Revision Multiligament Knee Reconstruction Surgery
J Knee Surg DOI: 10.1055/s-0039-3402791Failed multiligament knee reconstruction is a challenging problem due to recurrent pathologic laxity that is often associated with limb malalignment, meniscus deficiency, articular cartilage insufficiency, decreased motion, compromised bone stock, and a paucity of graft sources. Revision surgical indications and techniques require a comprehensive evaluation of the patient, injury and treatment factors along with a focused physical examination and advanced imaging. A stepwise treatment approach can be effective in the evaluation of revision surgery and also in setting realistic patient...
Source: Journal of Knee Surgery - January 2, 2020 Category: Orthopaedics Authors: Stuart, Michael B. Woodmass, Jarret M. Krych, Aaron J. Levy, Bruce A. Stuart, Michael J. Tags: Special Focus Section Source Type: research

Comparison of the Kirschner Wire Tension Band with a Novel Nickel –Titanium Arched Shape–Memory Alloy Connector in Transverse Patellar Fractures: A Retrospective Study
This study aims to compare the clinical outcomes of the nickel–titanium arched shape–memory alloy connector (hereafter referred to as the ASC) and tension band fixation for the treatment of transverse patellar fractures. We retrospectively analyzed a total of 257 patients with transverse patellar fractures who were treated at our emergency orthopaedics department from March 2010 to March 2017. Either an ASC or the Kirschner wire (K-wire) tension band had been used to treat these fractures according to surgeons' experience and preference. We compared operative details, postoperative recovery, and postoperative k...
Source: Journal of Knee Surgery - January 2, 2020 Category: Orthopaedics Authors: Wang, Yang Xia, Demeng Luo, Xi Zhang, Hongyue Wu, Jianghong Zhou, Panyu Xu, Shuogui Tags: Original Article Source Type: research

Insulin-Dependence Predicts Surgical Complications and Hospital Admission Following Knee Arthroscopy
J Knee Surg DOI: 10.1055/s-0039-3402803While prior studies have demonstrated that insulin-dependence is an independent risk factor for postoperative complications, morbidity, and mortality following spine and shoulder, hip, and knee arthroplasty, it has not been evaluated in the setting of knee arthroscopy. Therefore, the purpose of this study is to compare the risk of postoperative complications among patients with insulin-dependent diabetes mellitus and noninsulin-dependent diabetes mellitus (IDDM and NIDDM respectively) with the general population following knee arthroscopy. A retrospective analysis of the National Surg...
Source: Journal of Knee Surgery - January 2, 2020 Category: Orthopaedics Authors: Traven, Sophia A. Reeves, Russell A. Walton, Zeke J. Woolf, Shane K. Slone, Harris S. Tags: Original Article Source Type: research

Accelerometer-Based Portable Navigation System Is Useful for Tibial Bone Cutting in Modified Kinematically Aligned Total Knee Arthroplasty
This study compares an accelerometer-based portable navigation system with a conventional navigation system on tibial bone resection and clinical outcomes in KA-TKA. This study included 60 knees of patients who underwent primary KA-TKA between May 2015 and September 2017. They were randomly assigned to the OrthoPilot and iASSIST groups. A tibial bone cut was performed with 3 degree varus and 7 degree posterior slope in relation to the mechanical axis in all cases. The tibial component angle (TCA) and posterior slope angle (PSA) were evaluated by postoperative radiography, and those that deviated more than 2 degree were set...
Source: Journal of Knee Surgery - December 31, 2019 Category: Orthopaedics Authors: Tsubosaka, Masanori Kamenaga, Tomoyuki Kuroda, Yuichi Takayama, Koji Hashimoto, Shingo Ishida, Kazunati Hayashi, Shinya Kuroda, Ryosuke Matsumoto, Tomoyuki Tags: Original Article Source Type: research

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis
J Knee Surg DOI: 10.1055/s-0039-3402482Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met in...
Source: Journal of Knee Surgery - December 31, 2019 Category: Orthopaedics Authors: Sundaram, Kavin Arnold, Nicholas R. Mont, Michael A. Sodhi, Nipun Warren, Jared Kamath, Atul F. Piuzzi, Nicolas S. Tags: Original Article Source Type: research

Gait Analysis 1 Year after Primary TKA: No Difference between Gap Balancing and Measured Resection Technique
J Knee Surg DOI: 10.1055/s-0039-3402079Mechanical alignment in total knee arthroplasty (TKA) can be achieved using dependent bone cuts. The hypothesis is that patients have a better balanced TKA, as a result. The aim of this study was to determine if this technique is superior to an independent bone cut technique in terms of gait parameters, patient-reported outcome measures (PROMs), and satisfaction assessed before surgery and at 1-year follow-up. A total of 58 patients were evaluated before and 1 year following TKA, using the Press Fit Condylar (PFC) Sigma posterior stabilizer (PS) design; 39 (70 ± 8...
Source: Journal of Knee Surgery - December 31, 2019 Category: Orthopaedics Authors: Miozzari, Hermes H. Armand, St éphane Turcot, Katia L übbeke, Anne Bonnefoy-Mazure, Alice Tags: Original Article Source Type: research

Minimally Invasive Inlay Prosthesis Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Prospective Observational Cohort Study with Minimum 2-Year Outcomes and up to 14-Year Survival
J Knee Surg DOI: 10.1055/s-0039-3400536There are limited medium-term outcome data available for the Repicci II device in unicompartmental knee arthroplasty (UKA). The purpose of this study was to report the medium-term (minimum 2 years) patient-reported outcomes and long-term (up to 14 years) procedure survival in a consecutive series of patients undergoing an inlay prosthesis UKA (Repicci II) at an independent orthopaedic clinic. Patients presenting with medially localized unicompartmental knee osteoarthritis and meeting the criteria appropriate for UKA were recruited to a clinical patient registry at the time of presenta...
Source: Journal of Knee Surgery - December 30, 2019 Category: Orthopaedics Authors: Scholes, Corey Ebrahimi, Milad Field, Clarice Farah, Sami Kerr, Dennis Kohan, Lawrence Tags: Original Article Source Type: research

Risk Factors for Requiring a Revision Anterior Cruciate Ligament Reconstruction: A Case-Control Study
J Knee Surg DOI: 10.1055/s-0039-3402075Anterior cruciate ligament (ACL) reconstruction is considered as a successful orthopaedic procedure that attempts to help patients return to their preinjury level of activity. However, some patients may need to undergo revision surgery, and this potentially may be associated with certain surgery-specific or patient risk factors. Therefore, the purpose of this study was to assess the potential role of (1) demographics, (2) family history, (3) graft choice, (4) sport, and (5) mechanism of injury (contact vs. noncontact) in the risk for needing a revision ACL for improved clinical outcom...
Source: Journal of Knee Surgery - December 30, 2019 Category: Orthopaedics Authors: Pierce, Todd P. Kurowicki, Jennifer Kelly, John J. Issa, Kimona Festa, Anthony McInerney, Vincent K. Scillia, Anthony J. Tags: Original Article Source Type: research

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-3402044Since a hindfoot alignment is not included in the conventional mechanical axis (hip–ankle [HA] line), a mechanical axis including the calcaneus (hip–calcaneus [HC] line) has recently attracted attention as an alternative weight-bearing line. However, there are few reports on unicompartmental knee arthroplasty (UKA) regarding the HC line. Therefore, this study aimed to compare postoperative alignments after UKA between the HA line and the HC line. Postoperatively, HC radiographs were taken in 88 consecutive patients who underwent medial UKA. The hip–knee–ankle (...
Source: Journal of Knee Surgery - December 30, 2019 Category: Orthopaedics Authors: Kuroda, Yuichi Takayama, Koji Ishida, Kazunari Hayashi, Shinya Hashimoto, Shingo Tsubosaka, Masanori Kamenaga, Tomoyuki Matsushita, Takehiko Niikura, Takahiro Kuroda, Ryosuke Matsumoto, Tomoyuki Tags: Original Article Source Type: research

Appropriate Timing for Evaluation of the Short-Term Effectiveness of Unicompartmental Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-3402480Satisfactory results have been achieved with unicompartmental knee arthroplasty (UKA) for the treatment of isolated unicompartmental knee disease. However, UKA is associated with a significantly higher rate of revision. There is a tendency toward early revision of UKA for persistent pain because surgeons are not aware that outcomes can spontaneously improve with time. The aim of this study was to identify the time period that patients achieved the highest clinical outcomes following UKA. In total, we examined 72 knees that underwent Oxford UKA. We evaluated the range of motion and cli...
Source: Journal of Knee Surgery - December 30, 2019 Category: Orthopaedics Authors: Inui, Hiroshi Taketomi, Shuji Yamagami, Ryota Kono, Kenichi Kawaguchi, Kohei Nakazato, Keiu Takagi, Kentarou Kage, Tomofumi Tanaka, Sakae Tags: Original Article Source Type: research

Preoperative Performance of Patient-Reported Outcomes Measurement Information System in Patients with Meniscal Root Tears
J Knee Surg DOI: 10.1055/s-0039-3402076The purpose of this study was to establish preoperative validity of the Patient-Reported Outcomes Measurement Information System physical function computer adaptive test (PROMIS PF-CT) with legacy patient-reported outcome measures (PROMs) for meniscal root tears (MRTs). Our study included 51 patients (52 knees) with MRT. Patients completed PROMIS PF-CT, Short Form 36 (SF-36 physical function, pain, general health, vitality, social function, emotional well-being, role limitations due to physical health, and role limitations due to emotional problems), Knee Injury and Osteoarthritis Out...
Source: Journal of Knee Surgery - December 30, 2019 Category: Orthopaedics Authors: Gulbrandsen, Trevor R. Khazi, Zain M. Bollier, Matthew Wolf, Brian Larson, Christopher Duchman, Kyle An, Qiang Westermann, Robert W. Tags: Original Article Source Type: research

Local Vancomycin Concentrations after Intra-articular Injection into the Knee Joint: An Experimental Porcine Study
J Knee Surg DOI: 10.1055/s-0039-3402078Intra-articular injection of vancomycin may be an important antimicrobial prophylactic supplement to systemic administration in the prevention of prosthetic joint infections. In eight female pigs, 500 mg of diluted vancomycin was given by intra-articular injection into the knee joint. Microdialysis was used for dense sampling of vancomycin concentrations over 12 hours in the synovial fluid of the knee joint, and in the adjacent femoral and tibial cancellous bone and subcutaneous tissue. Venous blood samples were obtained as reference. The mean (standard deviation [SD]) p...
Source: Journal of Knee Surgery - December 30, 2019 Category: Orthopaedics Authors: Bue, Mats Thomassen, Maja B. Larsen, Ole H. J ørgensen, Andrea R. Stilling, Maiken S øballe, Kjeld Hanberg, Pelle Tags: Original Article Source Type: research

Neurologic Assessment and Management of the Multiple Ligament Injured Knee: A Review and Synthesis of Current Evidence
This article provides an overview of relevant injury demographics, anatomy, diagnosis, and prognosis, and suggests a treatment algorithm for nerve injury associated with multiligament knee injury. [...] 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 24, 2019 Category: Orthopaedics Authors: Hoit, Graeme Farag, Jordan Whelan, Daniel B. Tags: Special Focus Section Source Type: research

Factors Associated with Knee Arthroplasty in a Knee Osteoarthritis Patient Cohort Treated with Intra-articular Injections of Hylan G-F 20
This study evaluated time to knee arthroplasty (KA), KA risk factors, and health care resource utilization in patients aged ≥18 years with claims in the Optum Clinformatics Data Mart database (2006–2016) for knee osteoarthritis treated with at least one course of hylan G-F 20. Kaplan–Meier analysis estimated KA risk from osteoarthritis diagnosis and first hylan G-F 20 treatment. KA risk factors were determined using multivariate Cox regression. Among 62,033 patients treated with hylan G-F 20 and/or hylan G-F 20 single intra-articular injection, 60 to 64% did not undergo KA 8 years following first injection. ...
Source: Journal of Knee Surgery - December 24, 2019 Category: Orthopaedics Authors: Ong, Kevin Lau, Edmund Runa, Maria Daley, William Altman, Roy Tags: Original Article Source Type: research

Is there a Threshold Preoperative WOMAC Score That Predicts Patient Satisfaction after Total Knee Arthroplasty?
J Knee Surg DOI: 10.1055/s-0039-3401826The aim of this study was to identify threshold preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores that were predictive of patient dissatisfaction 1 year after total knee arthroplasty (TKA). A retrospective cohort of 3,324 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, comorbidities, and the WOMAC score were collected preoperatively. Patient satisfaction was assessed at 1 year using four questions that focused on: overall outcome, activity, work, and pain. Receiver operating char...
Source: Journal of Knee Surgery - December 12, 2019 Category: Orthopaedics Authors: Clement, Nicholas D. Weir, David J. Holland, James Deehan, David J. Tags: Original Article Source Type: research

The Effects of Patient Occupation, Hobbies, and Body Mass Index on Kneeling after Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-3400740A common patient concern after total knee arthroplasty (TKA) is the ability to kneel. Kneeling may have a substantial impact on the patients' ability to perform many activities of daily living, occupations, and hobbies. The purpose of this study was to quantify the percentage of patients able to kneel after TKA after 2 years and to evaluate preoperative patient characteristics that influence the patient's perceived ability to kneel after TKA such as obesity, occupation, and hobbies. We retrospectively assessed a cohort of 404 patients who underwent primary TKA with patellar resurfacin...
Source: Journal of Knee Surgery - December 9, 2019 Category: Orthopaedics Authors: Sabeh, Karim G. Hernandez, Victor H. Cohen-Levy, Wayne B. Ong, Alvin Orozco, Fabio Bennett, Veronica Post, Zachary Tags: Original Article Source Type: research

Long-Term Results of ACL Reconstruction Using a Nonanatomic Double-Bundle Technique with Extra-Articular Reinforcement
J Knee Surg DOI: 10.1055/s-0039-1700575Extra-articular procedures for the improvement in rotational stability after anterior cruciate ligament (ACL) reconstruction have gained popularity in the last decade. This surgical gesture hoped to improve resistance to the high tensional forces affecting the ACL graft during cutting and pivoting movements of the lower extremity and eventually prevent ACL reconstruction failure. We performed this study to analyze the long-term results of patients undergoing ACL reconstruction using a nonanatomic double-bundle technique with an additional extra-articular augmentation. All the cases th...
Source: Journal of Knee Surgery - December 9, 2019 Category: Orthopaedics Authors: Dalla-Rosa, J. Espejo-Reina, A. Tamimi, I. Espejo-Reina, M. J. Lombardo-Torre, M. Espejo-Baena, A. Tags: Original Article Source Type: research

ACL Reconstruction in the Multiple Ligament Injured Knee
We present a summary of the current knowledge with respect to the treatment of ACL injuries in the context of the multiple ligament injured knee. [...] 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 3, 2019 Category: Orthopaedics Authors: Marx, Robert G. Wolfe, Isabel A. Tags: Special Focus Section Source Type: research

Extended Oral Antibiotics and Infection Prophylaxis after a Primary or Revision Total Knee Arthroplasty
This article reviews the use and attributes of commonly used oral antibiotics, especially extended or long-term utilization, as prophylaxis and treatment for prosthetic joint infections in a primary or revision total knee arthroplasty, which include debridement, antibiotics, and implant retention, one-stage and two-stage exchange arthroplasty. [...] 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 3, 2019 Category: Orthopaedics Authors: Hong, Cierra S. Black, Collin S. Ryan, Sean P. Seyler, Thorsten M. Tags: Special Focus Section Source Type: research

Intraoperative Conversion to Five-Strand Hamstring Autograft Configuration Significantly Increases Anterior Cruciate Ligament Graft Diameter Independent of Patient Characteristics
J Knee Surg DOI: 10.1055/s-0039-3400955Intraoperative conversion of a four-strand hamstring autograft to a five-strand configuration during an anterior cruciate ligament (ACL) reconstruction has been reported. However, the expected change in graft size and the dependence on patient characteristics are currently not well described. The purpose of this study was to determine the effective change in hamstring graft diameter and reliance on patient characteristics when intraoperatively converting a four-strand hamstring autograft into a five-strand configuration during an ACL reconstruction. A prospective, paired cohort study ...
Source: Journal of Knee Surgery - December 3, 2019 Category: Orthopaedics Authors: Walczak, Brian E. Hetzel, Scott J. Akoh, Craig Chike Baer, Geoffrey S. Tags: Original Article Source Type: research

Aseptic Revision Total Knee Can Be Performed as Part of a Short-Stay Arthroplasty Program: An Analysis of the National Surgical Quality Improvement Program Database
This study aims to determine the effect of rapid discharge at 0- to 2-day postoperative stay compared to the conventional 3- to 4-day postoperative stay on postdischarge complications in patients undergoing revision TKA. A retrospective cohort study was conducted using data collected through the American College of Surgeons National Quality Improvement Program Database. All patients who underwent aseptic revision TKA between 2005 and 2016 were identified and stratified into groups based on length of stay: 0 to 2 days versus 3 to 4 days. Patients suffering from predischarge complications were excluded to minimize bias. Sing...
Source: Journal of Knee Surgery - December 3, 2019 Category: Orthopaedics Authors: Gu, Alex Gerhard, Eleanor F. Wei, Chapman Bovonratwet, Patawut Stake, Seth Sculco, Peter K. McLawhorn, Alexander S. Tags: Original Article Source Type: research

Operative Times in Primary Total Knee Arthroplasty: Can We Predict the Future Based on Contemporary Nationwide Data
J Knee Surg DOI: 10.1055/s-0039-3400949Recently, the Centers for Medicare & Medicaid Services announced its decision to review “potentially misvalued” Current Procedural Terminology (CPT) codes, including those for primary total knee arthroplasty (TKA). CPT 27447 is being reevaluated to determine contemporary relative value units for work value, with operative time considered a primary factor in this revaluation. Despite broader indications for TKA, including extension of the procedure to more complex patient populations, it is unknown whether operative times may remain stable in the future. Therefore, the ...
Source: Journal of Knee Surgery - November 28, 2019 Category: Orthopaedics Authors: Sultan, Assem A. Samuel, Linsen T. Karnuta, Jaret M. Acu ña, Alexander J. Mahmood, Mustafa Kamath, Atul F. Tags: Original Article Source Type: research

Opioid Requirement following Arthroscopic Knee Surgery: Are There Predictive Factors Associated with Long-Term Use
J Knee Surg DOI: 10.1055/s-0039-3400754The purpose of this study is to identify patterns of postoperative narcotic use and determine the impact of psychosocial and perioperative factors on postoperative opioid consumption following arthroscopic knee surgery. Fifty consecutive patients undergoing arthroscopic knee surgery were prospectively enrolled. Patients were contacted via telephone at 1 week postoperatively to report their pain level and opioid consumption. The patient was contacted again at 2 weeks, 4 weeks, and 90 days as necessary until opioid cessation, at which time the patient's plan for unused pills was inquire...
Source: Journal of Knee Surgery - November 28, 2019 Category: Orthopaedics Authors: Glogovac, Georgina Kennedy, Mark Parman, Michael D. Bowers, Katherine A. Colosimo, Angelo J. Grawe, Brian M. Tags: Original Article Source Type: research

Micronized Dehydrated Human Amnion Chorion Membrane Injection in the Treatment of Knee Osteoarthritis —A Large Retrospective Case Series
J Knee Surg DOI: 10.1055/s-0039-3400951Osteoarthritis (OA) of the knee is a leading cause of chronic pain and disability in the United States. Current treatment options primarily target OA symptoms reserving surgical intervention and knee replacement for those who fail conservative measures. With average age of patients with knee OA decreasing, regenerative treatment approaches to reduce symptoms, increase quality of life, and delay the need for surgical intervention are increasingly sought. Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate m...
Source: Journal of Knee Surgery - November 28, 2019 Category: Orthopaedics Authors: Alden, Kris J. Harris, Stan Hubbs, Brandon Kot, Kimberly Istwan, Niki B. Mason, David Tags: Original Article Source Type: research

The Olerud Extensile Anterior Approach for Complex Distal Femoral Fractures: A Systematic Review
J Knee Surg DOI: 10.1055/s-0039-3400954The management of AO/OTA (AO Foundation/Orthopaedic Trauma Association) 33-C3 complex distal femoral fractures presents challenges for orthopaedic surgeons. The extensile anterior approach may be an appropriate alternative treatment technique. The purpose of this systematic review is to (1) evaluate the Olerud approach (extensile anterior approach) for the treatment of 33-C3 complex distal femoral fractures and (2) evaluate postoperative patient outcomes. A systematic literature search was performed to retrieve studies that evaluated the treatment of 33-C3 complex distal femoral fract...
Source: Journal of Knee Surgery - November 27, 2019 Category: Orthopaedics Authors: Khlopas, Anton Samuel, Linsen T. Sultan, Assem A. Yao, Benjamin Billow, Damien G. Kamath, Atul F. Tags: Original Article Source Type: research

Multiple ACL Revision: Failure Analysis and Clinical Outcomes
J Knee Surg DOI: 10.1055/s-0039-3400741Anterior cruciate ligament (ACL) reconstruction represents one of the most successful orthopedic surgical procedures. Nevertheless, ACL revisions are still very frequent, with a small but relevant number of failures. The purpose of this study is to analyze the failure causes and the clinical outcomes of patients who underwent a re-revision ACL reconstruction. Between January 2009 and December 2017, 263 ACL revisions were performed by a single senior surgeon. Seventeen patients (12 males and 5 females) underwent re-revision ACL reconstruction meeting the inclusion criteria. The mean ag...
Source: Journal of Knee Surgery - November 27, 2019 Category: Orthopaedics Authors: Dini, Francesco Tecame, Andrea Ampollini, Aldo Adravanti, Paolo Tags: Original Article Source Type: research

Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles
J Knee Surg DOI: 10.1055/s-0039-3400742Knee osteotomies show efficacy in slowing knee osteoarthritis progression and delaying the need for total knee arthroplasty in younger patients. Despite evolutions in indications, techniques, and hardware that have improved outcomes, longitudinal trends demonstrate a decline in high tibial osteotomy (HTO) and distal femoral osteotomy (DFO) use. Unfortunately, knowledge of the current usage and complications associated with HTO and DFO is limited. The purpose of this study was to compare the preoperative demographics and early complication rates of HTO and DFO. We analyzed the HTOs and...
Source: Journal of Knee Surgery - November 27, 2019 Category: Orthopaedics Authors: Delva, Mona Lisa Samuel, Linsen T. Roth, Alexander Yal çin, Sercan Kamath, Atul F. Tags: Original Article Source Type: research

The Irreducible Knee Dislocation
This article sheds light on previous case reports and describes how to identify irreducible knee dislocations and provides an algorithm on how to manage ligament injuries in posterolateral dislocations. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - November 22, 2019 Category: Orthopaedics Authors: Malik, Shahbaz S. MacDonald, Peter B. Tags: Special Focus Section Source Type: research

Patellofemoral Chondromalacia Does Not Influence Radiographic and Clinical Outcomes following High Tibial Osteotomy
J Knee Surg DOI: 10.1055/s-0039-3400492Effect of patellofemoral (PF) chondromalacia on results of high tibial osteotomy (HTO) has not been identified. Therefore, the objective of the present study was to analyze the effect of PF chondromalacia on relatively short-term radiographic and clinical outcomes of HTO. Patients who underwent open wedge HTO (OWHTO) from February 2010 to January 2015 were enrolled. A total of 101 knees were divided into two groups: 56 knees without PF chondromalacia in group A, while 45 knees with PF chondromalacia extended to subchondral bone in group B. Radiologic outcomes were compared using mecha...
Source: Journal of Knee Surgery - November 21, 2019 Category: Orthopaedics Authors: Kim, You Keun Yoo, Jae Doo Oh, Minjoon Cho, Euihwan Kim, Nam Ki Tags: Original Article Source Type: research

Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function
This study comprised of 12 patients whose knees were evaluated with standard radiographs and MRI to identify and localize the bone marrow lesions. They then underwent subchondroplasty under intraoperative radiographic guidance. Preoperative and postoperative visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Knee Injury and Arthritis Outcome Scores (KOOS) were obtained. VAS scores improved significantly from 7.5 ± 1.8 before surgery to 5.2 ± 2.7 after surgery. This further improved to 2.1 ± ...
Source: Journal of Knee Surgery - November 21, 2019 Category: Orthopaedics Authors: Chua, Kenon Kang, Joseph Yida Benjamin Ng, Favian Ding Jie Pang, Hee Nee Lie, Denny Tjiauw Tjoen Silva, Amila Chang, Paul Chee Cheng Tags: Original Article Source Type: research

Improved Patient Satisfaction Following Robotic-Assisted Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1700837Approximately 20% of the patients are dissatisfied with their total knee arthroplasty (TKA). Computer technology has been introduced for TKA to provide real time intraoperative information on limb alignment and exact flexion/extension gap measurements. The purpose of this study was to determine if patient satisfaction could be improved with the use of robotic-assisted (RA) technology following primary TKA. A total of 120 consecutive patients undergoing RA-TKA with real time intraoperative alignment and gap balancing information were compared with a prospective cohort of 103 consecutiv...
Source: Journal of Knee Surgery - November 15, 2019 Category: Orthopaedics Authors: Smith, Austin F. Eccles, Christian J. Bhimani, Samrath J. Denehy, Kevin M. Bhimani, Rohat B. Smith, Langan S. Malkani, Arthur L. Tags: Original Article Source Type: research

One Versus Two Doses of Intravenous Tranexamic Acid in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1700805Tranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary ...
Source: Journal of Knee Surgery - November 15, 2019 Category: Orthopaedics Authors: Charette, Ryan S. Bernstein, Jenna A. Sloan, Matthew Nchako, Corbyn M. Kamath, Atul F. Nelson, Charles L. Tags: Original Article Source Type: research

Factors Affecting Hospital Length of Stay following Total Knee Replacement: A Retrospective Analysis in a Regional Hospital
J Knee Surg DOI: 10.1055/s-0039-1698818In an effort to reduce hospital length of stay (LoS) following total knee arthroplasty (TKA), patient management strategies have evolved over time. The aims of this study were threefold: first, to quantify the reduction in LoS for TKA in a regional hospital; second, to identify the patient, surgical and management factors associated with hospital LoS; and lastly, to assess the change in complications incidence and hospital readmission as a function of LoS. A retrospective chart review was conducted on a consecutive series of primary and revision TKAs from January 2012 to March 2018. F...
Source: Journal of Knee Surgery - November 7, 2019 Category: Orthopaedics Authors: Scholes, Corey Cowley, MacDougal Ebrahimi, Milad Genon, Michel Martin, Samuel J. Tags: Original Article Source Type: research

Agreement and Reliability of Lateral Patellar Tilt and Displacement following Total Knee Arthroplasty with Patellar Resurfacing
This study evaluated the range and reliability of lateral patellar tilt and lateral patellar displacement following total knee arthroplasty (TKA) with a resurfaced patella among three observers on 45° Merchant view in 139 TKAs. Intraclass correlation coefficient (ICCs) were used to evaluate intraobserver agreement (IOA) and inter-rater reliability (IRR). IRR was high between each of the observers for lateral patellar tilt (ICC = 0.8) and lateral patellar displacement (ICC = 0.87). IOA was also high upon repeat measurement for the same observer for lateral patellar tilt (ICC ≥&thins...
Source: Journal of Knee Surgery - November 7, 2019 Category: Orthopaedics Authors: Kleimeyer, John P. McQuillan, Thomas J. Arsoy, Diren Aggarwal, Vinay K. Amanatullah, Derek F. Tags: Original Article Source Type: research

The Association of International Normalized Ratio with Postoperative Complications in Revision Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1700841The purpose of this study was to examine the relationship between elevated preoperative international normalized ratio (INR) and (1) mortality, (2) postoperative bleeding, and (3) other postoperative complications in a national cohort of patients who underwent revision total knee arthroplasty (rTKA). The American College of Surgeons National Surgical Quality Improvement Program was queried for rTKA procedures conducted between 2006 and 2017. Cohorts were based on INR ranges:
Source: Journal of Knee Surgery - November 7, 2019 Category: Orthopaedics Authors: Churchill, Jessica L. Samuel, Linsen T. Karnuta, J. M. Acu ña, Alexander J. Kamath, Atul F. Tags: Original Article Source Type: research

Femoral Trochlear Geometry in Patients with Trochlear Dysplasia Using MRI Oblique Trochlear View
The objective of this study was to evaluate trochlear morphology in patients with trochlear dysplasia using a new oblique trochlear magnetic resonance imaging (MRI) view (OTV) in comparison with standard axial MRI sequences. MRI exam of 73 patients with patellofemoral instability (PFI) and the same number of controls were retrospectively reviewed. The oblique trochlear sequence was acquired by inclining the axial plane parallel to the intercondylar roof of the sagittal image, showing the anterior cruciate ligament (ACL) in its entire length. Trochlear morphology was assessed on axial and oblique trochlear sequences at thre...
Source: Journal of Knee Surgery - November 7, 2019 Category: Orthopaedics Authors: Ambra, Luiz Felipe Galv ão, Pedro Henrique Schmidt Alves Ferreira Mameri, Enzo Salviatto Farr, Jack Gomoll, Andreas H. Tags: Original Article Source Type: research

Accuracy of Bone Resection in MAKO Total Knee Robotic-Assisted Surgery
J Knee Surg DOI: 10.1055/s-0039-1700570Accurate component positioning and planning is vital to prevent malalignment of total knee arthroplasty (TKA) as malalignment is associated with an increased rate of polyethylene wear and revision arthroplasty. The MAKO total knee robotic arm-assisted surgery (Stryker, Kalamazoo, MI) uses a preoperative computed tomography scan of the patient's knee and three-dimensional planning to size and orientate implants prior to bone resection. The aim of this study was to determine the accuracy of the MAKO Total Knee system in achieving the preoperative plan for bone resection and final limb c...
Source: Journal of Knee Surgery - November 6, 2019 Category: Orthopaedics Authors: Sires, James D. Craik, Johnathan D. Wilson, Christopher J. Tags: Original Article Source Type: research

Chronological Changes in Anterior Knee Stability after Anatomical Anterior Cruciate Ligament Reconstruction Using Bone –Patellar Tendon–Bone and Hamstring Grafts
This study aimed to characterize the chronological changes in anterior knee stability after anatomical ACL reconstruction and to compare the anterior knee stability achieved with bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) grafts. A total of 59 patients underwent anatomical rectangular tunnel ACL reconstruction using the BPTB graft and 23 patients underwent anatomical double-bundle ACL reconstruction using the HT graft. Anterior knee stability was quantitatively assessed using the KneeLax 3 arthrometer at 6 months, 1 year, and 2 years after surgery using side-to-side differences. The values for a...
Source: Journal of Knee Surgery - November 6, 2019 Category: Orthopaedics Authors: Kawaguchi, Kohei Taketomi, Shuji Inui, Hiroshi Yamagami, Ryota Nakazato, Keiu Takagi, Kentaro Kage, Tomofumi Kawata, Manabu Tanaka, Sakae Tags: Original Article Source Type: research

Timing of Repair or Reconstruction after Knee Dislocation
This article will present the author's approach and experience in the initial assessment and treatment of the acute multiple ligament injured (dislocated) knee, and also present considerations in the treatment of chronic multiple ligament injured knee. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Fanelli, Gregory C. Tags: Special Focus Section Source Type: research

Removal of Well-Fixed Tibial Cone in Revision Total Knee Arthroplasty —A Uniquely Challenging Yet Necessary Scenario
J Knee Surg DOI: 10.1055/s-0039-1700572The number of revision total knee arthroplasties (TKA) performed in the United States continues to increase. While advancements in implant design and surgical technique have led to improved outcomes compared with historical data, these cases remain technically demanding with high rates of aseptic failure and worse patient reported outcome scores compared with primary total knee arthroplasty. One particular problem commonly encountered in revision knee arthroplasty is bone loss, particularly in the epiphyseal region, which negatively impacts the structural integrity of the implants. Va...
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Scully, William F. Deren, Matthew E. Sultan, Assem A. Samuel, Linsen T. Nageotte, William Molloy, Robert M. Krebs, Viktor E. Tags: Original Article Source Type: research

The Effects of Tensioning of the Anterior Cruciate Ligament Graft on Healing after Soft Tissue Reconstruction
In conclusion, we found that ACL graft–tunnel healing is sensitive to the magnitude of graft pretension at the time of surgery in a preclinical model of ACL reconstruction with joint immobilization. The combination of high-graft tension and immobilization is also deleterious for the articular surface. Further study is necessary to understand the interaction between the magnitude of graft tensioning and joint motion. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Ma, Richard Schaer, Michael Chen, Tina Nguyen, Joseph Voigt, Clifford Deng, Xiang-Hua Rodeo, Scott A. Tags: Original Article Source Type: research

Repair of Longitudinal Meniscal Tears by Single or Double Vertical Loop Sutures: In vitro Biomechanical Study under Cyclic Loading
J Knee Surg DOI: 10.1055/s-0039-1700571One of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to si...
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Kurnaz, Recep A şçı, Murat Erg ün, Selim Akg ün, Umut G üneş, Taner Tags: Original Article Source Type: research

Subvastus Exposure Compared to Parapatellar Approach in Navigated Sequential Bilateral Total Knee Arthroplasty (SBTKA): A Prospective Randomized Study
J Knee Surg DOI: 10.1055/s-0039-1700496Subvastus approach preserves the quadriceps mechanism and may lead to improved early functional outcomes as compared with a parapatellar approach in primary knee arthroplasty. We performed a prospective randomized study to test the hypothesis if subvastus approach improves patient- and physician-reported outcomes in navigated sequential bilateral knee arthroplasty when compared with the standard parapatellar approach. A total of 93 patients were allotted in each group after power analysis and randomization done by computer-generated sequence: group S by subvastus approach and control ...
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Jhurani, Anoop Agarwal, Piyush Aswal, Mukesh Rasquinha, Chetan Srivastava, Mudit Tags: Original Article Source Type: research

The Reliability of Classifying the Morphology of Anterior Cruciate Ligament Remnants during Surgery
In conclusion, the Crain classification of torn ACL remnant morphology has moderate interobserver reliability; however, a suggested classification with modified and additional configurations has almost perfect reliability and may be useful for studies on ACL repair and preservation. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Haviv, Barak Shemesh, Shai Kittani, Mohamed Yassin, Mustafa Yaari, Lee Tags: Original Article Source Type: research

Decreased Opioid Consumption and Length of Stay Using an IPACK and Adductor Canal Nerve Block Following Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1700840Peripheral nerve blocks such as a femoral + sciatic block have demonstrated significant pain relief following TKA. However, these nerve blocks have residual motor deficits which prevent immediate postoperative ambulation. The purpose of this study was to compare outcomes in patients undergoing primary TKA with femoral and sciatic (Fem + Sci) motor nerve blocks versus an adductor canal and the interspace between the popliteal artery and the capsule of the posterior knee and adductor canal block (IPACK + ACB) sensory nerve blocks. A total of 100...
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Eccles, Christian J. Swiergosz, Andrew M. Smith, Austin F. Bhimani, Samrath J. Smith, Langan S. Malkani, Arthur L. Tags: Original Article Source Type: research

Computer-Navigated versus Conventional Total Knee Arthroplasty: A Meta-Analysis of Functional Outcomes from Level I and II Randomized Controlled Trials
This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. All Level I and II randomized controlled trials (RCTs) in PubMed, EMBASE, and Cochrane that compared functional outcomes after NAV- and CON-TKA were included in the review. Selected end points for random effects, pairwise meta-analysis included Knee Society Knee Score (KSKS), KS Function Score (KSFS), KS Total Score (KSTS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion at three arbitrary follow-up times. ...
Source: Journal of Knee Surgery - November 4, 2019 Category: Orthopaedics Authors: Chin, Brian Zhaojie Seck, Victor Mun Hin Syn, Nicholas Li-Xun Wee, Ian Jun Yan Tan, Sharon Si Heng O ’Neill, Gavin Kane Tags: Original Article Source Type: research

Timely Topics for Today's Arthroplasty Surgeon
J Knee Surg 2019; 32: 1039-1039 DOI: 10.1055/s-0039-1698454 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 - November 4, 2019 Category: Orthopaedics Authors: Sodhi, Nipun Anis, Hiba K. Ehiorobo, Joseph O. Vakharia, Ajit M. Roche, Martin W. Mont, Michael A. Tags: Special Focus Section Source Type: research

Anthropometric Measures of the Posterior Condyles: Gender Differences and Correlation to Implant Sizing
The objectives of this study were to analyze the dimensions of posterior condylar bone resection from a group of patients undergoing TKA and correlate the measurements to one prosthetic system. We retrospectively reviewed single surgeon morphological data from the posterior condyles of 105 knees during TKA. The study included 54 males and 51 females. Measurement of the posterior condylar bones was performed with a standard metric metal ruler by one investigator. Known dimensions of a single type of implant design were compared with the resection data. The average difference of posterior medial and lateral condylar width wa...
Source: Journal of Knee Surgery - October 23, 2019 Category: Orthopaedics Authors: Ehmke, Thomas Aghazadeh, Mehran Bono, Olivia J. Robbins, Claire Bono, James V. Tags: Original Article Source Type: research

Manipulation under Anesthesia after Knee Arthroplasty Is Associated with Worse Long-Term Clinical Outcomes and Survivorship
J Knee Surg DOI: 10.1055/s-0039-1700569The literature is mixed on the long-term fate of knees that undergo manipulation under anesthesia (MUA). The purpose of this study is to evaluate the long-term outcomes and survivorship of patients who required a MUA after primary total knee arthroplasty (TKA) compared with a cohort of patients who did not undergo a MUA. Between 2003 and 2007, 2,193 patients (2,783 knees) underwent primary TKA with 2-year minimum follow-up; 182 knees (6.5%) had a MUA. Patients who had a manipulation were younger (p 
Source: Journal of Knee Surgery - October 23, 2019 Category: Orthopaedics Authors: Crawford, David A. Adams, Joanne B. Morris, Michael J. Berend, Keith R. Lombardi, Adolph V. Tags: Original Article Source Type: research

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting
This article will (1) provide an outline of the types of pain most often sustained in the multiligament knee injury, (2) outline the phases of pain management for this injury, and (3) provide an overview of persistent postoperative pain. The principles of multimodal analgesia in combination with effective regional anesthesia and attentive intraoperative management can position patients for successful rehabilitation and recovery. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source...
Source: Journal of Knee Surgery - October 22, 2019 Category: Orthopaedics Authors: Fanelli, David Gregory Vu, To-Nhu Tags: Special Focus Section Source Type: research