Results in The Journal of Knee Surgery: 2,280
(searched for: container_group_id:(4747))
The Journal of Knee Surgery, Volume 31, pp 212-226; https://doi.org/10.1055/s-0037-1607294
Focal chondral defects are common in the patellofemoral (PF) joint and can significantly impair the quality of life. The autologous chondrocytes implantation (ACI) technique has evolved over the past 20 years: the first-generation technique involves the use of a periosteal patch, the second-generation technique (collagen-cover) uses a type I/III collagen membrane, and the newest third-generation technique seeds and cultivates the collagen membrane with chondrocytes prior to implantation and is referred to as matrix-induced autologous chondrocyte implantation. Particulated juvenile allograft cartilage (PJAC) (DeNovo NT) is minced cartilage allograft from juvenile donors. A thorough physical exam is important, especially for issues affecting the PF joint, to isolate the location and source of pain, and to identify associated pathologies. Imaging studies allow further characterization of the lesions and identification of associated pathologies and alignment. Conservative management should be exhausted before proceeding with surgical treatment. Steps of surgical treatment are diagnostic arthroscopy and biopsy, chondrocytes culture and chondrocyte implantation for the three generations of ACI, and diagnostic arthroscopy and implantation for PJAC. The techniques and their outcomes will be discussed in this article.
The Journal of Knee Surgery, Volume 31, pp 227-230; https://doi.org/10.1055/s-0037-1607324
Fresh osteochondral allograft (OCA) transplantation has become a mainstay for the treatment of osteochondral defects in the tibiofemoral joint. With excellent outcomes and high survival times, this technology has recently become more interesting for use in the patellofemoral (PF) joint. This review article will point out the historical difficulties that the use of fresh OCA poses. With newer surgical approaches and a better understanding of the mechanical requirements of the PF joint, the use of OCA transplantation has shown increasingly better results. Illustrating the technique for the preparation and implantation of single plug allografts and bulk allografts to the trochlea and patella as well as the analysis of the available literature, we point out the current state of the art as well as potentially achievable long-term results. Finally, we will point out emerging technology seeking to further develop the use of allograft technology in patellofemoral chondral defects.
The Journal of Knee Surgery, Volume 30, pp 849-853; https://doi.org/10.1055/s-0037-1607450
Robotic arm-assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In today's health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high-volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Student's t-tests. A p-value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short-term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short-term outcomes when compared with patients who undergo manual TKA.
The Journal of Knee Surgery, Volume 31; https://doi.org/10.1055/s-0037-1607350
It has been brought to the publisher's attention that the name of author Chantelle C. Bozynski was listed incorrectly in the above article in the Journal of Knee Surgery, published online on September 15, 2017 (DOI: 10.1055/s-0037-1606575). The author's name was originally published as “Chantelle C. Bozynksi.” The correct listing of the author's name appears above.
The Journal of Knee Surgery, Volume 31; https://doi.org/10.1055/s-0037-1607351
It has been brought to the publisher's attention that the name of author Mark S. Collins was listed incorrectly in the above article in the Journal of Knee Surgery, published online on September 26, 2017 (DOI: 10.1055/s-0037-1607038). The author's name was originally published as “Mark S. Collin.” The correct listing of the author's name appears above.
The Journal of Knee Surgery, Volume 31, pp 723-729; https://doi.org/10.1055/s-0037-1607060
Revision total knee arthroplasty (rTKA) is a challenging problem in the setting of soft tissue defects. The purpose of this study was to evaluate patients who underwent rTKA requiring flap coverage and determine patient factors that predisposed them to failure. Forty-three consecutive patients (mean follow-up, 46.5 months) who underwent rTKA requiring flap coverage were retrospectively reviewed between January 1, 2000 and December 31, 2010. Sixteen of 43 patients experienced failure requiring either flap revision (n = 2) or above the knee amputation (n = 14). Patients with heart failure (p = 0.008), cancer (p = 0.049), or infection with Klebsiella pneumoniae (p = 0.002) had greater rates of failure. Smoking (p = 0.287), diabetes (p = 0.631), and flap type (p = 0.634, p = 0.801) were not associated with increased failure. Mean survival was 46.4 months. Survival of patients with a history of cancer (34.3 months) was less (p = 0.033) than those without (49.2 months). Flap coverage in rTKA is a viable limb salvage option for patients with soft tissue defects; however, failure rates are much higher than in patients not requiring flap coverage.
The Journal of Knee Surgery, Volume 31, pp 716-722; https://doi.org/10.1055/s-0037-1607074
Techniques using the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) are commonly used in anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using the AMP or AAMP technique to drill the femoral tunnel. The records of 157 patients who underwent single-bundle ACL reconstruction using the AMP or AAMP technique between 2011 and 2015 were reviewed. The femoral tunnel clock-face position and femoral tunnel and tibial tunnel anterior–posterior (AP) inclination angles were assessed on axial or AP magnetic resonance images. At last follow-up, the Lachman test and pivot-shift test were used to evaluate AP and rotational stability, respectively. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) form were used to evaluate clinical and functional results. No statistically significant differences were found between the groups in patient age, sex, follow-up period, or affected side distribution. The mean femoral tunnel inclination angle was 31.13 ± 8.06 degrees in the AMP group and 30.17 ± 9.02 degrees in the AAMP group (p = 0.513). The tibial tunnel inclination angle in the AMP group (16.28 ± 7.89 degrees) was not different from that in the AAMP group (13.70 ± 6.08 degrees). No significant differences were observed between the two groups in the Lachman test, pivot-shift test, Lysholm knee scoring scale, or IKDC scores. The AAMP technique was not clinically superior to the AMP technique in ACL reconstruction. This is a retrospective comparative study and its level of evidence is III.
The Journal of Knee Surgery, Volume 31, pp 117-117; https://doi.org/10.1055/s-0037-1607220
Knee pathology is extremely common with a vast array of injury and disease mechanisms. Given its frequency and complexity, it is essential for clinicians and radiologists alike to be familiar with the capabilities of imaging modalities and understand how to effectively communicate their findings to provide diagnoses, staging, interventions, and treatment monitoring for patients. Advances in imaging technology and applications are ever growing, therefore, remaining “current” becomes invaluable when working to ensure patients are receiving the best possible care. The special focus section of this issue of The Journal of Knee Surgery contains five original articles focused on providing a concise overview of current knee imaging. The issue will provide an algorithmic approach for clinically assessing a patient, performing the physical examination, and choosing the appropriate imaging modalities to assist with diagnostic and therapeutic strategies. Also, the issue specifically covers imaging modalities focused on ligamentous, tendinous, cartilaginous, and meniscal pathology. Understanding the principles for optimally utilizing imaging modalities to accurately diagnose pathology and evaluate treatment outcomes will be reviewed. Finally, emerging techniques that hold promise for future advances in diagnostic imaging will be briefly discussed. This journal issue is not intended to be an all-inclusive didactic text but is meant to serve as a valuable resource platform based on current recommendations and technology. Clinicians and radiologists can utilize the provided information as a tool for optimizing clinical imaging of the knee, resulting in improved communication with their patients and each other. We are very honored to have the world's leading experts accept our invitations to author the articles included in this special focus section. It is a humbling experience to work with such an amazing caliber of collaborators and to learn from them through this outstanding collection of articles. We would also like to acknowledge and thank Dr. Leon Lenchik, Professor of Radiology at Wake Forest School of Medicine, for his guidance and efforts when assembling the topics and authors for this special issue. The peer-reviewed articles collected are intended to be high yield, and we hope you find them informative. We hope that this issue serves to provide a conscientious and efficient way to approach imaging of various knee pathologies resulting in improved patient care.
The Journal of Knee Surgery, Volume 31, pp 730-735; https://doi.org/10.1055/s-0037-1607059
Lateral compartment cartilage deterioration is the most common complication affecting medial unicompartmental knee arthroplasty (UKA) survivorship. The purpose of this study was to determine the best method of judging the degeneration of cartilage in the lateral compartment after medial UKA through analysis of different radiographic views. Forty-two participants were divided into two groups. Patients in Group A were followed for at least 10 months after undergoing a medial UKA (mean: 17.67 ± 7.65 months, range: 10–24 months), whereas those in Group B were evaluated 3 days after surgery. Joint space width in the lateral compartment of all patients was evaluated using three types of knee radiographs: weight-bearing anterior posterior (AP), supine AP, and supine valgus stress. No difference in joint space width in the lateral compartment after medial UKA was found for the three kinds of radiographs in Group A (F = 0.97, p = 0.39) and Group B (F = 1.499, p = 0.233). After evaluating the patients 3 days after surgery or following them for approximately 18 months after medial UKA, we determined that weight-bearing AP, supine AP, and supine valgus stress knee radiographs were comparable when used to assess residual cartilage thickness of the lateral compartment.
The Journal of Knee Surgery, Volume 31, pp 206-211; https://doi.org/10.1055/s-0037-1607199
Osteochondritis dissecans (OCD) lesions of the patellofemoral joint can be difficult to identify and treat. Asymptomatic or stable lesions in skeletally immature patients may be treated nonoperatively, but symptomatic lesions often require surgical intervention. Evidence of instability should be carefully evaluated with preoperative magnetic resonance imaging or computed tomography arthrogram. Careful preoperative planning is necessary to ensure the appropriate surgical approach and implants are selected for surgical management. Multiple techniques have been described, but internal fixation of both “classic” and cartilage-only OCD lesions has been shown to have strong outcomes in managing these difficult cases.
The Journal of Knee Surgery, Volume 31, pp 698-704; https://doi.org/10.1055/s-0037-1607038
Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction. The purpose of this study was to evaluate changes in the medial compartment of the knee over time following the diagnosis of a MMPRT on MRI. A retrospective review of the institutional database was performed for patients with an initial MRI diagnosis of a MMPRT. Patients were included if they had a subsequent follow-up MRI on the same knee. Patients with surgical intervention, including debridement or repair, were excluded. MRIs were evaluated by two board-certified musculoskeletal radiologists. MMPRTs were defined using the LaPrade classification, and the medial compartment articular cartilage was graded using the modified Outerbridge classification. MRIs were reviewed for meniscus extrusion, subchondral bone edema, and insufficiency fractures. Patients were divided into two groups for the analysis to account for differences in MRI time intervals. Group 1 had a follow-up MRI within 12 months of initial imaging (subacute group) and Group 2 had a follow-up MRI greater than 12 months after initial imaging (chronic group). Forty-one knees and 82 MRIs were analyzed, including 20 knees/40 MRIs (13 females, 7 males) in the subacute group and 21 knees/42 MRIs (14 females, 7 males) in the chronic group. Subacute patients had a mean age of 59.5 ± 8.8 years and a mean interval of 4.8 ± 2.6 months between MRIs compared with 53.6 ± 11.0 years and 38.2 ± 20.8 months, respectively, for the chronic group. Meniscal extrusion, femoral modified Outerbridge grade, and tibial modified Outerbridge grade worsened between initial and final MRI in both groups (p < 0.05). In both groups, there were no significant differences between initial and final MRIs with regard to the LaPrade classification, insufficiency fracture, or subchondral cysts of the tibia. Progressive meniscus extrusion and medial compartment articular cartilage degeneration were seen in patients with MMPRTs within a year from diagnosis.
The Journal of Knee Surgery, Volume 31, pp 686-697; https://doi.org/10.1055/s-0037-1606575
Stromal vascular fraction (SVF) contains a small number of mesenchymal stem cells and has been used as a treatment for osteoarthritis and cartilage injury. Due to limited evidence of successful cartilage regeneration with injected stem cell therapies, there is interest in combining cellular therapies with injectable scaffolding materials to increase intra-articular residence times of stem cells and improve tissue regeneration. However, the safety of intra-articular injection of SVF combined with injectable scaffolds is unestablished. Also, it is unclear if SVF therapy is superior to more easily prepared biologics, such as platelet-rich plasma (PRP). The purpose of this study was to assess the safety of SVF when combined with an injectable poly(L-lactide-co-glycolide) nanofiber scaffold and to provide a comparison of SVF therapy to PRP. A total of 12 Beagles had osteochondral defects created in both medial femoral condyles and 4 dogs each were allocated to treatment groups of SVF (n = 4), SVF plus PLGA scaffolding (n = 4), or leukoreduced PRP (n = 4). One knee in each dog received treatment, and the contralateral knee was sham treated with saline. Dogs were assessed over a 6-month period, and outcome measures included functional, radiographic, biochemical, and histological assessments. PRP treatment resulted in improvements in lameness scores and objective kinetic assessments of function. There were no statistically significant improvements in function, cartilage biochemical composition, or histology for SVF-treated knees. The combination of SVF and the injectable PLGA scaffold had worse outcomes than other groups including sham treatment based upon functional, biochemical, and histological assessments, raising concerns over the safety of this scaffold for intra-articular injection.
The Journal of Knee Surgery, Volume 31, pp 664-669; https://doi.org/10.1055/s-0037-1606549
Cartilage degeneration is believed to be the primary event in the development of osteoarthritis (OA). On the other hand, meniscal degeneration is observed with high prevalence, and some researchers have pointed out that pathological changes in menisci precede that of cartilage. The purpose of the present study is to investigate comprehensive gene expression pattern of cartilage and menisci in the initial phase of surgically induced OA and to compare them. Secondary OA was surgically induced in 10-week-old male Wistar rats by anterior cruciate ligament transection (ACLT). Articular cartilage and menisci were separately dissected from six ACLT- and six sham-operated rats. Each specimen was analyzed by microarray, histological, and immunohistochemical analysis 3 weeks after surgery. Of the 36,685 transcripts detectable by microarray, the number of upregulated transcripts in ACLT menisci was >2.5-fold compared with that in ACLT menisci in any given threshold. Cluster analysis using the Database for Annotation Visualization and Integrated Discovery (DAVID) showed genes related to OA, such as response to stimulus, angiogenesis, and apoptosis, which were predominantly found in menisci in ACLT rats. Representative proteases including Adamts2, 4, Mmp2, 12, 13, 14, 16, extracellular matrix genes including versican (Vcan), lumican (Lum), syndecan1 (Sdc1), and Prostaglandin endoperoxide synthase2 (Ptgs2) were up-regulated in menisci, but were not up-regulated in cartilage. Our results indicated that the molecular changes that occurred in menisci preceded those occurred in cartilage in the very early phase of surgically induced OA models.
The Journal of Knee Surgery, Volume 31, pp 677-685; https://doi.org/10.1055/s-0037-1606564
This review aims to compare the outcomes of revision total knee arthroplasty (TKA) performed using a tantalum cone and a titanium sleeve. A rigorous and systematic search was performed. Each of the selected studies was evaluated for methodological quality. Data were extracted according to the following: study design, level of evidence, cases enrolled, age, sex ratio, follow-up, involved part, bone defect, degree of constraint, augments (cone and/or sleeve), pre-clinical score, post-clinical score, radiological results, major complications, and endpoint analysis. Nineteen articles were included in the final analysis. The knee scores of the cone and sleeve groups were increased in all studies with or without statistical significance. For the radiological outcome, radiolucent line was seen in six cases in the cone group and in 15 cases in the sleeve group. Only a few specific augment-related complications were noted. Our results support the use of the newly devised augments in bone defect during revision TKA in terms of clinical and radiological outcome.
The Journal of Knee Surgery, Volume 31, pp 670-676; https://doi.org/10.1055/s-0037-1606561
The aim is to assess the association between computed tomography (CT) findings and clinical outcomes in posterior tibial plateau fractures (TPF). This is a retrospective analysis of the records of 23 patients with posterior TPF treated at our institution between 2004 and 2011. Two indices of residual articular displacement of posterior TPF (gap and step-off) were measured from CT images, and clinical outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA) questionnaire. Spearman's rank correlation coefficient analysis was used to evaluate the correlations between the postoperative posterior TPF radiological findings and the clinical outcomes. Both the intraobserver and the interobserver correlation coefficients were high (0.90 and 0.92, respectively), indicating excellent agreement between the reviewers for the assessment of residual displacement via CT scans. Additionally, residual articular step displacement showed a strongly negative correlation with clinical outcomes (R = 0.700, p = 0.036), whereas the residual gap displacement did not (R = 0.400, p = 0.505). More importantly, the medial posterior step displacement was significantly correlated with the clinical outcomes (p = 0.040), whereas the lateral posterior step displacement was not (p = 0.618). Based on the data of this study, the higher the step-off deformity of the medial posterior tibial plateau, the worse the SMFA. More attention should be paid to this factor when treating medial posterior TPF.
The Journal of Knee Surgery, Volume 31, pp 649-653; https://doi.org/10.1055/s-0037-1606375
This study aims to investigate the functional outcomes of pinless navigation (BrainLAB VectorVision Knee 2.5 navigation system; Munich, Germany) as an intraoperative alignment guide in total knee arthroplasty (TKA). A prospective, 24-month follow-up study of 100 patients who were scheduled and randomized into two groups, the pinless navigation and conventional surgery, was conducted. All TKAs were performed with the surgical aim of achieving neutral coronal alignment with the 180-degree mechanical axis. The outcomes measured in this study were Oxford Knee Score (OKS), Knee Society Score (KSS), Short Form-36 (SF-36), and range of motion (ROM). At 24-month postoperatively, four and two patients were lost to follow-up from the pinless navigation group and conventional group, respectively. There were no significant differences in absolute scores of the OKS, KSS, and ROM, as well as changes from preoperative baseline, between pinless navigation and conventional groups at both 6 and 24 months postoperatively. Pinless navigation results in comparable functional outcomes as conventional TKA at 6 and 24 months postoperatively.
The Journal of Knee Surgery, Volume 31, pp 654-663; https://doi.org/10.1055/s-0037-1606376
The use of tranexamic acid (TXA) during primary total knee arthroplasty (TKA) is well documented. However, considering the potential side effects, including deep vein thrombosis (DVT) and pulmonary embolism (PE), the ideal route of administration remains controversial. Therefore, we performed a meta-analysis to compare the efficacy of topical versus intravenous TXA and explore the most effective regimen in patients undergoing primary TKA. We conducted a systematic literature search in PubMed, Embase, and the Cochrane database through July 2016 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of topical and intravenous TXA in primary TKA. We assessed the risk of bias using the Cochrane Collaboration's tool. We assessed the quality of evidence using the GRADE profiler software. A total of 15 RCTs including 1,240 participants met the inclusion criteria. We found no statistically significant difference between topical and intravenous TXA in terms of transfusion rate (p = 0.75), total blood loss (p = 0.51), total drain output (p = 0.60), maximum hemoglobin drop (p = 0.24), length of stay (p = 0.08), and thromboembolic complications (p = 0.73). Subgroup analyses showed that compared with 1 g topical TXA, 2 g topical TXA was more effective to reduce blood transfusion rate and total blood loss, and did not increase thromboembolic complications. We also found three times intravenous TXA was more effective than one time of intravenous TXA to reduce blood transfusion rate and total blood loss without increasing of thromboembolic complications. Topical TXA had a similar efficacy to intravenous TXA in reducing blood transfusion and blood loss, and did not increase the risk of thromboembolic complications in primary TKA. Besides, the current meta-analysis suggested that three times of intravenous TXA is efficient and safe. We also recommended 2 g topical TXA instead of 1 g topical TXA because it was more efficient to reduce blood transfusion rate and total blood loss and did not increase thromboembolic complications.
The Journal of Knee Surgery, Volume 31, pp 710-715; https://doi.org/10.1055/s-0037-1606378
Although the suture-hook technique remains popular for meniscal ramp lesions, which frequently occur after anterior cruciate ligament (ACL) injury, it is unclear whether the all-inside FasT-Fix technique (Smith & Nephew, Andover, MA) is appropriate for the repair of ramp lesions. This study evaluated results of arthroscopic FasT-Fix meniscal ramp lesion repair using second-look arthroscopy. From August 2010 to December 2014, 46 knees diagnosed with combined ACL injury and ramp lesion underwent ACL reconstruction with meniscal repair using the FasT-Fix technique. We classified ramp lesions into three types according to tear pattern: meniscotibial ligament tear, meniscocapsular tear, and combined meniscotibial/meniscocapsular tear. Second-look arthroscopy was performed postoperatively. The healing capacity of the ramp lesion was evaluated retrospectively. At the final follow-up (mean = 32 months), the Lysholm knee score and the International Knee Documentation Committee (IKDC) objective score were compared with preoperative scores. All patients (n = 46) underwent a second-look arthroscopy, with 45 (97.8%) exhibiting complete or partial healing after the FasT-Fix technique was used in conjunction with ACL reconstruction. The Lysholm knee score and IKDC objective score were significantly better than preoperative scores at final follow-up. The FasT-Fix technique for meniscal ramp lesion repair—when performed with concomitant ACL reconstruction—exhibits excellent healing results.
The Journal of Knee Surgery, Volume 31, pp 705-709; https://doi.org/10.1055/s-0037-1606377
Medial collateral ligament (MCL) pie-crusting technique in total knee arthroplasty (TKA) is one of the methods of medial release. The effects and risks of blade pie-crusting have been reported in previous studies. However, only a few have reported the safety and efficacy of needle pie-crusting. In this cadaveric study, we quantitatively evaluated the amount of gap change by MCL needle pie-crusting. We investigated five knees of four fresh human cadavers and performed posterior-stabilized TKA. Only deep MCL release as the medial release was conducted. We punctured the MCL from the deep layer to the superficial layer using a 18 G needle in a 90-degree flexion position for 0, 10, 20, 50, 75, and 100 times. Medial and lateral gaps were measured accurately with a balancer at determined times in 0 and 90-degree flexion positions. Changes in medial and lateral gaps were not significant differences in flexion and extension position. However, in 90-degree flexion, medial gap changes were tended to be larger than lateral gap changes. A 0.6 mm additional medial release and a 0.2 mm additional lateral release were found per 10 times pie crust in flexion position (100 times, p: 0.08). However, large differences existed among the cases. Needle pie-crusting is safer than blade pie-crusting because of the small efficacy of one-time pie crust. MCL needle pie-crusting showed varied effects for each case. This result indicates the risk of relaxation of an unexpected gap. Caution should be taken when choosing between needle pie-crusting and blade pie-crusting.
The Journal of Knee Surgery, Volume 30, pp 784-792; https://doi.org/10.1055/s-0037-1606261
Anatomical reduction of the articular surface, restoration of mechanical axis, and containment of articular rim are the goals of the treatment of tibial plateau fractures, with an ultimate aim to restore joint congruity and stability. Tibial plateau malunions or nonunions are a result of a failed treatment. This article aims to review the most typical failure models and some strategies to overcome them by using joint preservation surgical techniques.
The Journal of Knee Surgery, Volume 30, pp 735-735; https://doi.org/10.1055/s-0037-1606305
Osteoarthritis of the knee is a disabling and prevalent condition in the contemporary society. It has a broad spectrum of presentation and is becoming more common at younger ages, especially because of repetitive trauma, as we notice in the practice of high-impact sports activities, or as the outcomes of knee injuries. Osteotomies are surgical procedures aimed to preserve the joint by improving its biomechanics. This is the second special focus section of the Journal of Knee Surgery dedicated to this topic, where we have the privilege to get access to seven original contributions. The assessment and correction of the tibial slope are critical in cases of cruciate-deficient knees. This topic is covered in the article dedicated to sagittal plane corrections around the knee. The current principles of management in valgus knees are presented here, highlighting the advantages of a closing-wedge technique. Complex deformities may be addressed at two levels, above and below the knee, to avoid the obliquity of the joint line, and this is very well illustrated in the article about combined osteotomies. Joint salvage procedures are of keen interest in young and active patients. A new alternative that combines osteotomy and biological joint resurfacing with osteochondral and meniscal allografts is a very original article of this section. The pendulum between high-tibial osteotomy and unicompartmental knee replacement has been the scope of the literature in cases of varus knee. We present a review of this topic characterizing that each of them has unique indications. Another myth is that total knee replacements may be challenging after previous osteotomies around the joint. This topic is also covered here by presenting the current literature evidence based on more modern osteotomy techniques. Finally, osteotomies are shown as an alternative for cases of failed tibial plateau fractures, postponing or even preventing the substitution of the joint. Very experienced authors were invited to contribute to this special focus section, and we hope that it may collaborate with your understanding of indications, planning, execution, and outcomes of osteotomies around the knee. Enjoy reading!
The Journal of Knee Surgery, Volume 30, pp 774-783; https://doi.org/10.1055/s-0037-1606266
Osteotomy around the knee preceding total knee arthroplasty (TKA) has long been perceived as a factor contributing to higher complication rates and increased risk of revision as compared with primary TKA. However, recent systematic reviews and large registry analysis have not been able to confirm this perception. Technical difficulties and slightly higher complication rates can be attributed to older lateral closing wedge tibial osteotomy techniques and are not reported for the more frequently performed tibial medial opening wedge techniques. In the first part of this article, the latest information on this topic will be summarized. The second part of this article deals with osteotomies combined with TKA. Guidelines will be presented for the treatment of osteoarthritic patients with large leg deformities or extra-articular deformities. We aim to describe the latest advances in preoperative planning techniques, including a stepwise decision-making process and a review of the literature about this topic.
The Journal of Knee Surgery, Volume 31, pp 585-590; https://doi.org/10.1055/s-0037-1605559
The purpose of this study was to determine the incidence of patient-reported numbness following anterior cruciate ligament reconstruction (ACLR), if postoperative numbness dissipates with time, and how the graft type affects numbness severity. A total of 218 patients undergoing ACLR were prospectively enrolled. At 6 weeks, 6 months, and 1 year postoperatively, patients completed a questionnaire assessing numbness severity and location. Each time, patients rated their sensory deficit from 0 to 10 (0 = no deficit; 10 = complete lack of sensation) and indicated the location of their sensory deficit by marking a picture of a knee divided into nine rectangular segments. A mixed effect linear regression model was used to identify predictors for the patient-reported numbness severity. Overall, 69.8% (150/218) of patients reported numbness at 6 weeks, 50.0% (97/194) at 6 months, and 42.2% (78/185) at 1 year. Allograft patients reported a mean numbness severity of 2.9 ± 0.3 (mean ± standard error), 1.7 ± 0.2, and 1.4 ± 0.3 at 6 weeks, 6 months, and 1 year, respectively. The 6-week, 6-month, and 1-year averages were 4.7 ± 0.4, 2.7 ± 0.4, and 1.7 ± 0.4 for bone-patellar tendon-bone (BTB) autograft patients and 4.3 ± 0.4, 2.9 ± 0.4, and 2.5 ± 0.4 for hamstring autograft patients. The model indicated that the use of hamstring autografts increased patient-reported numbness by an average of 1.4 ± 0.5 across all time points, and the use of a BTB autograft increased patient-reported numbness by 1.2 ± 0.4 across all time points. Time from surgery decreased the severity of patient-reported numbness for all graft types (−1.3 ± 0.2 at 6 months and −1.7 ± 0.2 at 1 year). Hypoesthesia in the distribution of the infrapatellar branch of the saphenous nerve is common after ACLR but is likely to dissipate with time. Patients undergoing ACLR with allograft may be less likely to develop sensory deficits, and these deficits may be less severe.
The Journal of Knee Surgery, Volume 31, pp 541-550; https://doi.org/10.1055/s-0037-1604442
This study compares the differences in hospital length of stay (LOS), operating room time (ORT), discharge status, and total hospital costs among primary total knee arthroplasty (TKA) patients implanted with one of two contemporary primary total knee systems. A retrospective cohort analysis of elective inpatient, primary, unilateral TKA patients in the United States from 2013 to 2014 was conducted using the Premier Perspective® hospital billing database. The included patients had a diagnosis for osteoarthritis and received an ATTUNE® Knee (Gradually Reducing Radius Knee) or Triathlon™ (Single Radius Knee) from a hospital where both devices were used. Patient, provider, and procedure characteristics were included in generalized estimating equation (GEE) models to explore the impact of device on LOS, ORT, discharge status, and costs accounting for clustering within hospitals. A 1:1 propensity score–matched sensitivity analysis was also conducted. There were 1,178 patients who received gradually reducing radius knee and 5,707 patients who received single radius knee. GEE models indicated that the adjusted mean LOS and ORT for patients who received gradually reducing radius knee were significantly shorter than those who received single radius knee (p < 0.001). The adjusted odds ratios for gradually reducing radius knee patients being discharged to a skilled nursing facility (SNF) or other facility were 39% lower than that for single radius knee patients (odds ratio = 0.61; 95% confidence interval: 0.50–0.75; p < 0.001). The adjusted mean costs for gradually reducing radius knee patients were significantly lower than the single radius knee patients ($12,824 [1,813] vs. $18,713 [1,505]; p < 0.01). Findings were similar in the propensity-matched cohort of 2,044 patients, which was balanced on baseline covariates between devices (standardized differences were ≤ 8%). Patients who received gradually reducing radius knee had a shorter LOS and ORT, were less likely to be discharged to a SNF or other facility, and had lower total hospital cost than those who received single radius knee. These outcomes are increasingly relevant as hospitals bear the financial burden for episodes of care, and will require optimization to achieve success under the Centers for Medicare and Medicaid Services' Comprehensive Care for Joint Replacement model.
The Journal of Knee Surgery, Volume 31, pp 635-641; https://doi.org/10.1055/s-0037-1605562
Knee arthroscopic surgery is usually performed on young or middle-aged patients with meniscal tears. However, we have noted an amount of active elderly patients who suffered from traumatic meniscal tear without significant degenerative changes. Outcome data were prospectively collected and retrospectively reviewed in patients older than 60 years who underwent partial arthroscopic meniscectomy between April 2008 and July 2013. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Kellgren–Lawrence (K–L) grade, Knee Society Score (KSS), and pain scores were collected, and conversion to total knee arthroplasty (TKA) was recorded. Subgroups comparing the clinical outcome of different level of K–L grade and Outerbridge's score were conducted. At an average of 31 months of follow-up (standard deviation [SD]: 8.9; range, 24–63 months) for 96 patients with a mean age of 65.8 years (SD: 5.7; range, 60–83 years), 12 patients underwent conversion to TKA at an average of 2.1 years. Patients with a clear traumatic history of the knee have better improvement in visual analog scale (p < 0.001), KSS functional score (p = 0.005), and WOMAC score (p < 0.001), patients with K–L grade greater than III were 3.1 times more likely to undergo conversion to TKA than patients with K–L grade less than III. The findings indicate that patients older than 60 years with mild osteoarthritis and clear traumatic history of the meniscus are a good indication for arthroscopic partial meniscectomy. The level of evidence is level IV (a retrospective case series).
The Journal of Knee Surgery, Volume 31, pp 580-584; https://doi.org/10.1055/s-0037-1605557
Patient expectations and demographics are vital factors in determining patient satisfaction and outcomes from total knee arthroplasty (TKA). This study was a retrospective chart review that analyzed data from TKA patients to determine the impact of age on patient-reported outcomes measures following TKA. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford knee scores were collected as primary outcome measures from 356 consecutive patients who underwent TKA. Oxford knee scores were further divided into pain and function subscores. Patients were age categorized as 79. Preoperative scores were compared among age categories including age category, gender, body mass index (BMI), and length of stay (LOS) in the model as fixed effects. Scores collected postoperatively (∼10, 30, 90, and 180 days postoperation) were analyzed as repeated measures including age category, day and their interaction, gender, BMI, LOS, and preoperative score in the model. Preoperative OXFORD scores significantly differed among age categories (p < 0.05) and were numerically higher for the older (≥60 years old) compared with younger patients (<60 years old). After adjusting for preoperative scores, postoperative WOMAC and overall, pain, and function OXFORD scores significantly differed among the age groups (p < 0.05), with patients younger than 60 years reporting the worst scores in the postoperative time period. Older patients reported better preoperative overall, pain, and function scores and greater post-TKA outcomes than younger patients. A better understanding of factors that influence patient-reported outcomes can help providers to better manage patient expectations.
The Journal of Knee Surgery, Volume 31, pp 642-648; https://doi.org/10.1055/s-0037-1605563
Corrective osteotomy of intra-articular tibial plateau malunions is technically demanding for orthopaedic surgeons. The aim of our study was to evaluate the feasibility of the combination of three-dimensional (3D) virtual planning and novel patient-specific guides for assisting correction of complex intra-articular tibial plateau malunions. Six patients with posttraumatic intra-articular tibial plateau malunions were included. Preoperatively 3D models of the tibias were reconstructed using the computed tomography scan data. Virtual surgical planning was performed, and patient-specific guides for osteotomy and reduction were designed, which were then 3D printed. Intraoperatively they were applied to guide the osteotomy and reduction. After surgery, radiographs were taken to evaluate the knee joint surface. The operating surgeons were asked to complete the Likert scale questionnaire to assess their attitude to the novel technology. The guides were successfully used for guiding osteotomy correction of malunion in all patients. Postoperative radiographs showed the articular step-off was considerably reduced and the articular congruency was satisfactory in all patients. The results of the questionnaire demonstrated a high level of surgeon satisfaction and acceptance to the technology. For selective patients with complex intra-articular tibial plateau malunions, the novel technique could serve as a valuable option for guiding precise malunion correction.
The Journal of Knee Surgery, Volume 30, pp 816-821; https://doi.org/10.1055/s-0037-1605560
This study aims to compare clinical outcomes in unicompartmental knee arthroplasty (UKA) patients with or without magnetic resonance imaging (MRI) evidence of bone marrow edema (BME) in the patella and to evaluate the effect of functional outcomes after UKA in patients with patellofemoral osteoarthritis (PF OA). Outcomes of 146 knees in 141 patients who underwent medial UKA were included. According to their preoperative condition of patellofemoral joints, patients were divided into three groups: Group A, non-PF OA (Kellgren–Lawrence [K–L] scale = 0); group B, PF OA without BME (K–L ≥ 1, bone marrow edema pattern [BMEP] = 0); group C, PF OA with BME (K–L ≥ 1, BMEP ≥ 1). Clinical outcomes including visual analog scale (VAS) scores of knee pain, Hospital for Special Surgery (HSS) scores, and range of motions (ROMs) were evaluated and analyzed at the postoperative follow-up of 3 months and 2 years. From our results, BME was highly correlated to poor outcome in patients with UKA. At follow-up of 3 months, BME influenced the clinical outcome of UKA at an early postoperative stage in terms of VAS scores, HSS scores, and ROMs. At the final follow-up of 2 years, the clinical outcome was improved in terms of HSS score, although the anterior knee pain and active ROMs were still worse than that of patients without BME. In conclusion, there was no significant difference in clinical outcomes in patients without BME regardless of PF OA. However, the condition of BME should be taken serious consideration because of its indication of an adverse effect on the outcome after UKA.
The Journal of Knee Surgery, Volume 30, pp 769-773; https://doi.org/10.1055/s-0037-1605558
Unicompartmental medial or lateral osteoarthritis of the knee is found in up to 50% of all osteoarthritic patients and may be addressed surgically either by knee osteotomies or unicompartmental replacements. The limits for indicating one procedure or the other are somehow not defined. This article discusses the diagnostic algorithm and the most important decision factors. A long-leg radiograph and formal deformity analysis is mandatory. If constitutional or posttraumatic metaphyseal deformity in the frontal plane is detected and the opposite compartment is intact, an osteotomy should be considered. The result is not depending on age and grade of osteoarthritis. Unicompartmental knee arthroplasty is indicated in substantial osteoarthritis of one compartment (bone-on-bone) with intact ligaments and a functionally intact contralateral compartment. The anatomy of the femur and tibia should be normal with no gross osseous deformity. Age, obesity, or asymptomatic patellofemoral degeneration are not considered exclusion criteria for those surgical procedures.
The Journal of Knee Surgery, Volume 30, pp 617-617; https://doi.org/10.1055/s-0037-1606259
For millions of patients, knee pain is a debilitating chronic condition that prevents them from enjoying an active lifestyle. Because knee pain can have many different etiologies and progress at various rates, no single therapy can be used for every patient. While knee pain is not a new phenomenon, today's orthopedic surgeon must be able to not only diagnose the cause of a patient's pain but also to be able to select an appropriate treatment modality to serve every patient relying on the most up-to-date literature. Therefore, in this special section edition, there are articles reviewing possible sources and management of knee pain, including fat pad impingement and osteoarthritis. Also, newer management options, including various physical therapy modalities are described. A major emphasis of this special edition will be on various aspects of patient satisfaction and how this impacts their quality of life after total knee arthroplasty. Knee pain is an ever-evolving problem for both patients and surgeons, making it essential to stay updated on potential causes and new management techniques. This issue fulfills many of these purposes for our readership.
The Journal of Knee Surgery, Volume 31, pp 625-634; https://doi.org/10.1055/s-0037-1605561
The present systematic review and meta-analysis were aimed to verify the effect of open-wedge (OW) and closed-wedge (CW) high-tibial osteotomy (HTO) on sagittal and axial alignments of the patella. A vigorous search was performed for studies that compared the changes of sagittal and axial alignments of patella after OW and CW HTO. After evaluating publication bias and heterogeneity, we aggregated variables by using the random-effects model. The weighted mean differences in sagittal and axial alignment of patella were estimated with 95% confidence intervals. Also, we analyzed the changes in sagittal alignment of various OW HTO techniques, such as uniplanar, biplanar, and retrotubercle osteotomy. Overall, 20 studies that included 831 OW HTOs and 206 CW HTOs were included in this study. Patellar height decreased after OW HTO based on the Blackburne–Peel index (BPI, mean: −0.10), and Caton–Deschamps index (CDI, mean: −0.08). However, the patellar height after CW HTO showed no change after surgery (BPI [mean: −0.02], and CDI [mean: 0.02]). Among OW HTO techniques, the retrotubercle osteotomy showed the least change in patellar height after surgery. The lateral patellar tilt decreased by 1.74 degrees, and lateral patellar shift showed no change after OW HTO. However, there was a lack of evidence to conclude the change of axial alignment of patella after CW HTO. Our results supported that the sagittal alignment of patella lowered after OW HTO. However, CW HTO maintained the constant sagittal position of the patella. Among OW HTO techniques, the retrotubercle osteotomy had the least effect on the sagittal alignment of the patella. Regarding the axial alignment of the patella, OW HTO resulted in a little change of lateral patellar tilt; however, there was little evidence to confirm the change of the axial alignment of patella after CW HTO.
The Journal of Knee Surgery, Volume 31; https://doi.org/10.1055/s-0037-1606195
It has been brought to the Publisher's attention that in the article published online in the Journal of Knee Surgery on March 29, 2017 (DOI: 10.1055/s-0037-1600090), the name of the author Mauricio Kfuri was incorrectly published as “Mauricio Kfuri Junior”. The correct listing of the author's name is Mauricio Kfuri as appears in the author byline. Also, the author affiliation “Department of Orthopedics, University of Missouri, Columbia, Missouri” for Mauricio Kfuri was missed being included in the published version. The affiliation has been included and linked to the author as shown above.
The Journal of Knee Surgery, Volume 30; https://doi.org/10.1055/s-0037-1606193
The Journal of Knee Surgery, Volume 18, pp 31-42; https://doi.org/10.1055/s-0030-1248155
Following transplantation of ovine neocartilage allografts, 26 sheep were divided into groups according to the following weight-bearing schedule: 8-week nonweight bearing (8NWB, n=14), and 8-week nonweight bearing+4-week weight bearing (8NWB+4WB, n=12). In addition, 7 and 6 sheep, respectively, in the 8NWB and 8NWB+4WB groups received tTG treatment after allograft transplantation, whereas the remaining 13 sheep in these groups did not receive tTG. Finally, 8 sheep served as sham-operated controls without allograft transplantation. After euthanasia, stifle joints were harvested for the analysis of gross appearance, chondrocyte viability, histology, and biomechanical testing. No significant differences were noted in macroscopic graft survival and union with host tissue in both 8NWB and 8NWB+4WB groups between the tTG treated and non-tTG treated animals. Analysis of histological scores demonstrated no significant difference between tTG and non-tTG treatments in both 8NWB and 8NWB+4WB groups. Confocal laser microscopic analysis of the explanted defects revealed 70%-100% cell viability in all treatment groups. This study shows that allogeneic chondrocytes harvested from neonatal donors provide sufficient metabolic activity to affect repair. Use of tTG to augment resorbable suture fixation of neocartilage grafts provided no advantage over suture alone in this pilot study.
The Journal of Knee Surgery, Volume 19, pp 125-127; https://doi.org/10.1055/s-0030-1248092
The Journal of Knee Surgery, Volume 20, pp 48-49; https://doi.org/10.1055/s-0030-1248021
The Journal of Knee Surgery, Volume 17, pp 113-116; https://doi.org/10.1055/s-0030-1248207
The Journal of Knee Surgery, Volume 18, pp 255-256; https://doi.org/10.1055/s-0030-1248189
The Journal of Knee Surgery, Volume 18, pp 220-227; https://doi.org/10.1055/s-0030-1248186
The Journal of Knee Surgery, Volume 18, pp 213-219; https://doi.org/10.1055/s-0030-1248185
Despite the recent focus on the limited use of urgent arteriograms in the evaluation of acute knee dislocations, physical examination remains the cornerstone of assessment. Several clinical scenarios dictate an orthopedic emergency: vascular disruption, open wound, compartment syndrome, or an irreducible joint/dimple sign. In the acute setting, every attempt should be made to rule out associated injuries and the need for intervention. The multiple ligament knee injury or knee dislocation is a complex dilemma that requires close attention. Concomitant injuries about the knee often arise and must be addressed prior to ligamentous repair, and therefore the orthopedic surgeon must maintain a high index of suspicion for associated injuries in the evaluation of a multiple ligament knee injury.
The Journal of Knee Surgery, Volume 18, pp 209-211; https://doi.org/10.1055/s-0030-1248183
The Journal of Knee Surgery, Volume 18, pp 203-205; https://doi.org/10.1055/s-0030-1248182
The Journal of Knee Surgery, Volume 18, pp 183-191; https://doi.org/10.1055/s-0030-1248179
This study reports the initial clinical results of 540° of graft rotation or free tibial bone block to address graft tunnel mismatch in endoscopic anterior cruciate ligament (ACL) reconstruction. The operative reports of patients who underwent endoscopic ACL reconstruction between 1999 and 2001 were reviewed. Nine of 11 patients treated with a free tibial bone block and 14 of 17 patients treated with 540° of graft rotation were evaluated. Mean follow-up was 20 months (range: 13-40 months) for the bone block group and 34 months (range: 18-48 months) for the 540° group. There were statistically significant improvements in physical examination test results postoperatively, and only one patient in the 540° group had a grade one positive pivot shift test. KT-1000 arthrometer testing demonstrated a statistically significant decrease in manual maximum and side-to-side differences at final follow-up. Mean Lysholm and Noyes sports function scores were excellent or good for all patients. One patient required reoperation for flexion contracture, one patient required an arthroscopic irrigation and debridement for a minor infection, and one patient required arthroscopic subtotal medial meniscectomy for failed meniscal repair. No difference was noted between these results and previous results of patients undergoing conventional endoscopic ACL reconstruction. These results demonstrate graft rotation and free bone block techniques are effective in addressing graft tunnel mismatch in endoscopic ACL reconstruction.
The Journal of Knee Surgery, Volume 18, pp 5-6; https://doi.org/10.1055/s-0030-1248151
The Journal of Knee Surgery, Volume 19, pp 206-206; https://doi.org/10.1055/s-0030-1248108
The Journal of Knee Surgery, Volume 19, pp 199-201; https://doi.org/10.1055/s-0030-1248106
The Journal of Knee Surgery, Volume 19, pp 157-158; https://doi.org/10.1055/s-0030-1248099
The Journal of Knee Surgery, Volume 19, pp 145-148; https://doi.org/10.1055/s-0030-1248097
The Journal of Knee Surgery, Volume 19, pp 128-128; https://doi.org/10.1055/s-0030-1248093