IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-07 DOI: 10.1016/j.knee.2024.10.014

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

Background

Total knee arthroplasty (TKA) infection or exposure associated with soft tissue deficiency represents a challenging scenario for the reconstructive surgeon. The aim of the study is to determine the most successful reconstructive option for infected or exposed TKA comparing local muscle flaps (LMF), local fasciocutaneous flaps (LFF), and free muscle flaps (FMF).

Methods

A systematic review and single-arm network meta-analysis (PRISMA) was conducted to compare outcomes of complicated TKA requiring soft tissue coverage with either LMF, LFF and FMF. The protocol was registered on PROSPERO (CRD42023388731). PubMed, Embase, Web of Science and Cochrane Library were queried. MINORS criteria were employed for bias assessment. Outcomes included infection recurrence, TKA failure, above-knee amputation, and arthrodesis.

Results

A total of 30 studies and 555 flaps were included. Pooled prevalence was 0.18 (95% CI: 0.11–0.26) for infection recurrence, 0.18 (95% CI: 0.11–0.28) for arthroplasty failure, 0.10 (95% CI: 0.08–0.13) for above-knee amputation and 0.10 (95% CI: 0.08–0.13) for arthrodesis. Local fasciocutaneous flaps demonstrated the lowest risk of infection recurrence (LFF = 0.04 ± 0.037, LMF = 0.27 ± 0.043, FMF = 0.26 ± 0.092), arthroplasty failure (LFF = 0.11 ± 0.068, LMF = 0.28 ± 0.045, FMF = 0.22 ± 0.094) and knee arthrodesis (LFF = 0.03 ± 0.027, LMF = 0.14 ± 0.03, FMF = 0.08 ± 0.06) after flap coverage of infected TKA. Free muscle flaps were associated with the lowest risk of above knee amputation (FMF = 0.08 ± 0.07, LFF = 0.10 ± 0.07, LMF = 0.11 ± 0.03). The mean MINORS score was 11.1 (95% CI: 11–12) with major weakness being the lack of prospective enrollment of the patients.

Conclusion

Based on the available literature, when appropriate, LFF appear to be the best reconstructive choice for soft tissue reconstruction in complicated TKA.

背景：与软组织缺损相关的全膝关节置换术（TKA）感染或外露对重建外科医生来说是一种挑战。本研究的目的是通过比较局部肌肉瓣（LMF）、局部筋膜皮瓣（LFF）和游离肌肉瓣（FMF），确定治疗感染或暴露的 TKA 最成功的重建方案：进行了一项系统性回顾和单臂网络荟萃分析（PRISMA），以比较需要用局部肌皮瓣、局部筋膜皮瓣和游离肌皮瓣覆盖软组织的复杂 TKA 的疗效。该研究方案已在 PROSPERO 上注册（CRD42023388731）。查询了 PubMed、Embase、Web of Science 和 Cochrane Library。采用 MINORS 标准进行偏倚评估。结果包括感染复发、TKA失败、膝上截肢和关节置换：共纳入 30 项研究和 555 个皮瓣。感染复发的汇总发生率为0.18（95% CI：0.11-0.26），关节成形术失败的发生率为0.18（95% CI：0.11-0.28），膝上截肢的发生率为0.10（95% CI：0.08-0.13），关节固定的发生率为0.10（95% CI：0.08-0.13）。局部筋膜瓣显示感染复发（LFF = 0.04 ± 0.037，LMF = 0.27 ± 0.043，FMF = 0.26 ± 0.092）、关节成形术失败（LFF = 0.11±0.068，LMF=0.28±0.045，FMF=0.22±0.094）和皮瓣覆盖感染性TKA后的膝关节固定术（LFF=0.03±0.027，LMF=0.14±0.03，FMF=0.08±0.06）。游离肌皮瓣与膝上截肢的最低风险相关（FMF = 0.08 ± 0.07，LFF = 0.10 ± 0.07，LMF = 0.11 ± 0.03）。MINORS评分的平均值为11.1（95% CI：11-12），主要缺点是缺乏前瞻性的患者招募：根据现有文献，在适当的情况下，LFF 似乎是复杂 TKA 软组织重建的最佳选择。

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引用次数: 0

Hip and knee joints mechanics and asymmetries in individuals with a history of anterior cruciate ligament reconstruction during overground running 有前交叉韧带重建史的人在地面跑步时的髋关节和膝关节力学和不对称情况

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-11-06 DOI: 10.1016/j.knee.2024.10.010

Mostafa Shahbazi , Hamed Esmaeili , Fatemeh Salari-Esker , Behzad Bashiri , Davood Khezri

Background

Individuals with a history of anterior cruciate ligament reconstruction (ACLR) represent altered knee joint mechanics in running. Hip joint can make subtle compensations in response to ACLR. Effects of ACLR on hip joint compensatory mechanisms is not well known. The aim of this study was to evaluate the hip join mechanics and asymmetry in individuals with ACLR history. We hypothesized that ACLR individuals’ hip exhibit altered mechanics which can increase the risk of hip overuse or osteoarthritis.

Methods

Kinetic and kinematic data of 20 males with ACLR history and 20 healthy males were collected bilaterally while running at 3.3 m·s⁻¹. Hip and knee joints peak angles, peak moments, peak negative and positive power and negative and positive work in the sagittal plane were calculated. Also, asymmetry of the outcomes was calculated. A mixed design MANOVA was used to detect between-group and within-group (side-by-group interaction) effects of ACLR on outcomes.

Results

Involved knee showed smaller flexion angle and negative work compared to uninvolved and control knee. In the hip joint, involved leg showed a higher flexion angle, extension moment, and peak positive and negative power as well as negative and positive work compared to uninvolved and control leg. ACLR group showed greater asymmetries in knee flexion angle, knee flexion moment, hip flexion angle, hip extension angle and hip negative power compared to healthy group.

Conclusion

Hip and knee joints mechanics of involved and uninvolved sides of the ACLR individuals are different. These results show that ACLR affects hip joint as well as knee joint. When returning to activity and sport, mechanics of the hip joint as well as knee joint, must be considered in ACLR individuals.

背景曾接受过前交叉韧带重建术（ACLR）的人在跑步时膝关节力学会发生改变。髋关节可对前交叉韧带重建作出微妙的代偿反应。前交叉韧带重建对髋关节代偿机制的影响尚不清楚。本研究的目的是评估前交叉韧带损伤患者的髋关节力学和不对称情况。我们假设，前交叉韧带损伤患者的髋关节会表现出力学改变，这可能会增加髋关节过度使用或骨关节炎的风险。方法收集了 20 名有前交叉韧带损伤史的男性和 20 名健康男性在 3.3 m-s-1 奔跑时的双侧动力学和运动学数据。计算了髋关节和膝关节的峰值角度、峰值力矩、峰值负功和正功以及矢状面上的负功和正功。此外，还计算了结果的不对称性。结果与未受累膝关节和对照膝关节相比，受累膝关节的屈曲角度和负功较小。在髋关节，与未受累腿和对照腿相比，受累腿显示出更大的屈曲角、伸展力矩、正负功率峰值以及负功和正功。与健康组相比，前交叉韧带损伤组在膝关节屈曲角、膝关节屈曲力矩、髋关节屈曲角、髋关节伸展角和髋关节负功率方面表现出更大的不对称性。这些结果表明，前交叉韧带损伤对髋关节和膝关节都有影响。前交叉韧带损伤患者在恢复活动和运动时，必须考虑髋关节和膝关节的力学问题。

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引用次数: 0

Intrawound vancomycin powder in primary total knee arthroplasty: Does it reduce early postoperative infection? 原发性全膝关节置换术中的伤口内万古霉素粉：它能减少术后早期感染吗？

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-30 DOI: 10.1016/j.knee.2024.10.008

Stephen A. Doxey , Torben H. Urdahl , Rafat H. Solaiman , Mariah N. Wegner , Harsh Parikh , Brian P. Cunningham , Patrick K. Horst

Background

The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA).

Methods

From October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively.

Results

A total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15).

Conclusions

The overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.

背景：这项前瞻性质量控制项目的回顾性分析旨在确定使用万古霉素粉（IVP）是否会降低初次全膝关节置换术（TKA）后 90 天内的假体关节感染（PJI）率：方法：2021年10月至2022年9月期间，开展了一项前瞻性质量控制项目，10名工作量大的关节置换外科医生每月交替使用或不使用IVP。接受 IVP 治疗的患者与未接受 IVP 治疗的患者进行比较。主要结果是初级全膝关节置换术后 90 天内 PJI 培养阳性。次要结果包括总体再手术率、伤口并发症和术后90天内的再入院率：共有 1,317 名初级全膝关节置换术患者接受了分析。56.7%的患者（n = 747）被纳入IVP组，43.3%的患者（n = 570）被纳入非IVP组。总的 PJI 发生率为 0.5%。两组患者的 90 天培养阳性 PJI 率没有差异（0.7% 对 0.2%，P = 0.24）。IVP 组和非 IVP 组的总再手术率没有差异（6.4% 对 4.6%，P = 0.15）。因疑似感染而再次手术的比例在统计学上没有因使用 IVP 而不同（1.2% 对 0.5%，P = 0.25）。此外，伤口并发症（p = 0.80）或再住院（p = 0.15）的发生率也没有差异：结论：该队列的总体感染率较低。IVP与培养阳性PJI、伤口并发症、再次手术或再次入院率的降低无关。应进一步分析 IVP 在 TKA 中的应用，以全面确定其疗效和安全性。

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引用次数: 0

Letter to the editor: Aseptic loosening of the option stemmed tibial tray in the Zimmer NexGen LPS total knee arthroplasty system. Knee. 2024 Mar;47:1-12. 致编辑的信：Zimmer NexGen LPS 全膝关节置换系统中的可选柄胫骨托无菌性松动。膝关节。2024年3月；47:1-12。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-26 DOI: 10.1016/j.knee.2024.10.004

引用次数: 0

Response to : Letter to the editor on "Aseptic loosening of the option stemmed tibial tray in the Zimmer NexGen LPS total knee arthroplasty system". 回应：致编辑的信，主题为 "Zimmer NexGen LPS 全膝关节置换系统中的可选柄胫骨托无菌性松动"。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-26 DOI: 10.1016/j.knee.2024.10.005

引用次数: 0

Long term outcomes following tibial plateau fracture fixation and risk factors for progression to total knee arthroplasty 胫骨平台骨折固定术后的长期疗效及发展为全膝关节置换术的风险因素。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.003

Matthew Howell , Alisa Khalid , Callum Nelson , James Doonan , Bryn Jones , Mark Blyth

Introduction

Tibial plateau fractures are complex, peri-articular fractures that can have poor outcomes resulting in conversion to total knee arthroplasty (TKA). This study evaluates the 10-year survival of tibial plateau fractures treated with open reduction and internal fixation and identifies risk factors associated with conversion to TKA.

Methods

This retrospective cohort study evaluates the outcomes of 126 patients undergoing tibial plateau ORIF from January 2011 to December 2012 at Glasgow Royal Infirmary. As well as patient factors, radiographic assessments were analysed including the degree of articular depression, medial proximal tibial angle, and femoral width ratio pre-operatively, peri-operatively and at the time of union. Patients requiring further surgical intervention, including TKA, were evaluated further.

Results

A bell-shaped distribution of patient age was observed. Schatzker II fractures were most prevalent (48%). Pre-operative articular depression averaged 6.9 mm ranging from 0.0 – 36.0 mm. Operative reduction was generally satisfactory (mean articular depression 1.3 mm, femoral width 0.96, mPTA 89.6⁰), with 82% achieving an anatomical reduction. 12 patients (9.3%) required TKA during follow-up with Kaplan-Meier calculated as 91.9% at 5 years and 87.4% at 10 years. Articular depression > 4 mm (HR = 16.2), femoral width ratio > 1.05 (HR = 14.7) and age > 50 years (HR = 4.2) at time for fracture union were independently associated with progression to TKA.

Conclusion

9.3% of patients required TKA within 10 years of tibial plateau ORIF, Kaplan Meier 10-year survivorship was 87.4%. Joint depression and increased tibial width at time of union and age were independent risk factors associated with need for TKA. Particular care must be taken during operative intervention to ensure adequate reduction to lower this risk.

导言：胫骨平台骨折是一种复杂的关节周围骨折，治疗效果不佳，可能导致患者转为全膝关节置换术（TKA）。本研究评估了采用切开复位内固定术治疗的胫骨平台骨折的 10 年存活率，并确定了转为全膝关节置换术的相关风险因素：这项回顾性队列研究评估了2011年1月至2012年12月在格拉斯哥皇家医院接受胫骨平台开放复位内固定术的126名患者的治疗效果。除患者因素外，研究还分析了放射学评估，包括术前、围手术期和骨结合时的关节凹陷程度、胫骨内侧近端角度和股骨宽度比。对需要进一步手术治疗（包括全膝关节置换术）的患者进行了进一步评估：患者年龄呈钟形分布。Schatzker II型骨折最为常见（48%）。术前关节凹陷平均为 6.9 毫米，范围在 0.0 - 36.0 毫米之间。手术复位效果普遍令人满意（平均关节凹陷1.3毫米，股骨宽度0.96，mPTA 89.6⁰），82%的患者实现了解剖复位。12名患者（9.3%）在随访期间需要进行全膝关节置换术，根据Kaplan-Meier计算，5年时91.9%的患者需要进行全膝关节置换术，10年时87.4%的患者需要进行全膝关节置换术。关节凹陷>4毫米（HR=16.2）、股骨宽度比>1.05（HR=14.7）和骨折结合时年龄>50岁（HR=4.2）与进展为TKA有独立关联。结论：9.3%的患者在胫骨平台ORIF术后10年内需要TKA，Kaplan-Meier 10年生存率为87.4%。关节凹陷、关节结合时胫骨宽度增加以及年龄是需要进行 TKA 的独立风险因素。在进行手术干预时必须特别小心，以确保充分缩小以降低这种风险。

{"title":"Long term outcomes following tibial plateau fracture fixation and risk factors for progression to total knee arthroplasty","authors":"Matthew Howell , Alisa Khalid , Callum Nelson , James Doonan , Bryn Jones , Mark Blyth","doi":"10.1016/j.knee.2024.10.003","DOIUrl":"10.1016/j.knee.2024.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Tibial plateau fractures are complex, <em>peri</em>-articular fractures that can have poor outcomes resulting in conversion to total knee arthroplasty (TKA). This study evaluates the 10-year survival of tibial plateau fractures treated with open reduction and internal fixation and identifies risk factors associated with conversion to TKA.</div></div><div><h3>Methods</h3><div>This retrospective cohort study evaluates the outcomes of 126 patients undergoing tibial plateau ORIF from January 2011 to December 2012 at Glasgow Royal Infirmary. As well as patient factors, radiographic assessments were analysed including the degree of articular depression, medial proximal tibial angle, and femoral width ratio pre-operatively, <em>peri</em>-operatively and at the time of union. Patients requiring further surgical intervention, including TKA, were evaluated further.</div></div><div><h3>Results</h3><div>A bell-shaped distribution of patient age was observed. Schatzker II fractures were most prevalent (48%). Pre-operative articular depression averaged 6.9 mm ranging from 0.0 – 36.0 mm. Operative reduction was generally satisfactory (mean articular depression 1.3 mm, femoral width 0.96, mPTA 89.6⁰), with 82% achieving an anatomical reduction. 12 patients (9.3%) required TKA during follow-up with Kaplan-Meier calculated as 91.9% at 5 years and 87.4% at 10 years. Articular depression > 4 mm (HR = 16.2), femoral width ratio > 1.05 (HR = 14.7) and age > 50 years (HR = 4.2) at time for fracture union were independently associated with progression to TKA.</div></div><div><h3>Conclusion</h3><div>9.3% of patients required TKA within 10 years of tibial plateau ORIF, Kaplan Meier 10-year survivorship was 87.4%. Joint depression and increased tibial width at time of union and age were independent risk factors associated with need for TKA. Particular care must be taken during operative intervention to ensure adequate reduction to lower this risk.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 303-311"},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513604","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

Influence of varus-producing distal femur osteotomy correction and hinge width in relation to hinge fractures: Biomechanical study on porcine femora 股骨远端变曲截骨矫正和铰链宽度对铰链骨折的影响：猪股骨生物力学研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.002

Michel Meisterhans , Anna-Katharina Calek , Christoph Zindel , Esteban Ongini , Mario Somm , Lazaros Vlachopoulos , Sandro F. Fucentese

Background

Hinge fractures in varus-producing distal femoral osteotomies (DFOs) lead to decreased axial and torsional stability. The purpose of this study was to assess (1) which hinge width has a high risk of hinge fracture in DFO for lateral opening wedge (LOW) and medial closing wedge (MCW) osteotomies, (2) which osteotomies allow for greater correction before risking a fracture, (3) whether patient-specific instrumentation (PSI) allows accurate hinge width planning.

Methods

Thirty porcine femoral bones were divided into two groups: LOW, MCW with hinge widths of 5 mm, 7.5 mm, and 10 mm as subgroups. Osteotomies were performed in a PSI-navigated fashion. A force parallel to the longitudinal bone axis was applied in a uniaxial testing machine until a fracture occurred.

Results

The maximum correction was 6.7 ± 1.1° for LOW and 13.4 ± 1.9° for MCW (β₀ < 0.001_, β₁ = 0.002, β₂ = 0.02_, β₃ = 0.005). The relative error of the planned hinge width compared with the actual hinge width was −3.7 ± 12.3% for LOW (P = 0.25) and 12.3 ± 13.1% for MCW (P = 0.003).

Conclusions

Increasing the hinge width allows for greater correction in MCW osteotomies. For LOW osteotomies, a smaller hinge width seems to be advantageous because it allows a greater correction without the risk of hinge fracture. With PSI-guided LOW osteotomies, the planned hinge width could be achieved intraoperatively with greater accuracy than with MCW osteotomies. However, the MCW osteotomy appears to be the preferred option when larger corrections are desired because a larger correction angle can be achieved without the risk of intraoperative hinge fracture.

背景：股骨远端截骨术（DFO）中产生的变位铰链骨折会导致轴向和扭转稳定性下降。本研究旨在评估：（1）在股骨远端截骨术（DFO）中，外侧开放楔形截骨术（LOW）和内侧闭合楔形截骨术（MCW）哪种铰链宽度发生铰链骨折的风险较高；（2）哪种截骨术可在发生骨折风险前进行较大程度的矫正；（3）患者特异性器械（PSI）是否可准确规划铰链宽度：将 30 块猪股骨分为两组：方法：将 30 块猪股骨分为两组：LOW 组、MCW 组（铰链宽度分别为 5 毫米、7.5 毫米和 10 毫米）。以 PSI 导航方式进行截骨。在单轴试验机中施加平行于纵向骨轴的力，直至发生骨折：LOW和MCW的最大矫正角度分别为6.7 ± 1.1°和13.4 ± 1.9°（β0 , β1 = 0.002, β2 = 0.02, β3 = 0.005）。计划铰链宽度与实际铰链宽度的相对误差，LOW 为 -3.7 ± 12.3% (P = 0.25)，MCW 为 12.3 ± 13.1% (P = 0.003)：结论：在MCW截骨术中，增加铰链宽度可获得更大的矫正效果。对于 LOW 截骨术，较小的铰链宽度似乎更有优势，因为它可以在不产生铰链断裂风险的情况下实现更大的矫正。与MCW截骨术相比，PSI引导下的LOW截骨术可以在术中更准确地达到计划的铰链宽度。然而，当需要较大的矫正时，MCW截骨术似乎是首选，因为它可以实现较大的矫正角度，而不会有术中铰链骨折的风险。

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引用次数: 0

Surgical treatment of progressive melorheostosis worsening over 19 years: A case report 对 19 年来不断恶化的进行性黑变病进行手术治疗：病例报告

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.001

Ziyang Dong , Yang Li , Feng Li , Hua Tian

Background

Melorheostosis is a relatively rare disease, which may cause chronic pain, soft tissue mass and restricted range of motion. Diagnosis and treatment of melorheostosis remains challenging.

Case report

We describe a patient with sclerotic bone involving the left acetabulum, femur, tibia, and talus. Over 19 years this patient showed slow progression of disease. The bone mass in the right popliteal region resulted in limitation of knee motion. Comprehensive management including physical therapy, medications and surgeries were adopted to obtain a full range of motion and no recurrence for 2 years.

Discussion

Accurate diagnosis and adequate treatments are critical to melorheostosis patients. Resection of redundant calcified mass is an effective method to treat severe limitation of range of motion associated with knee melorheostosis.

背景介绍骨化性骨质疏松症是一种相对罕见的疾病，可导致慢性疼痛、软组织肿块和活动范围受限。黑骨症的诊断和治疗仍具有挑战性：病例报告：我们描述了一名左侧髋臼、股骨、胫骨和距骨骨质硬化的患者。19 年来，该患者的病情发展缓慢。右侧腘窝部位的骨块导致膝关节活动受限。经过物理治疗、药物治疗和手术治疗等综合治疗后，患者的膝关节活动范围得以恢复，且两年来未再复发：讨论：准确的诊断和适当的治疗对骨质疏松症患者至关重要。讨论：准确诊断和适当治疗对膝关节骨质疏松症患者至关重要，切除多余的钙化块是治疗膝关节骨质疏松症活动范围严重受限的有效方法。

引用次数: 0

Validity of wearable sensors for total knee arthroplasty (TKA) rehabilitation: A study in younger and older healthy participants 用于全膝关节置换术（TKA）康复的可穿戴传感器的有效性：一项针对年轻和年长健康参与者的研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-24 DOI: 10.1016/j.knee.2024.10.006

L. Forsyth , A. Ligeti , M. Blyth , J.V. Clarke , P.E. Riches

Background

With 100,000 total knee arthroplasty (TKA) procedures taking place in the United Kingdom annually, the demand on rehabilitation services is high. Most regimes are home-based. Without clinician-patient interaction, detection of rehabilitation concerns can be delayed, reducing the chance of successful early intervention. Wearable technologies, such as MotionSense^TM (Stryker, US), may offer a solution to this problem by remotely supporting post-operative TKA rehabilitation through the provision of personalised rehabilitation and tracking of home exercises, enabling healthcare professionals to continuously monitor rehabilitation progress remotely. Validation of such devices against a known kinematic model in activities of daily living is important for confident interpretation of resulting clinical data. The aim of this study therefore was to validate the accuracy of MotionSense^TM against a clinical motion capture standard.

Methods

Twenty younger and 14 older healthy, able-bodied adults attended one testing session (Younger: 24 ± 4 years old; Older: 71 ± 5 years old). Movement was tracked using Vicon motion analysis and a Plug-In-Gait lower body model was applied to all participants. Three activities were performed – walking, stair ascent, stair descent. The knee flexion angle root mean square error (RMSE) between the technologies was determined.

Results

For both groups the knee flexion RMSE remained below 3° for all activities. The combined RMSE for all adults was 2.4° for walking, 2.7° for stair ascent, and 2.6° for stair descent. The signed error increased during the swing phase of gait.

Conclusion

MotionSense^TM was found to accurately estimate knee flexion angles during several common activities compared to Vicon motion capture.

背景：英国每年有 10 万例全膝关节置换术 (TKA) 手术，因此对康复服务的需求很高。大多数康复治疗都是在家中进行的。如果没有临床医生与患者之间的互动，康复问题就可能被延迟发现，从而降低早期干预的成功机会。MotionSenseTM（史赛克，美国）等可穿戴技术可为这一问题提供解决方案，通过提供个性化康复服务和跟踪家庭锻炼，远程支持TKA术后康复，使医护人员能够持续远程监控康复进展。根据日常生活活动中的已知运动学模型对此类设备进行验证，对于自信地解释由此产生的临床数据非常重要。因此，本研究旨在根据临床运动捕捉标准验证 MotionSenseTM 的准确性：方法：20 名年轻人和 14 名老年人参加了一次测试（年轻人：24 ± 4 岁；老年人：71 ± 5 岁）。使用 Vicon 运动分析对运动进行跟踪，并对所有参与者应用 Plug-In-Gait 下半身模型。进行了三种活动--行走、上楼梯和下楼梯。结果显示，两组参与者的膝关节屈曲角度均方根误差（RMSE）均为0：结果：两组人在所有活动中的膝关节屈曲均方根误差都低于 3°。所有成年人的综合均方根误差分别为：步行 2.4°、上楼梯 2.7°、下楼梯 2.6°。步态摆动阶段的签名误差有所增加：结论：与 Vicon 运动捕捉相比，MotionSenseTM 能够准确估计几种常见活动中的膝关节屈曲角度。

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引用次数: 0

Establishment of anterior cruciate ligament injury thresholds for injured pediatric population with GNRB®, a prospective study on 141 children 通过对 141 名儿童进行前瞻性研究，为使用 GNRB® 的受伤儿童群体确定前十字韧带损伤阈值。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-19 DOI: 10.1016/j.knee.2024.09.011

Théo Cojean , Catherine Mulier , Laurence Cheze , Franck Chotel

Background

Treating an anterior cruciate ligament (ACL) injury in pediatric patients is challenging. The GNRB® is a diagnostic tool for laximetry and can provide valuable information for clinical decision. As few data exist on this subject, the first objective is to provide physiological laxity values of anterior tibial translation in healthy and pathological knees in pediatric population by age and gender groups. A second objective is to establish injury thresholds with the GNRB®.

Methods

This prospective study included 141 pediatric patients with a complete ACL tear. They all underwent GNRB® measurements before the surgery. Age and gender groups were created: child/adolescent girls and child/adolescent boys. Thresholds were established using ROC curves and 2-factors ANOVA tests were used for comparisons.

Results

A significant age effect was found for laxities measured on healthy knees. Significant age and gender effects were found for laxities measured on pathological knees and for side-to-side differences of laxity (SSD) between healthy and pathological knees. The optimal threshold to detect a complete ACL rupture with GNRB® is 1.5 mm at 134N with a sensitivity of 83.7% and a specificity of 92.7%.

Conclusion

GNRB® brought new information about ACL laxities for healthy and pathological knees in pediatric population. Children have a greater anterior tibial translation which decreases gradually with age, and girls have grater laxities than boys. Thresholds for complete ACL tears, presenting good predictive values, were established and can help surgeons in their decisions to improve clinical practice.

Level of evidence: Prospective cohort study, level of evidence III.

背景：治疗儿童患者的前十字韧带损伤具有挑战性。GNRB® 是一种松弛测量诊断工具，可为临床决策提供有价值的信息。由于这方面的数据很少，我们的第一个目标是按年龄组和性别组提供健康和病理膝关节的胫骨前平移生理松弛值。第二个目标是使用 GNRB® 确定损伤阈值：这项前瞻性研究包括 141 名前交叉韧带完全撕裂的儿科患者。他们都在手术前接受了 GNRB® 测量。年龄和性别分组为：儿童/青少年女孩组和儿童/青少年男孩组。使用 ROC 曲线确定阈值，并使用 2 因子方差分析进行比较：结果：在健康膝关节上测量的松弛程度存在明显的年龄效应。在病理膝关节上测量的松弛度以及健康膝关节和病理膝关节之间的侧向松弛度差异（SSD）均有明显的年龄和性别效应。使用 GNRB® 检测前交叉韧带完全断裂的最佳阈值是 134N 处的 1.5 毫米，灵敏度为 83.7%，特异度为 92.7%：结论：GNRB®为健康和病理膝关节的前交叉韧带松弛带来了新的信息。儿童的胫骨前移较大，随着年龄的增长而逐渐减小，女孩的松弛程度大于男孩。前交叉韧带完全撕裂的阈值已经确定，具有良好的预测价值，可以帮助外科医生做出决定，改善临床实践：前瞻性队列研究，证据等级 III。

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