The Use of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis
J Knee Surg DOI: 10.1055/s-0038-1675170With average life expectancy and the rising prevalence of obesity, osteoarthritis (OA) is creating an increasingly large financial and physical burden on the U.S. population today. As the body ages and experiences trauma, articular cartilage surfaces in joints are gradually worn away, leading to OA. Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures. More recently, hyaluronic acid, micronized dehydrated human amniotic/chorionic membrane...
Source: Journal of Knee Surgery - November 13, 2018 Category: Orthopaedics Authors: Southworth, Taylor M. Naveen, Neal B. Tauro, Tracy M. Leong, Natalie L. Cole, Brian J. Tags: Special Focus Section Source Type: research

A Retrospective Comparative Study of Different Methods of Blood Management in Total Knee Replacement
J Knee Surg DOI: 10.1055/s-0038-1675217Perioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A (n 1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group B (n 2 = 24) ...
Source: Journal of Knee Surgery - November 13, 2018 Category: Orthopaedics Authors: Pappa, Eleni Vergados, Nikolaos Spiridakis, Emanouil Chountas, George Apostolopoulou, Anna Sourmelis, Savas Tags: Original Article Source Type: research

Cognitive Training for Robotic Arm-Assisted Unicompartmental Knee Arthroplasty through a Surgical Simulation Mobile Application
J Knee Surg DOI: 10.1055/s-0038-1675190Advances in mobile device technology combined with the implementation of surgical simulation have led to the development of novel applications (apps) as a potential learning tool for surgical trainees. Touch Surgery (TS) (Kinosis Limited, London, United Kingdom) is a mobile-based app that combines cognitive task analysis with a virtual reality medium to familiarize the user with a surgical procedure through interactive rehearsal. The purpose of this study was to compare the educational efficacy of the TS app with a traditional paper-based learning program in performing a robotic arm-a...
Source: Journal of Knee Surgery - November 10, 2018 Category: Orthopaedics Authors: Vestermark, George L. Bhowmik-Stoker, Manoshi Springer, Bryan D. Tags: Original Article Source Type: research

What Kinds of Posterior Cruciate Ligament Bundles Are Preserved in Cruciate-Retaining Total Knee Arthroplasty? A Three-Dimensional Morphology Study
In this study, the effects of tibial bone cutting on the attachment area of the posterior cruciate ligament (PCL), including both the anterolateral bundle (ALB) and posteromedial bundle (PMB), in cruciate-retaining total knee arthroplasty (CR-TKA) were simulated using a three-dimensional (3D) model of the tibial reconstruction. A total of 40 knees with medial osteoarthritis in patients scheduled for TKA were evaluated. Following surface registration of 3D computed tomography (CT) and 3D magnetic resonance imaging (MRI) models of the tibia with the PCL, the area of PCL attachment was calculated. Tibial bone cutting in the 3...
Source: Journal of Knee Surgery - November 10, 2018 Category: Orthopaedics Authors: Inou, Yoshinori Tomita, Tetsuya Kiyotomo, Dai Yoshikawa, Hideki Sugamoto, Kazuomi Tags: Original Article Source Type: research

Manipulation under Anesthesia: Does Polyethylene Thickness Matter?
J Knee Surg DOI: 10.1055/s-0038-1675403Total knee arthroplasty (TKA) has been established as the most effective treatment for end-stage, symptomatic osteoarthritis of the knee. However, improper polyethylene size selection has been proposed to predispose patients to postoperative stiffness following TKA. The aim of this study is to evaluate if there is a correlation between the use of the thinnest tibial implant thickness and implant manufacturer with the likelihood of undergoing manipulation under anesthesia (MUA). A retrospective review of unilateral TKAs performed between January 2012 and November 2015 was performed. Ea...
Source: Journal of Knee Surgery - November 10, 2018 Category: Orthopaedics Authors: Feng, James E. Anoushiravani, Afshin A. Ziegler, Jacob Schwarzkopf, Ran Long, William J. Tags: Original Article Source Type: research

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee
J Knee Surg DOI: 10.1055/s-0038-1675421We hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were re...
Source: Journal of Knee Surgery - November 9, 2018 Category: Orthopaedics Authors: Shelton, Trevor J. Howell, Stephen M. Hull, Maury L. Tags: Original Article Source Type: research

Evaluation of Femoral –Tibial Flexion Gap in Total Knee Arthroplasty with Everted or Lateralized Patella
The objective of this study is to evaluate the femoral external rotation angle in each patient with everted patella as well as with pure subluxated patella. The purpose of this study is to offer guidance about the optimal femoral rotation angle to achieve best outcomes of a knee replacement. The evaluation was done using an instrument developed by Medacta International (Switzerland) with our direct collaboration (Tensor, Medacta, Switzerland) and standardizing the basic conditions of each patient (knee 90 degrees flexed, medial transquadricipital surgical access, lateral displacement of the patella, tourniquet inflated at ...
Source: Journal of Knee Surgery - November 9, 2018 Category: Orthopaedics Authors: Malavolta, Michele Cochetti, Andrea Mezzari, Silvio Residori, Alberto Lista, Gianpietro Tags: Original Article Source Type: research

Wound Closure in Flexion versus Extension following Total Knee Replacement: Outcomes and Complications
J Knee Surg DOI: 10.1055/s-0038-1675416Position of the knee may affect the range of movement (ROM) after a total knee replacement (TKR). It has been postulated that wound closure in extension may cause shortening of the extensor mechanism and increased tension on the soft tissues. The aim of this study was to determine effect of wound closure in TKR with the knee in flexion or extension on postoperative ROM and rehabilitation. A consecutive series of 121 patients underwent primary TKR between May 2011 and August 2012. Group A (60 patients) had wound closure in extension. Group B (61 patients) had wound closure in flexion. ...
Source: Journal of Knee Surgery - November 9, 2018 Category: Orthopaedics Authors: Mahmood, Aatif Fursdon, Thomas Peter, Viju Kumar, Gunasekaran Tags: Original Article Source Type: research

Prevalence of Persistent Pain after Total Knee Arthroplasty and the Impact of Neuropathic Pain
In conclusion, a significant number of patients experienced moderate-to-severe and unclear pain after TKA. Moderate-to-severe pain was associated with unclear pain. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - November 9, 2018 Category: Orthopaedics Authors: Hasegawa, Masahiro Tone, Shine Naito, Yohei Wakabayashi, Hiroki Sudo, Akihiro Tags: Original Article Source Type: research

Cooled Radio Frequency Ablation for the Treatment of Osteoarthritis-Related Knee Pain: Evidence, Indications, and Outcomes
The objective of this review article is to provide the rationale, available evidence, indications, and outcomes associated with C-RFA for the treatment of chronic knee OA. A total of eight reports that use C-RFA in the treatment of chronic knee pain were identified and analyzed. There were two prospective trials, one retrospective cohort study, and five case reports or case series. C-RFA is an emerging procedure with encouraging early results; however, additional long-term prospective clinical trials are necessary to further characterize how C-RFA can best be used to treat chronic knee pain. [...] Thieme Medical Publishers...
Source: Journal of Knee Surgery - November 5, 2018 Category: Orthopaedics Authors: Oladeji, Lasun O. Cook, James L. Tags: Special Focus Section Source Type: research

Histological Findings in Infected and Noninfected Second Stage Revision Knee Arthroplasties
J Knee Surg DOI: 10.1055/s-0038-1675341Tissues from a periprosthetic joint infection (PJI) of the knee contain a heavy neutrophil polymorph (NP) infiltrate (> 5 NPs per high-powered field [HPF] by Musculoskeletal Infection Society [MSIS] criteria). PJI of the knee can be treated by a two-stage procedure and our aim was to determine whether the MSIS histological criteria for PJI diagnosis are valid in a second-stage revision knee arthroplasty. Periprosthetic tissues from 45 second-stage revision knee cases were analyzed histologically by hematoxylin–eosin and chloroacetate esterase (CAE) staining for the identifica...
Source: Journal of Knee Surgery - November 5, 2018 Category: Orthopaedics Authors: Uchihara, Yoshinobu Inagaki, Yusuke Munemoto, Mitsuru Tanaka, Yasuhito Athanasou, Nicholas Tags: Original Article Source Type: research

The Treatment of Adult Osteochondritis Dissecans with Autologous Cartilage Implantation: A Systematic Review
J Knee Surg DOI: 10.1055/s-0038-1675568We sought to evaluate the effectiveness of autologous chondrocyte implantation (ACI) for the treatment of adult osteochondritis dissecans (OCD) lesions according to patient-reported outcomes, complication rates, and failure rates. A search of MEDLINE, Scopus, and Cochrane Library was performed to identify clinical studies (levels I–IV) reporting outcomes after ACI treatment for OCD in adult knees. Our inclusion criteria included the following: (1) published between January 2000 and April 2017, (2) stable and unstable OCD lesions of the knee, (3) use of ACI in at least one group,...
Source: Journal of Knee Surgery - November 5, 2018 Category: Orthopaedics Authors: Sacolick, Davidson A. Kirven, James C. Abouljoud, Moneer M. Everhart, Joshua S. Flanigan, David C. Tags: Original Article Source Type: research

Improvement of the Gap Adjustment in Total Knee Arthroplasty Using the Posterior Condylar Pre-cut Technique
J Knee Surg DOI: 10.1055/s-0038-1675420To provide adequate gaps for knee extension and flexion during total knee arthroplasty, a femoral component placement decreases the extension gap because the posterior capsule tension increases against the protrusion of the posterior part of the femoral component. We thought that the influence of this component on the extension gap depends on the amount of posterior femoral bone resection and the thickness of the posterior femoral components. We hypothesized that less bone resection and a thinner posterior part of the femoral component might avoid these problems. To verify our hypothe...
Source: Journal of Knee Surgery - November 5, 2018 Category: Orthopaedics Authors: Kaneyama, Ryutaku Higashi, Hidetaka Oinuma, Kazuhiro Miura, Yoko Tamaki, Tatsuya Shiratsuchi, Hideaki Tags: Original Article Source Type: research

Cementless versus Cemented Fixation in Total Knee Arthroplasty: Usage, Costs, and Complications during the Inpatient Period
J Knee Surg DOI: 10.1055/s-0038-1675413Cemented fixation has been the gold standard in total knee arthroplasty (TKA). However, with younger and more active patients requiring TKA, cementless (press-fit) fixation has sparked renewed interest. Therefore, we investigated differences in (1) patient demographics, (2) inpatient costs, (3) short-term complications, and (4) discharge disposition between patients who underwent TKA with cemented and cementless fixation. The National Inpatient Sample database was queried for TKA patients with cement or cementless fixation between October 1 and December 31, 2015. Primary outcomes of i...
Source: Journal of Knee Surgery - November 5, 2018 Category: Orthopaedics Authors: Gwam, Chukwuweike U. George, Nicole E. Etcheson, Jennifer I. Rosas, Samuel Plate, Johannes F. Delanois, Ronald E. Tags: Original Article Source Type: research

Efficacy of Liposomal Bupivacaine Compared with Multimodal Periarticular Injections for Postoperative Pain Control following Total Knee Arthroplasty
This study retrospectively compares the efficacy of multimodal periarticular injection consisting of a combination of ropivacaine, duramorph, epinephrine, and toradol (HC) with liposomal bupivacaine (LB) periarticular injection in TKA. This study was a retrospective matched comparative chart review of two cohorts of patients who underwent TKA within a single health care system and cared for by one provider. We compared 22 patients who were treated with LB intraoperatively (LBG) with 41 matched controls who were treated with HC periarticular injection (HCG). These cases were retrospectively reviewed at 0 to 6, 6 to 12, 12 t...
Source: Journal of Knee Surgery - November 5, 2018 Category: Orthopaedics Authors: Britten, Tyler Hughes, Jonathan D. Munoz Maldonado, Yolanda Hitt, Kirby D. Tags: Original Article Source Type: research

Liposomal Bupivacaine Utilization in Total Knee Replacement Does Not Decrease Length of Hospital Stay
In conclusion, we cannot justify the extra cost of liposomal bupivacaine as compared with plain bupivacaine as an adjunct for perioperative pain management in TKR patients. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - October 29, 2018 Category: Orthopaedics Authors: Schumer, Grace Mann, John W. Stover, Matthew David Sloboda, John F. Cdebaca, Carol Sue Woods, Gina Moss Tags: Original Article Source Type: research

Total Knee Arthroplasty in Complex Scenarios
J Knee Surg 2018; 31: 927-927 DOI: 10.1055/s-0038-1669911 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - October 22, 2018 Category: Orthopaedics Authors: Sodhi, Nipun Sultan, Assem A. Khlopas, Anton Mont, Michael A. Tags: Special Focus Section Source Type: research

Periprosthetic Infection: Major Cause of Early Failure of Primary and Revision Total Knee Arthroplasty
The objective of this study is to evaluate the survivorship and determine the predominant causes of failure of RTKA. A total of 146 patients undergoing RTKA between 2003 and 2013 were identified from the institutional database. Revision was defined as surgery in which the whole prostheses (inlay and both femoral and tibial components) required exchange. Median follow-up was 6.3 ± 2.7 years (range: 2.2–10). Patient demographics, year of primary implantation, reasons for revision surgery, implant type, pain, knee mobility, systemic or local postoperative complications, and treatment of the complica...
Source: Journal of Knee Surgery - October 18, 2018 Category: Orthopaedics Authors: Evangelopoulos, Dimitrios S. Ahmad, Sufian S. Krismer, Anna M. Albers, Christoph E. Hoppe, Sven Kleer, Barbara Kohl, Sandro Ateschrang, Atesch Tags: Original Article Source Type: research

Matched-Pair Analysis of Local Infiltration Analgesia in Total Knee Arthroplasty: Patient Satisfaction and Perioperative Pain Management in 846 Cases
In this study, postoperative pain management and patient satisfaction were evaluated in patients undergoing total knee replacement surgery with or without intraoperative LIA. Within the context of the “Quality Improvement in Postoperative Pain Management” (QUIPS) project, parameters were collected on the first postoperative day. All patients included in this study underwent primary knee replacement surgery with general anesthesia. Parameters were compared after performing a 1:1 matched-pair analysis within 14 orthopaedic departments. Pain levels and pain management satisfaction were measured using the numerous ...
Source: Journal of Knee Surgery - October 6, 2018 Category: Orthopaedics Authors: Greimel, Felix Maderbacher, G ünther Baier, Clemens Schwarz, Timo Zeman, Florian Meissner, Winfried Grifka, Joachim Benditz, Achim Tags: Original Article Source Type: research

Albumin, Prealbumin, and Transferrin May Be Predictive of Wound Complications following Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1672122Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) al...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Roche, Martin Law, Tsun Yee Kurowicki, Jennifer Sodhi, Nipun Rosas, Samuel Elson, Leah Summers, Spencer Sabeh, Karim Mont, Michael A. Tags: Special Focus Section Source Type: research

Effect of Femoral Antetorsion on Tibiofemoral Translation and Rotation in the Anterior Cruciate Ligament Deficient Knee
J Knee Surg DOI: 10.1055/s-0038-1672198We aimed to investigate how increased or decreased femoral antetorsion would affect the biomechanics of the knee in an anterior cruciate ligament (ACL)-deficient cadaveric model. We hypothesized that external or internal rotation of the distal femur, achieved through a femoral osteotomy, would affect the magnitude of tibiofemoral translation and rotation. Navigated measurements of tibiofemoral translation and rotation during the anterior drawer, Lachman, and pivot shift tests were performed on six whole-body cadaveric specimens in each of the following four conditions: native, ACL-def...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Omar, Mohamed Al Saiegh, Yousif Liodakis, Emmanouil Stuebig, Timo Guenther, Daniel Steimer, David Hawi, Nael Krettek, Christian Suero, Eduardo M. Tags: Original Article Source Type: research

Effects of an Intervention to Improve Life-Space Mobility and Self-Efficacy in Patients following Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1672199Life-space mobility describes the spatial areas through which an individual moves, and the frequency and need for assistance. Although patients with knee osteoarthritis (OA) have shown restricted life-space mobility, total knee arthroplasty (TKA) does not improve it beyond preoperative levels. Life-space mobility after TKA was influenced by self-efficacy for walking tasks; thus, an intervention to improve self-efficacy for walking tasks may contribute to better life-space mobility. We provided a walking event including several walking tasks as the intervention. We assessed the effect ...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Hiyama, Yoshinori Kamitani, Tsukasa Mori, Kazuaki Tags: Original Article Source Type: research

Clinical Results after Combined Distal Femoral Osteotomy in Patients with Patellar Maltracking and Recurrent Dislocations
J Knee Surg DOI: 10.1055/s-0038-1672125The purpose of this study is to analyze the clinical results after treatment of patellofemoral instability and maltracking caused by torsional or axial deformities of the lower extremity by combined distal femoral osteotomies (DFOs). We analyzed 31 DFOs (25 patients) with patellar maltracking and instability, treated in our clinic. Torsional angles and the leg axis in the frontal plane were measured preoperatively. Standardized scoring systems were determined pre- and postoperatively including a clinical examination. Nineteen cases of torsional and 12 cases of axis deformities were ev...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Frings, Jannik Krause, Matthias Akoto, Ralph Frosch, Karl-Heinz Tags: Original Article Source Type: research

Periprosthetic Fracture following Partial Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1672204Partial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and Apri...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Brown, Nicholas M. Engh, Gerard Fricka, Kevin Tags: Original Article Source Type: research

All-Polyethylene Tibial Components in Total Knee Replacement: Early Failures
J Knee Surg DOI: 10.1055/s-0038-1672124In total primary knee replacement surgery, the use of all-polyethylene tibial (APT) components has many advantages, including no backside wear and no linear dissociation. In addition, the greater polyethylene thickness permits more conservative bone resection compared with that for metal-backed components, with a lower unit cost and similar functional results. Thus, the use of an APT in primary total knee arthroplasty remains an attractive option. This is a review of 158 patients who underwent primary knee replacement using APT components from a single manufacturer. Data collection in...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Alhifzi, Zaki Suliman Khoja, Yousef Tawfik Wood, Gavin C. Tags: Original Article Source Type: research

Onlay Reconstruction of the Posterior Cruciate Ligament: Biomechanical Comparison of Unicortical and Bicortical Tibial Fixation
The objective of this study was to compare immediate postimplantation biomechanics of unicortical versus bicortical tibial fixation of onlay PCL grafts. Eight knees were randomly assigned to one of two onlay PCL techniques (n = 4 knees/technique), performed by a single experienced surgeon. Testing consisted of a posterior-directed force at four knee flexion angles, 10, 30, 60, and 90 degrees, to measure load to 5 mm of posterior displacement, maximum displacement (at 100 N load), and stiffness. For statistical analyses, data for each knee were normalized to the native PCL-intact knee and were th...
Source: Journal of Knee Surgery - October 3, 2018 Category: Orthopaedics Authors: Albuquerque II, Jo ão Bourbon de Pfeiffer, Ferris Stannard, James P. Cook, James L. Kfuri, Mauricio Tags: Original Article Source Type: research

Allograft Reconstruction of the Knee —Methods and Outcomes
J Knee Surg DOI: 10.1055/s-0038-1672123Although allograft usage has decreased over the past three decades in favor of segmental metal implants, they still have an important role in the reconstruction of large osteochondral defects following tumor resection. The decline of allografts in limb salvage is multifactorial and includes limited availability, technical difficulty, increased rates of infection and fracture, and unpredictable results. There are circumstances where allograft transplantation is useful around the knee resulting in improved function, bone and joint preservation, and acceptable long-term outcomes. [...] T...
Source: Journal of Knee Surgery - September 27, 2018 Category: Orthopaedics Authors: Temple, H. Thomas Tags: Special Focus Section Source Type: research

Managing Superficial Distal Medial Collateral Ligament Insufficiency in Primary Total Knee Arthroplasty Using Bone Staples
J Knee Surg DOI: 10.1055/s-0038-1669954Superficial medial collateral ligament (MCL) injury is an occasional intraoperative complication during total knee arthroplasty (TKA) that can lead to failure. Although previous studies have recommended complex repair or conversion to a constrained implant, the authors evaluated results of superficial distal MCL reapproximation using bone staples. Records of 31 patients who underwent staple reapproximation for superficial MCL avulsion from the tibial attachment during primary TKA from 2005 to 2015 were reviewed. They were compared with 685 patients who underwent uncomplicated TKA (pri...
Source: Journal of Knee Surgery - September 18, 2018 Category: Orthopaedics Authors: White, Kevin T. Fleischman, Andrew Ackerman, Colin T. Chen, Antonia F. Rothman, Richard H. Tags: Original Article Source Type: research

Comparison of Knee Kinematics and Kinetics during Stair Ascent in Single-Radius and Multiradius Total Knee Arthroplasty
This study demonstrates that patients who receive SR TKA have kinematics more closely aligned to normal patterns postoperatively than those who received an MR TKA. The power production and sagittal moment of the healthy controls most closely match previously published values of younger adults, SR TKA group most closely matches older adults, while the MR TKA group has lower power production and sagittal moments than either previously published age group. This strongly suggests that the biomechanical differences found in this study are evidence of functional deficiencies. Further research is needed to determine how these def...
Source: Journal of Knee Surgery - September 18, 2018 Category: Orthopaedics Authors: Sumner, Bonnie McCamley, John D. Jacofsky, David J. Jacofsky, Marc C. Tags: Original Article Source Type: research

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study
J Knee Surg DOI: 10.1055/s-0038-1672121The aim of this multicentric retrospective study was to verify whether knee arthrodesis (KA) is a viable reconstructive option after two-stage revision for infection of proximal tibia (PT) endoprosthetic reconstruction (EPR). Sixty patients who underwent a two-stage revision were included. Definitive EPR or a KA with a modular system was performed following consideration of soft tissue and extensor mechanism conditions. Patients were evaluated with Musculoskeletal Tumor Society Score and Oxford Knee Score. Implant survival was assessed on the basis of recurrence of infection. Five pat...
Source: Journal of Knee Surgery - September 18, 2018 Category: Orthopaedics Authors: Sambri, Andrea Bianchi, Giuseppe Parry, Michael Frenos, Filippo Campanacci, Domenico Donati, Davide Jeys, Lee Tags: Original Article Source Type: research

Outcome after Combined Lateral Extra-articular Tenodesis and Anterior Cruciate Ligament Revision in Professional Soccer Players
We report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activi...
Source: Journal of Knee Surgery - September 18, 2018 Category: Orthopaedics Authors: Alessio-Mazzola, Mattia Formica, Matteo Russo, Antonio Sanguineti, Francesca Capello, Andrea Giorgio Lovisolo, Stefano Felli, Lamberto Tags: Original Article Source Type: research

Intravenous Corticosteroids to Improve Early Rehabilitation in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1670628 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - September 18, 2018 Category: Orthopaedics Authors: Kendall, Mark C. Castro Alves, Lucas J. Tags: Letter to the Editor Source Type: research

Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar –Tendon–Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis
J Knee Surg DOI: 10.1055/s-0038-1669916The current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar–tendon–bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar–tendon–bone grafts were included. All clinical outcomes reported by three or more studies were included. Fiftee...
Source: Journal of Knee Surgery - September 13, 2018 Category: Orthopaedics Authors: Tan, Si Heng Sharon Huh, Lau Bernard Puang Krishna, Lingaraj Tags: Original Article Source Type: research

Early Failure in Medial Unicondylar Arthroplasty: Radiographic Analysis on the Importance of Joint Line Restoration
This study explored modes of failure in 266 medial UKAs. Radiological comparison was performed between 24 failures and 24 matched controls, to determine the importance of UKA positioning in terms of femorotibial angle (FTA), tibial plateau angle, and posterior tibial slope (PTS). Radiographic comparative analysis showed statistically significant differences in the failure group compared with the control group in terms of variation in FTA (p = 0.0222), PTS (p = 0.0025), and JL height (p = 0.0022). Variations not only in FTA but also PTS and JL height were correlated with failures ob...
Source: Journal of Knee Surgery - September 13, 2018 Category: Orthopaedics Authors: Lo Presti, Mirco Raspugli, Giovanni Francesco Reale, Davide Iacono, Francesco Zaffagnini, Stefano Filardo, Giuseppe Marcacci, Maurilio Tags: Original Article Source Type: research

Peroneus Longus Tendon Autograft is a Safe and Effective Alternative for Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0038-1669951The ipsilateral peroneus longus tendon (PLT) was utilized as an autograft for anterior cruciate ligament (ACL) reconstruction of patients with acute ACL rupture and grade III medial collateral ligament (MCL) injury. We investigated the efficacy and safety of this alternative autograft compared with autologous hamstring tendon (HT). Biomechanical testing of the graft options was performed and compared with the native ACL. Thirty-eight patients with acute ACL ruptures and grade III MCL injuries were treated with ACL reconstruction with a doubled autologous PLT or quadrupled autologous H...
Source: Journal of Knee Surgery - September 11, 2018 Category: Orthopaedics Authors: Shi, Fu-Dong Hess, Daniel Edward Zuo, Jin-Zeng Liu, Shi-Jie Wang, Xue-Chen Zhang, Yong Meng, Xiao-Guang Cui, Ze-Jun Zhao, Shao-Ping Li, Chang-Jiang Hu, Wan-Ning Tags: Original Article Source Type: research

Treatments of Choice for Isolated, Full-Thickness Tears of the Posterior Cruciate Ligament: A Nationwide Survey of Orthopaedic Surgeons
J Knee Surg DOI: 10.1055/s-0038-1669787The ideal treatment for isolated, full-thickness tears of the posterior cruciate ligament (PCL) is uncertain. The purpose of this study was to determine how the majority of orthopaedic surgeons treat isolated, full-thickness tears of the PCL. In July 2017, a 17-question multiple-choice survey regarding the treatment of isolated, full-thickness tears of the PCL was emailed to 3,500 orthopaedic sports medicine surgeons with membership in the American Orthopaedic Society for Sports Medicine. Responders answered multiple-choice questions related to indications, technique, graft choice, br...
Source: Journal of Knee Surgery - September 11, 2018 Category: Orthopaedics Authors: Schumaier, Adam Minoughan, Chelsea Jimenez, Andrew Grawe, Brian Tags: Original Article Source Type: research

Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-Analysis Comparing Semitendinosus Alone and Semitendinosus with Gracilis Tendon Autografts
This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. All studies in PubMed and Embase that reported functional knee parameters and patient-reported outcomes after ACL reconstruction with ST and ST-G grafts independently were included in the review. Selected end points for random effects, pairwise meta-analysis included side-to-side deficit (%) in isokinetic peak torque, peak torque ratio (%), side-to-side difference (mm) in anterior laxity, and patient-reported outcome scores at minimu...
Source: Journal of Knee Surgery - September 11, 2018 Category: Orthopaedics Authors: Chin, Brian Zhaojie Wee, Ian Jun Yan Syn, Nicholas Li-Xun Krishna, Lingaraj Tags: Original Article Source Type: research

Incidence of Drug Abuse in Revision Total Knee Arthroplasty Population
J Knee Surg DOI: 10.1055/s-0038-1669915Substance abuse can have strong negative impacts on surgical outcomes. Therefore, this study assessed the effects of drug abuse in total knee arthroplasty (TKA) patients. Specifically, we identified revision TKA (RTKA): (1) incidence, (2) causes, (3) time to revision, and (4) patient demographics in patients with a history of drug abuse. The Medicare database within the PearlDiver Supercomputer (Warsaw, IN) was queried to identify 2,159,221 TKAs performed between 2005 and 2012. Drug abuse was subdivided into cocaine, cannabis, opioids, sedatives/hypnotics/anxiolytics (SHA), amphetamin...
Source: Journal of Knee Surgery - September 7, 2018 Category: Orthopaedics Authors: Roche, Martin Law, Tsun Yee Sodhi, Nipun Rosas, Samuel Kurowicki, Jennifer Disla, Shanell Wang, Kevin Mont, Michael A. Tags: Special Focus Section Source Type: research

Neutral or Natural? Functional Impact of the Coronal Alignment in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1669788Total knee arthroplasty (TKA) is a very successful procedure. The alignment in TKA has been identified as being of importance to prevent early implant failure and patient dissatisfaction. Our hypothesis was that patients with a preoperative varus deformation remaining in a slight varus alignment as their natural alignment after TKA will have superior clinical results compared with patients who are restored in neutral alignment. A total of 115 patients were corrected from varus to neutral (varus–neutral) and in 33 patients a preoperative varus alignment was kept in varus (varus)....
Source: Journal of Knee Surgery - September 7, 2018 Category: Orthopaedics Authors: Schiffner, Erik Wild, Michael Regenbrecht, Bertram Schek, Alberto Hakimi, Mohssen Thelen, Simon Jungbluth, Pascal Schneppendahl, Johannes Tags: Original Article Source Type: research

Similar Outcomes of Two-Stage Revisions for Infection and One-Stage Revisions for Aseptic Revisions of Knee Endoprostheses
J Knee Surg DOI: 10.1055/s-0038-1670627Two-stage revision knee arthroplasty using an antibiotic-loaded spacer is the most widely performed procedure for infected knee arthroplasties. The clinical outcome of this type of surgery compared with aseptic joint revision with exchange of tibial and femoral components is still controversial. Therefore, we analyzed clinical outcomes of septic two-stage revisions compared with aseptic one-stage revision total knee arthroplasties (TKAs). In a retrospective study, we assessed 135 consecutive patients who underwent two-stage revision for septic TKA (52 patients) and one-stage aseptic t...
Source: Journal of Knee Surgery - September 7, 2018 Category: Orthopaedics Authors: Konrads, Christian Franz, Arno Hoberg, Maik Rudert, Maximilian Tags: Original Article Source Type: research

Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft with Remnant Preservation: Comparison of Outcomes According to the Amount of Remnant Tissue
J Knee Surg DOI: 10.1055/s-0038-1669902There has been controversy about whether remnant tissue of anterior cruciate ligament (ACL) has to be preserved in ACL reconstruction. The purpose of the study was to compare clinical outcomes between groups of patients who underwent ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft divided according to amount of ACL remnant and investigate effect of remnant preservation on outcomes of ACL reconstruction. A total of 185 patients who underwent ACL reconstruction with BPTB autograft were retrospectively reviewed. Patients were divided into four groups according to propo...
Source: Journal of Knee Surgery - September 7, 2018 Category: Orthopaedics Authors: Kim, Sung-Jae Choi, Chong Hyuk Chun, Yong-Min Kim, Sung-Hwan Lee, Su-Keon Jung, Woo Seok Jung, Min Tags: Original Article Source Type: research

Comparing Cementing Techniques in Total Knee Arthroplasty: An In Vitro Study
J Knee Surg DOI: 10.1055/s-0038-1669917Aseptic loosening remains to be a major reason for revision in total knee arthroplasty. Cement penetration of 2 to 5 mm increases the interface strength and consequently decreases the likelihood of loosening. But despite this overall accepted optimal cement penetration, there is still a wide variety of cementing techniques used in total knee arthroplasty. The purpose of this study was to evaluate two cementing techniques on the tibial and femoral sides, with regard to cement penetration. Five paired cadaveric knees were used. A total knee arthroplasty was placed according to st...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Wetzels, Thomas van Erp, Joost Brouwer, Reinoud W. Bulstra, Sjoerd K. van Raay, Jos J. A. M. Tags: Original Article Source Type: research

Magnetic Resonance Imaging-Based Prevalence of Anterolateral Ligament Abnormalities and Associated Injuries in Knees with Acute Anterior Cruciate Ligament Injury
J Knee Surg DOI: 10.1055/s-0038-1669449The purpose of this study was to determine and compare the prevalence of anterolateral ligament abnormality and associated injuries among patients with complete and partial anterior cruciate ligament tears. In addition, the prevalence of associated injuries with anterolateral ligament abnormality was further analyzed. Of the 158 patients diagnosed with acute anterior cruciate ligament tear, 82 patients were diagnosed with acute complete anterior cruciate ligament confirmed by magnetic resonance imaging (MRI) and arthroscopic procedures (Group C), and 74 patients were diagnosed with ac...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Song, Yoonah Yang, Jae-Hyuk Choi, Won Rak Lee, Jin Kyu Tags: Original Article Source Type: research

Biomechanical Evaluation of Suture Anchor versus Transosseous Tunnel Patellar Tendon Repair Techniques
The objective of this study is to compare the cyclic loading strength and ultimate failure load in suture anchor repair versus transosseous tunnel repair of patellar tendons using a cadaver model. Twelve cadaveric patella specimens were used (six matched pairs). Dual-energy X-ray absorptiometry (DXA) measurements were performed to ensure equal bone quality among groups. All right knees were assigned to the suture anchor repair group (n = 6), whereas all left knees were assigned to the transosseous bone tunnel group (n = 6). Suture type and repair configuration were equivalent. After the respecti...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Sherman, Seth L. Black, Brandee Mooberry, Matthew A. Freeman, Katie L. Gulbrandsen, Trevor R. Milles, Jeffrey L. Evans, Laura Flood, David Pfeiffer, Ferris Tags: Original Article Source Type: research

Stacked Tantalum Cones as a Method for Treating Severe Distal Femoral Bone Deficiency in Total Knee Arthroplasty
This study aims to evaluate the mid-term outcomes and possible complications in patients treated with this novel technique. We retrospectively analyzed the prospectively maintained records of 16 knees (in 16 patients) presenting with severe distal femoral bone deficiency due to septic loosening (5), giant cell tumor (GCT; 4), periprosthetic fracture (3), aseptic loosening (3), and distal femoral comminuted fracture with severe osteoarthritis (1). A standard medial parapatellar approach was taken in all our cases followed by preparation of distal femoral bone defect and use of two bridging tantalum trabecular metal cones to...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Rajgopal, Ashok Panda, Inayat Yadav, Sidharth Wakde, Om Tags: Original Article Source Type: research

What Is the Price and Claimed Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis in the United States?
J Knee Surg DOI: 10.1055/s-0038-1669953Platelet-rich plasma (PRP) injections are often used for the treatment of knee osteoarthritis (OA), despite clinical value and cost-effectiveness not being definitely established. PRP injections are considered as a potential means of reducing pain and improving function in patients with knee OA, in the hope of delaying or avoiding the need for surgical intervention. Centers that offer PRP injections usually charge patients out of pocket and directly market services. Therefore, the purpose of this study was to quantify the current (1) prices and (2) marketed clinical efficacy of autolo...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Piuzzi, Nicolas S. Ng, Mitchell Kantor, Ariel Ng, Kenneth Kha, Stephanie Mont, Michael A. Muschler, George F. Tags: Original Article Source Type: research

Evaluation of Accuracy of a Three-Dimensional Printed Model in Open-Wedge High Tibial Osteotomy
This study retrospectively evaluated 20 patients with medial knee osteoarthritis and varus deformity. Between October 2015 and July 2016, the patients underwent open-wedge HTO using a 3D printed model. The mean age of patients was 55.2 years (range, 51–60 years). The mean preoperative mechanical femorotibial angle (mFTA) was varus 7.8 degrees (range, varus 4.7–11.6 degrees). After measuring the target angle using full-length lower limb weight-bearing radiography, the osteotomy was simulated using 3D images obtained from computed tomography (CT) with the 3D Slicer program. On the basis of the simulated osteotomy...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Kim, Hee-June Park, Jaeyeong Park, Kyeong-Hyeon Park, Il-Hyung Jang, Jin-An Shin, Ji-Yeon Kyung, Hee-Soo Tags: Original Article Source Type: research

The Influence of Implant Position on Final Clinical Outcome and Gait Analysis after Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1669913The aim of the study was to evaluate the impact of implant component alignment on objective and subjective outcomes after total knee arthroplasty (TKA). The rotation of the femoral component and its influence on the final results were also examined. After exclusion, the study examined 102 patients (mean age, 66.28 years; range, 51–79 years) who had undergone unilateral TKA. All of the operative procedures were performed by one surgeon with one type of implant. One year after the operation, improvements in Knee Society's Knee Scoring System, functional score, Western Ontario and ...
Source: Journal of Knee Surgery - September 6, 2018 Category: Orthopaedics Authors: Jab łoński, Jarosław Sibi ński, Marcin Polguj, Micha ł Kowalczewski, Jacek Marczak, Dariusz Faflik, Łukasz Jab łońska, Dorota Tags: Original Article Source Type: research

Operative Time, Length of Stay, Short-Term Readmission, and Complications after Hinged Primary Total Knee Arthroplasty: A Propensity Score Matched Analysis
J Knee Surg DOI: 10.1055/s-0038-1668580Despite the wide utilization of total knee arthroplasty (TKA), it can be technically challenging to perform in patients who have concomitant bone loss, ligamentous laxity, or high-grade deformity, whether in a revision situation or due to a primary pathology. Therefore, hinged knee prostheses have been developed to provide more stable fixation in these situations. The purpose of this study was to compare the short-term peri- and postoperative outcomes of patients undergoing primary TKA with and without hinged prosthesis. Specifically, we compared (1) mean operative times, (2) lengths ...
Source: Journal of Knee Surgery - August 29, 2018 Category: Orthopaedics Authors: Sodhi, Nipun Patel, Yatindra H. George, Jaiben Sultan, Assem A. Anis, Hiba K. Newman, Jared M. Kryzak, Thomas J. Khlopas, Anton Moskal, Joseph T. Mont, Michael A. Tags: Special Focus Section Source Type: research

Is ICD-9 Coding of Morbid Obesity Reliable in Patients Undergoing Total Knee Arthroplasty?
J Knee Surg DOI: 10.1055/s-0038-1668567Morbid obesity is considered to have a stronger association with complications after total knee arthroplasty (TKA). Although the impact of obesity coding errors has been previously reported, the extent of coding inaccuracies with respect to morbid obesity is unclear. Therefore, the purpose of this study was to assess (1) the utility of coding in identifying morbid obesity and (2) the effects of morbid obesity on 90-day complications after TKA when morbid obesity was defined by both body mass index (BMI) and International Classification of Diseases 9th edition (ICD-9) coding. A total o...
Source: Journal of Knee Surgery - August 29, 2018 Category: Orthopaedics Authors: George, Jaiben Sodhi, Nipun Anis, Hiba K. Khlopas, Anton Moskal, Joseph T. Klika, Alison K. Barsoum, Wael K. Mont, Michael A. Higuera, Carlos A. Tags: Special Focus Section Source Type: research