Knee最新文献

{"title":"Correction of severe varus deformity in total knee arthroplasty with the technique of tibial plateau reduction","authors":"Guo-Chun Zha,&nbsp;Gang Bao,&nbsp;Hao Wu,&nbsp;He-Ping Wang,&nbsp;An-Dong Wang,&nbsp;Zhi-Jun Shen","doi":"10.1016/j.knee.2024.12.005","DOIUrl":"10.1016/j.knee.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>The optimal soft tissue release technique for severe varus total knee arthroplasty (TKA) remains controversial. The technique of tibial plateau reduction was suggested for severe varus deformity during TKA. The purpose of this study was to evaluate the clinical and radiological outcomes of the technique of tibial plateau reduction.</div></div><div><h3>Methods</h3><div>Fifty-one knees (39 patients) with a mechanical femoro-tibial angle (MFTA) greater than 15° treated with TKA was presented. The clinical and radiographic data were gathered prospectively. The patients were divided into two groups according to the preoperative angle: Group A comprised patients with a preoperative MFTA less than or equal to 20°, while Group B included patients with a preoperative MFTA greater than 20°.</div></div><div><h3>Results</h3><div>Among the 51 knees, 46 knees (90.2%) had femoro-tibial component size mismatch. The KSS-KS improved from preoperative 39.9 ± 11.3 points (range:18–68 points) to 92.3 ± 5.2 points (range: 83–100 points) at the final follow up (t = 30.141, <em>P</em> &lt; 0.001); the KSS-FS improved from preoperative 48.0 ± 11.5 points (range: 31–71 points) to 87.2 ± 8.7 points (range: 63–100 points) at the final follow up (t = 19.413, <em>P</em> &lt; 0.001). The mean MFTA was corrected from 21.0 ± 4.7° preoperatively to 2.9 ± 1.8° at the latest follow up (<em>P</em> &lt; 0.001). The preoperative MFTA was less than or equal to 20° in 27 knees (Group A), and greater than 20° in 24 knees (Group B). The mean postoperative MFTA was 1.9 ± 0.9° in Group A, and 4.1 ± 1.7° in Group B (<em>P</em> &lt; 0.001). The neutral limb alignment was reached in 26 knees (96.3%) in group A, which was significantly higher than that in group B (29.7%) (<em>P</em> = 0.019).</div></div><div><h3>Conclusions</h3><div>The technique of tibial plateau reduction provided satisfactory clinical and radiological outcomes without instability for severe varus TKA. However, surgeons should remain aware that the greater the preoperative varus deformity, the greater the postoperative residual varus deformity, and that there is a high incidence of femoro-tibial component size mismatch using the technique.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 138-146"},"PeriodicalIF":1.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911202","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":"Lower extremity joint kinematics in individuals with and without bilateral knee osteoarthritis during normal and narrow-base walking: A cross-sectional study","authors":"Zohreh Shafizadegan ,&nbsp;Omid Rasouli ,&nbsp;Javad Sarrafzadeh ,&nbsp;Farzam Farahmand ,&nbsp;Reza Salehi","doi":"10.1016/j.knee.2024.12.001","DOIUrl":"10.1016/j.knee.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteoarthritis (KOA) is a prevalent musculoskeletal disease affecting joint mechanics. Considering the effect of step-width changes on the biomechanics of gait, especially the alteration of stability dynamics during narrow-base gait, this study investigated the kinematic parameters of the lower extremities during both normal and narrow-base walking in individuals with and without KOA.</div></div><div><h3>Methods</h3><div>A cross-sectional study with 20 individuals with bilateral KOA and 20 controls was conducted. Participants walked on a treadmill at a preferred speed across normal and narrow paths. Joint angles and angular velocities in the sagittal and frontal planes were recorded, and mixed ANOVA was used to analyze group × condition effects.</div></div><div><h3>Results</h3><div>Significant main effects of walking condition were observed for hip (<em>p</em> = 0.001) and ankle angles (<em>p</em> = 0.002) in the frontal plane, and knee (<em>p</em> = 0.004) and ankle angular velocities (<em>p</em> = 0.002) in the sagittal plane. Moreover, there were significant main effects of group on the hip (<em>p</em> = 0.01) and knee angles (<em>p</em> = 0.04) in the sagittal plane. KOA group showed higher peak hip adduction (<em>p</em> &lt; 0.001) and ankle inversion (<em>p</em> = 0.02]) during narrow-base walking than on the normal path. People with KOA had also significantly higher peak angular velocity of knee flexion (<em>p</em> = 0.03), ankle dorsiflexion (<em>p</em> = 0.002), and ankle inversion (<em>p</em> = 0.03) during narrow-base walking.</div></div><div><h3>Conclusions</h3><div>The findings suggest that KOA and narrow-base gait challenges may trigger distinct kinematic adaptation strategies, potentially contributing to cartilage degeneration and altering balance mechanisms.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 126-137"},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900742","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":"Superior One-year Forgotten Joint Scores with cruciate-retaining mobile bearings versus posterior-stabilized mobile and fixed bearings in a contemporary total knee system","authors":"Sung Eun Kim ,&nbsp;Hyun Suk Shin ,&nbsp;Hyuk-Soo Han","doi":"10.1016/j.knee.2024.11.003","DOIUrl":"10.1016/j.knee.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) mainly involves the femoral, tibial, and bearing implants. Bearings are categorized by posterior cruciate ligament (PCL) status (cruciate-retaining [CR] vs. posterior-stabilized [PS]) and motion (mobile vs. fixed). This study assessed the impact of three bearing combinations (CR Mobile, PS Mobile, and PS Fixed) on one-year patient-reported outcome measures (PROMs) following TKA.</div></div><div><h3>Methods</h3><div>In this retrospective analysis of 486 TKAs using the same prosthesis with varied bearings, patients were grouped as CR Mobile, PS Mobile, and PS Fixed. Patient characteristics, preoperative, and one-year postoperative PROMs (Forgotten Joint Scores [FJS] and Knee Society Scores [KSS], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), were collected. Multivariate analysis was conducted to assess the impact of bearing type on one-year PROMs.</div></div><div><h3>Results</h3><div>The multivariate regression model showed that bearing type significantly impacted the one-year FJS, with CR Mobile showing higher scores than PS Mobile and PS Fixed bearings (<em>p</em> &lt; 0.001). However, bearing type did not significantly influence one-year KSS and WOMAC scores (all <em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study was the first to analyze the impact of the combination of PCL status and bearing motion in TKA. Bearing type selection had an impact on the one-year postoperative FJS, particularly favoring CR Mobile bearings. Other PROMs were not affected by the choice of bearing type.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 118-125"},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900747","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":"Hyaluronic acid injections administered within two months prior to total knee arthroplasty increase the risk for periprosthetic joint infection","authors":"Conor M. Jones,&nbsp;Alexander J. Acuña,&nbsp;Enrico M. Forlenza,&nbsp;John D.D. Higgins,&nbsp;Tad Gerlinger,&nbsp;Craig J. Della Valle","doi":"10.1016/j.knee.2024.12.003","DOIUrl":"10.1016/j.knee.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>It remains unknown how timing of preoperative intra-articular knee hyaluronic acid (HA) injections impacts risk for developing postoperative periprosthetic joint infection (PJI) following total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>The PearlDiver Mariner database was utilized to identified patients undergoing primary TKA between 2015 and 2022 who received an HA injection without a corticosteroid injection within 12 months prior to surgery. The HA cohort was matched 1:1 to a control cohort undergoing no preoperative injections (corticosteroid or HA). Multivariable logistic regression analysis was utilized to determine the risk of preoperative HA injections on PJI at 1, 3, 6, 12, and 24 months postoperative. The following pre-operative intervals between injection and TKA were evaluated: 0–1 month, 1–2 months, 2–3 months, 4–6 months, and 7–12 months.</div></div><div><h3>Results</h3><div>38,546 patients (HA: n = 19,273; Control: n = 19,273) were analyzed. HA injections within 1 month prior to surgery demonstrated significant increase in rates of PJI at 3-months (OR: 3.00, 95% CI: 1.29 – 6.47; <em>p</em> = 0.005), 6-months (OR: 2.66, 95% CI: 1.30 – 5.46; <em>p</em> = 0.007), 12-months (OR: 2.37, 95% CI: 1.20 – 4.67; <em>p</em> = 0.013), and 24-months (OR: 2.65, 95% CI: 1.50 – 4.68; <em>p</em> &lt; 0.001) postoperatively. HA injections between 1–2 months prior to surgery showed increased rates of PJI at 12-months (OR: 1.60, 95% CI: 1.06–2.41; <em>p</em> = 0.011) postoperatively. No difference in infection risk was demonstrated between patients receiving injections &gt; 2 months prior to surgery relative to matched controls.</div></div><div><h3>Conclusions</h3><div>Intra-articular hyaluronic acid injections administered within 2 months of TKA appear to increase the risk of PJI.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 103-107"},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873597","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 morphology of the distal medial femoral surface that should be considered when performing coronal osteotomy in medial closed wedge distal femoral varus osteotomy","authors":"Fumiyoshi Kawashima ,&nbsp;Ryuichi Nakamura ,&nbsp;Akira Okano ,&nbsp;Koji Kanzaki","doi":"10.1016/j.knee.2024.12.002","DOIUrl":"10.1016/j.knee.2024.12.002","url":null,"abstract":"<div><h3>Aims</h3><div>The aim of the present study was to evaluate the morphology of the distal medial femoral surface during coronal osteotomy in medial closed wedge distal femoral varus osteotomy (MCWDFO) using plain CT.</div></div><div><h3>Methods</h3><div>Twenty knees (mean age, 55.3 years) were included. Preoperative CT images were obtained prior to MCWDFO for valgus OA. In the cross-section depicting the starting position of the transverse cut, a curve was drawn that passed through the centre of the femoral cortex, and lines parallel and perpendicular to the surgical epicondylar axis (SEA) were drawn to analyse the medial side. Inflection points on the medial line were defined as P1-P4. The radii of circles passing through P1-P3 (PR, posterior radius) and P2-P4 (AR, anterior radius) were drawn. Values for the PR, AR, and radius ratio (PR/AR) were measured.</div></div><div><h3>Results</h3><div>Based on the PR/AR, the cross-sectional morphologies were classified into 5 triangular types (PR/AR &lt; 0.5), 4 flat types (PR/AR &gt; 0.8), and 11 convex types (PR/AR 0.6 to 0.7).</div></div><div><h3>Conclusion</h3><div>The medial anteroposterior width and flange thickness were easier to assess in the flat type; however, these were difficult to assess in the triangular type with a gentle anterior slope. Surgeons should consider the differences in the anterior slope according to cross-sectional morphologies when performing coronal osteotomy in MCWDFO.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 108-117"},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873595","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":"Predictors of Increased Complication Rate Following Tibial Tubercle Osteotomy (TTO)","authors":"Kevin Lehane,&nbsp;Isabel Wolfe,&nbsp;Alison Buseck,&nbsp;Michael R. Moore,&nbsp;Larry Chen,&nbsp;Eric J. Strauss,&nbsp;Laith M. Jazrawi,&nbsp;Alexander Golant","doi":"10.1016/j.knee.2024.11.005","DOIUrl":"10.1016/j.knee.2024.11.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of the current study was to define the incidence of minor and major complications following TTO at a tertiary-care institution, with determination of predictive factors related to the occurrence of a major complication.</div></div><div><h3>Study design</h3><div>Retrospective case series. Level IV.</div></div><div><h3>Methods</h3><div>Patients who underwent TTO from 2011 to 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up and revision cases were excluded. Complications classified as “major” included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, recurrent patellar instability, reoperation for other indications, readmission, and revision. Complications classified as minor included superficial infection, deep venous thrombosis, wound dehiscence, and postoperative neuropraxia. Chi-square tests were used for categorical variables, t-tests for continuous variables.</div></div><div><h3>Results</h3><div>Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years (range 1 month-10 years). Patients were 68.5% female with average age 28.3 years (range 13–57 years). The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of TTOs, and minor complications in 8.4% of TTOs. Reoperation was required in 16.6% of TTOs at a mean of 14 months following the index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (OR) (5.0%). Prior ipsilateral surgery was identified as a significant independent predictor of major complication by regression analysis. Hardware removal was more common with headed screws. Arthrofibrosis requiring reoperation was more common in patients who underwent a concomitant cartilage restoration/repair procedure.</div></div><div><h3>Conclusion</h3><div>The overall complication rate following tibial tubercle osteotomy was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and an overall reoperation rate of 16.6%. TTOs with major complications were performed at earlier years, in patients who were older, had a previous ipsilateral arthroscopic knee surgery, had an indication of cartilage lesion/arthritis, and had a steeper osteotomy cut angle. Hardware removal was found to be more common in patients with headed as compared to headless screws. Complications also varied based on timing after surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 93-102"},"PeriodicalIF":1.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856997","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":"Consensus statement on problematic knee replacement and revision knee replacement: A collaboration between EKS and BASK","authors":"Andrew Porteous ,&nbsp;Frank-Christiaan Wagenaar ,&nbsp;Andrew Price ,&nbsp;Jonathan Phillips ,&nbsp;Gijs van Hellemondt ,&nbsp;BASK/EKS Consensus Group on Problematic Knees Replacement","doi":"10.1016/j.knee.2024.11.018","DOIUrl":"10.1016/j.knee.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Up to 20% of primary total knee arthroplasty (TKA) patients are not satisfied with their outcome. Both the analysis of these patients and revision surgery can be complex, expensive and outcomes can vary widely.</div></div><div><h3>Aim</h3><div>The aim of this study was to deliver consensus recommendations regarding outpatient analysis, surgical treatment and arrangement of clinical services concerning patients with a problematic TKA or revision knee replacement (RTKA).</div></div><div><h3>Methods</h3><div>Members of BASK and EKS were invited to attend a joint meeting in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Eighty delegates attended the meeting and five consensus statements were considered, with a threshold level of 80% agreement required as the definition consensus. A further consensus meeting of EKS members in Kitzbuhl, Austria (January 2023) followed similar methodology and considered a further four statements on this topic.</div></div><div><h3>Results</h3><div>From the first meeting, 5 consensus statements with accompanying supporting evidence and text were agreed. 1) In suspected infection, a recognised diagnostic pathway and definition should be used (e.g. MSIS, ICM, EBJIS) and documented; 2) Revision of an infected TKA should be treated in units with a multidisciplinary team; 3) Initial investigation of a problematic TKA should include a minimum of: clinical investigation, X-Rays and blood tests, with further discussion with the MDT if required; 4) Units providing RTKA should have surgeons with evidence of specific training or experience, and on-going minimum unit numbers; 5) National Orthopaedic/Knee Societies should develop a strategy on Revision TKA provision taking into account: workforce, revision burden, location, hospital infrastructure.</div><div>From the second meeting a further 4 consensus statements were agreed. Two statements were agreed text content answering the questions: 1) What should be included in the basic diagnostic workup of a painful TKA? and 2) Which are the key factors for surgeons to consider before offering the patient revision surgery? The two other agreed statements are: 3) Pre-operative diagnosis is related to outcome in RTKA and 4) RTKA for pain, without a surgically treatable diagnosis, is unpredictable.</div></div><div><h3>Conclusions</h3><div>The agreed joint BASK-EKS consensus statements and the EKS consensus statements on the assessment of problematic RTKA are recommended as the contemporary basis of optimal care for these patients and should inform future training and service developments.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 86-92"},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848470","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":"Dynamic variation of tibiofemoral compression force during total knee arthroplasty: Implications for soft tissue balance and functional outcomes","authors":"Yoshinori Okamoto,&nbsp;Tomohiro Okayoshi,&nbsp;Hitoshi Wakama,&nbsp;Takafumi Saika,&nbsp;Shuhei Otsuki","doi":"10.1016/j.knee.2024.11.021","DOIUrl":"10.1016/j.knee.2024.11.021","url":null,"abstract":"<div><h3>Background</h3><div>Achieving precise alignment and soft tissue balance is crucial for optimal total knee arthroplasty (TKA) outcomes. We aimed to explore how tibiofemoral compression force (TFCF) varies with knee flexion and its correlation with functional outcomes.</div></div><div><h3>Methods</h3><div>This prospective study included 60 patients undergoing cruciate-retaining TKA (FINE Total Knee System). Sensor-equipped trial inserts were used to measure the TFCF at 15° intervals, from full extension to 90° flexion. Patients were classified into anterior and posterior force groups based on whether the medial TFCF was higher in the anterior than in the posterior region at 60° flexion. The 2-year outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR).</div></div><div><h3>Results</h3><div>The total TFCF increased from 0° to 60° flexion and then decreased. The medial compressive forces were consistently higher than lateral forces. Anteromedial TFCF differed significantly between the anterior and posterior force groups at 60°, 75°, and 90° flexion. KOOS-JR scores showed a significant interaction between force type and time, with greater improvements in the anterior force group. Anteromedial TFCF at 60° flexion and KOOS-JR correlated significantly (<em>R</em> = 0.574).</div></div><div><h3>Conclusion</h3><div>Evaluating TFCF at multiple knee flexion angles provides valuable insights into optimising outcomes in TKA. TFCF variations, especially in the anteromedial compartment, considerably impact functional outcomes. Dynamic TFCF measurements during TKA may enhance soft tissue balance and improve outcomes. Further research is needed to validate these findings in diverse populations and with long-term follow ups.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 49-61"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820191","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":"Lesser posterior tibial slope angle ≤70 (PTS-Angle) has negative effect on outcome of isolated PCL reconstruction: Comparative analysis of PTS ≤70 vs > 70 degrees","authors":"Silvampatti Ramasamy Sundararajan ,&nbsp;Owais Ahmed ,&nbsp;Rajagopalakrishnan Ramakanth ,&nbsp;Terence Dsouza ,&nbsp;Mahshook Irfan ,&nbsp;Arumugam Palanisamy ,&nbsp;Shanmuganathan Rajasekaran","doi":"10.1016/j.knee.2024.11.017","DOIUrl":"10.1016/j.knee.2024.11.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine incidence of posterior-tibial-slope (PTS) distribution in patients with isolated posterior-cruciate-ligament (PCL) tear, as-well-as the effect of PTS on radiological, clinical, and functional outcomes after PCL-reconstruction (PCL-R).</div></div><div><h3>Methods</h3><div>63 patients with symptomatic isolated PCL-tears who underwent PCL-R were divided into two groups based on a PTS-angle with a cut-off value of 7⁰-degrees: group-A (less than ≤7⁰-degree) and group-B (more than &gt;7⁰-degree). All the patients were subjected to the same technique. The effect of PTS-angle on the radiological-outcome, (posterior-tibial-translation (PTT)) at 6-month and 1-year intervals was compared. Clinical-outcomes (knee range-of-motion (ROM), quadriceps-wasting (QW)), and functional outcomes (IKDC and Tegner-Lysholm scores) at 6-month, 1-year, and final follow-up was compared between the groups.</div></div><div><h3>Results</h3><div>PTS of less than ≤7⁰-degrees was seen in 66.7%. The mean-PTS-angle was 6.47 ± 2.40degrees. Radiologically, there was no statistical-difference in PTT at 6-months. However, at 1-year, PTT was less in group-A (3.98 ± 2.21 mm) than in group-B (3.03 ± 1.42 mm) (P = 0.04). Two patients in group-A had grade-III PTT at 6-months, and one of them had grade-III PTT at 1-year. At the mean-follow-up, group-A had lower IKDC and Tegner-Lysholm (81.55 ± 11.4, 90.19 ± 5.53) than group-B (86.56 ± 7.2, 94.6 ± 4.42), indicating a statistically significant difference (IKDC:P = 0.038, Tegner-Lysholm:P = 0.001). At 1-year and mean-follow-up, group-A had a significantly lower ROM(p = 0.047). There was no significant difference for QW at 6-months and 1-year.</div></div><div><h3>Conclusion</h3><div>Lesser preoperative PTS angle (≤7⁰) has a negative effect on the outcome of isolated PCL-R and leads to secondary<!--> <!-->posterior knee laxity than in patients with higher PTS angle (&gt;7⁰). Incidence of lesser posterior tibial slope (≤7⁰)  in isolated PCL injuries is 66.7%.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 69-78"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820200","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":"Total knee arthroplasty in hemophilic knees requires its own learning phase: Lessons learned from 90 cases","authors":"Arman Vahabi,&nbsp;Elcil Kaya Biçer,&nbsp;Semih Aydoğdu","doi":"10.1016/j.knee.2024.11.024","DOIUrl":"10.1016/j.knee.2024.11.024","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative challenges and complications and their course over experience in total knee arthroplasty (TKA) applications in hemophilic arthropathy have seldom been studied. Our study aimed to analyze the learning dynamics and the evolving perspective of a single arthroplasty surgeon in hemophilic knees.</div></div><div><h3>Methods</h3><div>The study encompassed all primary TKAs performed on hemophilic patients by a single experienced arthroplasty surgeon from May 2002 to October 2023. A total of 90 knees from 63 patients were included in the final analysis. Demographic characteristics, range of motion (ROM), degree of flexion contracture, and hip–knee angle (HKA) were noted. Anesthesia type, tourniquet duration, surgical approach, need for bone graft use, and lateral retinacular release (LRR) were also documented. Cases were categorized into three groups: the initial 30 cases (Group A), the subsequent 30 cases (Group B), and the final 30 cases (Group C).</div></div><div><h3>Results</h3><div>All groups were homogenous in terms of age (<em>P</em> = 0.102), HKA (<em>P</em> = 0.696), ROM (<em>P</em> = 0.582), and degree flexion contracture (<em>P</em> = 0.546). Extended approaches were needed in seven cases (23.3%) in Group A, and in two cases (6.7%) in Group B. There was no need for extended exposure in Group C. LRR application rate and tourniquet time showed no differences across groups (<em>P</em> = 0.401, <em>P</em> = 0.482). The intraoperative problem rate exhibited a statistically significant decrease throughout the series (<em>P</em> = 0.016).</div></div><div><h3>Conclusions</h3><div>Arthroplasty in hemophilic knees poses unique challenges which require their own learning process. Intraoperative complication rate and need for utilizing extended approaches decreases after the initial 30 cases and decreases further after the subsequent 30 cases.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 28-34"},"PeriodicalIF":1.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820209","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}