoperative CT images were obtained prior to MCWDFO for valgus OA. In the cross-section depicting the starting position of the transverse cut, a curve was drawn that passed through the centre of the femoral cortex, and lines parallel and perpendicular to the surgical epicondylar axis (SEA) were drawn to analyse the medial side. Inflection points on the medial line were defined as P1-P4. The radii of circles passing through P1-P3 (PR, posterior radius) and P2-P4 (AR, anterior radius) were drawn. Values for the PR, AR, and radius ratio (PR/AR) were measured.
Results
Based on the PR/AR, the cross-sectional morphologies were classified into 5 triangular types (PR/AR < 0.5), 4 flat types (PR/AR > 0.8), and 11 convex types (PR/AR 0.6 to 0.7).
Conclusion
The medial anteroposterior width and flange thickness were easier to assess in the flat type; however, these were difficult to assess in the triangular type with a gentle anterior slope. Surgeons should consider the differences in the anterior slope according to cross-sectional morphologies when performing coronal osteotomy in MCWDFO.
{"title":"A morphology of the distal medial femoral surface that should be considered when performing coronal osteotomy in medial closed wedge distal femoral varus osteotomy","authors":"Fumiyoshi Kawashima , Ryuichi Nakamura , Akira Okano , Koji Kanzaki","doi":"10.1016/j.knee.2024.12.002","DOIUrl":"10.1016/j.knee.2024.12.002","url":null,"abstract":"<div><h3>Aims</h3><div>The aim of the present study was to evaluate the morphology of the distal medial femoral surface during coronal osteotomy in medial closed wedge distal femoral varus osteotomy (MCWDFO) using plain CT.</div></div><div><h3>Methods</h3><div>Twenty knees (mean age, 55.3 years) were included. Preoperative CT images were obtained prior to MCWDFO for valgus OA. In the cross-section depicting the starting position of the transverse cut, a curve was drawn that passed through the centre of the femoral cortex, and lines parallel and perpendicular to the surgical epicondylar axis (SEA) were drawn to analyse the medial side. Inflection points on the medial line were defined as P1-P4. The radii of circles passing through P1-P3 (PR, posterior radius) and P2-P4 (AR, anterior radius) were drawn. Values for the PR, AR, and radius ratio (PR/AR) were measured.</div></div><div><h3>Results</h3><div>Based on the PR/AR, the cross-sectional morphologies were classified into 5 triangular types (PR/AR < 0.5), 4 flat types (PR/AR > 0.8), and 11 convex types (PR/AR 0.6 to 0.7).</div></div><div><h3>Conclusion</h3><div>The medial anteroposterior width and flange thickness were easier to assess in the flat type; however, these were difficult to assess in the triangular type with a gentle anterior slope. Surgeons should consider the differences in the anterior slope according to cross-sectional morphologies when performing coronal osteotomy in MCWDFO.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 108-117"},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873595","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}
Pub Date : 2024-12-17DOI: 10.1016/j.knee.2024.11.005
Kevin Lehane, Isabel Wolfe, Alison Buseck, Michael R. Moore, Larry Chen, Eric J. Strauss, Laith M. Jazrawi, Alexander Golant
Purpose
The purpose of the current study was to define the incidence of minor and major complications following TTO at a tertiary-care institution, with determination of predictive factors related to the occurrence of a major complication.
Study design
Retrospective case series. Level IV.
Methods
Patients who underwent TTO from 2011 to 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up and revision cases were excluded. Complications classified as “major” included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, recurrent patellar instability, reoperation for other indications, readmission, and revision. Complications classified as minor included superficial infection, deep venous thrombosis, wound dehiscence, and postoperative neuropraxia. Chi-square tests were used for categorical variables, t-tests for continuous variables.
Results
Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years (range 1 month-10 years). Patients were 68.5% female with average age 28.3 years (range 13–57 years). The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of TTOs, and minor complications in 8.4% of TTOs. Reoperation was required in 16.6% of TTOs at a mean of 14 months following the index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (OR) (5.0%). Prior ipsilateral surgery was identified as a significant independent predictor of major complication by regression analysis. Hardware removal was more common with headed screws. Arthrofibrosis requiring reoperation was more common in patients who underwent a concomitant cartilage restoration/repair procedure.
Conclusion
The overall complication rate following tibial tubercle osteotomy was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and an overall reoperation rate of 16.6%. TTOs with major complications were performed at earlier years, in patients who were older, had a previous ipsilateral arthroscopic knee surgery, had an indication of cartilage lesion/arthritis, and had a steeper osteotomy cut angle. Hardware removal was found to be more common in patients with headed as compared to headless screws. Complications also varied based on timing after surgery.
{"title":"Predictors of Increased Complication Rate Following Tibial Tubercle Osteotomy (TTO)","authors":"Kevin Lehane, Isabel Wolfe, Alison Buseck, Michael R. Moore, Larry Chen, Eric J. Strauss, Laith M. Jazrawi, Alexander Golant","doi":"10.1016/j.knee.2024.11.005","DOIUrl":"10.1016/j.knee.2024.11.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of the current study was to define the incidence of minor and major complications following TTO at a tertiary-care institution, with determination of predictive factors related to the occurrence of a major complication.</div></div><div><h3>Study design</h3><div>Retrospective case series. Level IV.</div></div><div><h3>Methods</h3><div>Patients who underwent TTO from 2011 to 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up and revision cases were excluded. Complications classified as “major” included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, recurrent patellar instability, reoperation for other indications, readmission, and revision. Complications classified as minor included superficial infection, deep venous thrombosis, wound dehiscence, and postoperative neuropraxia. Chi-square tests were used for categorical variables, t-tests for continuous variables.</div></div><div><h3>Results</h3><div>Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years (range 1 month-10 years). Patients were 68.5% female with average age 28.3 years (range 13–57 years). The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of TTOs, and minor complications in 8.4% of TTOs. Reoperation was required in 16.6% of TTOs at a mean of 14 months following the index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (OR) (5.0%). Prior ipsilateral surgery was identified as a significant independent predictor of major complication by regression analysis. Hardware removal was more common with headed screws. Arthrofibrosis requiring reoperation was more common in patients who underwent a concomitant cartilage restoration/repair procedure.</div></div><div><h3>Conclusion</h3><div>The overall complication rate following tibial tubercle osteotomy was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and an overall reoperation rate of 16.6%. TTOs with major complications were performed at earlier years, in patients who were older, had a previous ipsilateral arthroscopic knee surgery, had an indication of cartilage lesion/arthritis, and had a steeper osteotomy cut angle. Hardware removal was found to be more common in patients with headed as compared to headless screws. Complications also varied based on timing after surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 93-102"},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856997","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}
Pub Date : 2024-12-16DOI: 10.1016/j.knee.2024.11.018
Andrew Porteous , Frank-Christiaan Wagenaar , Andrew Price , Jonathan Phillips , Gijs van Hellemondt , BASK/EKS Consensus Group on Problematic Knees Replacement
Background
Up to 20% of primary total knee arthroplasty (TKA) patients are not satisfied with their outcome. Both the analysis of these patients and revision surgery can be complex, expensive and outcomes can vary widely.
Aim
The aim of this study was to deliver consensus recommendations regarding outpatient analysis, surgical treatment and arrangement of clinical services concerning patients with a problematic TKA or revision knee replacement (RTKA).
Methods
Members of BASK and EKS were invited to attend a joint meeting in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Eighty delegates attended the meeting and five consensus statements were considered, with a threshold level of 80% agreement required as the definition consensus. A further consensus meeting of EKS members in Kitzbuhl, Austria (January 2023) followed similar methodology and considered a further four statements on this topic.
Results
From the first meeting, 5 consensus statements with accompanying supporting evidence and text were agreed. 1) In suspected infection, a recognised diagnostic pathway and definition should be used (e.g. MSIS, ICM, EBJIS) and documented; 2) Revision of an infected TKA should be treated in units with a multidisciplinary team; 3) Initial investigation of a problematic TKA should include a minimum of: clinical investigation, X-Rays and blood tests, with further discussion with the MDT if required; 4) Units providing RTKA should have surgeons with evidence of specific training or experience, and on-going minimum unit numbers; 5) National Orthopaedic/Knee Societies should develop a strategy on Revision TKA provision taking into account: workforce, revision burden, location, hospital infrastructure.
From the second meeting a further 4 consensus statements were agreed. Two statements were agreed text content answering the questions: 1) What should be included in the basic diagnostic workup of a painful TKA? and 2) Which are the key factors for surgeons to consider before offering the patient revision surgery? The two other agreed statements are: 3) Pre-operative diagnosis is related to outcome in RTKA and 4) RTKA for pain, without a surgically treatable diagnosis, is unpredictable.
Conclusions
The agreed joint BASK-EKS consensus statements and the EKS consensus statements on the assessment of problematic RTKA are recommended as the contemporary basis of optimal care for these patients and should inform future training and service developments.
{"title":"Consensus statement on problematic knee replacement and revision knee replacement: A collaboration between EKS and BASK","authors":"Andrew Porteous , Frank-Christiaan Wagenaar , Andrew Price , Jonathan Phillips , Gijs van Hellemondt , BASK/EKS Consensus Group on Problematic Knees Replacement","doi":"10.1016/j.knee.2024.11.018","DOIUrl":"10.1016/j.knee.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Up to 20% of primary total knee arthroplasty (TKA) patients are not satisfied with their outcome. Both the analysis of these patients and revision surgery can be complex, expensive and outcomes can vary widely.</div></div><div><h3>Aim</h3><div>The aim of this study was to deliver consensus recommendations regarding outpatient analysis, surgical treatment and arrangement of clinical services concerning patients with a problematic TKA or revision knee replacement (RTKA).</div></div><div><h3>Methods</h3><div>Members of BASK and EKS were invited to attend a joint meeting in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Eighty delegates attended the meeting and five consensus statements were considered, with a threshold level of 80% agreement required as the definition consensus. A further consensus meeting of EKS members in Kitzbuhl, Austria (January 2023) followed similar methodology and considered a further four statements on this topic.</div></div><div><h3>Results</h3><div>From the first meeting, 5 consensus statements with accompanying supporting evidence and text were agreed. 1) In suspected infection, a recognised diagnostic pathway and definition should be used (e.g. MSIS, ICM, EBJIS) and documented; 2) Revision of an infected TKA should be treated in units with a multidisciplinary team; 3) Initial investigation of a problematic TKA should include a minimum of: clinical investigation, X-Rays and blood tests, with further discussion with the MDT if required; 4) Units providing RTKA should have surgeons with evidence of specific training or experience, and on-going minimum unit numbers; 5) National Orthopaedic/Knee Societies should develop a strategy on Revision TKA provision taking into account: workforce, revision burden, location, hospital infrastructure.</div><div>From the second meeting a further 4 consensus statements were agreed. Two statements were agreed text content answering the questions: 1) What should be included in the basic diagnostic workup of a painful TKA? and 2) Which are the key factors for surgeons to consider before offering the patient revision surgery? The two other agreed statements are: 3) Pre-operative diagnosis is related to outcome in RTKA and 4) RTKA for pain, without a surgically treatable diagnosis, is unpredictable.</div></div><div><h3>Conclusions</h3><div>The agreed joint BASK-EKS consensus statements and the EKS consensus statements on the assessment of problematic RTKA are recommended as the contemporary basis of optimal care for these patients and should inform future training and service developments.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 86-92"},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848470","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}
Achieving precise alignment and soft tissue balance is crucial for optimal total knee arthroplasty (TKA) outcomes. We aimed to explore how tibiofemoral compression force (TFCF) varies with knee flexion and its correlation with functional outcomes.
Methods
This prospective study included 60 patients undergoing cruciate-retaining TKA (FINE Total Knee System). Sensor-equipped trial inserts were used to measure the TFCF at 15° intervals, from full extension to 90° flexion. Patients were classified into anterior and posterior force groups based on whether the medial TFCF was higher in the anterior than in the posterior region at 60° flexion. The 2-year outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR).
Results
The total TFCF increased from 0° to 60° flexion and then decreased. The medial compressive forces were consistently higher than lateral forces. Anteromedial TFCF differed significantly between the anterior and posterior force groups at 60°, 75°, and 90° flexion. KOOS-JR scores showed a significant interaction between force type and time, with greater improvements in the anterior force group. Anteromedial TFCF at 60° flexion and KOOS-JR correlated significantly (R = 0.574).
Conclusion
Evaluating TFCF at multiple knee flexion angles provides valuable insights into optimising outcomes in TKA. TFCF variations, especially in the anteromedial compartment, considerably impact functional outcomes. Dynamic TFCF measurements during TKA may enhance soft tissue balance and improve outcomes. Further research is needed to validate these findings in diverse populations and with long-term follow ups.
背景：实现精确对齐和软组织平衡是最佳全膝关节置换术（TKA）结果的关键。我们的目的是探讨膝关节屈曲时胫股压迫力（TFCF）的变化及其与功能预后的关系。方法：本前瞻性研究纳入了60例接受全膝关节系统（FINE Total Knee System）的患者。使用配备传感器的试验插入物以15°间隔测量TFCF，从完全伸展到90°屈曲。根据60°屈曲时内侧TFCF是否在前区高于后区，将患者分为前后力组。使用膝关节损伤和骨关节炎结局评分关节置换术（KOOS-JR）评估2年结果。结果：总TFCF从0°屈曲到60°屈曲先升高后降低。内侧压缩力始终高于侧向力。前内侧TFCF在60°、75°和90°屈曲时前后力组之间差异显著。KOOS-JR评分在用力类型和时间之间表现出显著的交互作用，前用力组改善更大。60°屈曲时前内侧TFCF与KOOS-JR显著相关（R = 0.574）。结论：评估多个膝关节屈曲角度下的TFCF为优化TKA的预后提供了有价值的见解。TFCF的变化，特别是在前内侧室，显著影响功能结局。TKA期间动态TFCF测量可增强软组织平衡，改善预后。需要进一步的研究在不同人群中验证这些发现并进行长期随访。
{"title":"Dynamic variation of tibiofemoral compression force during total knee arthroplasty: Implications for soft tissue balance and functional outcomes","authors":"Yoshinori Okamoto, Tomohiro Okayoshi, Hitoshi Wakama, Takafumi Saika, Shuhei Otsuki","doi":"10.1016/j.knee.2024.11.021","DOIUrl":"10.1016/j.knee.2024.11.021","url":null,"abstract":"<div><h3>Background</h3><div>Achieving precise alignment and soft tissue balance is crucial for optimal total knee arthroplasty (TKA) outcomes. We aimed to explore how tibiofemoral compression force (TFCF) varies with knee flexion and its correlation with functional outcomes.</div></div><div><h3>Methods</h3><div>This prospective study included 60 patients undergoing cruciate-retaining TKA (FINE Total Knee System). Sensor-equipped trial inserts were used to measure the TFCF at 15° intervals, from full extension to 90° flexion. Patients were classified into anterior and posterior force groups based on whether the medial TFCF was higher in the anterior than in the posterior region at 60° flexion. The 2-year outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR).</div></div><div><h3>Results</h3><div>The total TFCF increased from 0° to 60° flexion and then decreased. The medial compressive forces were consistently higher than lateral forces. Anteromedial TFCF differed significantly between the anterior and posterior force groups at 60°, 75°, and 90° flexion. KOOS-JR scores showed a significant interaction between force type and time, with greater improvements in the anterior force group. Anteromedial TFCF at 60° flexion and KOOS-JR correlated significantly (<em>R</em> = 0.574).</div></div><div><h3>Conclusion</h3><div>Evaluating TFCF at multiple knee flexion angles provides valuable insights into optimising outcomes in TKA. TFCF variations, especially in the anteromedial compartment, considerably impact functional outcomes. Dynamic TFCF measurements during TKA may enhance soft tissue balance and improve outcomes. Further research is needed to validate these findings in diverse populations and with long-term follow ups.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 49-61"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820191","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}
To determine incidence of posterior-tibial-slope (PTS) distribution in patients with isolated posterior-cruciate-ligament (PCL) tear, as-well-as the effect of PTS on radiological, clinical, and functional outcomes after PCL-reconstruction (PCL-R).
Methods
63 patients with symptomatic isolated PCL-tears who underwent PCL-R were divided into two groups based on a PTS-angle with a cut-off value of 70-degrees: group-A (less than ≤70-degree) and group-B (more than >70-degree). All the patients were subjected to the same technique. The effect of PTS-angle on the radiological-outcome, (posterior-tibial-translation (PTT)) at 6-month and 1-year intervals was compared. Clinical-outcomes (knee range-of-motion (ROM), quadriceps-wasting (QW)), and functional outcomes (IKDC and Tegner-Lysholm scores) at 6-month, 1-year, and final follow-up was compared between the groups.
Results
PTS of less than ≤70-degrees was seen in 66.7%. The mean-PTS-angle was 6.47 ± 2.40degrees. Radiologically, there was no statistical-difference in PTT at 6-months. However, at 1-year, PTT was less in group-A (3.98 ± 2.21 mm) than in group-B (3.03 ± 1.42 mm) (P = 0.04). Two patients in group-A had grade-III PTT at 6-months, and one of them had grade-III PTT at 1-year. At the mean-follow-up, group-A had lower IKDC and Tegner-Lysholm (81.55 ± 11.4, 90.19 ± 5.53) than group-B (86.56 ± 7.2, 94.6 ± 4.42), indicating a statistically significant difference (IKDC:P = 0.038, Tegner-Lysholm:P = 0.001). At 1-year and mean-follow-up, group-A had a significantly lower ROM(p = 0.047). There was no significant difference for QW at 6-months and 1-year.
Conclusion
Lesser preoperative PTS angle (≤70) has a negative effect on the outcome of isolated PCL-R and leads to secondary posterior knee laxity than in patients with higher PTS angle (>70). Incidence of lesser posterior tibial slope (≤70) in isolated PCL injuries is 66.7%.
{"title":"Lesser posterior tibial slope angle ≤70 (PTS-Angle) has negative effect on outcome of isolated PCL reconstruction: Comparative analysis of PTS ≤70 vs > 70 degrees","authors":"Silvampatti Ramasamy Sundararajan , Owais Ahmed , Rajagopalakrishnan Ramakanth , Terence Dsouza , Mahshook Irfan , Arumugam Palanisamy , Shanmuganathan Rajasekaran","doi":"10.1016/j.knee.2024.11.017","DOIUrl":"10.1016/j.knee.2024.11.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine incidence of posterior-tibial-slope (PTS) distribution in patients with isolated posterior-cruciate-ligament (PCL) tear, as-well-as the effect of PTS on radiological, clinical, and functional outcomes after PCL-reconstruction (PCL-R).</div></div><div><h3>Methods</h3><div>63 patients with symptomatic isolated PCL-tears who underwent PCL-R were divided into two groups based on a PTS-angle with a cut-off value of 7<sup>0</sup>-degrees: group-A (less than ≤7<sup>0</sup>-degree) and group-B (more than >7<sup>0</sup>-degree). All the patients were subjected to the same technique. The effect of PTS-angle on the radiological-outcome, (posterior-tibial-translation (PTT)) at 6-month and 1-year intervals was compared. Clinical-outcomes (knee range-of-motion (ROM), quadriceps-wasting (QW)), and functional outcomes (IKDC and Tegner-Lysholm scores) at 6-month, 1-year, and final follow-up was compared between the groups.</div></div><div><h3>Results</h3><div>PTS of less than ≤7<sup>0</sup>-degrees was seen in 66.7%. The mean-PTS-angle was 6.47 ± 2.40degrees. Radiologically, there was no statistical-difference in PTT at 6-months. However, at 1-year, PTT was less in group-A (3.98 ± 2.21 mm) than in group-B (3.03 ± 1.42 mm) (P = 0.04). Two patients in group-A had grade-III PTT at 6-months, and one of them had grade-III PTT at 1-year. At the mean-follow-up, group-A had lower IKDC and Tegner-Lysholm (81.55 ± 11.4, 90.19 ± 5.53) than group-B (86.56 ± 7.2, 94.6 ± 4.42), indicating a statistically significant difference (IKDC:P = 0.038, Tegner-Lysholm:P = 0.001). At 1-year and mean-follow-up, group-A had a significantly lower ROM(p = 0.047). There was no significant difference for QW at 6-months and 1-year.</div></div><div><h3>Conclusion</h3><div>Lesser preoperative PTS angle (≤7<sup>0</sup>) has a negative effect on the outcome of isolated PCL-R and leads to secondary<!--> <!-->posterior knee laxity than in patients with higher PTS angle (>7<sup>0</sup>). Incidence of lesser posterior tibial slope (≤7<sup>0</sup>) in isolated PCL injuries is 66.7%.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 69-78"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820200","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}
Pub Date : 2024-12-12DOI: 10.1016/j.knee.2024.11.024
Arman Vahabi, Elcil Kaya Biçer, Semih Aydoğdu
Background
Intraoperative challenges and complications and their course over experience in total knee arthroplasty (TKA) applications in hemophilic arthropathy have seldom been studied. Our study aimed to analyze the learning dynamics and the evolving perspective of a single arthroplasty surgeon in hemophilic knees.
Methods
The study encompassed all primary TKAs performed on hemophilic patients by a single experienced arthroplasty surgeon from May 2002 to October 2023. A total of 90 knees from 63 patients were included in the final analysis. Demographic characteristics, range of motion (ROM), degree of flexion contracture, and hip–knee angle (HKA) were noted. Anesthesia type, tourniquet duration, surgical approach, need for bone graft use, and lateral retinacular release (LRR) were also documented. Cases were categorized into three groups: the initial 30 cases (Group A), the subsequent 30 cases (Group B), and the final 30 cases (Group C).
Results
All groups were homogenous in terms of age (P = 0.102), HKA (P = 0.696), ROM (P = 0.582), and degree flexion contracture (P = 0.546). Extended approaches were needed in seven cases (23.3%) in Group A, and in two cases (6.7%) in Group B. There was no need for extended exposure in Group C. LRR application rate and tourniquet time showed no differences across groups (P = 0.401, P = 0.482). The intraoperative problem rate exhibited a statistically significant decrease throughout the series (P = 0.016).
Conclusions
Arthroplasty in hemophilic knees poses unique challenges which require their own learning process. Intraoperative complication rate and need for utilizing extended approaches decreases after the initial 30 cases and decreases further after the subsequent 30 cases.
{"title":"Total knee arthroplasty in hemophilic knees requires its own learning phase: Lessons learned from 90 cases","authors":"Arman Vahabi, Elcil Kaya Biçer, Semih Aydoğdu","doi":"10.1016/j.knee.2024.11.024","DOIUrl":"10.1016/j.knee.2024.11.024","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative challenges and complications and their course over experience in total knee arthroplasty (TKA) applications in hemophilic arthropathy have seldom been studied. Our study aimed to analyze the learning dynamics and the evolving perspective of a single arthroplasty surgeon in hemophilic knees.</div></div><div><h3>Methods</h3><div>The study encompassed all primary TKAs performed on hemophilic patients by a single experienced arthroplasty surgeon from May 2002 to October 2023. A total of 90 knees from 63 patients were included in the final analysis. Demographic characteristics, range of motion (ROM), degree of flexion contracture, and hip–knee angle (HKA) were noted. Anesthesia type, tourniquet duration, surgical approach, need for bone graft use, and lateral retinacular release (LRR) were also documented. Cases were categorized into three groups: the initial 30 cases (Group A), the subsequent 30 cases (Group B), and the final 30 cases (Group C).</div></div><div><h3>Results</h3><div>All groups were homogenous in terms of age (<em>P</em> = 0.102), HKA (<em>P</em> = 0.696), ROM (<em>P</em> = 0.582), and degree flexion contracture (<em>P</em> = 0.546). Extended approaches were needed in seven cases (23.3%) in Group A, and in two cases (6.7%) in Group B. There was no need for extended exposure in Group C. LRR application rate and tourniquet time showed no differences across groups (<em>P</em> = 0.401, <em>P</em> = 0.482). The intraoperative problem rate exhibited a statistically significant decrease throughout the series (<em>P</em> = 0.016).</div></div><div><h3>Conclusions</h3><div>Arthroplasty in hemophilic knees poses unique challenges which require their own learning process. Intraoperative complication rate and need for utilizing extended approaches decreases after the initial 30 cases and decreases further after the subsequent 30 cases.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 28-34"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820209","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}
Pub Date : 2024-12-12DOI: 10.1016/j.knee.2024.11.022
Alexander J. Nedopil , Stefano Ghiradelli , S.M. Howell , M.L. Hull
Purpose
Unrestricted kinematically aligned total knee arthroplasty (unKA TKA) strives to restore the pre-arthritic posterior tibial slope (PTS), however consistency of achieving this alignment target is unknown. The present study determined the proportion of subjects with differences in PTS less than 2° from the target and the improvement in patient-reported function after unKA TKA.
Methods
A review of 562 postoperative scanograms identified 99 patients (51 female) with a unKA TKA in one limb, a contralateral healthy limb, and a postoperative axial CT scan. All patients were treated with a primary unKA TKA performed with mechanical instruments where the alignment target was setting the PTS to match that of the medial compartment of the contralateral healthy knee. The PTS of the TKA and the healthy medial tibial plateau were measured and the difference determined. The patient-reported Oxford Knee Score (OKS) measured pre- and post-operative function.
Results
The proportion of subjects within a tolerance interval of ±2° of the contralateral healthy knee at 95% confidence was 85%. The median OKS improved from 20 points preoperatively to 47 points (range 18–48) at 15 months postoperatively. Greater differences of the PTS from healthy were unrelated to poorer Oxford Knee Scores.
Conclusion
Unrestricted KA TKA using manual instruments with caliper verification of resection thickness restored a high percentage of patients within a clinically acceptable tolerance of the posterior tibial slope of the contralateral healthy knee. The median postoperative OKS indicated clinically important improvement in patient-reported function.
{"title":"Does the posterior tibial slope in caliper-verified unrestricted kinematically aligned TKA using manual instruments match the slope in the contralateral healthy knee and improve function?","authors":"Alexander J. Nedopil , Stefano Ghiradelli , S.M. Howell , M.L. Hull","doi":"10.1016/j.knee.2024.11.022","DOIUrl":"10.1016/j.knee.2024.11.022","url":null,"abstract":"<div><h3>Purpose</h3><div>Unrestricted kinematically aligned total knee arthroplasty (unKA TKA) strives to restore the pre-arthritic posterior tibial slope (PTS), however consistency of achieving this alignment target is unknown. The present study determined the proportion of subjects with differences in PTS less than 2° from the target and the improvement in patient-reported function after unKA TKA.</div></div><div><h3>Methods</h3><div>A review of 562 postoperative scanograms identified 99 patients (51 female) with a unKA TKA in one limb, a contralateral healthy limb, and a postoperative axial CT scan. All patients were treated with a primary unKA TKA performed with mechanical instruments where the alignment target was setting the PTS to match that of the medial compartment of the contralateral healthy knee. The PTS of the TKA and the healthy medial tibial plateau were measured and the difference determined. The patient-reported Oxford Knee Score (OKS) measured pre- and post-operative function.</div></div><div><h3>Results</h3><div>The proportion of subjects within a tolerance interval of ±2° of the contralateral healthy knee at 95% confidence was 85%. The median OKS improved from 20 points preoperatively to 47 points (range 18–48) at 15 months postoperatively. Greater differences of the PTS from healthy were unrelated to poorer Oxford Knee Scores.</div></div><div><h3>Conclusion</h3><div>Unrestricted KA TKA using manual instruments with caliper verification of resection thickness restored a high percentage of patients within a clinically acceptable tolerance of the posterior tibial slope of the contralateral healthy knee. The median postoperative OKS indicated clinically important improvement in patient-reported function.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 62-68"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820190","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}
Pub Date : 2024-12-12DOI: 10.1016/j.knee.2024.11.011
Zhu Dai , Jian Li , Juan Tan , Zhijun Yang , Zhihao Gong
Background
The tibial tuberosity–trochlear groove (TT-TG) distance is an important reference for the evaluation of patellar instability. However, measurement of the TT-TG distance has disadvantages with relatively low reproducibility. This study aimed to investigate the reliability of patellar tendon lateral deviation angle (PTLD-A) measured on a single computed tomography (CT) slice and the clinical significance for predicting patellar instability.
Methods
Seventy-eight knees with recurrent patellar dislocation were included as the study group, and 76 normal knees in the control group. The PTLD-A and the TT-TG distance were measured on CT images, inter- and intra-observer reproducibility were assessed, and correlation was analyzed, and compared between the groups. The predictive value of both measurements for patellar instability was examined using the receiver operating characteristic curve, and the cut-off value was predicted using the Youden index.
Results
Inter- and intra-observer reproducibility of PTLD-A was better than TT-TG distance in both groups as well as across all extents of trochlear types. The correlation between the two measurements was strong (r = 0.756, P < 0.001). Notably, both measurements were significantly higher in the study group than in the control group (P < 0.05). PTLD-A showed high predictive value for patellar instability, whereas TT-TG distance showed medium predictive value. A PTLD-A value of ≥ 13.7° was the threshold for diagnosis of patellar instability.
Conclusion
PTLD-A measured on a single computed tomography slice of the distal femoral trochlear groove is more reliable than TT-TG distance for prediction of patellar instability. A PTLD-A ≥ 13.7° predicts patellar instability.
{"title":"Patellar tendon lateral deviation angle: a new computed tomography scan measurement for evaluation of patellar instability","authors":"Zhu Dai , Jian Li , Juan Tan , Zhijun Yang , Zhihao Gong","doi":"10.1016/j.knee.2024.11.011","DOIUrl":"10.1016/j.knee.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>The tibial tuberosity–trochlear groove (TT-TG) distance is an important reference for the evaluation of patellar instability. However, measurement of the TT-TG distance has disadvantages with relatively low reproducibility. This study aimed to investigate the reliability of patellar tendon lateral deviation angle (PTLD-A) measured on a single computed tomography (CT) slice and the clinical significance for predicting patellar instability.</div></div><div><h3>Methods</h3><div>Seventy-eight knees with recurrent patellar dislocation were included as the study group, and 76 normal knees in the control group. The PTLD-A and the TT-TG distance were measured on CT images, inter- and intra-observer reproducibility were assessed, and correlation was analyzed, and compared between the groups. The predictive value of both measurements for patellar instability was examined using the receiver operating characteristic curve, and the cut-off value was predicted using the Youden index.</div></div><div><h3>Results</h3><div>Inter- and intra-observer reproducibility of PTLD-A was better than TT-TG distance in both groups as well as across all extents of trochlear types. The correlation between the two measurements was strong (r = 0.756, <em>P</em> < 0.001). Notably, both measurements were significantly higher in the study group than in the control group (<em>P</em> < 0.05). PTLD-A showed high predictive value for patellar instability, whereas TT-TG distance showed medium predictive value. A PTLD-A value of ≥ 13.7° was the threshold for diagnosis of patellar instability.</div></div><div><h3>Conclusion</h3><div>PTLD-A measured on a single computed tomography slice of the distal femoral trochlear groove is more reliable than TT-TG distance for prediction of patellar instability. A PTLD-A ≥ 13.7° predicts patellar instability.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 35-41"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820203","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}
Energy conversion efficiency of human gait can be evaluated by calculating the ratio of conversion of mechanical energy from vertical motion to horizontal motion of the center of gravity through the movement of the joints. Osteoarthritis (OA) of the knee joint impairs this energy conversion efficiency. Total knee arthroplasty is the standard treatment for knee OA. However, its effect on energy conversion efficiency is unclear. In this study, we investigated how energy conversion efficiency changed in the gait of patients with knee OA before and after surgery.
Methods
Twelve patients with unilateral knee OA who underwent total knee arthroplasty were included. Ground walking was measured using a motion capture system (VICON®) before and 6 months after surgery. We calculated potential and kinetic energy from the coordinate change of the center of mass to obtain energy conversion efficiency. Other gait parameters such as gait speed, vertical movement distance of the body center, step length, hip joint angle, and trailing and leading limb angles were assessed.
Results
Energy conversion efficiency on the operated side significantly improved from 41.4 ± 12.2% to 57.5 ± 9.2% 6 months after surgery. Other gait parameters on the operated side were significantly improved after surgery compared with before surgery. Step length on the operated and the non-operated sides and trailing limb angles on the non-operated side before surgery correlated to energy conversion efficiency, while at 6 months after surgery, gait speed and step length on the non-operated side correlated to energy conversion efficiency.
Conclusion
Energy conversion efficiency was strongly improved postoperatively in patients with knee OA.
{"title":"Total knee arthroplasty improves energy conversion efficiency during walking in patients with knee osteoarthritis","authors":"Ruido Ida , Gen Kuroyanagi , Yoshino Ueki , Satona Murakami , Takayuki Shiraki , Daiki Shimotori , Hideki Okamoto , Kunio Yamada","doi":"10.1016/j.knee.2024.11.020","DOIUrl":"10.1016/j.knee.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>Energy conversion efficiency of human gait can be evaluated by calculating the ratio of conversion of mechanical energy from vertical motion to horizontal motion of the center of gravity through the movement of the joints. Osteoarthritis (OA) of the knee joint impairs this energy conversion efficiency. Total knee arthroplasty is the standard treatment for knee OA. However, its effect on energy conversion efficiency is unclear. In this study, we investigated how energy conversion efficiency changed in the gait of patients with knee OA before and after surgery.</div></div><div><h3>Methods</h3><div>Twelve patients with unilateral knee OA who underwent total knee arthroplasty were included. Ground walking was measured using a motion capture system (VICON®) before and 6 months after surgery. We calculated potential and kinetic energy from the coordinate change of the center of mass to obtain energy conversion efficiency. Other gait parameters such as gait speed, vertical movement distance of the body center, step length, hip joint angle, and trailing and leading limb angles were assessed.</div></div><div><h3>Results</h3><div>Energy conversion efficiency on the operated side significantly improved from 41.4 ± 12.2% to 57.5 ± 9.2% 6 months after surgery. Other gait parameters on the operated side were significantly improved after surgery compared with before surgery. Step length on the operated and the non-operated sides and trailing limb angles on the non-operated side before surgery correlated to energy conversion efficiency, while at 6 months after surgery, gait speed and step length on the non-operated side correlated to energy conversion efficiency.</div></div><div><h3>Conclusion</h3><div>Energy conversion efficiency was strongly improved postoperatively in patients with knee OA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 42-48"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820206","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}
Pub Date : 2024-12-12DOI: 10.1016/j.knee.2024.11.023
Andrea Pintore , Ernesto Pintore , Giovanni Asparago , Emanuela Marsilio , Ernesto Torsiello , Olimpio Galasso
Background
Quadriceps tendon rupture (QTR) is an uncommon injury. In chronic QTR there may be a large defect and direct repair is not possible with sutures or transosseous anchors. There is no gold standard surgical procedure for the treatment of chronic QTR. We propose a novel technique in which the quadriceps tendon (QT) is reconstructed using a transfer of ipsilateral sartorius tendon.
Methods
Between January 2002 and April 2020, 19 patients undergoing sartorius muscle transfer for chronic QTR were prospectively recruited. The Knee Society Score (KSS), range of motion (ROM), and Medical Research Council (MRC) Scale for QT muscle strength were collected preoperatively and at a minimum of 2 years follow up.
Results
The mean age of our cohort was 53.4 ± 9.8 years with a female patient count of 12 (54%). The mean body mass index recorded was 28.5 ± 3.2 kg/m2 (range 23–30). At the mean follow up of 53.4 ± 28.1 months the mean KSS was 90.9 ± 6.3 (range 80–100) (P < 0.05), the mean ROM was 119.5 ± 9.9° for flexion (range 100–130) (P < 0.05) and the mean extension lag was 3.8 ± 5.1° (range 0–15) (P < 0.05). The mean MRC scale was 4.5 ± 0.7 (range 3–5) (P < 0.05). The most frequent complication was QT hypotrophy; it was noted in 14 patients.
Conclusion
Satisfactory clinical outcomes of ipsilateral sartorius muscle transfer for chronic QTR can be expected a mean of 4.4 years after surgery.
{"title":"Sartorius muscle transfer for chronic quadriceps tendon rupture: A prospective study","authors":"Andrea Pintore , Ernesto Pintore , Giovanni Asparago , Emanuela Marsilio , Ernesto Torsiello , Olimpio Galasso","doi":"10.1016/j.knee.2024.11.023","DOIUrl":"10.1016/j.knee.2024.11.023","url":null,"abstract":"<div><h3>Background</h3><div>Quadriceps tendon rupture (QTR) is an uncommon injury. In chronic QTR there may be a large defect and direct repair is not possible with sutures or transosseous anchors. There is no gold standard surgical procedure for the treatment of chronic QTR. We propose a novel technique in which the quadriceps tendon (QT) is reconstructed using a transfer of ipsilateral sartorius tendon.</div></div><div><h3>Methods</h3><div>Between January 2002 and April 2020, 19 patients undergoing sartorius muscle transfer for chronic QTR were prospectively recruited. The Knee Society Score (KSS), range of motion (ROM), and Medical Research Council (MRC) Scale for QT muscle strength were collected preoperatively and at a minimum of 2 years follow up.</div></div><div><h3>Results</h3><div>The mean age of our cohort was 53.4 ± 9.8 years with a female patient count of 12 (54%). The mean body mass index recorded was 28.5 ± 3.2 kg/m<sup>2</sup> (range 23–30). At the mean follow up of 53.4 ± 28.1 months the mean KSS was 90.9 ± 6.3 (range 80–100) (<em>P</em> < 0.05), the mean ROM was 119.5 ± 9.9° for flexion (range 100–130) (<em>P</em> < 0.05) and the mean extension lag was 3.8 ± 5.1° (range 0–15) (<em>P</em> < 0.05). The mean MRC scale was 4.5 ± 0.7 (range 3–5) (<em>P</em> < 0.05). The most frequent complication was QT hypotrophy; it was noted in 14 patients.</div></div><div><h3>Conclusion</h3><div>Satisfactory clinical outcomes of ipsilateral sartorius muscle transfer for chronic QTR can be expected a mean of 4.4 years after surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 79-85"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823004","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}
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