Journal of Knee Surgery最新文献

{"title":"A Systematic Review and Meta-Analysis of Total Knee Arthroplasty after Tibial Plateau Fracture Fixation.","authors":"Elizabeth Rieger, Andrew Fuqua, Jason Shah, Maya Sinha, Ajay Premkumar","doi":"10.1055/a-2608-0105","DOIUrl":"https://doi.org/10.1055/a-2608-0105","url":null,"abstract":"<p><strong>Introduction: </strong>Tibial plateau fractures are common injuries that pose a significant risk of post-traumatic osteoarthritis (PTOA) despite surgical fixation. Though total knee arthroplasty (TKA) has been proven as a viable treatment option for PTOA, there is a higher risk of postoperative complications in patients with prior tibial plateau fracture (TPF). This systematic review aimed to evaluate surgical considerations and outcomes of TKA in patients with prior TPF fixation.</p><p><strong>Methods: </strong>A search of PubMed MEDLINE, Embase, and Scopus databases from January 2008 to July 2023 was performed according to PRISMA guidelines using the following inclusion criteria: TPF, PTOA, TKA, and conversion TKA. Exclusion criteria included periprosthetic fractures, distal femoral fractures, and patients under 18. Two independent reviewers screened each study. For postoperative infection and revision rates, the results were pooled, and random-effects meta-analysis of single proportions was conducted to determine combined rate of infections and revisions.</p><p><strong>Results: </strong>9 studies involving a total of 572 patients who underwent TKA following TPF fixation were included. Average patient age ranged from 44.0 to 65.7 years, with mean TPF-to-TKA intervals from 1.7 to 13.6 years. TPF fixation details, implant types, and complication rates, including infection (range 3.2%-36.8%) and revision (range 0%-20%), were reported in most studies. The meta-analysis pooled estimates for postoperative infection and revision rates were 11% (95% CI 0.06-0.16) at an average of 7.0 years follow-up and 9% (95% CI 0.04-0.15) at an average of 7.4 years follow-up.</p><p><strong>Conclusion: </strong>TKA in patients with previous TPF fixation can be complex and may require augments and increased implant constraint. Though the literature reports good functional outcomes in this TKA population, TKA after TPF fixation carries increased risk of both infection and aseptic revision compared to patients undergoing TKA for osteoarthritis. Further high-quality prospective studies are needed to elucidate risk factors and optimize management strategies for patients undergoing TKA following TPF fixation.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Treatment of Articular Cartilage Defects and Patellar Instability with Autologous Chondrocyte Implantation and Patellar Stabilization.","authors":"Connor C Jacob, Ryan H Barnes, Jordan Haber, Parker A Cavendish, Eric Milliron, Robert A Magnussen, David C Flanigan","doi":"10.1055/a-2585-4916","DOIUrl":"10.1055/a-2585-4916","url":null,"abstract":"<p><p>High-grade chondral injuries in the setting of patellar instability are a challenging problem for patients and surgeons. In patients undergoing autologous chondrocyte implantation (ACI) to address cartilage defects, medial patellofemoral ligament (MPFL) reconstruction with or without tibial tubercle osteotomy (TTO) is one option to both treat patellar instability and repair and offload defects. The primary aim of this case series was to describe return to activity, reoperation rates, and instances of recurrent patellar instability after medial patellofemoral ligament reconstruction with ACI with or without TTO. We also discuss reoperation rates among patients with multiple cartilage defects in comparison to those with single cartilage defects. A retrospective chart review from 2010 to 2022 identified patients with patellar instability who underwent concurrent MPFL reconstruction and cartilage restoration at a single academic institution. Data regarding patient demographics, cartilage defect location and size, concomitant procedures, return to activity data, and repeat surgery risk were collected. Review identified 14 patients who underwent cartilage restoration and MPFL reconstruction, including 11 who underwent a concomitant TTO. Clinical follow-up was 2.68 years. All patients returned to activity with a mean time of 13.7 months. There were no instances of graft delamination or persistent symptoms necessitating arthroplasty. One patient underwent a second surgery on the index knee for tibial tubercle hardware removal. Cartilage restoration with patellar stabilization surgery may be effective for addressing high-grade cartilage defects associated with patellar instability.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Quadriceps Tendon Rupture-Surgical Treatment and Outcomes: A Systematic Review.","authors":"Daniel C Touhey, Nikko D Beady, Sina Tartibi, Robert H Brophy, Matthew J Matava, Matthew V Smith, Derrick M Knapik","doi":"10.1055/a-2585-5037","DOIUrl":"https://doi.org/10.1055/a-2585-5037","url":null,"abstract":"<p><p>Quadriceps tendon ruptures (QTR) lead to significant lower extremity weakness, gait abnormalities, and disability. Outcomes following surgical management of chronic QTR remain largely unknown. This study aimed to systematically review the management of chronic QTR to better understand the incidence, indications for repair versus reconstruction, complications, and outcomes. Studies published in PubMed, EMBASE, and the Cochrane Library reporting on patients with chronic QTR were identified. Inclusion criteria consisted of patients with chronic QTR (injuries ≥6 weeks) undergoing operative management, with reported injury mechanism, tear characteristics, surgical repair versus reconstruction, graft type (if used), postoperative complications, and outcomes. A total of 26 studies, consisting of 44 patients undergoing repair or reconstruction for chronic QTR, were identified. The mean patient age was 48.5 (range, 15-80) years, with 83% (<i>n</i> = 33/40) of patients being male. The mean interval between injury and surgery was 17.2 months (range, 6 weeks-303 months). Falls were the most frequently reported injury mechanism (59%, <i>n</i> = 16/27). Patient-related factors-primarily patient delay in seeking treatment-accounted for delayed management in 55% (<i>n</i> = 11/20) of patients. Tendon reconstruction using graft augmentation was performed in 46% (<i>n</i> = 20/44), most frequently with hamstring autograft (40%; <i>n</i> = 8/20). Quadriceps atrophy (<i>n</i> = 3) and superficial wound infection (<i>n</i> = 3) were the most commonly reported adverse outcomes, while no subsequent re-ruptures, revisions, or additional surgeries were reported. Postoperative active range of motion (ROM) was comparable in patients undergoing repair versus reconstruction (mean ROM = 0.0-124.4 degrees vs. 4.3-120.5 degrees, respectively). Chronic QTR was identified in 44 patients undergoing operative management, an average of 17.2 months following injury. The majority of patients were males, with a mean age of 48.5 years. Falls comprised the majority of injuries, while patient deferral in seeking treatment represented the most common reason for delay. Reconstruction was performed in 46% of cases, most commonly utilizing hamstring autograft. ROM was comparable irrespective of surgical management. Quadriceps atrophy and wound infection were the most commonly reported adverse outcomes, with no reported re-ruptures or revision procedures.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable Return-to-Sport Rates with Improved Pain and Patient-Reported Outcomes Following Osteochondral Allograft Transplantation: A Systematic Review.","authors":"Justin Fengyuan Xie, Garrett R Jackson, Justin T Childers, Benjamin T Lack, Colton C Mowers, Steven F DeFroda, Clayton W Nuelle","doi":"10.1055/a-2585-4806","DOIUrl":"https://doi.org/10.1055/a-2585-4806","url":null,"abstract":"<p><p>Osteochondral allograft transplantation (OCA) of the knee is a reliable surgical technique for managing symptomatic full-thickness chondral lesions ≥2 cm² in young and active patients. There is a need for comprehensive analysis of recent studies among a growing body of literature to better understand the outcomes of OCA among athletic patients, particularly in terms of return to sports participation and graft longevity. To systematically review existing literature reporting the return-to-sport (RTS) outcomes and patient-reported outcome measures (PROMs) following OCA of the knee among athletic patients. A systematic review was performed in PubMed, Web of Science, and Embase from database inception through December 22, 2024. Studies that reported RTS outcomes after knee OCA were included. Data were analyzed descriptively, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies. Inclusion criteria were met by 13 studies involving 699 patients. The mean patient age was 31.8 years (range 15.2-52.6), with a mean follow-up of 59.9 months (range 24-87.5). Reported RTS rates ranged from 59.4 to 90.9%. The mean time to RTS ranged from 9.0 to 14.6 months; one study documented a median RTS time of 16 months. Between 27.3 and 79.1% of athletes made RTS at the same level, 13.5 to 63.6% at higher levels, and 9.1 to 31.6% at lower levels. Significant (<i>p</i> < 0.05) improvements were noted in Tegner (delta -1.8 to 1.4), Visual Analog Scale-Pain (delta -5.7 to -3.7), and International Knee Documentation Committee scores (delta 25 to 33.0). The most common complications were deep vein thrombosis/pulmonary embolism (1.3%), symptomatic hardware (0.72%), and infections (0.72%). Graft failure ranged from 0 to 10.8%, and reoperation from 0 to 50%. OCA of the knee demonstrates variable RTS rates, with improved postoperative pain and outcomes scores. Graft failure occurred in 0 to 10.8% of patients. IV, Systematic Review of Level III and IV studies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Football League Players Have Higher Rates of Knee Extensor Mechanism Tears During Short and Normal Rest Weeks versus Long Rest Weeks.","authors":"Warren G Haralson, Ashwin R Garlapaty, John Baumann, Garrett R Jackson, James L Cook, Steven F DeFroda","doi":"10.1055/a-2585-5099","DOIUrl":"https://doi.org/10.1055/a-2585-5099","url":null,"abstract":"<p><p>Lower extremity injuries, particularly knee injuries, in National Football League (NFL) players are common. Extensor mechanism ruptures often require season-ending surgery. These ruptures, involving structures like the quadriceps and patellar tendons, are caused by powerful movements that overload the knee. Research on NFL injury risk factors, including time between games, is growing, but studies on rest periods and knee injuries have shown mixed results and are limited in scope. No prior research has specifically examined extensor mechanism tears in relation to short, normal, or long rest periods between games.Using publicly accessible resources (NFL injury reports, Pro-Football-Reference.com, and ESPN.com), an online search was conducted to identify NFL players who tore their quadriceps tendon or patellar tendon between the 2009 and 2023 seasons. Only regular season injuries after week 1 were included. The date of injury and prior game date were collected in order to calculate the length of rest. Next, each injury was categorized as a short (<7 days), normal (7 days), or long (>7 days) week injury. Other factors, such as age, football position, and playing surface (natural grass or artificial turf), were also collected.A total of 58 players met inclusion criteria. There was no difference in extensor mechanism injury rates between short weeks and normal weeks. Players were 4.7 times more likely to tear their extensor mechanism during normal weeks than long weeks (<i>p</i> = 0.0039) and 3.7 times more likely to tear their extensor mechanism during short weeks than long weeks (<i>p</i> = 0.0385). Regarding playing surface, extensor mechanism tears were more likely to occur on artificial turf than natural grass (<i>p</i> = 0.0324).During the 2009-2023 NFL seasons, players were found to have 4.7 times higher rates of knee extensor mechanism tears during short (<7 days) rest weeks and 3.7 times higher rates during normal (7 days) rest weeks between games, when compared to long (>7 days) rest weeks. There was no difference in knee extensor mechanism injury rates between the short and normal rest weeks. LEVEL OF EVIDENCE:  Level III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The 10-Year Outcomes of Single- versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review\".","authors":"Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1055/a-2584-4584","DOIUrl":"https://doi.org/10.1055/a-2584-4584","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcomes in Older Patients Following Patella Fracture Repair.","authors":"Amaya M Contractor, Sanjit R Konda, Philipp Leucht, Abhishek Ganta, Kenneth A Egol","doi":"10.1055/a-2585-4747","DOIUrl":"https://doi.org/10.1055/a-2585-4747","url":null,"abstract":"<p><p>The purpose of this study is to examine the effect of age on outcomes following repair of acute displaced patella fractures.A total of 248 patients who sustained a displaced patella fracture and underwent open reduction and internal fixation were identified. Patients included underwent a similar operative protocol, were prescribed a standard postoperative protocol of therapy, and were seen at standard follow-up intervals. Patients were divided into groups of <65 years old (young) and ≥65 years old (older). Statistical analysis was run to determine if there was a significant difference in range of knee motion and rate of major complications.Of the 248 patients, 149 were young and 99 were older. The mean age of the old group was 74.5 ± 6.7 and the mean age of the young group was 50 ± 12. Fracture pattern and BMI were the same across the groups. However, the old group had a higher average Charlson Comorbitiy Index (CCI) (<i>p</i> < 0.001). Additionally, the groups had similar length of follow-up (<i>p</i> = 0.693) and similar mean time to radiographic healing (<i>p</i> = 0.533). Older patients had limited knee extension at 6 months compared with young patients (<i>p</i> = 0.031). Finally, old patients had a higher rate of all complications compared with young patients. About 2% of old patients developed a fracture-related infection (FRI), 4% developed a symptomatic nonunion, and 11% were underwent reoperation including removal of hardware, total knee replacement, irrigation and debridement, and manipulation under anesthesia.Complication rates following patella fracture fixation in older patients were worse than young patients, despite having similar injury patterns, surgical treatment, and follow-up. These findings can better inform treating physicians during surgical intervention of older patients with patella fractures.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Synovialization and Clinical Outcomes between Anterior Cruciate Ligament Anteromedial Bundle Augmentation and Double-Bundle Anterior Cruciate Ligament Reconstruction.","authors":"Gil Yeong Ahn, Sung Hyun Hwang, Seo Won Kang, Jun Hyeok Song, Jee Soo Park, Yeong Hyeon Lee","doi":"10.1055/s-0044-1801748","DOIUrl":"10.1055/s-0044-1801748","url":null,"abstract":"<p><p>This study aimed to compare clinical outcomes and second-look arthroscopic findings between double-bundle anterior cruciate ligament (ACL) reconstruction for complete ACL rupture and anteromedial (AM) bundle augmentation with preservation of the posterolateral (PL) bundle in isolated AM bundle rupture. Between 2014 and 2021, we retrospectively analyzed 95 ACL reconstructions with at least 2 years of follow-up. Patients undergoing primary ACL reconstruction from January 2014 to June 2021 were included in the study. Double-bundle ACL reconstruction (group 1) was performed in the cases involving male patients, high activity levels, age below 40 years, or when there was a patient preference for double-bundle reconstruction. In contrast, for partial ACL ruptures with an intact PL bundle confirmed on preoperative magnetic resonance imaging, AM augmentation was performed (group 2). Preoperative and final follow-up clinical outcomes, along with synovial coverage during second-look arthroscopy, were compared between group 1 (65 cases) and group 2 (30 cases). Statistical analysis included correlation coefficients between the groups. The Lysholm score, Tegner activity scores, and International Knee Documentation Committee (IKDC) knee evaluation form score at final follow-up were 81.8 (±5.5), 7.2 (±0.9), and 79.4 (±6.7), respectively, in group 1, and they were 88.0 (±6.4, <i>p</i> = 0.038), 7.9 (±0.5, <i>p</i> = 0.042), and 86.2 (±5.4, <i>p</i> = 0.081), respectively, in group 2. For group 1, the Lachman test (<i>p</i> = 0.093) and the pivot shift test (<i>p</i> = 0.176) at the final follow-up showed no laxity in 57 and 59 knees, and there was plus one laxity in 8 and 6 knees. For group 2, there were no laxity in 27 and 28 knees, and plus one laxity in 3 and 2 knees. Synovial coverage area percentages of the grafted tendon were 74.3 (±10.7) and 86.9 (±7.3, <i>p</i> = 0.002) in groups and group 2, respectively, with superior synovial coverage observed in group 2. The AM bundle augmentation with preservation of the PL bundle in ACL injury yielded better synovial coverage and clinical scores compared with double-bundle ACL reconstruction for complete ACL rupture.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"273-281"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional Analysis of Preoperative Patient-Reported Outcomes Identifies Distinct Phenotypes in Total Knee Arthroplasty: Secondary Analysis of the SHARKS Registry in a Public Hospital Department.","authors":"Raquel McGill, Corey Scholes, Stephen Torbey, Lorenzo Calabro","doi":"10.1055/s-0044-1801750","DOIUrl":"10.1055/s-0044-1801750","url":null,"abstract":"<p><p>Traditional research on total knee arthroplasty (TKA) relies on preoperative patient-reported outcome measures (PROMs) to predict postoperative satisfaction. We aim to identify distinct patient phenotypes among TKA candidates, and investigate their correlations with patient characteristics. Between 2017 and 2021, patients with primary knee cases at a metropolitan public hospital were enrolled in a clinical quality registry. Demographics, clinical data, and the Veterans Rand 12 and Oxford Knee Score were collected. Imputed data were utilized for the primary analysis, employing <i>k</i>-means clustering to identify four phenotypes. Analysis of variance assessed differences in scores between clusters, and nominal logistic regression determined relationships between phenotypes and patient age, sex, body mass index (BMI), and laterality. The sample comprised 389 patients with 450 primary knees. Phenotype 4 (mild symptoms with good mental health) exhibited superior physical function and overall health. In contrast, patients in phenotype 2 (severe symptoms with poor mental health) experienced the most knee pain and health issues. Phenotype 1 (moderate symptoms with good mental health) reported high mental health scores despite knee pain and physical impairment. Patient characteristics significantly correlated with phenotypes; those in the severe symptoms with poor mental health phenotype were more likely to be younger, female, have a higher BMI, and bilateral osteoarthritis (<i>p</i> < 0.05). This multidimensional analysis identified TKA patient phenotypes based on common PROMs, revealing associations with patient demographics. This approach has the potential to inform prognostic models, enhancing clinical decision-making and patient outcomes in joint replacement.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"300-308"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic Effect of Intermittent Multiple IPACK Block Combined with ACB in Patients with Flexion Contracture Knee Arthritis Undergoing Total Knee Arthroplasty.","authors":"Yuqi Ren, Zhouhui Hou, Yue Zhang, Yue Li, Huanqiu Liu","doi":"10.1055/s-0044-1801822","DOIUrl":"10.1055/s-0044-1801822","url":null,"abstract":"<p><p>We aimed to compare the analgesic effects of intermittent multiple infiltrations between the popliteal artery and capsule of the posterior knee (IPACK) combined with adductor canal block (ACB) and intermittent ACB alone in patients with flexion contracture knee arthritis undergoing total knee arthroplasty (TKA). Forty-six patients who underwent elective unilateral TKA were divided into two groups (<i>n</i> = 23 each): intermittent multiple IPACK combined with ACB (group IA) and intermittent multiple ACB (group A). ACB was performed with 20 mL of 0.375% ropivacaine in each group and IPACK with 20 mL of 0.25% ropivacaine in group IA. Intermittent multiple nerve blocks were used for postoperative analgesia (IPACK block combined with ACB in group IA and ACB in group A between 7:30 and 8:30 a.m. on postoperative day 1 [POD1] and postoperative day 2 [POD2]). Primary outcomes assessed were pain at rest, motion-evoked pain (MEP), and range of motion (ROM) on POD1 and POD2. Secondary outcomes included opioid consumption, first ambulation time, ambulation distance, and postoperative complications. We observed that compared with group A, MEP decreased, ROM became wider, ambulation distance was longer, and opioid consumption decreased in group IA. Other outcomes were either similar between the groups or showed clinically insignificant differences. We conclude that multiple intermittent IPACK therapy combined with ACB provides superior analgesia than multiple intermittent ACB therapy alone in patients with flexion contracture knee arthritis undergoing TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"316-322"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}