Knee Surgery and Related Research最新文献

{"title":"Assessment of meniscal extrusion with ultrasonography: a systematic review and meta-analysis.","authors":"Khalis Boksh, Duncan E T Shepherd, Daniel M Espino, Jenna Shepherd, Arijit Ghosh, Randeep Aujla, Tarek Boutefnouchet","doi":"10.1186/s43019-024-00236-3","DOIUrl":"10.1186/s43019-024-00236-3","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) is the imaging of choice for meniscal extrusion (ME). However, they may underappreciate the load-dependent changes of the meniscus. There is growing evidence that weight-bearing ultrasound (WB US) is more suitable, particularly in revealing occult extrusion. We therefore perform a systematic review and meta-analysis on the validity and reliability of US in diagnosing extrusion. Furthermore, we explored whether it detects differences in extrusion between loaded and unloaded positions and those with pathological (osteoarthritis and meniscal injury) and healthy knees.</p><p><strong>Methods: </strong>The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Data pertaining to intra- and interrater reliability of US in measuring meniscal extrusion (ME), its correlation with magnetic resonance imaging (MRI), and head-to-head comparison of potential factors to influence ME were included [loading versus unloading position; osteoarthritis (OA) or pathological menisci (PM) versus healthy knees; mild versus moderate-severe knee OA]. Pooled data were analyzed by random or fixed-effects models.</p><p><strong>Results: </strong>A total of 31 studies were included. Intraclass correlation coefficients (ICC) for intra- and interrater reliability were minimum 0.94 and 0.91, respectively. The correlation between US and MRI was (r = 0.76). US detected ME to be greater in the loaded position in all knees (healthy, p < 0.00001; OA, p < 0.00001; PM, p = 0.02). In all positions, US detected greater extrusion in OA (p < 0.0003) and PM knees (p = 0.006) compared with healthy controls. Furthermore, US revealed greater extrusion in moderate-severe OA knees (p < 0.00001).</p><p><strong>Conclusions: </strong>This systematic review suggests ultrasonography can play an important role in the measurement of meniscal extrusion, with results comparable to that of MRI. However, to what extent it can differentiate between physiological and pathological extrusion requires further investigation, with an absolute cutoff value yet to be determined. Nevertheless, it is an appropriate investigation to track the progression of disease in those with meniscal pathologies or osteoarthritis. Furthermore, it is a feasible investigation to evaluate the meniscal function following surgery.</p><p><strong>Level of evidence: </strong>IV, Systematic review of level III-IV evidence.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523268","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":"Incidence of symptomatic discoid meniscus in Korea: epidemiologic big data analysis from HIRA database.","authors":"Jin Seong Kim, Jung Hoon Kim, Moon Young Choi, Jeong Ku Ha, Seung Hun Baek, Kyu Sung Chung","doi":"10.1186/s43019-024-00234-5","DOIUrl":"https://doi.org/10.1186/s43019-024-00234-5","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of evidence of the diagnosis and treatment-related epidemiological studies of symptomatic discoid meniscus. This study analyzed the national epidemiological data for discoid meniscus in South Korea.</p><p><strong>Methods: </strong>From 2011 to 2019, data related to the diagnosis and procedure codes of discoid meniscus were obtained from the Korean Health Insurance Review and Assessment Service database. All patients encoded as discoid meniscus were included. Data were extracted and further analyzed as follows: (1) the total number and the incidence (cases per 100,000) of discoid meniscus diagnosis per year, (2) sex distribution, (3) age distribution, (4) discoid meniscus ratio (total discoid meniscus coding per total meniscus injury coding), and (5) surgical procedures after discoid meniscus injury.</p><p><strong>Results: </strong>The total number of discoid meniscus diagnosed was 4576 in 2011 and increased to 6639 in 2019, representing a 45.1% increase. The incidence was 9.5 in 2011 and increased to 13.0 in 2019. Concerning sex, discoid meniscus was more common in females (55%) than in males (45%) over the study period. Regarding age, the peak age of discoid meniscus in 2011 was \"under 19,\" whereas in 2019, the peak age was observed in the 50s. The discoid meniscus ratio range was 2.12-2.60% from 2011 to 2019. The total number of meniscectomy increased by 20% from 2000 in 2011 to 2475 in 2014. However, the total number of meniscus repairs was 318 in 2011 and increased to 502 in 2019, indicating an increase of 58%.</p><p><strong>Conclusions: </strong>The total number and incidence of symptomatic discoid as well as the discoid meniscus ratio and the incidence of total discoid meniscus repair steadily increased from 2011 to 2019. The number of meniscus repair procedures increased more rapidly than that of meniscectomy. The current study helps understand the epidemiology of symptomatic discoid meniscus, its prevention, and cost-saving measures in South Korea.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509677","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":"Can individual functional improvements be predicted in osteoarthritic patients after total knee arthroplasty?","authors":"Sung Eun Kim, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han","doi":"10.1186/s43019-024-00238-1","DOIUrl":"https://doi.org/10.1186/s43019-024-00238-1","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, and achieving optimal outcomes can be challenging due to various influencing factors. Previous research has focused on identifying factors that affect postoperative functional outcomes. However, there is a paucity of studies predicting individual postoperative improvement following TKA. Therefore, a quantitative prediction model for individual patient outcomes is necessary.</p><p><strong>Materials and methods: </strong>Demographic data, radiologic variables, intraoperative variables, and physical examination findings were collected from 976 patients undergoing TKA. Preoperative and 1-year postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed, and multivariate regression analysis was conducted to identify significant factors influencing one-year WOMAC scores and changes in WOMAC scores. A predictive model was developed on the basis of the findings.</p><p><strong>Results: </strong>The predictive accuracy of the model for 1-year WOMAC scores was poor (all adjusted R² < 0.08), whereas the model for changes in WOMAC scores demonstrated strong predictability (all adjusted R² > 0.75). Preoperative WOMAC scores, sex, and postoperative knee range of motion significantly affected all pain, stiffness, and physical function aspects of the WOMAC scores (all P < 0.05). Age, cerebrovascular disease, and patellar resurfacing were associated with changes in physical function (all P < 0.05).</p><p><strong>Conclusions: </strong>The developed quantitative model demonstrated high accuracy in predicting changes in WOMAC scores after TKA. The identified factors influencing postoperative improvement in WOMAC scores can assist in optimizing patient outcomes after TKA.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476688","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":"Relationship between peroneus longus tendon graft thickness and anthropometric variables: a radiographic study using ultrasonography.","authors":"Koray Kaya Kilic, Fırat Dogruoz, Omer Faruk Egerci, Murat Yuncu, Aliekber Yapar, Ozkan Kose","doi":"10.1186/s43019-024-00235-4","DOIUrl":"https://doi.org/10.1186/s43019-024-00235-4","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the predictive value of anthropometric measurements for two-stranded peroneus longus tendon (PLT) graft thickness using ultrasonography MATERIALS AND METHODS: A prospective study was conducted on 204 healthy volunteers (102 males and 102 females) aged 18-40 years. Anthropometric measurements were recorded, including height, weight, body mass index (BMI), fibular length, calf circumference, and ankle circumference. The Tegner Activity Scale (TAS) was used to assess activity levels. PLT cross-sectional area (CSA) was measured using ultrasonography. Two-stranded PLT graft thickness was calculated using the previously reported formula by Luo et al. A thickness of less than 8 mm of PLT graft was accepted as an insufficient autograft for anterior cruciate ligament reconstruction (ACLR). Correlation and regression analyses were performed to identify predictors of two-stranded PLT graft thickness. Receiver operating characteristic (ROC) analysis was performed to establish the best threshold values.</p><p><strong>Results: </strong>Males had a significantly greater PLT CSA (0.17 ± 0.03 cm²) and predicted two-stranded PLT graft thickness (8.1 ± 0.6 mm) compared with females (0.15 ± 0.03 cm² and 7.5 ± 0.6 mm, respectively; p < 0.001 for both). Correlation analysis revealed that two-stranded PLT graft thickness positively correlated with height, weight, BMI, fibular length, calf circumference, ankle circumference, and Tegner Activity Scale in both genders, with stronger correlations observed in females. The logistic regression model identified height and calf circumference as significant predictors of sufficient two-stranded PLT graft thickness (≥ 8 mm) in males, while calf circumference and the TAS were significant predictors in females. ROC analysis demonstrated that calf circumference and the TAS had acceptable discriminatory abilities in females, with 36.25 cm and ≥ 4 cutoff points, respectively. However, no anthropometric variables in males exhibited strong discriminatory abilities for predicting two-stranded PLT graft thickness CONCLUSIONS: Calf circumference and the TAS are significant predictors for two-stranded PLT autograft thickness in females. However, no anthropometric variables in males could be used strongly for prediction. These anthropometric measurements can assist in preoperative planning and decision-making, potentially improving ACLR outcomes by ensuring adequate graft thickness in females.</p><p><strong>Level of evidence: </strong>Level II prospective study.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476689","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":"Medial soft tissue release is also related to the anterior stability of cruciate-retaining total knee arthroplasty: a cadaveric study.","authors":"Sayako Sakai, Shinichiro Nakamura, Takahiro Maeda, Shinichi Kuriyama, Kohei Nishitani, Yugo Morita, Yugo Morita, Yusuke Yamawaki, Yuki Shinya, Shuichi Matsuda","doi":"10.1186/s43019-024-00233-6","DOIUrl":"https://doi.org/10.1186/s43019-024-00233-6","url":null,"abstract":"<p><strong>Background: </strong>Medial soft tissue release is occasionally performed to achieve mediolateral ligament balance in total knee arthroplasty (TKA), whose sequential effect on mediolateral and anteroposterior stability remains unclear. This study aimed to quantitatively evaluate the difference in mediolateral and anteroposterior stability according to a sequential medial soft tissue release in TKA.</p><p><strong>Methods: </strong>Cruciate-retaining TKA was performed in six cadaveric knees. Medial and lateral joint gaps, varus-valgus angle, and tibial anterior and posterior translations relative to the femur with pulling and pushing forces, respectively, were measured. All measurements were performed at full extension and 45° and 90° flexion after release of the deep medial collateral ligament (MCL) (stage 1), the posteromedial capsule (stage 2), and the superficial MCL (stage 3). Mediolateral and anteroposterior stability were compared between stages, and correlations between mediolateral and anteroposterior stability were analyzed.</p><p><strong>Results: </strong>Medial joint gap significantly increased from stages 1 to 3 by 3.2 mm, 6.8 mm, and 7.2 mm at extension, 45° flexion, and 90° flexion, respectively, and from stages 2 to 3 by 3.5 mm at extension. Varus-valgus angle was varus at stage 2, which turned to valgus at stage 3 (-2.7° to 0.8°, -2.2° to 4.3°, and -5.5° to 2.5° at extension, 45° flexion, and 90° flexion, respectively). Anterior translation at 90° flexion significantly increased from stages 1 and 2 to stage 3 by 11.5 mm and 8.2 mm, respectively, which was significantly correlated with medial gap (r = 0.681) and varus-valgus angle (r = 0.495).</p><p><strong>Conclusions: </strong>Medial soft tissue release also increased tibial anterior translation as well as medial joint gap, and medial joint gap and tibial anterior translation were significantly correlated. Surgeons should be careful not to create too large medial joint gap and tibial anterior translation in flexion by excessive medial release up to the superficial MCL for achieving an equal mediolateral joint gap in extension.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393986","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":"Comparison of different cementing techniques for cement penetration under tibial component in total knee arthroplasty: a retrospective observational study.","authors":"Yu Okuno, Keita Nagira, Koji Ishida, Haruhisa Kanaya, Ikuta Hayashi, Makoto Enokida, Hideki Nagashima","doi":"10.1186/s43019-024-00232-7","DOIUrl":"https://doi.org/10.1186/s43019-024-00232-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the differences in cement penetration between cementing techniques in total knee arthroplasty (TKA).</p><p><strong>Materials and methods: </strong>We retrospectively evaluated knee undergone TKA at our hospital for both preoperative and postoperative computed tomographic (CT) evaluations. Cementing was performed with hand mixing and hand packing (HM group) and with vacuum mixing and cement gun use (VM group). We measured the area under the tibial baseplate (sclerotic and nonsclerotic sides) and compared the mean and maximum depths of cement penetration at each area.</p><p><strong>Results: </strong>Of the 44 knees evaluated, 20 and 24 knees were in the HM and VM groups, respectively. At the center of the sclerotic side, the mean penetration depths (2.0 ± 0.7 and 2.5 ± 0.7 mm, p = 0.02) and the maximum penetration depths (4.0 ± 0.9 and 5.0 ± 1.6 mm, p = 0.02) were significantly deeper in the VM group than in the HM group. The correlation between preoperative Hounsfield unit values and mean penetration were r = -0.617 (p < 0.01) and -0.373 (p = 0.01) in the HM and VM groups, respectively.</p><p><strong>Conclusion: </strong>The cementing technique of vacuum mixing and using a cement gun allowed for deeper cement penetration compared with the hand mixing and hand packing technique, even in bone sclerotic sites.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297358","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":"Tryptophanyl tRNA synthetase is an alternative synovial biomarker for diagnosis of septic arthritis in knee joint.","authors":"Byung Hoon Lee, Young Gon Na, Seong Hyup Ham, Mirim Jin, Yoon Tae Kim, Kyung-Ok Kim, Jae Ang Sim","doi":"10.1186/s43019-024-00229-2","DOIUrl":"https://doi.org/10.1186/s43019-024-00229-2","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the diagnostic characteristics of tryptophanyl tRNA synthetase (WRS) for the diagnosis of septic arthritis of the knee joint and to determine whether it is a reliable and sensitive synovial biomarker for discriminating septic arthritis from other types of arthritis.</p><p><strong>Methods: </strong>Patients joint effusions for which septic arthritis was suspected were prospectively recruited between January 2019 and September 2020. A total of 9 patients had septic arthritis, 6 had acute gout attack, 1 had an acute flare of chronic rheumatic arthritis, and 46 had pseudogout or reactive arthropathy. Traditional inflammatory markers were measured, and their diagnostic abilities were compared. Neutrophil count, C-reactive protein (CRP) level, WRS, and human neutrophil α-defensin levels were assessed in the synovial fluids. Demographic parameters and biomarkers with a P < 0.05 in differentiating septic from nonseptic arthritis were included in a multivariable model. A multivariable logistic regression with a stepwise selection was performed to build the final combined model. Receiver operating characteristic curves were used to establish optimal thresholds for the diagnosis of septic arthritis of the knee joint, and the area under the curve was calculated to determine the overall accuracy of these tests compared with patients with nonseptic inflammatory arthritis.</p><p><strong>Results: </strong>Patients with septic arthritis were more likely to display higher serum WBC and CRP levels, synovial neutrophil counts, and levels of two synovial biomarkers, including WRS and α-defensin. WRS showed the highest specificity (87.5%) and sensitivity (83.3%) with α-defensin among the three synovial biomarkers.</p><p><strong>Conclusions: </strong>Synovial fluid WRS is a relevant biomarker in discriminating septic arthritis from other inflammatory arthritis and should be tested in an independent cohort.</p><p><strong>Level of evidence: </strong>prospective observational study, III.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11403948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297359","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":"It is challenging to reproduce both anatomical and functional aspects of anterolateral reconstruction: postoperative 3D-CT analysis of the femoral tunnel position.","authors":"Dong Jin Ryu, Seoyeong Kim, Minji Kim, Joo Hwan Kim, Won Jae Kim, Dohyung Lim, Joon Ho Wang","doi":"10.1186/s43019-024-00230-9","DOIUrl":"10.1186/s43019-024-00230-9","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the femoral tunnel position and fiber length of the anterolateral ligament (ALL) reconstruction compared with the natural anatomy of the ALL. We also evaluated whether the femoral tunnel position would affect residual pivot shift.</p><p><strong>Methods: </strong>This study was a retrospective review of 55 knees that underwent ALL reconstruction considering the anatomical and functional aspects, during primary anterior cruciate ligament (ACL) reconstruction in the presence of a high-grade pivot shift or revisional ACL reconstruction. We determined the position of the femoral tunnel and the length of graft using a three-dimensional (3D)-computed tomography (CT) model after ALL reconstruction. We also measured graft excursion during surgery and examined pivot shift 2 years after surgery. We conducted a subgroup analysis of femoral tunnel position, fiber length, isometricity, and residual pivot shift depending on whether the tunnel was anterior or posterior to the lateral epicondyle (LE). We also performed a subgroup analysis depending on whether the ACL reconstruction was primary or revisional.</p><p><strong>Results: </strong>The mean femoral tunnel position was 2.04 mm posterior and 14.5 mm proximal from the center of the LE. The mean lengths of the anterior and posterior fibers were 66.6 and 63.4 mm, respectively. The femoral tunnel was positioned more proximally than the anatomical position, and both anterior and posterior ALL fibers were longer than the natural anatomy. The anteroposterior femoral tunnel position was significantly correlated with anterior (p = 0.045) and posterior (p = 0.037) fiber excursion. In the subgroup analysis, there was no significant difference in the residual pivot shift between the posterior and anterior tunnel positions. However, there were significant differences for proximal position (p < 0.001) and fiber length (p = 0.006). There was no significant difference between primary and revisional ACL regarding femoral tunnel position and fiber lengths.</p><p><strong>Conclusion: </strong>It is challenging to reproduce both anatomical and functional aspects of ALL reconstruction in both primary and revision ACL reconstruction. Especially for functional reconstruction, the femoral tunnel tended to be positioned more proximally than the anatomical position. However, the femoral tunnel position did not affect functional clinical outcomes at the 2-year follow-up.</p><p><strong>Level of evidence: </strong>Level IV Case series.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11360883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112999","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":"Internal rotational patellar resection and patella alta induced patellar maltracking in total knee arthroplasty: intraoperative measurement of the patellofemoral pressure.","authors":"Sanshiro Yasuma, Sakurako Kato, Takuya Usami, Yusuke Hattori, Yuji Joyo, Hiroo Shiraga, Masahiro Nozaki, Hideki Murakami, Yuko Waguri-Nagaya","doi":"10.1186/s43019-024-00231-8","DOIUrl":"10.1186/s43019-024-00231-8","url":null,"abstract":"<p><strong>Background: </strong>Anterior knee pain due to patellar maltracking following total knee arthroplasty (TKA) reduces patients' satisfaction. This study aimed to determine the patellofemoral pressure (PFP) in patients with favorable patellar tracking (FT) and impaired patellar tracking (IT) following TKA, the factors causing patellar maltracking, and the effect of lateral retinacular release (LRR) on patients with IT.</p><p><strong>Methods: </strong>Forty-four patients with varus knee osteoarthritis undergoing cruciate-retaining TKA were enrolled. After component implantation, patients with a separation of ≥ 2 mm of the patellar medial facet from the medial femoral trochlea throughout knee range of motion were classified into the IT group; meanwhile, the others were classified into the FT group. PFP was measured intraoperatively in three phases: (1) with the resurfaced patella (RP); (2) with the resurfaced patella and knee (RPK); and (3) when LRR was performed in IT (post-LRR). The PFPs at 0°, 90°, 120°, and 135° knee flexion were compared between FT and IT using the Mann-Whitney U test. Pairwise comparison of the PFP in IT between RPK and post-LRR was performed using the Wilcoxon signed-rank test. Correlations between PFP and pre- and postoperative radiographic parameters, such as hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, anterior femoral offset, Insall-Salvati ratio (ISR), patellar tilt, and patellar resection angle (PRA), were evaluated using Spearman's rank correlation coefficients.</p><p><strong>Results: </strong>High lateral PFP in the knee flexion position led to patellar maltracking. Patients with IT (n = 24) had higher lateral and lower medial PFP than did patients with FT (n = 20) at 90°, 120°, and 135° knee flexion in RP and RPK. LRR in IT reduced the lateral PFP in the knee flexion position. PRA and ISR were correlated with the lateral PFP at no less than 90° in RP and RPK.</p><p><strong>Conclusions: </strong>This study demonstrated that internal rotational patellar resection, which resulted in a thick medial patellar remnant and a thin lateral counterpart, and patella alta were the causative factors of high lateral PFP, which induced patellar maltracking after TKA. Surgeons should avoid internal rotational patellar resection to achieve FT and perform LRR in patients with patellar maltracking.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037274","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":"Accurate, automated classification of radiographic knee osteoarthritis severity using a novel method of deep learning: Plug-in modules.","authors":"Do Weon Lee, Dae Seok Song, Hyuk-Soo Han, Du Hyun Ro","doi":"10.1186/s43019-024-00228-3","DOIUrl":"10.1186/s43019-024-00228-3","url":null,"abstract":"<p><strong>Background: </strong>Fine-grained classification deals with data with a large degree of similarity, such as cat or bird species, and similarly, knee osteoarthritis severity classification [Kellgren-Lawrence (KL) grading] is one such fine-grained classification task. Recently, a plug-in module (PIM) that can be integrated into convolutional neural-network-based or transformer-based networks has been shown to provide strong discriminative regions for fine-grained classification, with results that outperformed the previous deep learning models. PIM utilizes each pixel of an image as an independent feature and can subsequently better classify images with minor differences. It was hypothesized that, as a fine-grained classification task, knee osteoarthritis severity may be classified well using PIMs. The aim of the study was to develop this automated knee osteoarthritis classification model.</p><p><strong>Methods: </strong>A deep learning model that classifies knee osteoarthritis severity of a radiograph was developed utilizing PIMs. A retrospective analysis on prospectively collected data was performed. The model was trained and developed using the Osteoarthritis Initiative dataset and was subsequently tested on an independent dataset, the Multicenter Osteoarthritis Study (test set size: 17,040). The final deep learning model was designed through an ensemble of four different PIMs.</p><p><strong>Results: </strong>The accuracy of the model was 84%, 43%, 70%, 81%, and 96% for KL grade 0, 1, 2, 3, and 4, respectively, with an overall accuracy of 75.7%.</p><p><strong>Conclusions: </strong>The ensemble of PIMs could classify knee osteoarthritis severity using simple radiographs with a fine accuracy. Although improvements will be needed in the future, the model has been proven to have the potential to be clinically useful.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"36 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976843","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}