IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-16 DOI: 10.1016/j.knee.2024.09.014

Shinya Tanaka, Yusuke Osawa, Yasuhiko Takegami, Yuto Ozawa, Shiro Imagama

Introduction

Patients with dysplastic hip arthritis (DHA) often present with abnormal knee alignment. We investigate the factors influencing varus and valgus knee alignment on the contralateral side in patients with unilateral DHA.

Methods

123 patients with unilateral DHA were enrolled between 2018 and 2022. Based on the hip-knee-ankle angle (HKAA), patients were divided into three groups: neutral group (HKAA <3° varus and valgus), varus group (>3° varus), and valgus group (>3° valgus). Demographics, radiographic parameters, and functional scores were compared between the groups.

Results

There were 58, 44, and 21 patients in the neutral, varus, and valgus group, respectively. The varus group had a varus HKAA and hip adduction angle in the affected hip and a large femoral offset in the healthy hip. The valgus group had a valgus HKAA and large hip adduction angle in the affected hip and a small femoral offset in the healthy hip. In addition, the valgus group presented with pelvic obliquity, expressed as an upper pelvic tilt on the affected side. Multivariate analysis identified a varus HKAA in the affected hip (odds ratio [OR], 0.64; 95% confidence interval [CI]: 0.51–0.79; p < 0.01) as a factor associated with the varus group, while pelvic obliquity (OR, 0.69; 95% CI: 0.53–0.89; p = 0.01) was associated with the valgus group. The varus and valgus groups had significantly worse functional scores than the neutral group.

Conclusions

This study demonstrated that varus and valgus alignments of the contralateral knee with unilateral DHA were associated with radiographic parameters and hip function.

导言发育不良性髋关节炎（DHA）患者通常表现为膝关节排列异常。我们研究了影响单侧DHA患者对侧膝关节屈曲和外翻的因素。方法在2018年至2022年期间，我们招募了123名单侧DHA患者。根据髋-膝-踝角度（HKAA），将患者分为三组：中性组（HKAA<3°变位和外翻）、变位组（>3°变位）和外翻组（>3°外翻）。结果中性组、曲张组和外翻组分别有 58、44 和 21 名患者。外翻组患侧髋关节的HKAA和髋关节内收角度为外翻，健侧髋关节的股骨偏移较大。瓣膜外翻组的受累髋关节 HKAA 和髋关节内收角度均为瓣膜外翻，而健康髋关节的股骨偏移量较小。此外，髋外翻组还伴有骨盆倾斜，表现为患侧骨盆上倾。多变量分析发现，患侧髋关节的香港开奖现场结果直墦曲度（几率比 [OR]，0.64；95% 置信区间 [CI]：0.51-0.79；P = 0.01）是与香港开奖现场结果直墦曲度相关的因素，而骨盆倾斜（OR，0.69；95% 置信区间 [CI]：0.53-0.89；P = 0.01）与外翻组相关。结论这项研究表明，单侧DHA对侧膝关节的屈曲和内翻排列与放射学参数和髋关节功能有关。

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引用次数: 0

Quadriceps strength can improve twelve months after opening wedge high tibial osteotomy and opening wedge distal tibial tubercle osteotomy, particularly after opening wedge high tibial osteotomy 开放式楔形高胫骨截骨术和开放式楔形胫骨远端结节截骨术后 12 个月，尤其是开放式楔形高胫骨截骨术后，股四头肌力量可得到改善

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-15 DOI: 10.1016/j.knee.2024.09.013

Ryo Goto , Takehiko Matsushita , Yuya Ueda , Yohei Shibata , Daisuke Miura , Kumiko Ono , Akihiro Kida , Kyohei Nishida , Kanto Nagai , Noriyuki Kanzaki , Yuichi Hoshino , Yoshitada Sakai , Ryosuke Kuroda

Background

Knee osteoarthritis (KOA) is a globally prevalent condition leading to joint pain and disabilities. Surgical interventions such as opening-wedge high tibial osteotomy (OWHTO) and opening-wedge distal tuberosity osteotomy (OWDTO) aim to alleviate symptoms and delay disease progression. Quadriceps strength, crucial for knee function, may decline postoperatively, affecting patient outcomes. However, little is known about quadriceps strength variation after OWHTO and OWDTO. This study investigated changes in quadriceps strength before and after OWHTO and OWDTO.

Methods

This retrospective study included patients who underwent OWHTO or OWDTO between 2016 and 2022. Quadriceps strength and demographic and surgical data were collected preoperatively and at 6 and 12 months postoperatively. Statistical analyses were performed to compare changes in quadriceps strength over time.

Results

Of 120 knees, 52 (OWHTO, 27; OWDTO, 25) were included in this study. Quadriceps strength increased over 12 months post-OWHTO, significantly improving at 12 months compared to the preoperative and 6-month values. In OWDTO, the strength improved but not significantly.

Conclusions

Quadriceps strength improved following OWHTO and OWDTO, with OWHTO showing significant enhancements. Future studies should investigate the relationship between quadriceps strength and functional outcomes and guide rehabilitation strategies for improved postoperative recovery.

背景膝关节骨关节炎（KOA）是一种导致关节疼痛和残疾的全球性疾病。开刃胫骨高位截骨术（OWHTO）和开刃远端结节截骨术（OWDTO）等手术干预措施旨在缓解症状并延缓疾病进展。股四头肌力量对膝关节功能至关重要，术后股四头肌力量可能会下降，从而影响患者的治疗效果。然而，人们对 OWHTO 和 OWDTO 术后股四头肌力量的变化知之甚少。本研究调查了OWHTO和OWDTO前后股四头肌力量的变化。方法这项回顾性研究纳入了2016年至2022年间接受OWHTO或OWDTO的患者。收集了术前以及术后6个月和12个月的股四头肌力量、人口统计学和手术数据。结果在120个膝关节中，52个（OWHTO，27个；OWDTO，25个）被纳入本研究。OWHTO术后12个月内，股四头肌力量有所增加，与术前和6个月的数值相比，12个月时的力量明显提高。结论 OWHTO 和 OWDTO 术后股四头肌力量均有改善，其中 OWHTO 术后改善明显。未来的研究应探讨股四头肌力量与功能结果之间的关系，并为改善术后恢复的康复策略提供指导。

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引用次数: 0

Robotic assistance improves success of cementless component fixation in one total knee arthroplasty system 机器人辅助提高了一种全膝关节成形术系统中无骨水泥组件固定的成功率

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-12 DOI: 10.1016/j.knee.2024.09.012

Catelyn A. Woelfle, Jeffrey A. Geller, Alexander L. Neuwirth, Nana O. Sarpong, Roshan P. Shah, H. John Cooper

Introduction

New cementless implant designs in total knee arthroplasty (TKA) have begun to shift the longstanding practice of cemented fixation. With aseptic loosening a leading cause for revision of cementless implants, initial osteointegration is critical for component survivorship. Robotic-assisted TKA (RA-TKA) has shown promising results in recent literature at improving component accuracy. The current study aims to evaluate if robotic assistance affects the success of cementless fixation in primary TKA.

Methods

445 cementless primary TKA components from one manufacturer implanted by five surgeons between June 2018 and October 2022 were retrospectively reviewed. Those with minimum one-year follow-up were analyzed. Femoral and tibial components were reviewed separately and grouped based on whether manual or RA-TKA from the same manufacturer was performed. Fisher’s exact test was used to analyze if aseptic loosening rates were different between the two techniques.

Results

373 (82%) cementless components from a single knee system were included. 146 femoral and 103 tibial components were implanted using RA-TKA, while 63 femoral and 61 tibial components were implanted manually. At a mean follow-up of 18 months (range, 12 to 51 months), successful fixation was achieved in 96.2% of all components. No femoral components from either group were revised due to aseptic loosening. Four manually implanted vs. no robotically assisted tibial components were revised due to aseptic loosening (6.6% vs 0.0%; P = 0.038).

Conclusion

The performance of modern cementless femoral components was excellent with or without robotic assistance, however RA-TKA improved the survivorship of the same system’s cementless tibial component.

Level of Evidence: Level III.

导言：全膝关节置换术（TKA）中的新型无骨水泥植入物设计已开始改变长期以来的骨水泥固定做法。无菌性松动是导致无骨水泥植入物翻修的主要原因，因此最初的骨结合对于植入物的存活至关重要。最近的文献显示，机器人辅助 TKA（RA-TKA）在提高组件准确性方面取得了可喜的成果。本研究旨在评估机器人辅助是否会影响原发性 TKA 中无骨水泥固定的成功率。方法回顾性审查了 2018 年 6 月至 2022 年 10 月间由五位外科医生植入的一家制造商生产的 445 个无骨水泥原发性 TKA 组件。对随访至少一年的组件进行了分析。分别回顾了股骨和胫骨组件，并根据是否进行了同一制造商的手动或 RA-TKA 进行了分组。采用 Fisher 精确检验分析两种技术的无菌性松动率是否存在差异。146个股骨和103个胫骨组件采用RA-TKA植入，63个股骨和61个胫骨组件采用人工植入。在平均 18 个月（12 至 51 个月）的随访中，96.2% 的组件成功固定。两组中均没有股骨组件因无菌性松动而进行翻修。结论无论是否有机器人辅助，现代无骨水泥股骨组件的性能都很好，但RA-TKA提高了同一系统的无骨水泥胫骨组件的存活率：证据等级：三级

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引用次数: 0

Next generation sequencing identifies an increased diversity of microbes in post lavage specimens in infected TKA using a biofilm disrupting irrigant 下一代测序发现，在使用生物膜破坏灌洗剂的感染性 TKA 患者灌洗后标本中，微生物的多样性有所增加。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-10 DOI: 10.1016/j.knee.2024.09.010

Madhav Chowdhry , Matthew V. Dipane , Stephen T. Duncan , Diego Pena , Alexandra Stavrakis , Edward J. McPherson

Background

Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty. In chronic PJI, a biofilm envelops the surface of implants, which contains microbiota within an extra-microbial polymeric matrix (EMPM). Microbial identification is paramount for effective treatment. In this study, we use a multi-modal, EMPM disrupting, neoadjuvant irrigant and compare the microbiota detected pre-lavage to post-lavage by two techniques: culture and Next Generation Sequencing (NGS). We suspect more organisms to be identified after applying an EMPM disrupting irrigant.

Methods

A multicenter, prospective study was conducted on 38 patients with known Total Knee Arthroplasty PJI. At initial arthrotomy, synovial fluid was obtained and analyzed for quantitative cultures and microbial NGS. Joint was then irrigated with Bactisure Lavage followed by Normal Saline. Post-lavage samples were similarly obtained and analyzed.

Results

In pre-lavage samples for cultures, 55.3% of samples were positive, identifying 11 unique organisms. In post-lavage samples for cultures, 13.2% of samples were positive, identifying 5 unique organisms. In pre-lavage samples for NGS, 79% were DNA signal positive, identifying 126 unique organisms. In post-lavage samples for NGS, 74% of samples were DNA signal positive, identifying 177 unique organisms. Moreover, 135/177 of these organisms were not identified pre-lavage.

Conclusion

In this pre-to-post irrigant study, culture showed a decrease in the number of identifiable organisms post-lavage. In contrast NGS revealed an increase in the number of identifiable organisms post-lavage. Furthermore, NGS identified 135 additional organisms, not detected pre-lavage. This suggests an increased diversity of microbes may exist within EMPM, which are not cultivable.

背景：假体周围感染（PJI）是关节置换术的一种破坏性并发症。在慢性假体周围感染中，生物膜包裹着假体表面，其中包含微生物群和微生物外聚合物基质（EMPM）。微生物鉴定是有效治疗的关键。在本研究中，我们使用了一种多模式、可破坏 EMPM 的新辅助灌洗剂，并通过培养和下一代测序 (NGS) 两种技术对灌洗前和灌洗后检测到的微生物群进行了比较。我们认为在使用 EMPM 干扰灌流剂后会发现更多微生物：我们对 38 名已知患有全膝关节置换术 PJI 的患者进行了多中心前瞻性研究。在最初的关节切开术中，获取滑液并进行定量培养和微生物 NGS 分析。然后用 Bactisure Lavage 冲洗关节，再用生理盐水冲洗。同样采集并分析灌洗后的样本：结果：在灌胃前培养样本中，55.3% 的样本呈阳性，鉴定出 11 种独特的微生物。在灌胃后的培养样本中，13.2%的样本呈阳性，确定了 5 种独特的生物。在用于 NGS 的前浸液样本中，79% 的样本 DNA 信号呈阳性，鉴定出 126 种独特的生物。在用于 NGS 的浸泡后样本中，74% 的样本 DNA 信号呈阳性，鉴定出 177 种独特的生物。此外，这些生物中有 135/177 在灌胃前没有被鉴定出来：结论：在这项灌胃前对灌胃后的研究中，培养显示灌胃后可识别生物的数量有所减少。相比之下，NGS 表明灌胃后可识别生物的数量有所增加。此外，NGS 还发现了 135 种灌胃前未检测到的生物。这表明在 EMPM 中可能存在更多的微生物多样性，而这些微生物是无法培养的。

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引用次数: 0

Prevalence of femoral condyle injuries in the setting of tibial plateau fractures 胫骨平台骨折时股骨髁损伤的发生率。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-09 DOI: 10.1016/j.knee.2024.09.009

Mees Paulus Emmelot , Robert Kaspar Wagner , Frank Floris Smithuis , Robert Hemke , Stein Jasper Janssen , Peter Kloen

Background

Tibial plateau fracture patterns are influenced by the direction and energy of the impact, and the bone quality. Associated articular femoral injuries can result from the same impact but are insufficiently studied. This study quantifies the prevalence of three distinct articular femoral condyle injuries: (1) impaction fractures, (2) contusions, and (3) condyle fractures. For impaction fractures we assessed the depth, width, length, and surface area.

Methods

We retrospectively reviewed patients who had undergone surgery for a tibial plateau fracture in a tertiary trauma center. Two fellowship-trained radiologists analyzed preoperative CT scans for associated femoral condyle injuries. We defined (1) impaction fractures (depressions ≥ 1.5 mm) with a sclerotic band, a fracture line, or both; (2) contusions (depressions < 1.5 mm) with a sclerotic band; and (3) condyle fractures as sub- or osteochondral fractures.

Results

We identified 149 patients (62 male) with a tibial plateau fracture with a CT scan available. The overall prevalence of articular femoral condyle injuries was 26% (n = 39). The prevalence of impaction fractures was 9.4% (n = 14), of contusions 14% (n = 21), and of condylar fractures 3.0% (n = 4). Factors associated with a higher prevalence of femoral condyle injury were younger age (p = 0.029), male sex (p = 0.014), and absence of comorbidity (p = 0.005). The mean depth of impaction fractures was 2.3 mm (SD: 0.78; range 1.6 to 4).

Conclusion

Concomitant articular femoral condyle injuries occur in one out of four patients with a tibial plateau fracture. Although most femoral injuries were subtle, and none underwent surgical treatment, they might harbor information regarding the likelihood of future joint degeneration and knee instability.

Level of evidence: IV.

背景：胫骨平台骨折模式受撞击方向、能量和骨质的影响。同样的撞击也可能导致相关的股骨关节损伤，但相关研究尚不充分。本研究量化了三种不同的股骨髁关节损伤的发生率：（1）撞击骨折，（2）挫伤和（3）髁骨折。我们对撞击性骨折的深度、宽度、长度和表面积进行了评估：我们对在一家三级创伤中心接受胫骨平台骨折手术的患者进行了回顾性研究。两名接受过研究培训的放射科医生对术前CT扫描进行了分析，以确定是否存在相关的股骨髁损伤。我们对以下情况进行了定义：（1）撞击性骨折（凹陷≥ 1.5 毫米），伴有硬化带、骨折线或两者；（2）挫伤（凹陷）：我们确定了 149 名有 CT 扫描结果的胫骨平台骨折患者（62 名男性）。股骨髁关节损伤的总发病率为 26%（n = 39）。撞击骨折发生率为9.4%（n = 14），挫伤发生率为14%（n = 21），髁状骨折发生率为3.0%（n = 4）。股骨髁损伤发生率较高的相关因素是年龄较小（p = 0.029）、男性（p = 0.014）和无合并症（p = 0.005）。撞击性骨折的平均深度为2.3毫米（SD：0.78；范围为1.6至4）：结论：每四名胫骨平台骨折患者中就有一名合并股骨髁关节损伤。虽然大多数股骨损伤并不明显，也没有人接受手术治疗，但这些损伤可能隐藏着未来关节退化和膝关节不稳定的可能性：证据等级：IV。

{"title":"Prevalence of femoral condyle injuries in the setting of tibial plateau fractures","authors":"Mees Paulus Emmelot , Robert Kaspar Wagner , Frank Floris Smithuis , Robert Hemke , Stein Jasper Janssen , Peter Kloen","doi":"10.1016/j.knee.2024.09.009","DOIUrl":"10.1016/j.knee.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Tibial plateau fracture patterns are influenced by the direction and energy of the impact, and the bone quality. Associated articular femoral injuries can result from the same impact but are insufficiently studied. This study quantifies the prevalence of three distinct articular femoral condyle injuries: (1) impaction fractures, (2) contusions, and (3) condyle fractures. For impaction fractures we assessed the depth, width, length, and surface area.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients who had undergone surgery for a tibial plateau fracture in a tertiary trauma center. Two fellowship-trained radiologists analyzed preoperative CT scans for associated femoral condyle injuries. We defined (1) impaction fractures (depressions ≥ 1.5 mm) with a sclerotic band, a fracture line, or both; (2) contusions (depressions < 1.5 mm) with a sclerotic band; and (3) condyle fractures as sub- or osteochondral fractures.</div></div><div><h3>Results</h3><div>We identified 149 patients (62 male) with a tibial plateau fracture with a CT scan available. The overall prevalence of articular femoral condyle injuries was 26% (n = 39). The prevalence of impaction fractures was 9.4% (n = 14), of contusions 14% (n = 21), and of condylar fractures 3.0% (n = 4). Factors associated with a higher prevalence of femoral condyle injury were younger age (<em>p</em> = 0.029), male sex (<em>p</em> = 0.014), and absence of comorbidity (<em>p</em> = 0.005). The mean depth of impaction fractures was 2.3 mm (SD: 0.78; range 1.6 to 4).</div></div><div><h3>Conclusion</h3><div>Concomitant articular femoral condyle injuries occur in one out of four patients with a tibial plateau fracture. Although most femoral injuries were subtle, and none underwent surgical treatment, they might harbor information regarding the likelihood of future joint degeneration and knee instability.</div><div><strong>Level of evidence:</strong> IV.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 221-230"},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395565","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}

引用次数: 0

Bone Patella Bone allografts show superior outcomes in revision ACL reconstruction: A systematic review and meta-analysis 骨髌骨骨异体移植在前交叉韧带翻修重建中显示出卓越的疗效：系统回顾和荟萃分析。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-07 DOI: 10.1016/j.knee.2024.09.006

Yuvraj Chhabra , Sarup Saroha , Kamrul Hasan , Raj Thakrar , Akash Patel

Backgrounds and Aims

This study explores the impact of allograft selection in revision ACL reconstruction (RACLR). Allografts reduce donor-site morbidity and surgery duration but are costly and may prolong graft integration times. We aimed to assess various allograft subtypes for their efficacy and failure rates in RACLR.

Materials and Methods

Following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and a pre-defined protocol (ID: CRD42023432517), a systematic review of Cochrane Library, Embase, MEDLINE, Web of Science, and Scopus was performed for allograft studies. The primary outcome was failure rate (graft re-rupture/revision). Secondary outcomes included functional scores, infection rates, and return to sport levels. The meta-analysis weighted studies by standard error.

Results

Studies assessing Bone Patella Bone (BPTB), Tibialis Anterior, and Achilles allografts were included. The results indicate non-statistically significant odds ratios when comparing re-rupture rates for BPTB versus both Achilles (OR 3.69) and Tibialis Anterior (OR 1.26) with low or no heterogeneity. Tibialis Anterior displayed a lower failure rate than Achilles (OR 1.26 vs. 3.69). Secondary outcomes favoured BPTB, showing positive KOOS and IKDC scores, while Achilles reported Lysholm scores (83.8 ± 11.3) and 62% return to sport. Tibialis Anterior outcomes included a Lysholm score (92 ± 4.0).

Conclusion

This study provides insights into graft selection for RACLR. BPTB demonstrated favourable graft failure rates compared to Tibialis Anterior and Achilles allografts. No statistically significant differences were observed in other outcomes between subtypes, emphasising the need for standardised reporting in RACLR studies and supporting avenues for future research.

背景和目的：本研究探讨了前交叉韧带翻修重建术（RACLR）中选择同种异体移植物的影响。同种异体移植物可降低供体部位的发病率并缩短手术时间，但成本高昂且可能延长移植物的整合时间。我们旨在评估各种同种异体移植物亚型在 RACLR 中的疗效和失败率：按照系统综述和荟萃分析首选报告项目（PRISMA）指南和预先确定的方案（ID：CRD42023432517），对 Cochrane 图书馆、Embase、MEDLINE、Web of Science 和 Scopus 中的同种异体移植研究进行了系统综述。主要结果是失败率（移植物再断裂/再植）。次要结果包括功能评分、感染率和恢复运动水平。荟萃分析根据标准误差对研究进行了加权：结果：纳入了评估髌骨（BPTB）、胫骨前端和跟腱同种异体移植的研究。结果显示，在比较髌骨异体移植与跟腱异体移植（OR 3.69）和胫骨前异体移植（OR 1.26）的再断裂率时，两者的几率均无统计学意义，且异质性较低或没有异质性。前胫骨的失败率低于跟腱（OR 1.26 对 3.69）。次要结果显示，BPTB 更受青睐，其 KOOS 和 IKDC 评分均为正值，而跟腱的 Lysholm 评分（83.8 ± 11.3）和运动恢复率均为 62%。胫骨前肌的结果包括 Lysholm 评分（92 ± 4.0）：这项研究为 RACLR 的移植物选择提供了启示。与胫骨前肌和跟腱同种异体移植物相比，BPTB 的移植物失败率较高。亚型之间的其他结果没有统计学意义上的显著差异，这强调了RACLR研究中标准化报告的必要性，并为未来的研究提供了支持。

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引用次数: 0

Patellar morphology is different in patellofemoral instability: An MRI comparative case-control study 髌骨股骨不稳的髌骨形态不同：磁共振成像对比病例对照研究。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-04 DOI: 10.1016/j.knee.2024.09.007

Clara Thouvenin , Julien Erard , Assala Abu Mukh , Léopold Joseph , Sébastien Lustig , Elvire Servien

Purpose

Although patellofemoral instability (PFI) affects both femoral and patellar compartments, literature provided little attention for the patellar morphology contribution on PFI. This study evaluates the patellar morphology patterns on MRI to establish their contribution in PFI.

Methods

This study retrospectively analyzes patellar MRI and X-ray measurements performed between 2018 and 2022. 50 knees with recurrent patellar dislocation were matched with 50 matched knees of ACL-reconstruction candidates with no history of patellar dislocation based on age and gender. Caton-Deschamps’ index, Wiberg’s patellar morphotype, Dejour’s trochlear dysplasia classification, sagittal patellofemoral engagement index and additional patellar cartilage and bone parameters and their relative ratio measurements were assessed in both groups.

Results

Study patients present differences in patellar morphology; a wider lateral facet (p = 0,019) and a narrower medial facet compared to the control group (p < 0,001). The subchondral patellar crest is medialized compared to the control group (p < 0,001). The cartilaginous crest measurements of the patella were not significantly different in both groups yet PFI group presents a wider Wiberg angle (p < 0,001), thus a flatter patella, compared to the control group.

Conclusion

The patella in PFI patients presents a larger lateral facet, a narrower medial facet, a flatter surface and a medialized patellar crest compared with the control group. In PFI, a rather medial patellar crest might predispose towards a greater patellar tilt and destabilize the already compromised patellar-trochlear groove congruence. PFI is a multifactorial disease and both trochlea and patella play a role in its manifestation, thus, literature should address patellar morphotype contribution in patellofemoral instability.

Level of Evidence: Level III.

目的：虽然髌骨股骨不稳（PFI）会影响股骨和髌骨，但文献很少关注髌骨形态对 PFI 的影响。本研究评估了 MRI 上的髌骨形态模式，以确定其在 PFI 中的作用：本研究回顾性分析了2018年至2022年间进行的髌骨MRI和X光测量。根据年龄和性别，将 50 个复发性髌骨脱位的膝关节与 50 个无髌骨脱位史的前交叉韧带重建候选者的匹配膝关节进行配对。对两组患者的Caton-Deschamps指数、Wiberg髌骨形态类型、Dejour髌骨发育不良分类、矢状髌股关节啮合指数以及其他髌骨软骨和骨骼参数及其相对比率测量进行评估：与对照组相比，研究组患者的髌骨形态存在差异：外侧切面更宽（p = 0.019），内侧切面更窄（p 结论：PFI 患者的髌骨形态与对照组不同：与对照组相比，PFI 患者的髌骨外侧切面较大，内侧切面较窄，表面较平坦，髌骨嵴内侧化。在 PFI 患者中，髌骨嵴偏内侧可能会导致髌骨更加倾斜，并破坏已经受损的髌骨-蝶骨沟一致性的稳定性。PFI是一种多因素疾病，跗关节和髌骨都在其表现中起作用，因此，文献应探讨髌骨形态在髌股不稳定中的作用：证据等级：三级。

{"title":"Patellar morphology is different in patellofemoral instability: An MRI comparative case-control study","authors":"Clara Thouvenin , Julien Erard , Assala Abu Mukh , Léopold Joseph , Sébastien Lustig , Elvire Servien","doi":"10.1016/j.knee.2024.09.007","DOIUrl":"10.1016/j.knee.2024.09.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Although patellofemoral instability (PFI) affects both femoral and patellar compartments, literature provided little attention for the patellar morphology contribution on PFI. This study evaluates the patellar morphology patterns on MRI to establish their contribution in PFI.</div></div><div><h3>Methods</h3><div>This study retrospectively analyzes patellar MRI and X-ray measurements performed between 2018 and 2022. 50 knees with recurrent patellar dislocation were matched with 50 matched knees of ACL-reconstruction candidates with no history of patellar dislocation based on age and gender. Caton-Deschamps’ index, Wiberg’s patellar morphotype, Dejour’s trochlear dysplasia classification, sagittal patellofemoral engagement index and additional patellar cartilage and bone parameters and their relative ratio measurements were assessed in both groups.</div></div><div><h3>Results</h3><div>Study patients present differences in patellar morphology; a wider lateral facet (<em>p</em> = 0,019) and a narrower medial facet compared to the control group (<em>p</em> < 0,001). The subchondral patellar crest is medialized compared to the control group (<em>p</em> < 0,001). The cartilaginous crest measurements of the patella were not significantly different in both groups yet PFI group presents a wider Wiberg angle (<em>p</em> < 0,001), thus a flatter patella, compared to the control group.</div></div><div><h3>Conclusion</h3><div>The patella in PFI patients presents a larger lateral facet, a narrower medial facet, a flatter surface and a medialized patellar crest compared with the control group. In PFI, a rather medial patellar crest might predispose towards a greater patellar tilt and destabilize the already compromised patellar-trochlear groove congruence. PFI is a multifactorial disease and both trochlea and patella play a role in its manifestation, thus, literature should address patellar morphotype contribution in patellofemoral instability.</div><div><strong>Level of Evidence</strong>: Level III.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 199-205"},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378653","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}

引用次数: 0

Inflammatory markers in early knee joint osteoarthritis differ from well-matched controls and are associated with consistent, rather than intermittent knee pain 早期膝关节骨性关节炎的炎症标记物与匹配良好的对照组不同，与持续性而非间歇性膝关节疼痛有关。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-03 DOI: 10.1016/j.knee.2024.09.003

Shane M. Heffernan , Gillian E. Conway , Conor McCarthy , Stephen Eustace , Mark Waldron , Giuseppe De Vito , Eamonn Delahunt

Background

Osteoarthritis (OA) is characterised by the failure of normal biological processes to repair following damage. Traditionally, OA was considered a “wear and tear” disorder; however, it is now a recognised inflammatory condition, preceded by molecular modifications. The aim of this study was to evaluate inflammatory markers among individuals with early knee OA (eKOA) and well-matched asymptomatic controls.

Methods

Twenty six eKOA (females, n = 13; age = 60.2 ± 5.4 yrs, height = 1.73 ± 0.11 m, body mass = 77.8 ± 12.8 kg, body fat = 33.9 ± 8.5%) and twenty-three asymptomatic individuals (females, n = 14; age = 59.9 ± 5.5yrs, height = 1.71 ± 0.09 m, body mass = 72.6 ± 11.3 kg, body fat = 30.4 ± 8.2%) were recruited. The Timed Up and Go, and the 6 Minute Walk Tests evaluated physical function in addition to pain specific questionnaires (KOOS and ICOAP). Serum levels of IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8(CXCL8), IL-10, hsCRP and TNF-α were quantified using a multiplex assay via V-plex®Sector Imager 2400.

Results

As hypothesised, only KOOS and EQ-5D-5L metrics differed between the groups for non-blood derived measures (p < 0.04). Only IL-6 was higher in eKOA (P = 0.02; 95% CI = 0.202; by 0.197 pg/mL; 34.5%). Among eKOA, IL-6 did not relate to severity of KOOS pain (P = 0.696, r = −0.088), but had a positive relationship with ICOAP consistent (r = 0.469, P = 0.045) rather than intermittent pain. There was a moderate correlation between 6MWD and IL-8 (r = 0.471, P = 0.012).

Conclusion

Our results illustrate the potential for IL-6 as a biomarker for eKOA, and introduce the proposition for particular consideration in those with consistent pain. Further, for the first time the present data showed greater walking distance in eKOA with lower circulating IL-8. Future work should seek to verify these results and further investigate IL-6 and IL-8 related molecular pathways in eKOA, and their potential relationships with consistent knee pain and physical function.

背景：骨关节炎（OA）的特点是正常生物过程无法修复损伤。传统上，OA 被认为是一种 "磨损 "性疾病；但现在，它是一种公认的炎症性疾病，在发病之前会发生分子改变。本研究旨在评估早期膝关节 OA（eKOA）患者和匹配良好的无症状对照组的炎症标志物：招募了 26 名早期膝关节 OA 患者（女性，n = 13；年龄 = 60.2 ± 5.4 岁，身高 = 1.73 ± 0.11 米，体重 = 77.8 ± 12.8 千克，体脂 = 33.9 ± 8.5%）和 23 名无症状者（女性，n = 14；年龄 = 59.9 ± 5.5 岁，身高 = 1.71 ± 0.09 米，体重 = 72.6 ± 11.3 千克，体脂 = 30.4 ± 8.2%）。除了疼痛专项调查问卷（KOOS 和 ICOAP）外，还进行了定时起立行走和 6 分钟步行测试，以评估身体功能。血清中的 IL-1α、IL-1β、IL-2、IL-4、IL-6、IL-8(CXCL8)、IL-10、hsCRP 和 TNF-α 水平通过 V-plex®Sector Imager 2400 使用多重分析法进行量化：结果：正如假设的那样，只有 KOOS 和 EQ-5D-5L 指标在非血液衍生指标方面存在组间差异（p 结论：我们的研究结果表明，IL-10 和 EQ-5D-5L 指标在非血液衍生指标方面存在组间差异：我们的研究结果表明，IL-6 有可能成为 eKOA 的生物标志物，并提出了对有持续疼痛的患者进行特别考虑的建议。此外，目前的数据首次显示，循环 IL-8 较低的 eKOA 患者步行距离更远。未来的工作应设法验证这些结果，并进一步研究 eKOA 中与 IL-6 和 IL-8 相关的分子通路，以及它们与持续膝关节疼痛和身体功能的潜在关系。

{"title":"Inflammatory markers in early knee joint osteoarthritis differ from well-matched controls and are associated with consistent, rather than intermittent knee pain","authors":"Shane M. Heffernan , Gillian E. Conway , Conor McCarthy , Stephen Eustace , Mark Waldron , Giuseppe De Vito , Eamonn Delahunt","doi":"10.1016/j.knee.2024.09.003","DOIUrl":"10.1016/j.knee.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Osteoarthritis (OA) is characterised by the failure of normal biological processes to repair following damage. Traditionally, OA was considered a “wear and tear” disorder; however, it is now a recognised inflammatory condition, preceded by molecular modifications. The aim of this study was to evaluate inflammatory markers among individuals with early knee OA (eKOA) and well-matched asymptomatic controls.</div></div><div><h3>Methods</h3><div>Twenty six eKOA (females, <em>n</em> = 13; age = 60.2 ± 5.4 yrs, height = 1.73 ± 0.11 m, body mass = 77.8 ± 12.8 kg, body fat = 33.9 ± 8.5%) and twenty-three asymptomatic individuals (females, <em>n</em> = 14; age = 59.9 ± 5.5yrs, height = 1.71 ± 0.09 m, body mass = 72.6 ± 11.3 kg, body fat = 30.4 ± 8.2%) were recruited. The Timed Up and Go, and the 6 Minute Walk Tests evaluated physical function in addition to pain specific questionnaires (KOOS and ICOAP). Serum levels of IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8(CXCL8), IL-10, hsCRP and TNF-α were quantified using a multiplex assay via V-plex®Sector Imager 2400.</div></div><div><h3>Results</h3><div>As hypothesised, only KOOS and EQ-5D-5L metrics differed between the groups for non-blood derived measures (<em>p</em> < 0.04). Only IL-6 was higher in eKOA (<em>P</em> = 0.02; 95% CI = 0.202; by 0.197 pg/mL; 34.5%). Among eKOA, IL-6 did not relate to severity of KOOS pain (<em>P</em> = 0.696, <em>r</em> = −0.088), but had a positive relationship with ICOAP consistent (<em>r</em> = 0.469, <em>P</em> = 0.045) rather than intermittent pain. There was a moderate correlation between 6MWD and IL-8 (<em>r</em> = 0.471, <em>P</em> = 0.012).</div></div><div><h3>Conclusion</h3><div>Our results illustrate the potential for IL-6 as a biomarker for eKOA, and introduce the proposition for particular consideration in those with consistent pain. Further, for the first time the present data showed greater walking distance in eKOA with lower circulating IL-8. Future work should seek to verify these results and further investigate IL-6 and IL-8 related molecular pathways in eKOA, and their potential relationships with consistent knee pain and physical function.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"51 ","pages":"Pages 189-198"},"PeriodicalIF":1.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376295","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}

引用次数: 0

Sex and body height influences on patellofemoral joint reaction force during stair ascent 性别和身高对爬楼梯时髌股关节反作用力的影响

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-03 DOI: 10.1016/j.knee.2024.09.005

Lee T. Atkins , Rachel Davis , Joseph DiMercurio , Cory Harrison , Justin Ebmeyer , C. Roger James

Background

Females are at greater risk of developing patellofemoral pain (PFP) than males, and an excessive patellofemoral joint reaction force (PFJRF) may contribute to this discrepancy. It is unknown if the PFJRF differs between males and females during stair ascent. Additionally, body height may also influence the PFJRF. This study investigated PFJRF differences between males and females and explored relationships between body height and PFJRF during stair ascent.

Methods

Thirty males (25.6 (2.7) yr) and thirty females (23.7 (2.2) yr) ascended stairs (96 steps/min). Three-dimensional kinematics (200 Hz) and kinetics (2000 Hz) were recorded and used to calculate biomechanical dependent variables.

Results

Females experienced a greater PFJRF magnitude (mean difference (MD) = 3.2 N/kg; 95% CI = 0.5, 5.9; p = 0.022) and rate (MD = 23.8 N/kg/sec; 95% CI = 2.7, 45.1; p = 0.029), quadriceps muscle force (3.1 N/kg; 95% CI = 0.2, 6.0; p = 0.036), and knee flexion angle (MD = 2.3°; 95% CI = 0.3, 4.3; p = 0.026). Females exhibited shorter quadriceps lever arm length (MD = −0.1 cm; 95% CI = −0.2, 0.0; p = 0.024) and body height (MD = −16.9 cm; 95% CI = −20.5, −13.2, p < 0.001) compared to males. Body height was inversely correlated with PFJRF magnitude (r = −0.31; p = 0.017), rate (r = −0.28; p = 0.032), and knee flexion angle (r = −0.54; p < 0.001).

Conclusion

Females experienced a greater PFJRF than males. Additionally, the PFJRF and body height were inversely correlated. This observed difference may contribute to the PFP sex discrepancy and be due, at least in part, to body height differences.

背景：与男性相比，女性患髌骨股骨痛（PFP）的风险更大，而过大的髌骨股骨关节反作用力（PFJRF）可能是造成这种差异的原因之一。目前尚不清楚男性和女性在上楼梯时的髌股关节反作用力是否存在差异。此外，身高也可能影响 PFJRF。本研究调查了男性和女性之间的 PFJRF 差异，并探讨了爬楼梯时身体高度和 PFJRF 之间的关系：方法：30 名男性（25.6 (2.7) 岁）和 30 名女性（23.7 (2.2) 岁）爬楼梯（96 步/分钟）。记录三维运动学（200 Hz）和动力学（2000 Hz）并用于计算生物力学因变量：结果：女性的 PFJRF 幅值（平均差异 (MD) = 3.2 牛/公斤；95% CI = 0.5，5.9；p = 0.022）和速率（MD = 23.8 牛/公斤/秒；95% CI = 2.7，45.1；p = 0.029）、股四头肌肌力（3.1 牛/公斤；95% CI = 0.2，6.0；p = 0.036）和膝关节屈曲角度（MD = 2.3°；95% CI = 0.3，4.3；p = 0.026）。女性的股四头肌杠杆臂长（MD = -0.1厘米；95% CI = -0.2，0.0；p = 0.024）和身高（MD = -16.9厘米；95% CI = -20.5，-13.2，p）均较短：女性的 PFJRF 比男性大。此外，PFJRF 与身高成反比。这种观察到的差异可能是导致 PFP 性别差异的原因，至少部分原因是身高差异。

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引用次数: 0

Letter to the editor commenting on “Prognostic factors of knee pain and function 12 months after total knee arthroplasty: A prospective cohort study of 798 patients” 致编辑的评论信“全膝关节置换术后12个月膝关节疼痛和功能的预后因素:798例患者的前瞻性队列研究”

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2024-10-01 DOI: 10.1016/j.knee.2023.10.008

引用次数: 0

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