Biomechanical Analysis of Ideal Knee Flexion Angle for ACL Graft Tensioning Utilizing Multiple Femoral and Tibial Tunnel Locations
J Knee Surg DOI: 10.1055/s-0041-1731826Anterior cruciate ligament (ACL) graft failure rate has been reported to be greater than 5% at 5 years. Our study evaluated ACL excursion with anatomic and nonanatomic femoral and tibial tunnels to determine optimal flexion angle to tension the ACL to minimize excursion. Ten cadaveric knee specimens were used. The ACL was sectioned and the femoral and tibial attachments were marked. A 1/16-inch drill created a tunnel in the center of the ACL footprint on the tibia and femur and additional tunnels were made 5 mm from this. A suture was passed through each tunnel combination and attache...
Source: Journal of Knee Surgery - July 29, 2021 Category: Orthopaedics Authors: Hammarstedt, Jon E. Guth, J. Jared Schimoler, Patrick J. Kharlamov, Alexander Miller, Mark C. Akhavan, Sam Demeo, Patrick J. Tags: Original Article Source Type: research

Correction of Varus Alignment with Peripheral Osteophyte Removal during Total Knee Arthroplasty: An Assessment with Computer Navigation
This study aimed to clarify whether resection of peripheral osteophytes could restore neutral hip–knee–ankle (HKA) angle of varus deformity of arthritic knees. Data from 90 varus arthritic knees that had undergone total knee arthroplasty (TKA) using a nonimage-based navigation system were analyzed. The change in the coronal mechanical axis, while applying manual valgus stress at extension and 90 degrees of knee flexion, was recorded after the following sequential procedures: (1) anterior cruciate ligament (ACL) sectioning, (2) subperiosteal stripping of the deep medial collateral ligament (MCL) from the ...
Source: Journal of Knee Surgery - July 16, 2021 Category: Orthopaedics Authors: Nishihara, Nobuhiro Masuda, Hironari Shimazaki, Naoya Toyooka, Seikai Kawano, Hirotaka Nakagawa, Takumi Tags: Original Article Source Type: research

Midterm Survival of a Varus –Valgus Constrained Implant following One-Stage Revision for Periprosthetic Joint Infection: A Single-Center Study
J Knee Surg DOI: 10.1055/s-0041-1731739Revision total knee arthroplasty (TKA) is challenging to perform in patients with periprosthetic joint infection (PJI) due to the difficulty of eradicating the infection and potential for bone and ligamentous deficits. The current study aimed to evaluate the midterm survival of varus–valgus constrained (VVC) implants used in one-stage revision TKA for chronic PJI at our institution. This retrospective analysis included 132 patients with chronic PJI who underwent one-stage revision using a VVC implant. The average follow-up was 51.6 months (range: 24–85 months). Five-year s...
Source: Journal of Knee Surgery - July 16, 2021 Category: Orthopaedics Authors: Ji, Baochao Li, Guoqing Zhang, Xiaogang Wang, Yang Mu, Wenbo Cao, Li Tags: Original Article Source Type: research

Radiographic and Clinical Evolution of the Oxford Unicompartmental Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1731718The aim of the study is to evaluate whether the use of the new instrumentation Microplasty (MP) improves component positioning and the reliability of the surgical technique, reducing the implant outliers from the recommended range and providing a more accurate resection, while avoiding insufficient or excessive tibial resection and clinical scores. We prospectively analyzed clinical and radiographic outcomes of three consecutive cohorts for a total of 227 implants at a minimum follow-up of 36 months. The first cohort consisted of 67 Oxford unicompartmental knee arthroplasty (OUKA), us...
Source: Journal of Knee Surgery - July 16, 2021 Category: Orthopaedics Authors: D'Ambrosi, Riccardo da Silva, Manuel J. de S.V. Moura, Jo ão L. M. Mariani, Ilaria Serrao, Luca D. Di Feo, Fabrizio Ursino, Nicola Tags: Original Article Source Type: research

Effects of the Use of Tourniquet in Total Knee Arthroplasty on the Clinical and Functional Outcomes with 5 Years of Follow-up: A Randomized Controlled Trial
This study aims to show the effects of tourniquet use in TKA on the functional and clinical outcomes with follow-up of 5 years. This is a randomized, double-blind, and single-center study of 101 patients who were treated by TKA and divided randomly into two groups. Tourniquet was used in group A and was not used in group B. Both groups were assessed by Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), visual analogue scale (VAS) score for thigh pain, and postoperative complications. Both groups were followed up for 5 years. The group of no tourniquet showed significant better functional outcome...
Source: Journal of Knee Surgery - July 14, 2021 Category: Orthopaedics Authors: Hamawandi, Sherwan A. Amin, Hazhar I. Al-Humairi, Ameer K. Tags: Review Article Source Type: research

Early Infection Trends for Primary Total Knee Arthroplasty: A 5-Year Review
J Knee Surg DOI: 10.1055/s-0041-1731736The aim of this study was to track the annual rates and trends of overall, deep, and superficial surgical site infections (SSIs) following total knee arthroplasty using the most recent results from a large and nationwide database. A total of 197,192 cases were performed between 2012 and 2016 from a nationwide database stratified into years and based on superficial and/or deep SSIs. Cohorts were analyzed individually and then combined to evaluate overall SSI rates. The infection incidence for each year was calculated. After a 6-year correlation and trends analysis, univariate analyses ...
Source: Journal of Knee Surgery - July 14, 2021 Category: Orthopaedics Authors: Sodhi, Nipun Anis, Hiba K. Acu ña, Alexander J. Gold, Peter Garbarino, Luke Higuera, Carlos A. Mont, Michael A. Tags: Original Article Source Type: research

Wound Management following Total Knee Arthroplasty: An Updated Review
J Knee Surg DOI: 10.1055/s-0041-1731740Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniq...
Source: Journal of Knee Surgery - July 14, 2021 Category: Orthopaedics Authors: Naylor, Brandon H. Tarazi, John M. Salem, Hytham S. Harwin, Steven F. Mont, Michael A. Tags: Original Article Source Type: research

Short-Term Outcomes after High Tibial Osteotomy Aimed at Neutral Alignment Combined with Arthroscopic Centralization of Medial Meniscus in Osteoarthritis Patients
J Knee Surg DOI: 10.1055/s-0041-1731738The study aimed to improve the long-term outcomes of open-wedge high tibial osteotomy (OWHTO); procedures combining OWHTO aimed at neutral alignment and arthroscopic centralization for meniscal extrusion have been introduced. The present study evaluated short-term patient-reported outcome measures; namely, the patient subjective satisfaction scores and Numeric Rating Scale (NRS) for walking pain after OWHTO aimed at neutral alignment with and without arthroscopic centralization for an extruded medial meniscus. A retrospective review of 50 primary OWHTO patients was conducted. Thirty-n...
Source: Journal of Knee Surgery - July 14, 2021 Category: Orthopaedics Authors: Katagiri, Hiroki Nakagawa, Yusuke Miyatake, Kazumasa Ohara, Toshiyuki Shioda, Mikio Sekiya, Ichiro Koga, Hideyuki Tags: Original Article Source Type: research

The Effect of Aberrant Rotation on Radiographic Patellar Height Measurement Using Canton-Deschamps Index: A Cadaveric Analysis
This study found that aberrant radiographic rotation in the axial plane resulted in a significantly different mean CDI measurement when compared with true lateral radiographs. All degrees of error in both directions and in both planes could have a clinically significant effect on CDI (≥0.1). Our findings confirm the importance of a perfect true lateral radiograph when measuring patella height. [...] 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 - July 14, 2021 Category: Orthopaedics Authors: Huddleston, Hailey P. Redondo, Michael L. Cregar, William M. Christian, David R. Hannon, Charles P. Yanke, Adam B. Tags: Original Article Source Type: research

Comparison with Navigation of a Novel Three-Step Technique for Improving Accuracy of the Distal Femoral Resection during Conventional TKA: A Case –Control Study
J Knee Surg DOI: 10.1055/s-0041-1731458Correct placement of the femoral component in the coronal plane during primary total knee arthroplasty (TKA) is related to long-term survival. The aim of this radiographic study was to determine the accuracy of a novel three-step technique for improving the accuracy of the distal femoral cut during conventional technique and compare it with computer navigation during TKA. A total of 458 TKAs were retrospectively analyzed (178 conventional TKAs with the novel technique and 280 navigated TKAs) for postoperative femoral component coronal alignment and compared between the two groups. Mea...
Source: Journal of Knee Surgery - July 8, 2021 Category: Orthopaedics Authors: Mullaji, Arun B. Khalifa, Ahmed A. Shetty, Gautam Thakur, Harshad Tags: Original Article Source Type: research

Analyzing the Burden of Revision Total Knee Arthroplasty in the United States between 2009 and 2016
J Knee Surg DOI: 10.1055/s-0041-1731324As the number of total knee arthroplasties (TKAs) increases, it is reasonable to expect the number of revision TKAs (rTKAs) to rise in parallel. The patient-related and societal burdens of rTKA are poorly understood. Therefore, the purpose of this study was to determine temporal changes in: (1) the incidence of rTKA; (2) patient and hospital characteristics; (3) complications, hospital lengths of stay (LOSs), and discharge dispositions; and (4) costs, charges, and payer types. All patients who underwent rTKA between 2009 and 2016 were identified from the National Inpatient Sample data...
Source: Journal of Knee Surgery - July 8, 2021 Category: Orthopaedics Authors: Livshetz, Isaac Sussman, Benjamin H. Papas, Vivian Mohamed, Nequesha S. Salem, Hytham S. Delanois, Ronald E. Mont, Michael A. Scuderi, Giles R. Tags: Original Article Source Type: research

Steroids Significantly Decrease Postoperative Postural Hypotension in Total Knee Replacement
J Knee Surg DOI: 10.1055/s-0041-1731722Total knee replacement (TKR) is one of the most common orthopaedic procedures performed, and enhanced recovery after surgery (ERAS) has been developed and incorporated into inpatient surgical pathways to improve patient outcomes. Under ERAS recommendations, multimodal prophylaxis has been used to help manage postoperative nausea and vomiting (PONV) following TKR. Dexamethasone is one of the commonly used for this and the anti-inflammatory properties could depress vagal activity, reducing postural hypotension (PH). The hypothesis of this study is that postoperative dexamethasone use is...
Source: Journal of Knee Surgery - July 8, 2021 Category: Orthopaedics Authors: Cheng, Gloria H. M. Tan, Gabriel K. Y. Kamarudin, Muhammad F. B. Lee, Bryan W. W. Mei, Yap Yan Tan, Kelvin G. Tags: Original Article Source Type: research

The Effect of Smoking on the Outcome of Matrix-Based Autologous Chondrocyte Implantation: Data from the German Cartilage Registry
J Knee Surg DOI: 10.1055/s-0041-1731456Smoking is known to have various deleterious effects on health. However, it is not clear whether smoking negatively affects the postoperative outcome following matrix-based autologous cartilage implantation (MACI) in the knee. The purpose of this study was to evaluate the effect of smoking on the outcome of MACI in the knee. A total of 281 patients receiving MACI in the knee between 2015 and 2018 were registered in the German Cartilage Database. The cohort was divided into ex-smokers, smokers, and nonsmokers. Data regarding the Knee Injury and Osteoarthritis Outcome Score (KOOS), the ...
Source: Journal of Knee Surgery - July 8, 2021 Category: Orthopaedics Authors: Betz, Volker M. Holzgruber, Martin Simon, Johanna Uhlemann, Felix Niemeyer, Philipp M üller, Peter E. Niethammer, Thomas R. Tags: Original Article Source Type: research

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender
J Knee Surg DOI: 10.1055/s-0041-1731455Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients ...
Source: Journal of Knee Surgery - July 5, 2021 Category: Orthopaedics Authors: Pereira, Eduardo G. Carvalho, Maria M. Oliveira, Tiago Sacramento, Telmo Cruz, Henrique Viegas, Rui Fontes, Ana P. Marreiros, Ana Sousa, Jo ão P. Tags: Original Article Source Type: research

Trends in Lateral Retinacular Release from 2010 to 2017
J Knee Surg DOI: 10.1055/s-0041-1731457Historically, lateral retinacular release (LRR) procedures have been utilized in the treatment of a variety of patellofemoral disorders, including lateral patellar instability. However, in the past decade, there has been an increasing awareness of the importance of the lateral stabilizers in patellar stability, as well as the complications of LRR, such as recurrent medial patellar instability. The purpose of this study was to investigate current trends in LRR procedures from 2010 through 2017 using a large national database. The American College of Surgeons-National Surgical Quality I...
Source: Journal of Knee Surgery - July 5, 2021 Category: Orthopaedics Authors: Huddleston, Hailey P. Drager, Justin Cregar, William M. Walsh, Justin M. Yanke, Adam B. Tags: Original Article Source Type: research

Tobacco Use Is Associated with More Severe Adverse Outcomes Than Morbid Obesity after Aseptic Revision TKA
This study was performed to evaluate whether morbid obesity was more strongly associated with adverse aseptic rTKA outcomes than diabetes or tobacco use history—when present as a solitary major risk factor. Demographic characteristics, surgical indications, and adverse outcomes (reoperation, revision, infection, and amputation) were compared between 270 index aseptic rTKA performed for patients with morbid obesity (n = 73), diabetes (n = 72), or tobacco use (n = 125) and 239 “healthy” controls without these risk factors at a mean 75.7 (range: 24–111) months....
Source: Journal of Knee Surgery - July 5, 2021 Category: Orthopaedics Authors: Hagerty, Michael P. Walker-Santiago, Rafael Tegethoff, Jason D. Stronach, Benjamin M. Keeney, James A. Tags: Original Article Source Type: research

Multiligamentous Knee Injuries: Current Concepts Review
J Knee Surg DOI: 10.1055/s-0041-1731325Multiligamentous knee injuries (MLKI) are rare but devastating injuries that have a potential to cause long-term sequelae and significant morbidity. Frequently occurring concomitantly with knee dislocations (KD), MLKI have many risk factors that influence their incidence and treatment outcomes. Proper understanding of these risk factors can assist the surgeon with evaluation, surgical planning, and managing patient expectations both pre- and postoperatively. The purpose of this review is fourfold: (1) identify the risk factors and injuries associated with MLKI, (2) describe factors im...
Source: Journal of Knee Surgery - July 2, 2021 Category: Orthopaedics Authors: Holloway, Calvin Rizzi, Andrew Dickherber, Jason Athiviraham, Aravind Tags: Original Article Source Type: research

Outcomes of Fixed-Hinged Knee Prosthesis for Distal Femoral Osteosarcoma in Skeletally Immature Patients: First Results
This study aims to report the (1) clinical outcomes after prosthetic replacement, (2) postoperative complications, and (3) length of discrepancy of the operative tibia with the unaffected tibia. Thirty-four skeletally immature patients (averaged 9 years at surgery; range, 5–12 years) with distal femoral osteosarcoma underwent placement of this hinged knee prosthesis between January 2015 and August 2018. Postoperative function and complications were assessed. Length discrepancy was measured using a series of full-length standing anteroposterior radiographs of the bilateral lower extremity. The average follow-up durati...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: Zhao, Zhiqing Yang, Yi Yan, Taiqiang Tang, Xiaodong Yang, Rongli Guo, Wei Tags: Original Article Source Type: research

A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture
This study is a therapeutic case series and its level of evidence is IV. [...] 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 - June 29, 2021 Category: Orthopaedics Authors: Sun, Changjiao Du, Ruiyong Luo, Song Chen, Lianxu Ma, Qi Cai, Xu Tags: Original Article Source Type: research

Distal Femoral Replacement for Fractures Allows for Early Mobilization with Low Complication Rates: A Multicenter Review
J Knee Surg DOI: 10.1055/s-0041-1731353Periprosthetic fractures around a total knee arthroplasty (TKA), comminuted and intra-articular femur fractures, or fracture nonunions in osteoporotic bone represent technically challenging problems. This is particularly true when the fracture involves a loose femoral component or the pattern results in suboptimal fixation potential. These clinical indications often arise in an older and comorbid patient population in whom a principal goal of treatment includes allowing for early mobilization. Limited data indicate that arthroplasty via distal femoral replacement (DFR) is a reasonable...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: Stancil, Ryan Romm, Jacob Lack, William Bohnenkamp, Frank Sems, Stephen Cross, William Cass, Joseph Keeney, James Nam, Denis Nunley, Ryan Fernando, Navin Sassoon, Adam Tags: Original Article Source Type: research

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention
This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infe...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: Sargin, Serdar Atik, Aziz Aslan, Ahmet Tags: Original Article Source Type: research

Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis
J Knee Surg DOI: 10.1055/s-0041-1731323The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional data...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: Samuel, Linsen T. Karnuta, Jaret M. Banerjee, Aditya Briskin, Isaac Cantrell, William A. George, Joseph W. Higuera-Rueda, Carlos A. Kamath, Atul F. Khlopas, Anton Klika, Alison Krebs, Viktor E. Mesko, Nathan W. Mont, Michael A. Murray, Trevor G. Piuzzi, N Tags: Original Article Source Type: research

Do Intra-articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review
This study revealed no absolute or temporal association between preoperative, intra-articular corticosteroid injections, and complications after TKA. Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions. [...] 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 - June 29, 2021 Category: Orthopaedics Authors: Rhode, David T. Siegel, Matthew A. Volchenko, Elan Patetta, Michael J. Schwarzman, Garrett R. Chmell, Samuel J. Gonzalez, Mark H. Tags: Original Article Source Type: research

Association between Patellofemoral Anatomy and Chondral Lesions of the Knee in Patellofemoral Instability
J Knee Surg DOI: 10.1055/s-0041-1731351Chondral injury is a serious consequence of patellar dislocation and patellofemoral instability (PFI). There is limited data on the relationship between radiological features such as sulcus angle and patellar height to the presence, location, and severity of chondral lesions. The purpose of this study was to determine the association of anatomical variants in patellofemoral instability with injuries sustained due to patellar dislocation. A cohort of 101 patients who had four or more episodes of dislocation or instability undergoing isolated arthroscopy or arthroscopies at the time of ...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: O'Malley, Olivia Choudhury, Aliya Biggs, Alexandra Humdani, Alina J. Brown, Oliver Smith, Toby O. Ejindu, Vivian Hing, Caroline B. Tags: Original Article Source Type: research

Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up
J Knee Surg DOI: 10.1055/s-0041-1731349Robotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) ...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: Marchand, Kevin B. Moody, Rachel Scholl, Laura Y. Bhowmik-Stoker, Manoshi Taylor, Kelly B. Mont, Michael A. Marchand, Robert C. Tags: Original Article Source Type: research

During Arthroscopic Repair of Medial Meniscal Tears: Do Not Be Afraid to Perform “Pie Crust” Technique
J Knee Surg DOI: 10.1055/s-0041-1731352In the absence of effective long-term repair of meniscal injuries, damage to the knee may lead to the development of osteoarthritis. Recent reports have recommended meniscal repair to be undertaken in all cases of meniscal tears. However, the most common complication encountered during repair of the medial meniscus is iatrogenic cartilage and meniscal injury due to its unclear visualization. The aim of this study is to evaluate the long-term clinical and radiological results of the pie-crust (PC) technique performed during the repair of medial meniscal tears. This retrospective study ...
Source: Journal of Knee Surgery - June 29, 2021 Category: Orthopaedics Authors: Ar ıcan, Gökhun Ercan, Niyazi Atmaca, Emre İltar, Serkan Alemdaro ğlu, Kadir B. Tags: Original Article Source Type: research

Knee Stability following Posterior-Stabilized Total Knee Arthroplasty: Comparison of Medial Preserving Gap Technique and Measured Resection Technique
This study aimed to compare the MPGT with the measured resection technique (MRT) to determine which provides better postoperative knee stability after posterior-stabilized total knee arthroplasty (PS-TKA). Primary PS-TKA, using either MPGT (n = 65) or MRT (n = 65), was performed in 130 patients with varus knee osteoarthritis. Postoperative knee stabilities at extension and flexion were assessed using varus–valgus stress radiographs and stress epicondylar view, respectively (at 1 month, 6 months, 1 year, and 3 years postoperatively). The distance between the femoral prosthesis and polyethyl...
Source: Journal of Knee Surgery - May 15, 2021 Category: Orthopaedics Authors: Tsubosaka, Masanori Muratsu, Hirotsugu Nakano, Naoki Kamenaga, Tomoyuki Kuroda, Yuichi Inokuchi, Takao Miya, Hidetoshi Kuroda, Ryosuke Matsumoto, Tomoyuki Tags: Original Article Source Type: research

Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1729967The posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the...
Source: Journal of Knee Surgery - May 15, 2021 Category: Orthopaedics Authors: Lee, O-Sung Lee, Jangyun Lee, Myung Chul Han, Hyuk-Soo Tags: Original Article Source Type: research

Rotational Soft-Tissue Balance Is Highly Correlated with Rotational Kinematics in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1729619Recovery of normal knee kinematics is critical for improving functional outcomes and patient satisfaction after total knee arthroplasty (TKA). The kinematics pattern after TKA varies from case to case, and it remains unclear how to reproduce normal knee kinematics. The present study aimed to evaluate rotational knee kinematics and soft-tissue balance using a navigation system and to assess the influence of intraoperative soft-tissue balance on the rotational knee kinematics. We evaluated 81 osteoarthritic knees treated with TKA using a posterior stabilized (50 knees) or cruciate retai...
Source: Journal of Knee Surgery - May 15, 2021 Category: Orthopaedics Authors: Kinoshita, Tomofumi Hino, Kazunori Kutsuna, Tatsuhiko Watamori, Kunihiko Miura, Hiromasa Tags: Original Article Source Type: research

Impact of Preoperative Opioid Use on Patient-Reported Outcomes after Revision Total Knee Arthroplasty: A Propensity Matched Analysis
J Knee Surg DOI: 10.1055/s-0041-1729966This is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre- and postoperative PROMs was identified. Due to differences i...
Source: Journal of Knee Surgery - May 15, 2021 Category: Orthopaedics Authors: Ingall, Eitan Klemt, Christian Melnic, Christopher M. Cohen-Levy, Wayne B. Tirumala, Venkatsaiakhil Kwon, Young-Min Tags: Original Article Source Type: research

Effects of Tourniquet Application on Faster Recovery after Surgery and Ischemia-Reperfusion Post –Total Knee Arthroplasty, Cementation through Closure versus Full-Course and Nontourniquet Group
This study aimed to assess the effects of tourniquet application on faster recovery post-TKA. Our hypothesis was that inflammation and limb function would be similar with different tourniquet applications. A prospective randomized double-blinded trial assessed tourniquets effects on postoperative pain, swelling, and early outcome in TKA. In present study, 50 TKAs were enrolled in each group as follows: full course (FC), cementation through closure (CTC), and no tourniquet (NT), CTC as treatment group while FC and NT as control groups. Topical blood samples of 3 mL from the joint cavity and drainage bags were obtaine...
Source: Journal of Knee Surgery - May 15, 2021 Category: Orthopaedics Authors: Cao, Qinggang Wu, Qiong Liu, Yun He, Zhiwei Cong, Yu Meng, Jia Zhao, Jianning Bao, Nirong Tags: Original Article Source Type: research

Do Patients with Paget's Disease Have Worse Outcomes following Primary Total Knee Arthroplasty?
The objective of this study was to determine whether Paget's disease patients undergoing primary TKA have higher rates of complications. A query of an administrative database was performed identifying Paget's disease patients undergoing primary TKA as the study cohort. Patients who did not have Paget's disease served as a matching cohort. Study group patients were matched in a 1:5 ratio by age, sex, and comorbidities. The query yielded 34,284 patients in the study (n = 5,714) and matched (n = 28,570) cohorts. Outcomes analyzed included length of stay (LOS), costs of care, 90-day medical and surg...
Source: Journal of Knee Surgery - May 14, 2021 Category: Orthopaedics Authors: Hernandez, Nicholas M. Vakharia, Rushabh M. Bolognesi, Michael P. Mont, Michael A. Seyler, Thorsten M. Roche, Martin W. Tags: Original Article Source Type: research

Posterior Cruciate Ligament —Part 2
J Knee Surg 2021; 34: 581-581 DOI: 10.1055/s-0041-1725178 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 - May 10, 2021 Category: Orthopaedics Authors: Fanelli, Gregory C. Tags: Special Focus Section Source Type: research

Treatment of Periprosthetic Joint Infection in Total Knee Arthroplasty with a Temporary Intramedullary Nail: Is a Long or Short Nail Better?
J Knee Surg DOI: 10.1055/s-0041-1729552To our knowledge, no studies have compared postoperative outcomes between patients who received a temporary short or long intramedullary (IM) nail in the setting of infected total knee arthroplasty (TKA). Therefore, the aim of this study was to compare short-term outcomes for patients who underwent long or short IM nail insertion for treatment of periprosthetic knee infection. Specifically, we compared: (1) success rates; (2) patient reported/functional outcomes; and (3) complications between patients implanted with a short or a long IM nail following PJI of the knee. A retrospective ...
Source: Journal of Knee Surgery - May 4, 2021 Category: Orthopaedics Authors: Mohamed, Nequesha S. Castrodad, Iciar M. Davila Etcheson, Jennifer I. Kelemen, Margaret N. Plate, F. Johannes Conway, Janet D. Delanois, Ronald E. Tags: Original Article Source Type: research

Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft
J Knee Surg DOI: 10.1055/s-0041-1729553The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bear...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Perez-Mozas, Maria Payo-Ollero, Jesus Montiel, Veronica Valenti-Nin, Juan Ramon Valenti-Azcarate, Andres Tags: Original Article Source Type: research

Which Asymmetric Tibial Component Is Optimally Designed for Calipered Kinematically Aligned Total Knee Arthroplasty?
J Knee Surg DOI: 10.1055/s-0041-1728815Calipered kinematically aligned (KA) total knee arthroplasty (TKA) restores the patient's prearthritic joint lines and sets internal-external rotation of the tibial component parallel to the flexion-extension (FE) plane, which is not a mechanical alignment (MA) target. Two asymmetric tibial components designed for MA set the tibial component to either a femoral component (FC) target or a tibial tubercle (TT) target. The study determined the optimal asymmetric tibial component to use with KA as the one with smaller IE deviation from the MA target, greater coverage of tibial resection, ...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Nedopil, Alexander J. Zamora, Tomas Delman, Connor Howell, Stephen M. Hull, Maury L. Tags: Original Article Source Type: research

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Results in Superior Rotational Stability Compared with Isolated Anterior Cruciate Ligament Reconstruction in High Grade Pivoting Sport Patients: A Prospective Randomized Clinical Trial
J Knee Surg DOI: 10.1055/s-0041-1729621The purpose of the current randomized clinical trial (RCT) was to evaluate the clinical outcomes of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction and to compare them with those of isolated ACL reconstruction. The hypothesis was that combined ACL and ALL reconstruction will result in superior clinical outcomes in terms of the rotational stability of the knee. This prospective RCT included 57 patients (44 men and 13 women, mean age = 31 ± 7.1 years) who underwent ACL reconstruction either isolated (Group I: 2...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Mogo ş, Ştefan D'Ambrosi, Riccardo Antonescu, Dinu Stoica, Ioan-Cristian Tags: Original Article Source Type: research

The Accuracy of Computed Tomography-Based, Three-Dimensional Implant Planning in Robotic-Assisted Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0041-1729548Advanced imaging used in robotic-assisted total knee arthroplasty (TKA), such as computed tomography (CT)-based three-dimensional (3D) planning, may provide an accurate means of implant sizing preoperatively. The purpose of this study was to examine preoperative CT-based implant planning accuracy for robotic-assisted TKA in patients who have (1) varus deformities, (2) valgus deformities, (3) neutral alignment, and (4) retained hardware. A total of 393 patients underwent a robotic-assisted TKA by a single surgeon received preoperative CT scans. The surgeon reviewed the CT-based model p...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Marchand, Kevin B. Salem, Hytham S. Mathew, Kevin K. Harwin, Steven F. Mont, Michael A. Marchand, Robert C. Tags: Original Article Source Type: research

Allergy Testing Has No Correlation with Intraoperative Histopathology from Revision Total Knee Arthroplasty for Implant-Related Metal Allergy
J Knee Surg DOI: 10.1055/s-0041-1729618Lymphocyte transformation testing (LTT) is often used in the workup for possible metal allergy after total knee arthroplasty (TKA) but the correlation of this test with other diagnostic metal-allergy findings in patients undergoing revision TKA for suspected metal allergy has not been established. A single-center, single-surgeon cohort of 19 TKAs in which both components were revised for presumed implant-related metal allergy based on history, physical, and LTT testing, to nonnickel-containing implants were retrospectively identified. Histopathologic samples obtained intraoperatively ...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Malahias, Michael-Alexander Bauer, Thomas W. Manolopoulos, Philip P. Sculco, Peter K. Westrich, Geoffrey H. Tags: Original Article Source Type: research

Interobserver Reliability and Change in the Sagittal Tibial Tubercle –Trochlear Groove Distance with Increasing Knee Flexion Angles
This study aims to (1) describe interobserver reliability of the sTT-TG distance and (2) characterize the change in the sTT-TG distance with respect to changing knee flexion angles. In this cadaveric study, six nonpaired cadaveric knees underwent magnetic resonance imaging (MRI) studies at each of the following degrees of knee flexion: −5, 0, 5, 10, 15, and 20. The sTT-TG distance was measured on the axial T2 sequence. Four reviewers measured this distance for each cadaver at each flexion angle. Intraclass correlation coefficients were calculated to determine interobserver reliability and reproducibility of the sTT-T...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: MacLean, Ian S. Southworth, Taylor M. Dempsey, Ian J. Naveen, Neal B. Huddleston, Hailey P. Lansdown, Drew A. Yanke, Adam B. Tags: Original Article Source Type: research

Comparative Efficacy of Root Repair versus Partial Meniscectomy and Observation for Patients with Meniscus Root Tears
J Knee Surg DOI: 10.1055/s-0041-1729622The purpose of this study was to (1) compare the efficacy of root repair versus partial meniscectomy and observation for patients with meniscus root tears; (2) compare osteoarthritis (OA) progression and functional outcomes in patients with isolated repair and with adjuvant surgery; and (3) evaluate OA progression and functional outcomes after pullout repair or all-inside repair of meniscus root tears. We performed a systematic literature search in PubMed, Embase, Scopus, and the Cochrane Library up to September 1, 2020, to identify studies that evaluated the efficacy of root repair v...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Dai, Wenli Yan, Wenqiang Leng, Xi Wang, Junyan Hu, Xiaoqing Ao, Yingfang Tags: Original Article Source Type: research

Perioperative Opioid Use in Anterior Cruciate Ligament Reconstruction Patients
J Knee Surg DOI: 10.1055/s-0041-1729620Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed outpatient orthopaedic procedures, yet there is little data about perioperative opioid prescribing practices. The purposes of this study were to quantify the perioperative opioid prescriptions filled by patients who underwent ACLR and to identify factors associated with greater postoperative opioid use. Patients who underwent ACLR at a single institution between June 2015 and May 2017 were studied using a regional prescription monitoring database to identify all preoperative and postoperative outpat...
Source: Journal of Knee Surgery - May 1, 2021 Category: Orthopaedics Authors: Aneizi, Ali Friedmann, Elizabeth Henry, Leah E. Perraut, Gregory Sajak, Patrick M. J. Ventimiglia, Dominic J. Burt, Cameran I. Zhang, Tina Packer, Jonathan D. Henn III, R. F. Tags: Original Article Source Type: research

Early Aseptic Loosening with Increased Presence and Severity of Backside Burnishing in the Optetrak Logic Posterior-Stabilized Total Knee Arthroplasty Femoral Component
J Knee Surg DOI: 10.1055/s-0041-1729549Concerns persist that the Optetrak Logic posterior-stabilized (PS) total knee arthroplasty (TKA) femoral component might correlate with early failures due to aseptic loosening. The primary aim of this study was to examine if the use of the Optetrak Logic PS femoral component is associated with early (
Source: Journal of Knee Surgery - April 30, 2021 Category: Orthopaedics Authors: Malahias, Michael-Alexander Iacobelli, David A. Torres, Lisa Rojas Marcos, Carolena Nocon, Allina A. Wright, Timothy M. Sculco, Peter K. Sculco, Thomas P. Tags: Original Article Source Type: research

Diagnostic Value of MRI and Radiographs of the Knee to Identify Osteochondral Lesions in Acute Patellar Instability
In conclusion, MRI and XR are poorly sensitive at identifying loose bodies or osteochondral defects after patellar dislocations. The poor sensitivity of imaging studies must be considered when determining whether or not to recommend operative management to a patient with patellar instability. This is a Level IV, diagnostic study. [...] 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 - April 30, 2021 Category: Orthopaedics Authors: Baker, Hayden Dickherber, Jason Reddy, Manoj Rizzi, Andrew Kahn, Adam Athiviraham, Aravind Tags: Original Article Source Type: research

Comparison of All Arthroscopic Implantation of Chitosan-Based Liquid Scaffold and Hyaluronan-Based Soft Scaffold in the Treatment of Condylar Osteochondral Lesions in the Knee
This study shows that both scaffolds are useful in cartilage regeneration but have no clinical or radiological superiority to each other. Surgeons should select the method with which they feel comfortable. This is a level III, retrospective comparative study. [...] 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 - April 30, 2021 Category: Orthopaedics Authors: Akme şe, Ramazan Özbek, Emre Anıl Kocao ğlu, Hakan Ertan, Mehmet Batu İnanç, İrem Erdemli, Esra Tags: Original Article Source Type: research

Is Valgus Cut Angle Based on Radiographic Measurements in Total Knee Arthroplasty Really Inaccurate? A Comparison of Two- and Three-Dimensional Measurements
This study used three-dimensional (3D) reconstruction models to verify the accuracy of VCA measurements on radiographs, and explore the correlation of VCA with hip–knee–ankle (HKA) angle and lateral femoral bowing angle (FBA). A total of 444 osteoarthritis knees of 444 patients from August 2016 to June 2018 was included retrospectively. On radiographs, two-dimensional VCA (VCA-2D) was measured between the femoral mechanical axis and the distal femoral anatomical axis, and HKA was measured between the femoral mechanical axis and the tibial mechanical axis. On the coronal projection of computed tomography 3D mode...
Source: Journal of Knee Surgery - April 29, 2021 Category: Orthopaedics Authors: Liu, LiMing Lei, Kai Chen, Xin Fan, HuaQuan Yang, Liu Guo, Lin Tags: Original Article Source Type: research

A Cadaveric Anatomical Study of the Relationship between Proximal Tibial Slope and Coronal Plane Deformity
This study utilized a large cadaveric collection to explore relationships between tibial slope and coronal plane deformity of the tibia. We utilized 462 well-preserved skeletons (924 tibiae), excluding any with fracture or obvious rheumatologic or infectious findings. Custom cards were made with different sized arcs on the bottom surface, so that they could rest on the anterior and posterior aspects of the medial and lateral tibial plateaus of each bone to measure PPTA. Previously measured MPTA values for the same bones were also utilized. Multiple regression analysis was used to determine relationship between MPTA and med...
Source: Journal of Knee Surgery - April 28, 2021 Category: Orthopaedics Authors: Foos, Julia Amakoutou, Kouami Cooperman, Daniel R. Liu, Raymond W. Tags: Original Article Source Type: research

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