Unicompartmental Knee Arthroplasty: The Past, Current Controversies, and Future Perspectives
J Knee Surg DOI: 10.1055/s-0038-1625961Unicompartmental knee arthroplasty (UKA) is a bone conserving and ligament-sparing procedure that reliably restores normal knee kinematics and function for arthritis limited either to the medial or the lateral compartment of the knee. Although there is enough evidence to demonstrate that the UKA offers good medium to long-term success given the correct patient selection, prosthesis design, and implantation technique, there are several reports to suggest inferior survival rates in comparison with the total knee arthroplasty (TKA). Furthermore, it is a specialized procedure which works ...
Source: Journal of Knee Surgery - March 7, 2018 Category: Orthopaedics Authors: Johal, Sim Nakano, Naoki Baxter, Mark Hujazi, Ihab Pandit, Hemant Khanduja, Vikas Tags: Original Article Source Type: research

The Relationship between Soft-Tissue Balance and Intraoperative Kinematics of Guided Motion Total Knee Arthroplasty
In this study, intraoperative kinematics of 95 patients whose TKA was performed with a guided-motion prosthesis (Journey II BCS Smith and Nephew) were measured using the computed tomography (CT)-free navigation system. All procedures were performed via the same soft-tissue balancing technique, which focused on the medial compartment because guided-motion TKA must acquire medial stability to induce medial pivot motion. We measured the extension and flexion osteotomy gaps using a force-controlled compartment-specific ligament tensioner with a distraction force of 80 N for each compartment and divided patients into thr...
Source: Journal of Knee Surgery - March 7, 2018 Category: Orthopaedics Authors: Inui, Hiroshi Taketomi, Shuji Yamagami, Ryota Shirakawa, Nobuyuki Kawaguchi, Kouhei Tanaka, Sakae Tags: Original Article Source Type: research

One-Stage Arthroscopic Reduction Combined with Multiligament Reconstruction or Repair for Irreducible Posterolateral Knee Dislocation: A Retrospective Case Series with Minimum 2-Year Follow-Up
J Knee Surg DOI: 10.1055/s-0038-1632394The purpose of this study was to evaluate the clinical outcomes after arthroscopic management of irreducible posterolateral knee dislocation. Twenty-one patients with irreducible posterolateral knee dislocation were treated in our institution from January 2009 to May 2014. Inclusion criteria were as follows: (1) patients who underwent one-stage arthroscopic reduction combined with multiligament reconstruction or repair and (2) patients with a minimum 2-year follow-up. Knee stability was assessed using physical examination and side-to-side differences (SSD) determined with a KT-1000 ar...
Source: Journal of Knee Surgery - March 7, 2018 Category: Orthopaedics Authors: Hongwu, Zhuo Li, Jian Tags: Original Article Source Type: research

Patellofemoral Imbalance in a Balanced Total Knee Arthroplasty: How Does it Occur?
J Knee Surg DOI: 10.1055/s-0038-1635112Despite the overall successful outcomes following primary total knee arthroplasty (TKA) and the concept that a well-balanced TKA yields a more successful result, concerns still remain in the reported literature regarding the patellofemoral joint. Diminished outcomes have been associated with poorly balanced or placed patella implants. The effect of different techniques to achieve flexion–extension balance and the use of posterior stabilized (PS) versus cruciate retaining (CR) implant designs on patellofemoral balancing has not been previously studied. The purpose of this study i...
Source: Journal of Knee Surgery - March 7, 2018 Category: Orthopaedics Authors: Evangelista, Perry Jaymes Lenz, Nathan Laster, Scott Sheth, Neil P. Schwarzkopf, Ran Tags: Original Article Source Type: research

Comparison of Techniques for Preimplantation Treatment of Osteochondral Allograft Bone
J Knee Surg DOI: 10.1055/s-0038-1636834Articular defects are a major problem with few effective treatment options. Osteochondral allograft (OCA) transplantation can be an effective treatment; however, lack of OCA bone integration can cause failure. This controlled laboratory study was designed to compare clinically applicable methods for marrow element removal and enhanced delivery of bone marrow aspirate concentrate (BMC) to OCA bone. We hypothesized that compressed carbon dioxide (CO2) treatment of OCA bone would result in significantly better marrow element removal, significantly more retention and distribution of viabl...
Source: Journal of Knee Surgery - March 7, 2018 Category: Orthopaedics Authors: Baumann, Charles A. Baumann, John R. Bozynski, Chantelle C. Stoker, Aaron M. Stannard, James P. Cook, James L. Tags: Original Article Source Type: research

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1636908Postoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophe...
Source: Journal of Knee Surgery - March 7, 2018 Category: Orthopaedics Authors: Barrington, John W. Hansen, Ryan N. Lovelace, Belinda B öing, Elaine A. Chughtai, Morad Newman, Jared M. Pham, An T. Khlopas, Anton Sodhi, Nipun Sultan, Assem A. Mont, Michael A. Tags: Original Article Source Type: research

Erratum to: The Learning Curve Associated with Robotic Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1635082 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 - March 7, 2018 Category: Orthopaedics Authors: Sodhi, Nipun Khlopas, Anton Piuzzi, Nicolas S. Sultan, Assem A. Marchand, Robert C. Malkani, Arthur L. Mont, Michael A. Tags: Erratum Source Type: research

Distal Femoral Physeal Fractures
This article reviews the evaluation (including imaging), classification, and treatment of these injuries, and discusses their most important complications and their management, including vascular injury and growth arrest. [...] 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 - February 28, 2018 Category: Orthopaedics Authors: Young, Ernest Y. Stans, Anthony A. Tags: Special Focus Section Source Type: research

Anterior Knee Pain in Children and Adolescents: Overview and Management
J Knee Surg DOI: 10.1055/s-0038-1632376Anterior knee pain (AKP) is a common presenting complaint for pediatricians and orthopaedic surgeons and is often seen in young athletes. AKP is multifactorial and has a broad differential diagnosis. The growth changes, biomechanics, and anatomy around the knee add to the complexity of diagnosis and treatment of AKP. Common causes of AKP include Osgood–Schlatter's disease, patellar tendinitis, and patellofemoral instability. In the diagnosis of AKP, it is important to rule out serious and morbid causes of pain, including infection and tumor. It is crucial to complete a detailed ...
Source: Journal of Knee Surgery - February 28, 2018 Category: Orthopaedics Authors: Slotkin, Steven Thome, Andrew Ricketts, Cassandra Georgiadis, Andrew Cruz, Aristides Seeley, Mark Tags: Special Focus Section Source Type: research

A Modern Approach to Preventing Prosthetic Joint Infections
J Knee Surg DOI: 10.1055/s-0038-1636546Total knee arthroplasty (TKA) is recognized as one of the most successful surgical procedures performed today. One of the most common and dreaded complications of TKA is postoperative infection. To prevent infections, it is critical to identify patients at high risk through analyzing their risk factors, and help in addressing them prior to surgery. The effort to prevent infection must be carried through every step of the surgical process, from preoperative counseling to intraoperative measures and postoperative protocols. Hair removal, the application of antiseptics, the utilization o...
Source: Journal of Knee Surgery - February 28, 2018 Category: Orthopaedics Authors: Papas, Paraskevi Vivian Congiusta, Dominick Scuderi, Giles R. Cushner, Fred D. Tags: Special Focus Section Source Type: research

Femoral Component Sizing in Oxford Unicompartmental Knee Replacement: Existing Guidelines Do Not Work for Indian Patients
J Knee Surg DOI: 10.1055/s-0038-1635113Oxford unicompartmental knee replacement (OUKR) has shown excellent long-term clinical outcomes as well as implant survival when used for correct indications with optimal surgical technique. Anteromedial osteoarthritis is highly prevalent in Indian patients, and OUKR is the ideal treatment option in such cases. Uncertainty prevails about the best method to determine femoral component size in OUKR. Preoperative templating has been shown to be inaccurate, while height- and gender-based guidelines based on European population might not apply to the Indian patients. Microplasty instrument...
Source: Journal of Knee Surgery - February 28, 2018 Category: Orthopaedics Authors: Malhotra, Rajesh Gaba, Sahil Wahal, Naman Kumar, Vijay Srivastava, Deep N. Pandit, Hemant Tags: Original Article Source Type: research

Return to Sports after Unicompartmental Knee Arthroplasty: Reality or Utopia? A 48-Month Follow-Up Prospective Study
J Knee Surg DOI: 10.1055/s-0038-1635111Unicompartmental knee arthroplasty (UKA) has increased in popularity in the last years, also in younger and more active patients with great expectancies. The purpose of our study was to investigate the change in sports activities before and after medial UKA. We surveyed 53 athletic patients; all underwent cemented medial UKA, to determine not only their subjective and objective evaluation of clinical status with Hospital for Special Surgery (HSS) and visual analog score (VAS) score, but also their sporting and recreational activities at a mean follow-up of 48 ± 6 ...
Source: Journal of Knee Surgery - February 28, 2018 Category: Orthopaedics Authors: Lo Presti, Mirco Costa, Giuseppe Gianluca Cialdella, Sergio Agr ò, Giuseppe Grassi, Alberto Caravelli, Silvio Mosca, Massimiliano Marcheggiani Muccioli, Giulio Maria Zaffagnini, Stefano Tags: Original Article Source Type: research

More Severe Preoperative Kellgren –Lawrence Grades of Knee Osteoarthritis were Partially Associated with Better Postoperative Patient-Reported Outcomes in TKA Patients
This study investigated if preoperative radiographic severity was associated with postoperative pain, function, and quality of life after TKA. We performed a cross-sectional cohort study including 327 TKA patients. Radiographic severity was determined by two independent radiologists using the Kellgren and Lawrence (KL) score. The Knee Injury and Osteoarthritis Outcome Score (KOOS), the New Knee Society Score (New KSS), and Anterior Knee Pain Score (AKPS) were collected. We evaluated the association between KL grade and patient-reported outcome measures (PROMs) with the use of regression analysis techniques. Out of 228 resp...
Source: Journal of Knee Surgery - February 28, 2018 Category: Orthopaedics Authors: Hoorntje, Alexander Witjes, Suzanne Koenraadt, Koen L. M. Aarts, Ruud Weert, Thomas de van Geenen, Rutger C. I. Tags: Original Article Source Type: research

Trends in Knee Articular Cartilage Treatments: An American Board of Orthopaedic Surgery Database Study
This study aims to evaluate the trends in treatment of knee articular cartilage lesions over the past decade using data obtained from the American Board of Orthopaedic Surgery (ABOS) Part II database. The ABOS Part II database was queried from 2004 to 2013 for chondroplasty, microfracture, and osteochondral grafting procedures. All cases were analyzed for patient age and operating surgeon's fellowship training status. Univariate analysis including chi-square test for categorical variables and Student's t-test for continuous variables was performed to determine if any significant changes in practice patterns were present. L...
Source: Journal of Knee Surgery - February 28, 2018 Category: Orthopaedics Authors: Hancock, Kyle John Westermann, Robert R. Shamrock, Alan Gregory Duchman, Kyle R. Wolf, Brian R. Amendola, Annunziato Tags: Original Article Source Type: research

Preoperative Care of the TKA Patient
J Knee Surg DOI: 10.1055/s-0038-1629905Total knee arthroplasty continues to increase in popularity and remains the most common joint replacement surgery. The success of total knee replacement surgery is attributed to improved outcomes, a better patient experience, and lower cost. Rapid recovery total knee replacement protocols have led to these advances by decreasing length of hospital stay, minimizing readmissions, and reducing the cost of surgery. Rapid recovery total knee replacement pathway efforts should focus on preoperative education, optimization of modifiable risk factors, and identification of patients that may n...
Source: Journal of Knee Surgery - February 23, 2018 Category: Orthopaedics Authors: Edwards, Paul K. Mears, Simon C. Barnes, C. Lowry Tags: Special Focus Section Source Type: research

Posterolateral Corner Reconstruction using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee
This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series. [...] 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 - February 14, 2018 Category: Orthopaedics Authors: Woodmass, Jarret M. Sanders, Thomas L. Johnson, Nick R. Wu, Isabella T. Krych, Aaron J. Stuart, Michael J. Levy, Bruce A. Tags: Original Article Source Type: research

Kinematically Aligned Total Knee Arthroplasty or Mechanically Aligned Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1632378Kinematically aligned total knee arthroplasty (KATKA) was developed to more anatomically align the knee prosthesis to restore the native alignment of the knee and promote physiological kinematics. Even though there are concerns with implant survival, and follow-up at 10 years or more after KATKA has not been reported, there is a negligible incidence of failure of a tibial component at 2 to 9 years. Early clinical results with this technique are encouraging and demonstrate better functional outcomes compared with mechanically aligned TKA (MATKA). The purpose of this study is to perform...
Source: Journal of Knee Surgery - February 14, 2018 Category: Orthopaedics Authors: Takahashi, Tsuneari Ansari, Juned Pandit, Hemant G. Tags: Original Article Source Type: research

Functional Regions of the Medial Patellofemoral Ligament
J Knee Surg DOI: 10.1055/s-0038-1627467The purpose of this study was to explore the anatomy and discuss functional regions of the medial patellofemoral ligament (MPFL). Twelve fresh-frozen knees specimens were dissected. All medial surfaces of knees were intact and did not have indication of injury. General feature of the MPFL were observed. All anatomical landmarks were carefully identified and marked. The length of the two functional regions were conducted and recorded. All data were obtained, described, and analyzed in the form of mean ± standard deviation. The MPFL was found in all specimens we dis...
Source: Journal of Knee Surgery - February 14, 2018 Category: Orthopaedics Authors: Ji, Gang Sun, Yifei Lu, Jiangfeng Niu, Yingzhen Wang, Fei Tags: Original Article Source Type: research

The Impact of Computed Tomography on Decision Making in Tibial Plateau Fractures
J Knee Surg DOI: 10.1055/s-0038-1627464Schatzker introduced one of the most used classification systems for tibial plateau fractures, based on plain radiographs. Computed tomography brought to attention the importance of coronal plane-oriented fractures. The goal of our study was to determine if the addition of computed tomography would affect the decision making of surgeons who usually use the Schatzker classification to assess tibial plateau fractures. Image studies of 70 patients who sustained tibial plateau fractures were uploaded to a dedicated homepage. Every patient was linked to a folder which contained two radiogr...
Source: Journal of Knee Surgery - February 14, 2018 Category: Orthopaedics Authors: Castiglia, Marcello Teixeira Nogueira-Barbosa, Marcello Henrique Messias, Andre Marcio Vieira Salim, Rodrigo Fogagnolo, Fabricio Schatzker, Joseph Kfuri, Mauricio Tags: Original Article Source Type: research

Quality of Life and Functional Outcomes after Multiligament Knee Reconstruction
J Knee Surg DOI: 10.1055/s-0038-1626737We aimed to determine factors that affect the quality of life of patients undergoing a standardized surgical and postoperative management protocol for knee dislocations. A total of 31 patients (33 knees) were included in this study. We contacted patients at a minimum of 12 months postoperatively (mean: 38 months; range, 12–111 months) and administered the previously validated Multiligament Quality of Life questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests...
Source: Journal of Knee Surgery - February 12, 2018 Category: Orthopaedics Authors: Hatch, George F. Rick Villacis, Diego Damodar, Dhanur Dacey, Michael Yi, Anthony Tags: Original Article Source Type: research

Variability in the Clock Face View Description of Femoral Tunnel Placement in ACL Reconstruction Using MRI-Based Bony Models
J Knee Surg DOI: 10.1055/s-0038-1626736Though controversial, the “clock face view” of the intercondylar notch remains a way some surgeons communicate regarding placement of the femoral tunnel in anterior cruciate ligament reconstruction. The purpose of this study was to quantify the differences in angle measurement between several previous descriptions of the clock face view by using a new reference standard. Three-Tesla magnetic resonance imaging (MRI) was used to scan 10 human knees to create three-dimensional MRI-based bony models which were used for measurements. A standardized clock face view was developed...
Source: Journal of Knee Surgery - February 8, 2018 Category: Orthopaedics Authors: Kraeutler, Matthew J. Patel, Kushal V. Hosseini, Ali Li, Guoan Gill, Thomas J. Bravman, Jonathan T. Tags: Original Article Source Type: research

All-Inside Anterior Cruciate Ligament Reconstruction —A Systematic Review of Techniques, Outcomes, and Complications
J Knee Surg DOI: 10.1055/s-0038-1627446The all-inside technique (AIT) for anterior cruciate ligament reconstruction (ACLR) is gaining popularity as a more anatomic, less invasive, technique with the potential for more rapid recovery. This systematic review aims to critically assess components of the technique, its safety profile, outcomes, and complications. PUBMED, EMBASE, and MEDLINE were searched for studies discussing primary ACLR using the AIT. Article screening, quality assessment, and data abstraction were completed in duplicate, and a minimal clinically important difference (MCID) was used to frame the descriptive ...
Source: Journal of Knee Surgery - February 8, 2018 Category: Orthopaedics Authors: de SA, Darren Shanmugaraj, Ajaykumar Weidman, Melissa Peterson, Devin C. Simunovic, Nicole Musahl, Volker Ayeni, Olufemi R. Tags: Original Article Source Type: research

Knee Pain and the Use of Various Types of Footwear —A Review
J Knee Surg DOI: 10.1055/s-0038-1626735Knee pain is a highly prevalent condition in the United States with multiple etiologies, with two of the most common sources being osteoarthritis (OA) and patellofemoral pain (PFP). These conditions can lead to reduced physical function and a poor quality of life. Various modalities have been used to decrease the amount of knee pain that individuals' experience; however, they are not always successful and can be expensive. Several studies have reported on specialized footwear for symptomatic alleviation of conditions that affect the knee, this is because it has been theorized that cer...
Source: Journal of Knee Surgery - February 8, 2018 Category: Orthopaedics Authors: Chugthai, Morad Newman, Jared M. Akil, Samuel Khlopas, Anton Sultan, Assem A. Sodhi, Nipun Bhave, Anil Harwin, Steven F. Mont, Michael A. Tags: Original Article Source Type: research

All-Inside Single-Bundle Reconstruction of the Anterior Cruciate Ligament with the Anterior Half of the Peroneus Longus Tendon Compared to the Semitendinosus Tendon: A Two-Year Follow-Up Study
J Knee Surg DOI: 10.1055/s-0038-1627466The anterior half of the peroneus longus tendon (AHPLT) has been reported to be acceptable for ligament reconstruction with respect to strength and safety. However, there is little information regarding the clinical outcomes after using the AHPLT compared with other autograft tendons. A prospective randomized controlled study was performed to compare the results of 62 cases of all-inside anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using the AHPLT and 62 cases using semitendinosus graft with an average of 30.0 ± 3.6 months' follow-up. T...
Source: Journal of Knee Surgery - February 8, 2018 Category: Orthopaedics Authors: Bi, Mingguang Zhao, Chen Zhang, Shuijun Yao, Bin Hong, Zheping Bi, Qing Tags: Original Article Source Type: research

Extensor Mechanism Injury in the Pediatric Population —A Clinical Review
J Knee Surg DOI: 10.1055/s-0038-1625955The extensor mechanism of the knee—consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament—is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuri...
Source: Journal of Knee Surgery - February 6, 2018 Category: Orthopaedics Authors: Sessions, William Cody Herring, Matthew Truong, Walter H. Tags: Special Focus Section Source Type: research

Polyethylene on Cement Spacers: An Economic Approach to an Effective Infection Eradication in a Two-Stage Knee Revision Articulating Spacers
J Knee Surg DOI: 10.1055/s-0038-1625960Although two-stage revision surgery is generally considered as the gold standard treatment for periprosthetic joint infection (PJI) after total knee arthroplasty, the procedure is limited by the costs of commercially preformed spacers used for treatment. In this work, we aim to report a modified approach by which the cost of the spacer could be significantly reduced without compromising eradication of infection. Between 2010 and 2016, we performed a total of 11 two-stage revision arthroplasties using a surgically handmade spacer with a new polyethylene insert. Patients were aged 59 to...
Source: Journal of Knee Surgery - February 6, 2018 Category: Orthopaedics Authors: Lu, Junren Han, Jing Zhang, Chi Yao, Zhenjun Yang, Yi Tags: Original Article Source Type: research

A Transpatellar Approach to Treat Distal Femoral Type C3 Fractures Combined with Patellar Fractures
We report our surgical method used to treat type C distal femur fractures accompanied by patella fractures whereby we approach the articular surface of the femur through the already-fractured patella. We treated 10 patients with type C3 distal femur and patella fractures between May 2013 and April 2015. Because the patella was fractured in all cases, we could approach the articular surface of the distal femur through the transverse gap between the retracted patellar fracture fragments, “transpatellar approach.” Any surgical complications were recorded. Knee function was evaluated using the Böstman system. ...
Source: Journal of Knee Surgery - February 6, 2018 Category: Orthopaedics Authors: Lee, Seung Hoo Kim, Min Bom Sim, Jae Ang Han, Do Hwan Tags: Original Article Source Type: research

Cartilage Restoration: Microfracture and Osteochondral Autograft Transplantation
J Knee Surg DOI: 10.1055/s-0037-1618592The treatment of patellofemoral cartilage defects presents several distinct challenges when compared with cartilage restoration techniques used for other compartments of the knee due to the unique anatomy and distribution of forces. The etiologies of patellofemoral articular cartilage lesions include acute traumatic instability injuries, such as dislocation and subluxation, osteochondritis dissecans, and chronic degenerative changes. Regardless of the etiology, untreated patellofemoral cartilage lesions can contribute to activity-limiting anterior knee pain. The goal of patellofemoral...
Source: Journal of Knee Surgery - February 2, 2018 Category: Orthopaedics Authors: Redondo, Michael L. Beer, Adam J. Yanke, Adam B. Tags: Special Focus Section Source Type: research

Osteochondral Injuries of the Knee in Pediatric Patients
J Knee Surg DOI: 10.1055/s-0038-1625956Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most “classic” location for OCD lesions of the knee is the lateral as...
Source: Journal of Knee Surgery - January 30, 2018 Category: Orthopaedics Authors: Bauer, Kathryn L. Tags: Special Focus Section Source Type: research

Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures
This study demonstrates that locked plate osteosynthesis for operative patella fractures can reliably achieve bony union with potentially superior functional outcomes as compared with traditional methods. Further studies are needed to evaluate plate fixation for patella fractures, but early results are promising. [...] 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 - January 30, 2018 Category: Orthopaedics Authors: Siljander, Matthew Koueiter, Denise M. Gandhi, Sapan Wiater, Brett P. Wiater, Patrick J. Tags: Original Article Source Type: research

Surgical Accuracy of an Early Intervention Knee Implant Instrumentation System
In this study, we performed a laboratory evaluation of an instrumentation system which was designed for an early intervention (EI) type of unicompartmental knee. The accuracy of fit was evaluated by implanting in 20 sawbones full leg models. The overall alignment of the limb was compared pre- and postoperatively. The accuracy of placement of each component on its bone was measured. The mean overall alignment angle in the frontal plane was within 1° of target with less than 1° standard deviation. The components were positioned in frontal and sagittal planes with maximum errors of 2°. The angular accuracy was bet...
Source: Journal of Knee Surgery - January 30, 2018 Category: Orthopaedics Authors: Lowry, Mike Buza, John Liu, James Rosenbaum, Heather Lavery, Jessica Bosco, Joseph Walker, Peter S. Tags: Original Article Source Type: research

A Study of Coagulation Changes at Early Stage after Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1625957Coagulation changes after total knee arthroplasty (TKA) can provide evidence for optimization of timing of perioperative anticoagulation medicine. To evaluate the changes, 50 patients with knee osteoarthritis or rheumatoid arthritis were recruited for the study and underwent thrombelastography tests pre-, 6 hours, 12 hours, and 24 hours after TKA surgery and Doppler ultrasound examination 20 to 24 hours after surgery. The results have shown prolonged clotting time (R value) at 6 and 12 hours, while shortened at 24 hours. Similar results have been found in combined clotting and coagula...
Source: Journal of Knee Surgery - January 30, 2018 Category: Orthopaedics Authors: Huang, Jian Zhang, Peng Wang, Dawei Tags: Original Article Source Type: research

Comparing the Efficacy of the Total Stabilizing and Posterior Stabilizing Knee Prostheses in Obese and Preobese Females: A Retrospective Cohort Study
This study retrospectively analyzed knee range of motion and stability of one TKA designs with two different degrees of polyethylene conformity in the obese female population. The implants (Stryker Triathlon total stabilizing [TS] and Stryker Triathlon posterior stabilizing [PS]) differ in their level of constraint, with the TS being more constrained. We hypothesized that the TS implants would be associated with improved functional outcomes in the obese female population, secondary to increased coronal stability to offset the ligamentous laxity. Of 482 knees reviewed, 173 met the inclusion criteria of: female, body mass in...
Source: Journal of Knee Surgery - January 22, 2018 Category: Orthopaedics Authors: Worhacz, Kellen Jacofsky, Marc C. Jacofsky, David J. Ahmed, Sarim Tags: Original Article Source Type: research

Magnetic Resonance Imaging of Articular Cartilage within the Knee
J Knee Surg DOI: 10.1055/s-0037-1620233Magnetic resonance imaging (MRI) provides an effective and noninvasive means by which to evaluate articular cartilage within the knee. Existing techniques can be utilized to detect and monitor longitudinal changes in cartilage status due to injury or progression of degenerative disease. Quantitative MRI (qMRI) techniques can provide a metric by which to evaluate the efficacy of cartilage repair techniques and offer insight into the composition of cartilage and cartilage repair tissue. In this review, we provide background on MR signal generation and decay, the utility of morphologic M...
Source: Journal of Knee Surgery - January 18, 2018 Category: Orthopaedics Authors: Argentieri, Erin C. Burge, Alissa J. Potter, Hollis G. Tags: Special Focus Section Source Type: research

Diagnosing Meniscal Pathology and Understanding How to Evaluate a Postoperative Meniscus Based on the Operative Procedure
J Knee Surg DOI: 10.1055/s-0037-1620251Magnetic resonance imaging (MRI) represents the preferred noninvasive imaging technique to diagnose meniscal pathology in the pre- and postoperative setting. Furthermore, characterization of meniscal tissue MR properties has been possible by the development of advanced MRI techniques. Suspected meniscal tears are a frequent indication for MRI and the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system has been developed to facilitate accurate and uniform reporting of such meniscal tears. Partial meniscectomy and meniscal su...
Source: Journal of Knee Surgery - January 12, 2018 Category: Orthopaedics Authors: Tafur, Monica Probyn, Linda Chahal, Jaskarndip White, Lawrence M. Tags: Special Focus Section Source Type: research

Imaging of Ligamentous Structures within the Knee Includes Much More Than the ACL
J Knee Surg DOI: 10.1055/s-0037-1620259Ligamentous structures of the knee are numerous and complex, including the anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, ligaments of the posteromedial and posterolateral corners, and the anterolateral ligament. Clinical assessment after a knee injury is paramount and can direct both the clinician's choice of imaging study and the radiologist's interpretation. Imaging is crucial in that it provides additional information for diagnosis, management, and surgical planning. Multiple imaging modalities can be used in the evaluation of the knee injuries...
Source: Journal of Knee Surgery - January 10, 2018 Category: Orthopaedics Authors: Gaetke-Udager, Kara Yablon, Corrie M. Tags: Special Focus Section Source Type: research

Imaging of Tendons of the Knee: Much More than just the Extensor Mechanism
J Knee Surg DOI: 10.1055/s-0037-1617418The tendons of the knee play a critical role in the motion and stability of the knee. Knee pain, a common clinical complaint, can frequently be attributed to pathology of these structures. While the cornerstones of the radiological evaluation of the knee are radiography and magnetic resonance imaging, ultrasound can also play an important diagnostic role and can be useful for guided interventional procedures. Understanding the utility of each modality in the assessment for tendon pathology and a familiarity with the normal and abnormal imaging appearance of these structures are crucia...
Source: Journal of Knee Surgery - January 4, 2018 Category: Orthopaedics Authors: Husseini, Jad S. Chang, Connie Y. Palmer, William E. Tags: Special Focus Section Source Type: research

Risk Factors for Contralateral ACL Injury: A Single Institution Case –Control Study
J Knee Surg DOI: 10.1055/s-0037-1615823Our purpose was to evaluate if there is any association between requiring contralateral anterior cruciate ligament (ACL) reconstruction and various: (1) demographics, (2) patient characteristics, and (3) surgery-specific factors. A prospectively collected database at a single institution was queried to find all patients who underwent primary ACL reconstruction between 2012 and 2014. We identified 312 primary ACL reconstruction patients with a mean age of 24 years and a mean follow-up of 3 years (range, 2–5 years). This cohort was compared with all those who had primary ACL recon...
Source: Journal of Knee Surgery - January 3, 2018 Category: Orthopaedics Authors: Pierce, Todd P. Issa, Kimona Cassidy, Kaitlin Festa, Anthony McInerney, Vincent K. Scillia, Anthony J. Tags: Original Article Source Type: research

Preoperative FIBTEM Predicts Postoperative Hemorrhage in Total Knee Arthroplasty
This study retrospectively evaluated 54 patients who had undergone unilateral primary TKA. Laboratory coagulation parameters, including FIBTEM, were recorded before anesthesia induction and after admission to the postanesthetic care unit. The decrease in hemoglobin (Hb), amount of hemorrhage via closed suction drainage, fluid administration, and amount transfused were reviewed postoperatively. The preoperative FIBTEM amplitudes 10 (A10) and 20 (A20) minutes after clotting time and maximum clot firmness (MCF) had the highest correlations with the postoperative decrease in Hb (p = 0.001, p = 0.002...
Source: Journal of Knee Surgery - January 3, 2018 Category: Orthopaedics Authors: Kim, Seong-Hyop Oh, Chung-Sik Kim, Tae-Hoon Park, Sewon Rhee, Ka Young Tags: Original Article Source Type: research

Have the Annual Trends of Total Knee Arthroplasty in Rheumatoid Arthritis Patients Changed?
J Knee Surg DOI: 10.1055/s-0037-1615822As the use of disease modifying antirheumatic drugs have increased, it remains unclear whether or not this has affected the rates of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients. Therefore, the purpose of this study was to evaluate the annual trends of RA patients who underwent TKA. Specifically, we evaluated: (1) the annual trends of TKAs due to RA in the United States population; and (2) the annual trends in the proportion of TKAs due to RA in the United States. The Nationwide Inpatient Sample was used to identify all patients who underwent TKA between 2002 an...
Source: Journal of Knee Surgery - January 3, 2018 Category: Orthopaedics Authors: Harb, Matthew A. Solow, Max Newman, Jared M. Sodhi, Nipun Pivec, Robert George, Jaiben Sultan, Assem A. Khlopas, Anton Shah, Neil V. Roche, Martin W. Mont, Michael A. Tags: Original Article Source Type: research

Clinical Outcomes Following Primary Anterior Cruciate Ligament Reconstruction with Hamstring Autograft versus Planned Hybrid Graft
J Knee Surg DOI: 10.1055/s-0037-1617417Few studies have compared outcomes between autografts versus hybrid grafts (combination of autograft and allograft) for anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare revision rate and patient-reported outcomes following primary ACLR with a hamstring autograft versus a preoperatively planned hybrid autograft-allograft. At a minimum 2-year follow-up, patients who had undergone primary ACLR with a double-stranded semitendinosus and gracilis hamstring autograft (A) or a planned hybrid (H) graft (single-strand semitendinosus with nonirradiated p...
Source: Journal of Knee Surgery - January 2, 2018 Category: Orthopaedics Authors: Kraeutler, Matthew J. Kim, Seong H. Brown, Colin C. Houck, Darby A. Domby, Brian C. Reynolds, Kirk A. McCarty, Eric C. Tags: Original Article Source Type: research

Complex Regional Pain Syndrome after Total Knee Arthroplasty is Rare and Misdiagnosis Potentially Hazardous —Prospective Study of the New Diagnostic Criteria in 100 Patients with No Cases Identified
J Knee Surg DOI: 10.1055/s-0037-1615746Previous studies suggest that complex regional pain syndrome (CRPS) occurs in up to 21% of patients following total knee arthroplasty (TKA). However, this diagnosis has a substantial impact on the patient's management if it is incorrect. We aimed to identify cases, using updated internationally accepted criteria, while investigating potential causes of misdiagnosis.We prospectively studied a consecutive series of 100 primary TKA patients. Each patient was assessed 6-week post-TKA. Pain levels were recorded with the presence of symptoms and signs of CRPS (Budapest Diagnostic Criteria) ...
Source: Journal of Knee Surgery - January 2, 2018 Category: Orthopaedics Authors: Kosy, Jonathan D. Middleton, Simon W.F. Bradley, Benjamin M. Stroud, Rowenna M. Phillips, Jonathan R.A. Toms, Andrew D. Tags: Original Article Source Type: research

The Role of Barbed Sutures in Wound Closure Following Knee and Hip Arthroplasty: A Review
J Knee Surg DOI: 10.1055/s-0037-1615812Lower extremity joint arthroplasty procedures often require a large incision to have an adequate exposure, which subsequently leads to lengthy wounds that may contribute to long closure, anesthesia, and overall operative times. The recently introduced knotless barbed suture may provide better outcomes, faster closure time, and decreased material utilization. Therefore, the aim of this study was to review the impact of barbed sutures on: (1) wound-related complications; (2) closure and operative time; (3) patient outcomes (range of motion and Knee Society Scores [KSS]); and (4) effects...
Source: Journal of Knee Surgery - January 2, 2018 Category: Orthopaedics Authors: Faour, Mhamad Khlopas, Anton Elmallah, Randa K. Chughtai, Morad Kolisek, Frank R. Barrington, John W. Mont, Michael A. Tags: Original Article Source Type: research

Closed Suction Drainage after Primary Total Knee Arthroplasty: A Prospective Randomized Trial
J Knee Surg DOI: 10.1055/s-0037-1615297The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were ev...
Source: Journal of Knee Surgery - January 2, 2018 Category: Orthopaedics Authors: Erne, Felix Wetzel, Stefanie W ülker, Nikolaus Gesicki, Marco Hofmann, Ulf Krister Tags: Original Article Source Type: research

Metabolic Responses of Meniscus to IL-1 β
This article identifies the potential mechanisms of action for meniscal degeneration in response to joint inflammation and potential contributions of the meniscus to the development and progression of osteoarthritis (OA). It was hypothesized that interleukin-1β (IL-1β) stimulation of meniscal explants would result in significant increases in nitric oxide (NO), matrix metalloproteinase (MMP) production and activity, and relevant cytokine production compared with controls. Canine meniscal explants (4 mm) were cultured for 21 days with (IL-1) or without (negative control [NC]) 50 ng/mL rcIL-1β (n =&thins...
Source: Journal of Knee Surgery - January 2, 2018 Category: Orthopaedics Authors: Cook, Alex E. Cook, James L. Stoker, Aaron M. Tags: Original Article Source Type: research

Bone-Patellar Tendon-Bone Autograft versus Hamstring Tendon Autograft for Anatomical Anterior Cruciate Ligament Reconstruction with Three-Dimensional Validation of Femoral and Tibial Tunnel Positions
In conclusion, BPTB grafts showed significantly better anterior knee stability than HT grafts, although no significant differences in other objective evaluations and all subjective evaluations were detected between the two graft types in anatomical ACLR. Additional 3D CT data validated the anatomical concepts of these two procedures. [...] 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 - December 28, 2017 Category: Orthopaedics Authors: Taketomi, Shuji Inui, Hiroshi Yamagami, Ryota Shirakawa, Nobuyuki Kawaguchi, Kohei Nakagawa, Takumi Tanaka, Sakae Tags: Original Article Source Type: research

Surgical Management of Simultaneous Anterior Cruciate Ligament and Patellar Tendon Ruptures: A Systematic Review
This study performs a systematic review to determine (1) if a significant difference exists in return to preinjury activity level between one- and two-stage treatment of combined anterior cruciate ligament (ACL) and patellar tendon (PT) tears; and (2) if a significant difference exists in the number of postoperative complications between the two differing surgical treatment approaches. A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO. MEDLINE, Cochrane Central Register of Controlled Trials, SCOPUS, and Sport Discus were...
Source: Journal of Knee Surgery - December 28, 2017 Category: Orthopaedics Authors: Meheux, Carlos J. Jack, Robert A. McCulloch, Patrick C. Lintner, David M. Harris, Joshua D. Tags: Original Article Source Type: research

Bilayer Matrix Autologous Chondrocyte Implantation without Bone Graft for Knee Osteochondral Lesion less than 8  mm Deep
This article investigates the clinical and radiological results of bilayer matrix autologous chondrocyte implantation (MACI) membrane technique in the treatment of shallow osteochondral defects. An analysis was made of eight patients who were operated on using the bilayer MACI (Genzyme Biosurgery, Cambridge, MA) technique (mean age: 20.2 years, mean defect size: 3.8 cm2, mean defect depth: 6.2 ± 0.9 mm, and mean follow-up time: 22.1 ± 5.3 [14–26.1] months). According to the defect, the first membrane was secured to the base of the defect with the cells facing up, and t...
Source: Journal of Knee Surgery - December 28, 2017 Category: Orthopaedics Authors: Bozkurt, Murat Isik, Cetin Gursoy, Safa Akkaya, Mustafa Algin, Oktay Dogan, Metin Tags: Original Article Source Type: research

Response to: Confidence in the ATTUNE Knee is Driven by Real-World Scientific Evidence: Response to Bonutti et al. Article
J Knee Surg DOI: 10.1055/s-0037-1608945 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 - December 28, 2017 Category: Orthopaedics Authors: Bonutti, Peter Tags: Letter to the Editor Source Type: research

Day of Week and Surgery Location Effects on Stay Length and Cost for Total Joint Arthroplasty: Academic versus Orthopaedic-Specific Hospital
This study examined the effects that day of week and surgery location [academic (AH) versus orthopaedic-specific (OsH) hospital] have on length of stay (LOS) and cost for primary TJA patients in one multihospital university-based medical center. An Institutional Review Board-approved database of adult patients undergoing primary THA or TKA from June 2013 to December 2014 was constructed. Surgery location, day of procedure, age, American Society of Anesthesiologists (ASA) classification, LOS, and cost were recorded for each patient. Data were compared for significant differences using analysis of variance, t-Test or rank su...
Source: Journal of Knee Surgery - December 21, 2017 Category: Orthopaedics Authors: Martino, John Peterson, Blake Thompson, Samuel Cook, James L. Aggarwal, Ajay Tags: Original Article Source Type: research