Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

{"title":"Surgical management and rehabilitation of ultra-low velocity bilateral multi-ligament knee injury: A case report","authors":"Stephen G. Melancon ,&nbsp;Michelle E. Kew ,&nbsp;Michael R. Dunne ,&nbsp;Scott A. Rodeo","doi":"10.1016/j.jisako.2024.100332","DOIUrl":"10.1016/j.jisako.2024.100332","url":null,"abstract":"<div><div>Bilateral low-velocity multi-ligament knee Injury (MLKI) is a rare injury increasing in prevalence along with obesity. Early surgical intervention is indicated to improve long-term outcomes. We describe the surgical and postoperative management of a bilateral MLKI. The patient underwent staged multi-ligament knee reconstruction 17 and 35 days after injury. Return to light duty was achieved 4 weeks following each procedure and progression to exercise at 6 months. The patient is 2 years postoperative and returned to all activity without complaint. We describe successful surgical and rehabilitation management, which encourages early surgery and rehabilitation strategies to improve long-term outcomes.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373050","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":"The Mobile Bearing Prosthesis: How to know When It's is Right for My Patient and Tips for Surgical Success.","authors":"Patricia R Melvin, Todd Bertrand, Keith Berend, Adolph V Lombardi","doi":"10.1016/j.jisako.2024.100330","DOIUrl":"https://doi.org/10.1016/j.jisako.2024.100330","url":null,"abstract":"<p><p>Unicompartmental knee arthroplasty (UKA) has seen a revival of popularity in the last thirty years in the United States. The benefits of a medial UKA over the previous \"gold standard\" for knee osteoarthritis, the total knee arthroplasty, include increased postoperative range of motion (ROM), maintenance of natural knee mechanics, faster recovery, similar pain relief and decreased morbidity. Mobile-bearing UKA (MB-UKA) implants have been developed to improve polyethylene wear while maintaining normal knee kinematics. In this review, we will cover indications and contraindications for a MB-UKA, patient selection, and technical tips and tricks.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex specific considerations in anterior cruciate ligament injuries in the female athlete: State of the art","authors":"Arianna L. Gianakos ,&nbsp;Claudia Arias ,&nbsp;Cecile Batailler ,&nbsp;Elvire Servien ,&nbsp;Mary K. Mulcahey","doi":"10.1016/j.jisako.2024.100325","DOIUrl":"10.1016/j.jisako.2024.100325","url":null,"abstract":"<div><div>The increased participation of females in sports has been accompanied by an increase in the rate of anterior cruciate ligament (ACL) injuries. The literature has identified risk factors for noncontact ACL injuries in female athletes, including anatomic, hormonal, biomechanical, neuromuscular, and environmental factors. This review will provide an overview of sex-specific considerations when managing female athletes with ACL injuries. A discussion of sex-specific surgical and rehabilitative treatment strategies with the goal of optimizing return to sport after ACL reconstruction will be emphasized.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355695","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":"Trends of ankle arthroscopy in Italy: Analysis of an official national database","authors":"Umile Giuseppe Longo ,&nbsp;Alessandro Mazzola ,&nbsp;Sergio De Salvatore ,&nbsp;Ilaria Piergentili ,&nbsp;Alessandro Tancioni ,&nbsp;Valentina Piccioni ,&nbsp;Antonio Sarubbi ,&nbsp;Riccardo Picozzi ,&nbsp;MaCalus V. Hogan","doi":"10.1016/j.jisako.2024.100326","DOIUrl":"10.1016/j.jisako.2024.100326","url":null,"abstract":"<div><h3>Objectives</h3><div>Ankle arthroscopy has become increasingly popular as a less invasive surgical diagnostic and therapeutic procedure for a variety ankle disorder previously managed with open surgery. Despite literature reports encouraging outcomes and low complication rates, nationwide trends in ankle arthroscopy have been poorly investigated. To fully understand the burden of an emerging surgical approach as well as helping to create global standards for the diagnosis and treatment of ankle diseases, this study aimed to evaluate the incidence and demographics of patients undergoing ankle arthroscopy in Italy from 2001 to 2016.</div></div><div><h3>Methods</h3><div>Data were obtained from the National Hospital Discharge Records (SDO) provided by the Italian Ministry of Health. The patient's age, gender, length of hospital stays, primary diagnosis, and primary procedure are among the anonymized data. Population data were obtained from the National Institute for Statistics (ISTAT). According to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) ankle arthroscopy was defined by the following procedure code: 80.27.</div></div><div><h3>Results</h3><div>A total of 23,644 procedures were performed in Italy. The 25 to 29 and 30 to 34 age groups underwent this type of surgery at most. The majority of patients were males. The median length of hospital stay was 2.1 ​± ​2.3 days. Each year in Italy, this surgery costs an average of 2,133,401€ ± 342,143€. The main primary codified diagnoses were: “contracture of joint, ankle and foot” (13.4 ​%), “articular cartilage disorder, ankle and foot” (8.6 ​%), “late effect of sprain and strain without mention of tendon injury” (7.5 ​%) and “other joint derangement, not elsewhere classified, ankle and foot” (6.4 ​%).</div></div><div><h3>Conclusions</h3><div>The present study evaluated the burden of ankle arthroscopy on the national health care system and the distribution of the main diseases requiring this type of surgery. Surgeons and policy makers can allocate healthcare resources more effectively and provide patients with high-quality care by having a better understanding of national practice patterns.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355696","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 ChatGPT answer patient questions regarding reverse shoulder arthroplasty?","authors":"Benjamin T. Lack ,&nbsp;Edwin Mouhawasse ,&nbsp;Justin T. Childers ,&nbsp;Garrett R. Jackson ,&nbsp;Shay V. Daji ,&nbsp;Payton Yerke-Hansen ,&nbsp;Filippo Familiari ,&nbsp;Derrick M. Knapik ,&nbsp;Vani J. Sabesan","doi":"10.1016/j.jisako.2024.100323","DOIUrl":"10.1016/j.jisako.2024.100323","url":null,"abstract":"<div><h3>Introduction</h3><div>In recent years, artificial intelligence (AI) has seen substantial progress in its utilization, with Chat Generated Pre-Trained Transformer (ChatGPT) is emerging as a popular language model. The purpose of this study was to test the accuracy and reliability of ChatGPT's responses to frequently asked questions (FAQ) pertaining to reverse shoulder arthroplasty (RSA).</div></div><div><h3>Methods</h3><div>The ten most common FAQs were queried from institution patient education websites. These ten questions were then input into the chatbot during a single session without additional contextual information. The responses were then critically analyzed by two orthopedic surgeons for clarity, accuracy, and the quality of evidence-based information using The Journal of the American Medical Association (JAMA) Benchmark criteria and the DISCERN score. The readability of the responses was analyzed using the Flesch-Kincaid Grade Level.</div></div><div><h3>Results</h3><div>In response to the ten questions, the average DISCERN score was 44 (range 38–51). Seven responses were classified as fair and three were poor. The JAMA Benchmark criteria score was 0 for all responses. Furthermore, the average Flesch-Kincaid Grade Level was 14.35, which correlates to a college graduate reading level.</div></div><div><h3>Conclusion</h3><div>Overall, ChatGPT was able to provide fair responses to common patient questions. However, the responses were all written at a college graduate reading level and lacked reliable citations. The readability greatly limits its utility. Thus, adequate patient education should be done by orthopedic surgeons. This study underscores the need for patient education resources that are reliable, accessible, and comprehensible.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297494","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":"Isolated in-situ mosaicplasty fixation of unstable knee osteochondritis dissecans in skeletally mature patients; a combined mechanical and biological solution with excellent outcomes and a low re-operation rate","authors":"AIW Mayne ,&nbsp;PSE Davies ,&nbsp;L. Lam ,&nbsp;M. Finsterwald ,&nbsp;S. Dalgleish ,&nbsp;S. Gohil ,&nbsp;PA D'Alessandro","doi":"10.1016/j.jisako.2024.100322","DOIUrl":"10.1016/j.jisako.2024.100322","url":null,"abstract":"<div><h3>Objectives</h3><div>Unstable osteochondritis dissecans (OCD) of the knee can result in substantial morbidity; the aims of surgical management are to provide stability to the lesion and to stimulate biological healing. The aim of this study was to review the outcomes of a previously described, but uncommonly used, technique involving isolated mosaicplasty fixation of unstable knee OCD.</div></div><div><h3>Methods</h3><div>A retrospective review of skeletally mature patients treated with in-situ mosaicplasty fixation of unstable OCD of the knee was performed. Two out of thirteen knees also underwent concomitant realignment osteotomy. Postoperative magnetic resonance imaging (MRI) and patient-reported outcome measures were reviewed.</div></div><div><h3>Results</h3><div>Twelve patients (13 knees) were included; there were 5 females and 7 males. The mean age at time of surgery was 22 years (range 16–32). The lesion location was lateral femoral condyle in 7 cases and medial femoral condyle in 6 cases. Follow-up MRI scans confirmed fragment healing in 12 knees (92%). One patient required further surgical intervention for ongoing symptoms and radiological non-union: the patient underwent an off-loading distal femoral osteotomy to correct valgus mal-alignment.</div></div><div><h3>Conclusion</h3><div>This series describes the outcomes following an uncommonly performed, yet reproducible and effective method of fixation of unstable knee OCDs. We believe in-situ mosaicplasty fixation represents an opportunity to provide both mechanical stability and biological augmentation of OCD healing, and the series confirms that excellent results can be achieved with a low re-operation rate.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297495","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":"Distal femoral osteotomies improves recurrent patellar instability in patients with genu valgum: A systematic review","authors":"Thomas E. Moran,&nbsp;Elizabeth K. Driskill,&nbsp;J. Brett Goodloe,&nbsp;Pradip Ramamurti,&nbsp;G. Bradley Reahl,&nbsp;Alyssa D. Althoff,&nbsp;David R. Diduch","doi":"10.1016/j.jisako.2024.100318","DOIUrl":"10.1016/j.jisako.2024.100318","url":null,"abstract":"<div><h3>Importance</h3><div>Coronal plane malalignment can contribute to recurrent patellar instability, a common knee pathology, particularly in adolescents that can negatively impact knee function and stability.</div></div><div><h3>Objective</h3><div>To systematically review the literature in order to summarize the clinical and radiologic outcomes of the surgical treatment of recurrent lateral patellar instability in patients with genu valgum using varus-producing distal femoral osteotomies (DFOs).</div></div><div><h3>Evidence review</h3><div>A systematic review was conducted using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were: outcomes of lateral opening- and medial closing-DFOs performed for treatment of recurrent patellar instability with associated genu valgum, minimum 90-day follow-up, English language articles, and human studies. Data extracted included demographic information, type of osteotomy and concomitant procedures, radiological outcomes, patient reported outcome scores, and incidence of complications.</div></div><div><h3>Findings</h3><div>Nine studies, with a total of 147 knees were available for review. All included studies were retrospective case series, with a weighted mean follow-up of 2.75 ​± ​0.75 years. 6 of 147 (4.08%) knees demonstrated recurrent patellar instability. All studies reported good to excellent patient-reported outcomes postoperatively, with improvement from pre-operative measures. All studies reported relative normalization of measurements of mechanical axis and/or lateral distal femoral angle (LDFA) postoperatively. 63 of 147 (42.86%) knees underwent re-operation, with hardware removal [53 of 147 (36.05%) knees] being the most commonly performed procedure.</div></div><div><h3>Conclusions</h3><div>Varus-producing DFOs are an efficacious procedure to improve functionality and radiographic malalignment and address recurrent patellar instability in patients with associated valgus deformity. Additional higher-level of evidence studies utilizing matched control groups, such as patients undergoing conservative treatment, with standardized reporting of outcomes should be performed in order to better understand clinical and radiographic outcomes of varus-producing DFOs for this indication.</div></div><div><h3>Study design</h3><div>Systematic review.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196800","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":"Lateral meniscus root tear in anterior cruciate ligament injured patients is not associated with increased rotatory knee laxity: A quantitative pivot shift analysis","authors":"Gian Andrea Lucidi ,&nbsp;Bálint Zsidai ,&nbsp;Joseph D. Giusto ,&nbsp;Ryosuke Kuroda ,&nbsp;James J. Irrgang ,&nbsp;Kristian Samuelsson ,&nbsp;Stefano Zaffagnini ,&nbsp;Volker Musahl","doi":"10.1016/j.jisako.2024.100319","DOIUrl":"10.1016/j.jisako.2024.100319","url":null,"abstract":"<div><h3>Objectives</h3><div>Biomechanical investigations conducted in vitro have elucidated the detrimental impact of lateral meniscus posterior root (LMPR) tears on knee contact pressures in the anterior cruciate ligament (ACL)-injured knee. Nevertheless, the influence of LMPR tears on the kinematics of ACL-injured patients remains ambiguous. The purpose of this study was to assess the impact of LMPR tears on anteroposterior and rotatory knee laxity employing a clinically validated quantitative pivot shift (QPS) analysis system.</div></div><div><h3>Methods</h3><div>Patients with ACL injury recruited in a prospective ACL registry spanning from 2012 to 2020 were retrospectively screened for eligibility. Criteria for inclusion encompassed complete primary ACL tears, absence of concurrent ligamentous or osseous injuries requiring operative treatment, and no prior knee surgeries.</div><div>Patients were assigned to two cohorts based on the presence (LMPR+) or absence (LMPR-) of an LMPR tear concomitant with ACL injury. Each patient underwent a standardized PS test, measurement of anterior tibial translation (ATT) (mm) using the Rolimeter, and QPS (mm) with a tablet-based image analysis system (PIVOT App). Comparative analyses of categorical variables were performed using the Fisher exact and Chi-square tests, while non-normally distributed continuous variables were compared between groups with the Mann–Whitney U test. Alfa was set at 0.05.</div></div><div><h3>Results</h3><div>A total of 99 patients were included in the study, of which 22 were assigned to the LMPR+ and 77 to the LMPR- group. Tear depth was considered partial in 13 (59%) patients and full in 9 (41%) patients. The prevalence of medial meniscus tears was greater in the LMPR+ (n ​= ​16, 73%) compared with the LMPR- (n ​= ​33, 43%) group (p ​= ​0.01). No difference was observed in ATT measured with the Rolimeter (p ​= ​0.63). Similarly, no difference was found in QPS between the LMPR+ (2.3 ​mm) and the LMPR- (1.9 ​mm) group (p ​= ​0.08).</div></div><div><h3>Conclusion</h3><div>Utilizing QPS in this investigation, LMPR tears do not significantly increase ATT or rotatory knee laxity. Consequently, although repairing LMRT associated with ACL injuries may be advisable for minimizing joint stress, their impact on controlling the PS in patients remains uncertain.</div></div><div><h3>Level of evidence</h3><div>III, retrospective comparative study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255215","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":"Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases","authors":"Peter S.E. Davies,&nbsp;Michael Goldberg,&nbsp;Jon A. Anderson,&nbsp;John Dabis,&nbsp;Andrew Stillwell,&nbsp;Timothy J. McMeniman,&nbsp;Peter T. Myers","doi":"10.1016/j.jisako.2024.100316","DOIUrl":"10.1016/j.jisako.2024.100316","url":null,"abstract":"<div><h3>Objective</h3><div>While meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure.</div></div><div><h3>Methods</h3><div>A retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red–red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score.</div></div><div><h3>Results</h3><div>Fifty one inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14–70). The median time from injury to repair was 122 days (range 4–1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white–white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs during the study period. All patients were followed up to a median of 46 months (range 22–87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p ​= ​0.4).</div></div><div><h3>Conclusions</h3><div>FC augmented meniscal repair performed for tears considered to be at higher risk of failure may result in acceptably low rates of clinical failure.</div></div><div><h3>Level of evidence</h3><div>Level IV, case series.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113017","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":"Thick-shell sulcus-deepening trochleoplasty for recurrent patellar dislocation leads to clinically meaningful improvements and high patient satisfaction in adolescents with open physes","authors":"Neil P. Blanchard ,&nbsp;Thomas E. Moran ,&nbsp;Brock J. Manley ,&nbsp;Laurel A. Barras ,&nbsp;David R. Diduch","doi":"10.1016/j.jisako.2024.100315","DOIUrl":"10.1016/j.jisako.2024.100315","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate clinical and radiological outcomes of thick-shell, sulcus-deepening trochleoplasty in patients with open distal femoral physes and less than two years of growth remaining. We hypothesized that patients would have clinical and radiographic improvements in addition to high patient-reported outcomes following thick-shell, sulcus-deepening trochleoplasty.</div></div><div><h3>Methods</h3><div>Bone age was determined on preoperative magnetic resonance imaging (MRI) using the Pennock Knee Bone Age Atlas. Pre- and postoperative radiographs were used to measure the anatomic lateral distal femoral angle (aLDFA) and Blumensaat angle. International Knee Documentation Committee (IKDC), Kujala, and numerical patient satisfaction scores were assessed. Pre- and postoperative aLDFA and Blumensaat angles as well as patient-reported outcomes were analyzed via the Wilcoxon signed-rank test.</div></div><div><h3>Results</h3><div>Seventeen adolescents (21 knees) with DeJour Types B and D trochlear dysplasia and open distal femoral physes underwent Dejour thick-shell, sulcus-deepening trochleoplasty at a single institution. In twelve females (16 knees, 76.2%) the median chronological and bone ages at the time of operation were 14.9 and 14.3 years, respectively. In 5 males (5 knees, 27.7%), the median chronological and bone ages at the time of operation were 15.7 and 15.2 years, respectively. Mean follow-up time was 64 months postoperatively. Physes were closed in all knees at the time of final clinical and radiographic follow-up. The mean change in aLDFA and Blumensaat Angle was 0.73 (p ​= ​0.1074, 95% CI -0.09–1.57) and 0.88° (p ​= ​0.0477, 95% CI 0.10–1.88), respectively. Median IKDC scores improved from 57.3 preoperatively to 90.9 postoperatively, for a mean difference of 26.1 (p ​= ​0.00064, 95% CI 18.0–34.2). Median Kujala scores improved from 55.0 preoperatively to 95.0 postoperatively, for a mean change of 30.2 (p ​= ​0.0008, 95% CI 19.6–40.8). Overall mean numerical patient satisfaction was high (mean 9.26/10). One of 21 knees (4.8%) underwent additional surgery to address recurrent patellar instability.</div></div><div><h3>Conclusion</h3><div>Thick-shell sulcus-deepening trochleoplasty for addressing recurrent lateral patellar instability in patients with open distal femoral physes and less than two years of growth remaining is safe and provides clinically meaningful improvements in addition to high patient satisfaction when combined with other patellar stabilization procedures.</div></div><div><h3>Level of evidence</h3><div>IV, Retrospective Case Series.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093872","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}