The Effect of Patellar Positioning on Femoral Component Rotation when Performing Flexion Gap Balancing Using a Tensioning Device for Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1713896There is an increasing interest in new devices such as tensiometers for flexion gap balancing during total knee arthroplasty (TKA). The purpose of this study was to determine the influence of patella positioning during flexion gap balancing on femoral component rotation. We prospectively evaluated 32 consecutive knees in 31 patients who underwent primary TKA for degenerative osteoarthritis and where soft tissue balancing was performed using the same tensiometer. Preoperative measurements included valgus/varus deformation, mechanical axis, epicondylar axis, and tibial slope. Intraopera...
Source: Journal of Knee Surgery - July 14, 2020 Category: Orthopaedics Authors: Ernstbrunner, Lukas Andronic, Octavian Grubhofer, Florian Jundt-Ecker, Mich èle Fucentese, Sandro F. Tags: Original Article Source Type: research

Same Day versus Staged Total Knee Arthroplasty: Do Cost Savings Justify the Risk?
J Knee Surg DOI: 10.1055/s-0040-1713734Same-day bilateral total knee arthroplasties (BTKAs) are associated with increased complications compared with staged procedures; however, as complication rates and lengths of stay (LOS) for same-day procedures decrease, they may become attractive alternatives to staged procedures. The void of recent nationwide studies comparing the 30-day total cost and risks of these procedures inspired this propensity matched review. Therefore, we compared 30-day outcomes in staged and same-day BTKAs occurring in 2016 and 2017 using the National Readmission Database (NRD), a nationwide database. Th...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Wilkie, Wayne Mohamed, Nequesha Remily, Ethan Pastore, Mark Nace, James Delanois, Ronald E. Tags: Original Article Source Type: research

Modified Partial Lateral Facetectomy of the Patella for Stage III Patellofemoral Osteoarthritis with 5-Year Follow-Up
J Knee Surg DOI: 10.1055/s-0040-1713899The main aim of this article was to examine the therapeutic evaluation of our modified partial lateral facetectomy of the patella for stage III lateral patellofemoral osteoarthritis (PFOA), which includes (1) partial lateral patella articular facet that was resected; (2) coronal Z-shaped incision to lengthen lateral retinaculum; (3) patellar perimeter electrocoagulation to denervate. Between December 2008 and January 2013, 36 knees of 32 patients with severe patellofemoral (PF) osteoarthritis (OA) were treated with our modified partial patellar lateral facetectomy. All patients were s...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Wang, Mingjun Li, Xiaofeng Li, Peng Wang, Hongyan Gao, Wenxiang Tags: Original Article Source Type: research

Is There a Role of Meniscal Morphology in the Risk of Noncontact Anterior Cruciate Ligament Rupture? A Case –Control Study
J Knee Surg DOI: 10.1055/s-0040-1713814The purpose of this study was to identify the anatomical risk factors and determine the role of meniscal morphology in noncontact anterior cruciate ligament (ACL) rupture. A total of 126 patients (63 with noncontact ACL rupture and 63 age- and sex-matched controls) with intact menisci were included in this retrospective case–control study. On knee magnetic resonance imaging (MRI), meniscal morphometry (anterior, corpus, and posterior heights and widths of each meniscus), tibial slope (medial and lateral separately), notch width index, roof inclination angle, anteromedial bony ri...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Unal, Melih Kose, Ozkan Aktan, Cemil Gumussuyu, Gurkan May, Hasan Kati, Yusuf Alper Tags: Original Article Source Type: research

Obesity Does Not Affect Patient-Reported Outcomes following Patellofemoral Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1713862Patellofemoral arthroplasty (PFA) has garnered attention in recent years as an effective alternative to total knee arthroplasty for patients with symptomatic, isolated patellofemoral joint arthritis. Obesity has previously been identified as a risk factor for revision surgery, but its effect on patient-reported outcome measures (PROMs) has not been evaluated. A retrospective review of a consecutive series of PFA surgeries was conducted at a single, specialized orthopedics center in a major urban center. Patients were dichotomized by body mass index (BMI) as obese (O, BMI>30) or non...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Tishelman, Jared C. Pyne, Abigail Kahlenberg, Cynthia A. Gruskay, Jordan A. Strickland, Sabrina M. Tags: Original Article Source Type: research

The Influence of Posterior Cruciate Ligament Resection on Tibiofemoral Joint Gap in Varus Osteoarthritic Knees
J Knee Surg DOI: 10.1055/s-0040-1713810Posterior cruciate ligament (PCL) resection during posterior-stabilized total knee arthroplasty (PS-TKA) has been reported to preferentially increase the tibiofemoral joint gap in flexion compared with extension. However, previous assessments of the joint gaps have been performed after bone resection and medial soft tissue release. Thus, these procedural steps may have the potential to influence soft tissue balance. In native knees, soft tissue laxity is generally greater in the lateral compartment than in the medial compartment both with the knee in extension and in flexion. Some sur...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Oshima, Yasushi Majima, Tokifumi Iizawa, Norishige Hoshikawa, Naoya Takahashi, Kenji Takai, Shinro Tags: Original Article Source Type: research

Comparison between Mid-Term Results of Total Knee Arthroplasty with Single-Radius versus Multiple-Radii Posterior-Stabilized Prostheses
J Knee Surg DOI: 10.1055/s-0040-1713897Single-radius (SR) prostheses and multiple-radii (MR) prostheses have different theoretical advantages; however, few comparative studies have been reported. The aim of the study was to compare mid-term clinical, radiological, and survival outcomes of SR and MR posterior-stabilized prostheses in total knee arthroplasty (TKA). Two hundred consecutive patients who underwent TKA between January 2012 and July 2013 were enrolled in the SR group (100 patients) and an MR group (100 patients), with a minimum follow-up of 5 years. Functional, radiological, satisfaction, and survival rates were ...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Luo, Zhenyu Zhou, Kai Wang, Haoyang Pei, Fuxing Zhou, Zongke Tags: Original Article Source Type: research

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors
J Knee Surg DOI: 10.1055/s-0040-1713898The purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinica...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Lee, Jae Ik Jaffar, Mohd Shahrul Azuan Choi, Han Gyeol Kim, Tae Woo Lee, Yong Seuk Tags: Original Article Source Type: research

Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1713861The aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to ...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Ifran, Nadia Nastassia Mok, Ying Ren Krishna, Lingaraj Tags: Original Article Source Type: research

Comparative Cost Analysis of Robotic-Assisted and Jig-Based Manual Primary Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1713895Excellent durability with traditional jig-based manual total knee arthroplasty (mTKA) has been noted, but substantial rates of dissatisfaction remain. Robotic-assisted TKA (raTKA) was introduced to improve clinical outcomes, but associated costs have not been well studied. The purpose of our study is to compare 90-day episode-of-care (EOC) costs for mTKA and raTKA. A retrospective review of an institutional database from 4/2015 to 9/2017 identified consecutive mTKAs and raTKAs using a single implant system performed by one surgeon. The raTKA platform became available at our institutio...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Cotter, Eric J. Wang, Jesse Illgen, Richard L. Tags: Original Article Source Type: research

Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action
J Knee Surg DOI: 10.1055/s-0040-1713756The purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) primary total knee arthroplasty (pTKA), (2) septic revision total knee arthroplasty (rTKA), and (3) aseptic revision total knee arthroplasty (TKA). The State Inpatient Databases were queried for all TKAs from 2005 to 2014 yielding 563,144 patients. Patients were separated into the following cohorts: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition and the following specific conditions were compared between the three cohorts: schizoph...
Source: Journal of Knee Surgery - July 13, 2020 Category: Orthopaedics Authors: Anis, Hiba K. Warren, Jared A. Klika, Alison K. Navale, Suparna M. Zhou, Guangjin Barsoum, Wael K. Higuera, Carlos A. Piuzzi, Nicolas S. Tags: Original Article Source Type: research

Rasch Analysis for the Knee Injury and Osteoarthritis Outcome Score Joint Replacement Version in Individuals Awaiting Total Knee Replacement Surgery
J Knee Surg DOI: 10.1055/s-0040-1713812The aim of this study was to verify the single-factor structure of the joint replacement version of the Knee Injury and Osteoarthritis Outcome Score (KOOS-JR) and examine its measurement properties in the context of Rasch analysis in patients with end-stage osteoarthritis of the knee (KOA) awaiting total knee replacement (TKR). The study design was retrieval of prospectively collected clinical data. The data were extracted from the presurgery visit for individuals with KOA who were scheduled for primary TKR at a tertiary care hospital. Those who were scheduled for revision of TKR had ...
Source: Journal of Knee Surgery - July 8, 2020 Category: Orthopaedics Authors: Mehta, Saurabh P. Jobes, Joshua Parsemain, Chloe Lu, Steve Kelley, Kristie Oliashirazi, Ali Tags: Original Article Source Type: research

Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management
J Knee Surg DOI: 10.1055/s-0040-1713777The purpose of this study was to determine (1) the correlation between preoperative and postoperative opioid use and (2) risk factors associated with rerupture in patients undergoing open extensor mechanism repair. A retrospective review of patients who underwent operative repair of quadriceps or patellar tendon rupture was performed. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before surgery, or as acute users or chronic users if they received at least one opioid prescription within 1 month or 3 months preceding surgery....
Source: Journal of Knee Surgery - July 8, 2020 Category: Orthopaedics Authors: Khalil, Lafi S. Jildeh, Toufic R. Ussef, Najib Rahman, Tahsin Carter, Erika Pawloski, Megan Tandron, Marissa Moutzouros, Vasilios Tags: Original Article Source Type: research

Tibial Spine Location Influences Tibial Tunnel Placement in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1713736The purpose of this study was to assess the influence of tibial spine location on tibial tunnel placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT). A total of 39 patients undergoing anatomical single-bundle ACL reconstruction were included in this study (30 females and 9 males; average age: 29 ± 15.2 years). In anatomical single-bundle ACL reconstruction, the tibial and femoral tunnels were created close to the anteromedial bundle insertion site using a transportal technique. Us...
Source: Journal of Knee Surgery - July 8, 2020 Category: Orthopaedics Authors: Iriuchishima, Takanori Goto, Bunsei Tags: Original Article Source Type: research

Baseline Analysis of Patients Presenting for Surgical Review of Anterior Cruciate Ligament Rupture Reveals Heterogeneity in Patient-Reported Outcome Measures
J Knee Surg DOI: 10.1055/s-0040-1713658Despite the establishment of successful surgical techniques and rehabilitation protocols for anterior cruciate ligament (ACL) reconstruction, published return to sport rates are less than satisfactory. This has led orthopaedic surgeons and researchers to develop more robust patient selection methods, and investigate prognostic patient characteristics. No previous studies have integrated baseline characteristics and responses to patient-reported outcome measures (PROMs) of patients with ACL rupture presenting for surgical review. Patients electing to undergo ACL reconstruction under th...
Source: Journal of Knee Surgery - July 6, 2020 Category: Orthopaedics Authors: Ting, Chee Han Scholes, Corey Zbrojkiewicz, David Bell, Christopher Tags: Original Article Source Type: research

The Relationship of Transepicondylar Width with the Distal and Posterior Femoral Condyles and Its Clinical Implications: A Three-Dimensional Study
The objective of this study was to determine a reliable method of restoring the anatomical joint line and posterior condylar offset in the setting of rTKA based on three-dimensional (3D) reconstruction of computed tomography (CT) images of the distal femur. Methods CT scans of 50 lower limbs were analyzed. Key anatomical landmarks such as the medial epicondyle (ME), lateral epicondyle, and transepicondylar width (TEW) were determined on 3D models constructed from the CT images. Best-fit planes placed on the most distal and posterior loci of points on the femoral condyles were used to define the distal and posterior...
Source: Journal of Knee Surgery - July 6, 2020 Category: Orthopaedics Authors: Lee, Merrill Ho, Jade Pei Yuik Chen, Jerry Yongqiang Ng, Chung Kia Yeo, Seng Jin Merican, Azhar M. Tags: Original Article Source Type: research

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis
J Knee Surg DOI: 10.1055/s-0040-1713355Despite the high incidence of sarcopenia in the orthopaedic community, studies evaluating the influence of sarcopenia following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study is to determine if sarcopenic patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) implant-related complications; (4) fall risk; (5) lower extremity fracture risk; and (6) costs of care. Sarcopenia patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The quer...
Source: Journal of Knee Surgery - July 6, 2020 Category: Orthopaedics Authors: Ardeljan, Andrew D. Polisetty, Teja S. Palmer, Joseph Vakharia, Rushabh M. Roche, Martin W. Tags: Original Article Source Type: research

A Comparison of Central Anatomic Single-Bundle Reconstruction and Anatomic Double-Bundle Reconstruction in Anteroposterior and Rotational Knee Stability: Intraoperative Biomechanical Evaluation
This study aimed to compare the central anatomical SB and anatomical DB ACL reconstruction in intraoperative knee kinematics during continuous knee flexion-extension. A total of 34 patients who underwent ACL reconstruction using the hamstring tendon were evaluated intraoperatively before and immediately after ACL reconstruction using OrthoPilot ACL Navigation System Version 3.0. The patients were prospectively randomized into the central anatomical SB (17 knees) and the anatomical DB reconstruction (17 knees) groups. The tibial translation and rotation were continuously measured during knee flexion-extension under conventi...
Source: Journal of Knee Surgery - July 2, 2020 Category: Orthopaedics Authors: Ikuta, Yasunari Nakamae, Atsuo Shimizu, Ryo Ishikawa, Masakazu Nakasa, Tomoyuki Ochi, Mitsuo Adachi, Nobuo Tags: Original Article Source Type: research

Neuromuscular Electrical Stimulation Use after Total Knee Arthroplasty Improves Early Return to Function: A Randomized Trial
J Knee Surg DOI: 10.1055/s-0040-1713420Neuromuscular electrical stimulation (NMES) has been reported as an effective method for quadriceps strengthening which could attenuate muscle loss in the early total knee arthroplasty (TKA) postoperative recovery period. The purpose of this randomized controlled trial was to test whether postoperative use of NMES on TKA patients results in increased quadriceps strength and ultimately improved functional outcomes. This randomized controlled clinical trial of 66 primary TKA patients was conducted at a large academic medical center. Patients were randomized 2:1 into treatment (NMES use,...
Source: Journal of Knee Surgery - July 1, 2020 Category: Orthopaedics Authors: Klika, Alison K. Yakubek, George Piuzzi, Nicholas Calabrese, Gary Barsoum, Wael K. Higuera, Carlos A. Tags: Original Article Source Type: research

Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients
The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were
Source: Journal of Knee Surgery - June 29, 2020 Category: Orthopaedics Authors: Thomas, Stephen Patel, Ankur Patrick, Corey Delhougne, Gary Tags: Original Article Source Type: research

Mobile Bearing versus Fixed Bearing for Total Knee Arthroplasty: Meta-analysis of Randomized Controlled Trials at Minimum 10-Year Follow-up
J Knee Surg DOI: 10.1055/s-0040-1713356This meta-analysis aimed to compare the clinical and radiographic outcomes between mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing total knee arthroplasty (FB-TKA) at a minimum 10-year follow-up. PubMed, EMBASE, and Cochrane databases were searched. All included articles were evaluated by two trained reviewers according to the guidelines of the Cochrane Collaboration Handbook for potential risk, and the Consolidated Standards on Reporting Trials (CONSORT) checklist and scoring system was also used to assess the methodological quality of each study. The extracted data...
Source: Journal of Knee Surgery - June 26, 2020 Category: Orthopaedics Authors: Chen, Pu Huang, Liuwei Zhang, Dong Zhang, Xiaozhe Ma, Yufeng Wang, Qingfu Tags: Original Article Source Type: research

Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment
J Knee Surg DOI: 10.1055/s-0040-1712944The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and...
Source: Journal of Knee Surgery - June 24, 2020 Category: Orthopaedics Authors: Schreiner, Anna J. Stoker, Aaron M. Bozynski, Chantelle C. Kuroki, Keiichi Stannard, James P. Cook, James L. Tags: Special Focus Section Source Type: research

Osteotomies for the Management of Medial Compartment Defects of the Knee
J Knee Surg DOI: 10.1055/s-0040-1712985For nearly three-quarters of a century the proximal tibia osteotomy has been used as an effective treatment for cartilage injuries of the knee. Over this same timeframe several advancements have been made in our diagnostic, preoperative planning, and technical execution of this procedure. As such, good-to-excellent short-, mid-, and long-term outcomes have been reported. Since its inception, the most important step in deciding on this procedure is identifying the ideal candidate. This candidate should be a young patient (
Source: Journal of Knee Surgery - June 24, 2020 Category: Orthopaedics Authors: Grimm, Nathan L. Levy, Benjamin J. Jimenez, Andrew E. Arciero, Robert A. Tags: Special Focus Section Source Type: research

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1713128Given a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were co...
Source: Journal of Knee Surgery - June 24, 2020 Category: Orthopaedics Authors: Rajaee, Sean S. Debbi, Eytan M. Paiement, Guy D. Spitzer, Andrew I. Tags: Original Article Source Type: research

Efficacy of Liposomal Bupivacaine versus Ropivacaine in Adductor Canal Block for Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1713114Adductor canal block (ACB) is advantageous for postoperative analgesia in total knee arthroplasty (TKA) because it results in minimal motor block. Liposomal bupivacaine (LB) is Food and Drug Administration-approved extended-release formulation of bupivacaine for interscalene peripheral nerve blocks. Its use is increasing in the TKA setting, mainly as a local infiltration agent. We compared the efficacy of ACB using LB versus ropivacaine in TKA. Two cohorts of patients were retrospectively analyzed at a single institution receiving ropivacaine and LB ACB for TKA. Duration of LB ACB, ti...
Source: Journal of Knee Surgery - June 24, 2020 Category: Orthopaedics Authors: Chen, Chang-Hwa Mary Yun, Andrew G. Fan, Teresa Tags: Original Article Source Type: research

Patellar Morphology and Osteoarthritis: A Cadaveric Analysis
J Knee Surg DOI: 10.1055/s-0040-1713127Previous studies have attempted to characterize patellar morphology and its relation to patellofemoral osteoarthritis but have utilized relatively small samples. We designed a large-scale cadaveric analysis to elucidate any potential relationship. Patellar morphology in 1,032 patellae was characterized using patellar facet concavity patterns initially developed by Wiberg and using the ratio of the lateral and medial facet lengths. Patellofemoral arthritis grading for specimens was previously completed based primarily on osteophytic burden. The average age at time of death was 56&thins...
Source: Journal of Knee Surgery - June 22, 2020 Category: Orthopaedics Authors: Shah, Nihar S. Wang, David M. Weinberg, Douglas S. Liu, Raymond W. Tags: Original Article Source Type: research

Cementless Tritanium Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 5-Year Minimum Follow-Up
This study assesses: (1) implant survivorship; (2) clinical outcomes; and (3) complications with radiographic outcomes at a 5-year minimum follow-up of cementless highly porous titanium-coated baseplates in TKAs. Methods Part of this study has been reported. We retrospectively reviewed a prospectively collected database at a single high-volume institution between July 1, 2013 and June 30, 2014 for patients who underwent a primary TKA using cementless highly porous titanium-coated baseplate implants. Patients were evaluated clinically at postoperative follow-up visits at a minimum of 5 years. To calculate the surviv...
Source: Journal of Knee Surgery - June 19, 2020 Category: Orthopaedics Authors: Tarazi, John M. Salem, Hytham S. Ehiorobo, Joseph O. Sodhi, Nipun Mont, Michael A. Harwin, Steven F. Tags: Special Focus Section Source Type: research

Fellow Involvement in Primary Total Knee Arthroplasty: Is There an “August Effect?”
J Knee Surg DOI: 10.1055/s-0040-1713113The purpose of this study is to determine if a fellow's involvement, as well as duration of a fellow's training, impacts complications, outcomes, and survivorship in primary total knee arthroplasty (TKA). A retrospective review identified 2,790 consecutive patients (3,530 knees) who underwent primary TKA between 2003 and 2008. A 2-year minimum follow-up was available on 2,785 knees (2,195 patients). Operative data, clinical outcomes, complications, and survivorship were compared between cases with and without a fellow involved as well as comparing cases in the first quarter (Q1) of th...
Source: Journal of Knee Surgery - June 19, 2020 Category: Orthopaedics Authors: Crawford, David A. Berend, Keith R. Lombardi, Adolph V. Tags: Original Article Source Type: research

Revision Anterior Cruciate Ligament Reconstruction after Surgical Management of Multiligament Knee Injury
J Knee Surg DOI: 10.1055/s-0040-1712969The purpose of this study is to determine factors associated with the need for revision anterior cruciate ligament reconstruction (ACLR) after multiligament knee injury (MLKI) and to report outcomes for patients undergoing revision ACLR after MLKI. This involves a retrospective review of 231 MLKIs in 225 patients treated over a 12-year period, with institutional review board approval. Patients with two or more injured knee ligaments requiring surgical reconstruction, including the ACL, were included for analyses. Overall, 231 knees with MLKIs underwent ACLR, with 10% (n =&thins...
Source: Journal of Knee Surgery - June 16, 2020 Category: Orthopaedics Authors: Worley, John R. Brimmo, Olubusola Nuelle, Clayton W. Zitsch, Bradford P. Leary, Emily V. Cook, James L. Stannard, James P. Tags: Original Article Source Type: research

The Importance of Staging Arthroscopy for Chondral Defects of the Knee
This study aims to evaluate the role of staging arthroscopy in the diagnosis of knee chondral defects and subsequent surgical planning prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and meniscus allograft transplantation (MAT). All patients who underwent staging arthroscopy prior to ACI, OCA, or MAT at our institution from 2005 to 2015 were identified. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, magnetic resonance imaging (MRI) findings and previous operative records. Operative records of the subsequent staging arthroscopy...
Source: Journal of Knee Surgery - June 16, 2020 Category: Orthopaedics Authors: Salem, Hytham S. Chaudhry, Zaira S. Lucenti, Ludovico Tucker, Bradford S. Freedman, Kevin B. Tags: Original Article Source Type: research

Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes —A Single Surgeon Experience
This study sought to evaluate the patient experience and short-term clinical outcomes associated with the hospital stay of patients who underwent robotic arm-assisted total knee arthroplasty (TKA). These results were compared with a cohort of patients who underwent TKA without robotic assistance performed by the same surgeon prior to the introduction of this technology. Materials and Methods A cohort of consecutive patients undergoing primary TKA for the diagnosis of osteoarthritis by a single fellowship trained orthopaedic surgeon over a 39-month period was identified. Patients who underwent TKA during the year th...
Source: Journal of Knee Surgery - June 16, 2020 Category: Orthopaedics Authors: King, Connor A. Jordan, Mark Bradley, Alexander T. Wlodarski, Caroline Tauchen, Alexander Puri, Lalit Tags: Original Article Source Type: research

HKA Angle —A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs
This study suggests that to correct the HKA angle and the WBL percentage within the target range on two-dimensional WLRs, the Miniaci angle must be controlled to an accuracy of ± 1.63 and ± 1.18 degrees, respectively. Theoretically, the HKA angle is highly suitable as a preoperative planning parameter for HTO with a large permissible error and a small variability in the degree of change in the Miniaci angle (ΔMiniaci). [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstr...
Source: Journal of Knee Surgery - June 16, 2020 Category: Orthopaedics Authors: Jiang, Xu Xie, Kai Han, Xuequan Ai, Songtao Wu, Haishan Wang, Liao Yan, Mengning Tags: Original Article Source Type: research

Importance of Three-Dimensional Evaluation of Surgical Transepicondylar Axis in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1712087In total knee arthroplasty, the surgical transepicondylar axis (SEA) is one of the most reliable rotation axes for stabilizing of the patellofemoral joint. The SEA is identified with reference to the lateral epicondyle and the medial sulcus of the medial epicondyle. However, these two structures rarely appear on the same plane on computed tomography (CT), and it is necessary to take two points in separate images. Many surgeons measure the SEA on the same image (pseudo SEA) instead. We aimed to determine the difference between true SEAs and pseudo SEAs. A total of 31 normal knees and 2...
Source: Journal of Knee Surgery - June 8, 2020 Category: Orthopaedics Authors: Ohmori, Takaaki Kabata, Tamon Kajino, Yoshitomo Inoue, Daisuke Ueno, Takuro Taga, Tadashi Yamamoto, Takashi Takagi, Tomoharu Yoshitani, Junya Ueoka, Ken Yamamuro, Yuki Tsuchiya, Hiroyuki Tags: Original Article Source Type: research

Construction and Comparison of Predictive Models for Length of Stay after Total Knee Arthroplasty: Regression Model and Machine Learning Analysis Based on 1,826 Cases in a Single Singapore Center
J Knee Surg DOI: 10.1055/s-0040-1710573The purpose of this study was to develop a predictive model for length of stay (LOS) after total knee arthroplasty (TKA). Between 2013 and 2014, 1,826 patients who underwent TKA from a single Singapore center were enrolled in the study after qualification. Demographics of patients with normal and prolonged LOS were analyzed. The risk variables that could affect LOS were identified by univariate analysis. Predictive models for LOS after TKA by logistic regression or machine learning were constructed and compared. The univariate analysis showed that age, American Society of Anesthesiolo...
Source: Journal of Knee Surgery - June 8, 2020 Category: Orthopaedics Authors: Li, Hui Jiao, Juyang Zhang, Shutao Tang, Haozheng Qu, Xinhua Yue, Bing Tags: Original Article Source Type: research

A Safe Interval between Preoperative Intra-articular Corticosteroid Injections and Subsequent Knee Arthroscopy
J Knee Surg DOI: 10.1055/s-0040-1712949The purpose of this study is to evaluate the influence of intra-articular corticosteroid injections prior to knee arthroscopy on the rate of postoperative infection and define a safe timing interval between intra-articular corticosteroid injections and subsequent knee arthroscopy. The PearlDiver Database was used to identify patients who underwent a knee arthroscopy from 2007 to 2017. Patients were sorted into an injection cohort if they received any intra-articular corticosteroid injections within 6 months before surgery and a control cohort if they received no such injections. The i...
Source: Journal of Knee Surgery - June 8, 2020 Category: Orthopaedics Authors: Lee, Wonyong Bhattacharjee, Sarah Lee, Michael J. Ho, Sherwin W. Athiviraham, Aravind Shi, Lewis L. Tags: Original Article Source Type: research

Anterior Cruciate Ligament Surgery Performed Less Than 3 Weeks After Injury Is Not Inferior to Delayed Surgery
J Knee Surg DOI: 10.1055/s-0040-1710365Performing anterior cruciate ligament (ACL) surgery in the immediate period after injury is controversial. However, there may be instances where the opportunity cost of delayed surgery for the patient may be unacceptable. Concomitant meniscus injuries may also prevent the patient from regaining range of motion in the preoperative period. Every week that surgery is delayed may increase pain and impair mobility for this group of patients. We investigate the functional and clinical outcomes in patients with ACL surgery in the immediate 3-week period following ACL injury. A cohort study w...
Source: Journal of Knee Surgery - June 8, 2020 Category: Orthopaedics Authors: Chua, Kenon Kang, Joseph Benjamin Yida Fook-Chong, Stephanie Tan, Andrew Hwee Chye Tags: Original Article Source Type: research

Evaluation of the Stability of the Subjects with Anterior Cruciate Injuries Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1710374Anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is often injured during sport-related activities. ACL injuries influence the abilities of the subjects during standing and walking. Although early surgical intervention is preferred treatment for the majority of knee surgeons, the effect of this approach on postural stability of patients is not fully understood. Therefore, the aim of this study was to determine the difference between stability of ACL-reconstructed subjects before and after surgery. A group of 15 consecutive ACL injured patients pa...
Source: Journal of Knee Surgery - June 8, 2020 Category: Orthopaedics Authors: Aghdam, Hossein Akbari Kavyani, Mahsa Bosak, Maryam Karimi, Mohammad Taghi Motififard, Mehdi Tags: Original Article Source Type: research

Superior Mid- to Long-Term Clinical Outcomes of Mobile-Bearing Total Knee Arthroplasty Compared to Fixed-Bearing: A Meta-analysis Based on a Minimum of 5 Years of Study
J Knee Surg DOI: 10.1055/s-0040-1709490As more patients undergo total knee arthroplasty (TKA) each year, and the average age of patients gets younger, the patients are generally more active requiring a greater physiological demand and increasing range of motion on the prosthesis than the previous patients. However, there is no consensus on the optimal TKA tibial bearing design. We performed this systematic review to compare the clinical differences between mobile and fixed bearing constructs used in contemporary TKA. We searched PubMed, EMBASE, and Cochrane Library databases, identifying 515 total publications, including 1...
Source: Journal of Knee Surgery - June 5, 2020 Category: Orthopaedics Authors: Wang, Kaiyang Zhang, Fang Fang Yan, Xu Shen, Yifan Cai, Weijie Xu, Jiaming Mei, Jiong Tags: Original Article Source Type: research

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction
J Knee Surg DOI: 10.1055/s-0040-1710521The purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms “anterior cruciate ligament reconstruction,” “anatomic or anatomical,” and “single bundle.” Studies were included when they reported clinical results, surgic...
Source: Journal of Knee Surgery - June 1, 2020 Category: Orthopaedics Authors: Iriuchishima, Takanori Goto, Bunsei Tags: Original Article Source Type: research

Outcomes of Cementless-Backed Patellar Components
J Knee Surg DOI: 10.1055/s-0040-1710378Because of the early follow-up positive outcomes with cementless fixation, continued evaluations need to be performed to ensure longer-term efficacy. Additionally, although many studies report on the results of femoral and tibial component fixation, few studies report specifically on patellar outcomes. Therefore, the purpose of this study was to report on the: (1) implant survivorship; (2) complications; and (3) radiographic outcomes in a large cohort of patients who received cementless total knee arthroplasties (TKAs), with particular attention to the patellar component. A total of 2...
Source: Journal of Knee Surgery - May 29, 2020 Category: Orthopaedics Authors: Harwin, Steven F. DeGouveia, William Sodhi, Nipun Gold, Peter A. Garbarino, Luke J. Ehiorobo, Joseph O. Salem, Hytham S. Mont, Michael A. Tags: Special Focus Section Source Type: research

Early Economic Analysis of Robotic-Assisted Unicondylar Knee Arthroplasty May Be Cost Effective in Patients with End-Stage Osteoarthritis
J Knee Surg DOI: 10.1055/s-0040-1712088Unicondylar knee arthroplasty (UKA), as an alternative to total knee arthroplasty (TKA), has been shown to be an effective option for patients with single-compartment end-stage knee osteoarthritis. Implant survival is contingent upon proper alignment, which has been improved with the advent of robotic-assisted surgery (r-UKA), but whether this outweighs the increased cost of the robotic-assist device has not been analyzed in the literature. The purpose of this study was to investigate the mid-term cost-effectiveness of r-UKA compared with UKA with traditional instrumentation (t-UKA) i...
Source: Journal of Knee Surgery - May 29, 2020 Category: Orthopaedics Authors: Yeroushalmi, David Feng, James Nherera, Leo Trueman, Paul Schwarzkopf, Ran Tags: Original Article Source Type: research

Journey around the Notch: A Systematic Review on the History of ACL Reconstruction in the United States
J Knee Surg DOI: 10.1055/s-0040-1712947The evolution of anterior cruciate ligament (ACL) surgery, seemingly circular at times, informs and provides context for past and current controversies in ACL management. The purpose of this systematic review is to objectively summarize the historical course of ACL reconstruction and repair in the United States over the last 40 years. Femoral tunnel drilling and graft selection have evolved dramatically over the last few decades. An initial focus on restoring ACL anatomy was for a period sacrificed for decreased operative morbidity. However, recent developments in operative techniques...
Source: Journal of Knee Surgery - May 29, 2020 Category: Orthopaedics Authors: White, Alex E. Van Nest, Duncan Tjoumakaris, Fotios P. Freedman, Kevin B. Tags: Original Article Source Type: research

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016
J Knee Surg DOI: 10.1055/s-0040-1712946Management of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon “gold-standard” management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416,...
Source: Journal of Knee Surgery - May 29, 2020 Category: Orthopaedics Authors: DeFroda, Steven F. Bokshan, Steven L. Yang, Daniel S. Daniels, Alan H. Owens, Brett D. Tags: Original Article Source Type: research

Concept Verification of a Remote Automatic Scoring System for Evaluating Knee Function after Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1710568The Knee Society Score (KSS) is the most commonly used scale for evaluating postoperative pain and physical function after total knee arthroplasty (TKA). However, this scale requires clinic visiting, which is not quite convenient. Our concept verification study demonstrated a remote automatic system for evaluating knee function after TKA using the KSS. The remote scoring system consists of two modules for data acquisition, an application for patients, a cloud server, and an application for doctors. The kinematic data are collected by the data acquisition modules and transmitted to the...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: Zhang, Haohua Zhou, Yixin Tags: Original Article Source Type: research

Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials
J Knee Surg DOI: 10.1055/s-0040-1710373Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Coc...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: Sun, Changjiao Chen, Lianxu Du, Ruiyong Wu, Sha Ma, Qi Cai, Xu Tags: Original Article Source Type: research

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?
J Knee Surg DOI: 10.1055/s-0040-1710362Soft tissue balancing, while accepted as crucial to total knee arthroplasty (TKA) outcomes, is incompletely defined as the subject of broad recommendations. We analyzed 120 computer-assisted, posterior stabilized TKA undertaken for osteoarthritis. Coronal plane laxity was measured, in the 91 varus and 29 valgus knees, prior to any bone resection or soft tissue release, and again after implant insertion. Soft tissue laxity parameters were correlated to the American Knee Society Score (2011) at a minimum follow-up of 12 months with a focus on patient function and satisfaction. Thirteen ...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: McAuliffe, Michael O'Connor, Patrick Major, Lisa Garg, Gautam Whitehouse, Sarah L. Crawford, Ross Tags: Original Article Source Type: research

Impact of Parkinson's Disease on Complications, Readmission Rates, and Costs of Care following Primary Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1710546Large-scale studies evaluating the effects of Parkinson's disease (PD) on primary total knee arthroplasty (TKA) are limited. The purpose of this study was to determine if PD patients undergoing primary TKA have increased: (1) medical complications; (2) implant-related complications; (3) readmission rates; and (4) costs. A query was performed using an administrative claims database. The study group consisted of all patients undergoing primary TKA who had a history of PD. Matched non-PD patients undergoing primary TKA served as a control group. The query yielded 72,326 patients (PD&thin...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: Marchand, Kevin B. Vakharia, Rushabh Sodhi, Nipun Anis, Hiba Salem, Hytham S. Scuderi, Giles R. Mont, Michael A. Roche, Martin William Tags: Original Article Source Type: research

The Impact of the Ligamentous Injury Pattern and Associated Neurovascular Injury on Ultimate Knee Function in Patients with Traumatic Knee Dislocations
J Knee Surg DOI: 10.1055/s-0040-1710368The present study aims to investigate whether there is a relationship between the ligamentous injury pattern and concomitant neurovascular injury with long-term functional outcomes in patients with traumatic knee dislocations (TKDs). A total of 42 patients with TKDs were categorized according to the Schenck's classification based on the pattern of ligamentous injury. Concomitant vascular and neural injuries were recorded. Long-term functional outcomes were assessed using several objective and subjective outcome measures. This retrospective study was conducted in two phases: (1) to ana...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: Kilicoglu, Onder I. Pehlivanoglu, Tuna Demirel, Mehmet Chodza, Mechmet Balc ı, Halil I. As ık, Mehmet Tags: Original Article Source Type: research

Total Knee Arthroplasty in Patients with Dementia
J Knee Surg DOI: 10.1055/s-0040-1712086There are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p  ≤  0.05). Two-year complications in patien...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: Hernandez, Nicholas M. Cunningham, Daniel J. Jiranek, William A. Bolognesi, Michael P. Seyler, Thorsten M. Tags: Original Article Source Type: research

Intraoperative Proximal Tibia Periprosthetic Fractures in Primary Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0040-1708037Intraoperative fracture of the proximal tibia is a rare complication of total knee arthroplasty (TKA) with few studies available reporting risk factors or prognosis. A review of our prospective joint registry was performed to determine the incidence and associated risk factors of intraoperative tibia fractures during primary TKA; 14,966 TKAs of all manufacturers were performed with 9 intraoperative tibia fractures. All fractures occurred in a single TKA design. There were 8,155 TKAs of this design performed with a fracture incidence of 0.110%. All but one fracture occurred on the medi...
Source: Journal of Knee Surgery - May 27, 2020 Category: Orthopaedics Authors: Damsgaard, Christopher W. Gad, Bishoy V. Bono, Olivia J. Anderson, Marie C. Brown, Jonathon M. Bono, James V. Talmo, Carl T. Tags: Original Article Source Type: research