IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.021

Yoshinori Okamoto, Tomohiro Okayoshi, Hitoshi Wakama, Takafumi Saika, Shuhei Otsuki

Background

Achieving precise alignment and soft tissue balance is crucial for optimal total knee arthroplasty (TKA) outcomes. We aimed to explore how tibiofemoral compression force (TFCF) varies with knee flexion and its correlation with functional outcomes.

Methods

This prospective study included 60 patients undergoing cruciate-retaining TKA (FINE Total Knee System). Sensor-equipped trial inserts were used to measure the TFCF at 15° intervals, from full extension to 90° flexion. Patients were classified into anterior and posterior force groups based on whether the medial TFCF was higher in the anterior than in the posterior region at 60° flexion. The 2-year outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR).

Results

The total TFCF increased from 0° to 60° flexion and then decreased. The medial compressive forces were consistently higher than lateral forces. Anteromedial TFCF differed significantly between the anterior and posterior force groups at 60°, 75°, and 90° flexion. KOOS-JR scores showed a significant interaction between force type and time, with greater improvements in the anterior force group. Anteromedial TFCF at 60° flexion and KOOS-JR correlated significantly (R = 0.574).

Conclusion

Evaluating TFCF at multiple knee flexion angles provides valuable insights into optimising outcomes in TKA. TFCF variations, especially in the anteromedial compartment, considerably impact functional outcomes. Dynamic TFCF measurements during TKA may enhance soft tissue balance and improve outcomes. Further research is needed to validate these findings in diverse populations and with long-term follow ups.

背景：实现精确对齐和软组织平衡是最佳全膝关节置换术（TKA）结果的关键。我们的目的是探讨膝关节屈曲时胫股压迫力（TFCF）的变化及其与功能预后的关系。方法：本前瞻性研究纳入了60例接受全膝关节系统（FINE Total Knee System）的患者。使用配备传感器的试验插入物以15°间隔测量TFCF，从完全伸展到90°屈曲。根据60°屈曲时内侧TFCF是否在前区高于后区，将患者分为前后力组。使用膝关节损伤和骨关节炎结局评分关节置换术（KOOS-JR）评估2年结果。结果：总TFCF从0°屈曲到60°屈曲先升高后降低。内侧压缩力始终高于侧向力。前内侧TFCF在60°、75°和90°屈曲时前后力组之间差异显著。KOOS-JR评分在用力类型和时间之间表现出显著的交互作用，前用力组改善更大。60°屈曲时前内侧TFCF与KOOS-JR显著相关（R = 0.574）。结论：评估多个膝关节屈曲角度下的TFCF为优化TKA的预后提供了有价值的见解。TFCF的变化，特别是在前内侧室，显著影响功能结局。TKA期间动态TFCF测量可增强软组织平衡，改善预后。需要进一步的研究在不同人群中验证这些发现并进行长期随访。

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引用次数: 0

Lesser posterior tibial slope angle ≤70 (PTS-Angle) has negative effect on outcome of isolated PCL reconstruction: Comparative analysis of PTS ≤70 vs > 70 degrees 小胫骨后坡角≤70 （PTS角）对离体PCL重建的预后有负面影响：PTS≤70与> 70度的比较分析。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.017

Silvampatti Ramasamy Sundararajan , Owais Ahmed , Rajagopalakrishnan Ramakanth , Terence Dsouza , Mahshook Irfan , Arumugam Palanisamy , Shanmuganathan Rajasekaran

Purpose

To determine incidence of posterior-tibial-slope (PTS) distribution in patients with isolated posterior-cruciate-ligament (PCL) tear, as-well-as the effect of PTS on radiological, clinical, and functional outcomes after PCL-reconstruction (PCL-R).

Methods

63 patients with symptomatic isolated PCL-tears who underwent PCL-R were divided into two groups based on a PTS-angle with a cut-off value of 7⁰-degrees: group-A (less than ≤7⁰-degree) and group-B (more than >7⁰-degree). All the patients were subjected to the same technique. The effect of PTS-angle on the radiological-outcome, (posterior-tibial-translation (PTT)) at 6-month and 1-year intervals was compared. Clinical-outcomes (knee range-of-motion (ROM), quadriceps-wasting (QW)), and functional outcomes (IKDC and Tegner-Lysholm scores) at 6-month, 1-year, and final follow-up was compared between the groups.

Results

PTS of less than ≤7⁰-degrees was seen in 66.7%. The mean-PTS-angle was 6.47 ± 2.40degrees. Radiologically, there was no statistical-difference in PTT at 6-months. However, at 1-year, PTT was less in group-A (3.98 ± 2.21 mm) than in group-B (3.03 ± 1.42 mm) (P = 0.04). Two patients in group-A had grade-III PTT at 6-months, and one of them had grade-III PTT at 1-year. At the mean-follow-up, group-A had lower IKDC and Tegner-Lysholm (81.55 ± 11.4, 90.19 ± 5.53) than group-B (86.56 ± 7.2, 94.6 ± 4.42), indicating a statistically significant difference (IKDC:P = 0.038, Tegner-Lysholm:P = 0.001). At 1-year and mean-follow-up, group-A had a significantly lower ROM(p = 0.047). There was no significant difference for QW at 6-months and 1-year.

Conclusion

Lesser preoperative PTS angle (≤7⁰) has a negative effect on the outcome of isolated PCL-R and leads to secondary posterior knee laxity than in patients with higher PTS angle (>7⁰). Incidence of lesser posterior tibial slope (≤7⁰) in isolated PCL injuries is 66.7%.

目的：了解孤立性后十字韧带（PCL）撕裂患者胫骨后斜（PTS）分布的发生率，以及PTS对PCL重建（PCL- r）后影像学、临床和功能结局的影响。方法：63例有症状的孤立性pcl撕裂行PCL-R的患者，根据pts -角度以70度为临界值分为a组（小于≤70度）和b组（大于70度）。所有的病人都采用了同样的方法。比较pts角度对6个月和1年的放射学预后（胫骨后平移（PTT））的影响。比较两组6个月、1年和最后随访时的临床结果（膝关节活动度（ROM）、股四头肌萎缩（QW））和功能结果（IKDC和Tegner-Lysholm评分）。结果：66.7%的患者PTS <≤70度。平均pts角为6.47±2.40°。放射学上，6个月时PTT无统计学差异。1年时，a组PTT（3.98±2.21 mm）小于b组（3.03±1.42 mm）（P = 0.04）。a组2例患者6个月时PTT为iii级，1年时PTT为iii级。平均随访时，a组IKDC和Tegner-Lysholm（81.55±11.4,90.19±5.53）低于b组（86.56±7.2,94.6±4.42），差异有统计学意义（IKDC:P = 0.038, Tegner-Lysholm:P = 0.001）。在1年和平均随访时，a组的ROM显著降低（p = 0.047）。6个月和1年的QW无显著差异。结论：术前PTS角度较低（≤70）对孤立性PCL-R的预后有负面影响，且与PTS角度较高（bbb70）的患者相比，会导致继发性膝关节后侧松弛。胫骨后小斜度（≤70）在孤立性PCL损伤中的发生率为66.7%。

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引用次数: 0

Total knee arthroplasty in hemophilic knees requires its own learning phase: Lessons learned from 90 cases 血友病膝关节的全膝关节置换术需要一个学习阶段：从 90 个病例中汲取的经验教训。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.024

Arman Vahabi, Elcil Kaya Biçer, Semih Aydoğdu

Background

Intraoperative challenges and complications and their course over experience in total knee arthroplasty (TKA) applications in hemophilic arthropathy have seldom been studied. Our study aimed to analyze the learning dynamics and the evolving perspective of a single arthroplasty surgeon in hemophilic knees.

Methods

The study encompassed all primary TKAs performed on hemophilic patients by a single experienced arthroplasty surgeon from May 2002 to October 2023. A total of 90 knees from 63 patients were included in the final analysis. Demographic characteristics, range of motion (ROM), degree of flexion contracture, and hip–knee angle (HKA) were noted. Anesthesia type, tourniquet duration, surgical approach, need for bone graft use, and lateral retinacular release (LRR) were also documented. Cases were categorized into three groups: the initial 30 cases (Group A), the subsequent 30 cases (Group B), and the final 30 cases (Group C).

Results

All groups were homogenous in terms of age (P = 0.102), HKA (P = 0.696), ROM (P = 0.582), and degree flexion contracture (P = 0.546). Extended approaches were needed in seven cases (23.3%) in Group A, and in two cases (6.7%) in Group B. There was no need for extended exposure in Group C. LRR application rate and tourniquet time showed no differences across groups (P = 0.401, P = 0.482). The intraoperative problem rate exhibited a statistically significant decrease throughout the series (P = 0.016).

Conclusions

Arthroplasty in hemophilic knees poses unique challenges which require their own learning process. Intraoperative complication rate and need for utilizing extended approaches decreases after the initial 30 cases and decreases further after the subsequent 30 cases.

背景：在血友病关节病的全膝关节置换术（TKA）应用中，术中挑战和并发症及其随经验变化的过程很少被研究。我们的研究旨在分析一名关节置换外科医生在嗜血性膝关节病中的学习动态和不断变化的观点：研究涵盖了自2002年5月至2023年10月期间，由一名经验丰富的关节置换外科医生为嗜血患者实施的所有初次TKAs手术。共有 63 名患者的 90 个膝关节被纳入最终分析。研究人员注意到了患者的人口统计学特征、活动范围（ROM）、屈曲挛缩程度和髋膝角度（HKA）。此外，还记录了麻醉类型、止血带持续时间、手术方法、植骨需求和侧视网膜松解术（LRR）。病例分为三组：最初的 30 例（A 组）、随后的 30 例（B 组）和最后的 30 例（C 组）：所有组别在年龄（P = 0.102）、HKA（P = 0.696）、ROM（P = 0.582）和屈曲挛缩程度（P = 0.546）方面均相同。A 组有 7 例（23.3%）需要延长入路，B 组有 2 例（6.7%）需要延长入路。在整个系列中，术中问题率出现了统计学意义上的显著下降（P = 0.016）：血友病膝关节置换术带来了独特的挑战，需要一个学习过程。在最初的 30 例手术后，术中并发症发生率和使用扩展方法的需求有所下降，而在随后的 30 例手术后，这一比率会进一步下降。

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引用次数: 0

Does the posterior tibial slope in caliper-verified unrestricted kinematically aligned TKA using manual instruments match the slope in the contralateral healthy knee and improve function? 在使用手动器械进行卡尺验证的无限制运动学对齐 TKA 中，胫骨后斜度是否与对侧健康膝关节的斜度一致，并能改善功能？

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.022

Alexander J. Nedopil , Stefano Ghiradelli , S.M. Howell , M.L. Hull

Purpose

Unrestricted kinematically aligned total knee arthroplasty (unKA TKA) strives to restore the pre-arthritic posterior tibial slope (PTS), however consistency of achieving this alignment target is unknown. The present study determined the proportion of subjects with differences in PTS less than 2° from the target and the improvement in patient-reported function after unKA TKA.

Methods

A review of 562 postoperative scanograms identified 99 patients (51 female) with a unKA TKA in one limb, a contralateral healthy limb, and a postoperative axial CT scan. All patients were treated with a primary unKA TKA performed with mechanical instruments where the alignment target was setting the PTS to match that of the medial compartment of the contralateral healthy knee. The PTS of the TKA and the healthy medial tibial plateau were measured and the difference determined. The patient-reported Oxford Knee Score (OKS) measured pre- and post-operative function.

Results

The proportion of subjects within a tolerance interval of ±2° of the contralateral healthy knee at 95% confidence was 85%. The median OKS improved from 20 points preoperatively to 47 points (range 18–48) at 15 months postoperatively. Greater differences of the PTS from healthy were unrelated to poorer Oxford Knee Scores.

Conclusion

Unrestricted KA TKA using manual instruments with caliper verification of resection thickness restored a high percentage of patients within a clinically acceptable tolerance of the posterior tibial slope of the contralateral healthy knee. The median postoperative OKS indicated clinically important improvement in patient-reported function.

目的：无限制运动对齐全膝关节置换术（unKA TKA）旨在恢复关节炎前胫骨后坡（PTS），但实现这一对齐目标的一致性尚不清楚。本研究确定了PTS与目标差小于2°的受试者比例，以及unKA TKA后患者报告的功能改善情况。方法：回顾562例术后扫描图，确定了99例（51例女性）单侧肢体、对侧健康肢体发生unKA TKA的患者，并进行了术后轴位CT扫描。所有患者均接受机械器械进行的原发性unKA TKA治疗，其中对准目标是使PTS与对侧健康膝关节的内侧腔室相匹配。测量TKA患者与健康胫骨内侧平台患者的PTS并测定其差异。患者报告的牛津膝关节评分（OKS）测量术前和术后功能。结果：受试者在对侧健康膝关节±2°的耐受区间（95%置信度）内的比例为85%。中位OKS从术前20分改善到术后15个月的47分（范围18-48）。健康患者PTS差异较大与较差的牛津膝关节评分无关。结论：使用手动器械和卡尺验证切除厚度的TKA在临床可接受的对侧健康膝关节胫骨后斜度范围内恢复了高比例的患者。术后中位OKS表明患者报告的功能有重要的临床改善。

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引用次数: 0

Patellar tendon lateral deviation angle: a new computed tomography scan measurement for evaluation of patellar instability 髌腱侧偏角：用于评估髌骨不稳的一种新的计算机断层扫描测量方法。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.011

Zhu Dai , Jian Li , Juan Tan , Zhijun Yang , Zhihao Gong

Background

The tibial tuberosity–trochlear groove (TT-TG) distance is an important reference for the evaluation of patellar instability. However, measurement of the TT-TG distance has disadvantages with relatively low reproducibility. This study aimed to investigate the reliability of patellar tendon lateral deviation angle (PTLD-A) measured on a single computed tomography (CT) slice and the clinical significance for predicting patellar instability.

Methods

Seventy-eight knees with recurrent patellar dislocation were included as the study group, and 76 normal knees in the control group. The PTLD-A and the TT-TG distance were measured on CT images, inter- and intra-observer reproducibility were assessed, and correlation was analyzed, and compared between the groups. The predictive value of both measurements for patellar instability was examined using the receiver operating characteristic curve, and the cut-off value was predicted using the Youden index.

Results

Inter- and intra-observer reproducibility of PTLD-A was better than TT-TG distance in both groups as well as across all extents of trochlear types. The correlation between the two measurements was strong (r = 0.756, P < 0.001). Notably, both measurements were significantly higher in the study group than in the control group (P < 0.05). PTLD-A showed high predictive value for patellar instability, whereas TT-TG distance showed medium predictive value. A PTLD-A value of ≥ 13.7° was the threshold for diagnosis of patellar instability.

Conclusion

PTLD-A measured on a single computed tomography slice of the distal femoral trochlear groove is more reliable than TT-TG distance for prediction of patellar instability. A PTLD-A ≥ 13.7° predicts patellar instability.

背景：胫骨结节-跗骨沟（TT-TG）距离是评估髌骨不稳定性的重要参考指标。然而，TT-TG 距离的测量存在可重复性相对较低的缺点。本研究旨在探讨单张计算机断层扫描（CT）片上测量的髌腱侧偏角（PTLD-A）的可靠性及其对预测髌骨不稳的临床意义：研究组包括78个复发性髌骨脱位的膝关节，对照组包括76个正常膝关节。在CT图像上测量PTLD-A和TT-TG距离，评估观察者之间和观察者内部的重复性，分析相关性，并进行组间比较。利用接收者操作特征曲线检验了这两项测量对髌骨不稳的预测价值，并利用尤登指数预测了临界值：结果：在两组中，PTLD-A的观察者间和观察者内再现性均优于TT-TG距离，也优于所有范围的髌骨类型。两种测量结果之间的相关性很强（r = 0.756，P 结论：PTLD-A 和 TT-TG 测量结果之间的相关性很强：在预测髌骨不稳方面，股骨远端套骨沟单片计算机断层扫描测量的PTLD-A比TT-TG距离更可靠。PTLD-A≥13.7°可预测髌骨不稳。

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引用次数: 0

Total knee arthroplasty improves energy conversion efficiency during walking in patients with knee osteoarthritis 全膝关节置换术提高膝关节骨关节炎患者行走时的能量转换效率。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.020

Ruido Ida , Gen Kuroyanagi , Yoshino Ueki , Satona Murakami , Takayuki Shiraki , Daiki Shimotori , Hideki Okamoto , Kunio Yamada

Background

Energy conversion efficiency of human gait can be evaluated by calculating the ratio of conversion of mechanical energy from vertical motion to horizontal motion of the center of gravity through the movement of the joints. Osteoarthritis (OA) of the knee joint impairs this energy conversion efficiency. Total knee arthroplasty is the standard treatment for knee OA. However, its effect on energy conversion efficiency is unclear. In this study, we investigated how energy conversion efficiency changed in the gait of patients with knee OA before and after surgery.

Methods

Twelve patients with unilateral knee OA who underwent total knee arthroplasty were included. Ground walking was measured using a motion capture system (VICON®) before and 6 months after surgery. We calculated potential and kinetic energy from the coordinate change of the center of mass to obtain energy conversion efficiency. Other gait parameters such as gait speed, vertical movement distance of the body center, step length, hip joint angle, and trailing and leading limb angles were assessed.

Results

Energy conversion efficiency on the operated side significantly improved from 41.4 ± 12.2% to 57.5 ± 9.2% 6 months after surgery. Other gait parameters on the operated side were significantly improved after surgery compared with before surgery. Step length on the operated and the non-operated sides and trailing limb angles on the non-operated side before surgery correlated to energy conversion efficiency, while at 6 months after surgery, gait speed and step length on the non-operated side correlated to energy conversion efficiency.

Conclusion

Energy conversion efficiency was strongly improved postoperatively in patients with knee OA.

背景：通过计算关节运动将机械能量从垂直运动转化为重心水平运动的比率，可以评价人体步态的能量转换效率。膝关节骨关节炎（OA）损害了这种能量转换效率。全膝关节置换术是膝关节OA的标准治疗方法。然而，其对能量转换效率的影响尚不清楚。在这项研究中，我们研究了膝关节OA患者手术前后步态中能量转换效率的变化。方法：12例单侧膝关节炎患者行全膝关节置换术。在手术前和手术后6个月，使用运动捕捉系统（VICON®）测量地面行走。通过质心的坐标变化计算势能和动能，得到能量转换效率。评估其他步态参数，如步态速度、身体中心垂直运动距离、步长、髋关节角度、前后肢角度等。结果：术后6个月手术侧能量转换效率由41.4±12.2%显著提高至57.5±9.2%。手术侧其他步态参数术后较术前有明显改善。术前手术侧与非手术侧步长、非手术侧尾肢角度与能量转换效率相关，术后6个月时，非手术侧步长、步态速度与能量转换效率相关。结论：膝关节OA患者术后能量转换效率明显提高。

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引用次数: 0

Sartorius muscle transfer for chronic quadriceps tendon rupture: A prospective study 缝匠肌转移治疗慢性股四头肌肌腱断裂：一项前瞻性研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-12 DOI: 10.1016/j.knee.2024.11.023

Andrea Pintore , Ernesto Pintore , Giovanni Asparago , Emanuela Marsilio , Ernesto Torsiello , Olimpio Galasso

Background

Quadriceps tendon rupture (QTR) is an uncommon injury. In chronic QTR there may be a large defect and direct repair is not possible with sutures or transosseous anchors. There is no gold standard surgical procedure for the treatment of chronic QTR. We propose a novel technique in which the quadriceps tendon (QT) is reconstructed using a transfer of ipsilateral sartorius tendon.

Methods

Between January 2002 and April 2020, 19 patients undergoing sartorius muscle transfer for chronic QTR were prospectively recruited. The Knee Society Score (KSS), range of motion (ROM), and Medical Research Council (MRC) Scale for QT muscle strength were collected preoperatively and at a minimum of 2 years follow up.

Results

The mean age of our cohort was 53.4 ± 9.8 years with a female patient count of 12 (54%). The mean body mass index recorded was 28.5 ± 3.2 kg/m² (range 23–30). At the mean follow up of 53.4 ± 28.1 months the mean KSS was 90.9 ± 6.3 (range 80–100) (P < 0.05), the mean ROM was 119.5 ± 9.9° for flexion (range 100–130) (P < 0.05) and the mean extension lag was 3.8 ± 5.1° (range 0–15) (P < 0.05). The mean MRC scale was 4.5 ± 0.7 (range 3–5) (P < 0.05). The most frequent complication was QT hypotrophy; it was noted in 14 patients.

Conclusion

Satisfactory clinical outcomes of ipsilateral sartorius muscle transfer for chronic QTR can be expected a mean of 4.4 years after surgery.

背景：股四头肌腱断裂（QTR）是一种不常见的损伤。慢性股四头肌腱断裂可能存在较大的缺损，无法通过缝合或经骨锚直接修复。目前还没有治疗慢性 QTR 的金标准手术方法。我们提出了一种新技术，利用同侧萨尔图里肌腱的转移重建股四头肌腱（QT）：方法：2002 年 1 月至 2020 年 4 月间，我们前瞻性地招募了 19 名因慢性 QTR 而接受萨尔特里肌转移的患者。在术前和至少两年的随访中收集膝关节社会评分（KSS）、活动范围（ROM）和医学研究委员会（MRC）QT肌力量表：患者的平均年龄为 53.4 ± 9.8 岁，其中女性患者 12 人（占 54%）。平均体重指数为 28.5 ± 3.2 kg/m2（23-30）。平均随访时间为（53.4 ± 28.1）个月，平均 KSS 为（90.9 ± 6.3）（范围为 80-100）：同侧腓肠肌转移治疗慢性 QTR 的临床疗效令人满意，平均可在术后 4.4 年实现。

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引用次数: 0

Optimal arithmetic hip–knee–ankle angle for performing prearthritic/kinematic alignment in unicompartmental knee arthroplasty 单室膝关节置换术中进行关节炎前/运动学对齐的最佳算法髋关节-膝关节-踝关节角度。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-06 DOI: 10.1016/j.knee.2024.11.013

Kyota Ishibashi , Eiji Sasaki , Shohei Yamauchi , Kento Ota , Ryo Tomita , Hikaru Kristi Ishibashi , Hironori Otsuka , Yasuyuki Ishibashi

Background

This study aimed to investigate whether arithmetic hip–knee–ankle angle (aHKA) can be a surrogate for valgus stress radiography (VSR). Furthermore, we investigated the optimal cutoff values for preoperative radiographic parameters, thereby validating the appropriate inclusion criteria for prearthritic/kinematic unicompartmental knee arthroplasty (prearthritic-UKA).

Methods

We retrospectively analyzed 123 patients who underwent medial UKA. We measured the HKA on VSR, termed sHKA. The aHKA was calculated by subtracting the lateral distal femoral angle from the medial proximal tibial angle. Prearthritic-UKA was defined as a postoperative HKA angle within 3° of the aHKA. We divided the patients into the prearthritic-UKA and non-prearthritic-UKA groups. To assess whether the aHKA serves as a surrogate for VSR, Spearman’s rank correlations were performed among the radiographic parameters. These radiographic parameters calculated the proper criteria for prearthritic-UKA using receiver operating characteristic (ROC) curve analysis and logistic regression analysis.

Results

Overall, 59 patients were classified into the prearthritic-UKA group. The aHKA was larger than the sHKA and exhibited no significant correlation with the sHKA. ROC analysis revealed that the cutoff values of aHKA for detecting overcorrected UKA (i.e., postoperative HKA – aHKA >3°) was −5.0°. Similarly, the cutoff values for detecting undercorrected UKA (i.e., postoperative HKA – aHKA <−3°) were −3°. Logistic regression analysis revealed that the aHKA was significantly associated with prearthritic-UKA.

Conclusion

The aHKA was not identified as a surrogate for the sHKA. Comprehensive preoperative radiographic assessment, including both aHKA and VSR, is crucial for optimizing UKA outcomes and minimizing risks of misalignment.

背景：本研究旨在探讨算术髋关节-膝关节-踝关节角（aHKA）是否可以作为外翻应力摄影（VSR）的替代指标。此外，我们研究了术前影像学参数的最佳截止值，从而验证了关节炎前/运动学单室膝关节置换术（prearthritis - uka）的合适纳入标准。方法：我们回顾性分析了123例内侧UKA患者。我们测量了VSR上的HKA，称为sHKA。aHKA通过从胫骨内侧近端角度减去股骨外侧远端角度计算。关节炎前uka定义为术后HKA角度在aHKA 3°以内。我们将患者分为关节炎前期uka组和非关节炎前期uka组。为了评估aHKA是否可以作为VSR的替代指标，在放射学参数之间进行Spearman秩相关。这些影像学参数通过受试者工作特征（ROC）曲线分析和logistic回归分析计算出关节炎前期uka的合适标准。结果：59例患者分为关节炎前期- uka组。aHKA大于sHKA，与sHKA无显著相关。ROC分析显示，检测过校正UKA（即术后HKA - aHKA >.3°）的aHKA截断值为-5.0°。同样，检测未校正的UKA的截止值（即术后HKA - aHKA）结论：aHKA不能作为sHKA的替代品。全面的术前x线评估，包括aHKA和VSR，对于优化UKA结果和最小化不对准风险至关重要。

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引用次数: 0

Does a medial congruent bearing in total knee arthroplasty compromise fixation? A randomized controlled trial 全膝关节置换术中内侧一致负重会影响固定吗？一项随机对照试验。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-06 DOI: 10.1016/j.knee.2024.11.015

Kristian R.L. Mortensen , Lina Holm Ingelsrud , Omar Muharemovic , Kirill Gromov , Anders Troelsen

Background

Medially congruent (MC) bearings aim at promoting medial pivoting after total knee arthroplasty (TKA), as the congruency provides further constraint for the medial femoral compartment. However, this design difference could alter intra-articular force distribution, potentially compromising fixation of the tibia implant. The aim of this study was to compare migration, measured with radiostereometric analysis (RSA), of an MC to a more traditional cruciate retaining (CR) TKA system. Secondary aims were to compare patient-perceived treatment outcome and number of complications between the treatment groups.

Methods

Sixty patients undergoing TKA were randomized to an MC or CR bearing and had follow up visits after 3 months, 1 and 2 years. Primary outcome was tibia implant migration, measured by maximal total point motion (MTPM) with model-based RSA, 2 years post-surgery. Secondary outcomes were tibia MTPM, change in patient-reported outcome measurements (PROMs) and number of complications registered at all follow up visits.

Results

Primary outcome was available for 52 patients (27 MC patients, 25 CR patients). We found no difference in tibia MTPM between the MC and CR groups 2 years post-surgery. Median (interquartile range) MTPM was 0.60 (0.39–0.97) mm and 0.48 (0.32–0.78) mm in the MC and CR group, respectively (P = 0.167). There were no between-group differences in improvement in PROMs and no between-group differences in number of complications.

Conclusion

We found no compromising of tibia implant fixation in TKA by choosing an MC bearing, when compared with a CR bearing. PROMs and complication rates suggest comparable treatment results with both types of bearings in TKA.

背景：内侧一致（MC）轴承旨在促进全膝关节置换术（TKA）后内侧旋转，因为一致性提供了进一步的股骨内侧室约束。然而，这种设计差异可能改变关节内的力分布，潜在地影响胫骨植入物的固定。本研究的目的是比较MC与更传统的交叉保留（CR） TKA系统的迁移，用放射立体分析（RSA）测量。次要目的是比较两组患者感知的治疗结果和并发症的数量。方法：60例TKA患者随机分为MC或CR组，分别于3个月、1年和2年后随访。术后2年，主要终点是胫骨植入物的移动，通过基于模型的RSA测量最大总点运动（MTPM）。次要结果是胫骨MTPM，患者报告的结果测量值（PROMs）的变化和所有随访中记录的并发症数量。结果：52例患者获得主要结局（27例MC患者，25例CR患者）。我们发现MC组和CR组术后2年胫骨MTPM无差异。MC组和CR组的MTPM中位数（四分位间距）分别为0.60 (0.39-0.97)mm和0.48 (0.32-0.78)mm （P = 0.167）。两组间PROMs改善无差异，并发症数量无差异。结论：我们发现选择MC轴承与CR轴承相比，在TKA中胫骨内固定没有妥协。prom和并发症发生率表明两种类型的TKA轴承的治疗结果相当。

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引用次数: 0

Analysis of microvascular density and collagen structure of the medial meniscotibial ligament of the knee: Immunohistochemical study with CD31 and histology with Picrosirius red 膝关节内侧半月板韧带微血管密度及胶原结构分析：CD31免疫组化及小天狼星红组织学研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-12-06 DOI: 10.1016/j.knee.2024.11.016

Amanda Progenio dos Santos , Jonatas Brito de Alencar Neto , Pedro Henrique Marques Amorim , Paulo Goberlânio de Barros Silva , Maria Luzete Costa Cavalcante

Background

The aim of the present study was to describe the structure of the collagen matrix and the microvascularization of the medial meniscotibial ligament (MMTL), in order to contribute to the refinement of the surgical technique for repairing these structures and consequently lead to a reduction in the risk of anterior cruciate ligament re-rupture.

Methods

Twelve MMTLs were obtained from deceased organ donors. The ligaments were initially analyzed macroscopically and evaluated histologically using hematoxylin and eosin staining. The evaluation of the collagen matrix was carried out using the Picrosirius red staining method under a polarized light microscope. Immunohistochemical study using monoclonal antibodies against CD31 was used to evaluate microvascularization.

Results

The MMTL was identified in 100% of the dissections. The hematoxylin and eosin-stained histological sections exhibited oriented and parallel collagen fibers, with low cellularity in its intrasubstance portion and increase in cellularity close to the meniscal insertion. Quantitative analysis of the collagen matrix showed a ratio of type I to type III collagen of 3.86 (±3.07). The average microvascular density in the intrasubstance portion was 33.71 ± 8.7 vessels/mm² and in the meniscal insertion portion it was 74.14 ± 23.85 vessels/mm².

Conclusion

The MMTL is a structure with a predominance of Type I collagen in relation to Type III collagen and high microvascular density in the region of meniscal insertion. These findings suggest that the healing potential of MMTL, regarding ramp injuries, is high because these injuries occur in the meniscal insertion area.

背景：本研究的目的是描述胶原基质的结构和内侧半月板胫韧带（MMTL）的微血管化，以促进修复这些结构的手术技术的改进，从而降低前交叉韧带再破裂的风险。方法：从死者器官供者中获得12个mmtl。韧带最初进行宏观分析，并用苏木精和伊红染色进行组织学评估。在偏光显微镜下，采用Picrosirius红染色法对胶原基质进行评价。采用CD31单克隆抗体免疫组化方法评价微血管形成。结果：MMTL的鉴别率为100%。苏木精和伊红染色的组织学切片显示胶原纤维取向平行，其实质部分细胞密度低，靠近半月板插入处细胞密度增加。胶原基质定量分析显示，I型与III型胶原的比例为3.86（±3.07）。物质内部分微血管密度平均值为33.71±8.7支/mm2，半月板止点部分微血管密度平均值为74.14±23.85支/mm2。结论：MMTL是一种I型胶原相对于III型胶原占优势的结构，在半月板止点区域微血管密度高。这些发现表明，对于斜坡损伤，MMTL的愈合潜力很高，因为这些损伤发生在半月板插入区。

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