Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA最新文献

{"title":"Relationship between bone plug position and morphological changes of tunnel aperture in anatomic rectangular tunnel ACL reconstruction.","authors":"Ryohei Uchida,&nbsp;Yoshiki Shiozaki,&nbsp;Yoshinari Tanaka,&nbsp;Keisuke Kita,&nbsp;Hiroshi Amano,&nbsp;Takashi Kanamoto,&nbsp;Tatsuo Mae,&nbsp;Yuta Tachibana,&nbsp;Rikio Takao,&nbsp;Shuji Horibe","doi":"10.1007/s00167-018-5224-8","DOIUrl":"https://doi.org/10.1007/s00167-018-5224-8","url":null,"abstract":"<p><strong>Purpose: </strong>In animal studies after ACL reconstruction (ACL-R) using the bone-patellar tendon-bone (BTB), the graft-healing pattern was found to depend on the relationship between bone plug and the tunnel wall. This difference of graft-healing pattern could influence the postoperative morphological changes of the tunnel. However, no study has assessed the relationship between bone plug position and the change of tunnel morphology. Therefore, the main purpose of this study was to investigate the relationship between the bone plug position within femoral or tibial tunnel and morphological changes of each tunnel aperture in ACL-R using computed tomography.</p><p><strong>Methods: </strong>Subjects were 30 consecutive patients (six females and 24 males; mean age, 20.4 ± 5.4 years) who underwent primary ACL-R using BTB. The distance from the tunnel aperture to the tendon-bone junction (TBJ) at 2 weeks postoperatively, and tunnel aperture enlargement and tunnel wall migration from 2 weeks to 6 months postoperatively, were evaluated.</p><p><strong>Results: </strong>The distance from the femoral tunnel aperture to the TBJ in most cases was less than 2 mm, whereas the TBJ was located within the tibial tunnel. Femoral tunnel aperture was significantly enlarged (17.0 ± 11.7%) distally, and the tibial tunnel aperture was significantly enlarged (19.6 ± 12.5%) posterolaterally. Only the position at distal portion of femoral bone plug was correlated with femoral tunnel aperture enlargement (r = 0.454, p = 0.0015).</p><p><strong>Conclusion: </strong>Both femoral and tibial tunnel aperture were significantly enlarged distally and posterolaterally 6 months postoperatively. Only correlation between the position at distal portion of femoral bone plug and femoral tunnel enlargement were found, suggesting the deep plug position in the tunnel is a risk factor for femoral tunnel enlargement, highlighting the importance of accurately locating the TBJ just at the femoral tunnel aperture. Another option is to deviate the harvest site in the patellar tendon to match the shape of the TBJ and the tunnel aperture.</p><p><strong>Level of evidence: </strong>4 (case series).</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2417-2425"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5224-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36696338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation.","authors":"Jorge Chahla,&nbsp;Iain R Murray,&nbsp;James Robinson,&nbsp;Koen Lagae,&nbsp;Fabrizio Margheritini,&nbsp;Brett Fritsch,&nbsp;Manuel Leyes,&nbsp;Björn Barenius,&nbsp;Nicolas Pujol,&nbsp;Lars Engebretsen,&nbsp;Martin Lind,&nbsp;Moises Cohen,&nbsp;Rodrigo Maestu,&nbsp;Alan Getgood,&nbsp;Gonzalo Ferrer,&nbsp;Silvio Villascusa,&nbsp;Soshi Uchida,&nbsp;Bruce A Levy,&nbsp;Richard Von Bormann,&nbsp;Charles Brown,&nbsp;Jacques Menetrey,&nbsp;Michael Hantes,&nbsp;Timothy Lording,&nbsp;Kristian Samuelsson,&nbsp;Karl Heinz Frosch,&nbsp;Juan Carlos Monllau,&nbsp;David Parker,&nbsp;Robert F LaPrade,&nbsp;Pablo E Gelber","doi":"10.1007/s00167-018-5260-4","DOIUrl":"https://doi.org/10.1007/s00167-018-5260-4","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a statement on the diagnosis, classification, treatment, and rehabilitation concepts of posterolateral corner (PLC) injuries of the knee using a modified Delphi technique.</p><p><strong>Methods: </strong>A working group of three individuals generated a list of statements relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries to form the basis of an initial survey for rating by an international group of experts. The PLC expert group (composed of 27 experts throughout the world) was surveyed on three occasions to establish consensus on the inclusion/exclusion of each item. In addition to rating agreement, experts were invited to propose further items for inclusion or to suggest modifications of existing items at each round. Pre-defined criteria were used to refine item lists after each survey. Statements reaching consensus in round three were included within the final consensus document.</p><p><strong>Results: </strong>Twenty-seven experts (100% response rate) completed three rounds of surveys. After three rounds, 29 items achieved consensus with over 75% agreement and less than 5% disagreement. Consensus was reached in 92% of the statements relating to diagnosis of PLC injuries, 100% relating to classification, 70% relating to treatment and in 88% of items relating to rehabilitation statements, with an overall consensus of 81%.</p><p><strong>Conclusions: </strong>This study has established a consensus statement relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries. Further research is needed to develop updated classification systems, and better understand the role of non-invasive and minimally invasive approaches along with standardized rehabilitation protocols.</p><p><strong>Level of evidence: </strong>Consensus of expert opinion, Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2520-2529"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5260-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36708091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction.","authors":"Matthew P Ithurburn,&nbsp;Andrew M Zbojniewicz,&nbsp;Staci Thomas,&nbsp;Kevin D Evans,&nbsp;Michael L Pennell,&nbsp;Robert A Magnussen,&nbsp;Mark V Paterno,&nbsp;Laura C Schmitt","doi":"10.1007/s00167-018-5291-x","DOIUrl":"https://doi.org/10.1007/s00167-018-5291-x","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose was to test the following hypotheses: (1) magnetic resonance imaging (MRI) markers of early knee cartilage degeneration would be present in the involved limb of young athletes after anterior cruciate ligament reconstruction (ACLR) and (2) poor knee function would be associated with MRI markers of cartilage degeneration.</p><p><strong>Methods: </strong>Twenty-five young athletes after primary, unilateral ACLR (mean age, 16.7 years) were followed to 5-year post-return-to-sport (RTS) clearance, as a part of a larger, prospective cohort study in young athletes post-ACLR. At 2-year post-RTS, patient-reported knee function was evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS). At 5-year post-RTS, qualitative MRI sequences (3 T) and quantitative T1rho and T2 maps segmented into six regions at the femur and tibia were performed for the involved and uninvolved knee cartilages. Relaxation times were compared between knees using Holm-corrected paired t tests. Linear regression was used to examine the association between KOOS scores at 2 years and relaxation times at 5 years.</p><p><strong>Results: </strong>Elevated T1rho and T2 relaxation times were observed in the involved knee at the anterior medial femoral condyle compared to the uninvolved knee (p = 0.006, p = 0.024, respectively). Lower KOOS-Pain, KOOS-Symptoms, KOOS-ADL, and KOOS-Sport scores at 2-year post-RTS were associated with higher T1rho or T2 relaxation times in various regions of the involved knee at 5-year post-RTS (all p < 0.05).</p><p><strong>Conclusions: </strong>MRI markers of early cartilage degeneration were identified in the medial compartment of the involved knee in young athletes 5-year post-RTS after ACLR. Lower KOOS scores at 2-year post-RTS were associated with elevated knee cartilage T1rho and T2 relaxation times at 5-year post-RTS. Evaluating patient-reported function over time after ACLR appears to provide insight into future degenerative changes in the knee cartilage matrix.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2643-2652"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5291-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36739326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial compartment defects progress at a more rapid rate than lateral cartilage defects in older adults with minimal to moderate knee osteoarthritis (OA): data from the OA initiative.","authors":"Joshua S Everhart,&nbsp;Moneer M Abouljoud,&nbsp;Sarah G Poland,&nbsp;David C Flanigan","doi":"10.1007/s00167-018-5202-1","DOIUrl":"https://doi.org/10.1007/s00167-018-5202-1","url":null,"abstract":"<p><strong>Purpose: </strong>To determine: (1) rates and risk factors for progression of lateral and medial full-thickness cartilage defect size in older adults without severe knee osteoarthritis (OA), and (2) whether risk factors for defect progression differ for knees with Kellgren-Lawrence OA grade 3 (moderate) OA versus grades 0-2 (none to mild) OA.</p><p><strong>Methods: </strong>Three-hundred and eighty adults enrolled in the Osteoarthritis Initiative were included (43% male, mean age 63.0 SD 9.2 years). Ethical approval was obtained at all study sites prior to enrollment. All participants had full-thickness tibial or weight-bearing femoral condylar cartilage defects on baseline knee MRIs. Baseline OA grade was KL grade 3 in 71.3% and grades 0-2 in 21.7% of participants. Repeat MRIs were obtained at a minimum 2-year follow-up. Independent risk of progression in defect size due to demographic factors, knee alignment, OA grade, knee injury and surgery history, and baseline knee symptoms was determined by multivariate Cox proportional hazards and linear regression modeling.</p><p><strong>Results: </strong>The average increase in defect size over 2 years for lateral defects was 0.18 cm² (SD 0.60) and for medial defects was 0.49 cm² (SD 1.09). Independent predictors of medical defect size progression were bipolar defects (beta 0.47 SE 0.08; p < 0.001), knee varus (per degree, beta 0.08 SE 0.03; p = 0.02) and increased weight (per kg, beta = 0.01 SE 0.004; p = 0.01). Independent predictors for lateral defect progression were larger baseline defect size (per 1.0 cm², beta 0.14 SE 0.03; p < 0.001) and tibial sided defects (beta 0.12 SE 0.04) and degrees valgus (per degree, beta 0.04 SE 0.01; p = 0.001).</p><p><strong>Conclusions: </strong>Medial compartment full-thickness defects progress at a more rapid rate than lateral defects in older adults with minimal to moderate OA. Medial defect progression was greatest for bipolar defects in heavier adults with varus knees. Lateral defect progression was greatest for large tibial-sided defects in adults with valgus knees.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2401-2409"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5202-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36578416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustable buttons for ACL graft cortical fixation partially fail with cyclic loading and unloading.","authors":"J Glasbrenner,&nbsp;C Domnick,&nbsp;M J Raschke,&nbsp;T Willinghöfer,&nbsp;C Kittl,&nbsp;P Michel,&nbsp;D Wähnert,&nbsp;Mirco Herbort","doi":"10.1007/s00167-018-5262-2","DOIUrl":"https://doi.org/10.1007/s00167-018-5262-2","url":null,"abstract":"<p><strong>Purpose: </strong>Despite good initial pullout strength, it is unclear whether adjustable button (AB) devices for anterior cruciate ligament (ACL) soft-tissue graft fixation, which are based on the Chinese finger trap technique, resist cyclic loading. Furthermore, they have never been tested in a cyclic protocol including complete unloading. It was hypothesized, that the displacement of AB devices with the Chinese finger trap technique would be greater than that of continuous suture loop devices and other available AB mechanisms in a cyclic loading with complete unloading protocol.</p><p><strong>Methods: </strong>ACL reconstruction was performed in a porcine knee model using three different types of cortical fixation devices: two different AB devices that use the Chinese finger trap design, one AB device that uses a locked suture loop mechanism and two different continuous loop devices as control groups (n = 40). Specimens were mounted in a material-testing machine (Instron Inc.) that permitted 2500 loading and complete unloading cycles to a maximum of 250 N, as well as continuous elongation recording. A one-way ANOVA was performed for statistical analysis.</p><p><strong>Results: </strong>The displacement of ABs with a Chinese finger trap loop (mean 8.1; SD 1.5 mm and mean 6.1; SD 1.4 mm) was significantly greater than that of AB with a locked suture loop (mean 4.7; SD 1.0 mm; p < 0.05) and devices with a continuous loop (mean 4.1; SD 0.5 mm and mean 4.4, SD 0.3 mm; p < 0.01). No significant differences were detected between the ABs with a locked suture loop and the continuous loops.</p><p><strong>Conclusion: </strong>Cyclic loading and unloading of AB using the Chinese finger trap technique leads to significantly greater construct lengthening compared with other devices. Complete unloading of the ACL is very likely to occur during rehabilitation after ACL reconstruction. Lengthening of the AB device due to cyclic loading might be a potential mode of failure of the ACL graft fixation. Therefore, when using an AB femoral fixation technique, a locked suture loop design or a careful rehabilitation protocol should be considered.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2530-2536"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5262-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36623552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of the medial patellofemoral ligament and reinforcement of the medial patellotibial ligament is an effective treatment for patellofemoral instability with patella alta.","authors":"Yimeng Yang,&nbsp;Qiang Zhang","doi":"10.1007/s00167-018-5281-z","DOIUrl":"https://doi.org/10.1007/s00167-018-5281-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical outcome of the combined reconstruction of the medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) for patellar instability with patella alta.</p><p><strong>Methods: </strong>A total of 108 patients underwent a combined reconstruction of the MPFL and MPTL, and 58 patients were included in this study. The clinical results were evaluated and compared using the International Knee Documentation Committee (IKDC) scores, Kujala scores, and visual analogue scale (VAS) scores. The tibial tuberosity-trochlear groove (TT-TG) distance, three indices of patellar height (Insall-Salvati ratio, modified Insall-Salvati ratio, and Caton-Deschamps index), and patellar shift and tilt were defined preoperatively and at the 12- and 24-month follow-up visits.</p><p><strong>Results: </strong>At the 12- and 24-month follow-up visits, 86.2% (50/58) and 87.9% (51/58) of the subjective outcomes were excellent, 5/58 (8.6%) and 4/58 (6.9%) were good, 1/58 (1.7%) and 2/58 (3.4%) were fair, and 2/58 (3.4%) and 1/58 (1.7%) were poor. There were significant improvements in the IKDC scores, from 51.9 ± 13.8 preoperatively to 80 ± 19.2 (P < 0.05) at 12 months and 85 ± 13.9 (P < 0.05) at 24 months; Kujala scores, from 55.1 ± 15.2 preoperatively to 82.6 ± 14.9 (P < 0.05) at 12 months and 89.5 ± 10.2 (P < 0.05) at 24 months; and VAS scores, from 58 ± 11 preoperatively to 12 ± 5 (P < 0.05) at 12 months and 11 ± 4 (P < 0.05) at 24 months. The patellar tilt, patellar shift, Insall-Salvati ratio, modified Insall-Salvati ratio, Caton-Deschamps index, and TT-TG distance all decreased significantly compared with the preoperative values, and there were no significant differences between the values at the 12- and 24-month follow-ups.</p><p><strong>Conclusion: </strong>The results of this study show that a combined reconstruction of the MPFL and MPTL is an effective treatment for patellar instability with patella alta. This article emphasizes the combined effect of MPFL and MPTL instead of MPFL alone and provides an effective option for the treatment of recurrent patellar dislocation with patella alta.</p><p><strong>Level of evidence: </strong>Case series, Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2599-2607"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5281-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36716757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significant effect of the medial hamstrings on dynamic knee stability.","authors":"Aneet S Toor,&nbsp;Orr Limpisvasti,&nbsp;Hansel E Ihn,&nbsp;Michelle H McGarry,&nbsp;Michael Banffy,&nbsp;Thay Q Lee","doi":"10.1007/s00167-018-5283-x","DOIUrl":"https://doi.org/10.1007/s00167-018-5283-x","url":null,"abstract":"<p><strong>Purpose: </strong>While hamstring autograft is a popular option for the general population, BTB autograft is still significantly more popular among professional athletes due to concerns of altering knee kinematics with hamstring harvest. This study seeks to quantify the contribution of the medial hamstrings to knee stability.</p><p><strong>Methods: </strong>Valgus knee laxity, anterior tibial translation, and rotational motion were measured in eight fresh-frozen cadaveric knees after forces were applied on the tibia in each plane (coronal, sagittal, and axial). Four muscle loading conditions were tested: (1) physiologic fully loaded pes anserinus, (2) semitendinosus only loaded, (3) gracilis only loaded, and (4) unloaded pes anserinus. The protocol was then repeated with the ACL transected.</p><p><strong>Results: </strong>In the ACL intact knee, the neutral position of the tibia with an unloaded pes anserinus was significantly more externally rotated (p < 0.01) and anteriorly translated (p < 0.05) at all knee flexion angles than a tibia with a physiologic loaded pes anserinus. Applying an external rotation torque significantly increased external rotation for the fully unloaded (p < 0.001), gracilis only loaded (p < 0.001), and semitendinosus only loaded (p < 0.01) conditions at all flexion angles. Applying a valgus torque resulted in a significant increase in laxity for the fully unloaded condition only at 30° of flexion (p < 0.05). Applying an anterior tibial force resulted in significant increase in anterior translation for the fully unloaded condition at all flexion angles (p < 0.01), and for the gracilis only loaded condition in 30° and 60° of flexion (p < 0.05). Similar results were seen in the ACL deficient model.</p><p><strong>Conclusion: </strong>The medial hamstrings are involved in rotational, translational, and varus/valgus control of the knee. Applying anterior, external rotation, and valgus forces on the hamstring deficient knee significantly increases motion in those planes. Harvesting the gracilis and semitendinosus tendons alters native knee kinematics and stability. This is clinically relevant and should be a consideration when choosing graft source for ACL reconstruction, especially in the elite athlete population.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2608-2616"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5283-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36716758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic is better than isometric posterior cruciate ligament tunnel placement based upon in vivo simulation.","authors":"Willem A Kernkamp,&nbsp;Axel J T Jens,&nbsp;Nathan H Varady,&nbsp;Ewoud R A van Arkel,&nbsp;Rob G H H Nelissen,&nbsp;Peter D Asnis,&nbsp;Robert F LaPrade,&nbsp;Samuel K Van de Velde,&nbsp;Guoan Li","doi":"10.1007/s00167-018-5233-7","DOIUrl":"https://doi.org/10.1007/s00167-018-5233-7","url":null,"abstract":"<p><strong>Purpose: </strong>To elucidate the effects of various tibial and femoral attachment locations on the theoretical length changes and isometry of PCL grafts in healthy knees during in vivo weightbearing motion.</p><p><strong>Methods: </strong>The intact knees of 14 patients were imaged using a combined magnetic resonance and dual fluoroscopic imaging technique while the patient performed a quasi-static lunge (0°-120° of flexion). The theoretical end-to-end distances of the 3-dimensional wrapping paths between 165 femoral attachments, including the anatomic anterolateral bundle (ALB), central attachment and posteromedial bundle (PMB) of the PCL, connected to an anterolateral, central, and posteromedial tibial attachment were simulated and measured. A descriptive heatmap was created to demonstrate the length changes on the medial condyle and formal comparisons were made between the length changes of the anatomic PCL and most isometric grafts.</p><p><strong>Results: </strong>The most isometric graft, with approximately 3% length change between 0° and 120° of flexion, was located proximal to the anatomic femoral PCL attachments. Grafts with femoral attachments proximal to the isometric zone decreased in length with increasing flexion angles, whereas grafts with more distal attachments increased in length with increasing flexion angles. The ALB and central single-bundle graft demonstrated a significant elongation from 0° to 120° of flexion (p < 0.001). The PMB decreased in length between 0° and 60° of flexion after which the bundle increased in length to its maximum length at 120° (p < 0.001). No significant differences in length changes were found between either the ALB or PMB and the central graft, and between the ALB and PMB at flexion angles ≥ 60° (n.s.).</p><p><strong>Conclusions: </strong>The most isometric attachment was proximal to the anatomic PCL footprint and resulted in non-physiological length changes. Moving the femoral attachment locations of the PCL significantly affected length change patterns, whereas moving the tibia locations did not. The importance of anatomically positioned (i.e., distal to the isometric area) femoral PCL reconstruction locations to replicate physiological length changes is highlighted. These data can be used to optimize tunnel positioning in either single- or double-bundle and primary or revision PCL reconstruction cases.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2440-2449"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5233-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36611664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supine lateral radiographs at 90° of knee flexion have a similar diagnostic accuracy for chronic posterior cruciate ligament injuries as stress radiographs.","authors":"Sang-Gyun Kim,&nbsp;Soo-Hyun Kim,&nbsp;Won-Suk Choi,&nbsp;Ji-Hoon Bae","doi":"10.1007/s00167-018-5228-4","DOIUrl":"https://doi.org/10.1007/s00167-018-5228-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate whether supine lateral radiographs (SLRs) could replace stress radiographs for diagnosing chronic posterior cruciate ligament (PCL) injuries and identifying combined PCL injuries (defined as PCL injury with medial collateral ligament or posterolateral ligament complex injury).</p><p><strong>Methods: </strong>In this retrospective study, both SLRs at 30° and 90° of knee flexion (30/90 SLRs) and Telos stress radiographs of patients with chronic PCL injuries (n = 38) and only 30/90 SLRs of healthy controls (n = 84) were taken. Injured-to-normal differences on 30/90 SLRs and stress radiographs were assessed. Correlation analysis was performed to evaluate injured-to-normal differences on 30/90 SLRs and stress radiographs in patients with chronic PCL injury. Subgroup analysis was performed to compare injured-to-normal differences on 30/90 SLRs and stress radiographs between the isolated and combined PCL injury groups. Receiver operating characteristic curves based on 30/90 SLRs were calculated to determine the cut-off value for diagnosing chronic PCL injury and identifying combined PCL injury.</p><p><strong>Results: </strong>Injured-to-normal differences on both 30 SLRs (3.1 ± 3.6 vs 1.6 ± 1.2, P = 0.019) and 90 SLRs (7.5 ± 3.5 vs 1.2 ± 1.0, P < 0.001) were significantly greater in patients with chronic PCL injuries than in healthy controls. Further, 90 SLRs had a highly accurate diagnostic value for chronic PCL injuries (area under the curve 0.958). The cut-off value for diagnosing chronic PCL injuries based on 90 SLRs was 3.0 mm (sensitivity, 94.7%; specificity, 92.9%). Injured-to-normal differences on 30/90 SLRs were significantly correlated with those on stress radiographs. The correlation coefficients were 0.397 (P = 0.014) for 30 SLRs and 0.605 (P < 0.001) for 90 SLRs. The cut-off value for diagnosing combined PCL injuries based on 90 SLRs was 9.6 mm (area under the curve 0.72).</p><p><strong>Conclusions: </strong>The diagnostic accuracy of 90 SLRs for chronic PCL injuries was similar to that of stress radiographs. Therefore, the 90 SLRs are reliable alternative method to assess the posterior knee laxity when the stress radiographs are not available.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2433-2439"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5228-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36619491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The medial proximal tibial angle accurately corrects the limb alignment in open-wedge high tibial osteotomy.","authors":"Mitsuaki Kubota,&nbsp;Ryuichi Ohno,&nbsp;Taisuke Sato,&nbsp;Junichiro Yamaguchi,&nbsp;Haruka Kaneko,&nbsp;Kazuo Kaneko,&nbsp;Muneaki Ishijima","doi":"10.1007/s00167-018-5216-8","DOIUrl":"https://doi.org/10.1007/s00167-018-5216-8","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to detect the pre- and intra-operative influential factors for lower limb alignment correction error in open-wedge high tibial osteotomy (OWHTO).</p><p><strong>Methods: </strong>This study involved 69 patients (71 knees) undergoing OWHTO for primary medial osteoarthritis. The weight-bearing line (WBL) ratio, medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured on radiographs preoperatively and at 1 month after surgery, and the differences between the pre- and postoperative values were calculated. The correction angle during surgery was also investigated. The radiological correction angle was defined as the difference between the pre- and postoperative MPTA. The correction error was defined as the difference between the correction angle during surgery and the radiological correction angle. The ideal correction angle was defined as when the postoperative WBL passed through Fujisawa's point (WBL = 62.5%), and the alignment error was defined as the difference between the postoperative WBL ratio and 62.5. The correlations among the alignment error, the correction error, correction angle during surgery, pre- and postoperative WBL ratio, MPTA, and JLCA and the differences between the pre and postoperative WBL ratio, MPTA, and JLCA were investigated. In addition, the factor most influential on the alignment error was determined.</p><p><strong>Results: </strong>The preoperative MPTA was the only predictor of the alignment error after OWHTO. The alignment error was positively correlated with the correction error and correction angle during surgery, and negatively correlated with pre- and postoperative WBL ratio, MPTA, and differences between the pre- and postoperative WBL ratio and JLCA.</p><p><strong>Conclusion: </strong>The preoperative MPTA was the only pre- and intra-operative predictor of the alignment error after OWHTO. The larger the correction angle, the greater the alignment error. The MPTA was recommended as an indicator for improving the correction accuracy. Accurate correction based on the MPTA provides good lower limb alignment and better clinical results.</p><p><strong>Level of evidence: </strong>III Case-control study/Retrospective comparative study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2410-2416"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5216-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36619492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}