Pub Date : 2024-11-16DOI: 10.1016/j.knee.2024.10.007
Alper Kirilmaz , Mustafa Özkaya , Turgut Emre Erdem , Faik Türkmen
Background
Precise high tibial osteotomy is crucial, especially for middle-aged individuals with medial compartment arthritis, aiming to prevent complications like lateral cortex fractures. This study explores how frontal plane osteotomy inclination impacts lateral cortex fractures during medial open-wedge high tibial osteotomy.
Methods
Using finite element analysis, tibia models underwent osteotomies at angles of 10°, 13°, 16°, 19°, and 22°, forming five models. Forces from 5 N to 75 N were applied incrementally, recording bone stresses (MPa) at the lateral hinge, angle changes (°) along the osteotomy line, and gap distances (mm).
Results
Models with higher frontal inclination showed increased gap distances under identical forces. For instance, at 5 N force, the 10° inclination model displayed a correction angle of 0.28° and a 1.43 mm gap, while the 22° model had a correction angle of 0.35° and a 1.37 mm gap. Under 75 N force, the 10° model had a correction angle of 10.81° and a 14.02 mm gap, while the 22° model had a correction angle of 16.86° and a 19.31 mm gap.
Conclusion
The osteotomy starting point’s distance from the joint doesn’t significantly impact final stress on the lateral cortex when the same gap distance is achieved. However, in cases requiring a higher degree of correction, we can say that the surgeon can achieve the result with less resistance by keeping the osteotomy starting point more distal to the joint line.
{"title":"The effect of frontal plane osteotomy angle on lateral cortex fracture in medial open wedge high tibial osteotomy procedure","authors":"Alper Kirilmaz , Mustafa Özkaya , Turgut Emre Erdem , Faik Türkmen","doi":"10.1016/j.knee.2024.10.007","DOIUrl":"10.1016/j.knee.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Precise high tibial osteotomy is crucial, especially for middle-aged individuals with medial compartment arthritis, aiming to prevent complications like lateral cortex fractures. This study explores how frontal plane osteotomy inclination impacts lateral cortex fractures during medial open-wedge high tibial osteotomy.</div></div><div><h3>Methods</h3><div>Using finite element analysis, tibia models underwent osteotomies at angles of 10°, 13°, 16°, 19°, and 22°, forming five models. Forces from 5 N to 75 N were applied incrementally, recording bone stresses (MPa) at the lateral hinge, angle changes (°) along the osteotomy line, and gap distances (mm).</div></div><div><h3>Results</h3><div>Models with higher frontal inclination showed increased gap distances under identical forces. For instance, at 5 N force, the 10° inclination model displayed a correction angle of 0.28° and a 1.43 mm gap, while the 22° model had a correction angle of 0.35° and a 1.37 mm gap. Under 75 N force, the 10° model had a correction angle of 10.81° and a 14.02 mm gap, while the 22° model had a correction angle of 16.86° and a 19.31 mm gap.</div></div><div><h3>Conclusion</h3><div>The osteotomy starting point’s distance from the joint doesn’t significantly impact final stress on the lateral cortex when the same gap distance is achieved. However, in cases requiring a higher degree of correction, we can say that the surgeon can achieve the result with less resistance by keeping the osteotomy starting point more distal to the joint line.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 108-120"},"PeriodicalIF":1.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649581","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 : 2024-11-16DOI: 10.1016/j.knee.2024.10.019
Guiguan Wang , Long Chen , Yancheng Chen , Jie Xu
Background
We aim to evaluate the causal relationship between different types of physical activity and the risk of knee osteoarthritis (KOA) through a two-sample Mendelian randomization study.
Methods
We performed a two-sample Mendelian randomization analysis using publicly available Genome-wide association study associated with physical activity (460 376 individuals) and KOA (403 124 individuals). Two-sample Mendelian randomization analyses were performed to investigate the effects of exposure traits on KOA risk.
Results
In this Mendelian randomization analysis, we investigated the impact of different types of physical activity on the risk of KOA. Light do-it-yourself and walking for pleasure demonstrated a protective effect on the risk of KOA (P = 8.19 × 10−4 and P = 4.24 × 10−6, respectively). No statistically significant differences were observed for heavy do-it-yourself, strenuous sports, other exercises or physical inactivity.
Conclusion
This study has revealed that engaging in light do-it-yourself activities and walking may serve as potential protective factors against KOA. These findings underscore the significance of introducing such activities into public health strategies designed for the prevention and management of KOA. Additional research is warranted to reveal the underlying mechanisms further.
{"title":"The impact of different types of physical activity on the risk of knee osteoarthritis: A Mendelian randomization study","authors":"Guiguan Wang , Long Chen , Yancheng Chen , Jie Xu","doi":"10.1016/j.knee.2024.10.019","DOIUrl":"10.1016/j.knee.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>We aim to evaluate the causal relationship between different types of physical activity and the risk of knee osteoarthritis (KOA) through a two-sample Mendelian randomization study.</div></div><div><h3>Methods</h3><div>We performed a two-sample Mendelian randomization analysis using publicly available Genome-wide association study associated with physical activity (460 376 individuals) and KOA (403 124 individuals). Two-sample Mendelian randomization analyses were performed to investigate the effects of exposure traits on KOA risk.</div></div><div><h3>Results</h3><div>In this Mendelian randomization analysis, we investigated the impact of different types of physical activity on the risk of KOA. Light do-it-yourself and walking for pleasure demonstrated a protective effect on the risk of KOA (P = 8.19 × 10−4 and P = 4.24 × 10−6, respectively). No statistically significant differences were observed for heavy do-it-yourself, strenuous sports, other exercises or physical inactivity.</div></div><div><h3>Conclusion</h3><div>This study has revealed that engaging in light do-it-yourself activities and walking may serve as potential protective factors against KOA. These findings underscore the significance of introducing such activities into public health strategies designed for the prevention and management of KOA. Additional research is warranted to reveal the underlying mechanisms further.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 90-98"},"PeriodicalIF":1.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645184","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 : 2024-11-16DOI: 10.1016/j.knee.2024.10.018
Owen J. Rabak , Jacob A Devenish , Diana M Perriman , Jennie M Scarvell , Catherine R Galvin , Paul N Smith , Mark R Pickering , Joseph T Lynch
Background
Stair climbing is a kinematically demanding activity, essential for maintaining independence and quality of life, yet is often impaired in patients with knee osteoarthritis (OA). The purpose of this study was to examine differences in kinematics of a step-up movement between participants with osteoarthritis and asymptomatic controls.
Methods
Thirty participants with end-stage OA awaiting total knee arthroplasty (TKA) and twenty-eight sex and age-similar asymptomatic participants were recruited. Participants performed a step-up task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Kinematic variables of position, displacement, and rate-of-change in six degrees of freedom were compared between the two groups.
Results
OA knees exhibited significantly different kinematics to asymptomatic knees during step-up. Knees with OA demonstrated a reduced terminal extension angle, inferior translation and increased internal rotation throughout the movement compared to asymptomatic. OA participants exhibited more variability in kinematic parameters compared to asymptomatic controls, reflecting the heterogeneity within OA pathology.
Conclusion
The findings of this study indicate that knee kinematics, particularly rotation, differ significantly between OA and asymptomatic knees during step-up. Optimising rotational profiles in OA knee management could help optimise patient function and inform rehabilitation and surgical protocols.
背景：爬楼梯是一项对运动学要求很高的活动，对保持独立性和生活质量至关重要，但膝关节骨性关节炎（OA）患者的爬楼梯能力往往会受到影响。本研究的目的是检查骨关节炎患者与无症状对照组患者在上台阶运动中的运动学差异：方法：招募了 30 名等待进行全膝关节置换术（TKA）的终末期 OA 患者和 28 名性别和年龄相似的无症状患者。参试者通过单平面透视进行上台阶操作。三维假体计算机辅助设计模型与透视成像进行了注册，从而获得了体内运动学数据。对两组的位置、位移和六个自由度的变化率等运动变量进行了比较：结果：在上台阶时，有 OA 的膝关节与无症状膝关节的运动学表现明显不同。与无症状膝关节相比，患有 OA 的膝关节在整个运动过程中表现出末端伸展角度减小、下移和内旋增加。与无症状对照组相比，OA 参与者的运动学参数表现出更大的变异性，这反映了 OA 病理学的异质性：本研究结果表明，膝关节运动学，尤其是旋转，在上台阶时，OA 膝关节和无症状膝关节之间存在显著差异。在膝关节OA治疗中优化旋转曲线有助于优化患者功能，并为康复和手术方案提供参考。
{"title":"In vivo kinematics during step ascent: Changes to the knee associated with osteoarthritis","authors":"Owen J. Rabak , Jacob A Devenish , Diana M Perriman , Jennie M Scarvell , Catherine R Galvin , Paul N Smith , Mark R Pickering , Joseph T Lynch","doi":"10.1016/j.knee.2024.10.018","DOIUrl":"10.1016/j.knee.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Stair climbing is a kinematically demanding activity, essential for maintaining independence and quality of life, yet is often impaired in patients with knee osteoarthritis (OA). The purpose of this study was to examine differences in kinematics of a step-up movement between participants with osteoarthritis and asymptomatic controls.</div></div><div><h3>Methods</h3><div>Thirty participants with end-stage OA awaiting total knee arthroplasty (TKA) and twenty-eight sex and age-similar asymptomatic participants were recruited. Participants performed a step-up task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Kinematic variables of position, displacement, and rate-of-change in six degrees of freedom were compared between the two groups.</div></div><div><h3>Results</h3><div>OA knees exhibited significantly different kinematics to asymptomatic knees during step-up. Knees with OA demonstrated a reduced terminal extension angle, inferior translation and increased internal rotation throughout the movement compared to asymptomatic. OA participants exhibited more variability in kinematic parameters compared to asymptomatic controls, reflecting the heterogeneity within OA pathology.</div></div><div><h3>Conclusion</h3><div>The findings of this study indicate that knee kinematics, particularly rotation, differ significantly between OA and asymptomatic knees during step-up. Optimising rotational profiles in OA knee management could help optimise patient function and inform rehabilitation and surgical protocols.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 69-77"},"PeriodicalIF":1.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645183","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}
An anatomical artificial bone implant inserted into the osteotomy gap might be useful for accurate alignment correction during open-wedge high tibial osteotomy (OWHTO). The aims of this study were to evaluate morphological variation in the osteotomy surface, identify an anatomical implant’s shape, and verify its usefulness for accurate three-dimensional (3D) correction.
Methods
Virtual OWHTO was performed with preoperative 3D computed tomography data from 100 knees. The tibial contour in the osteotomy plane was analyzed using principal component analysis to determine implant shape. An anatomical artificial bone implant with a 10° correction angle was made with a synthetic bone substitute. Coronal correction accuracy and changes in posterior tibial slope (PTS) and rotation were evaluated on eight cadaver knees that received the anatomical artificial bone implant and clinically on 85 in vivo knees that received conventional wedge-shaped spacers.
Results
The single-shape anatomical artificial bone implant was designed to occupy a posteromedial 30 × 25 mm region and had high contour congruency (mean mismatch, 0.73 mm; mean contact area coverage, 97.5%). Gap opening angle with the anatomical artificial bone implant was precise, avoiding excessive PTS change (mean, 0.6°) and rotational change (mean, 0.5°). In contrast, both PTS and rotational change with conventional spacers increased by a mean of 2.9°.
Conclusions
An anatomical artificial bone implant derived from the mean shape of 100 knees had high and consistent contour congruency. The anatomical artificial bone implant inserted with 3D surgical guidance provided accurate gap opening, reducing PTS change to less than 1° during OWHTO.
{"title":"An anatomical artificial bone implant can improve three-dimensional correction accuracy in open-wedge high tibial osteotomy","authors":"Yugo Morita , Shinichi Kuriyama , Yusuke Yamawaki , Shinichiro Nakamura , Kohei Nishitani , Hiromu Ito , Shuichi Matsuda","doi":"10.1016/j.knee.2024.10.017","DOIUrl":"10.1016/j.knee.2024.10.017","url":null,"abstract":"<div><h3>Background</h3><div>An anatomical artificial bone implant inserted into the osteotomy gap might be useful for accurate alignment correction during open-wedge high tibial osteotomy (OWHTO). The aims of this study were to evaluate morphological variation in the osteotomy surface, identify an anatomical implant’s shape, and verify its usefulness for accurate three-dimensional (3D) correction.</div></div><div><h3>Methods</h3><div>Virtual OWHTO was performed with preoperative 3D computed tomography data from 100 knees. The tibial contour in the osteotomy plane was analyzed using principal component analysis to determine implant shape. An anatomical artificial bone implant with a 10° correction angle was made with a synthetic bone substitute. Coronal correction accuracy and changes in posterior tibial slope (PTS) and rotation were evaluated on eight cadaver knees that received the anatomical artificial bone implant and clinically on 85 in vivo knees that received conventional wedge-shaped spacers.</div></div><div><h3>Results</h3><div>The single-shape anatomical artificial bone implant was designed to occupy a posteromedial 30 × 25 mm region and had high contour congruency (mean mismatch, 0.73 mm; mean contact area coverage, 97.5%). Gap opening angle with the anatomical artificial bone implant was precise, avoiding excessive PTS change (mean, 0.6°) and rotational change (mean, 0.5°). In contrast, both PTS and rotational change with conventional spacers increased by a mean of 2.9°.</div></div><div><h3>Conclusions</h3><div>An anatomical artificial bone implant derived from the mean shape of 100 knees had high and consistent contour congruency. The anatomical artificial bone implant inserted with 3D surgical guidance provided accurate gap opening, reducing PTS change to less than 1° during OWHTO.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 78-89"},"PeriodicalIF":1.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649578","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 : 2024-11-15DOI: 10.1016/j.knee.2024.10.020
İzzet İnce , Erkan Tortu
Background
Maximal force plays a pivotal role in enhancing performance across various dynamic sports, particularly in sprinting biomechanics. However, muscle strength asymmetry among major muscle groups like the hamstrings and quadriceps may hinder sprint performance and raise injury risks. This study examines how intra- and inter-limb strength asymmetry relates to sprint kinematics and the power-force–velocity profile in youth athletes.
Methods
Seventy-four youth athletes from football, volleyball, and handball completed two testing sessions, 48 h apart. Assessments included anthropometric measurements, sprint tests, and isokinetic dynamometer strength evaluations at 60°.s−1 and 180°.s−1. Sprint kinematics were analyzed using the Optojump Next system, and force–velocity profile variables were determined via Samozino’s method. Asymmetry analysis used a standard percentage difference equation.
Results
Weak to moderate correlations (r = −0.46 to 0.45) were found between strength asymmetry and sprint parameters, suggesting limited impact of asymmetry on sprint kinematics and kinetics. Although most participants showed asymmetry levels below the 15% threshold deemed functionally significant, outliers had asymmetry values up to 42%, indicating considerable variability.
Conclusions
Lower extremity strength asymmetry moderately affects sprint kinematics and force–velocity profiles in young team athletes, challenging traditional views. Further research is needed to explore the mechanisms between strength asymmetry and sprint performance, aiming to inform targeted training interventions that optimize performance and reduce injury risks in youth athletes.
{"title":"Association between intra and inter-limb strength asymmetry with sprint kinematics and force-velocity profile in youth team athletes","authors":"İzzet İnce , Erkan Tortu","doi":"10.1016/j.knee.2024.10.020","DOIUrl":"10.1016/j.knee.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Maximal force plays a pivotal role in enhancing performance across various dynamic sports, particularly in sprinting biomechanics. However, muscle strength asymmetry among major muscle groups like the hamstrings and quadriceps may hinder sprint performance and raise injury risks. This study examines how intra- and inter-limb strength asymmetry relates to sprint kinematics and the power-force–velocity profile in youth athletes.</div></div><div><h3>Methods</h3><div>Seventy-four youth athletes from football, volleyball, and handball completed two testing sessions, 48 h apart. Assessments included anthropometric measurements, sprint tests, and isokinetic dynamometer strength evaluations at 60°.s<sup>−</sup>1 and 180°.s<sup>−</sup>1. Sprint kinematics were analyzed using the Optojump Next system, and force–velocity profile variables were determined via Samozino’s method. Asymmetry analysis used a standard percentage difference equation.</div></div><div><h3>Results</h3><div>Weak to moderate correlations (r = −0.46 to 0.45) were found between strength asymmetry and sprint parameters, suggesting limited impact of asymmetry on sprint kinematics and kinetics. Although most participants showed asymmetry levels below the 15% threshold deemed functionally significant, outliers had asymmetry values up to 42%, indicating considerable variability.</div></div><div><h3>Conclusions</h3><div>Lower extremity strength asymmetry moderately affects sprint kinematics and force–velocity profiles in young team athletes, challenging traditional views. Further research is needed to explore the mechanisms between strength asymmetry and sprint performance, aiming to inform targeted training interventions that optimize performance and reduce injury risks in youth athletes.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 99-107"},"PeriodicalIF":1.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645182","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 : 2024-11-15DOI: 10.1016/j.knee.2024.10.015
Xinjie Wang, Hui Ma
{"title":"Letter to the Editor regarding \"The value of sequential application of hydrogen peroxide, povidone-iodine and physiological saline in reducing postoperative infections after total knee arthroplasty: A prospective, randomized, controlled study\".","authors":"Xinjie Wang, Hui Ma","doi":"10.1016/j.knee.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.knee.2024.10.015","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645181","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 : 2024-11-13DOI: 10.1016/j.knee.2024.10.012
Kristine Ifigenia Bunyoz , Anders Troelsen , Kirill Gromov , Abtin Alvand , Nicholas Bottomley , Will Jackson , Andrew Price
Background
While evidence-based indications are established for medial UKA, the optimal indications for lateral UKA have not received as much attention. There exists significant anatomical, osteoarthritis phenotype, kinematic, and surgical technique differences between medial and lateral UKA. The indications for the two procedures may therefore not be identical. Hence, this review aims to access the indications and contraindications in published cohort studies on lateral UKA, to assess if consensus exists.
Methods
In May 2024, a systematic review was carried out following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies on lateral UKA with a clear report of indications were included. Data on indications and contraindications were extracted to evaluate consensus. Furthermore, outcomes related to expanding or testing indications for lateral UKA were obtained.
Results
38 studies were included. Lateral UKA was mostly performed for primary lateral osteoarthritis. The most reported indications were moderate to severe lateral osteoarthritis, with full-thickness cartilage in the medial compartment, intact ligaments, a correctable valgus deformity, and a flexion contracture < 10–15 degrees. The most reported contraindications were inflammatory arthritis and severe patellofemoral involvement. Eight studies investigated different indications on outcomes after lateral UKA; suggesting better outcomes for primary lateral osteoarthritis, no significant impact from the state of the patellofemoral joint, and conflicting results regarding age and weight.
Conclusion
While the literature suggests that some agreement does exist regarding indications for lateral UKA, a strong consensus was not found, indicating that well-defined and consensus-based indications for lateral UKA do not yet exist.
背景：虽然内侧UKA的适应症已得到循证医学的证实，但外侧UKA的最佳适应症却没有得到如此多的关注。内侧和外侧UKA在解剖学、骨关节炎表型、运动学和手术技巧方面存在明显差异。因此，两种手术的适应症可能不尽相同。因此，本综述旨在查阅已发表的有关外侧UKA的队列研究中的适应症和禁忌症，以评估是否存在共识：方法：2024 年 5 月，按照《系统综述和荟萃分析首选报告项目》（Preferred Reporting Item for Systematic Reviews and Meta-Analyses，PRISMA）指南开展了一项系统综述。方法：2024 年 5 月，按照《系统综述和元分析首选报告项目》（PRISMA）指南进行了系统综述，纳入了明确报告适应症的外侧 UKA 队列研究。提取适应症和禁忌症数据以评估共识。此外，还获得了与扩大或测试侧位UKA适应症相关的结果：结果：共纳入 38 项研究。外侧UKA多用于治疗原发性外侧骨关节炎。报道最多的适应症是中度至重度外侧骨关节炎，内侧间室软骨全厚，韧带完好，外翻畸形可矫正，屈曲挛缩 结论：外侧UKA的适应症与内侧间室软骨全厚、韧带完好、外翻畸形可矫正、屈曲挛缩等因素有关：虽然文献表明，在外侧UKA的适应症方面存在一些共识，但并未达成强烈的共识，这表明外侧UKA尚不存在定义明确且基于共识的适应症。
{"title":"Indications for lateral unicompartmental knee arthroplasty – A systematic review","authors":"Kristine Ifigenia Bunyoz , Anders Troelsen , Kirill Gromov , Abtin Alvand , Nicholas Bottomley , Will Jackson , Andrew Price","doi":"10.1016/j.knee.2024.10.012","DOIUrl":"10.1016/j.knee.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>While evidence-based indications are established for medial UKA, the optimal indications for lateral UKA have not received as much attention. There exists significant anatomical, osteoarthritis phenotype, kinematic, and surgical technique differences between medial and lateral UKA. The indications for the two procedures may therefore not be identical. Hence, this review aims to access the indications and contraindications in published cohort studies on lateral UKA, to assess if consensus exists.</div></div><div><h3>Methods</h3><div>In May 2024, a systematic review was carried out following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort studies on lateral UKA with a clear report of indications were included. Data on indications and contraindications were extracted to evaluate consensus. Furthermore, outcomes related to expanding or testing indications for lateral UKA were obtained.</div></div><div><h3>Results</h3><div>38 studies were included. Lateral UKA was mostly performed for primary lateral osteoarthritis. The most reported indications were moderate to severe lateral osteoarthritis, with full-thickness cartilage in the medial compartment, intact ligaments, a correctable valgus deformity, and a flexion contracture < 10–15 degrees. The most reported contraindications were inflammatory arthritis and severe patellofemoral involvement. Eight studies investigated different indications on outcomes after lateral UKA; suggesting better outcomes for primary lateral osteoarthritis, no significant impact from the state of the patellofemoral joint, and conflicting results regarding age and weight.</div></div><div><h3>Conclusion</h3><div>While the literature suggests that some agreement does exist regarding indications for lateral UKA, a strong consensus was not found, indicating that well-defined and consensus-based indications for lateral UKA do not yet exist.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 58-68"},"PeriodicalIF":1.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633531","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 : 2024-11-11DOI: 10.1016/j.knee.2024.10.009
Davide Golinelli , Federico Polidoro , Simona Rosa , Agnese Puzzo , Giovanni Guerra , Stefano Raimondi , Antonio Chiaravalloti , Valentina Sisti , Francesco Sanmarchi , Francesca Bravi , Roberto Grilli , Maria Pia Fantini , Alberto Belluati
Background
With the shift towards personalized medicine, understanding the impact of robotic-assisted total knee arthroplasty (TKA) on patient-reported outcome measures (PROMs) is essential for evaluating its effectiveness and patient satisfaction. The QUAROB (Quality-assessment-of-ROBotic-orthopedic-surgery) study aims at assessing the impact of robotic surgery on quality of care and joint functionality at 6 months post-surgery among patients undergoing robotic-assisted TKA.
Methods
This observational, prospective cohort study included patients from Ravenna Hospital, Italy, who underwent elective robotic TKA (2022–2023), and a historical cohort who underwent traditional TKA (2019). PROMs questionnaires (EuropeanQualityofLife-Visual AnalogScale, EQ-VAS, EuropeanQualityofLife-5Dimensions-3Likert, EQ-5D-3L, and KneeinjuryOsteoarthritisOutcomeScore-PatientSatisfaction, KOOS-PS) were administered within 30 days before surgery and 6 months post-surgery. Statistical analysis involved comparing baseline and follow-up PROMs, focusing on patients achieving at least a 10% improvement (Minimal Clinically Important Difference, MCID).
Results
The study enrolled 214 robotic surgery patients, with 208 completing baseline and 103 completing 6-month follow-up questionnaires. Patients undergoing robotic-assisted TKA demonstrated significant improvements in EQ-VAS, EQ-5D-3L, and KOOS-PS scores at 6 months. A significant proportion of patients achieved improvements exceeding the MCID threshold (68.9% for EQ-VAS, 58.3% for EQ-5D-3L, and 68.9% for KOOS-PS). Robotic TKA patients experienced shorter hospital stays (7 vs. 9 days, p < 0.001) and higher engagement in rehabilitation compared to traditional TKA patients.
Conclusions
The QUAROB study provides evidence of the impact and benefits of robotic-assisted TKA, highlighting significant enhancements in PROMs, reduced hospital stays, and increased rehabilitation engagement. These outcomes reinforce the role of robotic technology in improving surgical precision and patient satisfaction in orthopedic surgery.
{"title":"Evaluating the impact of robotic-assisted total knee arthroplasty on quality of care through patient-reported outcome measures in a third-level hospital in Italy: A prospective cohort study","authors":"Davide Golinelli , Federico Polidoro , Simona Rosa , Agnese Puzzo , Giovanni Guerra , Stefano Raimondi , Antonio Chiaravalloti , Valentina Sisti , Francesco Sanmarchi , Francesca Bravi , Roberto Grilli , Maria Pia Fantini , Alberto Belluati","doi":"10.1016/j.knee.2024.10.009","DOIUrl":"10.1016/j.knee.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>With the shift towards personalized medicine, understanding the impact of robotic-assisted total knee arthroplasty (TKA) on patient-reported outcome measures (PROMs) is essential for evaluating its effectiveness and patient satisfaction. The QUAROB (Quality-assessment-of-ROBotic-orthopedic-surgery) study aims at assessing the impact of robotic surgery on quality of care and joint functionality at 6 months post-surgery among patients undergoing robotic-assisted TKA.</div></div><div><h3>Methods</h3><div>This observational, prospective cohort study included patients from Ravenna Hospital, Italy, who underwent elective robotic TKA (2022–2023), and a historical cohort who underwent traditional TKA (2019). PROMs questionnaires (EuropeanQualityofLife-Visual AnalogScale, EQ-VAS, EuropeanQualityofLife-5Dimensions-3Likert, EQ-5D-3L, and KneeinjuryOsteoarthritisOutcomeScore-PatientSatisfaction, KOOS-PS) were administered within 30 days before surgery and 6 months post-surgery. Statistical analysis involved comparing baseline and follow-up PROMs, focusing on patients achieving at least a 10% improvement (Minimal Clinically Important Difference, MCID).</div></div><div><h3>Results</h3><div>The study enrolled 214 robotic surgery patients, with 208 completing baseline and 103 completing 6-month follow-up questionnaires. Patients undergoing robotic-assisted TKA demonstrated significant improvements in EQ-VAS, EQ-5D-3L, and KOOS-PS scores at 6 months. A significant proportion of patients achieved improvements exceeding the MCID threshold (68.9% for EQ-VAS, 58.3% for EQ-5D-3L, and 68.9% for KOOS-PS). Robotic TKA patients experienced shorter hospital stays (7 vs. 9 days, p < 0.001) and higher engagement in rehabilitation compared to traditional TKA patients.</div></div><div><h3>Conclusions</h3><div>The QUAROB study provides evidence of the impact and benefits of robotic-assisted TKA, highlighting significant enhancements in PROMs, reduced hospital stays, and increased rehabilitation engagement. These outcomes reinforce the role of robotic technology in improving surgical precision and patient satisfaction in orthopedic surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 32-42"},"PeriodicalIF":1.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633529","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 : 2024-11-11DOI: 10.1016/j.knee.2024.09.015
Yan Dong, Weichun Huang, Lihong Wei, Yingxun Du, Bingmin Lin
Background
Patellar fractures, in particular inferior pole fractures, pose significant challenges due to the patella’s complex biomechanics and crucial role in knee extension and stability. This study aimed to compare the therapeutic effectiveness and long-term efficacy of two fixation methods: combined vertical wire and mini steel plate fixation versus independent vertical wire fixation. The comparison was based on clinical classification, addressing the ongoing debate regarding optimal management strategies for patellar inferior pole fractures.
Methods
A retrospective cohort study was conducted, analyzing 226 patients with patellar inferior pole fractures. Patients were divided into two groups: the independent vertical wire fixation group (n = 117) and the combined vertical wire and mini steel plate fixation group (n = 109). Demographic data, clinical characteristics, surgical outcomes, functional outcomes, pain levels, return to daily activities, quality of life, and both short-term and long-term complications were assessed and compared between the two groups.
Results
The combined fixation group demonstrated significantly superior surgical outcomes, including shorter operation times and lower infection rates, despite higher blood loss. Furthermore, this group exhibited enhanced functional outcomes, reduced pain levels, and lower rates of osteoarthritis and salvage procedures compared with the independent fixation group.
Conclusions
The findings of this study suggest potential advantages of combined vertical wire and mini steel plate fixation over independent vertical wire fixation in the treatment of patellar inferior pole fractures. The combined fixation method was associated with improved surgical outcomes, enhanced functional recovery, better pain management, and reduced long-term complication rates.
{"title":"Comparison of the treatment of patellar inferior pole fractures with combined vertical wire and mini steel plate fixation versus independent vertical wire fixation","authors":"Yan Dong, Weichun Huang, Lihong Wei, Yingxun Du, Bingmin Lin","doi":"10.1016/j.knee.2024.09.015","DOIUrl":"10.1016/j.knee.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Patellar fractures, in particular inferior pole fractures, pose significant challenges due to the patella’s complex biomechanics and crucial role in knee extension and stability. This study aimed to compare the therapeutic effectiveness and long-term efficacy of two fixation methods: combined vertical wire and mini steel plate fixation versus independent vertical wire fixation. The comparison was based on clinical classification, addressing the ongoing debate regarding optimal management strategies for patellar inferior pole fractures.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted, analyzing 226 patients with patellar inferior pole fractures. Patients were divided into two groups: the independent vertical wire fixation group (n = 117) and the combined vertical wire and mini steel plate fixation group (n = 109). Demographic data, clinical characteristics, surgical outcomes, functional outcomes, pain levels, return to daily activities, quality of life, and both short-term and long-term complications were assessed and compared between the two groups.</div></div><div><h3>Results</h3><div>The combined fixation group demonstrated significantly superior surgical outcomes, including shorter operation times and lower infection rates, despite higher blood loss. Furthermore, this group exhibited enhanced functional outcomes, reduced pain levels, and lower rates of osteoarthritis and salvage procedures compared with the independent fixation group.</div></div><div><h3>Conclusions</h3><div>The findings of this study suggest potential advantages of combined vertical wire and mini steel plate fixation over independent vertical wire fixation in the treatment of patellar inferior pole fractures. The combined fixation method was associated with improved surgical outcomes, enhanced functional recovery, better pain management, and reduced long-term complication rates.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 43-57"},"PeriodicalIF":1.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633521","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 : 2024-11-07DOI: 10.1016/j.knee.2024.10.013
Liza Kneebone , Peter Edwards , Nic Blackah , Ross Radic , Peter D’Alessandro , Jay R. Ebert
Background
A robust comparison of the recovery pathway between sexes after anterior cruciate ligament reconstruction (ACLR) is lacking. This study investigated sex-based differences in physical and psychological recovery, and return to sport (RTS), after ACLR.
Methods
104 community-level patients underwent ACLR. Patients were evaluated at 6-, 12- and 24-months with the Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI), International Knee Documentation Committee (IKDC) form and Tegner Activity Scale (TAS), a 4-hop test battery including the 6-meter timed hop (6MTH) and the single (SHD), triple (THD) and triple crossover (TCHD) hop tests for distance, and peak isokinetic knee extensor and flexor torque. Sex-based differences were assessed, while regression analysis modelled the relationship between patient characteristics and outcomes, with 24-month psychological readiness to RTS.
Results
All PROMS improved (p < 0.05), with males reporting higher 24-month ACL-RSI (p = 0.002), IKDC (p = 0.007) and TAS (p = 0.005) scores. A greater percentage of males returned to pivoting sports at 24 months (p = 0.030, males 60.0%, females 40.8%). Males demonstrated higher knee extensor strength LSIs at 6 (p = 0.037) and 24 (p = 0.047) months, and higher knee flexor strength LSIs at 6 (p = 0.007) and 12 (p = 0.002) months. IKDC knee scores (β = 24.9; 95% CI, 10.8 to 35.0), male sex (β = 12.2; 95% CI, 3.9 to 20.4) and the 6MTH LSI (β = 1.31; 95% CI, 0.6 to 2.1) were associated with the ACL-RSI.
Conclusions
In community-level ACLR patients, females demonstrated lower physical performance recovery, subjective function and psychological readiness, as well as a lower rate of RTS.
{"title":"Sex-based differences in physical and psychological recovery, and return to sport, following anterior cruciate ligament reconstruction","authors":"Liza Kneebone , Peter Edwards , Nic Blackah , Ross Radic , Peter D’Alessandro , Jay R. Ebert","doi":"10.1016/j.knee.2024.10.013","DOIUrl":"10.1016/j.knee.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>A robust comparison of the recovery pathway between sexes after anterior cruciate ligament reconstruction (ACLR) is lacking. This study investigated sex-based differences in physical and psychological recovery, and return to sport (RTS), after ACLR.</div></div><div><h3>Methods</h3><div>104 community-level patients underwent ACLR. Patients were evaluated at 6-, 12- and 24-months with the Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI), International Knee Documentation Committee (IKDC) form and Tegner Activity Scale (TAS), a 4-hop test battery including the 6-meter timed hop (6MTH) and the single (SHD), triple (THD) and triple crossover (TCHD) hop tests for distance, and peak isokinetic knee extensor and flexor torque. Sex-based differences were assessed, while regression analysis modelled the relationship between patient characteristics and outcomes, with 24-month psychological readiness to RTS.</div></div><div><h3>Results</h3><div>All PROMS improved (p < 0.05), with males reporting higher 24-month ACL-RSI (p = 0.002), IKDC (p = 0.007) and TAS (p = 0.005) scores. A greater percentage of males returned to pivoting sports at 24 months (p = 0.030, males 60.0%, females 40.8%). Males demonstrated higher knee extensor strength LSIs at 6 (p = 0.037) and 24 (p = 0.047) months, and higher knee flexor strength LSIs at 6 (p = 0.007) and 12 (p = 0.002) months. IKDC knee scores (β = 24.9; 95% CI, 10.8 to 35.0), male sex (β = 12.2; 95% CI, 3.9 to 20.4) and the 6MTH LSI (β = 1.31; 95% CI, 0.6 to 2.1) were associated with the ACL-RSI.</div></div><div><h3>Conclusions</h3><div>In community-level ACLR patients, females demonstrated lower physical performance recovery, subjective function and psychological readiness, as well as a lower rate of RTS.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"52 ","pages":"Pages 22-31"},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604323","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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