Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Partial weight-bearing and range of motion limitation significantly reduce the loads at medial meniscus posterior root repair sutures in a cadaveric biomechanical model.","authors":"Matthias Sukopp, Nina Schwab, Jonas Schwer, Julian Frey, Jonas Walter Metzger, Anita Ignatius, Mario Perl, Firooz Salami, Daniel Vogele, Thomas Kappe, Andreas Martin Seitz","doi":"10.1002/ksa.12465","DOIUrl":"https://doi.org/10.1002/ksa.12465","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to investigate the influence of medial meniscus posterior root avulsion (MMPRA) before and after surgical treatment on the biomechanics of the knee joint, including suture repair forces during daily and crutch-assisted gait movements.</p><p><strong>Methods: </strong>MMPRA were investigated in eight human cadaver knee joint specimens by a dynamic knee joint simulator with daily (normal gait, gait with additional rotational movement, standing up, sitting down) and rehabilitation-associated movements (crutch-assisted gait with limited flexion range of motion [30°] and 30% [toe-touch weight-bearing, TTWB] and 50% of body weight [partial weight-bearing, PWB]) with simulated physiologic muscle forces. Each specimen was tested in intact, torn and repaired (transtibial suture) state. The biomechanical parameters were: medial mean contact pressure and area, knee joint kinematics, medial displacement of the posterior meniscus horn and loading on the anchoring suture.</p><p><strong>Results: </strong>Significant reduction of the contact area due to the avulsion was observed in all movements except for PWB and sitting down. MMPRA repair significantly increased the contact areas during all movements, bringing them to levels statistically indistinguishable from the initial state. MMPRA resulted in a medial displacement up to 12.8 mm (sitting down) and could be reattached with a residual displacement ranging from 0.7 mm (PWB) to 5.7 mm (standing up), all significantly (p < 0.001) reduced compared to the torn state. The mean peak anchoring suture load increased from TTWB (77 N), PWB (91 N) to normal gait (194 N), gait rotation (207 N), sitting (201 N; p < 0.01) and to standing up (232 N; p = 0.03).</p><p><strong>Conclusion: </strong>Surgical treatment of MMPRA allows restoration of physiological knee joint biomechanics. Crutch-assisted movements reduce the loading of the repair suture, thus likewise the risk for failure. From a biomechanical point of view, crutch-assisted movements are recommended for the early rehabilitation phase after MMPRA repair.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290200","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":"Secondary matrix-associated autologous chondrocyte implantation after failed cartilage repair shows superior results when combined with autologous bone grafting: Findings from the German Cartilage Registry (KnorpelRegister DGOU).","authors":"Johannes Weishorn, Philipp Niemeyer, Peter Angele, Gunther Spahn, Thomas Tischer, Tobias Renkawitz, Yannic Bangert","doi":"10.1002/ksa.12467","DOIUrl":"https://doi.org/10.1002/ksa.12467","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate whether additive autologous bone grafting (ABG) improves clinical outcome and survival in revision matrix-associated autologous chondrocyte implantation (M-ACI) after failed cartilage repair (CR).</p><p><strong>Methods: </strong>A retrospective, registry-based, matched-pair analysis was performed to compare patient-reported outcomes and survival in secondary M-ACI with or without additional bone grafting for focal full-thickness cartilage defects of the knee and to compare it with those in primary M-ACI. Patients were matched for age, sex, body mass index, defect size and localization, and number of previous CRs. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed over a follow-up period of 36 months. The patient acceptable symptomatic state, the clinical response rate and the survival of the subgroups were determined.</p><p><strong>Results: </strong>A total of 818 patients were matched. Revision M-ACI (n = 238) with concomitant bone grafting was associated with significantly higher PRO as measured by KOOS (80.8 ± 16.8 vs. 72.0 ± 17.5, p = 0.032) and higher CRR (81.4% vs. 52.0%, p = 0.018) at 36 months compared to patients with revision M-ACI alone. KOOS and KOOS improvement in these patients did not differ from those who underwent primary M-ACI (p = n.s.). The combination of M-ACI and ABG resulted in a significantly higher KOOS at 36 months than M-ACI alone, regardless of whether bone marrow stimulation (89.6 ± 12.5 vs. 68.1 ± 17.9, p = 0.003) or ACI (82.6 ± 17.0 vs. 72.8 ± 16.0, p = 0.021) was performed before. Additional bone grafting results in equivalent survival rates at 7 years in secondary compared to primary M-ACI (83% vs. 84%, p = n.s.).</p><p><strong>Conclusions: </strong>Regardless of the type of previous CR, additional bone grafting in secondary M-ACI improves the clinical outcome, response rate and survival at 36 months compared to M-ACI alone. Secondary M-ACI with ABG had comparable clinical response and survival rates to primary M-ACI. Therefore, subchondral bone should be treated even in cases of mild bone involvement in revision M-ACI.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290201","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":"The early peak knee abduction moment waveform is a novel risk factor predicting anterior cruciate ligament injury in young athletes: A prospective study.","authors":"Haraldur Björn Sigurðsson,Melkorka Katrín Fl Pétursdóttir,Kristín Briem","doi":"10.1002/ksa.12471","DOIUrl":"https://doi.org/10.1002/ksa.12471","url":null,"abstract":"PURPOSEIn this study, prospective data were used to evaluate whether the early peak knee abduction moment waveform is associated with the risk of anterior cruciate ligament (ACL) injury.METHODSBiomechanical data from 84 athletes who participated in the study as adolescents were analysed after cross-referencing national health registry data to confirm ACL reconstruction in the subsequent years. The knee abduction moment waveform shape was obtained with cluster analysis for the first 100 ms of a cutting manoeuvre (1776 trials in total) and classified as either containing an early peak knee abduction moment or not, and the odds ratio for later ACL injury was then calculated. Additionally, discrete kinematic and kinetic variables were extracted, and tested against the risk of ACL injury using mixed model logistic regression.RESULTSOf 84 athletes, 8 (all female) sustained a total of 13 ACL injuries in the years after motion analysis data collection. Six clusters of knee abduction moment waveform shapes were identified. Two clusters containing 446 trials were classified as an early peak knee abduction waveform. This waveform was associated with a 7.2-fold increase in the risk of ACL injury (95% confidence interval: 2.4-24.6; p < 0.001). Of the kinematic and kinetic variables tested, only the knee abduction angle at initial contact was associated with an increased risk of ACL injury (p < 0.001).CONCLUSIONThis is the first study to confirm the association between the early peak knee abduction moment waveform and the risk of ACL injury. Using waveforms, instead of discrete peak values of the knee abduction moment, may better represent risky movement patterns. Replicating these findings in a larger cohort will support the use of this method to screen athletes for risk and guide targeted preventive interventions and their efficacy.LEVEL OF EVIDENCELevel II.","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142210872","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":"Significant systematic bias of alpha angles measured on MRI compared to various radiographic views in patients with femoroacetabular impingement syndrome.","authors":"Jairo Triana,Dhruv S Shankar,Michael A Moore,Berkcan Akpinar,Kinjal D Vasavada,Christopher J Burke,Mohammad M Samim,Thomas Youm","doi":"10.1002/ksa.12446","DOIUrl":"https://doi.org/10.1002/ksa.12446","url":null,"abstract":"PURPOSEThe aim of this study was to assess the inter-rater reproducibility and inter-method comparability of hip alpha angle measurements on magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA) and plain radiographs in patients with femoroacetabular impingement syndrome (FAIS).METHODSA cross-sectional study of patients who were diagnosed with symptomatic FAIS underwent preoperative MRI/MRA with axial oblique and/or radial plane imaging and had preoperative radiographs with anterior-posterior (AP), 45° Dunn and 90° Dunn views. Alpha angle measurements were performed independently by two musculoskeletal radiologists. Inter-rater reproducibility and inter-method comparability between MRI/MRA images and radiographic views were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval (CI).RESULTSNinety-seven patients were included of whom 93 (95.8%) received axial oblique plane images and 54 (55.6%) had radial plane MRI/MRA images. Inter-rater reproducibility was excellent (ICC > 0.9) for all planes on MRI/MRA and radiographs. MRI/MRA axial oblique images had poor (ICC 0.39, 95% CI [0.09, 0.59]), moderate (ICC 0.57, 95% CI [0.18, 0.75]) and moderate (ICC 0.64, 95% CI [0.20, 0.81]) comparability with AP, 45° Dunn and 90° Dunn, respectively. MRI/MRA radial plane images had equivocal (0 included in all CIs) comparability with AP (ICC 0.66), 45° Dunn (ICC 0.35) and 90° Dunn (ICC 0.14) radiographs. On average, alpha angle measurements were significantly higher with radial images and lower with axial oblique images, when compared to all radiographic views (p < 0.05), except axial oblique versus 45° Dunn views, where angles measured on axial oblique were significantly larger.CONCLUSIONAlpha angle measurements taken on axial oblique MRI/MRA images show moderate comparability to radiographic 45° Dunn and 90° Dunn views despite negative bias to measurements taken on radiographic AP and 45° Dunn view. Larger alpha angles were appreciated on MRI/MRA radial and axial oblique views compared to radiographic views supporting the inclusion of MRI/MRA alpha angle measurements to properly identify deformity.LEVEL OF EVIDENCELevel II.","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142210877","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":"Combined PCL instabilities cannot be identified using posterior stress radiographs in external or internal rotation: A cadaveric study.","authors":"Thorben Briese,Romy Riemer,Adrian Deichsel,Christian Peez,Elmar Herbst,Johannes Glasbrenner,Michael J Raschke,Christoph Kittl","doi":"10.1002/ksa.12458","DOIUrl":"https://doi.org/10.1002/ksa.12458","url":null,"abstract":"PURPOSEPosterior stress radiography is recommended to identify isolated or combined posterior cruciate ligament (PCL) deficiencies. The posterior drawer in internal (IR) or external rotation (ER) helps to differentiate between these combined instabilities. The purpose of this study was to evaluate posterior stress radiography (PSR) in isolated and combined PCL deficiency with IR and ER compared to PSR in neutral rotation (NR) for diagnosing combined PCL instabilities.METHODSSix paired fresh-frozen human cadaveric legs (n = 12) were mounted in a Telos device for PSR. The tibia was rotated using an attached foot apparatus capable of rotating the foot 30° internally and externally. A posterior tibial load of 15 kp (147.1 N) was applied to the tibial tubercle at 90° knee flexion, and a lateral radiograph was obtained. This was repeated with the foot in 30° IR and ER. The PCL, posterolateral complex (PLC), and posteromedial complex (PMC) were sectioned in six knees, while the PMC was sectioned before the PLC in the other six knees. Posterior tibial displacement (PTD) was measured radiographically. Statistical analysis was performed using a two-way ANOVA and a mixed model with Bonferroni correction, and the significance was set at p < 0.05. Furthermore, intra- and interobserver reliability was determined.RESULTSCutting the PCL significantly increased the radiographic PTD by 9.8 ± 1.8 mm (side-to-side difference compared to the intact state of the knee, n = 12; p < 0.001). This further increased to 12.2 ± 2.3 mm (n = 6; p < 0.01) with an additional PLC deficiency and to 15.4 ± 3.4 mm (n = 6; p < 0.05) with an additional PMC deficiency. A combined PLC and PMC deficiency resulted in an increase of the PTD to 15.9 ± 4.5 mm (n = 12; p < 0.01). In the PCL/PLC deficient state, ER did not demonstrate a higher PTD, compared to the NR and IR posterior drawer. In the PCL/PMC deficient state in IR, PTD was 1.6 ± 0.7 mm (p < 0.01) higher compared to NR and 3.2 ± 1.9 mm (p < 0.05) higher compared to ER. We showed excellent intra- and interobserver reliability (0.987-0.997).CONCLUSIONCombined PCL instabilities resulted in a significant increase in posterior tibial displacement in posterior stress radiographs. However, PSR in IR or ER was unable to differentiate between these combined instabilities. Based on our data, additional stress radiographs in rotation are unlikely to provide any diagnostic benefit in the clinical setting.LEVEL OF EVIDENCEThere is no level of evidence as this study was an experimental laboratory study.","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142210878","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":"A bone graft from the tibial resection or patella that rectified a tibial over-resection reliably healed and improved clinical outcome scores: A retrospective study of kinematically aligned TKA.","authors":"Alexander J Nedopil, Daniel Razick, Stephen M Howell, Maury L Hull","doi":"10.1002/ksa.12457","DOIUrl":"https://doi.org/10.1002/ksa.12457","url":null,"abstract":"<p><strong>Purpose: </strong>During kinematically aligned (KA) total knee arthroplasty (TKA), the surgeon may need to rectify an over-resection of the medial, lateral or posterior tibia. This study tested the hypothesis that a bone graft taken from the tibial resection or patella and impacted beneath a tibial baseplate would heal, regardless of whether the tibial component and knee were in outlier ranges according to mechanical alignment (MA) criteria. The study also tested the hypothesis that the Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) would improve beyond the substantial clinical benefit and that the source and thickness of the bone graft would not influence their improvement.</p><p><strong>Methods: </strong>This retrospective study radiographically assessed the healing of a bone graft from the tibial resection (n = 19) or patella (n = 10) in 29 KA TKAs (18 females, mean age 65 years). The tibial component and knee alignment were categorized as in-range or outliers based on reported MA criteria for bone graft healing and implant survival. The one-sample t test identified differences in the improvement of the OKS and KOOS JR from their reported substantial clinical benefit of 16 and 20 points, respectively.</p><p><strong>Results: </strong>At an average follow-up of 37 months, all bone grafts healed even though ≥55% of tibial components and 34% of knees were varus outliers according to MA criteria for bone healing and implant survival. Amongst the 29 patients, the mean OKS and KOOS JR improvements of 25 ± 11 and 47 ± 21 points, respectively, surpassed the threshold of their respective substantial clinical benefit (p < 0.01) and were not influenced by the bone graft's source and thickness (p ≥ 0.51).</p><p><strong>Conclusions: </strong>During cemented KA TKA, the surgeon can use a bone graft from the tibial resection or patella to rectify a tibial over-resection. This technique led to consistent bone healing and improved outcome scores.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154475","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":"Excellent results of restricted kinematic alignment total knee arthroplasty at a minimum of 10 years of follow-up.","authors":"Mina W Morcos, Gautier Beckers, Andrea Giordano Salvi, Mourad Bennani, Vincent Massé, Pascal-André Vendittoli","doi":"10.1002/ksa.12452","DOIUrl":"https://doi.org/10.1002/ksa.12452","url":null,"abstract":"<p><strong>Purpose: </strong>While restricted kinematic alignment (rKA) total knee arthroplasty (TKA) with cemented implants has been shown to provide a similar survivorship rate to mechanical alignment (MA) in the short term, no studies have reported on the long-term survivorship and function.</p><p><strong>Methods: </strong>One hundred four consecutive cemented cruciate retaining TKAs implanted using computer navigation and following the rKA principles proposed by Vendittoli were reviewed at a minimum of 10 years after surgery. Implant revisions, reoperations and clinical outcomes were assessed using knee injury and osteoarthritis outcome score (KOOS), forgotten joint score (FJS), patients' satisfaction and joint perception questionnaires. Radiographs were analyzed to identify signs of osteolysis and implant loosening.</p><p><strong>Results: </strong>Implant survivorship was 99.0% at a mean follow-up of 11.3 years (range: 10.3-12.9) with one early revision for instability. Patients perceived their TKA as natural or artificial without limitation in 50.0% of cases, and 95.3% were satisfied or very satisfied with their TKA. The mean FJS was 67.6 (range: 0-100). The mean KOOS were as follows: pain 84.7 (range: 38-100), symptoms 85.5 (range: 46-100), function in daily activities 82.6 (range: 40-100), function in sport and recreation 35.2 (range: 0-100) and quality of life 79.1 (range: 0-100). No radiological evidence of implant aseptic loosening or osteolysis was identified.</p><p><strong>Conclusion: </strong>Cemented TKA implanted with the rKA alignment protocol demonstrated excellent long-term implant survivorship and is a safe alternative to MA to improve patient function and satisfaction.</p><p><strong>Level of evidence: </strong>IV, continuous case series with no comparison group.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154476","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":"Several factors predict the achievement of the patient acceptable symptom state and minimal clinically important difference for patient-reported outcome measures following anterior cruciate ligament reconstruction: A systematic review.","authors":"Bryan Sun, Prushoth Vivekanantha, Hassaan Abdel Khalik, Darren de Sa","doi":"10.1002/ksa.12460","DOIUrl":"https://doi.org/10.1002/ksa.12460","url":null,"abstract":"<p><strong>Purpose: </strong>To summarize the predictors of the patient acceptable symptom state (PASS), minimal clinically important difference (MCID) and minimal important change (MIC) for patient-reported outcome measures (PROMs) following anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methods: </strong>MEDLINE, PubMed and Embase were searched from inception to 5 January 2024. The authors adhered to PRISMA/R-AMSTAR guidelines, and the Cochrane Handbook for Systematic Reviews of Interventions. Data on statistical associations between predictive factors and PROMs were extracted. Inverse odds ratios (ORs) and confidence intervals (reverse group comparison) were calculated when appropriate to ensure comparative consistency.</p><p><strong>Results: </strong>Thirteen studies comprising 21,235 patients (48.1% female) were included (mean age 29.3 years). Eight studies comprising 3857 patients identified predictors of PASS, including lateral extra-articular tenodesis (LET) (OR = 11.08, p = 0.01), hamstring tendon (HT) autografts (OR range: 2.02-2.63, p ≤ 0.011), age over 30 (OR range: 1.37-2.28, p ≤ 0.02), male sex (OR range: 1.03-1.32, p ≤ 0.01) and higher pre-operative PROMs (OR range: 1.04-1.21). Eight studies comprising 18,069 patients identified negative predictors of MCID or MIC, including female sex (OR = 0.93, p = 0.034), absence of HT autografts (OR = 0.70, p < 0.0001), higher pre-operative PROMs (OR = 0.76-0.84, p ≤ 0.01), meniscectomy (OR = 0.67, p = 0.014) and collision sports (OR = 0.02-0.60, p ≤ 0.05).</p><p><strong>Conclusion: </strong>Higher pre-operative PROMs, age over 30, male sex, LETs and HT autografts predicted PASS achievement. Lower pre-operative PROMs, male sex, non-collision sports, and lack of meniscectomies predicted MCID/MIC achievement. This review provides a comprehensive understanding of the predictors of clinically significant post-ACLR outcomes, thus improving clinical decision-making and the management of patient expectations.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154477","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":"The bioinductive collagen implant yields positive histological, clinical and MRI outcomes in the management of rotator cuff tears: A systematic review.","authors":"Umile Giuseppe Longo, Martina Marino, Alessandro de Sire, Miguel A Ruiz-Iban, Pieter D'Hooghe","doi":"10.1002/ksa.12429","DOIUrl":"https://doi.org/10.1002/ksa.12429","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to report and discuss the outcomes of clinical, histological and animal studies exploring the application of bio-inductive collagen implants (BCIs) to partial and full-thickness rotator cuff tears (PT- and FT-RCTs) in addition to reporting on cost-related factors.</p><p><strong>Methods: </strong>Review of literature was performed using the PRISMA guidelines. A systematic electronic literature search was conducted using the CENTRAL, CINAHL, Cochrane Library, EBSCOhost, EMBASE and Google Scholar bibliographic databases. Microsoft Excel was used to create tables onto which extracted data were recorded. Tables were organized based on the research statement formulated using the PICO approach. No statistical analysis was performed.</p><p><strong>Results: </strong>Nine studies evaluated clinical and MRI outcomes of BCI augmentation for FT-RCTs, seven evaluated similar outcomes when applied to PT-RCTs, two additional studies were case reports and three studies assessed application to FT- and PT-RCTs without stratification of results, one of which also reported on histological data. Two studies reported on histological data alone, and finally, two reported on healthcare costs. BCI augmentation, alone and combined with rotator cuff repair (RCR), displays generally good histological, postoperative clinical and MRI outcomes for PT- and FT-RCT treatment. Recent economic analyses seem to be in favour of the use of this procedure, when selected and applied for appropriate patient populations.</p><p><strong>Conclusion: </strong>Several studies have shown promising results of BCI application to PT- and FT-RCTs, both concomitantly and independently from RCR. Investigations report promising histological characteristics, improved clinical outcomes, increased tendon thickness, reduced defect size and lower re-tear rates.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133121","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":"Optimizing the patellofemoral compartment in total knee arthroplasty: Is it time for dynamic assessment?","authors":"Christos Koutserimpas, Mo Saffarini, Michel Bonnin, Michael T Hirschmann, Sébastien Lustig","doi":"10.1002/ksa.12450","DOIUrl":"https://doi.org/10.1002/ksa.12450","url":null,"abstract":"<p><p>Despite improvements in implant design, surgical techniques and assistive technologies for total knee arthroplasty (TKA), anterior knee pain (AKP) remains frequently reported, even by satisfied patients. This persistent problem calls for better understanding and management of the patellofemoral or anterior compartment during surgery, just as the techniques and strategies deployed to optimize the flexion and extension spaces through personalized alignment, bone cuts and ligament balancing. Assistive technologies such as navigation and robotics provide new tools to manage this 'third space' through precise pre-operative planning and dynamic intra-operative assessment. Such endeavors must start with clear definitions of the 'third space', how it should be measured, what constitutes its 'safe zone', and how it affects outcomes. There are yet no established methods to evaluate the patellofemoral compartment, and no clear thresholds to define over- or under-stuffing. Static assessment using lateral radiographs provides a limited understanding and depends considerably on flexion angle, while dynamic evaluation at multiple flexion angles or using intra-operative computer or robotic-assistance enables a broader perspective and solutions to manage patellar tracking and anterior offset. Future studies should investigate the impact of variations in anterior offset in TKA, define its safe zone, and understand the effects of of thresholds for over- or under-stuffing. Experimental methods such as in-vivo motion analysis and force sensors could elucidate the influence of anterior offset on flexion and extension biomechanics.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120166","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}