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Ishibashi T, Konda S, Tamaki M, Okada S, Tomita T. Tibial morphology of symptomatic osteoarthritic knees varies according to location: a retrospective observational study in Japanese patients. Sci Rep 2024; 14:3250. [PMID: 38332045 PMCID: PMC10853256 DOI: 10.1038/s41598-024-53222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
This study analyzed 31 patients with symptomatic osteoarthritic knees scheduled to undergo knee arthroplasty or high tibial osteotomy and demonstrated shape variations in their proximal tibia using an average three-dimensional (3D) bone model. Preoperative computed tomography of the affected knees was reconstructed as 3D bone models using a triangle mesh of surface layers. The initial case was defined as the template, and the other models were reconstructed into homologous models with the same number of mesh vertices as that in the template. The corresponding mesh vertices of the other models were averaged to evaluate the spatial position on the particular mesh vertex of the template. This was applied to all the mesh vertices of the template to generate the average 3D model. To quantify the variation in surface geometry, average minimum distance from the average bone model to 31 models was recorded. The medial proximal tibial cortex (1.63 mm) revealed lesser variation compared to the tibial tuberosity (2.50 mm) and lateral cortex (2.38 mm), (p = 0.004 and p = 0.020, respectively). The medial tibial plateau (1.46 mm) revealed larger variation compared to the lateral tibial plateau (1.16 mm) (p = 0.044). Understanding 3D geometry could help in development of implants for arthroplasty and knee osteotomy.
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Affiliation(s)
- Teruya Ishibashi
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 1-17 Machikaneyama, Toyonaka, Osaka, 560-0043, Japan
| | - Masashi Tamaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka-shi, Osaka, 559-8611, Japan.
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2
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Brown NM, Lingampalli N, Hellman MD. Intraoperative Challenges of the Kinematic Knee. Orthop Clin North Am 2024; 55:27-32. [PMID: 37980101 DOI: 10.1016/j.ocl.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment has gained increasing popularity as it can potentially restore a more natural joint function. However, despite its theoretical advantages, kinematic total knee replacement presents several operative challenges that necessitate a thorough understanding and analysis of patient-specific anatomy during surgical planning and execution. This review article aims to critically evaluate the operative challenges associated with kinematic TKA and explore potential strategies to optimize surgical outcomes. The challenges encompass multiple aspects including patient selection, preoperative planning, bone cuts, soft tissue balancing, and component positioning.
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Affiliation(s)
- Nicholas M Brown
- Loyola University Medical Center, 2160 South 1st Avenue #3328, Maywood, IL 60153, USA.
| | - Nithya Lingampalli
- Loyola University Medical Center, 2160 South 1st Avenue #3328, Maywood, IL 60153, USA
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Larson N, Nguyen C, Do B, Kaul A, Larson A, Wang S, Wang E, Bultman E, Stevens K, Pai J, Ha A, Boutin R, Fredericson M, Do L, Fang C. Artificial Intelligence System for Automatic Quantitative Analysis and Radiology Reporting of Leg Length Radiographs. J Digit Imaging 2022; 35:1494-1505. [PMID: 35794502 PMCID: PMC9261153 DOI: 10.1007/s10278-022-00671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/19/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Leg length discrepancies are common orthopedic problems with the potential for poor functional outcomes. These are frequently assessed using bilateral leg length radiographs. The objective was to determine whether an artificial intelligence (AI)-based image analysis system can accurately interpret long leg length radiographic images. We built an end-to-end system to analyze leg length radiographs and generate reports like radiologists, which involves measurement of lengths (femur, tibia, entire leg) and angles (mechanical axis and pelvic tilt), describes presence and location of orthopedic hardware, and reports laterality discrepancies. After IRB approval, a dataset of 1,726 extremities (863 images) from consecutive examinations at a tertiary referral center was retrospectively acquired and partitioned into train/validation and test sets. The training set was annotated and used to train a fasterRCNN-ResNet101 object detection convolutional neural network. A second-stage classifier using a EfficientNet-D0 model was trained to recognize the presence or absence of hardware within extracted joint image patches. The system was deployed in a custom web application that generated a preliminary radiology report. Performance of the system was evaluated using a holdout 220 image test set, annotated by 3 musculoskeletal fellowship trained radiologists. At the object detection level, the system demonstrated a recall of 0.98 and precision of 0.96 in detecting anatomic landmarks. Correlation coefficients between radiologist and AI-generated measurements for femur, tibia, and whole-leg lengths were > 0.99, with mean error of < 1%. Correlation coefficients for mechanical axis angle and pelvic tilt were 0.98 and 0.86, respectively, with mean absolute error of < 1°. AI hardware detection demonstrated an accuracy of 99.8%. Automatic quantitative and qualitative analysis of leg length radiographs using deep learning is feasible and holds potential in improving radiologist workflow.
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Affiliation(s)
- Nathan Larson
- Computer Science Department, Brigham Young University, Campus Dr, Provo, UT, 3361 TMCB84604, USA
| | - Chantal Nguyen
- Department of Orthopedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Bao Do
- Department of Radiology, Palo Alto VA Medical Center, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Aryan Kaul
- University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Anna Larson
- Computer Science Department, Brigham Young University, Campus Dr, Provo, UT, 3361 TMCB84604, USA
| | - Shannon Wang
- University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Erin Wang
- Harvey Mudd College, Claremont, CA, 91711, USA
| | - Eric Bultman
- Department of Radiology, Palo Alto VA Medical Center, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Kate Stevens
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Jason Pai
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Audrey Ha
- Menlo-Atherton High School, Atherton, CA, 94025, USA
| | - Robert Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Michael Fredericson
- Department of Orthopedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | | | - Charles Fang
- Department of Radiology, Palo Alto VA Medical Center, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
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Assirelli E, Caravaggi P, Mazzotti A, Ursini F, Leardini A, Belvedere C, Neri S. Location-Dependent Human Osteoarthritis Cartilage Response to Realistic Cyclic Loading: Ex-Vivo Analysis on Different Knee Compartments. Front Bioeng Biotechnol 2022; 10:862254. [PMID: 35782520 PMCID: PMC9240619 DOI: 10.3389/fbioe.2022.862254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Osteoarthritis (OA) is a multifactorial musculoskeletal disorder affecting mostly weight-bearing joints. Chondrocyte response to load is modulated by inflammatory mediators and factors involved in extracellular cartilage matrix (ECM) maintenance, but regulatory mechanisms are not fully clarified yet. By using a recently proposed experimental model combining biomechanical data with cartilage molecular information, basally and following ex-vivo load application, we aimed at improving the understanding of human cartilage response to cyclic mechanical compressive stimuli by including cartilage original anatomical position and OA degree as independent factors.Methods: 19 mono-compartmental Knee OA patients undergoing total knee replacement were recruited. Cartilage explants from four different femoral condyles zones and with different degeneration levels were collected. The response of cartilage samples, pooled according to OA score and anatomical position was tested ex-vivo in a bioreactor. Mechanical stimulation was obtained via a 3-MPa 1-Hz sinusoidal compressive load for 45-min to replicate average knee loading during normal walking. Samples were analysed for chondrocyte gene expression and ECM factor release.Results: Non parametric univariate and multivariate (generalized linear mixed model) analysis was performed to evaluate the effect of compression and IL-1β stimulation in relationship to the anatomical position, local disease severity and clinical parameters with a level of significance set at 0.05. We observed an anti-inflammatory effect of compression inducing a significant downmodulation of IL-6 and IL-8 levels correlated to the anatomical regions, but not to OA score. Moreover, ADAMTS5, PIICP, COMP and CS were upregulated by compression, whereas COL-2CAV was downmodulated, all in relationship to the anatomical position and to the OA degree.Conclusion: While unconfined compression testing may not be fully representative of the in-vivo biomechanical situation, this study demonstrates the importance to consider the original cartilage anatomical position for a reliable biomolecular analysis of knee OA metabolism following mechanical stimulation.
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Affiliation(s)
- Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- I Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Ursini
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- *Correspondence: Claudio Belvedere,
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ruggeri M, Gill HS, Leardini A, Zaffagnini S, MacLeod A, Ortolani M, Faccia F, Grassi A, Fabbro GD, Durante S, Belvedere C. Superimposition of ground reaction force on tibial-plateau supporting diagnostics and post-operative evaluations in high-tibial osteotomy. A novel methodology. Gait Posture 2022; 94:144-152. [PMID: 35334334 DOI: 10.1016/j.gaitpost.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A fully personalised combination of Gait Analysis (GA), including Ground Reaction Force (GRF), and patient-specific knee joint morphology has not yet been reported. This can provide valuable biomechanical insight in normal and pathological conditions. Abnormal knee varus results in medial knee condylar hyper-compression and osteoarthritis, which can be prevented by restoring proper condylar load distribution via High Tibial Osteotomy (HTO). RESEARCH QUESTION This study was aimed at reporting on an original methodology, merging GA, GRF and Computer-Tomography (CT) to depict a patient-specific representation of the knee mechanical condition during locomotion. It was hypothesised that HTO results in a lateralized pattern of GRF with respect to the tibial plateau. METHODS Four patients selected for HTO received clinical, radiological and instrumental examinations, pre- and post-operatively at 6-month follow-up. GA was performed during level walking and more demanding motor tasks using a 9-camera motion-capture system, combined with two force platforms, and an established protocol. Additional skin markers were positioned around the tibial-plateau rim. Weight-bearing CT scans of the knee were collected while still wearing these markers. Proximal tibial and marker morphological models were reconstructed. The markers from CT reconstruction were then registered to the corresponding trajectories as tracked by GA data. Resulting registration matrices were used to report GRF vectors on the plane best matching the tibial-plateau model and the intersection paths were calculated. RESULTS AND SIGNIFICANCE The registration procedure was successfully executed, with a max registration error of about 3 mm. GRF intersection paths were found medially to the tibial plateau pre-op, and lateralized post-op, thus much closer to the knee centre, as expected after HTO. The exploitation of the present methodology offers personalised quantification of the original mechanical misalignment and of the effect of surgical correction which could enhance diagnostics and planning of HTO as well as other knee treatments.
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Affiliation(s)
- Miriana Ruggeri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Harinderjit Singh Gill
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alisdair MacLeod
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Faccia
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Mortazavi SMJ, Vosoughi F. Association of alignment variables, posteromedial tibial cartilage wear and anterior cruciate ligament insufficiency in participants with varus knee osteoarthritis: a cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2022; 46:1029-1036. [PMID: 35244758 DOI: 10.1007/s00264-022-05358-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) and unicompartment knee arthroplasty (UKA) are among the most important treatment options for end-stage knee osteoarthritis. Previous papers have noted the importance of knowing the type of medial tibial wear in deciding to manage varus knee osteoarthritis patients with TKA vs UKA. But few studies have delineated the pre-operative variables predicting the type of tibia wear. METHODS This study assessed individuals with varus knee osteoarthritis planned for knee arthroplasty. After recording the demographic variables, hip-knee-ankle joint alignment views were taken from all patients. Finally, the type of tibial wear encountered during the surgery (posteromedial, non-posteromedial) was documented. RESULTS A total of 325 knees and 301 participants were evaluated in the study. Participants aged 67.12 (± SD 8.14) and the male to female ratio was 0.20. Between either non-posteromedial/posteromedial wear or insufficient/sufficient ACL cases, there was a statistically significant difference with regard to MPTA, LDFA, VA, and JCA (P value < 0.05). Sixty-three percent of knees had non-posteromedial wear in the tibia plateau and 37% had posteromedial wear. Posteromedial wear was associated with 95% chance of ACL tear. Non-posteromedial knee had nearly 50% chance of having ACL insufficiency. Among non-posteromedial cases, VA of 14.5 as cut-off value had 65% sensitivity, 90% specificity, 73% negative predictive value, 87% positive predictive value, and 78% accuracy in detecting ACL insufficiency. CONCLUSION Posteromedial tibial wear is associated with ACL insufficiency. However, regarding non-posteromedial cases, varus angle > 14.5 is highly predictive of ACL tear (87% positive predictive value).
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Affiliation(s)
- Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Orthopedic Surgery Department, End of Keshavarz Blvd, Imam Khomeini Hospital, 1419733141, Tehran, Iran.
| | - Farzad Vosoughi
- Joint Reconstruction Research Center, Orthopedic Surgery Department, End of Keshavarz Blvd, Imam Khomeini Hospital, 1419733141, Tehran, Iran
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7
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Roussi K, Saunders C, Ries C, Rolvien T, Boese CK. Anterior cruciate ligament intactness in osteoarthritic patients indicated for total knee arthroplasty: a systematic literature review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3458-3466. [PMID: 32997162 DOI: 10.1007/s00167-020-06292-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022]
Abstract
Bi-cruciate retaining total knee arthroplasty (BCR TKA) is thought to result in more natural knee kinematics compared to conventional TKA designs. This may lead to a reduction in dissatisfied patients after TKA. An intact anterior cruciate ligament (ACL) is a prerequisite for implantation of a BCR TKA but the frequency of an intact ACL in patients indicated for TKA is not well known. The objective of this systematic literature review was to determine the presence of an intact ACL in patients undergoing TKA by intraoperative macroscopic or MRI assessment. A systematic literature review was conducted using PubMed™ and EMBASE™ in June 2020. The ACL of patients with knee osteoarthritis (OA) undergoing TKA was classified as present (including intact and degenerated) vs. absent, and as intact vs. not fully intact. Proportional meta-analyses were performed. 2840 articles were identified and screened. 135 full texts were analyzed and 18 studies met the inclusion criteria for subsequent qualitative and quantitative meta-analysis. Analysis of the status of the ACL when assessed intraoperatively during TKA showed that the ligament was present in 79.4% of patients (CI: 73.5-84.3%), from 14 studies with 2067 cases studied. The ACL was determined to be intact in 55.0% of patients (CI: 45.3-64.4%), from 14 studies with 1916 cases. Preoperative ACL assessment using MRI (2 studies) revealed it was present in 82.9% of 193 cases (CI: 76.9-87.6%), and intact in 56.8% of 176 cases (CI: 8.2-94.7%). This systematic literature review shows that the ACL is macroscopically intact in more than half of patients with knee OA undergoing TKA, based on intraoperative assessment of the ligament. The results suggest BCR TKA may be considered as an alternative to traditional TKA in a large number of TKA patients. More high-quality studies are needed to better understand the functional status of the ACL in TKA patients.Level of evidence III.
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Affiliation(s)
| | | | - Christian Ries
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Tim Rolvien
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, 50931, Cologne, Germany. .,Smith + Nephew GmbH, Hamburg, Germany.
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Caravaggi P, Assirelli E, Ensini A, Ortolani M, Mariani E, Leardini A, Neri S, Belvedere C. Biomechanical-Based Protocol for in vitro Study of Cartilage Response to Cyclic Loading: A Proof-of-Concept in Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 9:634327. [PMID: 34012954 PMCID: PMC8126668 DOI: 10.3389/fbioe.2021.634327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is an evolving disease and a major cause of pain and impaired mobility. A deeper understanding of cartilage metabolism in response to loading is critical to achieve greater insight into OA mechanisms. While physiological joint loading helps maintain cartilage integrity, reduced or excessive loading have catabolic effects. The main scope of this study is to present an original methodology potentially capable to elucidate the effect of cyclic joint loading on cartilage metabolism, to identify mechanisms involved in preventing or slowing down OA progression, and to provide preliminary data on its application. In the proposed protocol, the combination of biomechanical data and medical imaging are integrated with molecular information about chondrocyte mechanotransduction and tissue homeostasis. The protocol appears to be flexible and suitable to analyze human OA knee cartilage explants, with different degrees of degeneration, undergoing ex vivo realistic cyclic joint loading estimated via gait analysis in patients simulating mild activities of daily living. The modulation of molecules involved in cartilage homeostasis, mechanotransduction, inflammation, pain and wound healing can be analyzed in chondrocytes and culture supernatants. A thorough analysis performed with the proposed methodology, combining in vivo functional biomechanical evaluations with ex vivo molecular assessments is expected to provide new insights on the beneficial effects of physiological loading and contribute to the design and optimization of non-pharmacological treatments limiting OA progression.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- I Orthopaedic and Traumatologic Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erminia Mariani
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
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9
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Kennedy JA, Molloy J, Mohammad HR, Mellon SJ, Dodd CAF, Murray DW. Mid- to long-term function and implant survival of ACL reconstruction and medial Oxford UKR. Knee 2019; 26:897-904. [PMID: 31174980 DOI: 10.1016/j.knee.2019.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/15/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to describe mid- to long-term outcomes of anterior cruciate ligament (ACL) reconstruction with simultaneous or staged medial unicompartmental knee replacement (UKR), and compare outcomes between (1) young patients aged younger than 55 at surgery and those older, (2) those with long-term follow-up greater than 10 years, (3) cemented and cementless UKR, and (4) compare outcomes to those with an intact ACL. PATIENTS AND METHODS We identified knees with staged or simultaneous ACL reconstruction and medial UKR from a prospectively followed designer UKR cohort, and describe mean Oxford Knee Score (OKS), mean Tegner activity score and Kaplan-Meier survival estimates. We matched these knees to ACL-intact knees. RESULTS Seventy-six consecutive UKR with staged or simultaneous ACL reconstruction were identified with mean six-year follow-up (range 1-15). There was significant improvement in OKS and Tegner score with surgery. At most recent follow-up, OKS was 41.0 (range 11 to 48), and Tegner score 3.6 (0 to 8). There were three revisions occurring at a mean of five years post-operatively. The five-, 10- and 15-year survival estimates were 97% (95% confidence interval [CI] 93-100), 92% (83-100), and 92% (83-100). There was no difference in functional scores or implant survival in young patients, those with long-term follow-up (>10 years), those with cementless fixation, or when compared to ACL intact knees. CONCLUSION These results demonstrate excellent mid- to long-term function and survival of selected patients who have undergone ACL reconstruction and medial UKR. Their outcome was similar to those with intact ACLs.
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Affiliation(s)
- J A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
| | - J Molloy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - H R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - S J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - C A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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10
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Slattery CA, Kweon CY, Hagen MS, Gee AO, Williamson RV. Comparison of medial and lateral posterior femoral condyle articular cartilage wear patterns. Knee 2018; 25:1165-1170. [PMID: 30414791 DOI: 10.1016/j.knee.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND While degenerative changes to the articular cartilage of the anterior and distal portions of the femoral condyles have been well studied in the literature, the changes that occur on the posterior femoral condyle are not as clear. The purpose of this study was to assess the difference in articular cartilage thickness between the medial and lateral posterior femoral condyles in knees undergoing unicompartmental knee arthroplasty. METHODS A retrospective review of prospectively gathered data on 107 consecutive patients undergoing unicompartmental knee arthroplasty performed by a single surgeon was performed. The remaining articular cartilage thickness after resection of the posterior femoral condyle was measured and simple analysis conducted to compare cartilage thickness between medial and lateral posterior femoral condyles. RESULTS Ninety-two medial unicompartmental arthroplasties and 15 lateral unicompartmental arthroplasties were performed during the 16 month study period. The majority of lateral UKA patients were female and had lower BMI than medial UKA patients. The articular cartilage thickness on the medial posterior femoral condyle was 3 mm ± 1 mm (mean ± standard deviation) and 1 mm ± 1 mm on the lateral side (p-value <0.001). CONCLUSIONS There is a significant difference in articular cartilage thickness between the medial and lateral posterior femoral condyles in patients undergoing unicompartmental knee arthroplasty. This coincides with a potentially inherently different pattern of articular cartilage degeneration between the medial and lateral compartments of the knee and has implications on implant designs and resurfacing techniques about the knee.
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Affiliation(s)
- Casey A Slattery
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Christopher Y Kweon
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Mia S Hagen
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Albert O Gee
- Department of Orthopaedic Surgery & Sports Medicine, University of Washington, 3800 Montlake Blvd NE, Campus Box 354060, Seattle, WA 98195-4060, USA.
| | - Richard V Williamson
- Department of Orthopedics and Sports Medicine, Skagit Regional Clinics, 2320 Freeway Drive, Mount Vernon, WA 98273, USA.
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11
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Kim SH, Park YB, Song MK, Lim JW, Lee HJ. Reliability and Validity of the Femorotibial Mechanical Axis Angle in Primary Total Knee Arthroplasty: Navigation versus Weight Bearing or Supine Whole Leg Radiographs. Knee Surg Relat Res 2018; 30:326-333. [PMID: 30466253 PMCID: PMC6254869 DOI: 10.5792/ksrr.18.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 10/27/2022] Open
Abstract
Purpose To evaluate the reliability and validity of the femorotibial mechanical axis angle from radiographs in the weight bearing (WB) and supine positions compared with navigation-measured values. Materials and Methods Sixty-eight cases of navigation-assisted total knee arthroplasty (TKA) were included. The pre- and postoperative whole leg radiographs (WLRs) in WB and supine positions were compared with the initial and final navigation values. Results The mean mechanical axis angle from the preoperative WBWLR and navigation were not statistically different (p=0.079) and were correlated strongly with each other (intraclass correlation [ICC], 0.818). However, on postoperative measurements, although the WBWLR and navigation values were not different (p=0.098), they were not correlated with each other (ICC, 0.093). The standard error of measurement was 1.8°±3.6° for the preoperative WBWLR and 2.5°±4.8° for the postoperative WBWLR. The validity that was determined by the Bland-Altman plot was not acceptable for both pre- and postoperative measurements. Conclusions The preoperative WBWLR could provide accurate but not precise measurement value of the femorotibial mechanical axis angle for navigation-assisted TKA, and postoperative measurements in navigation were not comparable with radiographic measurements. The lack of agreement was found between the radiographic and navigation measurements of the coronal alignment regardless of pre- or postoperative evaluation although the accuracy was found acceptable. Level of Evidence Level 4.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Min-Ku Song
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung-Won Lim
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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12
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Smith CR, Brandon SCE, Thelen DG. Can altered neuromuscular coordination restore soft tissue loading patterns in anterior cruciate ligament and menisci deficient knees during walking? J Biomech 2018; 82:124-133. [PMID: 30420173 DOI: 10.1016/j.jbiomech.2018.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/19/2018] [Indexed: 02/07/2023]
Abstract
Injuries to the anterior cruciate ligament (ACL) and menisci commonly lead to early onset osteoarthritis. Treatments that can restore normative cartilage loading patterns may mitigate the risk of osteoarthritis, though it is unclear whether such a goal is achievable through conservative rehabilitation. We used musculoskeletal simulation to predict cartilage and ligament loading patterns during walking in intact, ACL deficient, menisci deficient, and ACL-menisci deficient knees. Stochastic simulations with varying coordination strategies were then used to test whether neuromuscular control could be modulated to restore normative knee mechanics in the pathologic conditions. During early stance, a 3 mm increase in anterior tibial translation was predicted in the ACL deficient knee. Mean cartilage contact pressure increased by 18% and 24% on the medial and lateral plateaus, respectively, in the menisci deficient knee. Variations in neuromuscular coordination were insufficient to restore normative cartilage contact patterns in either the ACL or menisci deficient knees. Elevated cartilage contact pressures in the pathologic knees were observed in regions where cartilage wear patterns have previously been reported. These results suggest that altered cartilage tissue loading during gait may contribute to region-specific degeneration patterns, and that varying neuromuscular coordination in isolation is unlikely to restore normative knee mechanics.
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Affiliation(s)
- Colin R Smith
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA
| | - Scott C E Brandon
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA; School of Engineering, University of Guelph, Canada
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, USA.
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13
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FTFA change under valgus stress force radiography is useful for evaluating the correctability of intra-articular varus deformity in UKA. Arch Orthop Trauma Surg 2018; 138:1003-1009. [PMID: 29728833 DOI: 10.1007/s00402-018-2945-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this observational study was to investigate the postoperative alignment change with Oxford unicompartmental knee arthroplasties (UKA), and clarify whether femoro-tibial facet angle (FTFA) is useful for evaluating alignment correctability with UKA. METHODS This study evaluated 79 knees consecutive minimally invasive Oxford phase 3 UKAs performed between 2013 and 2014. Full-length weight-bearing radiographs of the lower limbs were obtained pre- and postoperatively to assess varus angle. Preoperative valgus stress radiography in the supine position was also performed. FTFA was measured on weight-bearing anteroposterior radiography and valgus stress radiography. RESULTS The preoperative varus angle of 4.6° ± 3.1° reduced to 1.7° ± 2.6° postoperatively. Preoperative varus angle and postoperative varus angle change strongly correlated with the FTFA value and its change on the valgus stress radiographs, respectively (p < 0.01). Based on preoperative FTFA under valgus stress radiography, intra-articular varus corrected group (37 knees) with preoperative varus angle 2.9° ± 2.4° was corrected to - 0.3° ± 2.0° after UKA. However, intra-articular varus uncorrected group (42 knees) with preoperative varus angle 6.0° ± 3.0° was only corrected to 3.5° ± 1.7°. Thirteen knees (16.5%) were overcorrected to valgus after UKA, with a mean FTFA of - 1.2° ± 0.4° under valgus stress force, which related with a postoperative valgus angle 0.8° ± 1.2°. CONCLUSION FTFA change under valgus stress force was useful for evaluating the correctability of UKA. It could reflect intra-articular varus deformity. Intra-articular varus deformity not corrected under valgus stress would result in varus after UKA. However, intra-articular deformity which could be overcorrected under valgus stress would have a tendency to valgus after Oxford UKA.
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14
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Favre J, Erhart-Hledik JC, Blazek K, Fasel B, Gold GE, Andriacchi TP. Anatomically Standardized Maps Reveal Distinct Patterns of Cartilage Thickness With Increasing Severity of Medial Compartment Knee Osteoarthritis. J Orthop Res 2017; 35:2442-2451. [PMID: 28233332 DOI: 10.1002/jor.23548] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/10/2017] [Indexed: 02/04/2023]
Abstract
While cartilage thickness alterations are a central element of knee osteoarthritis (OA), differences among disease stages are still incompletely understood. This study aimed to quantify the spatial-variations in cartilage thickness using anatomically standardized thickness maps and test if there are characteristic patterns in patients with different stages of medial compartment knee OA. Magnetic resonance images were acquired for 75 non-OA and 100 OA knees of varying severities (Kellgren and Lawrence (KL) scores 1-4). Three-dimensional cartilage models were reconstructed and a shape matching technique was applied to convert the models into two-dimensional anatomically standardized thickness maps. Difference thickness maps and statistical parametric mapping were used to compare the four OA and the non-OA subgroups. This analysis showed distinct thickness patterns for each clinical stage that formed a coherent succession from the non-OA to the KL 4 subgroups. Interestingly, the only significant difference for early stage (KL 1) was thicker femoral cartilage. With increase in disease severity, typical patterns developed, including thinner cartilage in the anterior area of the medial condyle (significant for KL 3 and 4) and thicker cartilage in the posterior area of the medial and lateral condyles (significant for all OA subgroups). The tibial patterns mainly consisted of thinner cartilage for both medial and lateral compartments (significant for KL 2-4). Comparing anatomically standardized maps allowed identifying patterns of thickening and thinning over the entire cartilage surface, consequently improving the characterization of thickness differences associated with OA. The results also highlighted the value of anatomically standardized maps to analyze spatial variations in cartilage thickness. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2442-2451, 2017.
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Affiliation(s)
- Julien Favre
- Department of Musculoskeletal Medicine, Centre Hospitalier Universiatire Vaudois, University of Lausanne, Lausanne, Switzerland.,Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Jennifer C Erhart-Hledik
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Palo Alto VA, Palo Alto, California
| | - Katerina Blazek
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Palo Alto VA, Palo Alto, California
| | - Benedikt Fasel
- Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California.,Department of Bioengineering, Stanford University, Stanford, California.,Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, California.,Palo Alto VA, Palo Alto, California.,Department of Orthopaedic Surgery, Stanford University, Stanford, California
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15
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In vivo kinematics of early-stage osteoarthritic knees during pivot and squat activities. Gait Posture 2017; 58:214-219. [PMID: 28806709 DOI: 10.1016/j.gaitpost.2017.07.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 02/02/2023]
Abstract
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43-57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or -2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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16
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Bontempi M, Cardinale U, Bragonzoni L, Macchiarola L, Grassi A, Signorelli C, Marcheggiani Muccioli GM, Zaffagnini S. Total knee replacement: intraoperative and postoperative kinematic assessment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:32-37. [PMID: 28657561 PMCID: PMC6179007 DOI: 10.23750/abm.v88i2 -s.6509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM The main goals of the total knee arthroplasty (TKA) is to reduce the perceived pain and restore knee mobility and function in case of osteoarthritic knees joints. Literature shows how the three major causes of TKA failures are related to wear, loosening and instability and this is due to a problem of imbalance and malalignment. Intraoperative and postoperative kinematics analysis could be of benefit for improving surgery outcome. The aim of the present paper is to give an overview of the two set-up with the highest accuracy for intraoperative and postoperative TKA kinematics evaluation, currently in use at Istituto Ortopedico Rizzoli. Introperative and Postoperative Evaluation: For intraoperative evaluation it has been presented a navigation system with a specifically developed software, while for the postoperative it has been presented the roentgen stereophotogrammetric analysis (RSA). The navigation system consists in a laptop connected with an optoelectronic localizer (Polaris, Northern Digital Inc, Canada). Two reference arrays with passive optical markers and a marked probe are used to localize the knee joint in the 3D space and track the joint kinematics. The RSA is a radiographic technique used in orthopaedic field for measuring micromotion at bone/prosthesis interface or for joint kinematics evaluation. The RSA uses two X-ray sources synchronized with two digital flat-panels. CONCLUSIONS The present paper shows that using the navigation system allows the surgeon to easily perform kinematic and alignment evaluation during TKA surgery while the RSA allows a quantitative evaluation of the joint kinematics during the recovery time.
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17
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Tsubosaka M, Ishida K, Sasaki H, Shibanuma N, Kuroda R, Matsumoto T. Effects of Suture and Tourniquet on Intraoperative Kinematics in Navigated Total Knee Arthroplasty. J Arthroplasty 2017; 32:1824-1828. [PMID: 28233604 DOI: 10.1016/j.arth.2017.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To investigate the effects of suture (soft tissue closure) and air tourniquet use on intraoperative kinematics in navigated total knee arthroplasty. METHODS The study included 20 patients with varus-type knee osteoarthritis who underwent primary posterior-stabilized total knee arthroplasty using computed tomography (CT)-based navigation. Intraoperative tibiofemoral kinematics from maximum extension to maximum flexion were measured using the computed tomography-based navigation. The measurements were performed 3 times as follows: measurement 1: before suture (tourniquet on), measurement 2: after suture (tourniquet on), and measurement 3: after tourniquet removal. Details of kinematics including knee joint gap, tibiofemoral rotational angles, and anteroposterior (AP) distance between the femur and tibia were compared among the 3 measurements and statistically evaluated. RESULTS On the medial side, there was no significant difference among the 3 measurements in the extension gap, but measurement 1 showed a significantly larger flexion gap compared with the other 2 measurements. On the lateral side, there was no significant difference between the extension and flexion gaps in all measurements. The anteroposterior distance in measurement 1 showed that the femur was positioned significantly more anterior to the tibia at 10° and 20° of flexion compared with the other 2 measurements after suture. There was no significant difference among the 3 measurements in the tibiofemoral rotation angles. CONCLUSION These results found that the effect of suture and tourniquet was minimal, and that intraoperative kinematics can effectively evaluate postoperative passive kinematic conditions.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Hiroshi Sasaki
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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Martins GC, Camanho GL, Ayres LM, Oliveiras ESD. Correlation between Ahlbäck radiographic classification and anterior cruciate ligament status in primary knee arthrosis. Rev Bras Ortop 2017; 52:69-74. [PMID: 28194384 PMCID: PMC5290133 DOI: 10.1016/j.rboe.2016.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/18/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To correlate the Ahlbäck radiographic classification with the anterior cruciate ligament (ACL) status in knee arthritis patients. Methods The study evaluated 89 knees of patients who underwent total knee arthroplasty due to primary osteoarthritis: 16 male and 69 females, with mean age 69.79 years (53–87 years). Osteoarthritis was classified radiographically by the Ahlbäck radiographic classification into five grades. The ACL was classified in the surgery as present or absent. The correlation of ACL status and Ahlbäck classification was assessed, as well as those of ACL status and the parameters age, gender, and tibiofemoral angulation (varus–valgus). Results In cases of varus knees, there was a correlation between grades I to III and ACL presence in 41/47 (86.7%) cases and between grades IV and V and ACL absence in 15/17 (88.2%) cases (p < 0.0001). In valgus knees, no statistically significant correlation was observed between the ACL status and the Ahlbäck classification. In the present study, absence of the ACL was more common in men (9/17; 52%) than in women (19/72; 26%). Conclusion In cases of medial osteoarthritis, the Ahlbäck radiographic classification is a useful parameter to predict ACL status (presence or absence). In gonarthritis in genu valgum, ACL status was not predicted by Ahlbäck's classification.
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Affiliation(s)
- Glaucus Cajaty Martins
- Hospital Federal de Ipanema, Serviço de Ortopedia e Traumatologia, Rio de Janeiro, RJ, Brazil
| | - Gilberto Luis Camanho
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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19
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Correlação entre a classificação radiográfica de Ahlbäck e o estado de conservação do ligamento cruzado anterior em gonartrose primária. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Tian S, Wang B, Wang Y, Ha C, Liu L, Sun K. Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament. BMC Musculoskelet Disord 2016; 17:327. [PMID: 27496245 PMCID: PMC4974734 DOI: 10.1186/s12891-016-1186-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Relative young and more active patients with osteoarthritis (OA) of the isolated medial femorotibial compartment in conjunction with anterior cruciate ligament (ACL) deficiency are difficult to treat. The aim of this study was to explore the early clinical outcomes of combined Oxford unicompartmental knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and isolated OA of the medial compartment. Methods Twenty-eight patients were included into the study. All patients were treated by combined Oxford UKA and ACL reconstruction. Plain radiographs in the antero-posterior and lateral view and long-leg standing radiographs were routinely performed prior to and after surgery. Stress radiographs in valgus were additionally available in order to verify the well-preserved lateral compartment. The varus deformity of the knee prior to surgery and the valgus degree after surgery, the posterior slope of the tibial component and the range of motion (ROM) of the knee after surgery were measured and recorded. Clinical evaluations include Oxford Knee Score (OKS), Knee Society Score (KSS-clinical score; KSS-function score) and Tegner activity score. Results All the patients were followed up for 52 ± 8 months. The leg alignment showed 3.1 ± 0.6° of varus deformity prior to surgery and 4.0 ± 0.7° of valgus after surgery. The OKS, KSS and Tegner activity score improved significantly after surgery (P < 0.05). The mean ROM of the operated knee was 123.5 ± 2.8° at the last follow-up. The posterior slope of the tibial component was 3.9 ± 1.2°. A significant correlation was found between them according to the Pearson’s correlation (r = 0.39, P = 0.03). There were 2 patients (7 %) with the complication of mobile bearing dislocation, and a second operation of replacing a thicker mobile bearing was performed for them. Conclusion The early clinical data have shown that combined surgery of UKA and ACL reconstruction has revealed promising results. However, long-term follow-up studies should be done in these patients. Trial registration Current trial ISRCTN24663935 (Retrospectively registered on 21 July 2016).
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Affiliation(s)
- Shaoqi Tian
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China.
| | - Bin Wang
- Department of Orthopaedics, Qingdao 3rd People's Hospital, Qingdao, 266000, China
| | - Yuanhe Wang
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China
| | - Chengzhi Ha
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China
| | - Lun Liu
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China
| | - Kang Sun
- Department of Orthopaedics, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Huangdao District, Qingdao, Shandong, 266000, China.
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21
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Nakagawa Y, Mukai S, Yabumoto H, Tarumi E, Nakamura T. Cartilage Degeneration and Alignment in Severe Varus Knee Osteoarthritis. Cartilage 2015; 6:208-15. [PMID: 26425258 PMCID: PMC4568735 DOI: 10.1177/1947603515595501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the relationship between cartilage, ligament, and meniscus degeneration and radiographic alignment in severe varus knee osteoarthritis in order to understand the development of varus knee osteoarthritis. DESIGN Fifty-three patients (71 knees) with primary varus knee osteoarthritis and who underwent total knee arthroplasty were selected for this study. There were 6 men and 47 women, with 40 right knees and 31 left knees studied; their mean age at operation was 73.5 years. The ligament, meniscus, degeneration of joint cartilage, and radiographic alignments were examined visually. RESULTS The tibial plateau-tibial shaft angle was larger if the condition of the cartilage in the lateral femoral condyle was worse. The femorotibial angle and tibial plateau-tibial shaft angle were larger if the conditions of the lateral meniscus or the cartilage in the lateral tibial plateau were worse. CONCLUSION Based on the results of this study, progression of varus knee osteoarthritis may occur in the following manner: medial knee osteoarthritis starts in the central portion of the medial tibial plateau, and accompanied by medial meniscal extrusion and anterior cruciate ligament rupture, cartilage degeneration expands from the anterior to the posterior in the medial tibial plateau. Bone attrition occurs in the medial tibial plateau, and the femoro-tibial angle and tibial plateau-tibial shaft angle increase. Therefore, the lateral intercondylar eminence injures the cartilage of the lateral femoral condyle in the longitudinal fissure type. Thereafter, the cartilage degeneration expands in the whole of the knee joints.
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Affiliation(s)
- Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiromitsu Yabumoto
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eri Tarumi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan,Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
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Factors affecting intraoperative kinematic patterns and flexion angles in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:1741-7. [PMID: 25763851 DOI: 10.1007/s00167-015-3572-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the factors affecting intraoperative kinematics, as measured with a navigation system, and their effect on maximum flexion angles during total knee arthroplasty (TKA). METHOD One hundred posterior stabilised (PS) TKAs performed using an image-free navigation system were evaluated. Tibial internal rotation angles at maximum extension, 30°, 45°, 60°, 90°, and maximum flexion were collected at registration and after implantation. The varus angles from the coronal mechanical axis were also collected. The rotational patterns were divided into four groups to investigate whether flexion contracture and varus deformity affected the kinematic patterns, and correlated with the maximum pre- and post-operative flexion angles. RESULTS At registration, the flexion angles at maximum extension differed significantly between the kinematic groups; the flexion angle at maximum extension at registration was negatively correlated with the pre-operative maximum flexion angle (R(2) = 0.226, p < 0.0001) and the post-operative maximum flexion angle (R(2) = 0.059, p = 0.0167). Varus deformity at registration also differed significantly between the kinematic groups; varus deformity at registration was negatively correlated with the pre-operative maximum flexion angle (R(2) = 0.087, p = 0.0036) and post-operative maximum flexion angle (R(2) = 0.101, p = 0.0027). CONCLUSION Navigation-based measurements in patients undergoing PS TKA indicated that pre-operative flexion contracture and varus deformity are negatively correlated with both pre- and post-operative maximum flexion angles. The results may improve the ease with which surgeons can interpret intraoperative kinematics, by providing a multi-dimensional perspective. With further knowledge regarding intraoperative kinematics, it might be possible to improve surgical approach, prosthesis design, and clinical outcomes. LEVEL OF EVIDENCE II.
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23
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Iijima H, Aoyama T, Ito A, Tajino J, Nagai M, Zhang X, Yamaguchi S, Akiyama H, Kuroki H. Immature articular cartilage and subchondral bone covered by menisci are potentially susceptive to mechanical load. BMC Musculoskelet Disord 2014; 15:101. [PMID: 24669849 PMCID: PMC3973825 DOI: 10.1186/1471-2474-15-101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/20/2014] [Indexed: 11/30/2022] Open
Abstract
Background The differences of mechanical and histological properties between cartilage covered by menisci and uncovered by menisci may contribute to the osteoarthritis after meniscectomy and these differences are not fully understood. The purpose of this study is to investigate potential differences in the mechanical and histological properties, and in particular the collagen architecture, of the superficial cartilage layer and subchondral bone between regions covered and uncovered by menisci using immature knee. Methods Osteochondral plugs were obtained from porcine tibial cartilage that was either covered or uncovered by menisci. Investigation of the thickness, mechanical properties, histology, and water content of the cartilage as well as micro-computed tomography analysis of the subchondral bone was performed to compare these regions. Collagen architecture was also assessed by using scanning electron microscopy. Results Compared to the cartilage uncovered by menisci, that covered by menisci was thinner and showed a higher deformity to compression loading and higher water content. In the superficial layer of cartilage in the uncovered regions, collagen fibers showed high density, whereas they showed low density in covered regions. Furthermore, subchondral bone architecture varied between the 2 regions, and showed low bone density in covered regions. Conclusions Cartilage covered by menisci differed from that uncovered in both its mechanical and histological properties, especially with regards to the density of the superficial collagen layer. These regional differences may be related to local mechanical environment in normal condition and indicate that cartilage covered by menisci is tightly guarded by menisci from extreme mechanical loading. Our results indicate that immature cartilage degeneration and subchondral microfracture may occur easily to extreme direct mechanical loading in covered region after meniscectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Fiacchi F, Zambianchi F, Digennaro V, Ricchiuto I, Mugnai R, Catani F. In vivo kinematics of medial unicompartmental osteoarthritic knees during activities of daily living. Knee 2014; 21 Suppl 1:S10-4. [PMID: 25382361 DOI: 10.1016/s0968-0160(14)50003-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 02/02/2023]
Abstract
Few studies exist describing unicompartmental osteoarthritic knee kinematics. Moreover, the role of the anterior cruciate ligament (ACL) in the determination of knee kinematics has not been fully described. The objective of the current study was to analyze the in vivo kinematics of knees with medial osteoarthritis (OA) and intact ACL during closed and open chained motion. Eight patients scheduled for UKA diagnosed with primary medial OA underwent knee CT-scans and video-fluoroscopy. Fluoroscopic analysis included stair climbing, chair rising and leg extension. Three-dimensional bone positions were obtained from each image by iterative procedures using a CAD-model-based shape-matching technique. Patterns of axial rotation and anterior-posterior (AP) motion of the medial and lateral femoral condyle were obtained with specific software. The femur reported an overall external rotation relative to the tibia from extension to flexion in all tasks. Average AP translation of the medial femoral condyle were smaller in open-chained tasks than in weight-bearing conditions. Average AP motion of the lateral femoral condyle reported an overall posterior translation with knee flexion. The absent natural "screw-home" mechanism and the lack of medial condyle posterior translation was explained by bone-cartilage defects and meniscal degeneration. Relevant findings were the kinematic pattern differences between weight-bearing and open chained activities, suggesting that in biphasic muscle contraction and unloaded conditions, the function of the cruciate ligaments was not physiological. The kinematics of knees with medial OA and intact ACL differed from healthy knees.
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Affiliation(s)
- Francesco Fiacchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy.
| | - Vitantonio Digennaro
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Ippazio Ricchiuto
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Raffaele Mugnai
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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25
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Rout R, McDonnell S, Hulley P, Jayadev C, Khan T, Carr A, Murray D, Gill H, Price A. The pattern of cartilage damage in antero-medial osteoarthritis of the knee and its relationship to the anterior cruciate ligament. J Orthop Res 2013; 31:908-13. [PMID: 23423802 DOI: 10.1002/jor.22253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
Within antero-medial gonarthrosis (AMG) of the knee, there is a spectrum of damage seen in the functionally intact anterior cruciate ligament (ACL). Our aim was to correlate the degree of ACL damage to the geographical extent and degree of cartilage loss on the tibial plateau. Ninety tibial plateaus resected during unicompartmental arthroplasty were photographed and digitally mapped. The ACL damage was graded (0: normal, 1: synovium loss, 2: longitudinal splits), and dimensions of full thickness cartilage loss and damage recorded. The percentage of full thickness loss in patients with a normal ACL was compared to those with a damaged, but functionally intact ligament. All specimens showed similar elliptical loss of cartilage in the antero-medial part of the tibial plateau. A total of 45(50%) patients had a macroscopically normal ACL, 21(23%) had synovial loss, and 24(27%) had longitudinal splits. An increase in the area of cartilage damage was seen with progressive ACL damage (p < 0.001). The area of macroscopically normal cartilage found posteriorly did not change. This study demonstrates that phenotypic distribution of cartilage damage in AMG is highly reproducible with a pattern of increasing cartilage erosion associated with increasing ACL damage.
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Affiliation(s)
- Raj Rout
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
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26
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Raju PK, Kini SG, Verma A. Wear patterns of tibiofemoral articulation in osteoarthritic knees: analysis and review of literature. Arch Orthop Trauma Surg 2012; 132:1267-71. [PMID: 22622796 DOI: 10.1007/s00402-012-1547-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Osteoarthritis is a degenerative joint disease characterized by progressive erosion of the articular cartilage. The sites of erosion of articular cartilage have been reported, but no explanation for this particular pattern has previously been suggested. AIMS To analyze the gross features of lesions, together with their frequency of occurrence and situation, and wear relationship with individual body profile. MATERIALS AND METHODS Data collected from the dissection of 102 cadavers at a tertiary hospital. RESULTS Wear patterns on the tibial surface show that the areas involved in the majority of cases include middle medial and middle lateral regions of the tibial plateau. There also seemed to be a strong correlation between age, body mass index and the wear pattern. The incidence of posteromedial erosions on the tibial plateau was mainly seen in the ACL-deficient knee. Also, incidence of lateral meniscus tears was found to be higher in the ACL-deficient knees. CONCLUSION In osteoarthritis of the knee joint, the middle third of both the femoral and tibial articular surfaces is most commonly involved in wears, followed by anteromedial and posterolateral compartments both for tibial and femoral surfaces. The wear patterns in the ACL-deficient knee changes due to altered loading characteristics.
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Affiliation(s)
- P K Raju
- Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, India
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27
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Weston-Simons JS, Pandit H, Jenkins C, Jackson WFM, Price AJ, Gill HS, Dodd CAF, Murray DW. Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction. ACTA ACUST UNITED AC 2012; 94:1216-20. [DOI: 10.1302/0301-620x.94b9.28881] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Oxford unicompartmental knee replacement (UKR) is an established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis (MCOA), which works well in the young and active patient. However, previous studies have shown that it is reliable only in the presence of a functionally intact anterior cruciate ligament (ACL). This review reports the outcomes, at a mean of five years and a maximum of ten years, of 52 consecutive patients with a mean age of 51 years (36 to 57) who underwent staged or simultaneous ACL reconstruction and Oxford UKR. At the last follow-up (with one patient lost to follow-up), the mean Oxford knee score was 41 (sd 6.3; 17 to 48). Two patients required conversion to TKR: one for progression of lateral compartment osteoarthritis and one for infection. Implant survival at five years was 93% (95% CI 83 to 100). All but one patient reported being satisfied with the procedure. The outcome was not significantly influenced by age, gender, femoral or tibial tunnel placement, or whether the procedure was undertaken at one- or two-stages. In summary, ACL reconstruction and Oxford UKR gives good results in patients with end-stage MCOA secondary to ACL deficiency.
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Affiliation(s)
- J. S. Weston-Simons
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - H. Pandit
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - C. Jenkins
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - W. F. M. Jackson
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - A. J. Price
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - H. S. Gill
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
| | - C. A. F. Dodd
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - D. W. Murray
- Botnar Research Centre, Nuffield Department
of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University
of Oxford, Windmill Road, Oxford
OX3 7LD, UK
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Nicholson JA, Sutherland AG, Smith FW, Kawasaki T. Upright MRI in kinematic assessment of the ACL-deficient knee. Knee 2012; 19:41-8. [PMID: 21163659 DOI: 10.1016/j.knee.2010.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/17/2010] [Accepted: 11/19/2010] [Indexed: 02/02/2023]
Abstract
The ability to quantify in vivo femoro-tibial relations in the knee holds great advantage to further patient care. There is little consensus on the optimal weight-bearing environment and measurement method for MRI assessment of in vivo knee kinematics. This study set out to establish the optimal method of measuring femoro-tibial relations in an upright, weight-bearing environment in normal individuals and those with ACL deficiency. Upright, load bearing, MRI scans of both knees were evaluated by two methods, flexion facet centre (FFC) and femoro-tibial contact point (FTCP), in order to establish femoro-tibial relations in the sagittal plane throughout different angles of knee flexion. A group of healthy volunteers (n=5) and a group with unilateral ACL insufficiency (n=8) were studied. Abnormal femoro-tibial relations were found in all ACL-deficient knees (n=8): the lateral tibial plateau was anteriorly displaced in extension and early flexion and, coupled with smaller changes in the medical compartment, this constitutes internal rotation of the tibia relative to the femur in early flexion. This study found that the FFC measurement technique holds an advantage over the FTCP technique in terms of validity, repeatability and ease of measurements, allowing detection of kinematic changes such as tibial internal rotation in early flexion in ACL-deficient knees in an upright weight-bearing model. We propose that FFC measurement in an upright, weight-bearing position is a reliable and representative tool for the assessment of femoro-tibial movement.
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Retrospective analysis of total knee arthroplasty cases for visual, histological, and clinical eligibility of unicompartmental knee arthroplasties. J Arthroplasty 2011; 26:1396-403. [PMID: 21353454 DOI: 10.1016/j.arth.2010.12.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 12/17/2010] [Indexed: 02/01/2023] Open
Abstract
We retrospectively analyzed 97 total knee arthroplasty cases with medial osteoarthritis from seven participating surgeons in our teaching hospital to determine the percentage of patients who met the following eligibility criteria for unicompartmental knee arthroplasty (UKA): healthy cartilage in the lateral compartment based on (1) visual analysis, (2) histological analysis and (3) absence of UKA contraindications based on clinical analysis. The cases with healthy lateral cartilage, intact anterior cruciate ligament and posterior cruciate ligament, lack of patello-femoral arthritis, preoperative range of motion (ROM) greater than 90, and genu varum less than 10° represented 21% of the 97 cases studied. This percentage would likely have been higher had the cases been assessed earlier in the disease process. It was concluded that there is the potential to utilize UKA more frequently in the future.
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Nicholson JA, Sutherland AG, Smith FW. Single bundle anterior cruciate reconstruction does not restore normal knee kinematics at six months. ACTA ACUST UNITED AC 2011; 93:1334-40. [DOI: 10.1302/0301-620x.93b10.26481] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abnormal knee kinematics following reconstruction of the anterior cruciate ligament may exist despite an apparent resolution of tibial laxity and functional benefit. We performed upright, weight-bearing MR scans of both knees in the sagittal plane at different angles of flexion to determine the kinematics of the knee following unilateral reconstruction (n = 12). The uninjured knee acted as a control. Scans were performed pre-operatively and at three and six months post-operatively. Anteroposterior tibial laxity was determined using an arthrometer and patient function by validated questionnaires before and after reconstruction. In all the knees with deficient anterior cruciate ligaments, the tibial plateau was displaced anteriorly and internally rotated relative to the femur when compared with the control contralateral knee, particularly in extension and early flexion (mean lateral compartment displacement: extension 7.9 mm (sd 4.8), p = 0.002 and 30° flexion 5.1 mm (sd 3.6), p = 0.004). In all ten patients underwent post-operative scans. Reconstruction reduced the subluxation of the lateral tibial plateau at three months, with resolution of anterior displacement in early flexion, but not in extension (p = 0.015). At six months, the reconstructed knee again showed anterior subluxation in both the lateral (mean: extension 4.2 mm (sd 4.2), p = 0.021 and 30° flexion 3.2 mm (sd 3.3), p = 0.024) and medial compartments (extension, p = 0.049). Our results show that despite improvement in laxity and functional benefit, abnormal knee kinematics remain at six months and actually deteriorate from three to six months following reconstruction of the anterior cruciate ligament.
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Affiliation(s)
- J. A. Nicholson
- University of Aberdeen, Department
of Orthopaedics, Polwarth Building, Foresterhill, Aberdeen
AB25 2ZD, UK
| | - A. G. Sutherland
- University of Aberdeen, Department
of Orthopaedics, Polwarth Building, Foresterhill, Aberdeen
AB25 2ZD, UK
| | - F. W. Smith
- University of Aberdeen, Department
of Radiology, Foresterhill, Aberdeen
AB25 2ZD, UK
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31
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Shimizu N, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K. The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty 2011; 26:1031-7. [PMID: 21435829 DOI: 10.1016/j.arth.2011.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 01/23/2011] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to investigate the effects of weight-bearing (WB) condition on the kinematics of total knee arthroplasty. We investigated 17 patients (20 knees) implanted with a high-flexion posterior-stabilized total knee arthroplasty using 2- to 3-dimensional registration techniques. In vivo kinematics of dynamic deep knee flexion under WB and non-WB (NWB) conditions were compared. Six degree-of-freedom kinematics and articular contacts including post-cam contact were evaluated. At midflexion, femorotibial contact points were located significantly more anteriorly under NWB than WB conditions. As a result, post-cam engagement occurred significantly earlier under NWB than WB conditions. With NWB conditions, early engagement of the femoral cam engages at the top part of tibial post, which puts it at risk of jumping the tibial post particularly if there is instability in midflexion.
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Affiliation(s)
- Norimasa Shimizu
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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32
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33
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Bennell KL, Creaby MW, Wrigley TV, Hunter DJ. Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology. ACTA ACUST UNITED AC 2010; 58:2776-85. [PMID: 18759296 DOI: 10.1002/art.23795] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is an organ-level failure of the joint involving pathologic changes in articular cartilage and bone. This cross-sectional study compared apparent volumetric bone mineral density (vBMD) of proximal tibial subchondral trabecular bone in people with and without knee OA, using peripheral quantitative computed tomography (pQCT). METHODS Seventy-five individuals with mild or moderate medial compartment knee OA and 41 asymptomatic controls were recruited. Peripheral QCT was used to measure vBMD of trabecular bone beneath medial and lateral tibiofemoral compartments at levels of 2% and 4% of tibial length, distal to the tibial plateau. RESULTS There was no significant difference in vBMD beneath the overall medial and lateral compartments between the 3 groups. However, in the affected medial compartment of those with moderate OA, lower vBMD was seen in the 2 posterior subregions compared with controls and those with mild knee OA, while higher vBMD was seen in the anteromedial subregion. Beneath the unaffected or lesser affected lateral compartment, significantly lower vBMD was seen at the 2% level in the anterior and lateral subregions of those with moderate disease. Volumetric BMD ratios showed relatively higher vBMD in the medial compartment compared with the lateral compartment, but these ratios were not influenced by disease status. CONCLUSION Subregional vBMD changes were evident beneath the medial and lateral compartments of those with moderate medial knee OA. Of import, the posterior subchondral trabecular regions of the medial tibial plateau have markedly lower vBMD.
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Affiliation(s)
- Kim L Bennell
- The University of Melbourne, Melbourne, Victoria, Australia.
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Hamai S, Moro-oka TA, Miura H, Shimoto T, Higaki H, Fregly BJ, Iwamoto Y, Banks SA. Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities. J Orthop Res 2009; 27:1555-61. [PMID: 19504589 DOI: 10.1002/jor.20928] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Dynamic knee kinematics were analyzed for medial osteoarthritic (OA) knees in three activities, including two types of maximum knee flexion. Continuous x-ray images of kneeling, squatting, and stair climbing motions were taken using a large flat panel detector. CT-derived bone models were used for the model registration-based 3D kinematic measurements. Three-dimensional joint kinematics and contact locations were determined using two methods: bone-fixed coordinate systems and by interrogation of CT-based bone model surfaces. The femur exhibited gradual external rotation with knee flexion for kneeling and squatting activities, and gradual internal rotation with knee extension for stair climbing. From 100 degrees to 120 degrees flexion, contact locations showed a medial pivot pattern similar to normal knees. However, knees with medial OA displayed a femoral internal rotation bias and less posterior translation when compared with normal knees. A classic screw-home movement was not observed in OA knees near extension. Decreased variability with both activities and methods of calculation were demonstrated for all three activities. In conclusion, the weight-bearing kinematics of patients with medial OA differs from normal knees. Pathological changes of the articulating surfaces and the ligaments correspond to observed abnormalities in knee kinematics.
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Affiliation(s)
- Satoshi Hamai
- Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, Mail Stop 116250, Gainesville, Florida 32611-6250, USA
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35
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Mascaro B, Prior J, Shark LK, Selfe J, Cole P, Goodacre J. Exploratory study of a non-invasive method based on acoustic emission for assessing the dynamic integrity of knee joints. Med Eng Phys 2009; 31:1013-22. [DOI: 10.1016/j.medengphy.2009.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 05/12/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
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Casino D, Zaffagnini S, Martelli S, Lopomo N, Bignozzi S, Iacono F, Russo A, Marcacci M. Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system. Knee Surg Sports Traumatol Arthrosc 2009; 17:369-73. [PMID: 19099289 DOI: 10.1007/s00167-008-0699-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
Interest in the kinematics of reconstructed knees has increased since it was shown that the alteration of knee motion could lead to abnormal wear and damage to soft tissues. We performed intraoperative kinematic measurements using a navigation system to study knee kinematics before and after posterior substituting rotating platform total knee arthroplasty (TKA). We verified intraoperatively (1) if varus/valgus (VV) laxity and anterior/posterior (AP) laxity were restored after TKA; (2) if TKA induced abnormal femoral rollback; and (3) how tibial axial rotation was influenced by TKA throughout the range of flexion. We found that TKA improved alignment in preoperative osteoarthritic varus knees which became neutral after surgery and maintained a neutral alignment in neutral knees. The VV stability at 0 degrees was restored while AP laxity at 90 degrees significantly increased after TKA. Following TKA, the femur had an abnormal anterior translation up to 60 degrees of flexion, followed by a small rollback of 12 +/- 5 mm. TKA influenced the tibia rotation pattern during flexion, but not the total amount of internal/external rotation throughout whole range of flexion, which was preserved after TKA (6 degrees +/- 5 degrees ). This study showed that the protocol proposed might be useful to adjust knee stability at time zero and that knee kinematic outcome during total knee replacement can be monitored by a navigation system.
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Affiliation(s)
- Daniela Casino
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136 Bologna, Italy.
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Hodge WA, Harman MK, Banks SA. Patterns of knee osteoarthritis in Arabian and American knees. J Arthroplasty 2009; 24:448-53. [PMID: 18534414 DOI: 10.1016/j.arth.2007.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 12/17/2007] [Indexed: 02/01/2023] Open
Abstract
This study illustrates differences in the cartilage degeneration in osteoarthritic knees in patients with more frequent hyperflexion activities of daily living compared with Western patients. Proximal tibial articular cartilage wear and cruciate ligament condition were assessed in Saudi Arabian and North American patients with varus osteoarthritis undergoing total knee arthroplasty. In anterior cruciate ligament (ACL) intact knees, there were significant differences in wear location, with a clearly more anterior pattern in Saudi Arabian knees. Complete ACL deficiency occurred in 25% of North American knees but only 14% of Saudi Arabian knees. These ACL-deficient knees showed the most severe cartilage wear in both groups and posterior medial wear patterns. Biomechanical descriptions of knee flexion and axial rotation during kneeling or squatting are consistent with the more pronounced anteromedial and posterolateral cartilage wear patterns observed on the Saudi Arabian knees. These observations provide insight into altered knee mechanics in 2 culturally different populations with different demands on knee flexion.
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Affiliation(s)
- W Andrew Hodge
- Institute for Mobility and Longevity, West Palm Beach, Florida 33480-0248, USA
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38
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Cove R. Re: Tibial articular cartilage wear in varus osteoarthritic knees: correlation with cruciate ligament integrity and severe deformity (Mullaji et al.). J Arthroplasty 2009; 24:487. [PMID: 19304062 DOI: 10.1016/j.arth.2008.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 09/03/2008] [Indexed: 02/01/2023] Open
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Casino D, Martelli S, Zaffagnini S, Lopomo N, Iacono F, Bignozzi S, Visani A, Marcacci M. Knee stability before and after total and unicondylar knee replacement: in vivo kinematic evaluation utilizing navigation. J Orthop Res 2009; 27:202-7. [PMID: 18752279 DOI: 10.1002/jor.20746] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Surgical navigation systems are currently used to guide the surgeon in the correct alignment of the implant. The aim of this study was to expand the use of navigation systems by proposing a surgical protocol for intraoperative kinematics evaluations during knee arthroplasty. The protocol was evaluated on 20 patients, half undergoing unicondylar knee arthroplasty (UKA) and half undergoing posterior-substituting, rotating-platform total knee arthroplasty (TKA). The protocol includes a simple acquisition procedure and an original elaboration methodology. Kinematic tests were performed before and after surgery and included varus/valgus stress at 0 and 30 degrees and passive range of motion. Both UKA and TKA improved varus/valgus stability in extension and preserved the total magnitude of screw-home motion during flexion. Moreover, compared to preoperative conditions, values assumed by tibial axial rotation during flexion in TKA knees were more similar to the rotating patterns of UKA knees. The analysis of the anteroposterior displacement of the knee compartments confirmed that the two prostheses did not produce medial pivoting, but achieved a postoperative normal behavior. These results demonstrated that proposed intraoperative kinematics evaluations by a navigation system provided new information on the functional outcome of the reconstruction useful to restore knee kinematics during surgery.
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Affiliation(s)
- Daniela Casino
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Lankester BJA, Cottam HL, Pinskerova V, Eldridge JDJ, Freeman MAR. Variation in the anatomy of the tibial plateau: a possible factor in the development of anteromedial osteoarthritis of the knee. ACTA ACUST UNITED AC 2008; 90:330-3. [PMID: 18310755 DOI: 10.1302/0301-620x.90b3.19898] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
From a search of MRI reports on knees, 20 patients were identified with evidence of early anteromedial osteoarthritis without any erosion of bone and a control group of patients had an acute rupture of the anterior cruciate ligament. The angle formed between the extension and flexion facets of the tibia, which is known as the extension facet angle, was measured on a sagittal image at the middle of the medial femoral condyle. The mean extension facet angle in the control group was 14 degrees (3 degrees to 25 degrees ) and was unrelated to age (Spearman's rank coefficient, p = 0.30, r = 0.13). The mean extension facet angle in individuals with MRI evidence of early anteromedial osteoarthritis was 19 degrees (13 degrees to 26 degrees , SD 4 degrees ). This difference was significant (Mann-Whitney U test, p < 0.001). A wide variation in the extension facet angle was found in the normal control knees and an association between an increased extension facet angle and MRI evidence of early anteromedial osteoarthritis. Although a causal link has not been demonstrated, we postulate that a steeper extension facet angle might increase the duration of loading on the extension facet during the stance phase of gait, and that this might initiate failure of the articular cartilage.
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Affiliation(s)
- B J A Lankester
- Yeovil District Hospital, Higher Kingston, Yeovil BA21 4AT, UK.
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