IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-29 DOI: 10.1016/j.knee.2024.11.001

Andreas Bjerregaard , Esben Kjeldgaard , Kasper Nordahl Wøbbe , Cecilie Køllner Olsen , Kristoffer W Barfod , Vasileios Korakakis

Purpose

To translate and cross-cultural adapt the Anterior Cruciate Ligament–Return To Sport After Injury (ACL-RSI) questionnaire into Danish (ACL-RSI-DK) and evaluate the psychometric properties with the purpose to identify the psychological readiness on returning to sport (RTS).

Methods

The ACL-RSI-DK followed a six-step translation and cultural-adaptation process. Statistical analysis included correlation for construct validity of the ACL-R-DK with the Lysholm, KOOS and K-SES. Moreover, we assessed reliability using Cronbach’s alpha and ICC and used Bland Atman methods to assess bias between test and re-test. An exploratory factor-analysis was used for the dimensionality of ACL-RSI-DK.

Results

102 Danish individuals (Female 49%, age 27.7 ± 7.3 years), 51.2 (±15.5) weeks post-op from anterior cruciate ligament reconstruction (ACLR) were included. The ACL-RSI-DK showed excellent internal consistency (Cronbach’s alpha 0.957) and test–retest reliability (ICC = 0.96), with no floor or ceiling effects. The Bland Atman analysis showed no systematic bias. The mean score was 48 ± 23 out of 100 points. The SEM was calculated to be 5/10 points and the MDC₉₅ was 13/100. The construct validity evaluation presented strong correlation between ACL-RSI-DK, K-SES (ρ = 0.63) and KOOS-Sport (ρ = −0.63), whereas a moderate correlation was found with Lysholm (ρ = 0.48) and KOOS (ρ = −0.58) and its subscales KOOS-Symptoms (ρ = −0.27), KOOS-Pain (ρ = −0.43), KOOS-ADL (ρ = −0.47) and KOOS-QoL (ρ = −0.59. ACL-RSI-DK was found to be an unidimensional scale with a total variance explained of 68.5%.

Conclusion

The ACL-RSI was successfully translated and cross-cultural adapted into Danish and displayed good psychometric properties. The ACL-RSI-DK is a valid and reliable tool to investigate the psychological readiness on RTS.

目的将前十字韧带损伤后重返运动（ACL-RSI）问卷翻译成丹麦语（ACL-RSI- dk）并进行跨文化改编，评估其心理测量特性，以确定运动员重返运动后的心理准备状态（RTS）。方法ACL-RSI-DK经过六步翻译和文化适应过程。统计分析ACL-R-DK与Lysholm、kos和K-SES的结构效度相关。此外，我们使用Cronbach 's alpha和ICC评估信度，并使用Bland Atman方法评估测试与再测试之间的偏倚。对ACL-RSI-DK的维度进行探索性因子分析。结果纳入102例丹麦患者，其中女性49%，年龄27.7±7.3岁，术后51.2（±15.5）周。ACL-RSI-DK具有良好的内部一致性（Cronbach 's alpha 0.957）和重测信度（ICC = 0.96），无下限或上限效应。Bland Atman的分析没有显示出系统性偏差。平均得分为48±23分（满分100分）。SEM计算为5/10分，MDC95为13/100。构建效度评价结果显示，ACL-RSI-DK、K-SES与KOOS- sport （ρ = - 0.63）具有较强的相关性，而Lysholm （ρ = 0.48）和KOOS （ρ = - 0.58）及其子量表KOOS- symptoms （ρ = - 0.27）、KOOS- pain （ρ = - 0.43）、KOOS- adl （ρ = - 0.47）和KOOS- qol （ρ = - 0.59）具有中等相关性。ACL-RSI-DK为单维量表，总方差解释率为68.5%。结论ACL-RSI量表成功翻译并跨文化改编为丹麦语，具有良好的心理测量特性。ACL-RSI-DK是一种有效、可靠的RTS心理准备调查工具。

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引用次数: 0

Association between distal tibial rotation and clinical outcomes of medial open-wedge high tibial osteotomy 胫骨远端旋转与胫骨内侧开楔高位截骨临床疗效的关系

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-28 DOI: 10.1016/j.knee.2024.11.009

Chang-Wan Kim, Chang-Rack Lee, Yong-Uk Kwon, Soo-Hwan Jung, Hyun-Seung Lee

Background

The purpose of this study was to evaluate the association between changes in knee joint geometry after medial open-wedge high tibial osteotomy (MOWHTO) and clinical outcomes.

Methods

This was a retrospective study of patients who underwent MOWHTO (101 knees) at our hospital between January 2015 and February 2022 and who were followed up for > 2 years. Radiological and functional outcomes were compared between those who were satisfied with surgery (satisfaction group) and patients who were dissatisfied with surgery (dissatisfaction group). Multiple regression analysis was performed to analyze factors affecting the radiological parameters that significantly differed between the two groups.

Results

The average follow up period was 38.0 ± 15.4 months. There were no significant differences regarding demographic characteristics and preoperative radiological parameters between the satisfaction and dissatisfaction groups. There was a significant intergroup difference with respect to postoperative distal tibial rotation and change in distal tibial rotation (13.5 ± 4.8° and 9.5 ± 4.3°, respectively; P < 0.001). The difference in tibial rotation before and after surgery was 4.3 ± 2.3° and 1.7 ± 1.8° in the dissatisfaction and satisfaction groups (P < 0.001) Multiple regression analysis showed that the correction angle affected the distal tibial rotation in MOWHTO (R² = 0.079, ß = 0.165, P = 0.038).

Conclusions

In MOWHTO, an increase in distal tibial rotation was associated with patient dissatisfaction. Because the increase in distal tibial rotation is associated with a large correction angle, excessive distal tibial rotation should be avoided when MOWHTO requires a large correction angle.

本研究的目的是评估内侧开楔形胫骨高位截骨术（MOWHTO）后膝关节几何形状变化与临床结果之间的关系。方法回顾性分析2015年1月至2022年2月在我院行MOWHTO（101膝关节）手术的患者，并对其进行随访。2年。比较手术满意组（满意组）和手术不满意组（不满意组）的放射学和功能预后。采用多元回归分析两组患者放射学参数差异的影响因素。结果平均随访时间为38.0±15.4个月。满意组和不满意组在人口学特征和术前放射学参数方面无显著差异。术后胫骨远端旋转和胫骨远端旋转变化组间差异显著（分别为13.5±4.8°和9.5±4.3°）；P & lt;0.001)。不满意组和满意组术后胫骨旋转度分别为4.3±2.3°和1.7±1.8°(P <；0.001)多元回归分析显示MOWHTO矫正角度影响胫骨远端旋转（R2 = 0.079， ß = 0.165, P = 0.038）。结论在MOWHTO中，胫骨远端旋转的增加与患者的不满有关。由于胫骨远端旋转的增加与较大的矫正角度有关，当MOWHTO需要较大的矫正角度时，应避免过度的胫骨远端旋转。

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引用次数: 0

Quantifying performance and joint kinematics in functional tasks crucial for anterior cruciate ligament rehabilitation using smartphone video and pose detection 利用智能手机视频和姿势检测量化对前十字韧带康复至关重要的功能性任务中的表现和关节运动学特性

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-26 DOI: 10.1016/j.knee.2024.11.006

Nicolas Lambricht , Alexandre Englebert , Laurent Pitance , Paul Fisette , Christine Detrembleur

Background

The assessment of performance during functional tasks and the quality of movement execution are crucial metrics in the rehabilitation of patients with anterior cruciate ligament (ACL) injuries. While measuring performance is feasible in clinical practice, quantifying joint kinematics poses greater challenges. The aim of this study was to investigate whether smartphone video, using deep neural networks for human pose detection, can enable the clinicians not only to measure performance in functional tasks but also to assess joint kinematics.

Methods

Twelve healthy participants performed the forward reach of the Star Excursion Balance Test 10 times, along with 10 repetitions of forward jumps and vertical jumps, with simultaneous motion capture via a marker-based reference system and a smartphone. OpenPifPaf was utilized for markerless detection of anatomical landmarks in video recordings. The OpenPifPaf coordinates were scaled using anthropometric data of the thigh, and task performance and joint kinematics were computed for both the marker-based and markerless systems.

Results

Comparing results for marker-based and markerless systems revealed similar joint angles, with mean root mean square errors of 2.8° for the knee, 3.1° for the hip, and 3.9° for the ankle. Excellent agreement was observed for clinically pertinent parameters, i.e., the performance, the peak knee flexion, and the knee range of motion (intraclass correlation coefficient > 0.97).

Conclusion

The results underscore the feasibility of using markerless methods based on OpenPifPaf for assessing performance and joint kinematics in functional tasks crucial for ACL patients’ rehabilitation. The simplicity of this approach makes it suitable for integration into clinical practice.

背景评估功能任务中的表现和动作执行的质量是前十字韧带（ACL）损伤患者康复的关键指标。虽然在临床实践中测量表现是可行的，但量化关节运动学却带来了更大的挑战。本研究的目的是探讨利用深度神经网络进行人体姿势检测的智能手机视频是否不仅能帮助临床医生测量功能性任务的表现，还能评估关节运动学。方法12名健康参与者进行了10次星际激增平衡测试的前伸动作，以及10次重复的前跳和垂直跳跃，并通过基于标记的参考系统和智能手机进行了同步动作捕捉。OpenPifPaf 用于在视频记录中无标记检测解剖地标。使用大腿的人体测量数据对 OpenPifPaf 坐标进行缩放，并计算基于标记系统和无标记系统的任务表现和关节运动学。临床相关参数，即运动表现、膝关节屈曲峰值和膝关节运动范围（类内相关系数为 0.97）的一致性非常好。这种方法简单易用，适合融入临床实践。

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引用次数: 0

SPECT-CT may aid in determining which side of a revision stemmed implant problematic total knee replacement is loose when planning revision surgery 在计划翻修手术时，SPECT-CT 可帮助确定翻修干式植入物问题全膝关节置换术哪一侧松动

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-25 DOI: 10.1016/j.knee.2024.10.016

Daniel Hill, Patrick Rogers, Jonathan Phillips, Ben Waterson, Andrew D. Toms

Aim

To evaluate SPECT-CT in the diagnosis of single component aseptic loosening in patients with a problematic cemented stemmed TKR (Total Knee Replacement).

Methods

SPECT-CT was performed where aseptic loosening was suspected but was not clear on plain radiography. Demographics, suspected diagnosis and intention to revise were collected prospectively before and after SPECT-CT.

Results

30 patients were investigated. 43% (95% CI: 0.5–0.9) had clear evidence of loosening on SPECT-CT. In 23% (95% CI: 0.1–0.4) intention to perform revision surgery following SPECT-CT changed (7/30) (p = 0.0004, standard error = 42.1, z = 3.5).

Intentions to perform revision surgery according to the radiologist’s overall summary were:

Normal SPECT-CT – 0% (95% CI: 0.0–0.8) intention to revise (0/2).

Possibly abnormal SPECT-CT – 13% (95% CI: 0.0–0.4) intention to revise (2/15).

Definitely abnormal SPECT-CT – 77% (95% CI: 0.5–0.9) intention to revise (10/13).

We report that SPECT-CT had a test sensitivity of 90.9% (95% CI: 0.6–1.0), a specificity of 100% (95% CI: 0.9–1.0), a positive predictive value of 100% and a negative predictive value of 97.7%.

In 70% (95% CI: 0.3–0.9) of cases where revision surgery was performed for aseptic loosening SPECT-CT provided information that guided pre-operative planning with regards single component or both component revision surgery (7/10).

CONCLUSION

When positive SPECT-CT was useful in determining single component revision. A normal SPECT-CT may have a negative predictive value; however, overall half of our series had a possibly abnormal or equivocal investigation.

目的评估SPECT-CT在诊断有问题的骨水泥柄全膝关节置换术（TKR）患者单个组件无菌性松动中的作用。在 SPECT-CT 前后，前瞻性地收集了患者的人口统计学资料、疑似诊断和复查意向。43%（95% CI：0.5-0.9）的患者在 SPECT-CT 上有明确的松动证据。23%（95% CI：0.1-0.4）的患者（7/30）在SPECT-CT检查后进行翻修手术的意向发生了变化（p = 0.0004，标准误差 = 42.1，z = 3.5）。根据放射科医生的总体总结，进行翻修手术的意向为：SPECT-CT检查正常 - 0%（95% CI：0.SPECT-CT可能异常--13%（95% CI：0.0-0.4）有修改意向（2/15）.SPECT-CT肯定异常--77%（95% CI：0.5-0.9）有修改意向（10/13）。我们报告称，SPECT-CT 的检测灵敏度为 90.9%（95% CI：0.6-1.0），特异性为 100%（95% CI：0.9-1.0），阳性预测值为 100%，阴性预测值为 97.7%。在70%（95% CI：0.3-0.9）因无菌性松动而进行翻修手术的病例中，SPECT-CT提供的信息可指导单个组件或两个组件翻修手术的术前计划（7/10）。正常的SPECT-CT可能具有阴性预测价值；但是，在我们的系列研究中，有一半的研究结果可能异常或不明确。

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引用次数: 0

The third gap – The forgotten space in total knee arthroplasty 第三个缺口--全膝关节置换术中被遗忘的空间

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-23 DOI: 10.1016/j.knee.2024.10.011

William Brown , Nicola Gallagher , Dai Roberts , Richard Napier , David Barrett , David Beverland

Aims

Total Knee Arthroplasty (TKA) aims to leave the proximal flange of the femoral component flush with the femoral cortex. Manually, the requisite plane is found using the anterior femoral cortex or the intramedullary canal, whereas navigation uses hip and knee centre. Presently, no system prioritises restoration of the third space or native trochlear groove height (TGH) and there is a deficiency of published data on the variation of TGH with respect to the anterior cortex. This study aims to address this deficit. Hypothetically, restoration of the third space occurs when trochlear component depth equals TGH.

Materials and Methods

Relative to the posterior femoral axis the height of the anterior femoral cortex is higher laterally than centrally. For simplicity, this study reports MRI measurements of TGH relative to the centre in 110 normal subjects.

Results

TGH varied from the anterior femoral cortex by a mean of 2.32 mm (standard deviation, SD 1.77 mm, range −1.50 mm to 6.80 mm). If a femoral component trochlear depth of 2.2 mm is assumed, then 24.5% would be either over- or understuffed by more than 2 mm.

Conclusion

There is significant variation in TGH relative to the anterior femoral cortex. Assuming a femoral component trochlear depth of 2.2 mm, approximately one quarter of patients (24.5%) will be over- or understuffed by more than 2 mm. Variation in femoral component flexion and extension combined with whether or not it is left proud or notched will add further variation. Failure to restore the third space is likely to contribute to unsatisfactory results following TKA. Future surgical workflows should address this.

目的全膝关节置换术（TKA）的目的是使股骨近端凸缘与股骨皮质平齐。人工方法是通过股骨前皮质或髓内管找到必要的平面，而导航则是利用髋关节和膝关节中心。目前，没有任何系统优先考虑恢复第三空间或原生套骨沟高度（TGH），也没有关于TGH相对于股骨前皮质的变化的公开数据。本研究旨在解决这一不足。材料和方法相对于股骨后轴线，股骨前皮质的高度在外侧高于中央。结果TGH与股骨前皮质的差异平均为2.32毫米（标准差，SD 1.77毫米，范围-1.50毫米至6.80毫米）。如果假定股骨组件套管深度为 2.2 mm，那么 24.5% 的患者会出现超过或不足 2 mm 的情况。假设股骨组件套管深度为 2.2 毫米，则约有四分之一的患者（24.5%）会出现超过或不足 2 毫米的情况。股骨组件屈伸的不同，以及是否留有凹槽，都会增加进一步的差异。如果不能恢复第三间隙，很可能会导致 TKA 术后效果不理想。未来的手术流程应解决这一问题。

{"title":"The third gap – The forgotten space in total knee arthroplasty","authors":"William Brown , Nicola Gallagher , Dai Roberts , Richard Napier , David Barrett , David Beverland","doi":"10.1016/j.knee.2024.10.011","DOIUrl":"10.1016/j.knee.2024.10.011","url":null,"abstract":"<div><h3>Aims</h3><div>Total Knee Arthroplasty (TKA) aims to leave the proximal flange of the femoral component flush with the femoral cortex. Manually, the requisite plane is found using the anterior femoral cortex or the intramedullary canal, whereas navigation uses hip and knee centre. Presently, no system prioritises restoration of the third space or native trochlear groove height (TGH) and there is a deficiency of published data on the variation of TGH with respect to the anterior cortex. This study aims to address this deficit. Hypothetically, restoration of the third space occurs when trochlear component depth equals TGH.</div></div><div><h3>Materials and Methods</h3><div>Relative to the posterior femoral axis the height of the anterior femoral cortex is higher laterally than centrally. For simplicity, this study reports MRI measurements of TGH relative to the centre in 110 normal subjects.</div></div><div><h3>Results</h3><div>TGH varied from the anterior femoral cortex by a mean of 2.32 mm (standard deviation, SD 1.77 mm, range −1.50 mm to 6.80 mm). If a femoral component trochlear depth of 2.2 mm is assumed, then 24.5% would be either over- or understuffed by more than 2 mm.</div></div><div><h3>Conclusion</h3><div>There is significant variation in TGH relative to the anterior femoral cortex. Assuming a femoral component trochlear depth of 2.2 mm, approximately one quarter of patients (24.5%) will be over- or understuffed by more than 2 mm. Variation in femoral component flexion and extension combined with whether or not it is left proud or notched will add further variation. Failure to restore the third space is likely to contribute to unsatisfactory results following TKA. Future surgical workflows should address this.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 164-170"},"PeriodicalIF":1.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700571","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

Non-steroidal anti-inflammatory drugs influence cartilage healing 非甾体抗炎药会影响软骨愈合。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.021

Asma Sajjad Khawaja , Maria Zafar , Rana Muhammad Zeeshan , Muhammad Saad Ilyas , Amer Aziz , Uruj Zehra

Background

Retrograde intramedullary nailing is commonly performed to stabilize distal femoral shaft fractures which may lead to iatrogenic injuries of the knee articular cartilage. The limited regenerative capability of cartilage may further be hindered by intake of non-steroidal anti-inflammatory drugs (NSAIDs) which are usually advised for injuries of the musculoskeletal system. The current study was designed to evaluate the histological changes in the femoral articular cartilage of knee joint after retrograde femoral nailing of rats.

Methods

Retrograde intramedullary nailing was performed in 36 adult male Wistar rats, divided into three groups of 12 each. Groups 1 and 2 were given nonselective and selective COX 2 inhibitors, respectively, while the third group was taken as control. Half of the animals from each group were sacrificed at the second week, and remainder on the seventh week, and samples of the femoral articular cartilage were assessed for cartilage regeneration according to the modified Mankin scoring on histology while BMP-2 expression was evaluated on immunohistochemistry.

Results

Mean modified Mankin scores for cartilage degradation were increased in animals taking NSAIDs at the second and seventh weeks of healing (P = 0.02, P < 0.001 respectively). There was a significant decrease in chondrocytes at the second week (P = 0.001), along with the loss of proteoglycan content in these animals at both time points (P = 0.001). The BMP-2 expression was significantly enhanced in the control group at the second (P = 0.001) and seventh weeks (P = 0.001).

Conclusion

The results reveal that intake of NSAIDs hinders the process of cartilage healing by reducing the number of chondrocytes and loss of proteoglycan content and decreased expression of BMP-2.

背景：逆行髓内钉是稳定股骨远端骨折的常用方法，可能会导致膝关节软骨的先天性损伤。软骨的再生能力有限，摄入非甾体抗炎药（NSAIDs）可能会进一步阻碍软骨的再生，而非甾体抗炎药通常是治疗肌肉骨骼系统损伤的首选药物。本研究旨在评估大鼠股骨逆行钉入后膝关节股骨关节软骨的组织学变化：方法：36 只成年雄性 Wistar 大鼠分为三组，每组 12 只。第一组和第二组分别给予非选择性和选择性 COX 2 抑制剂，第三组为对照组。每组一半动物在第二周处死，其余动物在第七周处死，并根据组织学改良 Mankin 评分法评估股关节软骨样本的软骨再生情况，同时用免疫组化法评估 BMP-2 的表达：结果表明，服用非甾体抗炎药会减少软骨细胞的数量和蛋白多糖的含量，并降低 BMP-2 的表达，从而阻碍软骨愈合的过程。

{"title":"Non-steroidal anti-inflammatory drugs influence cartilage healing","authors":"Asma Sajjad Khawaja , Maria Zafar , Rana Muhammad Zeeshan , Muhammad Saad Ilyas , Amer Aziz , Uruj Zehra","doi":"10.1016/j.knee.2024.10.021","DOIUrl":"10.1016/j.knee.2024.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Retrograde intramedullary nailing is commonly performed to stabilize distal femoral shaft fractures which may lead to iatrogenic injuries of the knee articular cartilage. The limited regenerative capability of cartilage may further be hindered by intake of non-steroidal anti-inflammatory drugs (NSAIDs) which are usually advised for injuries of the musculoskeletal system. The current study was designed to evaluate the histological changes in the femoral articular cartilage of knee joint after retrograde femoral nailing of rats.</div></div><div><h3>Methods</h3><div>Retrograde intramedullary nailing was performed in 36 adult male Wistar rats, divided into three groups of 12 each. Groups 1 and 2 were given nonselective and selective COX 2 inhibitors, respectively, while the third group was taken as control. Half of the animals from each group were sacrificed at the second week, and remainder on the seventh week, and samples of the femoral articular cartilage were assessed for cartilage regeneration according to the modified Mankin scoring on histology while BMP-2 expression was evaluated on immunohistochemistry.</div></div><div><h3>Results</h3><div>Mean modified Mankin scores for cartilage degradation were increased in animals taking NSAIDs at the second and seventh weeks of healing (<em>P</em> = 0.02, <em>P</em> < 0.001 respectively). There was a significant decrease in chondrocytes at the second week (<em>P</em> = 0.001), along with the loss of proteoglycan content in these animals at both time points (<em>P</em> = 0.001). The BMP-2 expression was significantly enhanced in the control group at the second (<em>P</em> = 0.001) and seventh weeks (<em>P</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>The results reveal that intake of NSAIDs hinders the process of cartilage healing by reducing the number of chondrocytes and loss of proteoglycan content and decreased expression of BMP-2.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 121-130"},"PeriodicalIF":1.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693786","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

Three-dimensional models demonstrate differences in correction depending on femoral derotational osteotomy site and may enhance the planning and precision in femoral derotational osteotomy – An observational study in eight femora and two surgeons 三维模型显示股骨截骨部位不同，矫正效果也不同，可提高股骨截骨术的计划性和精确性 - 一项针对 8 个股骨和 2 名外科医生的观察研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.023

Caterina Chiappe , Alejandro Roselló-Añón , Vicente Sanchis-Alfonso , Joan Carles Monllau , Julio Domenech-Fernández

Background

Increased femoral anteversion (FAV) is crucial in the genesis of anterior knee pain (AKP) and a femoral derotational osteotomy (FDO) has demonstrated good clinical results. It remains unclear at what level of the femur the osteotomy should be performed. Resulting degrees of FAV measured by Murphy’s method do not always correspond to the degrees that had been planned after an FDO. The hypothesis of this study is that the femur rotation axis and the osteotomy rotation axis do not coincide. Three-dimensional (3D) technology is used to objectify the discrepancy between these two axes and to find solutions so that the two axes can coincide. The objective is to demonstrate the reliability and reproducibility of the 3D technique for osteotomy adjustment through an intraobserver and interobserver study.

Methods

Images of eight computed tomography scans of the femur, corresponding to seven patients with a diagnosis of AKP and increased FAV, were selected. Two surgeons performed the FAV measurement and simulation of FDO on 3D biomodels. The femoral osteotomies were defined at three levels, at 10°, 20°, 30°. To determine interobserver agreement, measurements were performed independently by two surgeons. To evaluate intraobserver differences each surgeon repeated all measurements after 15 days.

Results

Interobserver and intraobserver agreement: intraclass correlation coefficient 0.930 (95% confidence interval (CI) 0.799–0.975) and 0.986 (95% CI 0.959–0.995). Significant differences between the resulting values were observed when the osteotomy was performed at the intertrochanteric level.

Conclusions

The misalignment of the axes results in hypocorrection when the osteotomy is intertrochanteric. This phenomenon is not observed when the osteotomy is diaphyseal or supracondylar.

背景：股骨外翻（FAV）是导致膝前疼痛（AKP）的关键因素，而股骨外翻截骨术（FDO）具有良好的临床效果。目前仍不清楚应在股骨的哪个水平进行截骨。用 Murphy's 方法测量的 FAV 度数并不总是与 FDO 后计划的度数一致。本研究的假设是股骨旋转轴与截骨旋转轴不一致。三维（3D）技术被用来确定这两个轴线之间的差异，并找到解决方案，使两个轴线能够重合。目的是通过一项观察者内部和观察者之间的研究，证明三维技术在截骨调整方面的可靠性和可重复性：方法：选取七名确诊为 AKP 且 FAV 增高的患者的八张股骨计算机断层扫描图像。两名外科医生在三维生物模型上进行FAV测量和FDO模拟。股骨截骨分为 10°、20° 和 30°三个级别。为确定观察者之间的一致性，由两名外科医生独立进行测量。为评估观察者内部差异，每位外科医生在 15 天后重复所有测量：观察者间和观察者内的一致性：类内相关系数分别为 0.930（95% 置信区间（CI）0.799-0.975）和 0.986（95% 置信区间（CI）0.959-0.995）。在转子间水平进行截骨时，观察到结果值之间存在显著差异：结论：在转子间水平进行截骨时，轴线的错位会导致矫正不足。结论：在转子间进行截骨时，轴线的错位会导致低校正，而在二骺或髁上进行截骨时则不会出现这种现象。

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引用次数: 0

Biomechanical differences of Asian knee osteoarthritis patients during standing and walking using statistical parametric mapping: A cross-sectional study 使用统计参数映射法研究亚洲膝关节骨关节炎患者在站立和行走时的生物力学差异：横断面研究

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.022

Yi Hu , Phillis Teng , Tsung-Lin Wu , Ross Clark , Yong-Hao Pua , Oliver Roberts , Jia Wei Yong , Amr Alhossary , Lek Syn Lim , Desmond Y.R. Chong , Wei Tech Ang , Bryan Yijia Tan

Background

Biomechanics of knee osteoarthritis (KOA) patients have been extensively studied using motion capture systems, but less have explored standing knee joint angles with the walking parameters, particularly in Asians. We aim to determine gait biomechanical differences between healthy and KOA participants in an Asian population using One-dimensional Statistical Parametric Mapping (SPM1D) and explore if they are associated with standing joint angles.

Methods

A total of 20 KOA and 24 healthy stood upright and walked 10 m at self-selected speeds. The standing angles, walking kinematic and kinetic parameters of the ankle, knee, hip and trunk were analysed. Lower limb muscle excitation was measured via electromyography. SPM1D was used to compare the healthy group with the KOA group, and for further subgroup analysis.

Results

The all KOA group had significantly greater standing knee flexion angles (KFA) (p < 0.001), standing ankle dorsiflexion angles (ADA) (p < 0.001), walking KFA during terminal stance (p = 0.001) and terminal swing (p = 0.02) and walking ADA during terminal stance (p = 0.02) and mid-swing to terminal swing (p = 0.001). Knee adduction moment (p = 0.04) and knee flexion moment (p = 0.03) were higher in severe KOA. A positive correlation was found between standing KFA and initial KFA (R² = 0.579), and mean walking KFA (R² = 0.801) in the KOA group.

Conclusion

The increase in standing KFA was associated with an increase in walking KFA in the KOA group. Static joint angles remain as an essential parameter, although further studies need to be carried out to determine if the increase in standing joint angles can be recommended as an adjunctive measure during gait analysis of KOA using motion capture.

背景：利用运动捕捉系统对膝关节骨性关节炎（KOA）患者的生物力学进行了广泛的研究，但对站立膝关节角度与行走参数，尤其是亚洲人的站立膝关节角度的研究较少。我们的目的是利用一维统计参数映射（SPM1D）确定亚洲人群中健康和 KOA 参与者的步态生物力学差异，并探讨这些差异是否与站立关节角度有关：共有 20 名 KOA 和 24 名健康人直立行走 10 米，速度自定。分析了站立角度、踝关节、膝关节、髋关节和躯干的行走运动学和动力学参数。通过肌电图测量了下肢肌肉的兴奋性。使用 SPM1D 对健康组和 KOA 组进行比较，并进一步进行分组分析：结果：所有 KOA 组的站立膝关节屈曲角 (KFA) 明显更大（P 2 = 0.579），KOA 组的平均行走膝关节屈曲角 (R2 = 0.801)也明显更大：结论：在 KOA 组中，站立膝关节屈曲角的增加与步行膝关节屈曲角的增加相关。静态关节角度仍然是一个重要参数，但还需要进行进一步研究，以确定在使用运动捕捉对 KOA 进行步态分析时，是否可以建议将站立关节角度的增加作为一项辅助测量指标。

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引用次数: 0

Patients submitted to re-revision ACL reconstruction present more knee laxity, more complications, and a higher failure rate than patients submitted to the first revision ACL reconstruction 与接受首次前交叉韧带翻修重建术的患者相比，接受再次前交叉韧带翻修重建术的患者膝关节更松弛，并发症更多，失败率更高。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.11.004

Camilo Partezani Helito , Andre Giardino Moreira da Silva , Riccardo Cristiani , Anders Stålman , Vitor Barion Castro de Pádua , Riccardo Gomes Gobbi , José Ricardo Pécora

Background

Few comparative studies have evaluated patients who underwent two revision anterior cruciate ligament reconstruction (ACLR) and patients who underwent one revision ACLR, and many of them have a short postoperative follow-up and a relatively small number of patients. The objective of this study is to evaluate the functional results, complications, and failure rates of patients who underwent one revision ACLR and patients who underwent two revision ACLRs.

Methods

This is a retrospective study comparing patients who underwent one revision ACLR (Group 1) with patients who underwent a re-revision ACLR (Group 2). Baseline demographic variables, operative data and post-operative data were evaluated.

Results

Among the 266 patients included, 226 were from Group 1 and 40 from Group 2. Patients in Group 2 had greater rotatory laxity and were more often subjected to associated osteotomy at the time of revision surgery. Postoperatively, patients from Group 2 reported poorer subjective IKDC score and showed greater knee laxity measured with the KT-1000 arthrometer, although both probably not clinically relevant. The complication rate was high in both groups, with a higher incidence in Group 2. Reconstruction failures were also higher in Group 2 (20% vs. 8.8%, p = 0.03).

Conclusion

Patients from Group 2 underwent a higher rate of associated osteotomy procedures, present higher complication rates and a higher failure rate compared with patients from Group 1. However, the functional scores (Lysholm and IKDC score) and the physical examination (KT-1000 and pivot-shift) did not show clinically relevant differences between the groups.

Level of Evidence

III, retrospective comparative therapeutic trial.

背景：很少有比较研究对接受过两次翻修前交叉韧带重建术（ACLR）的患者和接受过一次翻修前交叉韧带重建术的患者进行评估，而且许多研究的术后随访时间较短，患者人数相对较少。本研究旨在评估接受过一次翻修前交叉韧带重建术的患者和接受过两次翻修前交叉韧带重建术的患者的功能效果、并发症和失败率：这是一项回顾性研究，比较了接受过一次前交叉韧带翻修术的患者（第 1 组）和接受过一次前交叉韧带翻修术的患者（第 2 组）。对基线人口统计学变量、手术数据和术后数据进行了评估：在266名患者中，第一组有226人，第二组有40人。第二组患者的旋转松弛度更大，在翻修手术时更常需要进行相关的截骨手术。术后，第2组患者的IKDC主观评分较低，用KT-1000关节测量仪测量的膝关节松弛度较大，但这两点可能与临床无关。两组患者的并发症发生率都很高，其中第 2 组的发生率更高。第二组的重建失败率也更高（20% 对 8.8%，P = 0.03）：结论：与第1组患者相比，第2组患者接受相关截骨手术的比例更高，并发症发生率更高，失败率更高：证据等级：III，回顾性比较治疗试验。

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引用次数: 0

Patellar tendon–Hoffa fat pad interface: From anatomy to high-resolution ultrasound imaging 髌腱-霍法脂肪垫界面：从解剖学到高分辨率超声成像。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-21 DOI: 10.1016/j.knee.2024.10.024

Vincenzo Ricci , Giulio Cocco , Kamal Mezian , Ke-Vin Chang , Jorge Barbosa , Ondřej Naňka , Levent Özçakar

Aim

To propose a standardized, high-resolution ultrasound (US) protocol to assess the patellar tendon–Hoffa fat pad interface (PTHFPI) in patients with (proximal) patellar tendinopathy (PPT).

Methods

Using a high-frequency transducer and a high-level machine, we matched the cadaveric and histological microarchitecture of the PTHFPI with multiple sonographic patterns of patients with PPT. Likewise, high-sensitive color/power Doppler assessments were also performed to evaluate the microcirculation of the soft tissues beneath the patellar tendon.

Results

Modern US equipment allows for detailed assessment of the potential pain generators located inside the PTHFPI in patients with PPT. They include anterosuperior portion of the Hoffa body and the loose connective tissue of the deep paratenon with its microvascular plexus.

Conclusions

In patients with PPT, accurate sonographic assessment of the PTHFPI can be performed using adequate technological equipment. Accordingly, tailored ultrasound-guided interventions can also be planned if/when clinically indicated.

目的：提出一种标准化的高分辨率超声（US）方案，用于评估（近端）髌腱病（PPT）患者的髌腱-霍法脂肪垫界面（PTHFPI）：方法：我们使用高频换能器和高级机器，将髌腱-霍法脂肪垫界面（PTHFPI）的尸体和组织学微观结构与 PPT 患者的多种声像图模式相匹配。同样，我们还进行了高灵敏度彩色/功率多普勒评估，以评估髌腱下方软组织的微循环：结果：现代 US 设备可对 PPT 患者 PTHFPI 内部的潜在疼痛发生器进行详细评估。其中包括霍法体的前上部、髌骨旁深层的疏松结缔组织及其微血管丛：结论：使用适当的技术设备可对 PPT 患者的 PTHFPI 进行准确的超声评估。结论：使用适当的技术设备可以对 PTHFPI 患者进行准确的超声波评估，因此，如果/当临床需要时，也可以计划进行有针对性的超声波引导干预。

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引用次数: 0

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