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Vakili S, Lanting B, Getgood A, Willing R. Comparison of the Kinematics and Laxity of Total Knee Arthroplasty Bearing Designs Stabilized With Specimen-Specific Virtual Ligaments on a Joint Motion Simulator. J Biomech Eng 2024; 146:081005. [PMID: 38529555 DOI: 10.1115/1.4064621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 03/27/2024]
Abstract
A variety of total knee arthroplasty (TKA) designs offer increased congruency bearing options, primarily to compensate for a loss of posterior cruciate ligament (PCL) function. However, their efficacy in providing sufficient stability under different circumstances requires further investigation. The preclinical testing of prosthesis components on joint motion simulators is useful for quantifying how design changes affect joint stability. However, this type of testing may not be clinically relevant because surrounding ligaments are either ignored or greatly simplified. This study aimed to assess the kinematics and stability of TKA joints during various motions using condylar-stabilized (CS) bearings without a PCL versus cruciate-retaining (CR) bearings with an intact PCL. TKA prosthetic components were tested on a joint motion simulator while being stabilized with five different sets of specimen-specific virtual ligament envelopes. In comparison to CR knees, CS knees without a PCL exhibited a greater amount of posterior tibial displacement laxity, with a mean increase of 2.7±2.1 mm (p = 0.03). Additionally, significant differences were observed in the anterior-posterior kinematics of the knee joint during activities of daily living (ADL) between the two designs. These results were consistent with previous cadaveric investigations, which indicated that CS knees without a PCL are less resistant to posterior tibial displacement than CR knees with one. This study employing virtual ligaments confirms previous findings that the raised anterior lip of some CS bearings may not completely compensate for the absence of the PCL; however, as both studies used reduced joint contact forces, the contributions of this design feature may be attenuated.
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Affiliation(s)
- Samira Vakili
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada; Western's Bone and Joint Institute, Western University, London, ON N6A 5B9, Canada
| | - Brent Lanting
- Department of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada; Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
| | - Alan Getgood
- Department of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada; Fowler-Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada; Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
| | - Ryan Willing
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada; Department of Mechanical & Materials Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada; Western's Bone and Joint Institute, Western University, London, ON, Canada
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Xiong B, Yu Y, Xie B, Wang G, Yang X, Liu J, Gu Z, Li Y. Clinical efficacy and kinematic analysis of Chinese knotting technique-assisted posterior cruciate ligament reconstruction: A retrospective analysis. Medicine (Baltimore) 2024; 103:e37840. [PMID: 38669412 DOI: 10.1097/md.0000000000037840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
To investigate the clinical efficacy and knee joint kinematic changes of posterior cruciate ligament (PCL) reconstruction assisted by Chinese knotting technique (CKT). A retrospective analysis was conducted on 88 cases of PCL reconstructive surgery admitted between September 2016 and September 2020. All patients were operated on by the same senior doctor and his team. The patients were divided into 2 groups according to whether the CKT was applied, with 44 cases in each group. Both groups received active rehabilitation treatment after surgery. All patients were followed up for more than 2 years. International knee documentation committee, hospital for special surgery (HSS), and Lysholm scores were used to evaluate the clinical efficacy of the 2 methods at 3, 12, and 24 months after surgery. The motion cycle and kinematic indices of the knee joint were measured by the Opti_Knee three-dimensional motion measurement system before surgery and at 3, 12, and 24 months after surgery. A secondary arthroscopic examination was performed at 12 months after surgery, MAS score was used to evaluate the secondary endoscopic examination of PCL. All the patients had wound healing in stage I without infection. International Knee in both sets Documentation Committee scores, HSS scores and Lysholm scores were gradually improved at all time points (P < .05); compared with the traditional group, the HSS score was higher in the reduction group 12 months after surgery (P < .05), but there was no significant difference at 24 months after surgery. 12 months and 24 months after 3 dimensional motion measurement system using Opti_Knee showed a reduction group before and after displacement and displacement of upper and lower range than the traditional group (P < 0. 05). One year after surgery, the good and good rate of MAS score reduction group was higher than traditional group. CKT assisted PCL reconstruction can improve the subjective function score of the affected knee joint and the results of secondary microscopy. Satisfactory knee kinematic function can be obtained in the early stage, and the anteroposteric relaxation of the knee joint can be reduced.
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Affiliation(s)
- Bohan Xiong
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Martinez FA, Yuan BJ. Posterior Cruciate Ligament Injury After Retrograde Nailing of Periprosthetic Distal Femur Fractures: A Report of 2 Cases. JBJS Case Connect 2024; 14:01709767-202406000-00004. [PMID: 38579021 DOI: 10.2106/jbjs.cc.23.00510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
CASE A 51-year-old man and 64-year-old woman with bilateral cruciate-retaining total knee arthroplasties (CR-TKAs) who sustained unilateral periprosthetic distal femur fractures above their CR-TKA and experienced knee instability secondary to an iatrogenic posterior-cruciate-ligament (posterior cruciate ligament [PCL]) injury from retrograde intramedullary nailing. Both patients recovered knee stability after undergoing revision surgery. CONCLUSION Many CR-TKA designs have sufficient medial-lateral intercondylar distance to place a retrograde nail, femoral components with a relatively posterior transition from the trochlear groove to the intercondylar box will necessitate a nail starting point closer to the PCL origin. This may contribute to iatrogenic postoperative knee instability for patients with CR-TKA designs.
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Affiliation(s)
- Frank A Martinez
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brandon J Yuan
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester Minnesota
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Berninger MT, Drenck TC, Frings J, Krause M, Frosch KH. [Posterolateral instability of the knee joint]. Orthopadie (Heidelb) 2024; 53:297-307. [PMID: 38376535 DOI: 10.1007/s00132-024-04478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 02/21/2024]
Abstract
The posterolateral corner of the knee is composed of a multilayered complex of ligamentous, musculotendinous, and capsular structures, which interact in a synergistic stabilizing manner with the central structures, particularly the posterior cruciate ligament. Injuries of the posterolateral corner are generally accompanied by rupture of the posterior cruciate ligament. Depending on the injured structures, injuries of the posterolateral corner result in posterolateral rotational instability alone (Fanelli A) or with lateral instability (Fanelli B/C). For rotational instability alone, isolated popliteus bypass is an effective procedure; with concomitant lateral instability in flexion, additional stabilization of the lateral collateral ligament is required. Most of the various available techniques are described as open reconstruction procedures. In recent years, arthroscopic techniques for posterolateral reconstruction have also been successfully developed.
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Affiliation(s)
- M T Berninger
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - T C Drenck
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland
| | - J Frings
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - K-H Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland
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Chellamuthu G, Rathi NK, Ashraf M, Vinodh B. Maximum outcome with minimal resources: report of a multiligamentous knee injury managed with 'modified confluent tunnel technique'. BMJ Case Rep 2024; 17:e256609. [PMID: 38514157 PMCID: PMC10961577 DOI: 10.1136/bcr-2023-256609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Multiligamentous knee injuries (MLKIs) are rare and challenging to manage in many aspects. The injury requires prompt diagnosis, reconstruction of multiple ligaments, and management of associated neurovascular injuries. Another important aspect that surgeons should consider is resource availability. Successful management of a case of MLKI using the cost-effective 'modified confluent tunnel technique' is described in this case report. We used confluent tunnels for intra- and extra-articular ligament reconstructions at the femoral side. We incorporated the weave technique for medial collateral ligament (MCL) reconstruction, and Larson's technique for posterolateral corner (PLC) reconstruction in this construct, and augmented the anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction with the remaining PLC and MCL grafts, respectively. This was cost-effective and resulted in good functional outcomes. The technique also helped us to avoid tunnel convergence which is an expected complication in MLKI surgeries.
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Affiliation(s)
- Girinivasan Chellamuthu
- Orthopaedics, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, India
| | - Nitesh Kumar Rathi
- Orthopaedics, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, India
| | - Munis Ashraf
- Orthopaedics, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, India
| | - Benjamin Vinodh
- Orthopaedics, Saveetha Institute of Medical and Technical Sciences (Deemed to be University), Chennai, India
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万 丰, 汪 松, 王 远, 文 耿, 唐 金, 李 浩, 郑 伟. [Arthroscopic suspension fixation with Endobutton in treatment of tibial insertion avulsion fractures of posterior cruciate ligament]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:267-271. [PMID: 38500417 PMCID: PMC10982042 DOI: 10.7507/1002-1892.202401028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
Objective To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on the clinical data of 52 patients (52 knees) with tibial insertion avulsion fractures of PCL, who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022. There were 29 males and 23 females, with an average age of 40.6 years (range, 19-66 years). There were 24 cases of traffic accident injuries, 17 cases of sports injuries, and 11 cases of fall injuries. The time from injury to operation ranged from 6 to 19 days (mean, 13.3 days). According to the Meyers-McKeever classification, there were 30 cases of type Ⅱ and 22 cases of type Ⅲ fractures. All patients exhibited positive posterior drawer test results. Preoperative knee joint function was assessed with Lysholm score (21.3±6.7), International Knee Documentation Committee (IKDC) score (20.7±5.8), and visual analogue scale (VAS) score (5.3±0.7); and knee joint range of motion was (41.73±3.17)°. Based on preoperative CT three-dimensional reconstruction measurements, the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm (mean, 18.1 mm). Operation time and occurrence of complications were recorded, and postoperative imaging was used to assess fracture healing. Knee joint function and pain severity were evaluated using knee joint range of motion, Lysholm score, IKDC score, and VAS score. Results The operation time ranged from 46 to 81 minutes (mean, 56.2 minutes). All patients were followed up 12-28 months (mean, 20.1 months). The iatrogenic fractures of bone fragments occurred during operation in 4 cases; and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation. All incisions healed by first intention. Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure. All patients demonstrated good knee function and had returned to normal activities at 12 months after operation. At last follow-up, the knee joint range of motion was (133.44±4.17)°, Lysholm score 93.6±3.1, IKDC score 93.4±2.5, and VAS score 1.0±0.6, with significant differences compared to preoperative scores ( P<0.05). Conclusion Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate, and the knee joint function recovers well.
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Affiliation(s)
- 丰 万
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
| | - 松 汪
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
| | - 远 王
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
| | - 耿傲 文
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
| | - 金龙 唐
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
| | - 浩 李
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
| | - 伟 郑
- 徐州医科大学附属医院骨科 (江苏徐州 221000)Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China
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7
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Morita Y, Tajima T, Yamaguchi N, Yokoe T, Nagasawa M, Ota T, Ouchi K, Chosa E. Risk factors of failure results after double-bundle reconstruction with autogenous hamstring grafts for isolated posterior cruciate ligament rupture cases. Sci Rep 2024; 14:6192. [PMID: 38486115 PMCID: PMC10940282 DOI: 10.1038/s41598-024-56953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
Posterior tibial translation (PTT) after double-bundle posterior cruciate ligament (PCL) reconstruction has sometimes occurred. Purpose of this study is to identify the risk factors for postoperative PTT after double-bundle PCL reconstruction with a hamstring autograft. Comparing the results of bilateral gravity sag view (GSV) at 12 months after surgery, over 5-mm PTT was defined as 'failure' in this study. Of 26 isolated PCL reconstruction cases, over 5-mm PTT was seen in 7 cases (group F: 9.57 ± 1.28 mm), and 19 cases had less than 5 mm (group G: 2.84 ± 1.29 mm). Age, sex, body mass index (BMI), preoperative GSV, posterior slope angle of the tibia, anterolateral bundle (ALB) and posteromedial bundle (PMB) graft diameters, and tibial tunnel diameter were evaluated. The two groups were compared with the 2 × 2 chi-squared test, the Mann Whitney U-test, and Spearman's rank correlation coefficient. Multivariate logistic regression analysis was also performed to determine the risk factor. Statistical significance was indicated as p < 0.01 for correlation with postoperative PTT, and as p < 0.05 for all other comparisons. Mean age (group G 31.8 ± 12.5 vs group F 34.9 ± 15.9 years), sex (male/female: 15/4 vs 3/4), BMI (25.6 ± 4.6 vs 24.9 ± 3.9 kg/m2), preoperative GSV (11.3 ± 2.2 vs 11.6 ± 2.9 mm), PMB diameter (5.37 ± 0.33 vs 5.36 ± 0.48 mm), and tibial tunnel diameter (9.32 ± 0.58 vs 9.29 ± 0.49 mm) showed no significant differences. ALB diameter was significantly greater in group G (7.0 ± 0.5 mm) than in group F (6.5 ± 0.29 mm; p = 0.022). There was also a significant difference in posterior tibial slope angle (group G 9.19 ± 1.94 vs group F 6.54 ± 1.45, p = 0.004). On Spearman rank correlation coefficient analysis, ALB diameter GSV (correlation coefficient: - 0.561, p = 0.003) and posterior tibial slope angle (correlation coefficient: - 0.533, p = 0.005) showed a significant correlation with postoperative PTT. Multivariate logistic regression analysis showed that ALB diameter (OR 19.028; 95% CI 1.082-334.6; p = 0.044) and posterior slope angle of tibia (OR 3.081; 95% CI 1.109-8.556; p = 0.031) were independently associated with postoperative PTT, respectively. In double-bundle PCL reconstruction with hamstring, smaller ALB graft diameter and lower (flatted) tibial slope angle were considered risk factors for postoperative PTT.
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Affiliation(s)
- Yudai Morita
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuya Tajima
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Nami Yamaguchi
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuji Yokoe
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Makoto Nagasawa
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tomomi Ota
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kouki Ouchi
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Lee WC, Foong CMB, Khoo KMS, Kwan YH, Kunnasegaran R. Faster improvement in outcome scores in posterior stabilised total knee arthroplasty compared to medial congruent system with posterior cruciate ligament retained. Musculoskelet Surg 2024; 108:87-92. [PMID: 37644317 DOI: 10.1007/s12306-023-00797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Abstract
Most studies comparing medial pivot to the posterior stabilised (PS) systems sacrifice the PCL. It is unknown whether retaining the PCL in the Medial Congruent (MC) system may provide further benefit compared to the more commonly used PS system. A retrospective review of a single-surgeon's registry data comparing 44 PS and 26 MC with PCL retained (MC-PCLR) TKAs was performed. Both groups had similar baseline demographics. The PS and MC-PCLR groups had similar pre-operative range of motion (ROM) (PS:104º ± 20º vs. MC-PCLR: 101º ± 19º, p = 0.70), Oxford Knee Score (OKS) (PS: 27 ± 6 vs. MC-PCLR: 26 ± 7, p = 0.62), and Knee Society Scoring System (KS) Function Score (KS-FS) (PS: 52 ± 24 vs. MC-PCLR: 56 ± 23, p = 0.49). The pre-operative KS Knee Score (KS-KS) was significantly lower in the PS group (PS: 44 ± 14 vs. MC-PLR: 53 ± 18, p < 0.05). At 12-months post-operation, there was significant improvement in all parameters (p < 0.01). Both groups had similar ROM (PS: 115º ± 13º vs. MC-PCLR: 114º ± 10º, p = 0.98), OKS (PS: 41 ± 5 vs. MC-PCLR: 40 ± 4, p = 0.50), KS-FS (PS: 74 ± 22 vs. MC-PCLR: 77 ± 16, p = 0.78), and KS-KS (PS: 89 ± 10 vs. MC-PCLR: 89 ± 10, p = 0.89). The PS group had significant improvement in all parameters from preoperation to 3-month postoperation (p < 0.05), but not from 3-month to 1-year postoperation (p ≥ 0.05). The MC-PCLR group continued to have significant improvement from 3-month to 1-year postoperation (p < 0.05). Preserving the PCL when using MC may paradoxically cause an undesired additional restrain that slows the recovery process of the patients after TKA. Compared to MC-PCLR, a PS TKA may expect significantly faster improvement at 3 months post operation, although they will achieve similar outcomes at 1-year post operation.
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Affiliation(s)
- W C Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - C M B Foong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - K M S Khoo
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Y H Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - R Kunnasegaran
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Vishwanathan K, Vaishya R. Ultracongruent Designs Compared to Posterior-Stabilized and Cruciate-Retaining Tibial Inserts-What Does the Evidence Tell Us? A Systematic Review and Meta-Analysis.-Letter to Editor. J Arthroplasty 2024; 39:e22-e23. [PMID: 38341238 DOI: 10.1016/j.arth.2023.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/29/2023] [Accepted: 08/11/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India
| | - Raju Vaishya
- Orthopaedic & Joint Replacement Surgeon, Indraprastha Apollo Hospitals, New Delhi, India
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Akpinar B, DeClouette B, Gonzalez-Lomas G, Alaia MJ. Posterior Cruciate Ligament Reconstruction Current Concepts Review. Bull Hosp Jt Dis (2013) 2024; 82:4-9. [PMID: 38431970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Posterior cruciate ligament (PCL) injuries are a rare form of knee injury often seen in the setting of high energy polytraumas; however, these injuries can occur in isolation as well. Often, the posterolateral corner (PLC) is involved, which imparts further posterior translational and rotational instability to these injuries. While non-operative management is certainly a reliable option for low grade isolated PCL tears, high grade injuries with concomitant PLC involvement, additional intra-articular pathologies requiring operative management, multiligamentous injuries, or patients who have failed non-operative management require PCL repair or reconstruction. The current review focuses on the many facets of PCL reconstruction, including single versus double bundle reconstruction, tibial slope implications, graft selection, multiligamentous injury considerations, tunnel management, and onlay versus inlay tibial footprint creation. We conclude with a proposed algorithm in the management of this injury.
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Qu D, Zhang J, Li L, Fu H, Zhang D, Tang X, Han X, Qi C. [Comparison of intraoperative effects of computer navigation-assisted and simple arthroscopic reconstruction of posterior cruciate ligament tibial tunnel]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:155-161. [PMID: 38385227 PMCID: PMC10882236 DOI: 10.7507/1002-1892.202311012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. Methods The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. Results The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant ( P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups ( P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group ( P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values ( P<0.05), but there was no significant difference between the two groups ( P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values ( P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups ( P>0.05). Conclusion Computer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.
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Affiliation(s)
- Di Qu
- Qingdao Medical College of Qingdao University, Qingdao Shandong, 266073, P. R. China
| | - Jing Zhang
- Qingdao Medical College of Qingdao University, Qingdao Shandong, 266073, P. R. China
| | - Liping Li
- Department of Orthopedic Surgery, Qingdao Central Hospital, Qingdao Shandong, 266042, P. R. China
| | - Haitao Fu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P. R. China
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P. R. China
| | - Xinyu Tang
- Qingdao Medical College of Qingdao University, Qingdao Shandong, 266073, P. R. China
| | - Xinkun Han
- Qingdao Medical College of Qingdao University, Qingdao Shandong, 266073, P. R. China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P. R. China
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Wu J, He H, Yuan L, Ma T. Surgical treatment of posterior cruciate-ligament tibial avulsion fractures using arthroscopic wire combined with NICE ligation: A case series. Asian J Surg 2024; 47:1071-1072. [PMID: 38036369 DOI: 10.1016/j.asjsur.2023.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Jinqiu Wu
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China
| | - Hairong He
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China.
| | - Lingwei Yuan
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China
| | - Tao Ma
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China
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13
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Yang Q, Lu W, Luo Y, Li J, Huang X, You T. A Novel Predictor of the Length and Size of ACL Grafts in Chinese Han Adults for ACL Reconstruction: An MRI Study. Orthop Surg 2024; 16:481-489. [PMID: 38174408 PMCID: PMC10834193 DOI: 10.1111/os.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Currently, there is no simple and valid method to predict the length and size of the native anterior cruciate ligament (ACL) in each adult patient who will undergo ACL reconstruction. This study aimed to develop an imaging prediction method that can predict the length and size of ACL grafts using the intact posterior cruciate ligament (PCL), in order to enhance the graft preparation individualized sizing. METHODS Three hundred and nineteen patients aged 18 years or older who underwent magnetic resonance imaging (MRI) of the knee at an orthopaedic clinic between September 9, 2021, and February 5, 2023, were included. The length, sagittal diameter, and coronal diameter of the ACL and PCL were measured in all patients, and F-test were performed to explore linear relationship between ligament measurements. RESULTS Equations were established to predict a variable of the native ACL for the corresponding variable of the intact PCL (i.e., sagittal diameter of the ACL = 4.32 + 1.08 × sagittal diameter of the PCL, and coronal diameter of the ACL = 2.45 + 0.59 × coronal diameter of the PCL, length of the male ACL = 10.92 + 0.64 × length of the male PCL, length of the female ACL = 11.76 + 0.58 × length of the female PCL) (R2 = 0.532; R2 = 0.417; R2 = 0.488; R2 = 0.509; respectively). CONCLUSIONS The length and size of the intact PCL in cases without PCL buckling are predictors of the length and size of the native ACL in adults, respectively. The use of this information to optimize graft diameter may lower the rates of ACL graft failure in the future.
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Affiliation(s)
- Qingjun Yang
- Peking University Shenzhen HospitalShenzhenChina
| | - Wenqian Lu
- Clinical Medical CollegeShenzhen UniversityShenzhenChina
| | - Yong Luo
- Clinical Medical CollegeShantou UniversityShantouChina
| | - Jiatong Li
- Clinical Medical CollegeShenzhen UniversityShenzhenChina
| | - Xiancheng Huang
- Clinical Medical College, Weifang Medical UniversityWeifangChina
| | - Tian You
- Peking University Shenzhen HospitalShenzhenChina
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Tille E, Beyer F, Lützner C, Postler A, Lützner J. Better Flexion but Unaffected Satisfaction After Treatment With Posterior Stabilized Versus Cruciate Retaining Total Knee Arthroplasty - 2-year Results of a Prospective, Randomized Trial. J Arthroplasty 2024; 39:368-373. [PMID: 37598783 DOI: 10.1016/j.arth.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Both the cruciate-retaining (CR) and posterior-stabilized (PS) implant systems are commonplace in modern total knee arthroplasty (TKA) practice. However, there is controversy regarding functional outcomes and survivorship. The aim of the underlying study was to evaluate differences between CR and PS TKA regarding knee function, patient-reported outcome measures (PROMs) as well as complication rates. METHODS 140 patients with knee osteoarthritis scheduled for an unconstrained TKA were enrolled in a prospective, randomized study. Patients received either a CR or PS implant. Range of motion and PROMs (Oxford Knee Score, Knee Society Score, European Quality of Life 5 Dimensions 3 Level, University of California Los Angeles Activity scale and subjective satisfaction) were assessed prior to, 3 months, 1 and 2 years after surgery. RESULTS We found minor differences between treatment groups regarding demographic factors. Within the PS group duration of surgery was longer (mean PS 81.4 min vs CR 76.0 min, P = .006). We observed better flexion (median PS 120.0° vs CR 115°, P = .017) and an overall better range of motion (median PS 120.0° vs CR 115.0°, P = .008) for the PS group. PROMs did not differ between groups. At 2-year follow-up there were no revisions in either cohort. Five patients needed reoperations. Three patients needed manipulation under anesthesia, 2 in the CR and one in the PS group. CONCLUSION While PS TKA achieved a better flexion capability, PROMs were similar in CR and PS TKA. The CR implant design continues to be a reliable option for patients with an intact posterior cruciate ligament.
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Affiliation(s)
- Eric Tille
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany; Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Anne Postler
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopedic, Trauma and Plastic Surgery, University Hospital, Technical University Dresden, Dresden, Germany
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Merle du Bourg V, Orfeuvre B, Gaulin B, Sigwalt L, Horteur C, Rubens-Duval B. Functional and MRI results after a 7.5 year follow-up of 35 single-stage ACL and PCL reconstructions using gracilis and semitendinosus tendon grafts and LARS artificial ligaments. Eur J Orthop Surg Traumatol 2024; 34:1163-1172. [PMID: 37991595 DOI: 10.1007/s00590-023-03774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term functional and MRI results of 35 patients who underwent bicruciate ligament reconstruction combining an ACL autograft using the gracilis and semitendinosus tendons and double-bundle PCL reconstruction using the LARS artificial ligament. METHODS The outcomes were measured using the Lysholm score, the Tegner activity level scale and the International Knee Documentation Committee form (IKDC 2000). KT-1000 was used to assess the clinical anterior knee laxity. Radiographs and Magnetic Resonance Imaging (MRI) was used to evaluate osteoarthritis, the continuity and integrity of ACL autograft and LARS. RESULTS This retrospective study examined 35 patients who underwent single-stage bicruciate ligament reconstruction between May 2005 and January 2017 with a follow-up period ranging from 3 to 15 years (a mean of 7.5 years). The mean Lysholm score was 74, mean IKDC 2000 was 71. There was a statistically significant difference with a higher Lysholm score (78.9) in early versus delayed surgical intervention (p = 0.023). Using the Kellgren Lawrence osteoarthritis classification system, radiographic findings showed stage II or III in 83% of the sample population. The MRI results revealed a rupture rate of 22% of the anterior autografted ligament and 28% of the posterior LARS artificial ligament. However, there were no long-term artificial ligament-induced complications. There was no correlation between artificial ligament rupture and poor functional results (Lysholm < 65). CONCLUSION The results of this study with a mean follow-up of 7.5 years show satisfactory functional scores considering the initial trauma. It seems reasonable to propose early surgical treatment with double reconstruction of the cruciate ligaments within the first 21 days of the trauma. Post-traumatic osteoarthritis is inevitable in multi-ligament knee injuries despite anatomical reconstruction. The use of a LARS artificial ligament appears to be a valid alternative for PCL reconstruction in the context of multi-ligament injury and in the absence of sufficient autologous transplants.
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Affiliation(s)
- Valentin Merle du Bourg
- Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France.
| | - Benoit Orfeuvre
- Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France
| | - Benoit Gaulin
- Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France
| | - Loic Sigwalt
- Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France
| | - Clément Horteur
- Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France
| | - Brice Rubens-Duval
- Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France
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Niu Y, Chen Z, Jin L, Zheng Y, Zhang Z, Wang F, Zhang Z, Ma J, Men X, Dong J. A modified anatomical posterior cruciate ligament reconstruction technique using the posterior septum and posterior capsule as landmarks to position the low tibial tunnel. BMC Musculoskelet Disord 2024; 25:73. [PMID: 38238705 PMCID: PMC10795373 DOI: 10.1186/s12891-024-07176-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Lowering the exit position of the tibial tunnel can improve the clinical efficacy of posterior cruciate ligament (PCL) reconstruction, however, there is no unified positioning standard. This study aimed to use novel soft tissue landmarks to create a low tunnel. METHODS A total of 14 human cadaveric knees and 12 patients with PCL injury were included in this study. Firstly, we observed the anatomical position between the PCL, posterior septum, and other tissue, and evaluated the relationship between the center of the low tibial tunnel (SP tunnel) and posterior septum and distal reflection of posterior capsule, and using computed tomography (CT) to evaluate distance between the center of the SP tunnel with bony landmarks. Then, evaluated the blood vessels content in the posterior septum with HE staining. Finally, observed the posterior septum and distal reflection of the posterior capsule under arthroscopy to explore the clinical feasibility of creating a low tibial tunnel, and assessed the risk of surgery by using ultrasound to detect the distance between the popliteal artery and the posterior edge of tibial plateau bone cortex. RESULTS In all 14 cadaveric specimens, the PCL tibial insertions were located completely within the posterior medial compartment of the knee. The distance between the center of the SP tunnel and the the articular surface of tibial plateau was 9.4 ± 0.4 mm. All SP tunnels retained an intact posterior wall, which was 1.6 ± 0.3 mm from the distal reflection of the posterior capsule. The distances between the center of the SP tunnel and the the articular surface of tibial plateau, the champagne glass drop-off were 9.2 ± 0.4 mm (ICC: 0.932, 95%CI 0.806-0.978) and 1.5 ± 0.2 mm (ICC:0.925, 95%CI 0.788-0.975) in CT image. Compared with the posterior capsule, the posterior septum contained more vascular structures. Last, all 12 patients successfully established low tibial tunnels under arthroscopy, and the distance between the posterior edge of tibial plateau bone cortex and the popliteal artery was 7.8 ± 0.3, 9.4 ± 0.4 and 7.4 ± 0.3 mm at 30°, 60° and 90° flexion angels after filling with water and supporting with shaver in posterior-medial compartment of knee joint. CONCLUSIONS A modified low tibial tunnel could be established in the PCL anatomical footprint by using the posterior septum and posterior capsule as landmarks.
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Affiliation(s)
- Yingzhen Niu
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Zhen Chen
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Lingpeng Jin
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Yi Zheng
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Zhuangdai Zhang
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Fei Wang
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Zhenfeng Zhang
- Department of Orthopedics, Tiemenguan People's Hospital, Tiemenguan, China
| | - Jun Ma
- Department of Hebei Medical University, Shijiazhaung, China
| | - Xiaoqian Men
- Department of Ultrasound, Hebei Medical University Third Hospital, Shijiazhaung, China
| | - Jiangtao Dong
- Department of Joint Surgery, Hebei Medical University Third Hospital, Shijiazhaung, China.
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Yang H, Zhong J, Li Z, Liu J. Single-stage surgery of distal femoral type B fracture combined with posterior cruciate ligament injury. Asian J Surg 2024; 47:620-621. [PMID: 37805331 DOI: 10.1016/j.asjsur.2023.09.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Haibo Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Jun Zhong
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
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Rossi SMP, Sangaletti R, Jannelli E, Bova D, Montagna A, Benazzo F. PCL preservation or sacrifice does not influence clinical outcomes and survivorship at mid-term follow-up of a J-curve CR total knee replacement with a medial congruent liner and a functional coronal alignment. Arch Orthop Trauma Surg 2024; 144:307-313. [PMID: 37612567 DOI: 10.1007/s00402-023-05033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND In recent years, increasing interest has arisen for medial pivoting TKA implants, designed to mimic the physiological knee kinematics, maximizing the contact area on the medial compartment of the knee, increasing anterior-posterior stability, and contributing to a ball-in-socket effect that allows the posterior cruciate sacrifice without a post-CAM mechanism. The medial congruent liner works with a J-curve cruciate-retaining (CR) femur without a real ball-in-socket design. The aim of this study was to evaluate the clinical outcomes and survival of these implants, with or without PCL sparing, at a medium follow-up. METHODS Between October 2016 and October 2018, 165 TKRs were performed in 161 patients (69.2% females and 30.8% males) and prospectively followed. Mean follow-up was 72 ± 12 months. All surgeries were performed using an extramedullary device and the same prosthetic implant. Patients were matched in two groups: in 80 patients, the PCL was preserved; in 85 patients, the PCL was sacrificed with a reduction of the tibial slope. RESULTS The OKS and KSS improved in both groups. The difference between the two groups at the final follow-up was not statistically significant. Good-to-excellent clinical results according to the KSS were achieved in 93% of the knees in the PCP group and in 95% in the PCS group. At final follow-up, the Forgotten Joint Score (FJS) was 73.6 in the PCP group and 74.1 in the PCS group with no statistical difference between the two groups (P > 0.05). CONCLUSIONS TKA with a medially congruent insert, showed promising results at mid-term follow-up, PCL preservation or sacrifice did not affect the clinical outcomes and survival. Further follow-up will be needed to evaluate these results at long term.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
| | - Eugenio Jannelli
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Bova
- U.O. Ortopedia e Traumatologia, Humanitas Mater Domini, Castellanza, Italy
| | - Alice Montagna
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati, 57, 25124, Brescia, Italy
- IUSS, Istituto Universitario di Studi Superiori, Pavia, Italy
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Nedaie S, Vivekanantha P, O'Hara K, Slawaska-Eng D, Cohen D, Abouali J, Hoshino Y, Nagai K, Johnson J, de Sa D. Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:167-180. [PMID: 38226729 DOI: 10.1002/ksa.12025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE To determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction. METHODS Three databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p-values for comparisons of values between patients with PCL pathology and control patients, were recorded. RESULTS Nine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0-7.0) and 6.5 (range: 5.0-9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90-3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0-2.2) and 2.6 (range: 2.4-2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries. CONCLUSION Decreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Soroush Nedaie
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kaylin O'Hara
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Dan Cohen
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Jihad Abouali
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jansen Johnson
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Darren de Sa
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
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20
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Maniar AR, White AE, Musahl V, Ranawat A. Posterolateral Corner of the Knee: An Update on Current Evaluation and Management Strategies. J Am Acad Orthop Surg 2024; 32:e13-e23. [PMID: 37476845 DOI: 10.5435/jaaos-d-23-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023] Open
Abstract
Historically, the posterolateral corner (PLC) of the knee has been labelled as the "dark side" of the knee. The PLC is not a single structure but a confluence of multiple structures, including the lateral collateral ligament, popliteus muscle-tendon unit, and popliteofibular ligament. Understanding the individual components and their function is important to successfully identify these injuries. PLC injuries are commonly associated with cruciate injuries, and its early recognition is important to achieve successful outcomes. Injury to the PLC should be treated on a case-by-case basis, and an appropriate algorithm is required to manage them. Multiple surgical techniques ranging from primary repair to anatomic reconstruction have been reported in managing these injuries. We present the latest literature on the anatomy, biomechanics, clinical presentation, imaging, available techniques, and current management recommendations. There is a special focus on the pathoanatomy, which will help guide the treatment of these injuries.
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Affiliation(s)
- Adit R Maniar
- From the Ranawat Orthopaedic Research Foundation, New York, NY (Maniar), Hospital for Special Surgery, New York, NY (White), UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA (Musahl), and Hospital for Special Surgery, New York, NY (Ranawat)
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21
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Li Y, Liu JC, Wu J, Peng X, Sun GJ, Li Z, Yin Y. Biomechanical study of posterior cruciate ligament tibial arrest avulsion fracture fixation with triple tibial channel net sutures. Sci Rep 2023; 13:22980. [PMID: 38151505 PMCID: PMC10752874 DOI: 10.1038/s41598-023-50479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023] Open
Abstract
To investigate the biomechanical properties of posterior cruciate ligament avulsion fractures of the tibia fixed using four different methods, including triple tibial channel net suture fixation. In 40 porcine knees, a standardized bony avulsion of the posterior cruciate ligament was generated. Double tibial bone channel suture fixation was performed in group A, double-head hollow compression screw fixation was performed in group B, triple tibial bone channel net suture fixation was performed in group C, and cortical suspension EndoButton fixation was performed in group D. The constructs were cyclically loaded 500 times (10 to 100 N) to measure the initial displacement and stiffness values. Subsequently, loading to failure was performed, and the yield load and peak load were measured. The results were analysed by one-way ANOVA, with significance set at P < 0.05. The initial displacement in group D (1.00 ± 0.20 mm) was lower than that in group C (1.46 ± 0.33 mm, P = 0.000), group B (1.91 ± 1.71 mm, P = 0.000) and group A (3.91 ± 0.79 mm, P = 0.000), but there was no significant difference between groups B and C (P = 0.055). The initial stiffness in group A (50.59 ± 6.89 N/mm) was lower than that in group C (67.21 ± 12.80 N/mm, P = 0.001), group D (71.18 ± 9.20 N/mm, P = 0.000) and group B (78.67 ± 5.91 N/mm, P = 0.000). However, there was no significant difference between groups B and D or between groups C and D (P = 0.111 and P = 0.391). The yield load in group A (554.86 ± 71.43 N) was lower than that in group C (767.00 ± 34.53 N, P = 0.000), group D (777.62 ± 73.03 N, P = 0.000) and group B (837.50 ± 55.73 N, P = 0.000). There was no significant difference between groups C and D (P = 0.729). The peak load in group A (667.38 ± 61.54 N) was lower than that in group C (842.00 ± 26.20 N, P = 0.000), group D (867.63 ± 63.42 N, P = 0.000) and group B (901.25 ± 54.38 N, P = 0.000). There was no significant difference between groups C and D (P = 0.346). Different failure modes were found among the four groups. The triple tibial bone channel suture fixation group showed better initial stability and fixation strength, which was comparable to that in the cortical suspension EndoButton fixation group and double-head hollow compression screw fixation group and significantly stronger than that in the double tibial bone channel suture fixation group. This study analysed the dynamic and static indexes of posterior cruciate ligament tibial avulsion fractures fixed by four different fixation methods under cyclic loading tests and single failure loading tests, providing a theoretical basis for clinical treatment.
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Affiliation(s)
- Yuan Li
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Jun-Cai Liu
- Department of Orthopaedics, Sichuan Provincial Laboratory of Orthopaedic Engineering, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China
| | - Ju Wu
- Department of Stomatology, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Xu Peng
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Guan-Jun Sun
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, Sichuan Provincial Laboratory of Orthopaedic Engineering, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.
| | - Yi Yin
- Department of Joint Surgery, Suining Central Hospital, Suining, 629000, Sichuan, People's Republic of China.
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Inui H, Yamagami R, Kono K, Kawaguchi K, Kage T, Murakami R, Nakamura H, Saita K, Taketomi S, Tanaka S. Short-term clinical results of bicruciate-retaining total knee arthroplasty using personalized alignment. BMC Musculoskelet Disord 2023; 24:965. [PMID: 38087214 PMCID: PMC10714564 DOI: 10.1186/s12891-023-07083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Bicruciate-retaining (BCR) prosthesis has been introduced to recreate normal knee movement by preserving both the anterior and posterior cruciate ligaments. However, the use of BCR total knee arthroplasty (TKA) is still debatable because of several disappointing reports. We have been performing BCR TKAs with personalized alignment (PA). This study aimed to reveal the limb alignment and soft tissue balance of FA-BCR TKAs and compare the clinical outcomes of FA-BCR TKAs with those of unicompartmental knee arthroplasty (UKA). METHODS Fifty BCR TKAs and 58 UKAs were included in this study. The joint component gaps of BCR TKA were evaluated intraoperatively and the postoperative hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were measured using full-length standing radiography. The short-term clinical outcomes of BCR TKAs were compared with those of UKA using the scoring system of 2011 Knee Society Scoring (KSS) and the knee injury and osteoarthritis outcome score (KOOS) at an average of 2 years postoperatively (1-4yeras). RESULTS The coronal alignment values of PA-BCR TKA were as follows: HKA angle, 177.9° ± 2.3°; MPTA, 85.4° ± 1.9°; and LDFA, 87.5° ± 1.9°. The joint component gaps at flexion angles of 10°, 30°, 60°, and 90° were 11.1 ± 1.2, 10.9 ± 1.4, 10.7 ± 1.3, and 11.2 ± 1.4 mm for the medial compartment and 12.9 ± 1.5, 12.6 ± 1.8, 12.5 ± 1.8 and 12.5 ± 1.7 mm for the lateral compartment, respectively. The patient expectation score and maximum extension angle of PA-BCR TKA were significantly better than those of UKAs. CONCLUSIONS The short-term clinical outcomes of PA-BCR TKA were comparable or a slightly superior to those of UKAs.
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Affiliation(s)
- Hiroshi Inui
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Haruhiko Nakamura
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Kazuo Saita
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Ma W, Yang Y, Ha X. Two-stage ligament reconstruction with remnant preservation as treatment of knee dislocation. BMC Surg 2023; 23:371. [PMID: 38066516 PMCID: PMC10704695 DOI: 10.1186/s12893-023-02271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical outcomes of two-stage reconstruction (peripheral reconstruction in phase I and central anterior cruciate ligament (ACL) / posterior cruciate ligament (PCL) reconstruction in phase II) with remnant preservation for patients with knee dislocation. METHODS A total of 70 patients (10 IIIM, 17 IIIL, and 43 IV) with knee dislocation were randomly divided into the remnant-preserved group and the simple reconstruction group. Patients underwent two-stage reconstruction, including the reconstruction of collateral ligament in phase I and the reconstruction of ACL/PCL in phase II (12 weeks after phase I). Grafts were harvested from the semitendinosus and gracilis tendons from both lower limbs. After the surgery, the joint flexion and extension, bone tunnel and ligament healing, and joint stability were evaluated. RESULTS After the surgery, the lateral stability recovered in all patients, and X-ray revealed a good position of bone tunnel. Follow-up was performed at 12 months postoperatively and ranged from 24 to 91 months. At the final follow-up, knee flexion angle, IKDC, Lysholm, and Tegner scores were all higher in both groups compared to the preoperative period. Notably, the remnant-preserved group showed superior results in these parameters compared to the simple reconstruction group. There was statistical significance between the two groups in terms of the Lachman test. CONCLUSION The knee function was well recovered after two-stage ligament reconstruction with remnant preservation.
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Affiliation(s)
- Wenpu Ma
- Department of Orthopaedics, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China
| | - Yiqun Yang
- Department of Orthopaedics, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China
| | - Xin Ha
- Department of Electromyogram, Liaocheng People's Hospital, No. 67, Dongchang west Road, Liaocheng City, 252000, Shandong Province, China.
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24
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Favroul C, Batailler C, Naaim A, Foissey C, Kafelov M, Cheze L, Servien E, Lustig S. Cruciate-substituting and posterior-stabilised total knee arthroplasties had similar gait patterns in the short term. Knee Surg Sports Traumatol Arthrosc 2023; 31:5398-5406. [PMID: 37752347 DOI: 10.1007/s00167-023-07594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE Surgeons want to achieve native kinematics in primary total knee arthroplasty (TKA). Cruciate-substituting (CS) implants could restore the knee kinematics more efficiently than posterior-stabilised (PS) TKA. This study aimed to compare gait patterns in patients with CS or PS TKA at 6 months. The hypothesis was that CS implants would demonstrate comparable gait parameters to PS implants at 6 months. METHODS In this prospective case-control study, 38 primary TKA without coronal laxity were divided into 2 groups: 19 cruciate-substituting (CS) and 19 posterior-stabilised (PS) implants. The type of prosthesis was determined according to the surgical period. Exclusion criteria were TKA revision, associated procedures and inability to walk on a treadmill. Gait analysis was conducted on a treadmill 6 months postoperatively for each patient with a knee assessment device (KneeKG®). Gait characteristics included analysis in three spatial dimensions (flexion-extension, abduction-adduction, internal-external rotation, anterior-posterior translation). Clinical outcomes (Knee Society Score and Forgotten Joint Score) were compared between both groups at 6 months postoperatively. RESULTS At 6 months, the gait analysis did not demonstrate any significant difference between CS and PS implants. The range and the maximum anteroposterior translation were similar in both groups (9.2 ± 6.5 mm in CS group vs. 8.1 ± 3 mm in PS group (n.s.); and - 5.2 ± 5 mm in CS group vs. - 6.3 ± 5.9 mm in PS group (n.s.), respectively). The internal/external rotation, the flexion, and the varus angle were similar between CS and PS implants. The KSS Knee score was higher at 6 months in the CS group than in the PS group (92.1 ± 5.6 vs. 84.8 ± 8.9 (p < 0.01)). CONCLUSION Cruciate-substituting and posterior-stabilised TKA had similar gait patterns at 6 months postoperatively, despite a non-equivalent posterior stabilisation system. CS prostheses were an interesting option for primary TKA for knee kinematics restoration without requiring a femoral box. LEVEL OF EVIDENCE Prospective, case-control study; Level II.
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Affiliation(s)
- Clément Favroul
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
| | - Alexandre Naaim
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Constant Foissey
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Moussa Kafelov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Laurence Cheze
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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Fortier LM, Knapik DM, Condon JJ, DeWald D, Khan Z, Kerzner B, Matava MJ, LaPrade R, Chahla J. Higher success rate observed in reconstruction techniques of acute posterolateral corner knee injuries as compared to repair: an updated systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5565-5578. [PMID: 37848567 DOI: 10.1007/s00167-023-07582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE There remains controversy regarding the optimal surgical treatment for acute complete (grade III) posterolateral corner (PLC) injuries. The purpose of this article is to systematically review the contemporary literature regarding surgical options and subsequent outcomes of acute grade III PLC injuries. METHODS A systematic review was performed using the following search terms: posterolateral corner knee, posterolateral knee, posterolateral instability, multi-ligament knee, and knee dislocation. Inclusion criteria consisted of studies with level I-IV evidence, reporting on human patients with acute grade III PLC injuries undergoing operative management within 4 weeks from injury, with subjective and/or objective outcomes (including varus stress examinations or varus stress radiographs) reported at a minimum 2-year follow-up. Two investigators independently performed the search by sequentially screening articles. Accepted definitions of varus stability on examination or stress radiographs and revision surgery were used to determine success and failure of treatment. RESULTS A total of 12 studies, consisting of 288 patients were included. Ten studies reported primary repair, while reconstruction techniques were reported in seven studies. Overall, 43% (n = 125/288) of injuries involved the PLC, ACL and PCL. Staged reconstruction was reported in 25% (n = 3/12) of studies. The Lysholm score was the most commonly reported outcome measure. An overall failure rate of 12.4% (n = 35/282) was observed. Surgical failure was significantly higher in patients undergoing repair (21.9%; n = 21/96) compared to reconstruction (7.1%; n = 6/84) (p = 0.0058). Return to sport was greater in patients undergoing reconstruction (100%; n = 22/22) compared to repair (94%; n = 48/51) (n.s). The most common post-operative complication was arthrofibrosis requiring manipulation under anesthesia (8.7%; n = 25/288). A total of 3.8% (n = 11/288) of patients underwent revision PLC reconstruction. CONCLUSION There remains substantial heterogeneity in the surgical techniques of acute, grade III PLC injuries with an overall failure rate of 12.4%. Failure rates were significantly lower, and return to sport rates higher in patients undergoing PLC reconstruction compared to repair. The most common postoperative complication was arthrofibrosis requiring manipulation under anesthesia. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, Chesterfield, MO, 63017, USA
| | - Josh J Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL, 60612, USA
| | - Daniel DeWald
- Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Zeeshan Khan
- Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL, 60612, USA
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, Chesterfield, MO, 63017, USA
| | - Robert LaPrade
- Twin Cities Orthopaedics, 4010 W 65th St., Edina, MN, 55435, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, 1611 W Harrison St., Chicago, IL, 60612, USA.
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL, 60612, USA.
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Rehman Y, Korsvold AM, Lerdal A, Aamodt A. No difference in patient-reported outcomes with cruciate-retaining, anterior-stabilized, and posterior-stabilized total knee arthroplasty designs. Bone Joint J 2023; 105-B:1271-1278. [PMID: 38037687 DOI: 10.1302/0301-620x.105b12.bjj-2023-0064.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims This study compared patient-reported outcomes of three total knee arthroplasty (TKA) designs from one manufacturer: one cruciate-retaining (CR) design, and two cruciate-sacrificing designs, anterior-stabilized (AS) and posterior-stabilized (PS). Methods Patients scheduled for primary TKA were included in a single-centre, prospective, three-armed, blinded randomized trial (n = 216; 72 per group). After intraoperative confirmation of posterior cruciate ligament (PCL) integrity, patients were randomly allocated to receive a CR, AS, or PS design from the same TKA system. Insertion of an AS or PS design required PCL resection. The primary outcome was the mean score of all five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) at two-year follow-up. Secondary outcomes included all KOOS subscales, Oxford Knee Score, EuroQol five-dimension health questionnaire, EuroQol visual analogue scale, range of motion (ROM), and willingness to undergo the operation again. Patient satisfaction was also assessed. Results Patients reported similar levels of pain, function, satisfaction, and general health regardless of the prosthetic design they received. Mean maximal flexion (129° (95% confidence interval (CI) 127° to 131°) was greater in the PS group than in the CR (120° (95% CI 121° to 124°)) and AS groups (122° (95% CI 120° to 124°)). Conclusion Despite differences in design and constraint, CR, AS, and PS designs from a single TKA system resulted in no differences in patient-reported outcomes at two-year follow-up. PS patients had statistically better ROM, but the clinical significance of this finding is unclear.
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Affiliation(s)
- Yasser Rehman
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ann M Korsvold
- Department of Physiotherapy, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Research and Development, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
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Fiedler B, Bieganowski T, Anil U, Lin CC, Habibi AA, Schwarzkopf R. Can pain be improved with retention of the posterior cruciate ligament during total knee arthroplasty? Eur J Orthop Surg Traumatol 2023; 33:3395-3401. [PMID: 37140671 DOI: 10.1007/s00590-023-03562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE The purpose of the current study was to determine if differences exist between cruciate-retaining (CR) and posterior-stabilized (PS) implant articulations for total knee arthroplasty (TKA) with regards to early post-operative pain. METHODS We retrospectively reviewed patients who underwent primary TKA, with the same TKA implant design, at our institution between January 2018 and July 2021. Patients were stratified based on whether they received a CR or non-constrained PS (PSnC) articulation and propensity score matched in a 1:1 ratio. A sub-analysis matching patient who received a constrained PS implant (PSC) to those undergoing CR TKA and PSnC TKA was also carried out. Opioid dosages were converted to morphine milligram equivalents (MME). RESULTS 616 patients after CR TKA were matched 1:1 to 616 patients with a PSnC implant. There were no significant differences between demographic variables. There were no statistically significant differences in opioid usage measured by MME on post-operative day (POD) 0 (p = 0.171), POD1 (p = 0.839), POD2 (p = 0.307), or POD3 (p = 0.138); VAS pain scores (p = 0.175); or 90-day readmission rate for pain (p = 0.654). A sub-analysis of CR versus PSC TKA demonstrated no significant differences in opioid usage on POD0 (p = 0.765), POD1 (p = 0.747), POD2 (p = 0.564), POD3 (p = 0.309); VAS pain scores (p = 0.293); and 90-day readmission rate for pain (p > 0.9). CONCLUSION Our analysis demonstrated no significant difference in post-operative VAS pain scores and MME usage based on implant. The results suggest that neither the type of articulation or constraint used for primary TKA has a significant impact on immediate post-operative pain and opioid consumption. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA
| | - Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA
| | - Charles C Lin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA
| | - Akram A Habibi
- Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Center, NYU Langone Health, 301 East 17th Street, 14th Floor, New York, NY, USA.
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28
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Gensior TJ, Mester B, Achtnich A, Winkler PW, Henkelmann R, Hepp P, Glaab R, Krause M, Frosch KH, Zellner J, Schoepp C. Anatomic repair and ligament bracing as an alternative treatment option for acute combined PCL injuries involving the posteromedial or posterolateral corner-results of a multicentre study. Arch Orthop Trauma Surg 2023; 143:7123-7132. [PMID: 37691046 PMCID: PMC10635947 DOI: 10.1007/s00402-023-05015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Combined PCL injuries involving the posteromedial/-lateral corner (PMC/PLC) usually require surgical management. Literature shows controversy regarding the standards of treatment. Suture-augmented repair leads to excellent results in acute knee dislocations but has not been investigated clinically in combined PCL injuries. The purpose of this multicentre study was to evaluate the clinical outcome of this technique in acute combined PCL injuries. MATERIALS & METHODS N = 33 patients with acute combined PCL injuries involving the PMC/PLC were treated by one-stage suture repair with ligament bracing of the PCL and suture repair of the accompanying PMC/PLC injuries with/without ligament bracing or primary augmentation by semitendinosus autograft. Outcome was assessed by IKDC questionnaire, Lysholm Score, Tegner Activity Scale and KOOS. Additional PCL stress-radiography was performed. RESULTS N = 31 patients with combined PCL injuries (female: male = 7:24; age 39.1 ± 13.8 years) with a follow-up of 16.8 ± 9.6 months were finally evaluated. 18 had PMC injuries, 13 PLC injuries. 32.2% presented with accompanying meniscal tears (70% medial meniscus). 19.4% showed cartilage injuries grade III-IV. Complications included one infection and four knee stiffnesses. Three had symptomatic postoperative instability, all affiliated to the PLC group. The IKDC was 69.8 ± 16.5, Lysholm score 85 ± 14.4 and KOOS 89.7 ± 8.1. Median loss of activity (Tegner) was 0.89 ± 1.31. Comparing PMC and PLC, all scores showed a tendency towards more favourable outcomes in the PMC group (n.s.). Stress-radiography showed an overall side-to-side difference of 3.7 ± 3.8 mm. Subgroup evaluation showed statistically significant better results (p = 0.035) of PMC (2.5 ± 1.5 mm) versus PLC (5.8 ± 5.6 mm). CONCLUSIONS One-stage suture repair with ligament bracing is a viable technique for acute combined PCL injuries and predominantly leads to good and excellent clinical outcomes. Patients with PLC injuries show a tendency towards inferior outcomes and higher instability rates compared to PMC injuries. These results may help in therapy planning and counselling patients with these rare injury pattern. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Tobias J Gensior
- OPND Clinic Neuss-Düsseldorf, Neuss, Germany
- Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - Bastian Mester
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany.
- Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland.
| | - Andrea Achtnich
- Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Ligament Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - Philipp W Winkler
- Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria
| | - Ralf Henkelmann
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
- Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - Pierre Hepp
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
- Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - Richard Glaab
- Department of Traumatology, Cantonal Hospital Aarau, Aarau, Switzerland
- Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Ligament Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - 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 Clinic Hamburg, Hamburg, Germany
| | - Johannes Zellner
- Sporthopaedicum Regensburg, Regensburg, Germany
- Trauma Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
| | - Christian Schoepp
- Clinic for Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Clinic Duisburg, Duisburg, Germany
- Ligament Committee of the AGA (Society for Arthroscopy and Joint Surgery), Zurich, Switzerland
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Bakırhan S, Şahinoğlu E, Uysal E, Ünver B, Karatosun V. The effectiveness of cruciate-retaining versus posterior-stabilized designs on extensor mechanism function and knee function in patients after simultaneous bilateral total knee arthroplasty: A two-year retrospective follow-up study. Orthop Traumatol Surg Res 2023; 109:103701. [PMID: 37813332 DOI: 10.1016/j.otsr.2023.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION The importance of the posterior-cruciate ligament in knee functionality is known; however, the effect of preserving the posterior-cruciate ligament in total knee arthroplasty (TKA) on extensor mechanism function and knee function is not clear. We aimed to compare extensor mechanism function and knee function between patients operated with the cruciate-retaining and posterior-stabilized designs for simultaneous bilateral TKA. HYPOTHESIS Patients operated with the cruciate-retaining design would produce better outcomes than those operated with the posterior-stabilized design. MATERIALS AND METHODS A total of 104 patients were divided into two groups as the cruciate-retaining (n=52) and posterior-stabilized (n=52) groups. The groups were compared for extensor mechanism function (chair-rise test) and knee function (Hospital for Special Surgery [HSS] knee score). The follow-up points were six weeks, three months, six months, one year and two years. RESULTS No statistically significant effect on chair-rise performance of the group-by-time interaction (χ2 [5, n=104]=5.32, p=.37) or of group (χ2 [1, n=104]=1.69, p=.19). In the HSS knee score, the group-by-time interaction was statistically significant (F [5.510]=6.24, p<.001). A statistically significant difference of 7.4 points in favor of the posterior-stabilized group was found at six weeks (p=.002). No statistically significant differences were found between the groups at the other follow-up points. DISCUSSION The cruciate-retaining and posterior-stabilized designs have similar outcomes with regard to extensor mechanism function and knee function in the long-term period in patients who underwent simultaneous bilateral TKA. In the short-term period, the posterior-stabilized design shows better knee function than the cruciate-retaining design. LEVEL OF EVIDENCE III; a retrospective study.
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Affiliation(s)
- Serkan Bakırhan
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | | | - Emre Uysal
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | - Bayram Ünver
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Kersten RFMR, de Vries AJ, van Raaij JJAM, Brouwer RW. 12-Year clinical and radiological results of a double-blind randomized controlled trial comparing posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty. Knee 2023; 45:110-116. [PMID: 37925801 DOI: 10.1016/j.knee.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/10/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A subject of ongoing debate among orthopedic surgeons is the importance of preserving the posterior cruciate ligament in total knee arthroplasty (TKA), but long-term survival studies are scarce. The aim of this study was to compare long-term survival rates, and clinical and radiological follow up of a double-blind randomized controlled trial comparing posterior cruciate-retaining (PCR) versus posterior-stabilizing (PS) implant design of an AGC TKA. METHODS A total of 114 patients were included in the survival analysis (PCR n = 61; PS n = 53). Forty-five patients (PCR n = 25; PS n = 20) participated in the long-term follow up using patient-reported outcome measures (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form Health Survey (SF-36) and Kujala score (measuring anterior knee pain)). Thirty-one patients were assessed with a physical test (Knee Society Score (KSS)) and radiographs. RESULTS Overall survival rate was 95.6% (PCR 98.4% vs. PS 92.5%), with five patients having a major revision (PCR n = 1 vs. PS n = 4, respectively). Satisfying outcome scores for both groups were described at on average 12-year follow up with no significant differences in KSS knee and function scores, WOMAC, SF-36, or Kujala scores between groups. Radiographically, there were no findings of femoral or tibial loosening or polyethylene wear in either group. CONCLUSIONS Good long-term survival rates were described for the PCR and the PS design of an AGC TKA. There were no significant differences in clinical and radiological outcomes between a PCR and a PS design 12 years postoperatively.
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Affiliation(s)
- R F M R Kersten
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands.
| | - A J de Vries
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - J J A M van Raaij
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - R W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
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Mabrouk A, Olson CP, Tagliero AJ, Larson CM, Wulf CA, Kennedy NI, LaPrade RF. Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5721-5746. [PMID: 37923947 DOI: 10.1007/s00167-023-07617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Stress radiographs are an easily accessible, cost-effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques. METHODS The following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities. RESULTS Sixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm. CONCLUSION Despite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision-making, and provide benchmark values for future investigations. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Conner P Olson
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA
| | | | - Chris M Larson
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA
| | - Corey A Wulf
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA
| | | | - Robert F LaPrade
- Twin Cities Orthopedics, 4010 W 65th Street, Edina, MN, 55455, USA.
- University of Virginia, Charlottesville, VA, USA.
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Wenzel AN, Hasan SA, Chaudhry YP, Mekkawy KL, Oni JK, Khanuja HS. Ultracongruent Designs Compared to Posterior-Stabilized and Cruciate-Retaining Tibial Inserts - What Does the Evidence Tell Us? A Systematic Review and Meta-Analysis. J Arthroplasty 2023; 38:2739-2749.e7. [PMID: 37276953 DOI: 10.1016/j.arth.2023.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Posterior-stabilized (PS) and cruciate-retaining (CR) have been the most common tibial designs used in total knee arthroplasty. Ultra-congruent (UC) inserts are becoming popular because they preserve bone without relying on the posterior cruciate ligament balance and integrity. Despite increasing use, there is no consensus on how UC inserts perform versus PS and CR designs. METHODS A comprehensive literature search of 5 online databases was performed for articles from January 2000 to July 2022 comparing the kinematic and clinical outcomes of PS or CR tibial inserts to UC inserts. There were nineteen studies included. There were 5 studies comparing UC to CR and 14 comparing UC to PS. Only one randomized controlled trial (RCT) was rated "good quality". RESULTS For CR studies, pooled analyses showed no difference in knee flexion (n = 3, P = .33) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (n = 2, P = .58). For PS studies, meta-analyses showed better anteroposterior stability (n = 4, P < .001) and more femoral rollback (n = 2, P < .001) for PS but no difference in knee flexion (n = 9, P = .55) or medio-lateral stability (n = 2, P = .50). There was no difference with WOMAC (n = 5, P = .26), Knee Society Score (n = 3, P = .58), Knee Society Knee Score (n = 4, P = .76), or Knee Society Function Score (n = 5, P = .51). CONCLUSION Available data demonstrates there are no clinical differences between CR or PS and UC inserts in small short-term studies ending around 2 years after surgery. More importantly, high-quality research comparing all inserts is lacking, demonstrating a need for more uniform and longer-term studies beyond 5 years after surgery to justify increased UC usage.
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Affiliation(s)
- Alyssa N Wenzel
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed A Hasan
- Department of Orthopaedic Surgery, University of Central Florida/HCA Healthcare GME, Ocala, Florida
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Kevin L Mekkawy
- Department of Orthopaedic Surgery, Holy Cross Orthopaedic Institute, Fort Lauderdale, Florida
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Yoon KH, Lee HS, Jung C, Kim SG, Park JY. The Effect of Aging on Outcomes after Posterior Cruciate Ligament Reconstruction: Older (≥ 50 Years) Versus Younger (< 50 Years) Patients. Clin Orthop Surg 2023; 15:928-934. [PMID: 38045579 PMCID: PMC10689218 DOI: 10.4055/cios22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 12/05/2023] Open
Abstract
Background This study aimed to evaluate the clinical and radiological outcomes after posterior cruciate ligament (PCL) reconstruction in ≥ 50-year-old patients. Methods This retrospective case-control study reviewed 28 patients (age, ≥ 50 years) who underwent PCL reconstruction from 2004 to 2018. These patients were 1 : 1 matched to < 50-year-old patients by sex. Clinical, radiological, and survivorship outcomes of the patients were assessed at the final follow-up. Failure of PCL reconstruction was defined as the requirement for additional surgery (revision PCL reconstruction, high tibial osteotomy, or arthroplasty) due to unrelieved symptoms or grade III instability on stress radiographs. Results The mean follow-up periods (± standard deviation) in < 50- and ≥ 50-year-old patients were 3.9 ± 1.0 years and 3.6 ± 1.9 years, respectively (p = 0.583). In < 50- and ≥ 50-year-old patients, the mean International Knee Documentation Committee scores were 64.1 ± 10.3 and 53.5 ± 17.3; mean Lysholm scores were 81.4 ± 13.0 and 66.3 ± 21.5; and mean Tegner activity scores were 6.1 ± 1.4 and 4.8 ± 1.7, respectively (p = 0.032, p = 0.018, and p = 0.016, respectively). Side-to-side differences in posterior translation on Telos stress radiographs at the final follow-up were 4.4 ± 1.4 mm and 6.9 ± 3.0 mm in < 50- and ≥ 50-year-old patients, respectively (p < 0.001). According to Kaplan-Meier analysis, the failure-free survival rates of both groups were significantly different in the follow-up period (p = 0.014). The failure-free survival rates for < 50- and ≥ 50-year-old patients were 100% and 78.6%, respectively. Conclusions Clinical, radiological, and survivorship outcomes were inferior among ≥ 50-year-old patients after PCL reconstruction. Thus, surgeons should be careful when deciding and performing PCL reconstruction in patients 50 years old or over.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Hee Sung Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - CheolHyun Jung
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae-Young Park
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
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Boksh K, Ghosh A, Narayan P, Divall P, Aujla R. Fibular- Versus Tibiofibular-Based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3880-3892. [PMID: 36598154 DOI: 10.1177/03635465221138548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Fibular- and tibiofibular-based reconstructions are the gold standard treatment for posterolateral corner (PLC) injuries of the knee. Despite comparable outcomes in biomechanical studies, clinical results comparing these constructs remain elusive with no consensus reached regarding the best treatment option. PURPOSE To perform a systematic review and meta-analysis to compare fibular- and tibiofibular-based techniques for posterolateral corner reconstruction. We aimed to identify whether any differences existed between the 2 techniques in terms of clinical outcomes and rotational and varus stability. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms ("posterolateral corner" OR "fibular collateral ligament" OR "lateral collateral ligament" OR "popliteus tendon" OR "popliteofibular ligament") AND ("reconstruction" OR "LaPrade" OR "Larson" OR "Arciero"). Data pertaining to all patient-reported outcome measures (PROMs), postoperative complications, and valgus and rotational stability were extracted from each study. The pooled outcome data were analyzed by random- and fixed-effects models. RESULTS After abstract and full-text screening, 6 clinical studies were included. In total, there were 183 patients, of which 90 received fibular-based and 93 tibiofibular-based reconstruction. The majority of studies used similar surgical techniques regarding tunnel orientation, attachment sites, and graft fixation sequence. There were no differences between the groups in terms of PROMs and subjective knee scores at a mean of 20.3 months. The techniques were equally effective in restoring varus and rotational stability. Subgroup analysis revealed that the stability of a posterior cruciate ligament reconstruction postoperatively was not affected by either construct. CONCLUSION Both constructs had comparable clinical outcomes and were equally effective in restoring varus and rotational stability for PLC knee injuries. The fibular-based technique may offer advantages in view of being less technically demanding and invasive and requiring fewer grafts with a quicker operative time. However, higher quality studies are required to reinforce or refute such conclusions, as the majority of studies in this review were poor to fair quality.
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Affiliation(s)
- Khalis Boksh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Arijit Ghosh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Prithish Narayan
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pip Divall
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Randeep Aujla
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Budhiparama NC, Lumban-Gaol I, Novito K, Hidayat H, De Meo F, Cacciola G, Cavaliere P. PCL retained is safe in medial pivot TKA-a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5856-5863. [PMID: 37962615 PMCID: PMC10719124 DOI: 10.1007/s00167-023-07634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Medial pivot (MP) designs resemble native knee kinematics and restore the "natural" kinematics of a knee after total knee arthroplasty (TKA). However, whether to preserve or resect the posterior cruciate ligament (PCL) is still under debate. We inquired whether sacrificing the PCL would improve range of motion, functional outcomes, and limb alignment compared to preserving the PCL in TKA using medial pivot implants (MP-TKA). METHODS This prospective, double-blinded, randomized controlled trial consisted of 33 patients (66 knees) undergoing bilateral simultaneous MP-TKA. In one knee, a PCL preservation technique was performed, and in the contralateral knee, the PCL was resected. The primary outcome was postoperative range of motion (ROM). The secondary outcomes were visual analogue scale (VAS) score for knee pain at walking, Knee Injury and Osteoarthritis Outcome Score for symptoms (KOOS-S) and quality of life (KOOS-QoL), Oxford knee score (OKS), and Forgotten Joint Score (FJS), and measurement of the mechanical femoral-tibial axis (mFTA) on X-ray images. All patients were followed up for a minimum of 2 years after surgery. RESULTS Patients who underwent MP-TKA with PCL preservation had a similar ROM at 2 years (125.45 ± 7.00 vs. 126.21 ± 6.73, p = 0.65) as those who underwent MP-TKAs with PCL resection. There was also no difference in VAS score (1.94 ± 0.79 vs. 2.00 ± 0.71, respectively, p = 0.51), OKS (39.97 ± 2.01 vs. 39.67 ± 2.03, respectively, p = 0.52), KOOS-S (84.41 ± 3.77 vs. 84.19 ± 3.57, respectively, p = 0.92), KOOS-QoL (82.94 ± 4.76 vs. 82.75 ± 4.70, respectively, p = 0.84), or FJS (72.66 ± 8.99 vs. 72.35 ± 8.64, respectively, p = 0.76) at the 2-year follow-up. No difference in the measurement of the mFTA was found between the two groups (180.27 ± 2.25 vs. 181.30 ± 2.13, respectively, p = 0.59). CONCLUSION This study demonstrated that both medial pivot TKA with PCL preservation and PCL resection achieved excellent results. There was no difference at the 2-year follow-up in terms of postoperative ROM, patient-reported outcomes, or radiographic evaluation. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Nicolaas C Budhiparama
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands.
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia.
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Kiki Novito
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Hendy Hidayat
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jakarta, Indonesia
| | - Federico De Meo
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Pietro Cavaliere
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
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Kreutzer A, Bast N, Fan J, Gates J. Posterior Cruciate Ligament Agenesis Requiring Surgical Reconstruction. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00006. [PMID: 38047876 PMCID: PMC10697616 DOI: 10.5435/jaaosglobal-d-23-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023]
Abstract
Agenesis of the posterior cruciate ligament (PCL) is a rare disorder often found in conjunction with various other abnormalities within the knee. A 15-year-old adolescent boy presented with an absent PCL, leading to intermittent symptoms. At the age of 20 years, the patient underwent arthroscopically assisted PCL reconstruction. The patient was permitted to weightbear immediately after the procedure and started physical therapy 4 weeks after the procedure. No complications were encountered at the 2-year follow-up.
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Affiliation(s)
- Adam Kreutzer
- From the Department of Orthopaedic Surgery, Riverside University Health System Medical Center, Moreno Valley, CA (Dr. Kreutzer, Dr. Bast, and Dr. Fan), and the Department of Orthopedic Surgery, Kaiser Permanente, Moreno Valley, CA (Dr. Kreutzer, Dr. Bast, Dr. Fan, and Dr. Gates)
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Hernández-Aragón F, González-González F, Aguirre-Madrid A, Portillo-Ortiz NK, Muñoz-Cabello RA, Berumen-Nafarrate E. Innovative knee surgery: arthroscopic double bundle U-DOS reverse Technique for PCL tears. J ISAKOS 2023; 8:509-512. [PMID: 37562574 DOI: 10.1016/j.jisako.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
The Double Bundle U-DOS Reverse Technique for posterior cruciate ligament (PCL) tears is a novel arthroscopic technique that combines two well-known procedures: the mono-tunnel approach and the medial-portal approach, provides better posterior stability, improved functional outcomes, and a reduced risk of posterior tibial subluxation. This technique allows for the simultaneous treatment of anterolateral and posteromedial bundles and has been successfully performed on 16 patients, with follow-up showing sufficient support and resistance to posterior tibial subluxation or excessive displacement, resulting in a stable knee joint.
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Affiliation(s)
- Fernando Hernández-Aragón
- Department of Orthopedic Surgery, Christus Muguerza Del Parque Hospital, De La Llave St. No. 1419, Office 9, Col. Centro, Chihuahua, 31000 Chihuahua, Mexico; Medical Specialties, Vice-Rectory of Health Sciences, Universidad de Monterrey, Ignacio Morones Prieto Ave. 4500 W, San Pedro Garza Garcia, Nuevo Leon 66238, Mexico
| | - Fernando González-González
- Department of Orthopedic Surgery, Christus Muguerza Del Parque Hospital, De La Llave St. No. 1419, Office 9, Col. Centro, Chihuahua, 31000 Chihuahua, Mexico; Medical Specialties, Vice-Rectory of Health Sciences, Universidad de Monterrey, Ignacio Morones Prieto Ave. 4500 W, San Pedro Garza Garcia, Nuevo Leon 66238, Mexico
| | - Arturo Aguirre-Madrid
- Department of Orthopedic Surgery, Christus Muguerza Del Parque Hospital, De La Llave St. No. 1419, Office 9, Col. Centro, Chihuahua, 31000 Chihuahua, Mexico
| | - Nadia Karina Portillo-Ortiz
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua, 31125 Chihuahua, Chihuahua, Mexico
| | | | - Edmundo Berumen-Nafarrate
- Department of Orthopedic Surgery, Christus Muguerza Del Parque Hospital, De La Llave St. No. 1419, Office 9, Col. Centro, Chihuahua, 31000 Chihuahua, Mexico; Medical Specialties, Vice-Rectory of Health Sciences, Universidad de Monterrey, Ignacio Morones Prieto Ave. 4500 W, San Pedro Garza Garcia, Nuevo Leon 66238, Mexico.
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Yoo HJ, Kim YB, Jeong HW, Park SB, Nam HS, Lee YS. Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design. Arch Orthop Trauma Surg 2023; 143:6805-6813. [PMID: 37488457 DOI: 10.1007/s00402-023-04918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/21/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The outcomes of total knee arthroplasty (TKA) remain controversial, and we do not know which factors are important for successful outcomes. This study aimed to compare the mid-term outcomes of different conceptual designs by evaluating the radiological and clinical outcomes. MATERIALS AND METHODS A total of 478 total knee arthroplasties (TKAs) were enrolled and allocated into groups I [posterior stabilizing (PS) with anterior referencing (AR)], II [PS with posterior referencing (PR), and III [ultra-congruent (UC) TKA)]. Preoperative findings, last follow-up clinical outcomes, and final follow-up radiological and indirect assessments of the femoral rollback were compared between the groups. RESULTS The mean follow-up period was 72.6 ± 12.9 months. The tourniquet was used samely applied to every group. Flexion contracture was significantly larger in group III than in groups I and II (3.3 ± 2.7, p < 0.001), and further flexion was significantly smaller in group III (130.0° ± 2.7°, p < 0.001). Among the radiological parameters, posterior osteophyte formation was the most common in group III (67.8%). The rollback distance was significantly smaller in group III than in groups I and II (p < 0.001). The active deep flexion angle was affected by the posterior condylar offset (PCO) ratio, and the contact point changed the distance (p < 0.05). CONCLUSION PS TKAs showed better ROMs than UC TKAs; however, no differences were noted in the clinical outcome scales. The flexion angle was affected by the PCOR and rollback at both PS and UC TKAs. However, rollback negatively affected the flexion angle during UC TKAs. An inappropriate femoral rollback was identified, and femoral osteophyte formation was determined to be the most prominent in UC TKAs. Level of evidence Level III comparative study.
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Affiliation(s)
- Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunyang University Hospital, Seoul, Korea
| | - Ho Won Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Sung Bae Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Oronowicz J, Mouton C, Pioger C, Valcarenghi J, Tischer T, Seil R. The posterior cruciate ligament-posterior femoral cortex angle (PCL-PCA) and the lateral collateral ligament (LCL) sign are useful parameters to indicate the progression of knee decompensation over time after an ACL injury. Knee Surg Sports Traumatol Arthrosc 2023; 31:5128-5136. [PMID: 37805550 DOI: 10.1007/s00167-023-07583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE The posterior cruciate ligament-posterior cortex angle (angle between the most vertical part of the anterolateral PCL bundle and the posterior diaphyseal cortex of the femur; PCL-PCA) is the most accurate approach to describe the PCL buckling phenomenon observed in anterior cruciate ligament (ACL)-deficient knees. The aim of this study was to determine whether the PCL-PCA is associated with chronicity of the ACL rupture, the meniscal status, preoperative knee laxity or imaging signs such as the lateral collateral ligament (LCL) sign or the posterior tibial slope (PTS) in ACL-injured knees. METHODS Patients with a primary ACL reconstruction (ACLR) after physeal closure were selected retrospectively from a hospital-based ACL registry from 2015 to 2021. Exclusion criteria were: previous ipsilateral/contralateral knee surgery, previous ipsilateral ACL or meniscal tear, ipsilateral PCL and/or collateral ligament injuries or tibial plateau fracture. The ACL deficiency was defined as chronic if time from injury to MRI was > 6 months. The meniscal status was assessed during ACLR, separately for the medial and lateral meniscus, and classified into no tear, minor or major unstable tear. The MRI analyses included the assessment of the PCL-PCA and the LCL sign. PTS was assessed from the lateral plain radiographs of the injured knee. The side-to-side difference in anterior tibial translation (ATT) at 200N was obtained with the GNRB. RESULTS Eighty-two patients (forty-eight males/thirty-four females) were included in this study. The median PCL-PCA was 16.2° (Q1-Q3: 10.6-24.7) and differed between acute (18.4°) and chronic (10.7°) injuries (p < 0.01). The median PCL-PCA was significantly lower (- 4.6°) in patients with a positive LCL sign (p = 0.03) No significant association could be found between PCL-PCA and meniscal status, PTS or preoperative anterior knee laxity (Lachman, pivot shift and ATT in millimetres). CONCLUSION The PCL-PCA was significantly lower in chronic ACL injuries and in patients with a positive LCL sign, indicating a higher buckling phenomenon of the PCL in these patients. These results support the fact that PCL-PCA and the LCL sign may be useful parameters to indicate the progression of knee decompensation over time after an ACL injury, and therefore may constitute a helpful tool to optimise treatment choice and timing of ACL reconstruction if necessary. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jakub Oronowicz
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
| | - Charles Pioger
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Paris, France
| | - Jérôme Valcarenghi
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser St. Mary's Hospital, Erlangen, Germany
- Department of Orthopaedics, University of Rostock, Rostock, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
- Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg.
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxemburg Institute of Health, Luxembourg, Luxembourg.
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Dasari SP, Warrier AA, Condon JJ, Mameri ES, Khan ZA, Kerzner B, Gursoy S, Swindell HW, Hevesi M, Chahla J. A Comprehensive Meta-analysis of Clinical and Biomechanical Outcomes Comparing Double-Bundle and Single-Bundle Posterior Cruciate Ligament Reconstruction Techniques. Am J Sports Med 2023; 51:3567-3582. [PMID: 36533945 DOI: 10.1177/03635465221137059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Posterior cruciate ligament (PCL) reconstruction techniques have historically focused on single-bundle (SB) reconstruction of the larger anterolateral bundle without addressing the codominant posteromedial bundle. The SB technique has been associated with residual laxity and instability, leading to the development of double-bundle (DB) reconstruction techniques. PURPOSE To perform a meta-analysis of comparative clinical and biomechanical studies to differentiate the pooled outcomes of SB and DB PCL reconstruction cohorts. STUDY DESIGN Meta-analysis and systematic review: Level of evidence, 3. METHODS Six databases were queried in February 2022 for literature directly comparing clinical and biomechanical outcomes for patients or cadaveric specimens undergoing DB PCL reconstruction against SB PCL reconstruction. Biomechanical outcomes included posterior tibial translational laxity, external rotational laxity, and varus laxity at 30° and 90° of knee flexion. Clinical outcomes included the side-to-side difference in posterior tibial translation during postoperative stress radiographs, risk of a major complication, and the following postoperative patient-reported outcome measures: Lysholm, Tegner, and International Knee Documentation Committee (IKDC) subjective and objective scores. A random-effects model was used to compare pooled clinical and biomechanical outcomes between the cohorts. RESULTS Fifteen biomechanical studies and 13 clinical studies were included in this meta-analysis. The DB group demonstrated significantly less posterior tibial translation at 30° and 90° of knee flexion (P < .00001). Additionally, the DB group demonstrated significantly less external rotation laxity at 90° of knee flexion (P = .0002) but not at 30° of knee flexion (P = .33). There was no difference in varus laxity between the groups at 30° (P = .56) or 90° (P = .24) of knee flexion. There was significantly less translation on stress radiographs in the DB group (P = .02). Clinically, there was no significant difference between the groups for the Lysholm score (P = .95), Tegner score (P = .14), or risk of a major complication (P = .93). DB PCL reconstruction led to significantly higher odds of achieving "normal" or "near normal" objective IKDC outcomes for the included prospective studies (P = .04) and higher subjective IKDC scores (P = .01). CONCLUSION DB PCL reconstruction leads to superior biomechanical outcomes and clinical outcomes relative to SB PCL reconstruction. Re-creating native anatomy during PCL reconstruction maximizes biomechanical stability and clinical outcomes.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alec A Warrier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua J Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hasani W Swindell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Pizza N, Di Paolo S, Grassi A, Pagano A, Viotto M, Dal Fabbro G, Agostinone P, Lucidi GA, Monllau JC, Zaffagnini S. Good long-term patients reported outcomes, return-to-work and return-to-sport rate and survivorship after posterior cruciate ligament (PCL)-based multiligament knee injuries (MLKI) with posteromedial corner tears as significant risk factor for failure. Knee Surg Sports Traumatol Arthrosc 2023; 31:5018-5024. [PMID: 37668614 PMCID: PMC10598146 DOI: 10.1007/s00167-023-07547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To assess the survival rate and associated risk factors of a wide cohort of patient's underwent surgical treatment for posterior cruciate ligament (PCL)-based multiligament knee injury (MLKI) at long-term follow-up and to investigate the long-term patient's reported outcomes (PROMS) and functional activity. METHODS All cases of PCL-based MLKI performed at one single sport-medicine institution were extracted and patient's with a minimum 2 years of follow-up included. VAS, Lysholm, KOOS, Tegner Activity level scores, the incidence and time of return to sport (RTS) and return to work (RTW) were collected before, after surgery and at final follow-up. A multivariate logistic regression was performed to investigate the outcomes associated with the patient's acceptable symptoms state (PASS) for each sub-score of the KOOS. The Kaplan-Meier method with surgical failure (re-operation to one of the reconstructed ligaments) as endpoint was used to perform the survivorship analysis for the entire cohort. RESULTS Forty-two patients were included and evaluated at an average of 10 years. All PROMS significantly improved from pre- to post-surgery (range ηp2 0.21-0.43, p < 0.05) except for the Tegner score which significantly improved from pre-surgery and to final follow-up (ηp2 = 0.67, p < 0.001). RTW was achieved in the 95.2% after 2.4 ± 1.9 months. RTS was achieved in 78.6% after 6.7 ± 5.0 months. The higher number of surgeries were the significant negative predictors of PASS for the KOOS sub-scales Sport (p = 0.040) and Quality of Life (p = 0.046), while the presence of meniscal lesions was a significant negative predictor of PASS only for the KOOS sub-scale of Sport (p = 0.003). Six patients (14.3%) underwent reoperation and were considered as surgical failures. The global survivorship was 95.2%, 92.6%, 87.1%, and 74.7% at 2, 5, 12, and 15 years, respectively. The survivorship in patient undergoing PMC reconstruction surgery was significantly lower (p = 0.004; HR 7.1) compared to patients without a PMC lesion. CONCLUSION Good-to-excellent PROMS could be obtained and maintained at long-term follow-up after surgery, with the higher number of surgeries and meniscal lesions as significant negative predictors of the PASS. Moreover, the presence of a PMC lesion significantly increases the risk of the PCL reconstruction failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicola Pizza
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
| | - Anna Pagano
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marianna Viotto
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Juan Carlos Monllau
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
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Shao D, Xu J, Zhang X, Yang G, Wang J, Li H, Niu H. Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach. J Vis Exp 2023. [PMID: 37930010 DOI: 10.3791/65620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.
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Affiliation(s)
- Decheng Shao
- Department of Sports Medicine, The Third Hospital of Hebei Medical University
| | - Jianjiang Xu
- Department of Orthopedics, Wanzai County Hospital of Traditional Chinese Medicine
| | - Xiaoyang Zhang
- Department of Sports Medicine, The Third Hospital of Hebei Medical University
| | - Guang Yang
- Department of Sports Medicine, The Third Hospital of Hebei Medical University
| | - Jianchao Wang
- Department of Sports Medicine, The Third Hospital of Hebei Medical University
| | - Han Li
- Department of Sports Medicine, The Third Hospital of Hebei Medical University
| | - Haiyun Niu
- Department of Sports Medicine, The Third Hospital of Hebei Medical University;
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Meneghini RM, Deckard ER, Warth LC. Optimizing Asymmetric Native Knee Flexion Gap Balance Promotes Superior Outcomes in Primary Total Knee Arthroplasty. J Am Acad Orthop Surg 2023; 31:e834-e844. [PMID: 37390317 DOI: 10.5435/jaaos-d-23-00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Replicating native knee kinematics remains the ultimate goal of total knee arthroplasty (TKA). Technology, such as robotics, provides robust intraoperative data; however, no evidence-based targets currently exist for improved clinical outcomes. Furthermore, some surgeons target a rectangular flexion space in TKA unlike the native knee. This study evaluated the effect of in vivo flexion gap asymmetry on patient-reported outcome measures (PROMs) in contemporary TKA. METHODS In vivo tibiofemoral joint space dimensions were measured during 129 TKAs using a calibrated tension device before and after complete posterior cruciate ligament resection. PROMs were compared based on the final dimensions and the change in flexion gap dimensions at 90° of flexion: (1) equal laxity, (2) lateral laxity, and (3) medial laxity. Groups did not differ by demographics ( P ≥ 0.347), clinical follow-up ( P = 0.134), tibiofemoral alignment ( P = 0.498), or preoperative PROMs ( P ≥ 0.093). Mean follow-up for the cohort was 1.5 years (range, 1-3). RESULTS Pain with climbing stairs, pain while standing upright, and knees "always feeling normal" scores were superior for patients with equal or lateral laxity compared with medial laxity ( P ≤ 0.064). Pain with level walking, University of California Los Angeles activity level, KOOS JR, and satisfaction scores also tended to be superior for patients with equal or lateral laxity, although it lacked statistical significance ( P ≥ 0.111). DISCUSSION Results of this study suggest that patients with either an equally tensioned rectangular flexion space or with later-flexion lateral laxity after posterior cruciate ligament resection may achieve superior PROMs. Findings support the clinical benefit of facilitating posterolateral femoral roll back in flexion, which mimics native knee kinematics and further helps define targets for advanced technology.
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Affiliation(s)
- R Michael Meneghini
- From the Indiana Joint Replacement Institute, Indianapolis, Indiana (Meneghini and Deckard), the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Meneghini), and Forté Sports Medicine and Orthopedics, Indianapolis, Indiana (Warth)
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Zhou Z, Wang S, Xiao J, Mao Y, Li L, Xu W, She C. The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study. Medicine (Baltimore) 2023; 102:e35356. [PMID: 37773785 PMCID: PMC10545087 DOI: 10.1097/md.0000000000035356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.
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Affiliation(s)
- Zhaoxin Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shendong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jiazheng Xiao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Zhang X, Teng F, Geng B, Lu F, Liu Z, Guo L, Han H, Wu M, Xia Y, Teng Y. The tibial tunnel drilling angles of 60° provided a lower ultimate load to failure on a single bundle posterior cruciate ligament graft using interference screw fixation compared to 30°/45°. Knee Surg Sports Traumatol Arthrosc 2023; 31:4035-4042. [PMID: 37191693 DOI: 10.1007/s00167-023-07428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To biomechanically compare the initial fixation strength of grafts among three tibial tunnel angles (30°/45°/60°) in transtibial posterior cruciate ligament (PCL) reconstruction. METHODS A series of transtibial PCL reconstruction models were established with porcine tibias and bovine tendons. Specimens were randomly assigned to three groups according to the angles between the tibial tunnel and the perpendicular line of the tibial shaft: Group A (30°, n = 12), Group B (45°, n = 12), and Group C (60°, n = 12). The area of the tunnel entrance, the segmental bone mineral density (sBMD) of the graft fixation site of the tibia and the maximum insertion torque of the interference screw were measured. Finally, load to failure tests were carried out on the graft-screw-tibia constructs at the same rate. RESULTS Ultimate load to failure in Group C (335.2 ± 107.5 N) was significantly lower than that in Group A (584.1 ± 127.9 N, P < 0.01) and Group B (521.9 ± 95.9 N, P < 0.01). There were no significant differences between biomechanical properties of Groups A and B (n.s.). The posterior part fractures of the tibial tunnel exit occurred in eight specimens of Group C. In addition, the ultimate load was proven to be related to insertion torque (rho = 0.7, P < 0.01), sBMD (rho = 0.7, P < 0.01), and the area of the tunnel entrance (rho =- 0.4, P = 0.01). CONCLUSION The ultimate load to failure was significantly lower in tibial PCL interference screw fixation for tunnels drilled at 60° compared to 30°/45°. In addition, the ultimate load was significantly correlated with insertion torque, sBMD and the area of the tunnel entrance. Given that the load to failure of distal fixation may not be sufficient for early postoperative rehabilitation, a 60° tunnel should not be recommended to drill in tibia during PCL reconstruction.
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Affiliation(s)
- Xiaohui Zhang
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Fei Teng
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Bin Geng
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Fan Lu
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Zhongcheng Liu
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Laiwei Guo
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Hua Han
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Meng Wu
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.
| | - Yuanjun Teng
- Department of Orthopaedics, Orthopaedics Clinical Medical Research Center of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, People's Republic of China.
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Helal A, Marei AE, Shafik A, Elforse E. Clinical and radiological outcomes of a modified anatomic posterolateral corner reconstruction technique using a single semitendinosus autograft. Arch Orthop Trauma Surg 2023; 143:5767-5776. [PMID: 37140604 PMCID: PMC10449660 DOI: 10.1007/s00402-023-04862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE We aimed to assess the clinical and radiological outcomes of a modified anatomical posterolateral corner (PLC) reconstruction technique using a single autograft. METHODS This prospective case series included 19 patients with a posterolateral corner injury. The posterolateral corner was reconstructed using a modified anatomical technique that utilized adjustable suspensory fixation on the tibial side. Patients were evaluated subjectively using the international knee documentation form (IKDC), Lysholm, and Tegner activity scales and objectively by measuring the tibial external rotation angle, knee hyperextension, and lateral joint line opening on stress varus radiographs before and after surgery. The patients were followed-up for a minimum of 2 years. RESULTS Both IKDC and Lysholm knee scores significantly improved from 49 and 53 preoperatively to 77 and 81 postoperatively, respectively. The tibial external rotation angle and knee hyperextension showed significant reduction to normal values at the final follow-up. However, the lateral joint line opening measured on the varus stress radiograph remained larger than the contralateral normal knee. CONCLUSION Posterolateral corner reconstruction with a hamstring autograft using a modified anatomical reconstruction technique significantly improved both the subjective patient scores and objective knee stability. However, the varus stability was not completely restored compared with the uninjured knee. LEVEL OF EVIDENCE Prospective case series (Level of evidence IV).
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Affiliation(s)
- Ahmed Helal
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt.
| | - Abdelhakim E Marei
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
| | - Ahmed Shafik
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
| | - Elsayed Elforse
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
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Nyrhinen KM, Helkamaa T, Bister V, Schlenzka A, Sandelin H, Sandelin J, Harilainen A. Patient injury claims for posterior cruciate ligament injury: a nationwide registry study in Finland. Acta Orthop 2023; 94:426-431. [PMID: 37592854 PMCID: PMC10436284 DOI: 10.2340/17453674.2023.18265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Posterior cruciate ligament (PCL) injuries usually occur in combination with other ligamentous knee injuries. The outcome varies and may be poor due to suboptimal treatment. We investigated claims following PCL injury treatment on a nationwide scale. PATIENTS AND METHODS All patient PCL injury claims filed in Finland from 1997 to 2015 were collected from the Patient Insurance Centre (PIC) register. We reviewed and analyzed all records to determine the causes of claims. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO). RESULTS We found out from HILMO background data that, during the 19-year study period, 1,891 PCL and 1,380 multiligament reconstructions were performed in 99 different hospitals. The number of PCL injuries treated conservatively is unknown. During this same period, 49 claims arrived at the PIC, and 39/49 of these patients were operated on. 12/49 claims were compensated. Of these 12 claims, 6 were compensated for technical errors and 4 were compensated for diagnostic delays. CONCLUSION The number of patient injury claims was few, and compensated claims were even fewer. Technical errors and diagnostic delays were the most common reasons for reimbursement.
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Affiliation(s)
- Kirsi-Maaria Nyrhinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki.
| | - Teemu Helkamaa
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Ville Bister
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki; Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki
| | - Arne Schlenzka
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital, Vaasa, and University of Helsinki, Helsinki; Mehiläinen Sports Hospital, Vaasa; 5 Orton Orthopaedic Hospital, Helsinki, Finland
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Sun K, Wu Y, Wu L, Shen B. Comparison of clinical outcomes among total knee arthroplasties using posterior-stabilized, cruciate-retaining, bi-cruciate substituting, bi-cruciate retaining designs: a systematic review and network meta-analysis. Chin Med J (Engl) 2023; 136:1817-1831. [PMID: 37365688 PMCID: PMC10406014 DOI: 10.1097/cm9.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Despite the advent of innovative knee prosthesis design, a consistent first-option knee implant design in total knee arthroplasty (TKA) remained unsettled. This study aimed to compare the clinical effects among posterior-stabilized (PS), cruciate-retaining (CR), bi-cruciate substituting (BCS), and bi-cruciate retaining designs for primary TKA. METHODS Electronic databases were systematically searched to identify eligible randomized controlled trials (RCTs) and cohort studies from inception up to July 30, 2021. The primary outcomes were the range of knee motion (ROM), and the secondary outcomes were the patient-reported outcome measures (PROMs) and complication and revision rates. Confidence in evidence was assessed using Confidence in Network Meta-Analysis. The Bayesian network meta-analysis was performed for synthesis. RESULTS A total of 15 RCTs and 18 cohort studies involving 3520 knees were included. The heterogeneity and inconsistency were acceptable. There was a significant difference in ROM at the early follow-up when PS was compared with CR (mean difference [MD] = 3.17, 95% confidence interval [CI] 0.07, 7.18) and BCS was compared with CR (MD = 9.69, 95% CI 2.18, 17.51). But at the long-term follow-up, there was no significant difference in ROM in any one knee implant compared with the others. No significant increase was found in the PROMs and complication and revision rates at the final follow-up time. CONCLUSIONS At early follow-up after TKA, PS and BCS knee implants significantly outperform the CR knee implant in ROM. But in the long run, the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.
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Affiliation(s)
- Kaibo Sun
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Jin X, Xu Y. Differences in postoperative knee joint function and prognostic quality of life in patients undergoing posterior cruciate ligament reconstruction at different surgical timing under enhanced recovery after surgery. Medicine (Baltimore) 2023; 102:e34345. [PMID: 37505147 PMCID: PMC10378877 DOI: 10.1097/md.0000000000034345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
To explore the differences in postoperative knee joint function and prognostic quality of life in patients undergoing posterior cruciate ligament (PCL) reconstruction at different timing of surgery under the enhanced recovery after surgery (ERAS) protocol. A total of 266 cases of PCL injury admitted to our hospital between March 2019 and October 2022 were included in this retrospective study and divided them into a short-term group (147 cases with PCL reconstruction completed within 3 weeks after injury) and a long-term group (119 cases with PCL reconstruction performed 3 weeks after injury) according to the timing of surgery after injury. All patients received ERAS care during treatment. The operation time, intraoperative blood loss, and incision length of both cohorts were counted to evaluate the clinical efficacy. Perioperative patients were assessed by the Visual Analogue Scale for pain severity. The pre- and post-operative knee function and knee joint range of motion were assessed by the International Knee Documentation Committee and Lysholm Knee Scoring Scale. Furthermore, the complication rate was counted and the quality of life was evaluated by the Short-Form 36 Item Health Survey. Patients were also assessed for their psychological states using the Self-rating Anxiety/Depression Scale and their satisfaction with care. The 2 groups showed similar operation time, intraoperative blood loss, incision length, overall response rate, and Visual Analogue Scale (P > .05), but the short-term group had higher knee range of motion and scores of International Knee Documentation Committee and Lysholm Scale than the long-term group (P < .05). A similar complication rate was also determined in the 2 groups (P > .05), but the Short-Form 36 Item Health Survey scores were significantly higher in the short-term group (P < .05). Self-rating Anxiety Scale and Self-rating Depression Scale in both groups decreased after treatment (P < .05), and no statistical difference was determined in nursing satisfaction (P = 198). PCL reconstruction within 3 weeks after PCL injury is more conducive to the recovery of patients' knee joint function, and the ERAS protocol can more effectively improve the therapeutic effect of patients.
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Affiliation(s)
- Xiaoyun Jin
- Department of Anesthesiology, Fuyang TCM Hospital of Orthopedics Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuping Xu
- Department of Equipment, Fuyang TCM Hospital of Orthopedics Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
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Moran J, Homan MD, LaPrade CM, Kennedy NI, LaPrade RF. Treatment of a Failed Posterior Cruciate Ligament Avulsion Fracture Fixation in a Skeletally Immature Patient: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00045. [PMID: 37556573 DOI: 10.2106/jbjs.cc.23.00165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
CASE A 12-year-old skeletally immature girl presented with 1 year of persistent instability after an open reduction and internal fixation (ORIF) for a posterior cruciate ligament (PCL) avulsion fracture. With a period of nonoperative management, her PCL stress radiographic measurements significantly decreased and her posterior tibial slope increased because the primary ORIF effectively led to growth arrest with an early fusion of the posterior tibial physis. At age 13 years when she was skeletally mature, revision PCL and fibular collateral ligament (FCL) reconstructions were performed. Promising clinical outcomes were observed at age 17 years. CONCLUSION Pediatric patients with a failed PCL ORIF can successfully be managed with a period of nonoperative bracing and a revision PCL reconstruction once skeletally mature.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut
| | | | - Christopher M LaPrade
- Stanford Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
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