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

{"title":"Torn discoid lateral meniscus is associated with increased medial meniscal extrusion and worse articular cartilage status in older patients.","authors":"Zhong Zhang,&nbsp;Xiao-Ke Shang,&nbsp;Bei-Ni Mao,&nbsp;Jian Li,&nbsp;Gang Chen","doi":"10.1007/s00167-018-5287-6","DOIUrl":"https://doi.org/10.1007/s00167-018-5287-6","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical, imaging, and arthroscopic characteristics of the torn discoid lateral meniscus (TDLM) in patients greater than 40 years of age with matched controls.</p><p><strong>Methods: </strong>One hundred and ninety-four older patients (211 knees) who underwent arthroscopic surgery for a TDLM were consecutively recruited (Group 1). Another 211 age- and sex-matched controls with a torn semilunar lateral meniscus were included in this study (Group 2). Statistical analyses were used to determine the differences in the clinical, imaging, and arthroscopic characteristics between the two groups.</p><p><strong>Results: </strong>In our series, more severe medial meniscal extrusion on magnetic resonance imaging was present in Group 1 than in Group 2 and more serious osteoarthritic changes were observed in both the medial and lateral compartments in Group 1. Under the same conditions, chondral lesions in the knee were more serious in Group 1 than in Group 2 when patients were subgrouped according to the presence of a horizontal tear or complex tear.</p><p><strong>Conclusions: </strong>In the present study, older patients with a torn discoid lateral meniscus exhibited greater and more severe medial meniscal extrusion and more serious osteoarthritis. Therefore, knees with a discoid lateral meniscus displaying medial meniscal extrusion should be monitored carefully with long-term follow-up, because a medial meniscal extrusion may increase the risk of progression to degenerative osteoarthritis of the medial compartment. Regarding the clinical relevance, these findings will be helpful in further revealing that a torn discoid lateral meniscus may affect not only the cartilage in the lateral compartment but also the cartilage in the medial compartment and medial meniscal extrusion.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2624-2631"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5287-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36747117","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":"Nearly 90% participation in sports activity 12 years after non-surgical management for anterior cruciate ligament injury relates to physical outcome measures.","authors":"Susan L Keays,&nbsp;Peter Newcombe,&nbsp;Anthony C Keays","doi":"10.1007/s00167-018-5258-y","DOIUrl":"https://doi.org/10.1007/s00167-018-5258-y","url":null,"abstract":"<p><strong>Purpose: </strong>Traditionally reconstructive surgery is recommended for patients planning to return to sport (RTS), especially to pivoting sports after anterior cruciate (ACL) rupture. Recent trends focus on delaying or avoiding surgery as some studies have found similar rates of RTS following both surgical and conservative management. This study aimed to establish long-term RTS levels in ACL-ruptured individuals treated conservatively, and to investigate the relationship between outcome measures and RTS, in particular, pivoting sports.</p><p><strong>Method: </strong>Fifty-five patients from a cohort of 132 ACL-deficient patients were followed-up for  12 (IQR 8,19) years post injury. Mean-aged 42 years, 22 patients were females and 33 males, 35 had meniscal injuries. Patients were treated with physiotherapy focussing on strength and dynamic stability training and not reconstructive surgery. Return to sport was measured on a 6-point scale. Outcome measures included: objective stability, subjective stability, quadriceps and hamstring strength. Spearman's rho and Chi-square tests were used to assess the relationship between RTS and outcome measures.</p><p><strong>Results: </strong>Eighty-nine percent of ACL-deficient patients were currently participating in sport despite a 38% increase in anterior translation (p < 0.001) and a 7.5% loss of quadriceps strength (p = 0.004) compared to the contralateral side. Six patients (11%) did not RTS, ten (18%) returned to safe sports, five (9%) returned to running and 16 (29%) to non-strenuous sports involving limited twisting. Eighteen patients (33%) returned to pivoting sports, 12(22%) at recreational level and six (11%) at competitive level. The level of RTS was related to subjective stability (p = 0.002), and to quadriceps and hamstring strength of the injured leg (p < 0.001). Patients able to return to pivoting sports differed significantly from those not doing so in outcome measures including objective (p = 0.022) and subjective stability (p = 0.035), and quadriceps strength (p = 0.044).</p><p><strong>Conclusions: </strong>Eighty-nine percent of ACL-ruptured individuals treated conservatively lead an active sporting life. One-third returned to pivoting sports.  Overall RTS was related to subjective and objective stability and quadriceps and to a lesser extent hamstring strength. This finding reinforced the importance of dynamic stability training as an initial treatment option in most cases.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2511-2519"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5258-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36628773","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":"Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction.","authors":"Gabriel Peixoto Leão Almeida,&nbsp;Thamyla Rocha Albano,&nbsp;Antônio Kayro Pereira Melo","doi":"10.1007/s00167-018-5245-3","DOIUrl":"https://doi.org/10.1007/s00167-018-5245-3","url":null,"abstract":"<p><strong>Purpose: </strong>To verify the validity and diagnostic accuracy of the hand-held dynamometer (HHD) with the isokinetic dynamometer for evaluating the quadriceps strength of subjects who have undergone ACL reconstruction (ACLR).</p><p><strong>Methods: </strong>This validity and diagnostic accuracy study was conducted prospectively by examining 70 consecutive participants who had undergone ACLR at least 6 months previously. All participants performed strength evaluation of the quadriceps muscle using the HHD and isokinetic dynamometer.</p><p><strong>Results: </strong>The HHD presented high test-retest reliability [intraclass correlation coefficient (ICC) = 0.98], moderate to good validity with the isokinetic dynamometer when compared for the quadriceps strength (r = 0.62), 100% perfect specificity [LR + infinity, 95% confidence interval (CI) 81.4%-100%] to identify those with LSI > 10%, and a sensitivity of 63.4% (48.9%-76.3%).</p><p><strong>Conclusion: </strong>The HHD is an instrument valid and reliable of low cost and easy handling compared to the isokinetic dynamometer to evaluate the quadriceps torque and the limb symmetry index after the ACLR with high diagnostic accuracy.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2494-2501"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5245-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36633189","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":"Mountain ultramarathon results in temporary meniscus extrusion in healthy athletes.","authors":"Theresa Diermeier,&nbsp;Knut Beitzel,&nbsp;Laura Bachmann,&nbsp;Wolf Petersen,&nbsp;Katrin Esefeld,&nbsp;Klaus Wörtler,&nbsp;Andreas B Imhoff,&nbsp;Andrea Achtnich","doi":"10.1007/s00167-018-5303-x","DOIUrl":"https://doi.org/10.1007/s00167-018-5303-x","url":null,"abstract":"<p><strong>Purpose: </strong>In recent literature medial meniscus extrusion (MME) was demonstrated as an age, BMI and load dependent physiological phenomenon in healthy knees. The aim of the present study was to evaluate the influence of mountain ultramarathon running on the medial meniscus extrusion (MME) in healthy athletes.</p><p><strong>Methods: </strong>Healthy athletes of the 2017 Gore-Tex® Transalpine run (seven stages with in total 270.5 km and 16453 m altitude) with asymptomatic knee, and no history of knee injuries or surgeries were included. All athletes underwent standard knee examination, MRI to exclude further knee pathologies and ultrasound imaging (USI) for measurement of MME before the competition. Extrusion in USI was determined in supine position (unloaded) and in standing position with full weight bearing and 20° of flexion (loaded). After the 1st, 3rd, and 7th stage ultrasound measurements were repeated directly after the competition. For evaluation of recovery, ultrasound measurement of MME was repeated 2 weeks after the race. Difference between ultrasound measurements of MME was assessed by unpaired t-test with significance set at p < 0.05.</p><p><strong>Results: </strong>Eighteen athletes (mean age 37.4 ± 8.3 years, 5 females, 13 males) were included in the study. The mean USI MME before the race was 1.9 mm ± 0.3 mm in supine position and 2.4 mm ± 0.4 mm under full weight bearing. During the race the mean MME increased significantly compared to baseline measurements. After 7th stage the mean MME in supine position was 2.7 mm ± 0.7 mm and 3.1 mm ± 0.6 mm under full weight bearing. After 2 weeks of recovery medial meniscus demonstrated a complete reversibility of the extrusion to normal (N.S).</p><p><strong>Conclusion: </strong>Medial meniscus extrusion observed under extreme loads generated by a mountain ultramarathon is a temporary and reversible phenomenon in healthy athletes. This suggests, that the meniscus has viscoelastic capacities showing short-term adaptions to high loads, which are completely reversible over time. For clinical practice assessment of the MME by ultrasound might be favorable compared to MRI due to the ability of dynamic evaluation and the easy access. Furthermore, load should be taken in account when assessing the MME and the current cut-off value of 3 mm for meniscus pathologies should be reconsidered.</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":"2691-2697"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5303-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36696339","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":"Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling-a 3D and finite element analysis.","authors":"Thomas Tampere,&nbsp;Wouter Devriendt,&nbsp;Michiel Cromheecke,&nbsp;Thomas Luyckx,&nbsp;Matthias Verstraete,&nbsp;Jan Victor","doi":"10.1007/s00167-018-5272-0","DOIUrl":"https://doi.org/10.1007/s00167-018-5272-0","url":null,"abstract":"<p><strong>Purpose: </strong>Recent studies have emphasized the importance of anatomical ACL reconstruction to restore normal knee kinematics and stability. Aim of this study is to evaluate and compare the ability of the anteromedial (AM) and transtibial (TT) techniques for ACL reconstruction to achieve anatomical placement of the femoral and tibial tunnel within the native ACL footprint and to determine forces within the graft during functional motion. As the AM technique is nowadays the technique of choice, the hypothesis is that there are significant differences in tunnel features, reaction forces and/or moments within the graft when compared to the TT technique.</p><p><strong>Methods: </strong>Twenty ACL-deficient patients were allocated to reconstruction surgery with one of both techniques. Postoperatively, all patients underwent a computed tomography scan (CT) allowing 3D reconstruction to analyze tunnel geometry and tunnel placement within the native ACL footprint. A patient-specific finite element analysis (FEA) was conducted to determine reaction forces and moments within the graft during antero-posterior translation and pivot-shift motion.</p><p><strong>Results: </strong>With significantly shorter femoral tunnels (p < 0.001) and a smaller inter-tunnel angle (p < 0.001), the AM technique places tunnels with less variance, close to the anatomical centre of the ACL footprints when compared to the TT technique. Using the latter, tibial tunnels were more medialised (p = 0.007) with a higher position of the femoral tunnels (p = 0.02). FEA showed the occurrence of higher, but non-significant, reaction forces in the graft, especially on the femoral side and lower, however, statistically not significant, reaction moments using the AM technique.</p><p><strong>Conclusion: </strong>This study indicates important, technique-dependent differences in tunnel features with changes in reaction forces and moments within the graft.</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":"2568-2576"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5272-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36704989","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 6-m timed hop test is a prognostic factor for outcomes in patients with meniscal tears treated with exercise therapy or arthroscopic partial meniscectomy: a secondary, exploratory analysis of the Odense-Oslo meniscectomy versus exercise (OMEX) trial.","authors":"Nina Jullum Kise,&nbsp;Ewa M Roos,&nbsp;Silje Stensrud,&nbsp;Lars Engebretsen,&nbsp;May Arna Risberg","doi":"10.1007/s00167-018-5241-7","DOIUrl":"https://doi.org/10.1007/s00167-018-5241-7","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the prognostic factors for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears treated with exercise therapy (ET) or arthroscopic partial meniscectomy (APM).</p><p><strong>Methods: </strong>One hundred and seven patients, with mean age 49.6 (SD 6.2) years and BMI 25.7 (SD 3.7), were included in this analysis of data from the OMEX trial ( http://www.clinicaltrials.gov NCT01002794). Linear and Poisson regression models were built to explore the associations between potential prognostic factors (patient characteristics, knee function-related and disease-related factors) and 2-year patient-reported outcomes: the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Pain, Symptoms, ADL, Sport/Rec, QoL and 5-point Global Rating of Change scales for knee pain (GRC Pain) and function (GRC Function). Analyses were performed for the whole cohort and for the two treatment groups (n = 55 and 52) with adjustments for age, sex, BMI and baseline KOOS.</p><p><strong>Results: </strong>For the whole cohort, a 1-s better baseline 6-m timed hop test result was associated with 3.1-7.1 points better 2-year scores for all KOOS subscales (95% CIs 1.1-5.2 to 4.1-10.1 points). A 1.61-2.80 s better test was associated with scores equivalent to previously calculated clinical relevant differences for each KOOS subscale. For the groups of patients treated with ET and APM, respectively, 2.09-3.60 s and 0.63-1.99 s better tests were associated with clinical relevant differences. For the whole cohort, a 1-s better test was associated with 26% (95% CI 15-38%) and 22% (95% CI 11-34%) higher possibility for better or much better GRC Pain and Function scores. Patients treated with ET had 17% (95% CI 2-33%) increased possibility for better or much better GRC Pain score, and patients treated with APM had 65% (95% CI 32-108%) and 70% (95% CI 38-109%) increased possibility for better or much better GRC Pain and Function scores.</p><p><strong>Conclusions: </strong>The 6-m timed hop test result was a significant prognostic factor for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears, especially in those treated with APM.</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":"2478-2487"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5241-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36739325","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":"Superior graft maturation after anatomical double-bundle anterior cruciate ligament reconstruction using the transtibial drilling technique compared to the transportal technique.","authors":"Masahiko Saito,&nbsp;Arata Nakajima,&nbsp;Masato Sonobe,&nbsp;Hiroshi Takahashi,&nbsp;Yorikazu Akatsu,&nbsp;Tsutomu Inaoka,&nbsp;Junichi Iwasaki,&nbsp;Tsuguo Morikawa,&nbsp;Atsuya Watanabe,&nbsp;Yasuchika Aoki,&nbsp;Takahisa Sasho,&nbsp;Koichi Nakagawa","doi":"10.1007/s00167-018-5240-8","DOIUrl":"https://doi.org/10.1007/s00167-018-5240-8","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate and compare the femoral tunnel aperture position, graft bending angle and the magnetic resonance imaging (MRI) graft signal intensity after anatomical double-bundle anterior cruciate ligament (ACL) reconstruction between transtibial and transportal drilling techniques of the femoral tunnel.</p><p><strong>Methods: </strong>Eighty-seven patients who underwent anatomic double-bundle ACL reconstruction with hamstring tendon autograft between January 2012 and December 2014 were included in this retrospective study. Forty-one patients underwent reconstruction using a transportal technique (TP group) and 46 patients underwent reconstruction using a transtibial technique (TT group). The anteromedial (AM) femoral aperture position and the graft bending angle were assessed using transparent three-dimensional CT 2 weeks postoperatively. MRI assessment was performed with proton density-weighted images in an oblique coronal plane 6 and 12 months postoperatively. Signal/noise quotient was calculated for two specific graft sites (femoral tunnel site and mid-substance site). Femoral aperture position, the graft bending angle and signal/noise quotient were compared between the TP and TT groups.</p><p><strong>Results: </strong>There was no significant difference in the aperture position between the two groups. The graft bending angle of the AM tunnel in the axial plane was significantly greater in the TP group (p < 0.001). On the other hand, the TP group had a significantly more acute angle in the coronal plane (p < 0.001). There was no significant difference at either site in the signal/noise quotient of the graft between the two groups at 6 months. However, the TT group had a lower signal/noise quotient at 12 months at both sites (femoral aperture: p = 0.04, mid-substance: p = 0.004).</p><p><strong>Conclusion: </strong>There was a significant difference in signal/noise quotient between the two drilling techniques 12 months postoperatively. There was no significant difference in femoral tunnel aperture position between the two groups. However, graft bending angle at the femoral tunnel aperture was significantly different between the two groups, indicating the possibility that graft bending angle is a factor that influences graft maturation. This indicates that the TT technique has an advantage over the TP technique in terms of graft maturation.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2468-2477"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5240-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36629121","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":"Correction to: Meniscal extrusion is positively correlated with the anatomical position changes of the meniscal anterior and posterior horns, following medial meniscal allograft transplantation.","authors":"Nam-Ki Kim,&nbsp;Seong-Il Bin,&nbsp;Jong-Min Kim,&nbsp;Bum-Sik Lee,&nbsp;Chang-Rack Lee","doi":"10.1007/s00167-018-5313-8","DOIUrl":"https://doi.org/10.1007/s00167-018-5313-8","url":null,"abstract":"<p><p>The article Meniscal extrusion is positively correlated with the anatomical position changes of the meniscal anterior and posterior horns, following medial meniscal allograft transplantation.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2400"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5313-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36797433","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":"Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option-results of a multicentre study.","authors":"M Heitmann,&nbsp;R Akoto,&nbsp;M Krause,&nbsp;P Hepp,&nbsp;C Schöpp,&nbsp;T J Gensior,&nbsp;C Bartl,&nbsp;H Lill,&nbsp;Karl-Heinz Frosch","doi":"10.1007/s00167-018-5317-4","DOIUrl":"https://doi.org/10.1007/s00167-018-5317-4","url":null,"abstract":"<p><strong>Purpose: </strong>The literature shows no consensus regarding the best method and timing for the treatment of acute knee dislocations. Studies indicate that a one-stage procedure performed in the early stages of injury can lead to superior results. The aim of this study was to evaluate the results after performing early surgical repair with additional suture augmentation (ligament bracing) of all torn ligaments in acute knee dislocations.</p><p><strong>Methods: </strong>In this prospective multicentre study, 73 patients with an acute type III or IV knee dislocation were treated with one-stage ligament bracing within 10 days. Twenty-six patients sustained a type III medial dislocation, thirty-nine patients sustained a type III lateral dislocation, and eight patients presented a type IV dislocation. Four patients were lost to follow-up. Within the follow-up evaluation, various scores were collected (International Knee Documentation Committee IKDC Score, Tegner Score and Lysholm Score). Additional stress radiography was performed (Telos™) postoperatively.</p><p><strong>Results: </strong>Sixty-nine knee dislocations (Schenck III and IV) with a follow-up at a mean of 14 ± 1.6 months were evaluated. The average IKDC score was 75.5 ± 14.5, the average Lysholm score was 81.0 ± 15.5, and the median loss of activity in the Tegner score was 1 (range 0-3) point. Stress radiographs showed side-to-side differences at a mean of 3.2 ± 1.3 mm for the anterior cruciate ligament (ACL) and of 2.9 ± 2.1 mm for the posterior cruciate ligament (PCL). The operative revision rate (early and late) was 17.4%. In the early stage, one wound infection and one case of transient common peroneal nerve (CPN) paresis were successfully revised. In the later stage, four patients with knee stiffness and six cases with symptomatic knee instability needed reoperation. Patients without ultra-low velocity (ULV) dislocations or CPN showed good or excellent results in 87.5% according to the Lysholm score.</p><p><strong>Conclusion: </strong>In cases of acute knee dislocation, primary ACL and PCL transosseous sutures with additional suture augmentation predominantly lead to good and excellent clinical results. Obese patients sustaining ultra-low velocity (ULV) dislocations and patients following injury to the CPN show inferior outcomes. In patients without ULV and CPN intraoperative and postoperative complications occurred in 10.1%. The obtained results and revision rates show that early primary suture repair is a promising option.</p><p><strong>Level of evidence: </strong>Prospective multicentre study, II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2710-2718"},"PeriodicalIF":3.8,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-018-5317-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36842979","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":"C-reactive protein (CRP) in different types of minimally invasive knee arthroplasty.","authors":"Emmanuel Thienpont,&nbsp;Irina Grosu,&nbsp;Sylvie Jonckheere,&nbsp;Jean Cyr Yombi","doi":"10.1007/s00167-012-2345-3","DOIUrl":"https://doi.org/10.1007/s00167-012-2345-3","url":null,"abstract":"<p><strong>Purpose: </strong>C-reactive protein (CRP) is an acute-phase biomarker responding to surgical trauma. Typically, a first peak is observed at day 2 with a reduction at day 4 and normalization 3-6 weeks after surgery. CRP is often linked to prosthetic joint infection when elevated values are present longer time after surgery. The aim of this study was to analyse the kinetics of CRP in different types of minimally invasive (MI) arthroplasty and to observe if there were significant differences in between MI total knee arthroplasty (TKA), patient-specific instruments (PSI) TKA and unicompartmental arthroplasty (UKA).</p><p><strong>Materials and methods: </strong>Three hundred and seventy-two patients were prospectively studied with a blood test measuring CRP at day 2, 4, 21 and 42 in 3 different groups of patients: 257 MI TKA, 55 PSI TKA and 60 UKA. Mean peak values and kinetics were compared in between different groups of MI arthroplasty.</p><p><strong>Results: </strong>There was a significant age difference in the three MI arthroplasty groups. The difference in mean age for the conventional MI TKA group of 68.8 ± 9.8 years, 58.5 ± 11.7 years for the unicompartmental group (P < 0.05) and 63.3 ± 9.6 years for the PSI group (P < 0.05) was significant. Mean CRP level, for the entire study group, on day 2 was 16.7 ± 8.8 mg/dl that gradually decreased to 13.6 ± 7.8 mg/dl on day 4. On day 21 and 42, median CRP level was 0.6 (0-20) and 0.4 (0-7) mg/dl, respectively. Peak CRP values were lower for UKA compared to TKA at day 2 (11.6 vs. 17.5 mg/dl) and day 4 (8.0 vs. 15 mg/dl), but this was not observed for PSI-assisted arthroplasty (18.9 vs. 17.5 mg/dl). There was a trend for faster CRP normalization in UKA compared to the two other groups at day 21 and at day 42 and for PSI TKA to have a lower mean level at 4 days (12.9 vs. 15 mg/dl). There was no statistical difference in the normalization rate of PSI-assisted versus MI TKA.</p><p><strong>Conclusion: </strong>Kinetics of CRP in MI arthroplasty are identical to the published kinetics of conventional TKA. Most patients normalize CRP at 3 weeks; however, 18 % does not by 6 weeks. This is not a sign of early prosthetic joint infection. Peak values are significantly lower for UKA but not for PSI TKA.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2603-10"},"PeriodicalIF":3.8,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2345-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40196586","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}