Are Readmissions After Total Knee Arthroplasty Preventable?
J Knee Surg DOI: 10.1055/s-0039-1683890Readmission within 90 days following total joint arthroplasty has become a central quality measure of reimbursement initiatives; however, the validity of readmission rates as a measure of hospital care quality and the proportion of readmissions that are preventable are unknown. The purpose of this study is to determine if readmissions within 30 and 90 days after total knee arthroplasty (TKA) were related to orthopaedic or medical etiology and identify if these readmissions were preventable. We retrospectively reviewed 1,625 elective TKAs performed between 2011 and 2014 at our institut...
Source: Journal of Knee Surgery - March 28, 2019 Category: Orthopaedics Authors: Su, Charles A. Copp, Jonathan A. Weinberg, Douglas S. Kraay, Matthew J. Fitzgerald, Steven J. Wera, Glenn D. Tags: Original Article Source Type: research

Osteomeniscal Impact Edema (OMIE): Description of a Distinct MRI Finding in Displaced Flap Tears of the Medial Meniscus, with Comparison to Posterior Root Tears
J Knee Surg DOI: 10.1055/s-0039-1683938Bone marrow edema (BME) can be a late finding in osteoarthritis or a sign of subchondral insufficiency. The purpose of this study was to describe the magnetic resonance imaging (MRI) finding we refer to as “osteomeniscal impact edema” (OMIE), or reactive BME adjacent to a displaced meniscus flap tear. In addition, this edema pattern is compared with a control group of medial meniscus posterior root tears (MMPRT) with subchondral insufficiency edema. MRI records from 2000 to 2017 were retrospectively reviewed for studies that showed the presence of a medial meniscus displac...
Source: Journal of Knee Surgery - March 28, 2019 Category: Orthopaedics Authors: Krych, Aaron J. Wu, Isabella T. Desai, Vishal S. Kennedy, Nicholas I. Littrell, Laurel A. Collins, Mark S. Saris, Dani ël B.F. Stuart, Michael J. Tags: Original Article Source Type: research

Nail –Plate Constructs for Periprosthetic Distal Femur Fractures
This article will give the rationale for the use of the NPC as well as a review of the current published literature reviewing its use. [...] 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 - March 27, 2019 Category: Orthopaedics Authors: Mirick Mueller, Gudrun E. Tags: Special Focus Section Source Type: research

A Modified Direct Posterior Midline Approach for the Treatment of Posterior Column Tibial Plateau Fractures
J Knee Surg DOI: 10.1055/s-0039-1683927The purpose of this study was to introduce a modified surgical approach for the treatment of posterior column tibial plateau fractures. Fifteen patients with posterior column fractures with or without other column fractures were included and treated with this approach between July 2015 and June 2016. The patients were followed up for 18 to 24 months (20.9 ± 1.8 months). Outcomes included neural or vascular injuries, wound complications, nonunion, plate loosening or breakage, and Hospital for Special Surgery (HSS) scores. Bone union was observed in all cases, and t...
Source: Journal of Knee Surgery - March 27, 2019 Category: Orthopaedics Authors: Yin, Zhaowei Yang, Wengbo Gu, Yanqing Gu, Qiangrong Xu, Chenyang Yang, Lei Jiang, Chunzhi Liang, Bin Tags: Original Article Source Type: research

Higher Function Scores and Satisfaction in Patients with Anteromedial Osteoarthritis Compared with Other Wear Patterns of the Knee: 2 Years after Both Total and Unicondylar Knee Arthroplasties
In conclusion, patients treated with TKA for AMOA showed better knee-specific function scores and satisfaction scores compared with patients treated with TKA for other wear patterns, and only slight differences were found between both the AMOA groups (TKA for AMOA and UKA). Thus, the radiologic assessment of wear patterns might be useful to take into account the shared decision-making process, when discussing expectations, timing, and outcomes with knee osteoarthritis patients considering knee arthroplasty. When AMOA is present, it might be beneficial to choose UKA over TKA. [...] Thieme Medical Publishers 333 Seventh Aven...
Source: Journal of Knee Surgery - March 27, 2019 Category: Orthopaedics Authors: Witjes, Suzanne Hoorntje, Alexander Koenraadt, Koen L. M. Kerkhoffs, Gino M. M. J. van Geenen, Rutger C. I. Tags: Original Article Source Type: research

Age-Related Variances in Patients with Tibial Plateau Fractures
J Knee Surg DOI: 10.1055/s-0039-1683893Tibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who ...
Source: Journal of Knee Surgery - March 27, 2019 Category: Orthopaedics Authors: Oladeji, Lasun O. Worley, John R. Crist, Brett D. Tags: Original Article Source Type: research

The “Diagonal” Lesion: A New Type of Combined Injury Pattern Involving the Impingement Fracture of Anteromedial Tibial Plateau and the Injury of Posterior Cruciate Ligament and Posterolateral Corner
In this study, the incidence of the “diagonal” lesions was 9.5%. Patients who had larger fracture size tended to develop subsequent varus deformity of the lower extremity. It was important for us to recognize the PCL/PLC injuries and to fully reduce the large bony fracture during the initial treatment of the “diagonal” lesions to prevent the residual instability and varus deformity. [...] 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 - March 27, 2019 Category: Orthopaedics Authors: Li, Xu Song, Guanyang Li, Yue Liu, Xin Zhang, Hui Feng, Hua Tags: Original Article Source Type: research

Approximately 30% of Functioning Anterior Cruciate Ligaments Are Sacrificed for Knee Arthroplasty
This study aims to evaluate how often functional ACLs are sacrificed in arthroplasty. The type of arthroplasty (TKA or UKA) and condition of the ACL were studied in a total of 1,586 knees in 1,052 patients who underwent knee arthroplasties. Of 1,586 knees, TKA was performed on 653 knees (41%) and UKA on 933 knees (59%). The ACL was functioning in 77% of all knees. Of the TKA knees, the ACL was functioning in 357 knees (55%). Of these, around 30% of the functioning ACLs were sacrificed to perform TKA. To improve postoperative patient satisfaction after knee arthroplasty, further study regarding relationship between ACL pres...
Source: Journal of Knee Surgery - March 25, 2019 Category: Orthopaedics Authors: Hiranaka, Takafumi Hida, Yuichi Fujishiro, Takaaki Kamenaga, Tomoyuki Kikuchi, Kenichi Yoshikawa, Ryo Tachibana, Shotaro Okamoto, Koji Tags: Original Article Source Type: research

Changes in Total Knee Arthroplasty Utilization since the Implementation of ACA: An Analysis of Patient –Hospital Demographics, Costs, and Charges
This study explores patient–hospital level demographics, inpatient costs, and charges related to TKA procedures between 2009 and 2015. The National Inpatient Sample database was utilized to identify patients who received primary TKA between January 2009 and October 2015 (4,283,387 cases). Categorical, continuous, and ordinal data were analyzed using chi-square/Fisher's exact test, t-test/analysis of variance, or Kruskal–Wallis' test, respectively. There was an increase in proportion of TKA recipients belonging to minority groups and the lowest quartile of median income (p 
Source: Journal of Knee Surgery - March 25, 2019 Category: Orthopaedics Authors: Gwam, Chukwuweike U. Mohamed, Nequesha S. Etcheson, Jennifer I. D ávila Castrodad, Iciar M. Mistry, Jaydev B. Recai, Thea M. Delanois, Ronald E. Tags: Original Article Source Type: research

Risk of Reinfection after Irrigation and Debridement of Acute Periprosthetic Joint Infection following TKA
J Knee Surg DOI: 10.1055/s-0039-1683920The purpose of this study was to determine the risk factors associated with reinfection in patients treated with irrigation and debridement (I&D) with liner exchange for an acute (less than 3 months) prosthetic joint infection following the index primary total knee arthroplasty (TKA). Medicare claims database was queried to identify patients with periprosthetic joint infection within 3 months of their index TKA who underwent I&D with tibial polyethylene liner exchange. Exclusion criteria included age 
Source: Journal of Knee Surgery - March 25, 2019 Category: Orthopaedics Authors: Baker, James F. Dilworth, Brian Bhimani, Samrath J. Ong, Kevin L. Lau, Edmund C. Smith, Langan S. Malkani, Arthur L. Tags: Original Article Source Type: research

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome
The objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was 
Source: Journal of Knee Surgery - March 15, 2019 Category: Orthopaedics Authors: Jingbo, Cheng Mingli, Feng Guanglei, Cao Zheng, Li Shuai, An Jiang, Huang Tags: Original Article Source Type: research

The Use of Stems for Morbid Obesity in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1681078Morbidly obese patients undergoing total knee arthroplasty have worse functional outcomes and implant survival, and increased revision rates compared with nonobese patients. In addition to increased medical comorbidities and difficult exposure, increased stress on the tibial implant and altered kinematics of knee motion contribute to aseptic loosening and medial collapse. Increased implant fixation, including use of a stemmed tibial implant, may be a way to help avoid these complications. While there is limited data on tibial stems in the morbidly obese patients specifically, cemented...
Source: Journal of Knee Surgery - March 12, 2019 Category: Orthopaedics Authors: Schultz, Blake J. DeBaun, Malcolm R. Huddleston, James I. Tags: Special Focus Section Source Type: research

Reliability of 3-m Backward Walk Test in Patients with Primary Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1681099The 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk, and balance. The aim of the present study was to determine the test–retest reliability of the 3MBWT in patients with primary total knee arthroplasty (TKA). Twenty-eight patients with primary TKA, operated by the same surgeon, were included in this study. Patients performed trials for 3MBWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The 3MBWT showed an excellent test&ndash...
Source: Journal of Knee Surgery - March 12, 2019 Category: Orthopaedics Authors: Unver, Bayram Sevik, Kevser Yarar, Haci Ahmet Unver, Fatma Karatosun, Vasfi Tags: Original Article Source Type: research

Opening-Wedge High Tibial Osteotomy Using Autograft versus Allograft: A Systematic Review and Meta-Analysis
J Knee Surg DOI: 10.1055/s-0039-1681065Bone grafting is a good alternative for filling the inevitable void that is created following opening-wedge high tibial osteotomy (OWHTO). This systematic review and meta-analysis evaluated whether bone grafting is necessary for OWHTO and the successful outcomes of OWHTO using either autograft (AU) or allograft (AL). All analyzed studies were acquired from PubMed, Medline, Embase, CNKI, Google Scholar, and Cochrane Library. Data were independently extracted by two coauthors and were analyzed using RevMan5.3. Mean differences, odds ratios, and 95% confidence intervals were calculated. ...
Source: Journal of Knee Surgery - March 12, 2019 Category: Orthopaedics Authors: Ren, Yi-Ming Duan, Yuan-Hui Sun, Yun-Bo Yang, Tao Hou, Wei-Yu Zhu, Ru-Sen Tian, Meng-Qiang Tags: Original Article Source Type: research

Are Joint Surgeons Being Adequately Compensated for Single-Component versus Double-Component Revision TKA? An Analysis of Relative Value Units
J Knee Surg DOI: 10.1055/s-0039-1681094Relative value units (RVUs) are used for ensuring that physicians are appropriately reimbursed based on case complexity. While past research has elucidated that surgeons are reimbursed at a higher rate for primary total knee arthroplasty (TKA) versus revision TKA, no study has explored differences in reimbursements between single-component and double-component revisions, considering a double-component revision is likely to require more effort/skill as compared with single-component revision. The 2015 to 2016 American College of Surgeons National Surgical Quality Improvement Program fi...
Source: Journal of Knee Surgery - March 12, 2019 Category: Orthopaedics Authors: Malik, Azeem Tariq Scharschmidt, Thomas J. Li, Mengnai Jain, Nikhil Khan, Safdar N. Tags: Original Article Source Type: research

Comparison of Bone Healing in Open-Wedge High Tibial Osteotomy between the Use of Allograft Bone Chips with Autologous Bone Marrow and the Use of Allograft Bone Chips Alone for Gap Filling
This study analyzed 36 patients who underwent HTO with locking plate (mean age: 58.0 years). Allograft bone chips mixed with autologous BM aspirated from anterior superior iliac spine were used in 19 patients (group A) and allograft chips only were used in 17 patients (group B). The radiological and clinical results between two groups were compared during examination at 6 weeks, 3 months, 6 months, and 12 months after surgery. Clinical evaluations involving the Hospital for Special Surgery score, Knee Society knee score, and function score were performed at each assessment point. The osteotomy filling and osteoconductivity...
Source: Journal of Knee Surgery - March 12, 2019 Category: Orthopaedics Authors: Kim, Hee-June Seo, Il Shin, Ji-Yeon Lee, Kang San Park, Kyeong-Hyeon Kyung, Hee-Soo Tags: Original Article Source Type: research

Gender Influences Gait Asymmetry following Bicruciate-Retaining Total Knee Arthroplasty
This study aimed to determine if 3D gait kinematics, including 3D knee translations and rotations, differed in men and women following bicruciate-retaining (BCR) TKA. Twenty-nine well-functioning unilateral BCR TKA patients (14 males and 15 females) underwent evaluation of both knees during level walking on a treadmill at a self-selected speed using a dual fluoroscopic imaging system. Interlimb comparisons of in vivo 6 degree-of-freedom kinematics were compared between male and female patients. Differences of pre- and postoperative Knee Society scores (KSSs) were compared between the groups. Both groups were matched regard...
Source: Journal of Knee Surgery - March 12, 2019 Category: Orthopaedics Authors: Hennessy, David Arauz, Paul Klemt, Christian An, Shuai Kwon, Young-Min Tags: Original Article Source Type: research

Surgical Treatment of Meniscal RAMP Lesion
In this study, we aimed to present results of postoperative knee function scores and patient satisfaction after surgical repair of RAMP lesion. We included 15 patients who had undergone knee arthroscopy due to RAMP lesion in 2017. We recorded demographic data, diagnosis, pre- and postoperative International Knee Documentation Committee and Tegner–Lysholm scores of all patients. In this study, they included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18–35). Associated injuries included ACL rupture in 12 patients, additional medial men...
Source: Journal of Knee Surgery - March 8, 2019 Category: Orthopaedics Authors: G ülenç, Barış Kemah, Bahattin Yal çın, Sercan Sayar, Şafak Korkmaz, O ğuzhan Erdil, Mehmet Tags: Original Article Source Type: research

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone –Patellar Tendon–Bone Graft
J Knee Surg DOI: 10.1055/s-0039-1681064The purpose of this study was to retrospectively investigate the effects of variations in the length of the tendon within the tibial tunnel on tunnel widening (TW) following anatomical anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft. In total, 68 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. The patients were divided into two groups according to the length of the tendon within the tibial tunnel: group S (n = 30; tendon length, 
Source: Journal of Knee Surgery - March 5, 2019 Category: Orthopaedics Authors: Taketomi, Shuji Inui, Hiroshi Yamagami, Ryota Kawaguchi, Kohei Nakazato, Keiu Kono, Kenichi Kawata, Manabu Nakagawa, Takumi Tanaka, Sakae Tags: Original Article Source Type: research

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis
We report a complication rate of 19.7% with the majority (> 60%) being thromboembolic events and complaints of stiffness. Significant improvements were observed in general health, knee pain, and function with > 89% exceeding the MCID for the OKS and > 65% exceeding the PASS for the OKS at an average follow-up of 3.2 years. We report a cumulative revision rate of 4.3% at 5 years and 4.8% at 14 years, with significantly lower revision rates in females and patients aged 55 to 64 years compared with AOANJRR data for fixed bearing designs. The RBK rotating platform TKA provides good function...
Source: Journal of Knee Surgery - March 5, 2019 Category: Orthopaedics Authors: Scholes, Corey Ebrahimi, Milad Ektas, Nalan Ireland, John Tags: Original Article Source Type: research

Cementless versus Cemented Fixation in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1678687Despite the success of total knee arthroplasty (TKA), more than 20,000 revision TKA procedures are performed annually. In an effort to decrease failures due to loosening in the past, cementless fixation of TKA was suggested. The preliminary results of cementless fixation for TKA proved to be discouraging, with midterm results linking the use of uncemented components to early aseptic loosening. While cemented TKA has remained the gold standard fixation technique, the changing demographics of the average TKA patient have led some surgeons to revisit cementless fixation as an option. [.....
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Papas, Paraskevi Vivian Congiusta, Dominick Cushner, Fred D. Tags: Special Focus Section Source Type: research

A Cam –Post Mechanism Is No Longer Necessary in Modern Primary Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1681030Conclusive evidence supporting a clinical difference between posterior-stabilized (PS) and cruciate-retaining (CR) designs in total knee arthroplasty (TKA) does not currently exist, despite both designs being used for decades. Proponents of PS designs that employ a cam-and-post mechanism cite in vivo fluoroscopic data that demonstrate improved posterior rollback; however, optimal rollback has never been correlated to superior clinical outcomes. Recently, anterior-lipped and more conforming CR bearings, such as ultracongruent, medial pivot, and dual-pivot designs, have been used to sub...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Meneghini, R. Michael Stefl, Michael D. Hodge, W. Andrew Banks, Scott A. Tags: Special Focus Section Source Type: research

Robotics in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1681053Total knee arthroplasty (TKA) is a highly successful operation that improves patients' quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with their clinical result. Robotic TKA has gained increased attention and popularity as a means of improving patient satisfaction. The promise of robotic-assisted TKA is that it provides a surgeon with a tool that accurately executes bone cuts according to presurgical planning, as well as provides the surgeon with intraoperative feedback helpful for restoring knee kinematics and soft tissue balance. Several systems...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Bautista, Maria Manrique, Jorge Hozack, William J. Tags: Special Focus Section Source Type: research

Rationale and Results for Fixed-Bearing Pivoting Designs in Total Knee Arthroplasty
This article reviews the various design types of fixed-bearing pivoting TKA designs, and recounts their clinical, functional, and patient-preference performance from peer-reviewed studies. To date, the evidence suggests there is measurable benefit to providing closer-to-normal joint stability and kinematics, and that fixed-bearing, pivoting TKA designs may decrease instability-related revisions and improve patient satisfaction. [...] 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 - March 1, 2019 Category: Orthopaedics Authors: Banks, Scott A. Deckard, Evan Hodge, W. Andrew Meneghini, R. Michael Tags: Special Focus Section Source Type: research

Tourniquet Use in Total Knee Arthroplasty
This article summarizes the evidence for and against tourniquet use and provides an evidence-based approach to help guide surgeons in their own practice. [...] 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 - March 1, 2019 Category: Orthopaedics Authors: Arthur, Jaymeson R. Spangehl, Mark J. Tags: Special Focus Section Source Type: research

The Outcomes of Isolated Distal Realignment Procedures in Patellofemoral Instability: A Systematic Review and Meta-analysis
J Knee Surg DOI: 10.1055/s-0039-1681052Distal realignment procedures are now commonly performed routinely with proximal realignment procedures. Despite so, only a limited number of publications exist that have looked into the efficacy of isolated distal realignment procedures, and whether there is indeed a need for routine proximal realignment procedures to be added to the distal realignment procedures. The current systematic review and meta-analysis aims to evaluate the outcomes of isolated distal realignment procedures in the management of patellofemoral instability. The review was conducted using the preferred reporting...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Tan, Si Heng Sharon Lim, Sheng Yang Wong, Keng Lin Doshi, Chintan Lim, Andrew Kean Seng Hui, James Hoipo Tags: Original Article Source Type: research

The Outcomes of Distal Femoral Varus Osteotomy in Patellofemoral Instability: A Systematic Review and Meta-Analysis
J Knee Surg DOI: 10.1055/s-0039-1681043Distal femoral varus osteotomies have been novelly described in the recent years to be successful in the management of patellofemoral instability with genu valgum. However, these publications are limited to case reports and small case series and no published literature have attempted to analyze them in totality. The current review aims to pool together these small case series to evaluate the outcomes and complications of distal varus femoral osteotomies when performed for patellofemoral instability. The review was conducted using the preferred reporting items for systematic reviews an...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Tan, Si Heng Sharon Hui, Si Jian Doshi, Chintan Wong, Keng Lin Lim, Andrew Kean Seng Hui, James Hoipo Tags: Original Article Source Type: research

Relative Incidence of Proximal Fibula Fractures with Tibial Plateau Fractures: An Investigation of 354 Cases
J Knee Surg DOI: 10.1055/s-0039-1681045We aimed to investigate the incidence of proximal fibula fractures in patients with tibial plateau fractures and to identify risk factors for such combined injuries. From January 2011 to December 2015, 354 patients with tibial plateau fractures who had been admitted to a level 1 trauma center were retrospectively evaluated by an orthopaedic trauma surgeon and two skeletal radiologists. Anteroposterior plain radiography and computed tomography (CT) were used to characterize the injuries, and the incidence of associated proximal fibula fractures was determined. The tibial plateau fractu...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Liu, Yue Zhang, Yan Liang, Xu Shao, Jin Ai, Zisheng Yang, Tieyi Tags: Original Article Source Type: research

Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery
The objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center. Patients were included if there was a plan for potential s...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Lian, Jayson Patel, Neel K. Nickoli, Michael Vaswani, Ravi Irrgang, James J. Lesniak, Bryson P. Musah, Volker Tags: Original Article Source Type: research

Arthroscopic Posterior Cruciate Ligament Reconstruction: The Achilles Tendon Allograft versus the Quadriceps Tendon Allograft
J Knee Surg DOI: 10.1055/s-0039-1681029We aimed to compare and analyze the outcomes of arthroscopic posterior cruciate ligament (PCL) reconstruction with the Achilles tendon allograft and the quadriceps tendon allograft. Twenty-nine patients who received the same procedure of arthroscopic PCL reconstruction within our inclusion criteria were reviewed retrospectively. There were 13 patients in the Achilles tendon allograft group and 16 patients in the quadriceps tendon allograft group. At least in 2 years of follow-up period, we evaluated the patients using the posterior drawer test, KT 2000 test, Lysholm knee scoring scale...
Source: Journal of Knee Surgery - March 1, 2019 Category: Orthopaedics Authors: Kang, Seung Hoon Sohn, Kang Min Lee, Do Kyung Lee, Byung Hoon Yang, Seong Wook Wang, Joon Ho Tags: Original Article Source Type: research

Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1681077The prevalence of knee osteoarthritis is increasing, as is the projected use of total knee arthroplasty (TKA) to treat severe cases that fail to respond to conservative measures. Implant designs are either cruciate retaining or posterior stabilized, and while both have high success rates, management of the patella still remains a controversial topic. Although studies indicate that resurfacing the patella provides no significant clinical differences compared with non-resurfacing techniques, surgeons continue to resurface the patella during TKA. Rates of patella resurfacing continue to ...
Source: Journal of Knee Surgery - February 27, 2019 Category: Orthopaedics Authors: Allen, William Eichinger, Josef Friedman, Richard Tags: Special Focus Section Source Type: research

Midflexion Instability in Primary Total Knee Arthroplasty: A Review Article
This article reviews the current literature and identifies the best available evidence relevant to the concept of MFI. Our aim is to present an overview of the proposed causes and mechanisms for MFI. By doing so, we also aim to provide a focus on how MFI presents, whether it is indeed a discrete form of instability, and if it influences clinical results. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - February 27, 2019 Category: Orthopaedics Authors: Nagle, Matthew Glynn, Aaron Tags: Original Article Source Type: research

Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures
J Knee Surg DOI: 10.1055/s-0039-1678676The purpose of this study is to determine when functional outcome no longer improves following tibial plateau fracture. A patient series of operatively treated tibial plateau fractures was reviewed. Patients were evaluated using the short musculoskeletal function assessment (SMFA), range of motion (ROM) assessment, and pain levels at visual analog scale (VAS) at 3, 6, and 12 months postoperatively. Fractures were classified by the Schatzker's classification using preoperative imaging. The case series was divided into two groups based on fracture patterns. Friedman's tests were conduct...
Source: Journal of Knee Surgery - February 27, 2019 Category: Orthopaedics Authors: Christiano, Anthony V. Pean, Christian A. Kugelman, David N. Konda, Sanjit R. Egol, Kenneth A. Tags: Original Article Source Type: research

Primary Total knee Arthroplasty: A Viable Surgical Option for Complex Tibial Plateau Fractures in Elderly
In conclusion, primary TKA utilizing a stemmed tibial component is an effective treatment option for elderly patients with a complex acute fracture of the tibial plateau. This is a Type III therapeutic study. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Knee Surgery)
Source: Journal of Knee Surgery - February 27, 2019 Category: Orthopaedics Authors: Abdelbadie, Ahmed El-Hennawy, Ayman Sallam, Asser Tags: Original Article Source Type: research

A Nationwide Analysis of Preoperative Planning on Operative Times and Postoperative Complications in Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1677790Compared with nonelective total knee arthroplasties (TKAs), elective procedures have more time for preoperative planning, which allows for potentially improved patient optimization, risk factor modification, and patient education. The purpose of this study was to (1) determine nationwide trends in operative times and (2) evaluate associations between surgery type, elective or nonelective, with respect to (a) operative times, (b) length of stay (LOS), (c) discharge dispositions, (d) 30-day postoperative complications, (e) reoperations, and (f) readmissions. The American College of Surg...
Source: Journal of Knee Surgery - February 20, 2019 Category: Orthopaedics Authors: Sodhi, Nipun Anis, Hiba K. Coste, Marine Ehiorobo, Joseph O. Chee, Alexander Freund, Benjamin Sultan, Assem A. Moskal, Joseph T. Scuderi, Giles R. Mont, Michael A. Tags: Special Focus Section Source Type: research

The Who, What, and Where of Primary TKAs: An Analysis of HCUP Data from 2009 to 2015
J Knee Surg DOI: 10.1055/s-0039-1677857The aim of this study was to assess (1) temporal trends, (2) primary indication, (3) patient-level demographics (age, race, gender, health status, and median income quartile), and (4) region and hospital type for all patients receiving primary total knee arthroplasty (TKA) between 2009 and the third quarter of 2015. The National Inpatient Sample Database (NIS) was used to identify all patients who underwent a TKA between 2009 and the third quarter of 2015. Regression analysis was utilized to assess trends. Chi-square analysis was used to explore categorical variables whereas Kruskal&n...
Source: Journal of Knee Surgery - February 15, 2019 Category: Orthopaedics Authors: Gwam, Chukwuweike Rosas, Samuel Sullivan, Rashad Luo, T. David Emory, Cynthia L. Plate, Johannes F. Tags: Original Article Source Type: research

The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty
This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally. The transepicondylar axis (TEA), the Akagi line, and the line connecting the medial third of the tibial tubercle with the midpoint of the posterior cruciate ligament (PCL) were projected to the tibial cross-section and marked. The PLCL technique was applied using either symmetrical or asymmetrical tibial tray templates, and the anteroposterio...
Source: Journal of Knee Surgery - February 14, 2019 Category: Orthopaedics Authors: Fang, Chao-Hua Cheng, Cheng-Kung Qu, Tie-Bing Zhang, Jun-Hui Zhang, Bo Hua, Qun Yan, Shi-Gui Tags: Original Article Source Type: research

Tranexamic Acid Reduces Postoperative Blood Loss in Distal Femoral Osteotomy
J Knee Surg DOI: 10.1055/s-0039-1678540Blood loss remains a significant source of morbidity and mortality in orthopaedic surgery, with transfusions associated with an increased risk of infection, length of stay, delayed rehabilitation, and significantly increased hospitalization costs. The purpose of this study was to assess whether the use of tranexamic acid (TXA) is effective in reducing postoperative blood loss in patients undergoing distal femoral osteotomy (DFO). A retrospective review was performed of all patients undergoing DFO by a single surgeon from 2010 to 2017, with a change in protocol occurring in 2014, after...
Source: Journal of Knee Surgery - February 12, 2019 Category: Orthopaedics Authors: Steinhaus, Michael E. Buksbaum, Joshua Eisenman, Avraham Kohli, Monal Fragomen, Austin T. Rozbruch, S. Robert Tags: Original Article Source Type: research

Postoperative Infection in Cementless and Cemented Total Knee Arthroplasty: A Propensity Score Matched Analysis
J Knee Surg DOI: 10.1055/s-0039-1678678The ongoing debate on fixation in total knee arthroplasty (TKA) has become increasingly relevant with its increased use in a younger patient population and the advent of novel cementless prostheses. Recent literature suggests modern cementless implants are comparable to their cemented counterparts in terms of survivorship and functional outcomes. What has not been well-assessed is whether the two modalities differ with respect to infection rates which was the purpose of this study. Specifically, a propensity score matched study population was used to compare: (1) overall infection; (2...
Source: Journal of Knee Surgery - February 12, 2019 Category: Orthopaedics Authors: Anis, Hiba K. Ramanathan, Deepak Sodhi, Nipun Klika, Alison K. Piuzzi, Nicolas S. Mont, Michael A. Higuera, Carlos A. Molloy, Robert M. Tags: Original Article Source Type: research

Higher Axial Tibiofemoral Rotation and Functional Outcomes with Mobile-Bearing Compared with Fixed-Bearing Total Knee Arthroplasty at 1- but Not at 2-Year Follow-Up – A Randomized Clinical Trial
The objective of this study was to determine in vivo knee kinematics and clinical outcomes of patients who underwent fixed- and mobile-bearing total knee arthroplasty (TKA) at 1- and 2-year follow-up. This prospective double-blinded randomized controlled trial was performed from November 2011 to December 2012. A total of 64 patients were randomized to fixed- and mobile-bearing TKA groups (32 patients in each group). All patients were evaluated with the following: three-dimensional in vivo knee kinematics analysis during gait, stepping up and stepping down stair steps, and getting up from and sitting on a chair; and knee ra...
Source: Journal of Knee Surgery - February 12, 2019 Category: Orthopaedics Authors: Amaro, Joicemar Tarouco Novaretti, Jo ão Victor Astur, Diego Costa Cavalcante, Elton Luiz Batista Rodrigues Junior, Adilson G óes Debieux, Pedro Kaleka, Camila Cohen Cohen, Mois és Tags: Original Article Source Type: research

Preoperative Chronic Opioid Use and Its Effects on Total Knee Arthroplasty Outcomes
J Knee Surg DOI: 10.1055/s-0039-1678538Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared i...
Source: Journal of Knee Surgery - February 11, 2019 Category: Orthopaedics Authors: Kim, Kelvin Chen, Kevin Anoushiravani, Afshin A. Roof, Mackenzie Long, William J. Schwarzkopf, Ran Tags: Original Article Source Type: research

Cemented versus Cementless Stems in Revision Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1678686Successful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct. When placing a revision construct, ther...
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: Driesman, Adam S. Macaulay, William Schwarzkopf, Ran Tags: Special Focus Section Source Type: research

Torsional Osteotomy
This article provides an overview of symptomatic torsional deformities of the lower extremity, and operative treatment techniques are described in detail. A definition of torsion versus rotation as well as information to physical examination and the relevance of radiological evaluation is given. Based on current literature and the own personal experience of the authors in osteotomies, surgical techniques at the proximal and at the distal femur, as well as at the tibia are presented. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  | &...
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: Schr öter, Steffen Nakayama, Hiroshi Ihle, Christoph Ateschrang, Atesch Maiotti, Marco Harrer, J örg Dickschas, J örg Tags: Original Article Source Type: research

Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis
J Knee Surg DOI: 10.1055/s-0039-1678525The purpose of this meta-analysis was to assess the evidence supporting the use of cementless versus cemented total knee arthroplasties (TKAs). Specifically, we evaluated (1) all-cause survivorship, (2) aseptic survivorship, and (3) functional outcomes (Knee Society Scores [KSS], Oxford Knee Scores, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores, and ranges of motion [ROMs]). A literature search was performed for studies that evaluated cementless versus cemented TKAs published between 2000 and 2017. Selected studies included three randomized controlled t...
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: Newman, Jared M. Sodhi, Nipun Dekis, Joanne C. Khlopas, Anton Piuzzi, Nicolas S. Sultan, Assem A. Levin, Jay M. Mont, Michael A. Tags: Original Article Source Type: research

Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance
We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively. Depending on the position of measurement, medial laxity was between 0.5 and 9.5 degrees and lateral laxity between 1 and 12 degrees. The change in laxity between maximum extension and 90 degrees of flexion demonstrated a range of 7 degrees medially and 12 degrees laterally. The total coronal arc of movement did not affect functional outcomes. A ...
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: McAuliffe, Michael J. O'Connor, Patrick B. Major, Lisa J. Garg, Gautam Whitehouse, Sarah L. Crawford, Ross W. Tags: Original Article Source Type: research

Necessary Factors to Achieve Deep Flexion for Asian Populations after Oxford Unicompartmental Knee Arthroplasty
The objective of this study was to clarify the relationship between outcomes and the postoperative maximum flexion angle and reveal the necessary factors for maximum flexion angle ≥ 140 degrees which is considered necessary for Asian populations. We categorized 212 UKA patients into the following three groups based on the postoperative maximum flexion angle: group 1 had flexion angle ≥ 140 degrees in 80 patients (38%), group 2 had 130 degrees ≤ flexion angle 
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: Inui, Hiroshi Taketomi, Shuji Yamagami, Ryota Kawaguchi, Kohei Nakazato, Keiu Tanaka, Sakae Tags: Original Article Source Type: research

The Effect of Implant Design on Sagittal Plane Stability: A Randomized Trial of Medial- versus Posterior-Stabilized Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0039-1678524Up to 20% of total knee arthroplasty (TKA) patients report dissatisfaction with their outcome, especially with weight-bearing in flexion (WBiF) activities. Sagittal plane instability may contribute to dissatisfaction following TKA. We assessed the impact of implant design on TKA sagittal plane stability and clinical satisfaction. We randomized patients to receive one of two TKA implant designs: medial-stabilized (MS) or posterior-stabilized (PS). Sagittal stability was assessed using a KT-1000 arthrometer. Patient-reported outcome measures, including a custom bank of questions targeti...
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: Edelstein, Adam I. Bhatt, Surabhi Wright-Chisem, Josh Sullivan, Ryan Beal, Matt Manning, David W. Tags: Original Article Source Type: research

Is Intraoperative Fluoroscopy Necessary to Confirm Device Position for Femoral-Sided Cortical Suspensory Fixation during Anterior Cruciate Ligament Reconstruction?
This study evaluates the benefit of intraoperative fluoroscopy to confirm device position on the femur during ACL reconstruction using cortical suspensory fixation. One hundred consecutive patients who underwent soft tissue ACL reconstruction using a suspensory cortical device for femoral fixation were retrospectively evaluated. Patients were split into two groups: Group A utilized anteromedial portal visualization and had intraoperative fluoroscopic imaging performed at the time of ACL graft fixation to confirm femoral device placement on the lateral femoral metaphyseal cortex. Group B utilized anteromedial portal visuali...
Source: Journal of Knee Surgery - February 8, 2019 Category: Orthopaedics Authors: Balldin, B. Christian Nuelle, Clayton W. DeBerardino, Thomas D. Tags: Original Article Source Type: research

Are Subchondral Intraosseous Injections Effective and Safe for the Treatment of Knee Osteoarthritis? A Systematic Review
J Knee Surg DOI: 10.1055/s-0039-1677792Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. A systematic review was performed on PubMed-Medline, and the Cochrane Database of systematic...
Source: Journal of Knee Surgery - February 6, 2019 Category: Orthopaedics Authors: Sundaram, Kavin Vargas-Hern ández, Juan S. Sanchez, Tomas Roca Moreu, Nestor Moreno Mont, Michael A. Higuera, Carlos A. Piuzzi, Nicolas S. Tags: Special Focus Section Source Type: research

Biomechanical Properties of Bioabsorbable Fixation for Osteochondral Shell Allografts
This study compares bioabsorbable nail to metal screw fixation of shell osteochondral allograft (OCAs) for compression and shear strength. Cadaveric distal femurs (n = 5) yielding six 1.5 cm shell grafts (n = 30) were used. Three different fixation methods (2.0 and 2.4 mm headed screws, and copolymer absorbable nail) were compared for statistically significant differences (p 
Source: Journal of Knee Surgery - February 6, 2019 Category: Orthopaedics Authors: Thomas, Dimitri M. Stannard, James P. Pfeiffer, Ferris M. Cook, James L. Tags: Original Article Source Type: research