Knee Surgery and Related Research最新文献

{"title":"Deep vein thrombosis prophylaxis in patients who undergo knee arthroscopy: a systematic review.","authors":"Udit Dave, Emma G Lewis, Victoria K Ierulli, Shreya M Saraf, Mary K Mulcahey","doi":"10.1186/s43019-024-00250-5","DOIUrl":"10.1186/s43019-024-00250-5","url":null,"abstract":"<p><strong>Background: </strong>Knee arthroscopy is one of the most common procedures performed by orthopedic surgeons. A potentially life-threatening complication following this procedure is deep vein thrombosis (DVT). DVT prophylaxis can be obtained both mechanically (e.g., compression stockings) and chemically (e.g., aspirin, anticoagulants, and factor Xa inhibitors). Currently, there is no standardized guideline for DVT prophylaxis following knee arthroscopy. The purpose of this systematic review was to summarize how DVT prophylaxis is employed for patients who undergo knee arthroscopy.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane Library were searched for studies published after 1998 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated DVT prophylaxis regimens in patients of any age who underwent knee arthroscopy. Studies not written in English, that analyzed animals or cadavers, that did not directly evaluate patients undergoing knee arthroscopy, or that did not address DVT prophylaxis were excluded.</p><p><strong>Results: </strong>The initial search identified 300 studies, 15 of which were included. These 15 studies examined methods of DVT prophylaxis, including compression stockings (2 of 18; 11%), aspirin (1 of 18; 6%), factor Xa inhibitors (2 of 18; 11%), low-molecular-weight heparin (12 of 18; 67%), and neuromuscular electrical stimulation (1 of 18; 6%). Overall, 7 of 15 (47%) studies recommended DVT prophylaxis in all patients, and 3 (20%) studies supported its use for high-risk patients. Five (33%) studies did not support DVT prophylaxis, citing low incidence of postoperative DVT.</p><p><strong>Conclusions: </strong>Compression stockings, aspirin, factor Xa inhibitors, and low-molecular-weight heparin (LMWH) were identified as possible options for DVT prophylaxis in patients undergoing knee arthroscopy. For high-risk knee arthroscopy patients, factor Xa inhibitors and LMWH drugs are appropriate for DVT prophylaxis. Level of evidence Level III, systematic review of level I-III studies.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis.","authors":"Jisu Park, Moon Jong Chang, Tae Woo Kim, Darryl D D'Lima, Hyunkwon Kim, Hyuk-Soo Han","doi":"10.1186/s43019-024-00241-6","DOIUrl":"10.1186/s43019-024-00241-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the sequential changes in patient-reported outcome measures (PROMs) and the satisfaction rate during long-term follow-up after total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>Studies published until December 2023 were searched in MEDLINE, EMBASE, SCOPUS and Cochrane Library. The inclusion criteria were TKA as the primary procedure, a final post-operative follow-up period of at least seven years and reporting of PROMs data. The exclusion criteria were studies not reporting serial data of the same patient cohort, studies without mid-term data, comparative studies and reviews, comments or practice guidelines. Heterogeneity was assessed with the I² and tau² statistics. The quality of each study was evaluated using the methodological index for non-randomized studies (MINORS) criteria. The follow-up periods were divided into short-term, mid-term and long-term. Data were synthesised by narrative reviews and random-effects meta-analysis using standardised mean difference.</p><p><strong>Results: </strong>Among the 13 studies included in the review, six were included in the meta-analysis. The overall PROMs were maintained until the mid-term (0.14; 95% CI [confidence interval], -0.05 to 0.34; I² = 96%; tau² = 0.10; P = 0.16), but declined in the long-term (-0.23; 95% CI -0.34 to -0.13; I² = 88%; tau² = 0.04; P < 0.0001). According to the subgroup analysis, pain improved from the short-term to mid-term (0.21; 95% CI 0.14 to 0.29; I² = 0%; tau² = 0). Subscales including function (-0.28; 95% CI -0.52 to -0.03; I² = 94%; tau² = 0.09) and objective measure (-0.23; 95% CI -0.31 to -0.15; I² = 62%; tau² = 0.01) declined from the mid-term to long-term. The patient satisfaction rate remained consistent throughout the study period.</p><p><strong>Conclusions: </strong>The overall PROMs after TKA were maintained, with improvement observed in the pain subscale until the mid-term follow-up. However, in the long-term, overall PROMs, including function and objective measure, declined compared with those in the mid-term. Despite the decline in the physical aspects of PROMs over the long-term follow-up period, the patient satisfaction rate remained consistently high throughout the study period. Providing this information to patient pre-operatively may assist in establishing realistic expectations. Trial Registration This research was registered at PROSPERO (registration number: CRD42024578579).</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"43"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathologically altered articular cartilage attracts intense chondrocyte invasion into the extracellular matrix: in vitro pilot study.","authors":"Victoria A Shestakova, Ilya D Klabukov, Ilya V Kolobaev, Longfeng Rao, Dmitry A Atiakshin, Michael A Ignatyuk, Mikhail E Krasheninnikov, Bagavdin G Ahmedov, Sergey A Ivanov, Peter V Shegay, Andrey D Kaprin, Denis S Baranovskii","doi":"10.1186/s43019-024-00249-y","DOIUrl":"10.1186/s43019-024-00249-y","url":null,"abstract":"<p><strong>Background: </strong>Due to non-vascularized and aneural structure, articular cartilage has limited self-repairing capacity. The aim of this study was to investigate the revitalization of inflammatory injured articular cartilage matrices by human nasal chondrocytes (hNC).</p><p><strong>Materials and methods: </strong>Cartilage matrix was prepared by devitalization of articular cartilage samples obtained intraoperatively from an adult patient undergoing knee joint replacement. hNC were obtained from native tissues by enzymatic digestion with further expansion over two passages. The obtained nasal chondrocytes were used to seed decellularized scaffolds, which were then cultured in vitro for 7, 14, or 21 days in chondrogenic medium. Migration was observed by histologic staining with fast green, safranin-O, and hematoxylin and scanning electron microscopy. Biochemical analysis was performed to determine the glycosaminoglycan (GAG) and DNA content of the cartilage using dimethylmethylene blue and CyQuant Cell Proliferation Assay Kit.</p><p><strong>Results: </strong>We seeded healthy and inflamed cartilage with nasal chondrocytes and found that the cells actively invade mainly pathologically altered cartilage. The results of biochemical quantitative analysis showed that the amount of DNA significantly increased by day 7 and decreased by day 14, while the quantitative values of GAGs had the opposite trend. Histological staining showed that cartilage formation occurred on day 7, intercellular spaces were filled with de novo synthesized cartilage matrix with significantly low GAG content on day 14, and newly formed GAG-rich cartilage was observed on day 21. The obtained data on cartilage regeneration were confirmed by scanning electron microscopy.</p><p><strong>Conclusions: </strong>Our preliminary results showed that human nasal chondrocytes are capable of infiltrating the pathologically altered extracellular matrix of articular cartilage damaged by arthritis, thereby promoting its repair to a physiologically relevant state.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable postoperative outcomes in patients treated with either open or arthroscopic trochleoplasty for patella dysplasia.","authors":"Georg Riedl, Lukas A Holzer, Vinzenz Smekal","doi":"10.1186/s43019-024-00247-0","DOIUrl":"https://doi.org/10.1186/s43019-024-00247-0","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare the clinical and radiologic results of the arthroscopic and the open trochleoplasty techniques.</p><p><strong>Methods: </strong>A total of 83 trochleoplasties in 83 patients were performed between 2014 and 2021 in one institution. Surgical indications for trochleoplasty were recurrent patellofemoral instability and a lateral trochlear inclination angle (LTI) ≤ 11˚ and a trochlear depth ≤ 6 mm. Of the trochleoplasties, 40 were done by open technique (OT) and 43 by arthroscopic technique (AT). In every case an additional medial patellofemoral ligament (MPFL) reconstruction was performed. Additional tuberosity tibia transfer and/or de-rotation of the femur were done when indicated. Pre- and postoperative magnetic resonance imaging (MRI) were analyzed in respect to LTI, trochlear depth, and lateralization of the patella. Postoperative subjective clinical assessment was done using the Kujala Score, Banff II Score, Tegner Score, and Marx Score.</p><p><strong>Results: </strong>Of the patients, 15 with OT and 20 with AT were available for follow-up. The mean follow-up was 29.9 months in the OT group and 12.7 months in the AT group. No re-dislocation was observed in either groups. A significant reduction of LTI, increase of trochlear depth, and a reduction of lateralization of the patella was observed between the pre- and postoperative MRI scans in both groups. No significant difference in the observed MRI parameters was found between the two groups. Neither was there a difference in the postoperative Kujala Score, Banff II Score, Tegner Score, and Marx Score between the two groups. Length of stay was on average 6.2 days in the AT group and 8.1 days in the OT group. The surgical time was on average 141 min in the OT group and 160 min in the AT group.</p><p><strong>Conclusion: </strong>We found that patients undergoing an arthroscopic trochleoplasty had a comparable outcome with respect to clinical and radiological parameters compared with patients treated by open trochleoplasty.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a deep learning software for automated measurements on full-leg standing radiographs.","authors":"Louis Lassalle, Nor-Eddine Regnard, Marion Durteste, Jeanne Ventre, Vincent Marty, Lauryane Clovis, Zekun Zhang, Nicolas Nitche, Alexis Ducarouge, Jean-Denis Laredo, Ali Guermazi","doi":"10.1186/s43019-024-00246-1","DOIUrl":"10.1186/s43019-024-00246-1","url":null,"abstract":"<p><strong>Background: </strong>Precise lower limb measurements are crucial for assessing musculoskeletal health; fully automated solutions have the potential to enhance standardization and reproducibility of these measurements. This study compared the measurements performed by BoneMetrics (Gleamer, Paris, France), a commercial artificial intelligence (AI)-based software, to expert manual measurements on anteroposterior full-leg standing radiographs.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on a dataset comprising consecutive anteroposterior full-leg standing radiographs obtained from four imaging institutions. Key anatomical landmarks to define the hip-knee-ankle angle, pelvic obliquity, leg length, femoral length, and tibial length were annotated independently by two expert musculoskeletal radiologists and served as the ground truth. The performance of the AI was compared against these reference measurements using the mean absolute error, Bland-Altman analyses, and intraclass correlation coefficients.</p><p><strong>Results: </strong>A total of 175 anteroposterior full-leg standing radiographs from 167 patients were included in the final dataset (mean age = 49.9 ± 23.6 years old; 103 women and 64 men). Mean absolute error values were 0.30° (95% confidence interval [CI] [0.28, 0.32]) for the hip-knee-ankle angle, 0.75 mm (95% CI [0.60, 0.88]) for pelvic obliquity, 1.03 mm (95% CI [0.91,1.14]) for leg length from the top of the femoral head, 1.45 mm (95% CI [1.33, 1.60]) for leg length from the center of the femoral head, 0.95 mm (95% CI [0.85, 1.04]) for femoral length from the top of the femoral head, 1.23 mm (95% CI [1.12, 1.32]) for femoral length from the center of the femoral head, and 1.38 mm (95% CI [1.21, 1.52]) for tibial length. The Bland-Altman analyses revealed no systematic bias across all measurements. Additionally, the software exhibited excellent agreement with the gold-standard measurements with intraclass correlation coefficient (ICC) values above 0.97 for all parameters.</p><p><strong>Conclusions: </strong>Automated measurements on anteroposterior full-leg standing radiographs offer a reliable alternative to manual assessments. The use of AI in musculoskeletal radiology has the potential to support physicians in their daily practice without compromising patient care standards.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A deep learning based automatic two-dimensional digital templating model for total knee arthroplasty.","authors":"Jaeseok Park, Sung Eun Kim, Back Kim, Sanggyu Lee, Jae-Jun Lee, Du Hyun Ro","doi":"10.1186/s43019-024-00240-7","DOIUrl":"10.1186/s43019-024-00240-7","url":null,"abstract":"<p><strong>Background: </strong>Preoperative templating is an important step for total knee arthroplasty (TKA), facilitating hospital personnel in the anticipation and preparation of necessary surgical resources. Despite its importance, this process currently lacks automation. This study aimed to develop an artificial intelligence (AI) model to automate implant size prediction.</p><p><strong>Methods: </strong>A total of 13,281 (2938 anteroposterior, 10,343 lateral) knee radiographs obtained from the authors' institute were utilized for model training, with 2302 (1034 anteroposterior, 1268 lateral) images set apart for validation and testing. The templating AI model integrates a pipeline composed of multiple steps for automated implant size estimation. To predict implant size, anterioposterior (AP) and lateral radiograph predictions were merged, selecting the smaller of the predicted sizes to prevent implant overhang. The model's size predictions were validated with 81 real TKA data set apart from the training data, and its accuracy was compared to that of manual templating by an orthopedic specialist. Predictions matching the actual implanted sizes were labeled \"exact\" and those within one size, \"accurate.\" The influence of patient characteristics on the model's prediction accuracy was also analyzed. The measurement time elapsed for implant sizing was recorded for both the AI model and the orthopedic specialist. Implant position predicted by the model was validated by comparing insert locations with postoperative images.</p><p><strong>Results: </strong>Compared with data from 81 actual TKA procedures, the model provided exact predictions for 39.5% of femoral and 43.2% of tibial components. Allowing a one-size margin of error, 88.9% of predictions were deemed \"accurate\" for both components. Interobserver reliability (Cohen's kappa) were 0.60 and 0.70 for femoral and tibial implants, respectively, both classified as \"substantial.\" The orthopedic specialist produced results accurate within one-size margin of error in 95.1% and 100% of cases for femoral and tibial components, respectively. Interobserver reliability between the orthopedic specialist and ground truth was 0.76 and 0.8 for femoral and tibial components, respectively. The measurement time per case was 48.7 s for the AI model, compared with 97.5 s for the orthopedic specialist. Compared with postoperative radiographs, predicted implant position had an error of less than 4 mm on average.</p><p><strong>Conclusions: </strong>An AI-based templating tool for TKA was successfully developed, demonstrating satisfactory accuracy and efficiency. Its application could significantly reduce the clinical workload in TKA preparation.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current state of frailty in revision arthroplasty.","authors":"Brendan Kelly, Nicholas Stratigakis, Arsalaan Sayyed, Tyler K Williamson, Cameron Atkison, Taylor Manes, Nithin Gupta, Morgan Turnow, Frank A Buttacavoli","doi":"10.1186/s43019-024-00245-2","DOIUrl":"10.1186/s43019-024-00245-2","url":null,"abstract":"","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"39"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable and non-modifiable risk factors affecting surgical failure after revision ACL reconstruction: a cohort study.","authors":"Hyun-Soo Moon, Min Jung, Chong-Hyuk Choi, Kwangho Chung, Se-Han Jung, Junwoo Byun, Jin-Gyu Kim, Seungmin Lee, Sung-Hwan Kim","doi":"10.1186/s43019-024-00243-4","DOIUrl":"10.1186/s43019-024-00243-4","url":null,"abstract":"<p><strong>Background: </strong>Research on factors influencing the outcomes of revision anterior cruciate ligament (ACL) reconstruction is relatively scarce and mostly relies even on reports from a single group. Understanding the factors contributing to the failure of revision ACL reconstruction can provide valuable information for achieving better clinical outcomes and assist in patient counseling before surgery. Therefore, this study aimed to analyze the factors contributing to surgical failure after revision ACL reconstruction.</p><p><strong>Methods: </strong>The medical records of consecutive patients who underwent single-bundle revision ACL reconstruction using the transportal technique between 2010 and 2020 and had a minimum follow-up of 2 years were retrospectively reviewed. Eligible patients were classified into two groups on the basis of the presence of surgical failure during the follow-up period (group NF, patients who did not experience surgical failure; group F, patients who experienced surgical failure). In this study, surgical failure after revision ACL reconstruction was defined as meeting any of the following conditions during follow-up: the presence of graft re-tear confirmed by magnetic resonance imaging (MRI), anterior-posterior laxity graded ≥ 2, or rotational laxity graded ≥ 2. A comparative analysis was conducted on demographic data, as well as peri-, intra-, and postoperative data between the groups. Additionally, a regression analysis was performed to investigate factors influencing surgical failure after revision ACL reconstruction.</p><p><strong>Results: </strong>A total of 58 patients were included (group NF, 40 patients; group F, 18 patients). In between-group comparisons of demographic, peri-, and intra-operative data, group F exhibited a higher frequency of multiple revision surgeries (P = 0.001), increased preoperative osteoarthritis grade (P = 0.001), and shallower femoral tunnel depth (P = 0.002) compared with group NF. At the final follow-up, group F demonstrated relatively poor clinical outcomes, both subjectively and objectively. Multivariate regression analysis revealed that all variables that showed differences in the preceding comparisons were independent factors affecting surgical failure after revision ACL reconstruction.</p><p><strong>Conclusions: </strong>Surgical failure after revision ACL reconstruction can occur in a substantial number of patients, influenced by non-modifiable factors, such as cases corresponding to multiple revision surgery and preoperative osteoarthritis grade, and modifiable factors, such as femoral tunnel depth.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractures in Oxford unicompartmental knee arthroplasty are associated with a decreased medial keel-cortex distance of the tibial implant.","authors":"Julius Watrinet, Daniel Berger, Philipp Blum, Matthias P Fabritius, Jörg Arnholdt, Rolf Schipp, Wolfgang Reng, Paul Reidler","doi":"10.1186/s43019-024-00237-2","DOIUrl":"10.1186/s43019-024-00237-2","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective single-center study aimed to investigate incidence and risk factors influencing tibial periprosthetic fractures (TPF) in Oxford unicompartmental knee arthroplasty (UKA), with a specific focus on tibial component positioning and sizing.</p><p><strong>Methods: </strong>A total of 2063 patients with medial UKA using the Oxford® mobile partial knee implant were analyzed between July 2014 and September 2022. Various preoperative and postoperative radiographic parameters determining pre- and postoperative alignment and implant positioning, incidence and characteristics of periprosthetic fractures, and patient demographics were assessed. Statistical analyses, including Mann-Whitney U test and logistic regression, were conducted to identify significant associations and predictors of tibial fractures.</p><p><strong>Results: </strong>Of the 1853 cases that were finally included in the study, 19 (1%) patients experienced TPF. The fracture group presented with a significantly shorter relative mediolateral and posteroanterior distance between the keel and cortex [mediolateral: 23.3% (23.2-24.8%) versus 27.1% (25.7-28.3%), p < 0.001; posteroanterior: 8.4% (6.3-10.3%) versus 10.0% (9.8-10.1%), p = 0.004]. Additionally, an increased posterior tibial slope in pre- and postoperative radiographs [preoperative: 10.4° (8.6-11.1°) versus 7.7° (5.4-10.0°), p < 0.001; postoperative 9.1° ± 3.1° versus 7.5° (5.9-9.0°), p = 0.030] was observed in the fracture group. Furthermore, the use of smaller-sized implants (AA) was associated with higher fracture rates (p < 0.001). Anatomical variants, such as a medial overhanging tibial plateau, were not observed.</p><p><strong>Conclusions: </strong>In UKA, type Oxford TPF are linked to shorter mediolateral and posteroanterior keel-cortex distances, increased pre- and postoperative PTS, and small implant sizes (AA). Fracture lines often extend from the distal keel to the medial tibial cortex. These findings emphasize the importance of precise implant positioning and sizing to minimize fracture risk. Level of evidence Retrospective single-center study, III.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased kinematic changes in ascending compared with descending biplanar cut in open wedge high tibial osteotomy-a multibody simulation.","authors":"Maximilian Jörgens, Sonja Ehreiser, Lennart Schroeder, Julius Watrinet, Wolfgang Böcker, Boris Michael Holzapfel, Klaus Radermacher, Julian Fürmetz","doi":"10.1186/s43019-024-00244-3","DOIUrl":"10.1186/s43019-024-00244-3","url":null,"abstract":"<p><strong>Background: </strong>The ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model.</p><p><strong>Methods: </strong>Thirteen 3D computer models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 to 12 mm (in 1-mm intervals). Multibody simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation, and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion.</p><p><strong>Results: </strong>The main effects of an ascending compared with a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters.</p><p><strong>Conclusions: </strong>Significant differences in the changes in patellofemoral shift, tilt, rotation, and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}