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Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging. 磁共振成像对膝关节前外侧韧带的评价。
Joints Pub Date : 2018-11-02 eCollection Date: 2018-09-01 DOI: 10.1055/s-0038-1675163
Angelo De Carli, Edoardo Monaco, Daniele Mazza, Giuseppe Argento, Andrea Redler, Lorenzo Proietti, Edoardo Gaj, Andrea Ferretti
{"title":"Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging.","authors":"Angelo De Carli,&nbsp;Edoardo Monaco,&nbsp;Daniele Mazza,&nbsp;Giuseppe Argento,&nbsp;Andrea Redler,&nbsp;Lorenzo Proietti,&nbsp;Edoardo Gaj,&nbsp;Andrea Ferretti","doi":"10.1055/s-0038-1675163","DOIUrl":"https://doi.org/10.1055/s-0038-1675163","url":null,"abstract":"<p><p><b>Purpose</b>  The purpose of this study was to describe the anatomy of the anterolateral ligament (ALL) of the knee by the use of 1.5 Tesla (T) magnetic resonance imaging (MRI) in a series of young patients without knee injuries. <b>Methods</b>  Subjects aged 18 years or older without an anterior cruciate ligament injury, as confirmed on MRI, were included. MRI examinations were all performed on 1.5 T scans. The ALL was defined as the low signal band originating from the region of the lateral epicondyle of the femur, crossing the proximal surface of the lateral collateral ligament, deep to the iliotibial band, and inserting onto the tibia between the Gerdy's tubercle and the fibular head. <b>Results</b>  Twenty-six patients met the eligibility criteria and were enrolled into the study. In one patient, it was not possible to visualize the ALL. In all the other subjects, the ligament originated anterior and distal to the lateral epicondyle and inserted on the proximal tibia approximately 5 mm below the joint line and just distal to the Gerdy's tubercle. It had an average length of 33 ± 1.2 mm, an average width of 5.5 ± 0.3 mm, and an average thickness of 2 mm. <b>Conclusion</b>  The ALL is a distinct structure of the anterolateral capsule that can be easily identified using 1.5 T MRI scans. <b>Level of Evidence</b>  This is a level IV, observational study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"153-156"},"PeriodicalIF":0.0,"publicationDate":"2018-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853773","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}
引用次数: 10
The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception. 关节镜下肩袖修复术后标准康复方案对疼痛、功能和健康感知的影响。
Joints Pub Date : 2018-10-31 eCollection Date: 2018-09-01 DOI: 10.1055/s-0038-1673701
Roberta Monesi, Maria Grazia Benedetti, Alessandro Zati, Daniela Vigna, Domenico Romanello, Alberto Monello, Roberto Rotini
{"title":"The Effects of a Standard Postoperative Rehabilitation Protocol for Arthroscopic Rotator Cuff Repair on Pain, Function, and Health Perception.","authors":"Roberta Monesi,&nbsp;Maria Grazia Benedetti,&nbsp;Alessandro Zati,&nbsp;Daniela Vigna,&nbsp;Domenico Romanello,&nbsp;Alberto Monello,&nbsp;Roberto Rotini","doi":"10.1055/s-0038-1673701","DOIUrl":"https://doi.org/10.1055/s-0038-1673701","url":null,"abstract":"<p><p><b>Purpose</b>  There is still conflicting evidence to support postoperative rehabilitation protocols using immobilization following rotator cuff repair over early motion. The objective of the study was to evaluate the evolution of pain, shoulder function, and patients' perception of their health status up to 1 year after cuff rotator repair and a standard postoperative rehabilitation protocol consisting of 4 weeks of immobilization followed by a 2-week assisted controlled rehabilitation. <b>Methods</b>  Descriptive, longitudinal, uncontrolled case-series study was performed on 49 patients who underwent arthroscopic rotator cuff repair following traumatic or degenerative lesions. VAS scale for pain, Constant-Murley score for function, and SF-12 score for quality of life were used as outcome measures and were administered before the rehabilitation treatment, at the end of the 2-week rehabilitation, 3 months, and 1 year after surgery. <b>Results</b>  VAS pain score decreased significantly along the follow-up reaching almost a nil value after 1 year (0.2). Function as measured by Constant-Murley score had a significant improvement during follow-up, reaching a mean value of 84.6. The short form (SF)-12 score increased over time reaching 46.3 for the physical and 43.8 for the psychological dimension, respectively, at 1 year. <b>Conclusion</b>  The present study confirmed an excellent outcome at 1 year after rotator cuff repair using a traditional 4-week immobilization followed by a 2-week rehabilitation protocol without evidence of tendon un-healing or re-tearing. <b>Level of Evidence</b>  This is a level IV, therapeutic case series.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"145-152"},"PeriodicalIF":0.0,"publicationDate":"2018-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1673701","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853772","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}
引用次数: 6
Surgical Management of Comminuted, Displaced Greater Tuberosity Fractures: A New Technique of Subacromial Spacer on Top of Double-Row Suture Anchor Fixation. 粉碎性、移位性大结节骨折的外科治疗:肩峰下间隔双排缝合锚钉顶固定新技术。
Joints Pub Date : 2018-10-31 eCollection Date: 2018-09-01 DOI: 10.1055/s-0038-1675162
Leslie Naggar
{"title":"Surgical Management of Comminuted, Displaced Greater Tuberosity Fractures: A New Technique of Subacromial Spacer on Top of Double-Row Suture Anchor Fixation.","authors":"Leslie Naggar","doi":"10.1055/s-0038-1675162","DOIUrl":"https://doi.org/10.1055/s-0038-1675162","url":null,"abstract":"<p><p>Arthroscopic treatment of greater tuberosity (GT) fractures has been previously described. Arthroscopy allows identifying and addressing coexisting injuries, such as rotator cuff tears, labrum, or superior labrum anterior and posterior lesions, which are often present. Fracture comminution precludes the use of rigid fracture fixation with screws and arthroscopic rotator cuff repair is performed instead. Recent articles have depicted the role of the balloon-shaped subacromial spacer in massive and irreparable rotator cuff tears. The purpose of this technical report is to outline another use of the spacer in patients with a GT fracture. The concept is to leverage the advantage of the compression effect of the subacromial spacer to prevent displacement of the GT fracture and allow early active shoulder rehabilitation, especially in comminuted or eggshell fractures when rigid fixation is not feasible.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"211-214"},"PeriodicalIF":0.0,"publicationDate":"2018-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36812111","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}
引用次数: 7
Evaluation of Blood Loss and Implant Alignment after Total Knee Arthroplasty with Inertial Based Extramedullary Femoral Cutting Guide. 全膝关节置换术后基于惯性的股骨髓外切割导轨的失血量和假体对齐的评估。
Joints Pub Date : 2018-10-18 eCollection Date: 2018-09-01 DOI: 10.1055/s-0038-1673404
Tommaso Bonanzinga, Piergiuseppe Tanzi, Maria Pia Neri, Francesco Iacono, Claudio Mazzola, Alberto Belluati, Andrea Colombelli, Stefano Zaffagnini, Maurilio Marcacci
{"title":"Evaluation of Blood Loss and Implant Alignment after Total Knee Arthroplasty with Inertial Based Extramedullary Femoral Cutting Guide.","authors":"Tommaso Bonanzinga,&nbsp;Piergiuseppe Tanzi,&nbsp;Maria Pia Neri,&nbsp;Francesco Iacono,&nbsp;Claudio Mazzola,&nbsp;Alberto Belluati,&nbsp;Andrea Colombelli,&nbsp;Stefano Zaffagnini,&nbsp;Maurilio Marcacci","doi":"10.1055/s-0038-1673404","DOIUrl":"https://doi.org/10.1055/s-0038-1673404","url":null,"abstract":"<p><p><b>Purpose</b>  The purpose of this study was to compare, in terms of blood loss and implant alignment, a new generation of smart extramedullary (EM) cutting guides with the conventional intramedullary (IM) guide for total knee arthroplasty (TKA). The hypothesis was that the EM system would result in less blood loss and fewer days of hospitalization, while ensuring equal or higher accuracy in the alignment of the femoral implant. <b>Methods</b>  Thirty-six patients were enrolled for the present study: 18 patients underwent TKA using the EM guide and for the other 18 patients the IM guide was used. Preoperative and postoperative X-rays were acquired. The preoperative and postoperative hemoglobin values were compared. Lastly, length of hospital stay was recorded. <b>Results</b>  The hemoglobin difference was significantly lower in the EM group. The alignment of the prosthetic femoral implant in the two groups was comparable but all patients in the EM cohort had a final alignment within 3 degrees of range on the frontal view, while 22% of the patients in the IM cohort had a final alignment exceeding 3 degrees of range. The mean hospitalization duration showed no significant difference between groups, though EM group showed 1.6 days less compared with IM group. <b>Conclusions</b>  The inertial-based EM guide system could be useful for decreasing blood loss compared with conventional guide. This device tended to have better results even in terms of accuracy, but this difference was not significant. <b>Level of Evidence</b>  This is a level II, prospective cohort study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"161-166"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1673404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853775","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}
引用次数: 4
Opiate Pain Medication Consumption in Cigarette Smokers following Total Hip Arthroplasty. 全髋关节置换术后吸烟者阿片类止痛药的使用。
Joints Pub Date : 2018-10-18 eCollection Date: 2018-09-01 DOI: 10.1055/s-0038-1673405
Jennifer I Etcheson, Chukwuweike U Gwam, Nicole E George, Naval Walia, Christophe Jerjian, Ga-Ram Han, Sana Virani, Seth J Miller, Ronald E Delanois
{"title":"Opiate Pain Medication Consumption in Cigarette Smokers following Total Hip Arthroplasty.","authors":"Jennifer I Etcheson,&nbsp;Chukwuweike U Gwam,&nbsp;Nicole E George,&nbsp;Naval Walia,&nbsp;Christophe Jerjian,&nbsp;Ga-Ram Han,&nbsp;Sana Virani,&nbsp;Seth J Miller,&nbsp;Ronald E Delanois","doi":"10.1055/s-0038-1673405","DOIUrl":"https://doi.org/10.1055/s-0038-1673405","url":null,"abstract":"<p><p><b>Purpose</b>  The purpose of the present study was to assess perception of pain and pain management in smokers versus nonsmokers who received a total hip arthroplasty (THA). <b>Methods</b>  Patients who underwent THA from 2010 to 2016 were propensity score matched 1:1 based on race, body mass index, age, and sex. This yielded 124 smokers and 124 nonsmokers. Pain intensity was quantified using area under the curve for visual analog scale pain scores. Opioid consumption was determined using a morphine milliequivalent (mEq) conversion algorithm. An independent samples <i>t</i> -test and Chi-square analysis was conducted to assess continuous and categorical variables respectively. <b>Results</b>  Smokers experienced a nonsignificantly increased pain intensity (198.1 vs. 185.7; <i>p</i>  = 0.063). Smokers demonstrated significantly higher opioid consumption in both immediate postoperative (65.9 vs. 59.3 mEq; <i>p</i>  = 0.045) and 90 days postoperative periods (619.9 vs. 458.9 mEq; <i>p</i>  = 0.029). <b>Conclusion</b>  Our study demonstrated a nonsignificantly increased pain intensity, and (in both the immediate and 90 days postoperative periods) a significantly higher opioid consumption following THA in patients who smoke cigarettes. This may be due to a relatively small effect size, warranting the need for larger prospective studies. Nevertheless, arthroplasty surgeons should encourage preoperative smoking cessation and alternative nonopioid analgesics to smoking patients receiving THA. <b>Level of Evidence</b>  This is a level III, retrospective cohort study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"157-160"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1673405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853774","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}
引用次数: 13
New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years. 前交叉韧带重建的新趋势:近5年全国调查的系统回顾。
Joints Pub Date : 2018-09-27 eCollection Date: 2018-09-01 DOI: 10.1055/s-0038-1672157
Alberto Grassi, Christian Carulli, Matteo Innocenti, Massimiliano Mosca, Stefano Zaffagnini, Corrado Bait
{"title":"New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years.","authors":"Alberto Grassi,&nbsp;Christian Carulli,&nbsp;Matteo Innocenti,&nbsp;Massimiliano Mosca,&nbsp;Stefano Zaffagnini,&nbsp;Corrado Bait","doi":"10.1055/s-0038-1672157","DOIUrl":"https://doi.org/10.1055/s-0038-1672157","url":null,"abstract":"<p><p>The purpose of this study was to analyze national surveys of orthopaedic surgeons on anterior cruciate ligament (ACL) reconstruction to determine their preferences related to the preferred graft, femoral tunnel positioning, fixation and tensioning methods, antibiotic and anti-thromboembolic prophylaxis, and use of tourniquet and drains. A systematic search of PubMed, Web of Science, and Cochrane Library was performed. Inclusion criteria were surveys of ACL reconstruction trends and preferences published in the past 5 years (2011-2016), involving members of national societies of orthopaedics. Information regarding survey modalities, population surveyed, graft choice both in the general or in the athletic population, surgical technique, fixation, use of antibiotic, tourniquet, drains, and anti-thromboembolic prophylaxis was extracted. Eight national surveys were included from Europe (three), North or Latin America (three), and Asia (two). Overall, 7,420 questionnaires were sent, and 1,495 participants completed the survey (response rate ranging from 16 to 76.6%). All surveys reported the hamstring tendon (HT) autograft as the preferred graft, ranging from 45 to 89% of the surveyed population, followed by bone-patellar tendon-bone (BPTB) graft (2-41%) and allograft (2-17%). Only two surveys focusing on graft choice in athletic population underlined how in high-demand sportive population the graft choices changes in favor of BPTB. Single-bundle reconstruction was the preferred surgical technique in the four surveys that investigated this issue. Five surveys were in favor of anteromedial (AM) portal and two in favor of trans-tibial technique. Suspension devices for femoral fixation were the preferred choice in all but one survey, while interference screws were the preferred method for tibial fixation. The two surveys that investigated graft tensioning were in favor of manual tensioning. The use of tourniquet, antibiotics, drains, and anti-thromboembolic prophylaxis were vaguely reported. A trend toward the preference of HT autograft was registered in all the surveys; however, sport participation has been highlighted as an important variable for increased use of BPTB. Single-bundle reconstruction with AM portal technique and suspension femoral fixation and screws fixation for the tibia seem the preferred solution. Other variables such as tensioning, antibiotic, anti-thromboembolic prophylaxis, tourniquet use, and drains were investigated scarcely among the surveys; therefore, no clear trends could be delineated. This is a Level V, systematic review of expert opinion study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"177-187"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1672157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853778","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}
引用次数: 69
Patellofemoral Pain: Symptom or Disease? 髌股疼痛:症状还是疾病?
Joints Pub Date : 2018-07-25 DOI: 10.1055/s-0038-1667195
Giuseppe Milano
{"title":"Patellofemoral Pain: Symptom or Disease?","authors":"Giuseppe Milano","doi":"10.1055/s-0038-1667195","DOIUrl":"10.1055/s-0038-1667195","url":null,"abstract":"Two clinical studies published in this issue of Joints deal with the complex issueofpatellofemoral pain treatment. Enea et al1 report the results obtained using distalization and medialization of the tibial tuberosity, a surgical treatment for potential patellar instability (PPI) associated with a particularly “challenging” predisposing factor, namely, the patella alta. The index group (PPI group), consisting of patients with pain but no episodes of frank patellar instability, was compared with a group of patients reporting pain and objective patellar instability. The authors found that the treatment significantly reduced pain and improved knee function in both groups. However, the improvement in subjective instability was significantly more marked in the patients with PPI. In short, the proposed treatment was found to be particularly effective in the treatment of patients with PPI and patellofemoral pain. The article by Uboldi et al,2 concerns a prospective randomized trial on the efficacy of an elastomeric knee brace used in the treatment of patellofemoral pain syndrome (PFPS) in adjunct to a specifically developed rehabilitation program. Function was found to be significantly improved both in the study group and in the controls (who only received rehabilitation); however, use of the knee brace was associated with significantly reduced pain. Patellofemoral pain is, undoubtedly, a clinical problem with a high social and economic impact, given that it affects a young and active section of the population. Indeed, in addition to rehabilitation treatment costs, it is also necessary to consider the costs related to reduced productivity, due to days off work, and reduced work efficiency. Undoubtedly, surgery, when indicated, is effective in resolving symptoms. However, in most cases, the pain in PFPS is disabling, and surgical treatment, however adequately it corrects the factors underlying the clinical presentation, is rather invasive and not always predictable in terms of late sequelae. There have been few rigorous analyses of exercise therapy for the treatment of PFPS. A Cochrane review3 has highlighted the effectiveness of rehabilitation treatment in helping to reduce knee pain and function in patients with PFPS. Tan et al4 showed that annual direct medical costs are higher in patients receiving rehabilitation treatment compared with those not receiving treatment, although the latter generate higher social costs, in particular, deriving from loss of productivity and work efficiency. Overall, therefore, rehabilitation treatment of PFPS has a favorable cost-effectiveness ratio. But what arewe treating whenwe treat PFPS? A symptom or a disease? I certainly have no intention of wading into the complex debate regarding the nomenclature and classification of all those clinical situations in which patellofemoral pain, or anterior knee pain as it may more generally be defined, can be recognized as a component. However, it is certainly true that patellofem","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 2","pages":"73-74"},"PeriodicalIF":0.0,"publicationDate":"2018-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1667195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36348581","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}
引用次数: 1
Use of an Elastomeric Knee Brace in Patellofemoral Pain Syndrome: Short-Term Results. 使用弹性膝支具治疗髌骨股痛综合征:短期效果。
Joints Pub Date : 2018-06-22 eCollection Date: 2018-06-01 DOI: 10.1055/s-0038-1661339
Francesco Mattia Uboldi, Paolo Ferrua, Daniele Tradati, Pietro Zedde, Jim Richards, Andrea Manunta, Massimo Berruto
{"title":"Use of an Elastomeric Knee Brace in Patellofemoral Pain Syndrome: Short-Term Results.","authors":"Francesco Mattia Uboldi,&nbsp;Paolo Ferrua,&nbsp;Daniele Tradati,&nbsp;Pietro Zedde,&nbsp;Jim Richards,&nbsp;Andrea Manunta,&nbsp;Massimo Berruto","doi":"10.1055/s-0038-1661339","DOIUrl":"https://doi.org/10.1055/s-0038-1661339","url":null,"abstract":"<p><p><b>Purpose</b>  This article verifies the effectiveness of a new brace on patellofemoral pain syndrome (PFPS) in adjunct to a specifically developed rehabilitation program. <b>Methods</b>  Two groups of 30 patients with PFPS were prospectively and randomly allocated to a rehabilitation protocol, with (group A) or without (group B) the use of a specific brace. All the patients were assessed at 3, 6, and 12 months using the disease-specific Kujala scale and a visual analog scale (VAS) for pain; time to return to sport and patient satisfaction with the brace were also recorded. <b>Results</b>  Kujala scale's values showed constant and progressive improvement. The mean score at 6 months was 79.8 ± 6.8 points in group A and 76.8 ± 8.6 in group B, rising at 12 months to 80.9 ± 7.5 in group A and 78.4 ± 8.3 in group B. VAS scores significantly differed ( <i>p</i>  < 0.05) between the two groups at both 6 and 12 months; the score recorded at 12 months was 0.9 ± 1.3 in the brace-treated group and 1.8 ± 1.6 in the controls. The patients who used a brace showed a quicker return to sports and 75% of the patients in this group were satisfied. <b>Conclusion</b>  All the scores improved progressively in both groups. The most significant improvement concerned pain, showing that the brace used in this study may allow a better subjective outcome and a quicker return to sport. <b>Level of Evidence</b>  Level II, prospective randomized controlled trial.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 2","pages":"85-89"},"PeriodicalIF":0.0,"publicationDate":"2018-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1661339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36347437","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}
引用次数: 5
Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta. 胫骨结节远端和中端化治疗上髌骨潜在不稳。
Joints Pub Date : 2018-06-22 eCollection Date: 2018-06-01 DOI: 10.1055/s-0038-1661340
Davide Enea, Pier Paolo Canè, Marco Fravisini, Antonio Gigante, Luca Dei Giudici
{"title":"Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta.","authors":"Davide Enea,&nbsp;Pier Paolo Canè,&nbsp;Marco Fravisini,&nbsp;Antonio Gigante,&nbsp;Luca Dei Giudici","doi":"10.1055/s-0038-1661340","DOIUrl":"https://doi.org/10.1055/s-0038-1661340","url":null,"abstract":"<p><p><b>Purpose</b>  The aim of the study was to test the distalization and medialization of the tibial tuberosity (DMTT) for the treatment of patellar instability associated with patella alta, focusing on residual instability and pain. <b>Methods</b>  Twenty-four consecutive patients (26 knees) suffering from patellofemoral instability and patella alta were treated by DMTT. Two groups were identified, which differed for documented history of frank patella dislocation. The groups were named objective patellar instability (OPI) (history of dislocation) and potential patella instability (PPI) (no dislocation). Outcome was measured with visual analogue scale (VAS), Kujala score, and Tegner score. Comparison between groups was performed using Student's <i>t</i> -test, Wilcoxon rank score, and Fisher's exact test (significance at <i>p</i>  < 0.05). <b>Results</b>  At 50 ± 18 and 41 ± 18 months of follow-up, respectively, both PPI and OPI groups obtained a significant pain reduction and functional improvement. The PPI group showed a significant decrease of the subjective instability. No procedure-related complications were reported. <b>Conclusion</b>  This study suggests that DMTT is a viable option for PPI patients with patella alta. The outcome was comparable between PPI and OPI cases; however, decrease in subjective instability was significantly greater in PPI patients. <b>Level of Evidence</b>  Level III, retrospective comparative study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 2","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2018-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1661340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36347436","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}
引用次数: 12
Tibial Tubercle Osteotomy in Total Knee Arthroplasty: Midterm Results Experience of a Monocentric Study. 全膝关节置换术中胫骨结节截骨:单中心研究的中期结果。
Joints Pub Date : 2018-06-22 eCollection Date: 2018-06-01 DOI: 10.1055/s-0038-1661338
Stefano Biggi, Stefano Divano, Riccardo Tedino, Andrea Capuzzo, Stefano Tornago, Andrea Camera
{"title":"Tibial Tubercle Osteotomy in Total Knee Arthroplasty: Midterm Results Experience of a Monocentric Study.","authors":"Stefano Biggi,&nbsp;Stefano Divano,&nbsp;Riccardo Tedino,&nbsp;Andrea Capuzzo,&nbsp;Stefano Tornago,&nbsp;Andrea Camera","doi":"10.1055/s-0038-1661338","DOIUrl":"https://doi.org/10.1055/s-0038-1661338","url":null,"abstract":"<p><p><b>Purpose</b>  Difficult primary total knee arthroplasty (TKA) and revision TKA may be high demanding, especially during joint exposure. Aim of this article is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed. <b>Methods</b>  We retrospectively reviewed a cohort of 79 consecutives TKAs where TTO was performed. Patients were assessed clinically and radiographically at their last follow-up (mean, 7.4 ± 3.7 years). Clinical evaluation included the Knee Society Score (KSS), the pain visual analogue scale (VAS), and range of motion. Radiological assessment included the evaluation of radiolucent lines, osteolysis, cortical bone hypertrophy, time of bone healing of the TTO fragment, and the hardware complication. <b>Results</b>  KSS raised from 40.7 ± 3.1 to 75 ± 4.3 ( <i>p</i>  < 0.0001). Knee flexion increased from 78.7 ± 9.9° to 95.0 ± 9.5° ( <i>p</i>  < 0.0001), and VAS improved from 7.9 ± 0.9 to 3.8 ± 1 ( <i>p</i>  < 0.0001). No signs of loosening or evolutive radiolucency lines were found. Osteolytic areas around the stem were detected. No significant association was found between the implant design and the outcomes, while aseptic loosening showed significantly better results. Complications were: 4 painful hardware, 3 late periprosthetic infections, 1 extension lag of 5°, and 3 flexion lag. <b>Conclusion</b>  Our experience suggests the use of TTO to improve the surgical approach in difficult primary TKA or revision TKA. A precise surgical technique leads to good results with low risk of complications. <b>Level of Evidence</b>  Level IV, therapeutic case series.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 2","pages":"95-99"},"PeriodicalIF":0.0,"publicationDate":"2018-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1661338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36347439","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}
引用次数: 6
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