Journal of Knee Surgery最新文献

{"title":"Functional Imaging of the Knee-A Comprehensive Review.","authors":"Kenneth C Kim, Brooke Wakeman, Rob Wissman","doi":"10.1055/a-2216-5186","DOIUrl":"10.1055/a-2216-5186","url":null,"abstract":"<p><p>Knee pain is a common presenting problem in the general population. Radiographs and magnetic resonance imaging (MRI) are the cornerstones of imaging in current clinical practice. With advancements in technology, there has been increasing utilization of other modalities to evaluate knee disorders. Dynamic assessment utilizing computed tomography and portable ultrasounds have demonstrated the capacity to accurately assess and reproducibly quantify kinematics of knee disorders. Cartilage physiology can be evaluated with MRI. Emerging research has even demonstrated novel musculoskeletal applications of positron emission tomography to evaluate anterior cruciate ligament graft metabolic activity following reconstruction. As technology continues to evolve and traditional ways are improved upon, future comparative studies will elucidate the distinct advantages of the various modalities. Although radiology is still primarily an anatomic specialty, there is immense potential for functional imaging to be the standard of care. This review focuses on the most common musculoskeletal applications of functional imaging as well as future utilization.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"593-601"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296280","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":"Assessing Functional Outcomes After Knee Surgery.","authors":"James L Cook","doi":"10.1055/s-0044-1785501","DOIUrl":"https://doi.org/10.1055/s-0044-1785501","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":"37 8","pages":"555"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285846","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":"Prediction of Total Knee Arthroplasty Sizes with Demographics, including Hand and Foot Sizes.","authors":"Vincent W K Chan, Ping Keung Chan, Henry Fu, Man Hong Cheung, Amy Cheung, Thomas C M Tang, Kwong Yuen Chiu","doi":"10.1055/a-2198-7983","DOIUrl":"10.1055/a-2198-7983","url":null,"abstract":"<p><p>Anticipating implant sizes before total knee arthroplasty (TKA) allows the surgical team to streamline operations and prepare for potential difficulties. This study aims to determine the correlation and derive a regression model for predicting TKA sizes using patient-specific demographics without using radiographs. We reviewed the demographics, including hand and foot sizes, of 1,339 primary TKAs. To allow for comparison across different TKA designs, we converted the femur and tibia sizes into their anteroposterior (AP) and mediolateral (ML) dimensions. Stepwise multivariate regressions were performed to analyze the data. Regarding the femur component, the patient's foot, gender, height, hand circumference, body mass index, and age was the significant demographic factors in the regression analysis (R-square 0.541, <i>p</i> < 0.05). For the tibia component, the significant factors in the regression analysis were the patient's foot size, gender, height, hand circumference, and age (R-square 0.608, <i>p</i> < 0.05). The patient's foot size had the highest correlation coefficient for both femur (0.670) and tibia (0.697) implant sizes (<i>p</i> < 0.05). We accurately predicted the femur component size exactly, within one and two sizes in 49.5, 94.2, and 99.9% of cases, respectively. Regarding the tibia, the prediction was exact, within one and two sizes in 53.0, 96.0, and 100% of cases, respectively. The regression model, utilizing patient-specific characteristics, such as foot size and hand circumference, accurately predicted TKA femur and tibia sizes within one component size. This provides a more efficient alternative for preoperative planning.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"602-606"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163336","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":"An Evaluation of Anatomic Referencing for Femoral Component Sizing Using Computed Tomography-Based Computer Modeling.","authors":"Brett Campbell, Max Weinberg, Jeffrey Bischoff, Giles R Scuderi","doi":"10.1055/a-2240-3566","DOIUrl":"10.1055/a-2240-3566","url":null,"abstract":"<p><p>One of the critical steps in total knee arthroplasty is femoral component positioning and sizing. Historically, there was wider variability between femoral component sizes, necessitating the concepts of anterior referencing (AR) and posterior referencing (PR). With the introduction of smaller increments between sizes, the concept of anatomic referencing has been introduced to replace AR and PR. The intent of this study was to validate the concept of anatomic referencing and show that with 2 mm increments in femoral sizes, the femoral component can be placed flush to the anterior cortex while maintaining posterior condylar offset (PCO). Digital surface models were created using 515 femurs from an established computed tomography database. Virtual bone resections, component sizing and placement were performed assuming neutral mechanical axis and a cartilage thickness of 2 mm. The appropriately sized femoral component, which had 2 mm incremental sizes, was placed flush with the anterior cortex with restoration of the PCO. The anterior-posterior distance from the posterior surface of the component to the medial and lateral surfaces of the posterior condylar cartilage were measured. The medial condyle was the limiting condyle in the majority of cases (73%). The average medial gap after appropriate femoral component matching was 0.6 mm (0.39-1.41 mm) across all sizes. The overall average condylar gap was 1.02 mm. The most common femoral component was a size 7 (57.2 mm) and the average femoral AP width was 55.9 mm. Anatomic referencing with an implant system that has 2-mm increments in femoral component sizing provides an alternative to AR and PR without compromise. Anatomic referencing allows for perfect alignment of the anterior flange of the femoral component to the anterior cortex of the femur while restoring the native PCO to within 1 mm. This avoids having to choose between AR or PR when in between femoral sizes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"638-641"},"PeriodicalIF":1.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404889","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":"Are Femoral Stems in Primary Total Knee Arthroplasty Cost Effective in High Fracture Risk Patients? A Risk Model and Cost Analysis.","authors":"Forrest Rackard, Noah Gilreath, Ignacio Pasqualini, Robert Molloy, Viktor Krebs, Nicolas S Piuzzi, Matthew E Deren","doi":"10.1055/a-2265-9979","DOIUrl":"10.1055/a-2265-9979","url":null,"abstract":"<p><p>Femoral stemmed total knee arthroplasty (FS TKA) may be used in patients deemed higher risk for periprosthetic fracture (PPF) to reduce PPF risk. However, the cost effectiveness of FS TKA has not been defined. Using a risk modeling analysis, we investigate the cost effectiveness of FS in primary TKA compared with the implant cost of revision to distal femoral replacement (DFR) following PPF. A model of risk categories was created representing patients at increasing fracture risk, ranging from 2.5 to 30%. The number needed to treat (NNT) was calculated for each risk category, which was multiplied by the increased cost of FS TKA and compared with the cost of DFR. The 50th percentile implant pricing data for primary TKA, FS TKA, and DFR were identified and used for the analysis. FS TKA resulted in an increased cost of $2,717.83, compared with the increased implant cost of DFR of $27,222.29. At 50% relative risk reduction with FS TKA, the NNT for risk categories of 2.5, 10, 20, and 30% were 80, 20, 10, and 6.67, respectively. At 20% risk, FS TKA times NNT equaled $27,178.30. A 10% absolute risk reduction in fracture risk obtained with FS TKA is needed to achieve cost neutrality with DFR. FS TKA is not cost effective for low fracture risk patients but may be cost effective for patients with fracture risk more than 20%. Further study is needed to better define the quantifiable risk reduction achieved in using FS TKA and identify high-risk PPF patients.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"680-686"},"PeriodicalIF":1.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713210","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":"A Longitudinal Analysis of Weight Changes before and after Total Knee Arthroplasty: Weight Trends, Patterns, and Predictors.","authors":"Precious C Oyem, Pedro J Rullán, Ignacio Pasqualini, Alison K Klika, Carlos A Higuera, Trevor G Murray, Viktor E Krebs, Nicolas S Piuzzi","doi":"10.1055/a-2232-5083","DOIUrl":"10.1055/a-2232-5083","url":null,"abstract":"<p><p>Longitudinal data on patient trends in body mass index (BMI) and the proportion that gains or loses significant weight before and after total knee arthroplasty (TKA) are scarce. This study aimed to observe patients longitudinally for a 2-year period and determine (1) clinically significant BMI changes during the 1 year before and 1 year after TKA and (2) identify factors associated with clinically significant weight changes.A prospective cohort of 5,388 patients who underwent primary TKA at a tertiary health care institution between January 2016 and December 2019 was analyzed. The outcome of interests was clinically significant weight changes, defined as a ≥5% change in BMI, during the 1-year preoperative and postoperative periods, respectively. Patient-specific variables and demographics were assessed as potential predictors of weight change using multinomial logistic regression.Overall, 47% had a stable weight throughout the study period (preoperative: 17% gained, 15% lost weight; postoperative: 19% gained, 16% lost weight). Patients who were older (odds ratio [OR] = 0.95), men (OR = 0.47), overweight (OR = 0.36), and Obese Class III (OR = 0.06) were less likely to gain weight preoperatively. Preoperative weight <i>loss</i> was associated with postoperative weight <i>gain</i> 1 year after TKA (OR = 3.03). Preoperative weight <i>gain</i> was associated with postoperative weight <i>loss</i> 1 year after TKA (OR = 3.16).Most patients maintained a stable weight before and after TKA. Weight changes during the 1 year before TKA were strongly associated with reciprocal rebounds in BMI postoperatively, emphasizing the importance of ongoing weight management during TKA and the recognition of patients at higher risk for weight gain.Level of evidence II (prospective cohort study).</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"612-621"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138802029","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":"Biomechanical Comparison of Uniplanar versus Biplanar Lateral Opening-wedge Distal Femoral Osteotomy Techniques in Terms of Risk for Medial Hinge Fracture.","authors":"Cem Yıldırım, Mehmet Demirel, Mehmet Ekinci, Simge Öztürk, Süreyya Ergün Bozdağ","doi":"10.1055/a-2232-4971","DOIUrl":"10.1055/a-2232-4971","url":null,"abstract":"<p><p>The effect of osteotomy type on the initial stiffness of the bone-implant construct in lateral opening-wedge distal femoral osteotomy (LOWDFO) using a uniplanar compared with a biplanar technique has been investigated. However, no study has explored the biomechanical risk factors for medial hinge fracture. This study aimed to compare the biomechanical strength of uniplanar versus biplanar LOWDFO regarding the risk for medial hinge fracture during gap opening. Twelve composite femora were divided into two groups (six in each group) based on the distal femoral osteotomy technique: uniplanar versus biplanar LOWDFO. All LOWDFO models were subjected to incremental static loading. The gap distance was expanded by 1 mm, and displacement values were recorded as <i>anterior and posterior gap distances (mm)</i>. <i>The average force values</i> of all samples <i>at certain gap distances</i> were recorded, and <i>the head distance</i> was measured. The uniplanar group had higher load values than the biplanar group at all anterior gap distances. These differences were only significant at 2- and 3-mm gap distances (<i>p</i> = 0.025 and 0.037). At all posterior gap distances, the uniplanar group had higher load values than the biplanar group, but these differences only reached statistical significance at 2 mm (<i>p</i> = 0.037). Both groups had similar anterior, posterior, and average gap distances (<i>p</i> = 0.75, 0.522, 0.873). The uniplanar group had a higher head insertion distance (15.3 ± 5.7) than the biplanar group (14.7 ± 2.9), but it was not significant (<i>p</i> = 0.87). The uniplanar group had a lower average load before medial hinge fracture (46.41 ± 13.91 N) than the biplanar group (54.92 ± 31.94, <i>p</i> = 0.81). The biplanar group had an average maximum load value of 64.18 ± 25.6 N, while the uniplanar group had 57.90 ± 12.21 N (<i>p</i> = 0.81). This study revealed that the biplanar osteotomy technique allows a wider opening wedge gap with less risk of a medial hinge fracture than uniplanar LOWDFO.Level of evidence was level 3, case-control series.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"623-630"},"PeriodicalIF":1.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138802032","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":"Anterior Cruciate Ligament Return to Play: Where Are We Now?","authors":"Lasun Oladeji, Grace Reynolds, Hyeri Gonzales, Steven DeFroda","doi":"10.1055/a-2130-4909","DOIUrl":"10.1055/a-2130-4909","url":null,"abstract":"<p><p>Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure, and it is crucial to assess an athlete's readiness to safely return to sports following ACLR to minimize the risk of reinjury. Despite this, determining optimal return to play (RTP) criteria following ACLR that is accurate, accessible, and reproducible remains challenging. This review aims to discuss commonly employed RTP criteria domains, including functional assessments, patient-reported outcomes, and psychological tests, as well as emerging technologies such as magnetic resonance imaging (MRI) that may play a role as a gold standard in RTP assessment. The findings of this review suggest RTP decision making after ACL surgery is nuanced and traditionally used objective measures do not perfectly predict RTS rates or clinical outcomes. In the future, a standardized MRI screening tool could help predict reinjury. The role of functional and psychological patient-reported outcome measures needs to defined, and objective criteria should be rigorously evaluated for whether they accurately screen an athlete's physical readiness and should be expanded to include more sport-specific movement analysis.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"586-592"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947989","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":"Using a Markerless Motion Capture System to Identify Preinjury Differences in Functional Assessments.","authors":"Pat Laupattarakasem, James L Cook, James P Stannard, Patrick A Smith, Kyle M Blecha, Trent M Guess, Rex L Sharp, Emily Leary","doi":"10.1055/s-0043-1772238","DOIUrl":"10.1055/s-0043-1772238","url":null,"abstract":"<p><p>Functional assessments identify biomechanical issues which may indicate risk for injury and can be used to monitor functional recovery after an injury or surgery. Although the gold standard to assess functional movements is marker-based motion capture systems, these are cost prohibitive and have high participant burden. As such, this study was conducted to determine if a markerless motion capture system could detect preinjury differences in functional movements between those who did and did not experience a noncontact lower extremity injury (NCLEI). A three-dimensional markerless motion capture system comprised an area of 3 m × 5 m × 2.75 m was used. Participants were Division I collegiate athletes wearing plain black long-sleeve shirts, pants, and running shoes of their choice. Functional assessments were the bilateral squat, right and left squat, double leg drop vertical jump, static vertical jump, right and left vertical jump, and right and left 5 hop. Measures were recorded once and the first NCLEI was recorded during the first year after measurement. Two-factor analysis of variance models were used for each measure with factors sex and injury status. Preinjury functional measures averaged 8.4 ± 3.4 minutes capture time. Out of the 333 participants recruited, 209 were male and 124 were female. Of those, 127 males (61%) and 92 females (74%) experienced later NCLEI. The most common initial NCLEI was nonanterior cruciate ligament knee injury in 38 females (41.3%) and 80 males (62.0%). Females had decreased flexion and lower valgus/varus displacement during the bilateral squat (<i>p</i> < 0.006). In addition, knee loading flexion for those who were not injured were more than that seen in the injured group, and was more pronounced for injured females (<i>p</i> < 0.03). The markerless motion capture system can efficiently provide data that can identify preinjury functional differences for lower extremity noncontact injuries. This method holds promise for effectively screening patients or other populations at risk of injury, as well as for monitoring pre-/postsurgery function, without the large costs or participant burden.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"570-576"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10004971","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":"Prediction of Postoperative Range of Motion after Mobile-Bearing Medial Unicompartmental Knee Arthroplasty from the Preoperative Range of Motion and Other Preoperative Factors.","authors":"Kensuke Anjiki, Takafumi Hiranaka, Toshikazu Tanaka, Takaaki Fujishiro, Koji Okamoto, Shinya Hayashi, Ryosuke Kuroda, Tomoyuki Matsumoto","doi":"10.1055/a-2280-9851","DOIUrl":"10.1055/a-2280-9851","url":null,"abstract":"<p><p>Postoperative flexion after unicompartmental knee arthroplasty might be predicted from the preoperative range of motion and other preoperative factors, but this has not been sufficiently investigated. Between 2013 and 2017, 198 patients (198 knees) underwent unilateral knee arthroplasty with medial mobile-bearing unicompartmental knee arthroplasty. Range of motion was measured preoperatively and at the time of final follow-up. To investigate the accuracy of the prediction of preoperative to postoperative gain or loss of the flexion angle, we performed receiver operating characteristic analysis. Logistic regression analysis was used to evaluate other predictive factors. Change in flexion angle was significantly strongly and negatively correlated with the preoperative flexion angle (<i>R</i> = - 0.688; 95% confidence interval: -0.755 to -0.607; <i>p</i> < 0.001). Preoperative flexion angle was suggested to be a significant predictor of gain or loss of the flexion angle with the area under the curve of 0.781; the cutoff value calculated using the Youden index was 140 degrees. Logistic regression analysis showed that in addition to the preoperative flexion angle of the operated side, the postoperative flexion range was significantly affected by the patient's height and by the preoperative flexion angle of the contralateral knee. If the preoperative flexion angle in Oxford mobile-bearing medial unicompartmental knee arthroplasty is <140 degrees, the postoperative flexion angle may be improved; if it exceeds 140 degrees, the postoperative flexion angle may worsen. This predictive ability is further improved by consideration of the patient's height and the range of motion on the contralateral side.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"687-692"},"PeriodicalIF":1.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029378","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}