Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Validation of CLASS MRI for personalized ACL footprints identification.","authors":"Grégoire Thürig, Marc Barrera Usó, Raúl Panadero-Morales, Julien Galley, Joseph Schwab, Alexander Heimann, Moritz Tannast, Daniel Petek","doi":"10.1002/ksa.12555","DOIUrl":"https://doi.org/10.1002/ksa.12555","url":null,"abstract":"<p><strong>Purpose: </strong>In modern anterior cruciate ligament (ACL) surgery, the focus is usually on anatomical reconstruction to restore the natural kinematics of the knee. The individual optimal positioning of the ACL footprints (FPs) in primary surgery is still controversial and, especially in revision surgery, difficult to realize surgically. In this regard, a new MRI-based sequence, the Compressed Lateral and anteroposterior Anatomic Systematic Sequence (CLASS) with marked femoral and tibial FPs as a template, could help. The purpose of this study was to (1) validate the reliability and reproducibility of the localization of femoral and tibial FPs of ACL in the generation of CLASS and (2) compare the identification of ACL FPs by CLASS with previously described methods.</p><p><strong>Methods: </strong>Magnetic resonance imaging (MRI) of uninjured knees from a predominantly young cohort is used to apply the CLASS algorithm. ACL FPs were subsequently identified by a board-certified radiologist and an orthopaedic knee surgeon. Intraobserver reliability and interobserver reproducibility were assessed. Measurements of the ACL FPs according to established methods were performed and compared with the results from the literature.</p><p><strong>Results: </strong>Identification of ACL FPs and generation of CLASS images resulted in 'almost perfect' reliability and reproducibility. Most measurements also showed 'almost perfect' consistency. Statistical analysis showed significant variations between the deep-shallow and high-low positions when compared to the published literature.</p><p><strong>Conclusions: </strong>The CLASS MRI sequence is a reliable and reproducible method for identifying ACL FPs. The observed variability in the location of the ACL FP underlines the importance of a patient-specific surgical approach.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infratuberositary slope-decreasing anterior closed wedge proximal tibial osteotomy is safe and shows rapid bone healing","authors":"Philipp Schuster,&nbsp;Philipp Mayer,&nbsp;Ilona Schubert,&nbsp;Janina Leiprecht,&nbsp;Gregoire Micioi,&nbsp;Benoit Reuter,&nbsp;Jörg Richter,&nbsp;Jörg Dickschas","doi":"10.1002/ksa.12559","DOIUrl":"10.1002/ksa.12559","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Different techniques of slope-decreasing anterior closed-wedge proximal tibial osteotomy (ACW-PTO) have been described. To determine the peri- and post-operative complication rate and obtain data on bone healing in ACW-PTO with an infratuberositary approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 170 consecutive ACW-PTO of two sports-orthopaedic centres were retrospectively evaluated (97 and 73, respectively). Routine follow-up was performed after 6 weeks and was available in 166 cases (97.7%). Medical charts and x-rays of these cases were reviewed with regard to technique-specific complications. Lateral x-rays (<i>n</i> = 155) at 6 weeks post-operatively were evaluated with regard to bone healing (completely healed, partially healed or with no or delayed signs of bone healing). A multivariate binary logistic regression was performed to detect factors that influence bone healing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was one case with haematoma and superficial wound-healing problems after 5 weeks with progression to a deep wound infection and revision surgery (plate exchange) at 11 weeks after the index surgery. One case with delayed bone healing was treated with plate exchange combined with revision anterior cruciate ligament reconstruction after 4 months. The further course of both cases was uneventful. No other complications were observed. Therefore, the overall complication rate was 1.2% (2 out of 166). Radiologic evaluation at 6 weeks showed complete healing in 104 cases (67.1%), partial healing in 50 cases (32.3%) and delayed healing only in the aforementioned case (0.6%), respectively. All cases of partial healing showed complete healing at 12 weeks. In regression analysis, a completely closed osteotomy (odds ratio [OR] = 3.5, <i>p</i> = 0.003) and compression of the osteotomy (OR = 2.5, <i>p</i> = 0.026) were significantly associated with complete bone healing at 6 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ACW-PTO using an infratuberositary approach is very safe with regard to complication rate and shows rapid bone healing. The osteotomy should be completely closed and compression should be applied for optimal bone healing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Case series with pooled data of two centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level 4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 3","pages":"1033-1043"},"PeriodicalIF":3.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change of CPAK class does not affect functional outcomes in robotic arm-assisted total knee arthroplasty performed with functional alignment.","authors":"Enrico Bertugli, Francesco Zambianchi, Cécile Batailler, Gabriele Bazzan, Sébastien Lustig, Fabio Catani","doi":"10.1002/ksa.12561","DOIUrl":"https://doi.org/10.1002/ksa.12561","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the impact of post-operative coronal plane alignment of the knee (CPAK) class change on functional outcomes and determine the rate and type of CPAK class change after image-based robotic arm-assisted (RA)-total knee arthroplasty (TKA) performed with functional alignment (FA) at two different centres.</p><p><strong>Methods: </strong>The present retrospective, observational, multicentre study included 201 patients treated with RA-TKA between October 2020 and April 2022 at two different centres. The radiographic CPAK classification was adapted using CT images to achieve pre- and post-operative knee categorization into CPAK classes. At a minimum of 1 year post-operatively, patients were administered the Forgotten Joint Score-12 (FJS-12) and surveyed about their post-operative satisfaction level using a 5-level Likert scale (5-LLS).</p><p><strong>Results: </strong>The most common preoperative overall CPAK classes were: Types II, I, III, IV and V. Implant positioning after RA-TKA with FA within the alignment boundaries, determined distribution in the CPAK classification, predominantly maintaining classes I, II, IV, and V. No statistically significant FJS-12 differences were detected between subjects who maintained and changed their preoperative CPAK class. The mean 5-LLS for satisfaction in patients where the preoperative CPAK class was maintained intraoperatively was 4.4 ± 1.1 (range = 1-5), while subjects having the CPAK class changed had a mean 5-LLS of 4.4 ± SD 1.0 (range 1-5).</p><p><strong>Conclusion: </strong>In the setting of image-based RA-TKA with FA, CPAK can be changed within a 'functional safe-zone', without compromising functional outcomes. Good functional outcomes are the result of a stable and balanced knee with soft-tissue preservation, regardless of the maintenance of the preoperative CPAK class.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior cruciate ligament reconstruction with six and eight-strand hamstring tendon autografts produces adequate graft dimensions and functional outcomes: A systematic review.","authors":"Bryan Sun, Boss Lee, Justin Grad, Dan Cohen, Jihad Abouali, Sachin Tapasvi, Adit Maniar, Darren de Sa","doi":"10.1002/ksa.12556","DOIUrl":"https://doi.org/10.1002/ksa.12556","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to summarize the graft dimensions, failure rates, return-to-sport rates and patient-reported outcome measures (PROMs) following anterior cruciate ligament reconstruction (ACLR) with six or eight-strand hamstring tendon autografts (6SHG or 8SHG).</p><p><strong>Methods: </strong>Three databases were searched from inception to 12 February 2024. The authors adhered to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. All clinical studies reporting patient demographics, objective clinical outcomes and PROMs following ACLR with 6SHG or 8SHG were included for data synthesis. PROMs included the International Knee Documentation Committee (IKDC), Lysholm and Tegner scores.</p><p><strong>Results: </strong>Thirteen studies comprising 1103 patients were included (mean age: 30.6 years). The transtibial technique was used in all studies, except one study using anatomic ACLR (n = 38), and one study using transtibial and all-inside ACLR (n = 41). Eight studies comprising 512 patients used 6SHG, four studies comprising 507 patients 8SHG and two studies comprising 97 patients used either. Mean graft diameters ranged from 8.0 to 9.2 mm (6SHG) and 9.1 to 9.9 mm (8SHG). Mean graft lengths for 49 6SHG patients ranged from 60.0 to 83.3 mm. The failure rate for 817 patients (6SHG or 8SHG) was 4.8% (0.0%-20.0%). The return-to-sport rate for 112 patients (6SHG or 8SHG) was 75.9% (69.7%-100.0%). Mean IKDC, Lysholm and Tegner scores for 6SHG or 8SHG were 88.4 (86.1-96.3), 91.7 (90.4-96.5) and 6.9 (6.5-7.3), respectively.</p><p><strong>Conclusions: </strong>Both 6SHG and 8SHG produced graft diameters <8 mm. Data regarding PROMs suggested good patient satisfaction based on established criteria. Re-rupture and return-to-sport rates were 4.8% and 75.9%, respectively.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative quadriceps malalignment is associated with poor outcomes after knee replacement which are avoided by external rotation of the femoral component.","authors":"Simon Talbot, Rachel Zordan, Francesca Sasanelli, Matthew Sun","doi":"10.1002/ksa.12544","DOIUrl":"https://doi.org/10.1002/ksa.12544","url":null,"abstract":"<p><strong>Purpose: </strong>Lateralisation of the proximal apex of the quadriceps tendon relative to the mechanical axis or external rotation relative to the femoral shaft can be accurately measured and is strongly associated with patella maltracking. The aim of this study was to first assess the association between preoperative quadriceps tendon alignment (QTA) and the patient-reported outcomes (PROMs) of total knee replacement, and second, determine the influence of component position on outcomes in patients with preoperative quadriceps tendon malalignment (QTM).</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data was performed. All patients had preoperative and postoperative CT scans performed. PROMs were collected preoperatively and at 1 year postoperatively. QTA was measured by the quadriceps tendon axial angle (QTAx). The preoperative and postoperative coronal and axial alignment were measured. Femoral component rotation was measured relative to the preoperative posterior condyles.</p><p><strong>Results: </strong>Analysis was conducted on 388 cases and the mean preoperative QTAx was 6.2° externally rotated (standard deviation 12.0°). QTM (QTAx > 14°) was identified in 76 (19.8%) patients. The diagnosis of QTM was associated with reduced patient outcomes including Forgotten Joint Score (60.2 vs. 51.2, p = 0.008), EuroQol Visual Analogue Scale (81.3 vs. 75.7, p = 0.009), KOOS-12 (80.3 vs. 73.3, p = 0.001) and reduced PASS percentages for all KOOS subscales. In patients with preoperative QTM, femoral component external rotation >2° was associated with improved PROMs when compared to patients with <2° of femoral rotation. This included a clinically significant difference in the improvement of KOOS-12 (11.7 points, p = 0.013) and improved PASS percentages in all KOOS subscales. There was no association between coronal alignment or tibial axial alignment and outcomes.</p><p><strong>Conclusions: </strong>Quadriceps malalignment is a common cause for poorer patient outcomes following total knee replacement. This can be avoided by externally rotating the femoral component to accommodate the deformity in the extensor mechanism.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture tapes show superior biomechanical properties and greater meniscal healing compared to conventional sutures in posterior meniscal root tear repairs: A systematic review.","authors":"Khalis Boksh, Duncan E T Shepherd, Daniel M Espino, Arijit Ghosh, Tarek Boutefnouchet, Randeep Aujla","doi":"10.1002/ksa.12554","DOIUrl":"https://doi.org/10.1002/ksa.12554","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to perform a systematic review to determine whether ultra-high molecular weight polyethylene (UHMWPE) tapes have superior biomechanical properties compared to conventional sutures in posterior meniscal root tear (PMRT) repairs, and whether this translates into superior clinical outcomes.</p><p><strong>Methods: </strong>The Cochrane Controlled Register of Trials, PubMed and Embase were used to perform a systematic review using the following search terms: (meniscus OR meniscal) AND (root OR posterior horn) AND (suture OR tape OR wire OR cord). Data pertaining to certain biomechanical properties (load to failure, stiffness, displacement during cyclical loading and at failure), meniscal healing and patient-reported outcome measures (PROMs) were extracted.</p><p><strong>Results: </strong>Seven biomechanical and two clinical studies were included. There were 232 knees for biomechanical testing: 81 with UHMWPE tapes and 151 with conventional sutures (133 with UHMWPE sutures and 18 with Ethibond [Ethicon]). Testing set-up was similar across studies, but there were differences in repair techniques, including suture configuration, location and method of fixation. In general, the consensus was that tapes had a higher load to failure and stiffness, with similar displacement at failure to that of UHMWPE sutures. A similar trend was also observed when tapes were compared to Ethibond, except for FiberTape (Arthrex). This particular UHMWPE tape showed greater displacement during cyclical loading, resulting from knot slippage. Clinically, there were 73 patients, 41 with UHMWPE tapes and 32 with either UHMWPE sutures (n = 18) or braided polyester sutures (n = 14). Tapes led to greater meniscal healing 1 year postoperatively, with PROMs similar across groups.</p><p><strong>Conclusions: </strong>UHMWPE tapes generally demonstrated superior biomechanical properties compared to conventional sutures in PMRT repairs with a simple stitch configuration. However, further biomechanical studies are required to determine the extent to which tapes contribute to the repaired construct, especially with more complex repair configurations, as the existing evidence displayed a notable amount of methodological heterogeneity.</p><p><strong>Level of evidence: </strong>Level IV systematic review of level IV evidence.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short and proximalized interference screw fixation leads to tibial tunnel bone re-growth and better hamstring graft integration in ACL reconstruction.","authors":"Francisco J Simon-Sanchez, Simone Perelli, Nicola Pizza, Michelangelo Delmedico, Rodolfo Morales-Avalos, Raúl Torres Claramunt, Joan C Monllau","doi":"10.1002/ksa.12551","DOIUrl":"https://doi.org/10.1002/ksa.12551","url":null,"abstract":"<p><strong>Purpose: </strong>The stability of the graft in the bony tunnels is of utmost importance in the anterior cruciate ligament reconstruction (ACLR) since it ensures safe healing at the tendon-bone interface. The hypothesis was that when a double tibial fixation was used in ACLR with a short graft of autologous hamstrings, tibial tunnel bone re-growth and better graft integration would be observed at short-term follow-up.</p><p><strong>Methods: </strong>The analysis included a cohort of 112 patients after a primary ACLR with hamstring tendons who underwent postoperative magnetic resonance imaging (MRI) 3.0-Tesla (3.0-T) 6 months after the surgery. The patients were divided into three groups based on the tibial fixation technique: 40 had a screw (group S), 35 had a screw and cortical button (group S + B) and 37 had a screw and anchor (group S + A). Two orthopaedic specialists independently evaluated the images, who measured the screw-free tunnel space, and assessed the presence of bone filling in the free tunnel. Furthermore, Ge's protocol was used to determine the graft healing in the tunnel.</p><p><strong>Results: </strong>In 94 patients a screw-free tunnel space was detected, and a filling of the tunnel was reported in 80.85% of the cases (76 patients), being partial in 15.79% (12 patients) and complete in 84.21% (64 patients). Patients who presented better graft integration (Ge1) had significantly higher values of screw-free tunnel length compared to the other ones who had lower graft integration (Ge3)(p < 0.05).</p><p><strong>Conclusions: </strong>At 6 months postoperative MRI, tibial tunnel bone re-growth and graft-tunnel tibial integration after hamstring ACLR is significantly associated with the presence of free space between the anterior tibial cortex and the most distal portion of the interference screw, hence the use of a short and proximalized interference screw is suggested to restore bone stock after hamstring ACLR.</p><p><strong>Level of evidence: </strong>Level IV retrospective comparative cohort study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigated versus conventionally instrumented total knee arthroplasty techniques: No difference in functional alignment or balance.","authors":"Shane P Russell, Sarah Keyes, Grant Grobler, James A Harty","doi":"10.1002/ksa.12557","DOIUrl":"https://doi.org/10.1002/ksa.12557","url":null,"abstract":"<p><strong>Purpose: </strong>Much debate exists about the superiority of navigated versus conventional instrumentation for achieving optimal balance and alignment during total knee arthroplasty (TKA). Recent registry data indicate no long-term survivorship benefit for TKAs performed using technology assistance, despite the added resource and financial costs. However, outcome comparisons are confounded by varying surgeon techniques and targets for ideal balance and alignment. This study aimed to investigate alignment or balance outcome differences between navigated and conventionally instrumented TKAs performed using an identical operative sequence and alignment strategy.</p><p><strong>Methods: </strong>Fifty navigated and 50 conventionally instrumented primary TKAs, using an identical inverse kinematic alignment strategy, were included. Navigation equipment was used intraoperatively to 'post-cut' record the conventionally instrumented TKAs. Intraoperative balance, range, and alignment; and post-operative radiographic accuracy for restoration of constitutional alignment were compared.</p><p><strong>Results: </strong>Forty-nine navigated and 49 conventionally instrumented TKAs were compared (n = 2 excluded due to inadequate radiographs). No preoperative demographic or deformity severity differences existed. No intraoperative balance, range or alignment difference existed. Neither technique was more accurate for restoration of constitutional alignment.</p><p><strong>Conclusion: </strong>Whilst large registry data may be confounded by uncaptured variables such as surgeon balancing techniques or surgeon alignment strategy preferences, this study found no alignment or balance differences between navigated versus conventionally instrumented TKA techniques for a surgeon and technique-controlled study. Although the increased resources necessary for technology assistance are not justified by this study, further studies may identify significance using larger samples or comparison of alternative outcomes.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cut-off value for the posterior tibial slope indicating the risk for retear of the anterior cruciate ligament.","authors":"Anel Dracic, Domagoj Zeravica, Ivica Zovko, Marcus Jäger, Sascha Beck","doi":"10.1002/ksa.12552","DOIUrl":"https://doi.org/10.1002/ksa.12552","url":null,"abstract":"<p><strong>Purpose: </strong>The significance of the posterior tibial slope (PTS) has increasingly come into focus in anterior cruciate ligament (ACL) reconstruction being a risk factor for ACL graft failure. Nevertheless, inconsistent data on the critical value of the PTS exist. The purpose of this study was to define a cut-off value for the PTS in ACL surgery.</p><p><strong>Methods: </strong>In a retrospective cohort study, 350 revision ACL reconstructions (ACL-RR) with a failed ACL hamstring graft and 350 primary ACL reconstructions (ACL-R) were matched according to age, gender, concomitant injuries and graft characteristics and compared to a healthy control group. Using the proximal anatomic axis, lateral knee radiographs were evaluated for the PTS, interrater reliability was defined, ROC curves, Fischer's exact test and Baptista-Pike method were applied to define specificity and the odds ratio for a critical PTS value.</p><p><strong>Results: </strong>Radiographic evaluation proved excellent interrater reliability (intraclass correlation coefficient 0.969). Evaluation of the PTS revealed 10.0 ± 2.2 (5-15) degrees in the ACL-RR group, 7.8 ± 1.8 (4.2-13) degrees in the ACL-R group and 6.6 ± 1.9 (3.6-12) degrees in the control group with significant differences between the groups (p < 0.001). A PTS value of 10.1 degrees proved a specificity of 98% for the prediction of an ACL graft failure and indicated an 11-fold risk for a retear of the ACL.</p><p><strong>Conclusion: </strong>A PTS exceeding 10.1 degrees carries an 11-fold risk for ACL graft failure and, therefore, should be considered in ACL reconstruction. These findings might serve as a cut-off value for the indication of a slope-reducing high tibial osteotomy in ACL surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive analysis of economic and clinical outcomes in total knee arthroplasty: Identifying high-risk patients for increased costs and length of stay.","authors":"David Maman, Guy Liba, Michael Tobias Hirschmann, Lior Ben Zvi, Linor Fournier, Yaniv Steinfeld, Yaron Berkovich","doi":"10.1002/ksa.12547","DOIUrl":"https://doi.org/10.1002/ksa.12547","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to predict high-risk patients who experience significant increases in hospital charges and length of stay (LOS) following specific postoperative complications.</p><p><strong>Methods: </strong>This study analyzed over two million patients from the Nationwide Inpatient Sample database undergoing elective total knee arthroplasty (TKA) for primary osteoarthritis. Baseline demographics, clinical characteristics and incidence of postoperative complications were examined. A neural network model was utilized to predict high-risk patients who fall into the top 25% for both LOS and total hospital charges after complications such as sepsis or surgical site infection (SSI).</p><p><strong>Results: </strong>The most common complications were blood loss anaemia (14.6%), acute kidney injury (1.6%) and urinary tract infection (0.9%). Patients with complications incurred significantly higher total charges (mean $66,804) and longer LOS (mean 2.9 days) compared to those without complications (mean $58,545 and 2.1 days, respectively). The neural network model demonstrated strong predictive performance, with an area under the curve of 0.83 for the training set and 0.78 for the testing set. Key complications like sepsis and SSIs significantly impacted hospital charges and LOS. For example, a 57-year-old patient with diabetes and sepsis had a 100% probability of being in the top 25% for both total charges and LOS.</p><p><strong>Conclusion: </strong>Postoperative complications in TKA patients significantly increase hospital charges and LOS. The neural network model effectively predicted high-risk patients after specific complications occurred, offering a potential tool for improving patient management and resource allocation.</p><p><strong>Levels of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}