Journal of Knee Surgery最新文献

{"title":"Effect of Posterior Laxity on Knee Flexion Angle After Cruciate-Retaining Total Knee Arthroplasty.","authors":"Kenichi Saito, Masanori Terauchi, Kazuhisa Hatayama, Hirotaka Chikuda","doi":"10.1055/a-2638-9787","DOIUrl":"https://doi.org/10.1055/a-2638-9787","url":null,"abstract":"<p><p>It is still controversial whether anteroposterior laxity or posterior tibial slope (PTS) after total knee arthroplasty (TKA) affects maximum flexion angle. The purpose of this study was to evaluate the relationship between PTS and tibial anteroposterior laxity after TKA and to examine the effect of these factors on knee flexion angle after TKA. This study enrolled 96 knees in 80 patients undergoing cruciate-retaining TKA (CR-TKA). Anterior translation (AT) and posterior translation (PT) were measured separately at a flexion of 90 degrees using stress radiographs. Total anteroposterior translation (APT) was defined as the sum of AT and PT. PTS was measured in a lateral view. In univariate analysis, postoperative flexion angle was positively correlated with preoperative flexion (<i>R</i> = 0.51; <i>p</i> < 0.01), PT (<i>R</i> = 0.48; <i>p</i> < 0.01), and APT (<i>R</i> = 0.48; <i>p</i> < 0.01), whereas it was negatively correlated with body mass index (BMI; <i>R</i> = - 0.43; <i>p</i> < 0.01) and PTS (<i>R</i> = - 0.24; <i>p</i> = 0.02). In multivariate analysis, postoperative flexion angle was negatively correlated with BMI (<i>β</i> = - 0.243; <i>p</i> < 0.01), whereas it was positively correlated with preoperative flexion (<i>β</i> = 0.406; <i>p</i> < 0.01) and PT (<i>β</i> = 0.279; <i>p</i> < 0.01). A negative correlation was found between PTS and PT (<i>R</i> = - 0.39, <i>p</i> < 0.01). An increase in posterior laxity at 90 degrees of flexion significantly increased postoperative flexion. An increase in PTS was associated with decreased posterior laxity; however, it had no effect on postoperative flexion.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545708","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":"The Influence of Knee Phenotypes Based on Coronal Plane Alignment of the Knee on Intraoperative Soft Tissue Balance and Clinical Outcomes: Comparison between Kinematically and Mechanically Aligned Total Knee Arthroplasty.","authors":"Shotaro Tachibana, Tomoyuki Matsumoto, Naoki Nakano, Masanori Tsubosaka, Tomoyuki Kamenaga, Yuichi Kuroda, Shinya Hayashi, Ryosuke Kuroda","doi":"10.1055/a-2542-2583","DOIUrl":"10.1055/a-2542-2583","url":null,"abstract":"<p><p>This study examined the impact of preoperative coronal plane alignment of the knee (CPAK) classification on intraoperative soft tissue balance and postoperative clinical outcomes in patients undergoing modified kinematically aligned (mKA) and mechanically aligned (MA) total knee arthroplasty (TKA). A total of 90 knees treated with mKA-TKA and 63 knees treated with MA-TKA were classified based on CPAK. After adjusting for confounding factors, intraoperative soft tissue balance, including varus/valgus balance and joint component gap, range of motion (ROM), and the 2011 Knee Society score (KSS), were compared 1 year postoperatively using one-way ANOVA. The analysis included 69 knees classified as type I and 18 type II in the mKA group, and 52 type I and 11 type II in the MA group. Varus balance at 30 and 60 degrees flexion was significantly larger in mKA type I and MA type I compared to mKA type II (<i>p</i> < 0.001, 0.005, <0.001, 0.008). At 90 degrees, mKA type I showed a larger varus balance than both MA type I and mKA type II (<i>p</i> = 0.008, 0.002), while at 120 degrees, mKA type I demonstrated a larger varus balance than MA type I (<i>p</i> < 0.001). The improved ROM in mKA type I was greater than in MA type I (<i>p</i> = 0.04). Improvement in the objective indicator of the 2011 KSS was better in mKA type I than in mKA type II, and patient satisfaction was significantly better in mKA type I compared to both mKA type II and MA type I (<i>p</i> = 0.01, <0.001, 0.03). mKA type I preserved lateral laxity in mid- and deep flexion compared to both mKA type II and MA type I, potentially contributing to improved ROM and clinical outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"440-447"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469674","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":"Serum and Urine Biomarkers Can Predict Outcomes after Osteochondral Allograft Transplantation in the Knee.","authors":"James L Cook, Aaron M Stoker, Kylee Rucinski, James P Stannard","doi":"10.1055/a-2632-2488","DOIUrl":"10.1055/a-2632-2488","url":null,"abstract":"<p><p>Osteochondral allograft transplantation (OCAT) is safe and effective for the treatment of large articular defects in the knee. Yet, there are no quantitative methods for predicting OCAT outcomes. This study was designed to analyze serum and urine biomarkers collected prior to OCAT to determine their capabilities for predicting outcomes with respect to functional graft survival. Prospectively collected data for patients undergoing primary multisurface knee OCAT, enrolled in an outcomes registry, were analyzed for graft survival. Blood and urine samples were collected prior to surgery for biomarker analyses. Biomarker concentrations were analyzed for the capability to predict OCAT failures (revision or arthroplasty) that occurred within the first 2 years. Fifty consecutive patients were included for analysis; the 2-year graft survival (success) rate was 80%. In samples obtained prior to OCAT, concentrations of serum hyaluronan (HA) and urine cross-linked C-telopeptide of type II collagen (CTX-II) were significantly higher for failure patients. A urinary biomarker panel containing cross-linked C-telopeptide of type I collagen (CTX-I), CTX-II, HA, IL-8, MMP-2, MMP-3, MMP-13, osteoprotegrin (OPG), and osteopontin (OPN) was able to predict the likelihood of treatment failure with an area under the curve (AUC) of 0.895, sensitivity of 85.3%, and specificity of 93.8%. Preoperative concentrations of urine CTX-II and urine MMP-3 were significantly associated with a higher risk for OCAT treatment failure. Serum and urine protein biomarkers analyzed prior to surgery have the potential to predict functional graft survival at 2 years following complex multisurface OCAT surgery in the knee. With further validation, these biomarkers may be useful as a component of the shared decision-making process for patients and health care teams to evaluate this treatment option. Level of Evidence 2, prospective cohort study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276374","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":"Letter to the Editor on \"Contemporary Cementless Patellar Implant Survivorship: A Systematic Review and Meta-Analysis of 3005 Patellae\".","authors":"Nosaibah Razaqi, Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1055/a-2638-9752","DOIUrl":"https://doi.org/10.1055/a-2638-9752","url":null,"abstract":"<p><p>Not applicable.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327454","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":"Preoperative Patellofemoral Malalignment Worsened the Outcome of Patients after Total Knee Arthroplasty.","authors":"Nianlai Huang, Liangming Wang, Liquan Cai, Qingfeng Ke, Shiqiang Wu","doi":"10.1055/a-2618-4666","DOIUrl":"10.1055/a-2618-4666","url":null,"abstract":"<p><p>The impact of preoperative patellofemoral malalignment (PFM) on the prognosis of patients who underwent total knee arthroplasty (TKA) remains unknown. This study aimed to explore the effect of preoperative PFM on the prognosis of patients who underwent TKA. This retrospective observational study included patients who underwent TKA at the Second Hospital Affiliated to Fujian Medical University between February 2018 and July 2020. The primary outcome measure was the Hospital for Special Surgery Knee-Rating Scale (HSS) score. The secondary outcomes included postoperative radiographic parameters (X-rays) and the occurrence of complications. A total of 94 patients (107 knees) who underwent TKA were included in the study. Of these, 37 knees had PFM and 70 had normal patellofemoral alignment (PFA). Patients with preoperative PFM showed a change in patellar outward displacement from 7.01 ± 3.91 mm preoperatively to -0.31 ± 2.86 mm postoperatively (<i>p</i> < 0.001), and the lateral patellar tilt angle changed from 9.45 ± 7.47 degrees to 6.06 ± 3.61 degrees (<i>P</i> = 0.009). Postoperative radiographic parameters between the PFM and PFA groups did not show any significant difference (<i>p</i> > 0.05), but the postoperative HSS score in the PFM group was lower than in the PFA group (total score: 70.35 ± 8.39 vs. 80.47 ± 5.44, <i>p</i> < 0.001). In addition, 13 (35.14%) knees in the PFM group experienced postoperative anterior knee pain compared to 10 (14.29%) knees in the PFA group (<i>P</i> = 0.013). Preoperative PFM may have an impact on the HSS score and the occurrence of anterior knee pain in patients after TKA. These findings suggest that surgeons should carefully evaluate preoperative PFA in patients undergoing TKA. Furthermore, patients with PFM may require additional monitoring and management of postoperative anterior knee pain, as well as special considerations for optimizing functional outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128886","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":"The Three Pillars of Total Knee Arthroplasty and Alternative Alignment Strategies.","authors":"Robert N Steensen","doi":"10.1055/a-2549-6335","DOIUrl":"https://doi.org/10.1055/a-2549-6335","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":"38 7","pages":"323"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250449","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":"Alignment Strategies in Total Knee Arthroplasty: The Rise and Role of Enabling Technology.","authors":"Darren B Chen","doi":"10.1055/s-0044-1795074","DOIUrl":"10.1055/s-0044-1795074","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) remains the gold standard surgical care for end-stage knee arthritis. Since its inception, TKA has seen many transformative factors with advances in material properties, implant design, and fixation. Improvements in implant longevity has culminated in TKA being recognized as one of modern medicine's most successful surgical procedures. Patient satisfaction, however, remains a significant challenge. Recent studies report that patient satisfaction with current implants and techniques remains at 80 to 90%, suggesting that up to one in five patients remain dissatisfied with their procedure. A balanced knee, defined as equal medial and lateral gaps in knee extension and flexion, is a desired outcome in TKA. This has been shown to be associated with improved clinical outcomes. Given the poor rate of surgeon-defined balance, intraoperative knee balance can be confirmed with objective load data using sensor-embedded smart inserts or by measuring gaps using computer-assisted or robotic platforms. Currently, there is no consensus on the correct alignment or laxity targets for individualized alignment strategies in TKA, and further research in this area is required to answer this. Tremendous advances in our understanding of knee anatomy and kinematics have come to light in the recent past, and these insights have spawned interest in alternative alignment techniques in TKA. More recently, an appreciation of individual knee phenotypes and associated classification systems have provided a platform and the scientific justification behind these contemporary alignment strategies. Paired with enabling technologies, it is becoming an accepted paradigm that surgeons have the ability to select a desired alignment target when undertaking an individualized alignment strategy in TKA and execute the surgery with a high degree of precision. It is hoped that this may reduce the rate of dissatisfaction following TKA and improve clinical outcomes. This review article provides an overview of the concepts of knee phenotypes, current alignment strategies in TKA, and the emerging benefits of enabling technologies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"344-350"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792643","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":"Intraoperative Patellar Tendon Injuries during Total Knee Arthroplasty: A Comprehensive Review of Incidence, Risk Factors, and Management Strategies.","authors":"Evan Offord, Innocent Njoku, Nickelas Huffman, Ignacio Pasqualini, Viktor E Krebs, Nicolas S Piuzzi, Matthew E Deren","doi":"10.1055/a-2509-3559","DOIUrl":"10.1055/a-2509-3559","url":null,"abstract":"<p><p>Patellar tendon rupture (PTR) is a rare and severe postoperative complication of total knee arthroplasty (TKA). Even rarer is the intraoperative occurrence of PTR during TKA. PTR is a major complication as it can lead to chronic disability, functional limitations, and postoperative morbidity. Therefore, surgical repair of the intraoperative PTR is typically pursued through one of the following three methods: (i) primary repair with direct suturing; (ii) direct suturing with cerclage augmentation, and (iii) direct suturing with either autograft or synthetic graft augmentation. In the case of an incomplete tear, direct repair with suture anchors for distal tears, and end-to-end repair with/without synthetic graft augmentation for mid-substance and proximal tears, is recommended. In the case of complete tears, if adequate tissue is present, direct repair with extensor mechanism reconstruction should be performed, regardless of the location of the tear. Furthermore, for complete tears with defective tissue, extensor mechanism reconstruction should be performed using mesh or allograft augmentation, regardless of the location of the tear. This review aims to provide a comprehensive and thorough overview of the prevention, diagnosis, management, and outcomes of intraoperative extensor mechanism injuries during TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"360-366"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928492","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":"No Radiographic Evidence of Medial Collateral Ligament Elongation in Valgus Osteoarthritic Knees Enables Treatment with Kinematically Aligned Total Knee Arthroplasty.","authors":"Alexander J Nedopil, Anand Singh Dhaliwal, Antonio Klasan, Stephen M Howell, Maury L Hull","doi":"10.1055/a-2395-6831","DOIUrl":"10.1055/a-2395-6831","url":null,"abstract":"<p><p>When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11-23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to -14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (<i>p</i> ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL. LEVEL OF EVIDENCE::  IV.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"328-335"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009761","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}

{"title":"Additional Dose of Intravenous Dexamethasone Can Replace Patient-Controlled Analgesia in Pain Control after Total Knee Arthroplasty while Reducing Opioid Complications.","authors":"Jisu Park, Moon Jong Chang, Tae Woo Kim, Chong Bum Chang, Seung-Baik Kang","doi":"10.1055/a-2509-3502","DOIUrl":"10.1055/a-2509-3502","url":null,"abstract":"<p><p>The purpose of this study was to evaluate whether intravenous (IV) dexamethasone, within the current multimodal pain management protocol, (1) could maintain postoperative pain at a comparable level without IV patient-controlled analgesia (PCA), (2) could reduce opioids-related side effects, and (3) whether an additional dose of dexamethasone on postoperative day (POD) 2 would offer further pain-relieving effect without increasing the risk of complications. A total of 178 patients (182 knees) who underwent total knee arthroplasty for osteoarthritis were included in the study. The patients were divided into Dexa 2 & PCA and Dexa 3 & NoPCA groups. From operative day to POD 5, pain visual analogue score (VAS), rescue opioids consumption, episodes of postoperative nausea and vomiting (PONV), antiemetics usage, and side effects of opioids such as postoperative urinary retention (POUR) and constipation were checked. For safety, wound complication and infection were checked. There was no difference in pain VAS between the two groups during all six perioperative days. Rescue opioids consumption was lower in Dexa 2 & PCA group. Total dosage of used opioids for six perioperative days was lower in Dexa 3 & NoPCA group. Dexa 3 & NoPCA group had less PONV and POUR. There was a marked increase in pain VAS and the use of rescue opioids from POD 1 to POD 2 in the Dexa 2 & PCA. There were no wound problems or infections in either group. Under the current multimodal pain management protocol, comparable level of postoperative pain could be achieved by dexamethasone without the need of IV PCA. By not using IV PCA, overall opioid usage was reduced, which could lead to a lower frequency of PONV and POUR. While there is still room for further research on the duration and frequency of administering dexamethasone, additional administration on POD 2 is believed to provide additional pain management benefits compared with administering only until POD 1.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"351-359"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928491","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}