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Zhang J, Lai S, Li J, Zhang C, Yao L, Zhang Y, Chen K, Cai W, Li J, Li Q. Early Postoperative Rapid Rehabilitation Yields More Favorable Short-term Outcomes in Patients Undergoing Patellar Realignment Surgery for Recurrent Patellar Dislocation: A Prospective Randomized Controlled Study. Am J Sports Med 2024:3635465241254524. [PMID: 38884318 DOI: 10.1177/03635465241254524] [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] [Indexed: 06/18/2024]
Abstract
BACKGROUND Use of a rapid rehabilitation protocol for postoperative recovery after recurrent patellar dislocation (RPD) has gradually gained attention; nonetheless, evidence of its safety and effectiveness is lacking. PURPOSE To compare the short-term postoperative outcomes of early rapid rehabilitation with those of conservative rehabilitation in patients with RPD. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 50 patients with RPD who underwent tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction were enrolled between January 2018 and February 2019. Postoperatively, the patients were randomly assigned to either the early rapid group (rapid group; n = 25 patients) or the conservative group (control group; n = 25 patients) for rehabilitation training. The rapid group underwent faster progression in weightbearing and range of motion (ROM) training. Knee joint functional scores, ROM, bilateral thigh circumference differences, and imaging data were recorded preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively for comparison. Postoperative complications were recorded over the 24-month follow-up period. RESULTS The baseline data did not significantly differ between the 2 groups. Postoperatively, compared with the control group, the rapid group had higher Tegner scores at 6 weeks and 3 months; higher Lysholm scores at 3 and 6 months; higher International Knee Documentation Committee scores at 6 weeks, 3 months, and 12 months; better ROM; and smaller bilateral thigh circumference differences at 24 months (P < .05 for all). However, no differences were observed in the Tegner, Lysholm, and International Knee Documentation Committee scores at 24 months postoperatively. At the 6-week and subsequent follow-up visits, the Caton and Insall indices were lower in the control group than in the rapid group (P < .01 for all). Moreover, compared with the control group, the rapid group had a lower incidence of patella baja at 24 months (0% vs 17%) and fewer complications during the whole follow-up period (P < .01). CONCLUSION Early rapid postoperative rehabilitation appears to be safe and effective for patients who undergo tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction to treat RPD. In the short term, this approach was shown to be more advantageous than conservative rehabilitation in improving functional scores, allowing an earlier return to daily activities, although the lack of difference at 24 months implies no long-term benefits. In addition, it potentially helped to prevent the occurrence of complications, including patella baja. REGISTRATION ChiCTR1800014648 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jiayao Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Sike Lai
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Junqiao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenghao Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuyan Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kunhao Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wufeng Cai
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qi Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
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Ragab A, Gwyn R, Davies A. Effect of preservation of Hoffa's fat pad on patellar height in primary total knee arthroplasty procedures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2015-2019. [PMID: 38514577 DOI: 10.1007/s00590-024-03880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND We have previously reported our experience of the effect of complete excision of Hoffa's fat pad on patella height post TKR. In this study, we compared the change of patellar height post TKR before and after the senior author changed his practice to preserving Hoffa's fat pad. METHODS This was a retrospective analysis of a prospective series of TKRs performed or directly supervised by the senior author. In Group 1 were 72 patients performed before April 2011 who had complete excision of Hoffa's fat pad to maximise exposure during the procedure. In Group 2 were 138 patients performed after April 2011 who had the minimum excision of Hoffa's fat pad to allow adequate surgical exposure. The surgical technique and rehabilitation protocol were identical in all other respects. Patellar height was assessed using the Caton-Deschamps Index both immediately postoperative and at a minimum follow up of 1 year. RESULTS Group 1 included 28 males, 44 females with mean age 68.36 years. The mean CDI in this group changed from 0.54 immediately post-operatively to 0.46 at minimum one year follow-up (P = 0.001) indicating progressive patella baja. Group 2 included 56 males, 82 females with mean age 65 years. The mean CDI changed from 0.67 immediately post-operative to 0.68 at minimum one year post follow-up (P = 0.32) indicating no statistically or clinically relevant post-operative change in patellar height. CONCLUSION Total excision of Hoffa's fat pad is associated with progressive post-operative patella baja. This can be avoided by resecting the minimum amount of fat pad to allow adequate exposure during the procedure.
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Affiliation(s)
- Abdelaleem Ragab
- Health Education and Improvement Wales, Tu Dysgu, Cefn Coed, Nantgarw, CF15 7QQ, UK.
- Trauma and Orthopaedics Department, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, NP20 2UB, UK.
| | - Rhodri Gwyn
- Morriston Hospital, Swansea Bay University Health Board, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea, SA6 6NL, UK
| | - Andrew Davies
- Morriston Hospital, Swansea Bay University Health Board, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea, SA6 6NL, UK
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Sonnery-Cottet B, Ripoll T, Cavaignac E. Prevention of knee stiffness following ligament reconstruction: Understanding the role of Arthrogenic Muscle Inhibition (AMI). Orthop Traumatol Surg Res 2024; 110:103784. [PMID: 38056774 DOI: 10.1016/j.otsr.2023.103784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/06/2023] [Indexed: 12/08/2023]
Abstract
The knee is a joint that is often injured in sport, with a large and increasing number of ligament tears and repairs; postoperative complications can lead to poor outcome, such as stiffness. Beyond the well-known and well-described intra- and extra-articular causes of postoperative stiffness, the present study introduces the concept of a central reflex motor inhibition mechanism called arthrogenic muscle inhibition (AMI). AMI occurs after trauma and can be defined as active knee extension deficit due to central impairment of Vastus Medialis Obliquus (VMO) contraction, often associated with spinal reflex hamstring contracture. This explains the post-traumatic flexion contracture that is so common after knee sprain. The clinical presentation of AMI is easy to detect in consultation, in 4 grades from simple VMO inhibition to fixed flexion contracture by posterior capsule retraction in chronic cases. After recent anterior cruciate ligament (ACL) tear, more than 55% of patients show AMI, reducible in 80% of cases by simple targeted exercises initiated in consultation. Practically, in patients who have sustained knee sprain, it is essential to screen for this reflex mechanism and assess reducibility, as AMI greatly aggravates the risk of postoperative stiffness. In case of hemarthrosis, we recommend joint aspiration, which provides immediate benefit in terms of pain and motor inhibition. In case of persistent AMI, classical electrostimulation and "cushion crush", as used by all physiotherapists, are ineffective. To reduce the risk of postoperative stiffness, no surgery should be considered until AMI has resolved. LEVEL OF EVIDENCE: expert opinion.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Groupe Ramsay-Santé, centre orthopédique Santy, FIFA Medical Center of Excellence, hôpital privé Jean-Mermoz, Lyon, France.
| | - Thomas Ripoll
- Service de chirurgie orthopédique, CHU de Toulouse, hôpital Pierre-Paul-Riquet, rue Jean-Dausset, Toulouse, France
| | - Etienne Cavaignac
- Service de chirurgie orthopédique, CHU de Toulouse, hôpital Pierre-Paul-Riquet, rue Jean-Dausset, Toulouse, France
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Madan Mohan SN, Rajendiran S, Rajappa S. Management of Patients With Post-Traumatic Wrist Flexor Contracture by Carpectomy and Wrist Fusion. Cureus 2023; 15:e48812. [PMID: 38106722 PMCID: PMC10721435 DOI: 10.7759/cureus.48812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Post-traumatic wrist flexor contracture is most commonly seen in major trauma affecting the hand, wrist, and forearm. It produces debilitating complications affecting the quality of life, often requiring multiple staged surgeries, and prolonged rehabilitation with physiotherapy to yield functional improvement. Wrist flexion contracture correction is the first surgery performed to reduce the deformity and improve the functional status of the hand. Releasing the wrist flexion contracture due to stretch on the contracted structures could cause a vascular compromise of the hand and skin deficit, which needs flap cover. On the other hand, removing the carpal bones reduces the length of the extremity and makes the existing skin adequate, with the wrist in the neutral position. This procedure avoids the need for a flap and avoids the stretch of blood vessels in bringing the wrist to the neutral position. A retrospective study was performed on three patients who presented to our institution, i.e., Sri Ramachandra Institute of Higher Education and Research, Chennai, India, and underwent carpectomy and wrist fusion for correction of post-traumatic wrist flexor contracture between December 2019 and July 2021, with follow-up extending to a maximum of 18 months. The three patients underwent prior surgeries at different hospitals following injury and later presented at our institution for further management and subsequently underwent surgeries and extensive rehabilitation to improve wrist and hand function. The patients underwent a staged procedure for correction of wrist contracture by soft tissue release and carpectomy, followed by wrist arthrodesis. Postoperatively, none of the patients had neurovascular complications or complications related to wound healing. Hence, carpectomy and wrist fusion are safe procedures to correct the wrist flexion contracture without complication and motivate the patient to undergo further surgeries to improve hand function.
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Affiliation(s)
| | - Subashini Rajendiran
- Department of Hand Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Srinivasan Rajappa
- Department of Hand Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Dauty M, Menu P, Grondin J, Crenn V, Daley P, Fouasson-Chailloux A. Arthrofibrosis risk factors after anterior cruciate ligament reconstruction. Front Sports Act Living 2023; 5:1264150. [PMID: 37901391 PMCID: PMC10603237 DOI: 10.3389/fspor.2023.1264150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Knee arthrofibrosis is a disabling complication after anterior cruciate ligament reconstruction (ACLr). Different risk factors have been studied but are still controversial because of a diagnosis made only during reoperations for the treatment of the stiffness, which underestimates the occurrence rate. We aimed to confirm risk factors of arthrofibrosis after ACLr in case of clinically made diagnoses. Methods Ninety-two athletes with clinically diagnosed arthrofibrosis, complicating a primary ACLr, were compared to 482 athletes with ACLr without any complications. Usually considered risk factors were studied: age under 18, female, Body Mass Index (BMI ≥ 25), high sport level, time from ACL injury to ACLr < 1 month, Bone-Patella-Tendon-Bone surgical procedure (BPTB), meniscal repair, and intensive rehabilitation. Binary logistic regression was carried out to confirm or refute these risk factors. Results Female, time from ACL injury to ACLr < 1 month, BPTB procedure, meniscal repair, and BMI ≥ 25 were not confirmed as risk factors. Previous competitive sport level assessed by Tegner score was the only risk factor identified, OR: 3.56 (95%IC: 2.20-5.75; p = 0.0001). Age < 18, OR: 0.40 (95%IC: 0.19-0.84; p = 0.015) and inpatient rehabilitation program, OR: 0.28 (95%IC: 0.17-0.47; p = 0.0001), were protective factors. Discussion Competitive athletes are at risk of arthrofibrosis after ACLr and should benefit from protective inpatient rehabilitation program.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
| | - Jérôme Grondin
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Vincent Crenn
- Clinique Chirugicale Othopédique et Traumatologique, CHU Nantes, Nantes Université, Nantes, France
| | - Pauline Daley
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, Nantes, France
- Institut Régional de Médecine du Sport (IRMS), Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France
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Okita Y, Miura R, Morimoto M, Sadamatsu T, Kawahara T, Gamada K. Three-dimensional volume and shape of the infrapatellar fat pad during quasi-static knee extension from 30° to 0°: comparisons of patients with osteoarthritic knees and young, healthy individuals. J Phys Ther Sci 2023; 35:507-514. [PMID: 37405182 PMCID: PMC10315202 DOI: 10.1589/jpts.35.507] [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: 02/23/2023] [Accepted: 04/03/2023] [Indexed: 07/06/2023] Open
Abstract
[Purpose] Previous studies suggest that the infrapatellar-fat-pad is affected by aging or knee osteoarthritis, and that the infrapatellar-fat-pad in knee osteoarthritis cases may be associated with limited mobility during knee movement. This study aimed to determine changes in the shape and volume of the infrapatellar-fat-pad between 30° and 0° of knee extension in knee osteoarthritis cases and in young, healthy individuals, and to characterize differences in patellar mobility, patellar tendon mobility, and length between the groups. [Participants and Methods] We created 3D models of the infrapatellar-fat-pad, the patellar tendon, and bones using sagittal MRI with the knee at 30° and 0°. The following four parameters were determined: (1) movement of the infrapatellar-fat-pad; (2) infrapatellar-fat-pad volume; (3) angle and surface length of the patellar tendon; and (4) patellar movement. [Results] Compared with the knee osteoarthritis group, the healthy group showed (1) reduced anterior movement of the infrapatellar-fat-pad; (2) smaller volume changes only in the infero-postero-lateral portion; and (3) no changes in the angle of the patellar tendon to the tibial plateau between 30° to 0°. [Conclusion] In conclusion, between 30° and 0°, (1) the infrapatellar-fat-pad in patients with knee osteoarthritis exhibited less anterior movement, and (2) the patellar tendon angle was diminished in patients with knee osteoarthritis compared with those of young-healthy knees.
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Affiliation(s)
- Yuriko Okita
- Sadamatsu Hospital: 537 Higashi-honmachi, Omura, Nagasaki
856-0831, Japan
| | - Ryohei Miura
- Sadamatsu Hospital: 537 Higashi-honmachi, Omura, Nagasaki
856-0831, Japan
| | - Masashi Morimoto
- Sadamatsu Hospital: 537 Higashi-honmachi, Omura, Nagasaki
856-0831, Japan
| | | | - Toshio Kawahara
- Sadamatsu Hospital: 537 Higashi-honmachi, Omura, Nagasaki
856-0831, Japan
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Sacher SE, Neri JP, Gao MA, Argentieri EC, Potter HG, Koch KM, Koff MF. MAVRIC based T2 mapping assessment of infrapatellar fat pad scarring in patients with total knee arthroplasty. J Orthop Res 2023; 41:1299-1309. [PMID: 36262013 PMCID: PMC10113607 DOI: 10.1002/jor.25472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
The infrapatellar fat pad (IPFP) has been implicated as a source of postoperative knee pain. Imaging the IPFP is challenging in patients with total knee arthroplasty (TKA) due to metallic susceptibility artifact. Multi-Acquisition Variable-Resonance Image Combination (MAVRIC)-based T2 Mapping has been developed to mitigate this artifact and can generate quantitative T2 data. Objectives of this study were to (1) measure T2 values of the IPFP in patients with TKAs using a MAVRIC based T2 mapping technique and (2) determine if IPFP T2 values are related to the degree of fat pad scarring or clinical magnetic resonance imaging (MRI) findings. Twenty-eight subjects (10 males, 18 females, Age: 66 + 7.2 years [Mean ± standard deviations]) undergoing clinical MRIs were sequentially recruited. Morphological imaging and quantitative T2 mapping sequences were performed on a clinical 1.5 T scanner. The morphologic images were graded for the presence and severity of fat pad scarring and clinical outcomes. T2 values were calculated in the total fat pad volume, a normal regions of interest (ROI), and an abnormal ROI. T2 values were shortened in the total IPFP volume (p = 0.001) and within abnormal regions (p = 0.003) in subjects with more severe IPFP scarring. The difference between T2 values in normal-abnormal regions was greater in subjects with severe versus no scarring (+1426.1%, p = 0.008). T2 values were elevated in patients with MRI findings of osteolysis (+32.3%, p = 0.02). These findings indicate that MAVRIC-based T2 Mapping may be used as a quantitative biomarker of postoperative IPFP scarring in individuals following TKA.
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Affiliation(s)
- Sara E. Sacher
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | - John P. Neri
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | - Madeleine A. Gao
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | | | - Hollis G. Potter
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
| | | | - Matthew F. Koff
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021
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Isaji Y, Yamada T, Oka T, Mori K, Aoyama N. Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction. J Phys Ther Sci 2023; 35:128-132. [PMID: 36744197 PMCID: PMC9889214 DOI: 10.1589/jpts.35.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/09/2022] [Indexed: 02/04/2023] Open
Abstract
[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.
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Affiliation(s)
- Yuichi Isaji
- Department of Rehabilitation, Anshin Clinic: 4-1-4
Asahi-dori, Chuo-ku, Kobe-shi, Hyogo 651-0095, Japan,Corresponding author. Yuichi Isaji (E-mail: )
| | - Takumi Yamada
- Department of Physical Therapy, Tokyo Metropolitan
University, Japan
| | - Tomohiro Oka
- Department of Physical Therapy, Department of
Rehabilitation Science, Faculty of Health and Welfare, Osaka Health Science University,
Japan
| | - Kazuaki Mori
- Department of Rehabilitation, Anshin Hospital, Japan
| | - Naoki Aoyama
- Department of Orthopedics, Anshin Hospital, Japan
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Fahlbusch H, Krivec L, Müller S, Reiter A, Frosch KH, Krause M. Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04730-9. [PMID: 36520199 PMCID: PMC10374851 DOI: 10.1007/s00402-022-04730-9] [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: 08/21/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study is to systematically review multiligament knee injury (MLKI) outcome studies to determine definitions of arthrofibrosis (AF) and provide information about incidence, management as well as potential risk factors. METHODS A systematic literature search was performed (PubMed and Cochrane library) following the PRISMA guidelines of operatively treated MLKI (Schenck II-IV) studies reporting the incidence of AF. Twenty-five studies met the inclusion criteria. Injury pattern, timing of surgery, surgical technique, treatment of AF, rehabilitation programs and PROMS were inquired. Risk of bias and quality of evidence were assessed using the Coleman methodological score. RESULTS Twenty-five studies with a total of 709 patients with a mean age of 33.6 ± 4.8 years were included and followed 47.2 ± 32.0 months. The majority of studies (22/25) used imprecise and subjective definitions of AF. A total of 86 patients were treated for AF, resulting in an overall prevalence of 12.1% (range 2.8-57.1). Higher-grade injuries (Schenck III-IV), acute treatment and ROM (range of motion) limiting rehabilitation programs were potential risk factors for AF. The time from index surgery to manipulation anesthesia (MUA) and arthroscopic lysis of adhesions (LOA) averaged at 14.3 ± 8.8 and 27.7 ± 12.8 weeks. Prior to MUA and LOA, the ROM was 51.7° ± 23.5 and 80.2° ± 17.0, resulting in a total ROM gain after intervention of 65.0° ± 19.7 and 48.0° ± 10.6, respectively; with no reports of any complication within the follow-up. The overall methodological quality of the studies was poor as measured by the Coleman score with average 56.3 ± 12.5 (range 31-84) points. CONCLUSIONS AF is a common but poorly defined complication particularly in high-grade MLKI. Early postoperative and intensified physiotherapy is important to reduce the risk of AF. MUA and LOA are very effective treatment options and result in good clinical outcome. Prospective studies with bigger study population are needed to optimize treatment algorithms of further patients after MLKI. The protocol of this systematic review has been prospectively registered with PROSPERO (CRD42021229187, January 4th, 2021).
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Affiliation(s)
- Hendrik Fahlbusch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Krivec
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Müller
- Department of Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Alonja Reiter
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Biedert RM. Patellar tendon lengthening and augmentation with quadriceps tendon graft for treatment of severe patella infera. Knee 2022; 39:132-142. [PMID: 36191400 DOI: 10.1016/j.knee.2022.09.003] [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: 04/12/2022] [Revised: 07/29/2022] [Accepted: 09/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patella infera represents a permanent abnormally low position of the patella with three characteristics: distal position of the patella in the femoral trochlea, permanent shortening of the patellar tendon, and decreased distance between the inferior pole of the patella and the articular surface of the tibia. Several surgical techniques have been described to resolve this disabling condition with varying outcomes. HYPOTHESIS Lengthening of the shortened patellar tendon with augmentation using a quadriceps tendon graft in combination with excessive intra-articular release improve knee function in patients presenting with severe and permanent patella infera. METHODS Nine patients (four males, five females) with significant patella infera were treated between 2004 and 2020. The low position of the patella was documented using the Caton-Deschamps index. The Tegner Lysholm knee scoring scale and the Numerical Rating Scale (NRS) for pain were used as outcome measures before surgery and at follow up. Complete data were available in 100% of cases at 12 months follow up, and in 78% at final follow up. RESULTS The average follow up was 4.2 years (range, 1-16 years). The Tegner Lysholm score improved from a mean preoperative score of 43.8 to a mean postoperative score of 80.5. The median NRS status decreased from an average of 6.7 (range, 5-8) to 2.3 (range, 1-7). The median preoperative flexion was 103.3° (range, 40-125°), rising to 126.6° (range, 40-145°). The median preoperative Caton-Deschamps ratio of 0.32 (range, 0-0.6) improved to 0.99 (range, 0.9-1.1) at final follow up. Two patients needed additional surgical treatment (arthroscopic scar tissue removal and proximalisation of the tibial tuberosity). CONCLUSION Lengthening of a shortened patellar tendon with augmentation using a quadriceps tendon graft combined with excessive intra-articular release is an individually adapted surgical salvage procedure to treat permanent patella infera. It improves knee function and yields good to excellent results in most cases.
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Affiliation(s)
- Roland M Biedert
- Emeritus Professor of the Department of Clinical Research University Basel, Basel, Switzerland; Sportsclinic #1, Wankdorf Center, Papiermühlestrasse 73, CH-3014 Bern, Switzerland.
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11
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Abstract
PURPOSE OF REVIEW Patella baja is characterized by a loss of patellar height and can develop as either an acute or chronic complication following a knee injury or surgical procedure. The purpose of this review is to describe the diagnosis and management of patella baja and highlight the senior author's surgical technique. RECENT FINDINGS The pathogenesis of patella baja involves a complex interaction between quadriceps dysfunction, immobilization, and inflammation leading to infrapatellar scarring and adhesions. It is associated with fractures about the knee and can result as a complication of surgical procedures such as anterior cruciate ligament (ACL) reconstruction, particularly bone-patellar tedon-bone autografts, high tibial osteotomies (HTOs), tibial tubercle osteotomies (TTOs), and total knee arthroplasties (TKAs). Patients with patella baja can have limited knee range of motion, anterior knee pain, significant weakness with active knee extension, and an extensor lag. Surgical intervention is indicated in cases of symptomatic patella baja. Treatment strategies include tibial tubercle proximalization, patellar tendon lengthening, and patellar tendon reconstruction. Allografts and autografts can be utilized to augment tendon lengthening or reconstructive procedures. Various small case series have reported favorable outcomes for these procedures. The treatment of patella baja is challenging and little consensus exists on optimal management, as much of the literature is limited to small case series. The preferred surgical technique of the senior author involves an end-to-end patellar tendon lengthening with hamstring autograft augmentation.
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Affiliation(s)
- Kathryn A. Barth
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery-Department of Orthopedic Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Sabrina M. Strickland
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery-Department of Orthopedic Surgery, 535 E 70th St, New York, NY 10021 USA
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12
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Bendable osteochondral allografts for patellar resurfacing: a finite element analysis of congruence. J Biomech 2022; 142:111240. [DOI: 10.1016/j.jbiomech.2022.111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022]
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13
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Kuo LY, Chen CY, Lin KC. Combining a transosseous cerclage wire after patellar tendon reattachment to treat patella distal pole fracture did not improve functional outcome. Sci Rep 2022; 12:9587. [PMID: 35688938 PMCID: PMC9187669 DOI: 10.1038/s41598-022-13641-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
This study aims to investigate whether an augmented wire in the treatment of patella distal pole fracture could improve knee range of motion (ROM) and radiographic features. Thirty-five consecutive patients with patellar distal pole fracture were analyzed from January 2014 to July 2019. The treatment is divided into two groups according to the presence or absence of augmented wire. Knee ROM, bone union, extension lag, and patellar height were compared between these two groups as the clinical and radiological outcomes. There was no significant difference in mean knee ROM (110° vs. 108°, p = 0.79), proportion of patella baja or bone union. More extension lag was noted in the augmentation group (5/20, 25%) than in the tendon reattachment group (1/15, 6.7%) with no statistically significant difference. In the augmentation group, four cases (20%) would need to remove the fixator due to irritation or broken hardware. Maintaining the patella length by preserving the distal pole and repairing the torn retinaculum allowed early motion to avoid knee stiffness safely without augmentation wire, which doesn’t improve knee ROM. The patellar tendon reattachment alone could achieve a great recovery and prevent the need for a second surgery due to broken wire or irritation.
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Affiliation(s)
- Li-Yang Kuo
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan
| | - Chun-Yu Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan. .,Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan. .,Department of Biomedical Engineering, I-Shou University, Kaohsiung City, Taiwan.
| | - Kai-Cheng Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan.,Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan
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14
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Middleton AH, Perlewitz MA, Edelstein AI, Vetter CS. Knee Arthrofibrosis following Tibial Plateau Fracture Treated with Arthroscopic Lysis of Adhesions with Manipulation. J Knee Surg 2022; 35:816-820. [PMID: 33111273 DOI: 10.1055/s-0040-1718679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posttraumatic arthrofibrosis is a common problem encountered in the orthopaedic setting for which there is no agreement on the optimal management strategy. The literature does not optimally describe the efficacy of arthroscopic lysis of adhesions for arthrofibrosis following tibial plateau fracture. The purpose of this study is to quantify the efficacy of arthroscopic lysis of adhesions with manipulation for the treatment of arthrofibrosis of the knee in patients who previously underwent surgical management of tibial plateau fracture. All patients who underwent arthroscopic lysis of adhesions from a single surgeon since 1999 were retrospectively reviewed. Clinical outcomes were evaluated by flexion, extension, and range of motion (ROM) preoperatively, intraoperatively, and postoperatively at intervals of 1, 4, 8, and 12 weeks, and any additional long-term follow-up. A total of 28 patients who had developed arthrofibrosis following surgical management of a tibial plateau fracture and failed nonsurgical management of knee stiffness were included in this study. There were significant improvements in total ROM following intervention at all time points compared with preoperative values (p < 0.001), with mean improvements of 59.3 degrees intraoperatively, 32.9 degrees (1 week), 37.1 degrees (4 weeks), 41.5 degrees (8 weeks), and 47.6 degrees (12 weeks). There were significant improvements in degrees of knee flexion following intervention at all time points compared with preoperative values (p < 0.001), with mean improvements of 50.8 degrees intraoperatively, 27.3 degrees (1 week), 36.0 degrees (4 weeks), 38.3 degrees (8 weeks), and 43.9 degrees (12 weeks). There were significant increases in degrees of knee extension intraoperatively (8.5 degrees) and at 1 week postoperatively (5.9 degrees) compared with preoperative values (p <0.01). At 12 weeks postoperatively, those who had previously undergone external fixation had significantly greater increases in ROM (p = 0.048). Arthroscopic lysis of adhesions for knee arthrofibrosis following surgical management of tibial plateau fracture significantly improves knee ROM.
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Affiliation(s)
- Austin H Middleton
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Madeline A Perlewitz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adam I Edelstein
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carole S Vetter
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Okita Y, Sadamatsu T, Kawahara T, Gamada, K. Volume and mobility of the infrapatellar fat pad during quasi-static knee extension after manual therapy in patients with knee osteoarthritis: a randomized control trial study. J Phys Ther Sci 2022; 34:561-570. [PMID: 35937628 PMCID: PMC9345757 DOI: 10.1589/jpts.34.561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine whether the volume and mobility of the
infrapatellar fat pad (IPFP) change as a result of manual release or stretching during
quasi-static knee extension in patients with knee osteoarthritis (KOA). [Participants and
Methods] Fourteen patients with KOA were allocated to one of two groups: the manual
release (R) and stretching (S, control) groups. They all underwent 12 treatment sessions
in in a space of four weeks. We created 3D models of the IPFP, tibia, patella, and
patellar tendon using sagittal MRI scans with the knee at 30° or 0°. We compared the
differences in (1) the distance of anterior movement of the anterior surface of the IPFP
(IPFP movement) and (2) the volume of the IPFP, between the R and S groups, using the 3D
models. [Results] Neither group showed any anterior movement of the IPFP during
quasi-static knee extension at pre-intervention; however, both groups showed significant
anterior movement of the IPFP at post-intervention. IPFP movement decreased in the S
group, meanwhile it increased in the R group at post-intervention. [Conclusion] Anterior
movement of the IPFP was more increased by manual release than by stretching since the
latter may have shortened the distance between the patella and tibial tuberosity at 0° and
30° flexion.
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Affiliation(s)
- Yuriko Okita
- Department of Rehabilitation, Sadamatsu Hospital, Japan
| | | | | | - Kazuyoshi Gamada,
- ReaLine Lab., GLAB Corp.: 889-1 Kurose-cho, Munechika-Yanakuni, Higashihiroshima, Hiroshima 739-2504, Japan
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16
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Sebastian P, Michael Z, Frederik G, Michael M, Marcus W, Moritz C, Peter B, Chlodwig K. Influence of patella height after patella fracture on clinical outcome: a 13-year period. Arch Orthop Trauma Surg 2022; 142:1557-1561. [PMID: 33825039 PMCID: PMC9217897 DOI: 10.1007/s00402-021-03871-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/23/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The incidence of patella fracture is statistically low (0.5-1.5%) compared to other fractures of the extremities [Patella fractures 76(10):987-997, 2005]. In the latter research, patella fractures if treated surgically present an overall inferior functional outcome. Little is known about the influence of the postoperative patella height on the clinical outcome. Therefore, the aim of our study was to analyse the influence of the patella height on the patients' functional outcome after surgery. METHODS In this retrospective study the in-house trauma register of our level I University trauma center was screened for patients suffering patella fractures treated surgically. Patella height of the same patients was evaluated on lateral X-rays using the Insall-Salvati Ratio (ISR). The patients' X-rays were analyzed at two time points for the ISR, whereas group A presents ISR data right after surgery and group B data at the latest follow up (minimum 6 weeks). The change of mean ISR at both time points was tested for significance. The functional outcome was measured by the "Munich Knee Questionaire" (MKQ). These MKQ results of different patella heights and fracture types were compared. RESULTS The screening of our in-house trauma register revealed 375 patients between the years 2003 and 2016. Out of these 54 patients (34f, 20 m) were enrolled. In detail the follow-up time for ISR between group A and B accounted for a mean of 503.8 ± 655.7 days. The MKQ was assessed at a mean of 1367.0 ± 1042.8 days after surgery. According to the AO-classification 10% AO.34 type B and 90% AO.34 type C fractures were found. Group A showed in 9.1% a patella baja and in 27.3% a patella alta compared to group B presenting 20.0% patella baja and 14.5% patella alta. There was no significant difference in functional outcome referring to the MKQ in patella alta (MKQ 69.0% ± 18.2) or baja (MKQ 67.1% ± 17.9) (p = 0.9). No significant functional difference between AO34.type B (MKQ 74.5% ± 11.0) and AO34.type C fractures (MKQ 64.0% ± 15.0) resulted (p = 0.1). CONCLUSION Our results demonstrate that different postoperative patella heights apparently do not influence the functional outcome in the short follow-up.
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Affiliation(s)
- Pesch Sebastian
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Zyskowski Michael
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Greve Frederik
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Müller Michael
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Wurm Marcus
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Crönlein Moritz
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Biberthaler Peter
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Kirchhoff Chlodwig
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
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17
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Rodríguez-Merchán EC, De la Corte-Rodríguez H, Encinas-Ullán CA, Gómez-Cardero P. Complications of surgical reconstruction of multiligament injuries of the knee joint: diagnosis, prevention and treatment. EFORT Open Rev 2021; 6:973-981. [PMID: 34760296 PMCID: PMC8559571 DOI: 10.1302/2058-5241.6.210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The main complications of surgical reconstruction of multiligament injuries of the knee joint are residual or recurrent instability, arthrofibrosis, popliteal artery injury, common peroneal nerve injury, compartment syndrome, fluid extravasation, symptomatic heterotopic ossification, wound problems and infection, deep venous thrombosis, and revision surgery. Careful surgical planning and execution of the primary surgical reconstruction of multiligament injuries of the knee joint can minimize the risk of the aforementioned complications. Careful postoperative follow-up is required to detect complications. Early recognition and prompt treatment are of paramount importance. To obtain good results in the revision surgery of failed multiligamentary knee reconstructions, it is crucial to perform a thorough and exhaustive evaluation to detect all the causes of failure. Addressing all associated injuries during revision surgery will lead to the best possible subjective and objective results, although functional outcomes are often modest. However, advanced age and high-energy injuries have been associated with the poorest functional outcomes after revision surgery of failed multiligament injuries of the knee joint.
Cite this article: EFORT Open Rev 2021;6:973-981. DOI: 10.1302/2058-5241.6.210057
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Affiliation(s)
- E Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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18
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Flexion contracture can be relieved by concurrent notchplasty in medial open wedge high tibial osteotomy. Orthop Traumatol Surg Res 2021; 107:103020. [PMID: 34314903 DOI: 10.1016/j.otsr.2021.103020] [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: 08/01/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Given that medial open wedge high tibial osteotomy (OWHTO) not only delays the progression of osteoarthritis but also alleviates the resulting pain, surgical outcomes would be improved if limited ROM can also be managed. In this regard, the effect of concurrent notchplasty on flexion contracture has not been evaluated. HYPOTHESIS (1) Concurrent notchplasty in OWHTO would relieve flexion contracture regardless of the severity of osteoarthritis and this effect would be maintained over time, and (2) concurrent notchplasty would not cause any added complications compared to the same procedure without notchplasty. PATIENTS AND METHODS In total, 107 patients who underwent OWHTO between 2011 and 2017 with a mean follow-up period of 46.6months (range: 24-102months) were reviewed. ROM was measured at three time points as follows: before surgery, at 6-12months postoperatively, and at the latest follow-up. The measurements were analyzed using a linear mixed model in terms of notchplasty and other factors, including age, sex, body mass index, preoperative hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, correction angle, concurrent meniscectomy, postoperative posterior slope, and Kellgren-Lawrence grade. Then, ROMs at the three time points were compared between the notchplasty and non-notchplasty groups. RESULTS Of the 107 patients, 47 underwent concurrent notchplasty. The linear mixed model regarding flexion contracture showed a significant notchplasty-by-time interaction (p<0.001). When comparing preoperative flexion contractures between the two groups, a significant difference was found (p<0.001). At 6-12months postoperatively, flexion contractures were relieved regardless of notchplasty; however, the difference between the groups was decreased (p=0.026). At the latest follow-up, flexion contractures were partly aggravated in both groups, but no significant difference was found between the groups (p=0.461). Comparison of flexion contracture between before surgery and at the latest follow-up in each group revealed a significant difference only in the notchplasty group (p<0.001, with notchplasty; p=0.197, without notchplasty). The linear mixed model regarding maximal flexion did not show any factor having a significant interaction with time. There were no surgical complications such as infection, thromboembolic events, and hemarthrosis, in both notchplasty and non-notchplasty groups. CONCLUSION The preoperative difference in flexion contracture was overcome by adding notchplasty to OWHTO, and this improvement was maintained over time. No added complications were noted in the notchplasty group. The results should be interpreted with caution, considering measurement error of ROM. However, concurrent notchplasty in OWHTO deserves further study to validate its efficacy. LEVEL OF EVIDENCE III, retrospective cohort study. IRB INFORMATION Project No. S2020-0081, AMC IRB SOP.
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19
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Dauty M, Menu P, Mesland O, Fouasson-Chailloux A. Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery. Eur J Sport Sci 2021; 22:627-635. [PMID: 33487103 DOI: 10.1080/17461391.2021.1881620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Arthrofibrosis is a devastating complication after Anterior Cruciate Ligament reconstruction (ACLr) characterized by a muscle weakness secondary to an arthrogenic muscle inhibition process. The loss of knee isokinetic strength due to arthrogenic muscle inhibition may be more important after arthrofibrosis, compared to an ACLr population with no complication. The isokinetic strength deficit [Limb Symmetry Index (LSI) at 60 and 180°/s of angular speed] was measured at 4, 7 and 12 post-operative months. Knee function, return to running and return to sport were evaluated. A comparison of the Quadriceps and the Hamstring LSI between patients with arthrofibrosis and those without post-operative complication was performed according to time and taking into consideration the type of surgical procedure. 539 primary ACLr patients were assessed. The arthrofibrosis group presented at 4, 7 and 12 post-operative months a Quadriceps LSI significantly lower compared to the control group, without influence of the graft procedure (LSI: 38, 53, 68% vs 63, 73, 85% at 60°/s, respectively). The Hamstring LSI was significantly lower at 4 and 7 post-operative months, but comparable at 12 months with an influence of the Hamstring procedure. Knee function was significantly lower at 4 and 7 post-operative months. Few arthrofibrosis ACLr patients returned to running at 7 post-operative months (6.8% vs 69.9%; p < .0001). An important and durable Quadriceps muscle weakness occurred after arthrofibrosis, whatever the type of graft procedure. This is explained by an Arthrogenic muscle inhibition which compromised the return to sport at the same level until 12 post-operative months. HighlightsAn important and durable quadriceps muscle weakness occurred after arthrofibrosis.The arthrogenic muscle inhibition was significant on the operated side independently of the type of the graft procedure.Arthrogenic muscle inhibition compromised the return to sport at the same level until 12 post-operative months.
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Affiliation(s)
- Marc Dauty
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
| | - Pierre Menu
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
| | - Olivier Mesland
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Physical Medicine and Rehabilitation Center, University Hospital of Nantes, Nantes, France.,CHU Nantes, Service de Médecine du Sport, University Hospital of Nantes, Nantes, France.,INSERM UMR U1229/RMeS, Regenerative Medicine and Skeleton - Nantes University, Nantes, France
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20
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Hwang BH, Jung KA, Ong A, Ahn HS, Moon SH, Lee SC. Patellar Impingement on Tibial Polyethylene after Primary Total Knee Arthroplasty without Patellar Resurfacing. J Knee Surg 2021; 34:280-286. [PMID: 31470453 DOI: 10.1055/s-0039-1695704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellar impingement on tibial polyethylene (PIP) is one potential complication of total knee arthroplasty (TKA). When PIP occurs, it is often related to inaccurate restoration of the joint line or due to soft-tissue contracture. We investigated the prevalence and etiology of PIP in Asian patients with deeply flexed knees following posterior stabilized (PS)-TKA. We retrospectively reviewed 54 patients (65 knees) with PIP after primary PS-TKAs without patellar resurfacing performed between 2008 and 2011. These patients were compared with a group of 124 patients (130 knees) without PIP matched for age, sex, and body mass index (BMI). The minimum follow-up was 5 years (range, 5-8.1 years). Patients were evaluated by blinded, independent observers using the Oxford knee score, the Waters score, and radiographic parameters. Impingement between the patella and the tibial polyethylene had a mean onset of 13.5 months after PS-TKA. The development of PIP was significantly associated with change in patellar tendon length (odds ratio [OR] = 11.4, 95% confidence interval [CI]: 11.2-11.6%), shorter postoperative patellar tendon length (OR = 2.1, 95% CI: 1.8-2.5%), change in the Insall-Salvati ratio (OR = 0.9, 95% CI: 0.8-1.0%), and joint line elevation (OR = 5.3, 95% CI: 4.8-5.8%) on multiple logistic regression analysis. Our findings reinforce the importance of accurate joint line restoration and the avoidance of iatrogenic injury to the patellar tendon, which can lead to shortening of the patellar tendon. This is a retrospective comparative study and its level of evidence is III.
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Affiliation(s)
- Bo-Hyun Hwang
- Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Am Jung
- Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
| | - Alvin Ong
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia
| | - Hye-Sun Ahn
- Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Su-Chan Lee
- Department of Orthopaedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea
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21
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Vaish A, Vaishya R, Bhasin VB. Etiopathology and Management of Stiff Knees: A Current Concept Review. Indian J Orthop 2020; 55:276-284. [PMID: 33927806 PMCID: PMC8046887 DOI: 10.1007/s43465-020-00287-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Knee stiffness after trauma, fracture fixation, arthroscopic surgery, infection, and knee arthroplasty is a known complication, which is challenging to manage and causes significant disability to the patients. METHODS We did a comprehensive search on the stiff knees, in the last week of May 2020, from the search engines of PubMed, SCOPUS, Google Scholar, and Research Gates using the appropriate keywords. RESULTS We found two types of articles related to knees stiffness: (a) following trauma, internal and external fixation of fractures and arthroscopic surgery, and (b) following total knee arthroplasty. Arthroscopic surgery was found to be a favored mode of management of stiff knees in both of the above groups. The Manipulation under Anesthesia (MUA) was also found effective if done carefully and in the early course of the stiffness. CONCLUSION Knee stiffness due to any cause is a trouble proposition to both patients and treating surgeons. Various methods of management have been described to deal with knee stiffness. Amongst the operative treatment, MUA and arthroscopic surgery were found to be the most effective. Arthroscopic surgery offers a good option of release stiff knees in the majority of cases, and it is most valuable and effective if done earlier in the course of the stiffness (preferably between 3 and 6 months).
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Affiliation(s)
- Abhishek Vaish
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076 India
| | - Raju Vaishya
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076 India
| | - Vishwa Bandhu Bhasin
- grid.415985.40000 0004 1767 8547Department of Orthopaedics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 1100060 India
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Sun C, Zhang X, Lee WG, Tu Y, Li H, Cai X, Yang H. Infrapatellar fat pad resection or preservation during total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2020; 15:297. [PMID: 32758250 PMCID: PMC7409474 DOI: 10.1186/s13018-020-01823-2] [Citation(s) in RCA: 9] [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: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The infrapatellar fat pad (IPFP) or Hoffa's fat pad is often resected during total knee arthroplasty in order to improve visibility. However, the management of the IPFP during total knee arthroplasty (TKA) is the subject of an ongoing debate that has no clear consensus. The purpose of this review was to appraise if resection of the IPFP affects clinical outcomes. METHODS We conducted a meta-analysis to identify relevant randomized controlled trials involving infrapatellar fat pad resection and infrapatellar fat pad preservation during total knee arthroplasty in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database, up to March 2020. RESULTS Nine randomized controlled trials, involving 783 TKAs (722 patients), were included in the systematic review. Outcome measures included patellar tendon length (PTL), Insall-Salvati ratio (ISR), rate of anterior knee pain, Knee Society Scores (KSS), and knee range of motion. The meta-analysis identified a trend toward the shortening of the patellar tendon with IPFP resection at 6 months (P = 0.0001) and 1 year (P = 0.001). We found no statistical difference in ISR (P = 0.87), rate of anterior knee pain within 6 months (p = 0.45) and 1 year (p = 0.38), KSS at 1 year (p = 0.77), and knee range of motion within 6 months (p = 0.61) and 1 year (0.46). CONCLUSION Based on the available level I evidence, we were unable to conclude that one surgical technique of IPFP can definitively be considered superior over the other. More adequately powered and better-designed randomized controlled trial (RCT) studies with long-term follow-up are required to produce evidence-based guidelines regarding IPFP resection.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Woo Guan Lee
- Department of Orthopedic, Kuching Specialist Hospital, Tabuan Stutong Commercial Centre, 93350, Kuching, Sarawak, Malaysia
| | - Yan Tu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Huimin Li
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Huadong Yang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
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Abstract
Patella baja in total knee arthroplasty can result in impingement, pain, and decreased range of motion. Etiology can range from previous knee surgeries such as anterior cruciate ligament reconstruction, retrograde femoral nail, infrapatellar fat pad resection, and previous total knee arthroplasty. Diagnosis can be confirmed by one of a number of measurements of patellar height including Insall-Salvati and Blackburne-Peel ratios. It is important to differentiate between true patella baja and pseudopatella baja by patellar height ratio. Treatment includes correct identification of the underlying etiology and appropriate management. Surgical management strategies include tibial tubercle osteotomy, distal femoral augment and revision, proximalization of the patellar component, modification of the anterior tibial component, and/or Z-plasty of the patellar tendon. We review the outcomes for each of these procedures.
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Bernstein A, Reichert SNA, Südkamp NP, Hernandez SL, Nerlich AG, Kühle J, Mayr HO. Expression of xylosyltransferases I and II and their role in the pathogenesis of arthrofibrosis. J Orthop Surg Res 2020; 15:27. [PMID: 31973761 PMCID: PMC6979351 DOI: 10.1186/s13018-020-1544-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/02/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Arthrofibrosis is a painful and restraining complication that occurs after about 10% of total knee arthroplasty and cruciate ligament surgery. The pathogenesis of arthrofibrosis has not yet been fully understood. Stress signals stimulate immune cells, and fibroblast differentiates into myofibroblast, which produce a large amount of collagen. Xylosyltransferases also appear to be involved in these pathways. They catalyze proteoglycan biosynthesis, which is involved in tissue remodeling and myofibroblast differentiation. The aim of this study was to investigate the relationship between the disease arthrofibrosis and the expression of the two isoforms of xylosyltransferases I and II. METHODS Tissue samples from 14 patients with arthrofibrosis were compared with tissue samples from seven healthy controls. The xylosyltransferases were detected by immunohistochemistry. The tissues were divided into four different areas of interest: vessels, synovialis, cell-poor and cell-rich fibrosis, or cell-poor and cell-rich areas in the control group. A quantification of the results was performed by modification of the immunoreactive score according to Remmele and Stegner. RESULTS Xylosyltransferase I was expressed in the various tissue types at varying rates. Xylosyltransferase I expression was considerably and significantly stronger than that of xylosyltransferase II. The following sequences of xylosyltransferase I and xylosyltransferase II expression were determined as follows: vessels >> cell-rich fibrosis > cell-poor fibrosis > synovialis. A positive correlation between the number of positive fibroblasts and the immunoreactive scoring system (IRS) was documented. CONCLUSIONS The significant positive correlation of xylosyltransferase -I expression with increasing number of fibroblasts demonstrates a high myofibroblast differentiation rate, which implies a gradual event as the pathogenesis of arthrofibrosis.
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Affiliation(s)
- Anke Bernstein
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Sven N. A. Reichert
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Norbert P. Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Sergio Latorre Hernandez
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Andreas G. Nerlich
- Institute of Pathology, Academic Clinics München-Bogenhausen and München-Schwabing, 81925 Munich, Germany
| | - Jan Kühle
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Hermann O. Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany, Hugstetter Straße 55, 79106 Freiburg, Germany
- Department of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Strasse 51, 81547 Munich, Germany
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Okita Y, Oba H, Miura R, Morimoto M, Gamada K. Movement and volume of infrapatellar fat pad and knee kinematics during quasi-static knee extension at 30 and 0° flexion in young healthy individuals. Knee 2020; 27:71-80. [PMID: 31918962 DOI: 10.1016/j.knee.2019.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/12/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the changes in the shape and volume of the infrapatellar fat pad (IPFP) associated with knee flexion angle in young healthy individuals. METHODS Young, healthy individuals without a history of knee injuries participated in this cross-sectional study. Behavior of the IPFP was quantified using three-dimensional (3D) models of the IPFP, patella, patellar tendon, femur, and tibia obtained from MRI taken at 0° and 30° flexion. The outcomes were movement and volume change of the IPFP, movement of the patella and the tibia, and change of the patellar tendon angle and length. RESULTS The anterior surface of the IPFP significantly moved anteriorly by 5.23 mm (p = .003) between 30° and 0°. Change in the volume of the IPFP was significantly increased or decreased in eight hyperoctants defined by the tibial coordinate system. The IPFP moved from the postero-supero hyperoctants to anterior hyperoctants. Significant correlations were observed between the IPFP and mobility of the patella, patellar tendon or tibia. CONCLUSION The IPFP moves antero-inferiorly during quasi-static knee extension from 30 to 0° in young healthy individuals. Comparisons of IPFP behavior between the healthy and pathological knees may help us understand the role of IPFP and problems caused by IPFP contracture in future studies.
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Affiliation(s)
- Yuriko Okita
- Department of Rehabilitation, Sadamatsu Hospital, Higashihonmachi537, Omura, Nagasaki, Japan
| | - Hiroyuki Oba
- Department of Rehabilitation, Sadamatsu Hospital, Higashihonmachi537, Omura, Nagasaki, Japan
| | - Ryohei Miura
- Department of Rehabilitation, Sadamatsu Hospital, Higashihonmachi537, Omura, Nagasaki, Japan
| | - Masashi Morimoto
- Department of Rehabilitation, Sadamatsu Hospital, Higashihonmachi537, Omura, Nagasaki, Japan
| | - Kazuyoshi Gamada
- Department of Rehabilitation, Hiroshima International University, 555-36, Kurosegakuenndai, Higashihiroshimashi, Hiroshima, Japan.
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Perelli S, Ibañez M, Morales-Marin C, Acuña-Avila G, Espinoza-von Bischhoffshausen R, Masferrer-Pino A, Monllau JC. Patellar Tendon Lengthening: Rescue Procedure for Patella Baja. Arthrosc Tech 2019; 9:e1-e8. [PMID: 32021766 PMCID: PMC6993128 DOI: 10.1016/j.eats.2019.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/17/2019] [Indexed: 02/03/2023] Open
Abstract
Patella baja is a challenging pathologic condition that causes pain and functional restrictions and can even lead to premature osteoarthritis-even more so in cases of patella infera or cases associated with degeneration of the patellar tendon in which simple conservative treatment frequently is not resolutive. Several surgical options have been described for symptomatic patella baja: excision of the lower third of the patella, lengthening of the patellar tendon, reconstruction of the patellar tendon with allograft, and proximalization of the tibial tubercle. A combination of 2 or more of these treatments may be recommended in cases of significant patella baja. We present a simple and reproducible technique to address patella baja that combines a partial transposition of the tibial tubercle and patellar tendon lengthening using a subperiosteal patellar flap in continuity with the patellar tendon.
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Affiliation(s)
- Simone Perelli
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain,Address correspondence to Simone Perelli, M.D., Institut Català de Traumatologia i Medicina de l’Esport (ICATME)–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Carrer de Sabino Arana 5, 08028 Barcelona, Spain.
| | - Maximiliano Ibañez
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Morales-Marin
- Department of Orthopaedic Surgery, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Gabriel Acuña-Avila
- Department of Orthopaedic Surgery, Hospital de San Carlos, San Carlos, Chile
| | | | - Angel Masferrer-Pino
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Monllau
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)–Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain,Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Collett DJ, Sharma R, Goyal P. Intramedullary Insertion of the Patellar Tendon, a Rare Anatomical Variant, Its Sequelae, and Surgical Management: A Case Report. JBJS Case Connect 2019; 9:e0397. [PMID: 31441831 DOI: 10.2106/jbjs.cc.18.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CASE We report a rare cause of patella baja in a 25-year-old man presenting with right knee pain. He was found to have patella baja and a genu recurvatum deformity. Imaging revealed an extremely unusual variant of the patellar tendon-identified to have an intramedullary tibial insertion. A patellar tendon reconstructive procedure was performed. CONCLUSIONS An intramedullary insertion of the patellar tendon is a fascinating and rare cause of patella baja with subsequent altered biomechanics of the extensor mechanism. We believe this is the first case report to describe its surgical presentation and an operative approach to its management.
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Affiliation(s)
- David J Collett
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Macquarie University Hospital, NSW, Australia
| | - Rahul Sharma
- Department of Orthopaedic Surgery, Nepean Hospital, NSW, Australia
| | - Prateek Goyal
- Department of Orthopaedic Surgery, S.D.M.H Hospital, Jaipur, Rajasthan
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Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty part II: A systematic review of published evidence. Knee 2019; 26:422-426. [PMID: 30738721 DOI: 10.1016/j.knee.2019.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. In part 2 of this two part series the authors aimed to investigate if resection of the IPFP affects clinical outcomes. METHODS A systematic search of CENTRAL Cochrane library, Medline, Embase and Web-of-science databases for the past 10 years was performed. Studies of patients undergoing primary TKA comparing outcomes between IPFP resection and preservation were included. The meta-analysis was performed with Review Manager 5.3. RESULTS Seven studies, involving 2815 patients (3312 knees) were included in the systematic review, of which two were RCTs. Outcome measures included patellar tendon length (PTL), post-operative pain, Knee Society Scores (KSS) and Functional Scores. Meta-analysis identified a trend toward shortening of the patellar tendon with IPFP resection. Resection correlated with a lower incidence of post-operative pain at one to two months, however at three to six months pain scores were higher in this group. No statistical difference was found in KSS and Functional Scores. CONCLUSION There is wide variation in practice with regard to the IPFP in TKA. The available literature with regard to resection or preservation of the IPFP is not conclusive. IMPLICATIONS There is no clear consensus in the literature on the resection or preservation of the IPFP indicating a clear need for high quality studies in the future to provide meaningful answers.
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Brückner C, Straube E, Petersen I, Sachse S, Keller P, Layher F, Matziolis G, Spiegl U, Zajonz D, Edel M, Roth A. Low-grade infections as a possible cause of arthrofibrosis after total knee arthroplasty. Patient Saf Surg 2019; 13:1. [PMID: 30647774 PMCID: PMC6327456 DOI: 10.1186/s13037-018-0181-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Arthrofibrosis after total knee arthroplasty represents a considerable burden for the patient and a therapeutic challenge for the practitioner. One possible cause discussed in the literature is a low-grade infection. This hypothesis should be examined within the scope of this retrospective study. Patients and methods Nineteen patients with clinical symptoms of arthrofibrosis after primary total knee arthroplasty were examined between January, 1999 and January, 2012. Incorrect positioning was radiologically ruled out. All patients were examined clinically (score of Freeman as well as Blauth and Jäger), radiologically (component and leg alignment, patella height according to Insall and Salvati), microbiologically (culture-based procedures), molecular biologically (PCR) and histologically in the course of an open revision of the prosthesis. Results According to the score of Freeman et al. (1977), a highly significant improvement in pain (p = 0.007) and in the overall score (p = 0.003) was shown. The knee joint mobility did not change significantly (p = 0.795). PCR was negative in 17 patients. One patient showed a PCR-positive result of the synovial membrane for Corynebacterium spp., while Staphylococcus warneri was detected in the culture. Another patient had a positive result of synovia PCR for Enterococcus cecorum as well as Corynebacterium spp. However, this culture was sterile. In 16 patient samples, no bacterial growth was detectable. Two samples were not evaluable. The main histopathological findings were synovialitis and fibrosis. Conclusion The hypothesis of low-grade-infection-induced arthrofibrosis after total knee arthroplasty could not be confirmed in this study. However, based on this small study population the conclusion needs to be confirmed by new and larger studies, ideally prospectively designed including a control group.
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Affiliation(s)
- C Brückner
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - E Straube
- 2Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Jena, Germany
| | - I Petersen
- 3Institute of Pathology, Friedrich-Schiller-University Jena, Jena, Germany.,4Institute of Pathology, SRH Waldklinikum Gera, Gera, Germany
| | - S Sachse
- 2Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Keller
- 2Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Jena, Germany.,5Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - F Layher
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - G Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - U Spiegl
- 6Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - D Zajonz
- 6Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - M Edel
- ZESBO - Center for research on musculoskeletal systems, Leipzig, Germany
| | - A Roth
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany.,6Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.,8Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich Endoprothetik/Orthopädie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103 Leipzig, Germany
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Changes in patellar height due to bone-tendon-bone graft. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:337-342. [PMID: 30173729 DOI: 10.1016/j.recot.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/10/2018] [Accepted: 03/13/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. METHODS Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. RESULTS No significant differences were observed from the preoperative measurements or at the 2-year follow-up. CONCLUSIONS The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years.
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Seijas R, Sallent A, Pons A, Cusco X, Catala J, Cugat R, Ares O. Changes in patellar height due to bone-tendon-bone graft. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Calloway SP, Soppe CJ, Mandelbaum BR. Clinical Outcomes After Arthroscopic Release of Patellofemoral Arthrofibrosis in Patients With Prior Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018; 34:1603-1607. [PMID: 29397287 DOI: 10.1016/j.arthro.2017.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review our results of arthroscopic release in patients diagnosed with refractory patellofemoral arthrofibrosis (PFA) after having undergone anterior cruciate ligament (ACL) reconstruction. METHODS From 2006 to 2016, all patients who underwent arthroscopic release for refractory PFA after ACL reconstruction were reviewed retrospectively. All patients then completed surveys containing the International Knee Documentation Committee (IKDC) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and were asked 2 subjective questions. Patients included in the study exhibited at least one finding of PFA and failed conservative treatment for at least 3 months. Included patients also had a minimum of 12 months of postoperative follow-up after PFA release. Patients who underwent any other concomitant surgery in the same operative setting as arthroscopic release for PFA were excluded from the study. RESULTS Thirty-two patients were included in the study. The mean age was 32.8 years (range, 19-58 years) with an average follow-up of 43.6 months (range, 16-98 months). There was a statistically significant increase preoperatively to postoperatively in the IKDC score from 49.6 to 69.4 (P < .00001), and 16 of 32 patients (50%) achieved a minimal clinically important difference (MCID). WOMAC scores also significantly increased from 74 to 85.3 (P < .00001), with 15 of 32 patients (47%) achieving MCID. Thirty-one patients (97%) reported that the procedure helped, and 25 patients (78%) said they would have the procedure again. CONCLUSIONS Arthroscopic release, consisting of an extended lateral release, debridement of the notch/fat pad, and manual manipulation of the patella, results in significant increases in validated outcome measures and is well tolerated by patients. LEVEL OF EVIDENCE Level IV, case series.
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Abstract
Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. However, there have been no previous review articles regarding noise around the knee despite its high prevalence. We will review the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises. In addition, we will describe causes of the physiological and pathological noises and management of noise in the knee. An appropriate review of the characteristics of noise, its pathophysiology, and factors for differentiation between physiological and pathological noises can facilitate patient guidance. It is important to differentiate between physiological noise and pathologic noise. In most cases, noise after surgery is simply the perception of noise that had been present previously due to emotional concerns. Minor problems associated with surgery, such as postoperative noise, can decrease patient satisfaction, especially among patients with high expectations. Following surgical principles and providing accurate information about physiological noise can decrease the risk of both pathological noise and patient dissatisfaction. In total knee arthroplasty, every attempt should be made to avoid patellar crepitus and clunk by using modern prostheses with proper patellofemoral conformity and by avoiding surgical errors.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hu Liang
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Jun Kim
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Xu B, Xu WX, Lu D, Sheng HF, Xu XW, Ding WG. Application of different patella height indices in patients undergoing total knee arthroplasty. J Orthop Surg Res 2017; 12:191. [PMID: 29233153 PMCID: PMC5727872 DOI: 10.1186/s13018-017-0694-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/28/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND One complication of total knee arthroplasty (TKA) is patella baja (PB). Patellar tendon shortening and joint line elevation are two main causes of PB. The purpose of this study was to determine the incidence of PB before and after TKA by measuring the patellar height and provide evidence for choosing a suitable index. METHODS In total, 256 consecutive patients who underwent primary TKA were included in this study. Radiographic measurements were performed; the Insall-Salvati (IS) index, modified IS (MIS) index, Blackburne-Peel (BP) index, and Caton-Deschamps (CD) index were computed; and the incidence of PB was calculated before and after the operation. The consistency between the IS and MIS indices and between the BP and CD indices was analyzed. RESULTS The preoperative incidence of true PB (TPB) and pseudo-PB (PPB) was 9.4 and 0.8%, respectively. The postoperative incidence of TPB and PPB was 10.2 and 9.0%, respectively. The consistency between the IS and MIS indices was moderate preoperatively (pre-kappa = 0.602) and postoperatively (post-kappa = 0.742). The consistency between the BP and CD indices was moderate preoperatively (pre-kappa = 0.742) and good postoperatively (post-kappa = 0.797). CONCLUSION The incidence of PB, especially PPB, increased after TKA. The CD and BP indices are of greater importance for the diagnosis of PB after TKA. The MIS index is a better choice than the IS index to measure the length of the patellar tendon. To measure the height of the joint line, the BP index is better postoperatively and the CD index is better preoperatively.
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Affiliation(s)
- Bin Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Wei-Xing Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Di Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Hong-Feng Sheng
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Xin-Wei Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China
| | - Wei-Guo Ding
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, 234 Gu-cui Road, Hangzhou, 310012, People's Republic of China.
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Vandeputte FJ, Vandenneucker H. Proximalisation of the tibial tubercle gives a good outcome in patients undergoing revision total knee arthroplasty who have pseudo patella baja. Bone Joint J 2017; 99-B:912-916. [PMID: 28663396 DOI: 10.1302/0301-620x.99b7.bjj-2016-1267.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/14/2017] [Indexed: 12/20/2022]
Abstract
AIMS The aim of this study was to compare the outcome of revision total knee arthroplasty (TKA) with and without proximalisation of the tibial tubercle in patients with a failed primary TKA who have pseudo patella baja. PATIENTS AND METHODS All revision TKAs, performed between January 2008 and November 2013 at a tertiary referral University Orthopaedic Department were retrospectively reviewed. Pseudo patella baja was defined using the modified Insall-Salvati and the Blackburne-Peel ratios. A proximalisation of the tibial tubercle was performed in 13 patients with pseudo patella baja who were matched with a control group of 13 patients for gender, age, height, weight, body mass index, length of surgery and Blackburne-Peel ratio. Outcome was assessed two years post-operatively using the Knee Society Score (KSS). RESULTS The increase in KSS was significantly higher in the osteotomy group compared with the control group. The outcome was statistically better in patients in whom proximalisation of > 1 cm had been achieved compared with those in whom the proximalisation was < 1 cm. CONCLUSION In this retrospective case-control study, a proximal transfer of the tibial tubercle at revision TKA in patients with pseudo patella baja gives good outcomes without major complications. Cite this article: Bone Joint J 2017;99-B:912-16.
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Affiliation(s)
- F-J Vandeputte
- University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - H Vandenneucker
- University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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Stiefel EC, McIntyre L. Arthroscopic Lysis of Adhesions for Treatment of Post-traumatic Arthrofibrosis of the Knee Joint. Arthrosc Tech 2017; 6:e939-e944. [PMID: 29487783 PMCID: PMC5800957 DOI: 10.1016/j.eats.2017.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/02/2017] [Indexed: 02/03/2023] Open
Abstract
Normal knee range of motion varies slightly between individuals and measures approximately 0° to -5° of extension to 140° of flexion. A full arc of motion is required for normal gait and knee function. Loss of normal joint range of motion may occur after a traumatic knee injury and may contribute to increased pain, lower functional outcome scores, and decreased patient satisfaction. Although multiple factors may contribute to the development of motion loss, the occurrence of intra-articular scar tissue adhesions, or post-traumatic arthrofibrosis, may limit the patient's knee motion in the early postoperative period. Once motion loss has been identified, it can be a challenging complication to manage. Arthroscopic lysis of adhesions with manipulation under anesthesia is a reliable surgical technique that can improve range of motion in patients with knee stiffness due to post-traumatic arthrofibrosis.
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Affiliation(s)
- Eric C. Stiefel
- Valdosta Orthopedic Associates, Valdosta, Georgia, U.S.A
- Address correspondence to Eric C. Stiefel, M.D., Valdosta Orthopedic Associates, 3527 N Valdosta Rd, Valdosta, GA 31602, U.S.A.Valdosta Orthopedic Associates3527 N Valdosta RdValdostaGA31602U.S.A.
| | - Louis McIntyre
- Westchester Knee and Shoulder Center, White Plains, New York, U.S.A
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Wilk KE, Arrigo CA. Rehabilitation Principles of the Anterior Cruciate Ligament Reconstructed Knee: Twelve Steps for Successful Progression and Return to Play. Clin Sports Med 2017; 36:189-232. [PMID: 27871658 DOI: 10.1016/j.csm.2016.08.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The rehabilitation process begins immediately after injury to the anterior cruciate ligament (ACL). The goal of preoperative rehabilitation is to prepare the patient for surgery. Current rehabilitation programs focus on strengthening exercises and proprioceptive and neuromuscular control drills to provide a neurologic stimulus. It is also important to address preexisting factors, especially for the female athlete, that may predispose to future injury, such as hip and hamstring weakness. Our goal in the rehabilitation program is to restore full, unrestricted function and to assist the patient to return to 100% of the preinjury level while achieving excellent long-term outcomes.
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Affiliation(s)
- Kevin E Wilk
- Champion Sports Medicine, 805 Saint Vincent's Drive, Suite G100, Birmingham, AL 35205, USA; American Sports Medicine Institute, Birmingham, AL, USA.
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Fujita Y, Nakajo T, Muto M. Short-term effects of arthrotomy with and without infrapatellar fat pad resection on the normal canine stifle. Vet Surg 2017; 46:683-690. [PMID: 28334450 DOI: 10.1111/vsu.12646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the short-term effects of infrapatellar fat pad (IFP) resection in normal dogs. STUDY DESIGN Experimental in vivo study. ANIMALS Five normal adult female beagle dogs. METHODS The IFP was resected via arthrotomy in the left stifle joint (experimental side) while the right stifle underwent arthrotomy alone (sham side). An orthopedic examination was performed every week for 4 weeks and synovial fluid was analyzed before and 4 weeks after the procedure. The ratio of the length of the patellar ligament to the patellar length (L:P) was calculated on a lateral radiograph of the stifle before, 2 and 4 weeks after the procedure. Patellar depth (PD) and the contact area (CA) between the femur and patella were calculated from computed tomographic images taken at 3 different stifle angles (extended, flexed, hyperflexed) before, immediately after, and 4 weeks following the procedure. The dogs were euthanatized 4 weeks after the procedure for macroscopic and microscopic evaluation of the patellofemoral joint. RESULTS No difference was found between treatment groups throughout the study. No evidence of postoperative osteoarthritis was detected in any of the dogs. Orthopedic examinations, radiographs, and synovial fluid analyses remained within normal limits. Most PD, but not CA measurements, increased with time in both joints and at all stifle angles. CONCLUSIONS Excision of the IFP subsequent to medial arthrotomy did not result in any measurable changes in the canine patellofemoral joint when compared with medial arthrotomy alone after 4 weeks of follow-up.
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Affiliation(s)
- Yukihiro Fujita
- Laboratory of Surgery II, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
| | - Tetsuya Nakajo
- Laboratory of Surgery II, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
| | - Makoto Muto
- Laboratory of Surgery II, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
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Yoon KH, Tak DH, Ko TS, Park SE, Nam J, Lee SH. Association of fibrosis in the infrapatellar fat pad and degenerative cartilage change of patellofemoral joint after anterior cruciate ligament reconstruction. Knee 2017; 24:310-318. [PMID: 27916577 DOI: 10.1016/j.knee.2016.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/23/2016] [Accepted: 10/25/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the prevalence and risk factor of cartilage degeneration of the patellofemoral joint (PFJ) that was diagnosed by second-look arthroscopy. METHODS One-hundred and seven patients who underwent ACL reconstruction were evaluated by preoperative MRI, postoperative MRI and second-look arthroscopy. Severity of infrapatellar fat pad (IPFP) fibrosis was evaluated by MRI at an average of 26months after ACL reconstruction. Cartilage degeneration was assessed by second-look arthroscopy at 29months. RESULTS Twenty-five patients (24.0%) showed cartilage degeneration of the PFJ in second-look arthroscopy. Patients were divided into three groups according to severity of IPFP fibrosis of postoperative MRI (i.e. Group A, focal and incomplete band fibrosis, n=69; Group B, complete band fibrosis, n=31; and Group C, diffuse and infiltrated fibrosis, n=7). Cartilage degeneration of the PFJ was significantly worsened with more fibrosis formation of the IPFP (P<0.001). Other factors for instabilities (BMI, age, concomitant meniscal procedure, time from injury to reconstruction, severity of IPFP fibrosis at preoperative MRI and clinical scores) were not correlated with cartilage degeneration of the PFJ. The multivariate logistic regression analysis of degeneration of the PFJ after ACL reconstruction identified more severe fibrosis tissue formation of the IPFP and initial cartilage defect as significant predictors. CONCLUSIONS More extensive fibrosis of the IPFP and initial cartilage defect may be related to further degenerative changes of the PFJ. Other factors did not affect cartilage degeneration of the PFJ, although the muscle strength, the individual activity level or the rehabilitation protocol was not evaluated in the short-term follow-up period.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Tak
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Taeg Su Ko
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Sang Eon Park
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Juhyun Nam
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
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Namazi H, Torabi S. Novel Use of Botulinum Toxin to Ameliorate Arthrofibrosis: An Experimental Study in Rabbits. Toxicol Pathol 2017; 35:715-8. [PMID: 17763285 DOI: 10.1080/01926230701481923] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the effects of intra-articular botulinum toxin in preventing arthrofibrosis. Arthrofibrosis was induced in both stifle joints of 20 rabbits by transecting the anterior cruciate ligament under intramuscular anesthesia with ketamine and xylazine. Intra-articular toxin at a dose of 0.6 ml (50 unit) and physiologic saline solution (0.6 ml) were injected into the right and left stifle joints, respectively, 3 times with a 1-week interval between each injection. The rabbits were euthanized in the 12th week via high dose anesthesia to remove the stifle joint. The severity of adhesions was assessed, applying a universal scoring system. Also the stifle joints were histologically evaluated for fibrosis. With regards to severity of adhesion a significant reduction in the adhesion score was observed in the toxin-treated group in comparison to untreated controls with mean ± SE values of 0.2 ± 0.1 and 2.4 ± 0.2, respectively ( p < 0.01). The histological evaluation showed no significant fibroblast in the toxin-treated group versus dense fibers with mature fibroblasts in the control group. Our results suggest that botulinum toxin demonstrated efficacy in preventing adhesion after knee surgery and all the parameters monitored showed consistent statistically significant improvement.
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Affiliation(s)
- Hamid Namazi
- Shiraz University of Medical Sciences, Shiraz, Iran.
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Kalson NS, Borthwick LA, Mann DA, Deehan DJ, Lewis P, Mann C, Mont MA, Morgan-Jones R, Oussedik S, Williams FMK, Toms A, Argenson JN, Bellemans J, Bhave A, Furnes O, Gollwitzer H, Haddad FS, Hofmann S, Krenn V. International consensus on the definition and classification of fibrosis of the knee joint. Bone Joint J 2017; 98-B:1479-1488. [PMID: 27803223 DOI: 10.1302/0301-620x.98b10.37957] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this consensus was to develop a definition of post-operative fibrosis of the knee. PATIENTS AND METHODS An international panel of experts took part in a formal consensus process composed of a discussion phase and three Delphi rounds. RESULTS Post-operative fibrosis of the knee was defined as a limited range of movement (ROM) in flexion and/or extension, that is not attributable to an osseous or prosthetic block to movement from malaligned, malpositioned or incorrectly sized components, metal hardware, ligament reconstruction, infection (septic arthritis), pain, chronic regional pain syndrome (CRPS) or other specific causes, but due to soft-tissue fibrosis that was not present pre-operatively. Limitation of movement was graded as mild, moderate or severe according to the range of flexion (90° to 100°, 70° to 89°, < 70°) or extension deficit (5° to 10°, 11° to 20°, > 20°). Recommended investigations to support the diagnosis and a strategy for its management were also agreed. CONCLUSION The development of standardised, accepted criteria for the diagnosis, classification and grading of the severity of post-operative fibrosis of the knee will facilitate the identification of patients for inclusion in clinical trials, the development of clinical guidelines, and eventually help to inform the management of this difficult condition. Cite this article: Bone Joint J 2016;98-B:1479-88.
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Affiliation(s)
| | - L A Borthwick
- Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - D A Mann
- Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - D J Deehan
- Freeman Hospital, Newcastle Hospitals NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - P Lewis
- South Australian Health and Medical Institute, Adelaide, South Australia, Australia
| | - C Mann
- Norfolk and Norwich University NHS Trust, Norwich, UK
| | - M A Mont
- Cleveland Clinic , Cleveland, Ohio, USA
| | | | - S Oussedik
- Institute of Sport, Exercise and Health, University College London Hospitals, 235 Euston Road, London NW1 2BU, UK
| | - F M K Williams
- King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - A Toms
- Royal Devon and Exeter Hospital, Exeter, UK
| | - J N Argenson
- Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | | | - A Bhave
- Sinai Hospital, Baltimore, Maryland, USA
| | - O Furnes
- University of Bergen, Bergen, Norway
| | - H Gollwitzer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 Munich, Germany
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London NW1 2BU, UK
| | - S Hofmann
- LKH Stolzalpe Hospital & Teaching Hospital University Clinic Graz, Austria
| | - V Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
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Cadaveric study of the secondary medial patellar restraints: patellotibial and patellomeniscal ligaments. Knee Surg Sports Traumatol Arthrosc 2017; 25:144-151. [PMID: 27722769 DOI: 10.1007/s00167-016-4322-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To detail the anatomy of the medial patella stabilizers, medial patellotibial (MPTL), and medial patellomeniscal ligaments (MPML), focusing on the points of origin and insertion, length, thickness, width, and fibres orientation to study the frequency of anatomical variations and the anatomy of these ligaments, thereby improving surgical techniques. METHODS Thirty dissected knees were analysed. A digital caliper was used to measure the length, thickness, and width, as well as the mid-point of the ligaments insertion and the distance from the MPTL insertion to the articular surface of the tibia. The angle of inclination of the ligaments was calculated in the coronal plane. The collected data were tabulated and statistically analysed. RESULTS MPTL was present in 90 % as a visible thickening of the deep medial retinaculum and exhibiting only one anatomical variation. The MPML was absent in one of the dissected knees, and one anatomical variation was found. The tilt angle of the ligaments was very similar, with an average of 22.2° ± 7.6° for the MPTL and 24.2° ± 6.6° for the MPML. CONCLUSION The MPTL is a long visible structure of the deep layer of the medial retinaculum, but with a distinct origin and insertion. The MPML is thicker with an angular direction similar to MPTL. The presence of these ligaments in most of the specimens studied suggests that the real anatomical and biomechanical importance of these ligaments should be further investigated because they play a role in the patellar stability.
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Wylie JD, Marchand LS, Burks RT. Etiologic Factors That Lead to Failure After Primary Anterior Cruciate Ligament Surgery. Clin Sports Med 2017; 36:155-172. [DOI: 10.1016/j.csm.2016.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Guido W, Christian H, Elmar H, Elisabeth A, Christian F. Treatment of patella baja by a modified Z-plasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2943-2947. [PMID: 25786824 DOI: 10.1007/s00167-015-3576-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficiency of a modified Z-plasty for patellar tendon lengthening for the treatment of patella baja. Rather than adapting only two tendon reins according to the conventional Z-plasty method, the modified Z-plasty provides four reins to enable multifold overlapping of the tendon tissue. METHODS Between 2010 and 2012, a modified Z-plasty procedure was performed in four patients suffering from patella baja. Physical examinations and standardized scoring instruments served as the evaluation measures. RESULTS The median preoperative CD ratio of 0.53 (range 0.43-0.62) was corrected to 1.03 (range 1-1.06) after a median follow-up of 34 months (range 23-41 months). The median preoperative flexion of 108° (range 80-135°) improved to 143° (range 110-145°) compared with the flexion of 145° (range 140-145°) of the unaffected knee. No patients showed any signs of extension lag. The median Lysholm score improved from 49 (range 22-80) to 91 (range 67-95), and the Tegner activity level improved from 2 (range 0-6) to 6 (range 2-6). The median VAS status for pain decreased from an average of 8.5 (range 4-10) to 1 (range 0-2). No complications were observed. CONCLUSION The modified Z-plasty procedure is a valuable technique for the treatment of patella baja, especially if allografts are not available. This procedure allowed for early mobilization and achieved excellent clinical results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Wierer Guido
- Sportsclinic Austria, Innsbruck, Olympiastraße 39, 6020, Innsbruck, Austria
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Hoser Christian
- Sportsclinic Austria, Innsbruck, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Herbst Elmar
- Sportsclinic Austria, Innsbruck, Olympiastraße 39, 6020, Innsbruck, Austria
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Abermann Elisabeth
- Sportsclinic Austria, Innsbruck, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Fink Christian
- Sportsclinic Austria, Innsbruck, Olympiastraße 39, 6020, Innsbruck, Austria.
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Fraser EJ, Savage-Elliott I, Yasui Y, Ackermann J, Watson G, Ross KA, Deyer T, Kennedy JG. Clinical and MRI Donor Site Outcomes Following Autologous Osteochondral Transplantation for Talar Osteochondral Lesions. Foot Ankle Int 2016; 37:968-76. [PMID: 27177889 DOI: 10.1177/1071100716649461] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Autologous osteochondral transplantation (AOT) has an inherent risk of donor site morbidity (DSM). The reported rates of DSM vary from 0% to 50%, with few studies reporting clinical or imaging outcomes at the donor site as a primary outcome and even fewer report these outcomes when a biosynthetic plug backfill is employed. Although TruFit (Smith & Nephew, Andover, MA) plugs have been removed from the market for regulatory purposes, biphasic plugs (including TruFit plugs) have been used for several years and the evaluation of these is therefore pertinent. METHODS Thirty-nine patients who underwent forty AOT procedures of the talus, with the donor graft being taken from the ipsilateral knee, were included. Postoperative magnetic resonance imaging (MRI) was used to assess the donor site graded with magnetic resonance observation of cartilage repair tissue (MOCART) scoring. Lysholm scores were collected preoperatively, at the time of magnetic resonance imaging (MRI), and again at 24 months and at final follow-up to assess clinical outcomes. Statistical analysis was performed to establish if there was any correlation between MRI assessment of the donor site and clinical outcomes. The mean patient age was 36.2 ± 15.7 years with a mean follow-up of 41.8 ± 16.7 months. RESULTS All patient donor site defects were filled with OBI TruFit biphasic plugs. DSM was encountered in 12.5% of the patient cohort at 24 months, and in these patients, the Lysholm score was a mean 87.2 ± 5.0. At final follow-up, DSM was reduced to 5%. Lysholm scores for the entire cohort were 98.4 ± 4.6 and 99.4 ± 3.1 at 24 months and final follow-up, respectively. MRI of the donor sites were taken at an average of 18.1 ± 13.5 (range, 3-48) months postoperatively and the mean MOCART score was 60.0 ± 13.5. No correlation was found between the MOCART score and Lysholm outcomes at the donor knee (P = .43, r = 0.13). CONCLUSION Low incidence of DSM and good functional outcomes were achieved with AOT. Additionally, MRI findings did not predict clinical outcomes in our study. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | - Youichi Yasui
- Hospital for Special Surgery, New York, NY, USA Teikyo University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan
| | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, NY, USA
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Atluri K, De Jesus AM, Chinnathambi S, Brouillette MJ, Martin JA, Salem AK, Sander EA. Blebbistatin-Loaded Poly(d,l-lactide- co-glycolide) Particles For Treating Arthrofibrosis. ACS Biomater Sci Eng 2016; 2:1097-1107. [PMID: 33445238 DOI: 10.1021/acsbiomaterials.6b00082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Joint immobility is a debilitating complication of articular trauma that is characterized by thickening and stiffening of the joint capsule and the formation of fibrotic lesions inside joints. Capsule release surgery can temporarily restore mobility, but contraction often recurs due to the contractile activities of fibroblasts, which exert tension on the capsule ECM via nonmuscle myosin II. Based on these findings we hypothesized that blebbistatin, a drug that reversibly inhibits the activity of this protein, would relax ECM tension imposed by fibroblasts and reduce fibrosis. In this study, we characterized the effectiveness of blebbistatin as an anticontractile treatment. Given that sustained suppression of contractile activity may be required to achieve capsule release and reduce fibrosis, we compared the effects on fibroblast-mediated collagen ECM displacement of blebbistatin-loaded poly(lactide-co-gylcolide) (PLGA) particles versus bolus blebbistatin dosing. Time-lapse imaging of fluorescent microspheres embedded in collagen gels confirmed that PLGA/blebbistatin inhibited force generation and reduced both gel displacement and rate of displacement. In addition, collagen production at 10 days was significantly reduced. Taken together, these data indicate that blebbistatin-loaded PLGA particles can be used to inhibit fibroblast force-generation and reduce collagen production and lay the foundation for optimization of drug delivery technology for treating arthrofibrosis.
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Affiliation(s)
- K Atluri
- Division of Pharmaceutics and Translational Therapeutics, University of Iowa College of Pharmacy, 115 South Grand Avenue, Iowa City, Iowa 52242, United States
| | - A M De Jesus
- Department of Biomedical Engineering, University of Iowa College of Engineering, 1402 Seamans Center, Iowa City, Iowa 52242, United States
| | - S Chinnathambi
- Department of Biomedical Engineering, University of Iowa College of Engineering, 1402 Seamans Center, Iowa City, Iowa 52242, United States
| | - M J Brouillette
- Department of Orthopaedics and Rehabilitation, University of Iowa Roy J and Lucille A Carver College of Medicine, 25 South Grand Avenue, Iowa City, Iowa 52242, United States
| | - J A Martin
- Department of Orthopaedics and Rehabilitation, University of Iowa Roy J and Lucille A Carver College of Medicine, 25 South Grand Avenue, Iowa City, Iowa 52242, United States
| | - A K Salem
- Division of Pharmaceutics and Translational Therapeutics, University of Iowa College of Pharmacy, 115 South Grand Avenue, Iowa City, Iowa 52242, United States.,Department of Biomedical Engineering, University of Iowa College of Engineering, 1402 Seamans Center, Iowa City, Iowa 52242, United States
| | - E A Sander
- Department of Biomedical Engineering, University of Iowa College of Engineering, 1402 Seamans Center, Iowa City, Iowa 52242, United States
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Tardy N, Thaunat M, Sonnery-Cottet B, Murphy C, Chambat P, Fayard JM. Extension deficit after ACL reconstruction: Is open posterior release a safe and efficient procedure? Knee 2016; 23:465-71. [PMID: 26875053 DOI: 10.1016/j.knee.2016.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/24/2015] [Accepted: 01/02/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extension loss is a potentially devastating consequence of anterior cruciate ligament reconstruction (ACLR). It can often be treated by anterior arthroscopic release. In rare cases, a chronic flexion contracture requires an additional posterior open release. To our knowledge, no study analysing the results of both posteromedial and posterolateral approaches has been performed so far. The purposes of this study were (1) to analyse the midterm outcome and complications of a combined procedure, anterior arthroscopic debridement and posterior open capsulotomy - for the treatment of chronic extension deficits after ACLR and (2) to describe the surgical technique of posterior open release with both posteromedial and posterolateral approaches. MATERIAL AND METHODS This is a retrospective clinical cohort study. Twelve patients presenting a chronic flexion contracture of 10° or more after ACLR treated by open posterior arthrolysis with an average follow-up time of 38months (range six to 90) were included. At last follow-up, they underwent both a clinical examination with range of motion analysis, International Knee Documentation Committee (IKDC) and KOOS scores. RESULTS At follow-up, all patients except one (93%) achieved complete extension. Only one patient (7%) had a residual post-operative flexion deformity of five degrees. The range of motion (ROM) improved significantly after arthrolysis from 96°±14.3° (SD) to 14.3°±7°(SD)(p<0.001). No post-operative complications were recorded. No patients required further open debridement. The post-operative objective IKDC score was grade A for five patients, B for seven versus C for five patients and D for seven preoperatively. The mean post-operative subjective IKDC score was 86.4±9.7. The post-operative Knee injury and Osteoarthritis Outcome Score (KOOS) distribution was as follows: pain 93.8±5 (SD); symptoms 88±8.6 (SD); ADL 96.8±3.7 (SD); sports activities 83.6±12.3 (SD); and quality of life 82.9±8.8 (SD). Mean patients' satisfaction was 9.25±0.6 (SD) out of 10 after arthrolysis. CONCLUSIONS Open posterior release with both posteromedial and posterolateral approaches is a safe and efficient additional procedure in case of persistent flexion contracture after ACLR with good ROM gain, functional scores and patients' satisfaction. LEVEL OF EVIDENCE Therapeutic study - Level IV.
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Affiliation(s)
- Nicolas Tardy
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Colin Murphy
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Pierre Chambat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008 Lyon, France.
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Dean CS, Chahla J, Mikula JD, Mitchell JJ, LaPrade RF. Arthroscopic Posteromedial Capsular Release. Arthrosc Tech 2016; 5:e495-500. [PMID: 27656368 PMCID: PMC5021185 DOI: 10.1016/j.eats.2016.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/28/2016] [Indexed: 02/03/2023] Open
Abstract
Post-traumatic or postsurgical flexion contractures of the knee can significantly limit function and lead to gait abnormalities. In this setting, interventions to regain full extension may include bracing, physical therapy, and open or arthroscopic surgery. Open surgical approaches to restore full motion often demand extensive recovery and promote further adhesions and loss of motion, which has led to the advent of arthroscopic techniques to address these pathologies. We present a safe, effective, and reproducible arthroscopic technique for posteromedial capsular release to address knee flexion contractures.
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Affiliation(s)
- Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jacob D. Mikula
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Justin J. Mitchell
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A
| | - Robert F. LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Robert F. LaPrade, M.D., Ph.D., Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.Steadman Philippon Research InstituteThe Steadman Clinic181 W Meadow DrSte 400VailCO81657U.S.A.
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Does the hyperextension maneuver prevent knee extension loss after arthroscopic anterior cruciate ligament reconstruction? J Orthop Traumatol 2016; 17:327-331. [PMID: 27164977 PMCID: PMC5071236 DOI: 10.1007/s10195-016-0408-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 04/08/2016] [Indexed: 11/06/2022] Open
Abstract
Background Disruption of the anterior cruciate ligament (ACL) is one of the most frequent musculoskeletal injuries affecting physically active men and women. In the United States, an estimated 200,000 ACL reconstructions are performed annually. One of the most common complications of ACL reconstruction is loss of extension. The purpose of this study was to assess the effects of the hyperextension maneuver on preventing knee extension loss after arthroscopic ACL reconstruction. Materials and methods In this prospective randomized clinical trial study, 100 adult patients with a documented complete ACL tear were randomized to two groups. All patients underwent arthroscopic ACL reconstruction with quadrupled semitendinosus and gracilis autograft by the senior author based on the same technique and instruments. However, the hyperextension maneuver was only performed in 50 patients during autograft fixation on the tibial side (case group). The postoperative rehabilitation protocol was similar for both groups. The knee range of motion and extension limit was evaluated at 2, 6, 12, and 24 weeks and at 1 year postoperatively. Results One hundred patients (88 male and 12 female) aged from 17−36 years (average 26.9 years) were included in our study. The two groups were similar regarding age, sex, and dominant side involvement (P >0.4).The difference between the two groups was significant only at 2 weeks (P <0.02). After 2 weeks, although the rate of limited extension was higher in the control group, no significant difference was seen between the groups. Conclusion Although the hyperextension technique during graft fixation on the tibial side may induce better range of motion in the first 2 weeks after ACL reconstruction surgery, this effect is not significant after 2 weeks. Level of evidence Therapeutic level II.
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50
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Haro MS, Shelbourne KD. Prevention and Management of Loss of Motion in Anterior Cruciate Ligament Surgery. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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