Preoperative Determination of the Size of the Semitendinosus and Gracilis Tendon by Multidetector Row CT Scanner for Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0041-1727112Accurately measuring the length and diameter of the hamstring tendon autograft preoperatively is important for planning anterior cruciate ligament (ACL) reconstructive surgery. The purpose of this study was to assess the reliability of three-dimensional computed tomography (3D CT) scanning technique to produce the actual measurement of the gracilis and semitendinosus (GT and ST, respectively) tendon grafts' length and diameter for surgery. Ninety patients were scheduled for ACL reconstruction with hamstring autograft. Before the surgery, patients were examined under the multidetector ...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Truong, Pham N. Toan, Ngo V. Nam, V ũ H. Fang, William H. Vangsness Jr, C. Thomas Han, Bo Hoang, Ba X. Tags: Original Article Source Type: research

Biomechanical Evaluation of Anterolateral Ligament Repair augmented with Internal Brace
J Knee Surg DOI: 10.1055/s-0041-1726420Injuries to the anterolateral ligament (ALL) of the knee are commonly associated with anterior cruciate ligament (ACL) ruptures. Biomechanical studies have demonstrated conflicting results with regard to the role of the ALL in limiting tibial internal rotation. Clinically, residual pivot shift following ACL reconstruction has been reported to occur up to 25% and has been correlated with poor outcomes. As such, surgical techniques have been developed to enhance rotational stability. Recent biomechanical studies have demonstrated restoration of internal rotational control following ALL ...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Roach, Ryan P. Beason, David P. Slowik, Jonathan S. Moore, A. Ryves Lall, Ajay C. Dugas, Jeffrey R. Tags: Original Article Source Type: research

Robotic-Assisted Unicompartmental Knee Arthroplasty Reduces Components' Positioning Differences among High- and Low-Volume Surgeons
J Knee Surg DOI: 10.1055/s-0041-1727115Robotic-assisted medial unicompartmental knee arthroplasty (mUKA) has been introduced to improve accuracy in implant positioning and limb alignment, overcoming the reported high failure rates of conventional UKA. Indeed, mUKA is a technically challenging procedure strongly related to surgeons' skills and expertise. The purpose of this study was to evaluate the likelihood of robotic-assisted surgery in reducing the variability of coronal and sagittal component positioning between high- and low-volume surgeons. We evaluated a prospective cohort of 161 robotic mUKA implanted between May ...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Matassi, Fabrizio Innocenti, Matteo Giabbani, Niccol ò Sani, Giacomo Cozzi Lepri, Andrea Piolanti, Nicola Civinini, Roberto Tags: Original Article Source Type: research

Outcomes of Total Knee Arthroplasty in Patients with Prior Hardware: A Case –Control Study Using Handheld Navigation
J Knee Surg DOI: 10.1055/s-0041-1726419Presence of hardware in juxta-articular location poses challenge during total knee arthroplasty (TKA). When present in distal femur, it precludes the use of an intramedullary femoral jig during TKA often necessitating removal of hardware leading to prolonged surgery, higher risk of complications, and inferior results. We conducted a case–control study to assess the outcome of TKA among patients with post-traumatic arthritis using a handheld navigation system to perform bone cuts allowing retention of hardware in situ. In 15 patients with post-traumatic arthritis and hardware aro...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Malhotra, Rajesh Jain, Aditya Gupta, Saurabh Gautam, Deepak Tags: Original Article Source Type: research

Risk Factors for Infection and Revision Surgery following Patellar Tendon and Quadriceps Tendon Repairs: An Analysis of 3,442 Patients
J Knee Surg DOI: 10.1055/s-0041-1727113Disruption of the extensor mechanism is debilitating with surgical repair being the accepted treatment. The incidence of infection and reoperation after extensor mechanism repair are not well reported in the literature. Thus, the objective of the current study was to (1) determine the incidence of surgical site infection and reoperation within 1 year of primary extensor mechanism repair and (2) identify independent risk factors for infection and reoperation following patellar and quadriceps tendon repair. A retrospective review of the 100% Medicare Standard Analytic files from 2005 to...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Lewis, Daniel C. Athoff, Alyssa D. Kamalapathy, Pramod Yarboro, Seth R. Miller, Mark D. Werner, Brian C. Tags: Original Article Source Type: research

Efficacy of Adductor Canal Blocks in Total Knee Arthroplasty
The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI)
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Johns, Nicholas Noye, Nicholas Wall, Chris Martin, Glen Loch, Alan Tags: Original Article Source Type: research

Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series
J Knee Surg DOI: 10.1055/s-0041-1726418The techniques available to locate the femoral tunnel during anterior cruciate ligament (ACL) reconstruction have notable limitations. To evaluate whether the femoral tunnel center could be located intraoperatively with a ruler, using the posterior apex of the deep cartilage (ADC) as a landmark. This retrospective case series included consecutive patients with ACL rupture who underwent arthroscopic single-bundle ACL reconstruction at the Department of Orthopedics, Beijing Tongren Hospital between January 2014 and May 2018. During surgery, the ADC of the femoral lateral condyle was use...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Dong, Yan Tang, Jiaguang Cui, Peng Shen, Songpo Wang, Guodong Li, Jian Kong, Xiaochuan Hong, Gang Yuan, Shuo Zang, Lei Tags: Original Article Source Type: research

Rate of Insufficient Ipsilateral Hamstring Graft Harvesting in Primary Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0041-1726421Anterior cruciate ligament (ACL) reconstruction, using an ipsilateral hamstring graft, may necessitate an alternative graft source if the obtained graft is insufficient with regards to length or diameter. The study aims to determine the rate of insufficient ipsilateral hamstring graft harvesting in primary ACL reconstruction. Retrospective review of 50 consecutive primary ACL reconstructions performed by a single surgeon in the United Kingdom. In 3 of 50 cases, there was insufficient ipsilateral hamstring graft harvesting and a contralateral hamstring graft was used. In two cases, thi...
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Charalambous, Charalambos P. Kwaees, Tariq A. Lane, Suzanne Blundell, Clare Mati, Wael Tags: Original Article Source Type: research

Return to Sport and Work after Randomization for Knee Distraction versus High Tibial Osteotomy: Is There a Difference?
J Knee Surg DOI: 10.1055/s-0041-1727158 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - April 14, 2021 Category: Orthopaedics Authors: Hoorntje, Alexander Kuijer, P. Paul F. M. Koenraadt, Koen L. M. Waterval-Witjes, Suzanne Kerkhoffs, Gino M. M. J. Mastbergen, Simon C. Marijnissen, Anne C. A. Jansen, Myl ène P. van Geenen, Rutger C. I. Tags: Erratum Source Type: research

Posterior Cruciate Ligament —Part 1
J Knee Surg 2021; 34: 471-471 DOI: 10.1055/s-0041-1725177 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - April 13, 2021 Category: Orthopaedics Authors: Fanelli, Gregory C. Tags: Foreword Source Type: research

Total Infrapatellar Fat Pad Excision Leads to Worse Isokinetic Performance in Total Knee Arthroplasty: A Randomized Controlled Trial
J Knee Surg DOI: 10.1055/s-0041-1727114There are concerns that total infrapatellar fat pad (IPFP) excision in total knee arthroplasty (TKA) results in patellar tendon shortening due to ischemic contracture, but individual preference of the surgeon is still the main determinant between total or partial excision. The aim of this randomized controlled study was to compare isokinetic performance and clinical outcome of TKAs with total and partial excision of the IPFP. Seventy-two patients scheduled to undergo TKA for primary knee osteoarthritis by a single surgeon were randomly assigned to either total or partial excision grou...
Source: Journal of Knee Surgery - March 31, 2021 Category: Orthopaedics Authors: Cankaya, Deniz Akti, Sefa Yasar, Niyazi Erdem Karakus, Dilek Unal, Kazim Onur Karhan, Taha Esref Sezgin, Erdem Aras Tags: Original Article Source Type: research

Comparison of the Radiologic, Morphometric, and Clinical Outcomes between Kinematically and Mechanically Aligned Total Knee Arthroplasty: A Propensity Matching Study
J Knee Surg DOI: 10.1055/s-0041-1725006The purpose of this study was to compare radiologic, morphometric, and clinical outcomes between kinematically aligned (KA) and mechanically aligned (MA) total knee arthroplasty (TKA) in Korean patients. Overall, 168 patients who underwent primary TKA were retrospectively reviewed, and propensity matching (age, sex, and body mass index) was performed as 1:3 ration (KA TKAs [n = 42]: MA TKAs [n = 126]). Joint-line orientation angle (JLOA), coronal and axial alignments of implants, hip–knee–ankle (HKA) angle, and patellar tilt angle were assessed ...
Source: Journal of Knee Surgery - March 3, 2021 Category: Orthopaedics Authors: Kim, Tae Woo Lee, Jae Ik Choi, Han Gyeol Yoo, Hyun Jin Kim, Kyu Tae Lee, Yong Seuk Tags: Original Article Source Type: research

Medial Plication Using an Arthroscopic All-Inside Technique for Treatment of Patellar Instability in Adolescents
J Knee Surg DOI: 10.1055/s-0041-1723978The purpose of this study was to present a medial plication using an arthroscopic all-inside technique for the treatment of patellar instability in adolescents. From July 2009 to June 2012, 19 patients with acute patellar dislocation were operated by this technique. Of these patients, follow-up was available in 17 patients at an average of 3 years (range: 1.5–4 years). At the follow-up, we evaluated the patients with physical examinations, radiographs, computed tomography scan, as well as the Lysholm and Kujala scoring scales. No recurrence of patellar instability has been found...
Source: Journal of Knee Surgery - March 2, 2021 Category: Orthopaedics Authors: Ji, Gang Zhou, Jianwei Gao, Jinbao Bai, Weixia Wang, Fei Tags: Original Article Source Type: research

Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee
The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - March 1, 2021 Category: Orthopaedics Authors: Ewing, Michael A. Stannard, James P. Cook, James L. Tags: Special Section Article Source Type: research

Optimal Fluoroscopic Angulation to Determine Intercondylar Notch Violation during Pediatric Medial Patellofemoral Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0041-1724131Previous anatomic data has suggested that during pediatric medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel must be angled distally and anteriorly to avoid damage to the distal femoral physis and then intercondylar notch. The purpose of this study was to determine the optimal degree of fluoroscopic angulation necessary to radiographically determine the presence of intercondylar notch violation. Fourteen adult cadaveric human femora were disarticulated and under fluoroscopic guidance, Schöttle's point was identified. A 0.62-mm Kirschner wire was then drille...
Source: Journal of Knee Surgery - February 26, 2021 Category: Orthopaedics Authors: Knapik, Derrick M. McCarthy, Conor F. Drummond, Ian Liu, Raymond W. Gilmore, Allison Tags: Original Article Source Type: research

The Effect of Joint Line Elevation on In Vivo Knee Kinematics in Bicruciate Retaining Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1724132Prior studies have reported a negative effect on both clinical outcomes and patient-reported outcome measures (PROMS) following joint line elevation (JLE) in cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior stabilized (PS) TKA designs. This experimental study was aimed to quantify the effect of JLE on in vivo knee kinematics in patients with bicruciate retaining (BCR) TKA during strenuous activities. Thirty unilateral BCR TKA patients were evaluated during single-leg deep lunge and sit-to-stand using a validated combined computer tomography and dual fluoroscopic ima...
Source: Journal of Knee Surgery - February 26, 2021 Category: Orthopaedics Authors: Klemt, Christian Padmanabha, Anand Tirumala, Venkatsaiakhil Smith, Evan J. Kwon, Young-Min Tags: Original Article Source Type: research

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results
J Knee Surg DOI: 10.1055/s-0041-1723983Recently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor res...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Weiler, Andreas Dickschas, J örg Gwinner, Clemens Tags: Special Section Article Source Type: research

Anatomy and Biomechanics of the Posterior Cruciate Ligament
J Knee Surg DOI: 10.1055/s-0041-1725007Posterior cruciate ligament (PCL) injuries are often encountered in the setting of other knee pathology and sometimes in isolation. A thorough understanding of the native PCL anatomy is crucial in the successful treatment of these injuries. The PCL consists of two independent bundles that function in a codominant relationship to perform the primary role of resisting posterior tibial translation relative to the femur. A secondary role of the PCL is to provide rotatory stability. The anterolateral (AL) bundle has a more vertical orientation when compared with the posteromedial (PM) bund...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Lynch, Thomas B. Chahla, Jorge Nuelle, Clayton W. Tags: Special Focus Section Source Type: research

Imaging Review of the Posterior Cruciate Ligament
J Knee Surg DOI: 10.1055/s-0040-1722629Posterior cruciate ligament (PCL) injuries can often be missed on physical examination, especially in multiligament knee injuries. Therefore, a comprehensive approach to imaging the PCL should be implemented whenever history and examination findings indicate relative risk. Radiography, including a posterior-stress view, and magnetic resonance imaging, when available, provide consistently accurate diagnosis of PCL pathology and common knee comorbidities. Computed tomography and ultrasonography can be useful modalities with potential advantages with respect to availability and access, s...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Cook, Cristi Reeves Wissman, Robert D. Tags: Special Focus Section Source Type: research

Clinical Efficacy of Preoperative CT-Assisted Planning for Primary Total Knee Arthroplasty: A Pilot Randomized Clinical Trial
This study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of t...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Younis, Ahmed Saeed Awad, Mohammed El Sayed Samy, Tarek M. Osman, Wael Samir Abdeldayem, Sherif Mostafa Zakaria, Zeiad M. Fathy, Ayman Metwaly, Radwan G. Tags: Original Article Source Type: research

Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case –Control Study
The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (&plu...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Tamimi, Iskandar Enrique, David Bautista Alaqueel, Motaz Tat, Jimmy Lara, Almudena P érez Schupbach, Justin Burman, Mark Martineau, Paul Tags: Original Article Source Type: research

Biplane Medial Opening-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope more than Uniplane Osteotomy
J Knee Surg DOI: 10.1055/s-0040-1722659Few clinical studies have compared uniplane high tibial osteotomy (HTO) with biplane HTO. The study aim was to compare the radiological and clinical results of uniplane HTO and biplane HTO, especially in terms of the increase in the posterior tibial slope (PTS). Medial opening-wedge HTO patients' medical records and radiological results from a single institution were retrospectively reviewed. Pre- and postoperative serial radiographs, including the Rosenberg, lateral view, and standing anteroposterior view of the whole lower extremity, magnetic resonance imaging at postoperative day 2...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Suh, Dong Won Nha, Kyung Wook Han, Seung Beom Cheong, Kuhoang Kyung, Bong Soo Tags: Original Article Source Type: research

Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients
J Knee Surg DOI: 10.1055/s-0040-1722326The purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Song, Xuyang Sajak, Patrick M.J. Aneizi, Ali Alqazzaz, Aymen Burt, Cameran I. Ventimiglia, Dominic J. Meredith, Sean J. Leong, Natalie L. Packer, Jonathan D. Henn, R. Frank Tags: Original Article Source Type: research

Lumbar Spine Sagittal Mismatch Deformity Negatively Affects Total Knee Arthroplasty Outcomes
J Knee Surg DOI: 10.1055/s-0041-1723979There is currently a paucity of data regarding the potential relationships between preexisting spinal deformity and clinical outcomes following total knee arthroplasty (TKA). We sought to expand upon this deficit. We hypothesize that lumbar sagittal mismatch deformity (MD) will correlate with a decrease in functional outcomes after TKA. This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure sag...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Sheppard, William L. Upfill-Brown, Alexander McKay, Kevin M. Park, Howard Y. Shah, Akash Park, Don Y. Sassoon, Adam A. Tags: Original Article Source Type: research

An Investigation of Medial Tibial Component Overhang in Unicompartmental and Total Knee Replacements Using Ultrasound in the Outpatient Department
J Knee Surg DOI: 10.1055/s-0041-1723970Tibial component overhang is known to be a contributor to worse outcomes in knee arthroplasty. The aim of this study is to investigate the presence of tibial component overhang, and whether overhang correlates to a higher local tenderness in both medial unicompartmental and total knee replacements. Also, to determine if a rotational projection phenomenon is presented with radiographs when investigating tibial component overhang. A prospective study, including 64 participants, was performed, where ultrasound measurements were compared with postoperative radiographs. Local tenderness wa...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Mortensen, Jacob F. Hald, Julius T. Rasmussen, Lasse E. Østgaard, Svend E. Odgaard, Anders Tags: Original Article Source Type: research

Time from Injury Is the Key Predictor of Meniscal Injury in ACL-Deficient Knees
J Knee Surg DOI: 10.1055/s-0040-1722324The meniscus is one of the most important structures of the knee that needs to be saved if possible. Previous studies showed that increasing time from an anterior cruciate ligament (ACL) injury (TFI) could lead to a meniscal tear, especially medial meniscus (MM). We developed the present study to see if the TFI alone is a predictor of meniscal injury in ACL-deficient knees. We included 111 patients who had a reconstructed ACL injury at our institution from March 2015 to March 2016 in this retrospective cohort study. All demographic data, including age, gender, and body mass index (BMI...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Mortazavi, Seyed Mohammad Javad Moharrami, Alireza Tamhri, S. S. Okati, Ali Shamabadi, Ahmad Tags: Original Article Source Type: research

Polyethylene Components in Primary Total Knee Arthroplasty: A Comprehensive Overview of Fixed Bearing Design Options
J Knee Surg DOI: 10.1055/s-0041-1723981The articular design of a polyethylene insert influences the kinematics and overall function of a total knee arthroplasty (TKA). Standard symmetric posterior-stabilized and cruciate-retaining polyethylene designs have a long track record of high patient satisfaction and longevity in TKA. However, the number and variety of polyethylene inserts and articulations have continued to evolve in an attempt to better replicate native knee kinematics or provide additional constraint. Ultracongruent polyethylene designs have been touted as increasing stability while maintaining the benefits of c...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Kahlenberg, Cynthia A. Chalmers, Brian Sun, Hyung Jin Mayman, David J. Westrich, Geoffrey H. Haas, Steven B. Sculco, Peter K. Tags: Original Article Source Type: research

Early Stage Versus Late Stage Periarticular Injection during Unicompartmental Knee Arthroplasty for Postoperative Pain Relief: A Randomized Controlled Trial
J Knee Surg DOI: 10.1055/s-0041-1723982Controlling postoperative pain after unicompartmental knee arthroplasty (UKA) is essential to improve patient satisfaction and promote early recovery. The purpose of this study was to investigate the difference in clinical efficacy between early and late stage periarticular injection during UKA for postoperative pain relief. Eighty-four patients meeting the inclusion and exclusion criteria were randomly divided into the early stage periarticular injection group and late stage periarticular injection group by using a random number tables method. The difference between the two groups wa...
Source: Journal of Knee Surgery - February 22, 2021 Category: Orthopaedics Authors: Chen, Wang Sun, Jian-Ning Hu, Zheng-Hao Zhang, Yu Chen, Xiang-Yang Feng, Shuo Tags: Original Article Source Type: research

Clinical Pathways of Patients Denied Total Knee Arthroplasty Due to an Institutional BMI Cutoff
J Knee Surg DOI: 10.1055/s-0041-1723969Out of concern for the increased risk of complications with morbid obesity, institutional body mass index (BMI) cutoffs for total knee arthroplasty (TKA) have become commonplace. We sought to answer the questions: what percentage of morbidly obese patients with knee osteoarthritis who present to an arthroplasty clinic will, within 2 years, undergo TKA at (1) a BMI less than 40 kg/m2 or (2) at a BMI greater than 40 kg/m2? Of those who do not undergo surgery, (3) what percentage lose enough weight to become TKA-eligible, and (4) what percentage do not? We performed an obse...
Source: Journal of Knee Surgery - February 19, 2021 Category: Orthopaedics Authors: Wilson, Charlie D. Lundquist, Kathleen F. Baruch, Nathan H. Gaddipati, Ravindra Hammonds, Kendall A.P. Allen, Bryce C. Tags: Original Article Source Type: research

Clinical Outcomes and Experience of a Multiyear Consecutive Case Series of Total Knee Arthroplasty Procedures Conducted with a Bipolar Sealer System for Hemostasis
J Knee Surg DOI: 10.1055/s-0041-1723972Maximizing hemostasis during total knee replacement procedures remains a key challenge in current practice. Bipolar sealer technology achieves intraoperative hemostasis through tissue sealing and coagulation with adjustable radio frequency energy and a saline-irrigated tip. Optimal surgical site hemostasis is important to avoid potential complications such as hemarthrosis, wound drainage, increased pain, delayed discharge, and readmissions. The aim of this study is to evaluate the safety and effectiveness of the bipolar sealer device in primary knee replacement in the largest consecut...
Source: Journal of Knee Surgery - February 19, 2021 Category: Orthopaedics Authors: Sah, Alexander P. Tags: Original Article Source Type: research

Occupational Outcomes and Revision Rates for Medial Unicondylar Knee Arthroplasty in U.S. Military Servicemembers
This study evaluates return to work and revision rates for medial unicondylar knee arthroplasty (UKA) in a high-demand military cohort. Patient demographic and clinical variables were isolated from the medical records of active-duty military servicemembers with at least 2 years of postoperative follow-up and correlated with return to work, medial UKA survivorship, and perioperative complications. The medial UKA annual revision rate was calculated as the percentage of implants revised per observed component year. A total of 39 servicemembers underwent 46 primary medial UKAs (32 unilateral and 7 bilateral) with a mean follow...
Source: Journal of Knee Surgery - February 19, 2021 Category: Orthopaedics Authors: Rodriguez, Marina Heida, Ken Rider, Danielle E. Goodman, Gens P. Waterman, Brian R. Belmont, Philip J. Tags: Original Article Source Type: research

Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella
This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p 
Source: Journal of Knee Surgery - February 19, 2021 Category: Orthopaedics Authors: Park, Hyung Jun Chang, Moon Jong Kim, Tae Woo Chang, Chong Bum Kang, Kee Soo Kang, Seung-Baik Tags: Original Article Source Type: research

Continuous Bupivacaine Infusion versus Liposomal Bupivacaine in Adductor Canal Block for Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1722661Multimodal pain management for total knee arthroplasty (TKA) is essential to enhance functional recovery. Regional anesthesia became a vital component to decrease pain after TKA. Several studies compared femoral versus adductor canal blocks, including evaluating medications that can prolong adductor canal blocks. Liposomal bupivacaine (LB) and continuous local infusion (OnQ) both extend local anesthetic delivery beyond 24 hours. This superiority study compared the use of OnQ versus LB in adductor canal blocks. A retrospective study was conducted between two cohorts of consecuti...
Source: Journal of Knee Surgery - February 15, 2021 Category: Orthopaedics Authors: Chen, Chang-Hwa Mary Yun, Andrew G. Fan, Teresa Tags: Original Article Source Type: research

Double-Bundle Posterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1722312The optimal surgical technique for posterior cruciate ligament (PCL) reconstruction is a topic of debate among knee surgeons. There are many variables to consider including graft selection, graft fixation method, and single- versus double-bundle reconstruction. While there is a need for ongoing research to elucidate which technique yields the best results, this article discusses recent literature on the topic of single- versus double-bundle PCL reconstruction as well as the senior author's preferred reconstruction method. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th ...
Source: Journal of Knee Surgery - February 12, 2021 Category: Orthopaedics Authors: Stannard, James P. Temperato, Joseph Stannard, James T. Tags: Special Focus Section Source Type: research

Transtibial Posterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1722696The keys to successful posterior cruciate ligament (PCL) reconstruction are to identify and treat all pathology, utilize strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, mechanical graft tensioning, secure graft fixation, and the appropriate postoperative rehabilitation program. Adherence to these technical principles results in successful single- and double-bundle arthroscopic transtibial tunnel PCL reconstruction based upon stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements. The purp...
Source: Journal of Knee Surgery - February 12, 2021 Category: Orthopaedics Authors: Fanelli, Gregory C. Tags: Special Focus Section Source Type: research

All-Inside PCL Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1722313Many different techniques with multiple graft types have been described for the reconstruction of the injured posterior cruciate ligament (PCL); autograft versus allograft, single- versus double-bundle, open inlay versus arthroscopic inlay versus arthroscopic transtibial, and recently described the arthroscopic “all-inside” socket technique. Reported clinical outcomes have demonstrated no significant difference in any of these PCL reconstruction techniques, likely because of the heterogeneity in injury characteristics and patient population. The ideal surgical technique sh...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Therrien, Erik Pareek, Ayoosh Song, Bryant M. Wilbur, Ryan R. Stuart, Michael J. Levy, Bruce A. Tags: Special Section Article Source Type: research

Complications Associated with Posterior Cruciate Ligament Reconstruction and Avoiding Them
J Knee Surg DOI: 10.1055/s-0041-1723016Posterior cruciate ligament (PCL) injuries often occur as part of a multiligament injury pattern and can present a significant challenge to the treating surgeon. When PCL reconstruction is indicated, complications can arise in the intraoperative and postoperative period that lead to poor outcomes. These complications include neurovascular injury, fracture, compartment syndrome, persistent posterior laxity, motion loss, residual knee pain, osteonecrosis, and heterotopic ossification. The purpose of this review is to highlight complications associated with PCL reconstruction and strateg...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: James, Evan W. Taber, Caroline E. Marx, Robert G. Tags: Special Focus Section Source Type: research

Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1723014The impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedur...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Swiggett, Samuel J. Mannino, Angelo Vakharia, Rushabh M. Ehiorobo, Joseph O. Roche, Martin W. Mont, Michael A. Erez, Orry Tags: Original Article Source Type: research

Sensor Use in Cruciate-Retaining Total Knee Arthroplasty Compared with Posterior-Stabilized Total Knee Arthroplasty: Load Balancing and Posterior Femoral Rollback
J Knee Surg DOI: 10.1055/s-0041-1723012The purpose was to investigate the proportion of severe load imbalance after appropriate conventional gap balancing and analyze the intraoperative kinematics after load balancing in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasties (TKAs). In total, 45 sensor-assisted CR and 45 PS TKAs using NexGen prosthesis were prospectively evaluated. After appropriate conventional gap balancing, the loads at 10, 45, and 90 degrees of knee flexion were evaluated with a wireless load sensor placed in trial implants. The proportion of severe load imbalance (medial load&...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Song, Sang Jun Kim, Kang Il Park, Cheol Hee Tags: Original Article Source Type: research

Predictors of Mid- to Long-Term Outcomes in Patients Experiencing a Knee Dislocation: A Systematic Review of Clinical Studies
J Knee Surg DOI: 10.1055/s-0041-1723762Knee dislocations (KDs) are devastating injuries for patients and present complex challenges for orthopaedic surgeons. Although short-term outcomes have been studied, there are few long-term outcomes of these injuries available in the literature. The purpose of this study is to determine factors that influence mid- to long-term clinical outcomes following surgical treatment of KD. A review of the current literature was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies published from 2010 to 2019 with a minimum 2-year follow-up that reported o...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Smith, John-Rudolph H. Belk, John W. Friedman, Jamie L. Dragoo, Jason L. Frank, Rachel M. Bravman, Jonathan T. Wolcott, Michelle L. McCarty, Eric C. Tags: Original Article Source Type: research

Comparative Analysis of Outcomes in Medicare-Eligible Patients with a Hospital Stay Less than Two-Midnights versus Longer Length of Stay following Total Knee Arthroplasty: Implications for Inpatient-Outpatient Designation
This study aims to compare outcomes in Medicare-aged patients who underwent primary TKA and had an in-hospital stay spanning less than two-midnights to those with a length of stay greater than or equal to two-midnights. We retrospectively reviewed 4,138 patients ages ≥65 who underwent primary TKA from 2016 to 2020. Two cohorts were established based on length of stay (LOS), those with an LOS
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Singh, Vivek Lygrisse, Katherine A. Macaulay, William Slover, James D. Schwarzkopf, Ran Long, William J. Tags: Original Article Source Type: research

Transosseous Repair of Patellar Sleeve Fractures: A Case Series and Surgical Technique Guide
In this study, 20 patients, 17 males and 3 females, with a mean age of 11.7 years were included. ROM was initiated at a median of 27.5 days following surgery. All patients had a healed patellar sleeve fracture and intact extensor function at final follow-up. Final mean knee ROM among the 18 patients with minimum 3-month follow-up was 132 degrees. Thirteen patients (72%) achieved full ROM (≥ 130 degrees) and 5 patients (28%) achieved less than 130 degrees knee flexion. Duration of initial immobilization was found to be the only variable strongly associated with final postoperative ROM. Mean duration of immobilization for...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Perkins, Crystal A. Egger, Anthony C. Willimon, S. Clifton Tags: Original Article Source Type: research

A Flexible Intramedullary Guide Can Reduce the Anteroposterior Oversizing of Femoral Components Used in Total Knee Arthroplasty in Patients with Osteoarthritis and Severe Distal Femoral Sagittal Bowing
This study was performed to compare the sagittal alignment and clinical outcomes of TKAs performed with flexible and rigid femoral intramedullary guides. Thirty-eight knees that underwent primary TKAs with flexible intramedullary rods as femoral cutting guides were matched according to patient height and sex with 38 knees that underwent TKAs using conventional rigid rods. Clinical outcomes, including the range of motion and functional scores, and radiological variables, including the distal femoral bowing angle (DFBA), femoral component flexion angle (FFA), and mediolateral overhang and anteroposterior (AP) oversizing of f...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Lee, Do Weon Lee, Joonhee Lee, Junpyo Ro, Du Hyun Lee, Myung Chul Han, Hyuk-Soo Tags: Original Article Source Type: research

The Association between In Vivo Knee Kinematics and Patient-Reported Outcomes during Squatting in Bicruciate-Stabilized Total Knee Arthroplasty
This study was performed to clarify the relationship between in vivo kinematics and PROs in a cohort of patients undergoing BCS TKA. Forty knees were evaluated using a two-dimensional to three-dimensional registration technique obtained from sagittal plane fluoroscopy. In vivo kinematics including anteroposterior (AP) translation and tibiofemoral rotation were evaluated. Knee Society scores (KSSs) and Knee injury and Osteoarthritis Outcome Scores (KOOSs) were assessed before and after surgery. Relationships between tibiofemoral kinematics assessed with the knee in different positions of knee flexion and PROs were evaluated...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Kage, Tomofumi Inui, Hiroshi Tomita, Tetsuya Yamazaki, Takaharu Taketomi, Shuji Yamagami, Ryota Kono, Kenichi Kawaguchi, Kohei Takagi, Kentaro Sameshima, Shin Tanaka, Sakae Tags: Original Article Source Type: research

Preoperative Factors Associated with 2-Year Postoperative Survey Completion in Knee Surgery Patients
J Knee Surg DOI: 10.1055/s-0041-1723764Patient-reported outcomes, such as the Patient-Reported Outcomes Measurement Information System (PROMIS) measures, have become increasingly valued as measures of treatment. The purpose of the study was to determine preoperative factors associated with survey compliance 2 years after elective knee surgery. Five hundred patients, age 17 years and older, undergoing knee surgery from August 2015 and March 2017 were administered questionnaires preoperatively and 2 years postoperatively. Questionnaires included the International Knee Documentation Committee (IKDC) score, Numeric Pain Scales...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Kadiyala, Jagannath Zhang, Tina Aneizi, Ali Gopinath, Rohan Ventimiglia, Dominic J. Burt, Cameran I. Sajak, Patrick M.J. Meredith, Sean J. Henn, R. Frank Tags: Original Article Source Type: research

Good Short-Term Clinical Outcomes and Low Rates of Return to Sports after Repeat Revision ACL Reconstruction
J Knee Surg DOI: 10.1055/s-0041-1723765Repeat revision anterior cruciate ligament reconstruction (ACL-R) is a rare, demanding procedure and, as such, has not been well studied. Most of the available literature shows improved functional outcomes compared with preoperative state but inferior results when compared with primary ACL-R, particularly regarding return to preinjury level of sports. The purpose of this study was to assess functional outcomes in patients who had undergone repeat revision ACL-R. The secondary aims were to register return to sports, associated meniscal and/or chondral lesions, and evaluate radiological...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Gorodischer, Tom ás D. Zicaro, Juan Pablo Yacuzzi, Carlos Costa Paz, Mat ías Tags: Original Article Source Type: research

Outcomes of Combined Unicondylar Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1722322Young and more active patients with medial compartmental osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency are challenging for orthopaedic surgeons. The aim of the present study was to examine the early–mid clinical and radiological outcomes of combined Oxford unicondylar knee arthroplasty (UKA) and ACL reconstruction for the patients presenting ACL deficiency and concomitant medial compartment symptomatic OA. Twelve patients were included in the study. All patients were treated by combination of ACL reconstruction with medial UKA. The varus&nda...
Source: Journal of Knee Surgery - February 5, 2021 Category: Orthopaedics Authors: Aslan, Hakan Çevik, Hüseyin Bilgehan Tags: Original Article Source Type: research

Robotic Arm-Assisted Lateral Unicompartmental Knee Arthroplasty: How Are Components Aligned?
J Knee Surg DOI: 10.1055/s-0040-1722346The purpose of this multicenter, retrospective, observational study was to investigate the association between intraoperative component positioning and soft tissue balancing, as reported by robotic technology for a cohort of patients who received robotic arm-assisted lateral unicompartmental knee arthroplasty (UKA) as well as short-term clinical follow-up of these patients. Between 2013 and 2016, 78 patients (79 knees) underwent robotic arm-assisted lateral UKAs at two centers. Pre- and postoperatively, patients were administered the Knee Injury and Osteoarthritis Score (KOOS) and the...
Source: Journal of Knee Surgery - January 28, 2021 Category: Orthopaedics Authors: Zambianchi, Francesco Franceschi, Giorgio Banchelli, Federico Marcovigi, Andrea Ensini, Andrea Catani, Fabio Tags: Original Article Source Type: research

Effect of Manual versus Robotic-Assisted Total Knee Arthroplasty on Cervical Spine Static and Dynamic Postures
This study compared surgeon cervical (C) spine postures and repetitive motions when performing traditional manual total knee arthroplasty (MTKA) versus robotic-assisted TKA (RATKA). Surgeons wore motion trackers on T3 vertebra and the occiput anatomical landmarks to obtain postural and repetitive motion data during MTKA and RATKA performed on cadavers. We assessed (1) flexion–extension at T3 and the occiput anatomical landmarks, (2) range of motion (ROM) as the percentage of time in the flexion–extension angle, (3) repetition rate, defined as the number of the times T3 and the occiput flexion-extension angle ex...
Source: Journal of Knee Surgery - January 28, 2021 Category: Orthopaedics Authors: Scholl, Laura Y. Hampp, Emily L. Alipit, Vincent Sodhi, Nipun Bhowmik-Stoker, Manoshi Dropkin, Jonathan Chen, Antonia F. Mont, Michael A. Tags: Original Article Source Type: research

The Cost-Effectiveness of Closed Incisional Negative Pressure Wound Therapy for Infection Prevention after Revision Total Knee Arthroplasty
In this study, we used a break-even analysis to determine whether ciNPWT is a cost-effective measure for reducing prosthetic joint infection (PJI) after revision TKA. The cost of ciNPWT, cost of treatment for PJI, and baseline infection rates following revision TKA were collected from institutional data and the literature. The absolute risk reduction (ARR) in infection rate necessary for cost-effectiveness was calculated using break-even analysis. Using our institutional cost of ciNPWT ($600), this intervention would be cost-effective if the initial infection rate of revision TKA (9.0%) has an ARR of 0.92%. The ARR needed ...
Source: Journal of Knee Surgery - January 28, 2021 Category: Orthopaedics Authors: Pagani, Nicholas R. Moverman, Michael A. Puzzitiello, Richard N. Menendez, Mariano E. Kavolus, Joseph J. Tags: Original Article Source Type: research