Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty
J Knee Surg DOI: 10.1055/s-0038-1676068During cruciate retaining (CR) total knee arthroplasty (TKA), the posterior cruciate ligament (PCL) may avulse at its insertion. The incidence of PCL avulsion fracture has not been previously studied. The aim of this study is to report on the incidence and clinical significance of intraoperative PCL avulsion during primary CR TKA and to identify potential risk factors. Our institutional joint registry was retrospectively reviewed for PCL avulsion occurring during CR TKA implanted between April 2008 and April 2016. Patient demographics, preoperative range of motion (ROM), complications...
Source: Journal of Knee Surgery - December 13, 2018 Category: Orthopaedics Authors: Kim, Eric Talmo, Carl T. Anderson, Marie C. Bono, Olivia J. Bono, James V. Tags: Original Article Source Type: research

Femoral Intramedullary Alignment in Total Knee Arthroplasty: Indications, Results, Pitfalls, Alternatives, and Controversies
We present case studies as examples of indications for use of an extramedullary femoral guide. In addition, we demonstrate two different techniques for extramedullary femoral alignment using fluoroscopic guidance in cases incompatible with intramedullary alignment. [...] 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 13, 2018 Category: Orthopaedics Authors: Bono, Olivia J. Olcott, Christopher W. Carangelo, Robert Jamison, James P. Tigges, Russell G. Talmo, Carl T. Bono, James V. Tags: Original Article Source Type: research

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain
J Knee Surg DOI: 10.1055/s-0038-1676071Chronic knee pain is a widely prevalent issue that can have a significant impact on a patient's quality of life. One of the leading causes of chronic knee pain is osteoarthritis. Total knee replacement is often the last and definitive resort for patients with severe symptomatic osteoarthritis after trial of less invasive interventions with failure to achieve symptomatic relief. Intra-articular injections are a mainstay of adjunctive conservative management and have demonstrated efficacy in reducing pain. Radiofrequency treatment is a viable option for poor surgical candidates, or for ...
Source: Journal of Knee Surgery - November 30, 2018 Category: Orthopaedics Authors: Urits, Ivan Jones, Mark Patel, Riki Adamian, Leena Seifert, Danica Thompson, William Viswanath, Omar Tags: Special Focus Section Source Type: research

Adipose-Based Therapies for Knee Pain —Fat or Fiction
J Knee Surg DOI: 10.1055/s-0038-1672155Regenerative cell therapies are emerging as promising treatments for numerous musculoskeletal conditions, including knee osteoarthritis (OA). Adipose-derived stem cells and possibly other adipose-based therapies have a greater chondrogenic potential than stem cells derived from bone marrow, and thus a lot of attention is being placed on them as potential regenerative agents in the treatment of knee OA. Several types of adipose-based therapies have good basic science and preclinical data supporting their translation to human therapeutic intervention. Cultured, adipose-derived stem cell...
Source: Journal of Knee Surgery - November 30, 2018 Category: Orthopaedics Authors: Shimozono, Yoshiharu Fortier, Lisa A. Brown, Donald Kennedy, John G. Tags: Special Focus Section Source Type: research

Biological Effects of Bone Marrow Concentrate in Knee Pathologies
J Knee Surg DOI: 10.1055/s-0038-1676069With our aging population desiring to remain active, the incidence and costs associated with managing knee pain from both acute injury and symptomatic knee osteoarthritis continue to dramatically increase. Current treatment methods fall short with respect to their ability to improve the intra-articular environment and restore normal joint homeostasis. With increasing basic science and clinical evidence showing efficacy, cell-based therapies such as bone marrow concentrate (BMC) hold promise as a nonsurgical joint preserving treatment approach. BMC has inherent advantages over other tr...
Source: Journal of Knee Surgery - November 30, 2018 Category: Orthopaedics Authors: Fortier, Lisa A. Strauss, Eric J. Shepard, David O. Becktell, Liliya Kennedy, John G. Tags: Special Focus Section Source Type: research

Accelerated Discharge Following Total Knee Arthroplasty May Be Safe in a Teaching Institution
J Knee Surg DOI: 10.1055/s-0038-1676066Total knee arthroplasty (TKA) is one of the most commonly performed yet costly surgical procedures in orthopaedics. With national trends and reimbursements moving in favor of shorter hospital length-of-stay (LOS), it is important to understand the complications associated with discharging patients earlier. This is particularly more challenging in a teaching institution due to complexity and variety of layers of care. Therefore, the purpose of this study was to evaluate the 90-day postoperative outcomes among those who were discharged on postoperative day 2 (POD-2) and compare them to ...
Source: Journal of Knee Surgery - November 30, 2018 Category: Orthopaedics Authors: Novack, Thomas A. Kurowicki, Jennifer Issa, Kimona Pierce, Todd P. Festa, Anthony McInerney, Vincent K. Scillia, Anthony J. Tags: Original Article Source Type: research

Noninterventional Therapies for the Management of Knee Osteoarthritis
J Knee Surg DOI: 10.1055/s-0038-1676107The goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would ...
Source: Journal of Knee Surgery - November 26, 2018 Category: Orthopaedics Authors: Dadabo, Joseph Fram, Julia Jayabalan, Prakash Tags: Special Focus Section Source Type: research

Total Knee Arthroplasty in Patients of Advanced Age: A Look at Outcomes and Complications
J Knee Surg DOI: 10.1055/s-0038-1676067Total knee arthroplasty (TKA) is one of the most highly successful orthopaedic procedures performed in North America. It is also one of the most common procedures performed, and its incidence continues to increase. Despite this, it is the opinion of many that patients of advanced age groups are not ideal candidates to undergo such procedures secondary to the concern over higher complication rates and poorer functional outcomes. This review article attempts to analyze the current body of literature concerning TKA outcomes and to evaluate some of the issues that are more specific to thi...
Source: Journal of Knee Surgery - November 26, 2018 Category: Orthopaedics Authors: Passias, Peter G. Bono, Olivia J. Bono, James V. Tags: Original Article Source Type: research

Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction
J Knee Surg DOI: 10.1055/s-0038-1675794Knee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and pos...
Source: Journal of Knee Surgery - November 26, 2018 Category: Orthopaedics Authors: Otchwemah, Robin Naendrup, Jan-Hendrik Mattner, Frauke Tjardes, Thorsten B äthis, Holger Shafizadeh, Sven Tags: Original Article Source Type: research

The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model
J Knee Surg DOI: 10.1055/s-0038-1675599An enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without re...
Source: Journal of Knee Surgery - November 26, 2018 Category: Orthopaedics Authors: Cai, Jiangyu Wan, Fang Ai, Chengchong Jin, Wenhe Sheng, Dandan Liu, Xingwang Wang, Siheng Zhi, Yunlong Chen, Jun Chen, Shiyi Tags: Original Article Source Type: research

Malignant Bone Tumors of the Knee: How to Identify and Treat
J Knee Surg DOI: 10.1055/s-0038-1675828Malignant bone tumors are rare conditions that may be encountered by nononcologic surgeons only a few times in their careers, but a delay in diagnosis or a misinterpretation of data can have limb and life-threatening consequences. Prior literature suggests that unplanned resection of sarcoma was associated with an increased risk of local recurrence, decreased 10-year survival, and increased amputation rate compared with planned resection. In addition to patient morbidity, missed diagnoses and unplanned excisions of malignant tumors lead to increased cost of treatment and higher likeli...
Source: Journal of Knee Surgery - November 16, 2018 Category: Orthopaedics Authors: Voskuil, Ryan Evenski, Andrea J. Montgomery, Corey Emory, Cynthia L. Tags: Special Focus Section Source Type: research

Giant Cell Tumor of Bone: Review of Current Literature, Evaluation, and Treatment Options
J Knee Surg DOI: 10.1055/s-0038-1675815Giant cell tumor of bone is a benign albeit aggressive tumor commonly affecting the bones of the knee. Patients with these tumors present with pain, swelling, and inability to bear weight on the involved extremity. These destructive tumors typically arise in the metaphyseal region of the long bones in individuals in the second, third, and fourth generations of life. Histologically, the multinucleated giant cells are the hallmark of the lesion, easily recognized on histological review, which recently have become therapeutic targets for medical management of the disease. For decades, su...
Source: Journal of Knee Surgery - November 16, 2018 Category: Orthopaedics Authors: Montgomery, Corey Couch, Cory Emory, Cynthia L. Nicholas, Richard Tags: Special Focus Section Source Type: research

Diagnostic Imaging and Management of Common Intra-articular and Peri-articular Soft Tissue Tumors and Tumorlike Conditions of the Knee
J Knee Surg DOI: 10.1055/s-0038-1675609Intra-articular (IA) and peri-articular (PA) tumors of the knee are frequently encountered by orthopaedic surgeons. Nonetheless, due to the possibility of great morbidity and potential mortality, it is important to recognize and differentiate between benign and malignant lesions in a timely manner. Therefore, the purpose of this article is to provide a concise, practical, and updated review of commonly encountered IA and PA tumors including intratendinous gout, synovial chondromatosis, schwannoma, pigmented villonodular synovitis, and synovial sarcoma, and a detailed description of di...
Source: Journal of Knee Surgery - November 16, 2018 Category: Orthopaedics Authors: Evenski, Andrea J. Stensby, James Derek Rosas, Samuel Emory, Cynthia L. Tags: Special Focus Section Source Type: research

Posteromedial versus Anteromedial Hamstring Tendon Harvest for Anterior Cruciate Ligament Reconstruction: A Retrospective Comparison of Accidental Gracilis Harvests, Outcomes, and Operative Times
J Knee Surg DOI: 10.1055/s-0038-1675796Hamstring autografts are frequently harvested for anterior cruciate ligament reconstruction (ACLR), traditionally through the anteromedial (AM) approach. Recently, a posteromedial (PM) approach has been described. The primary purpose of this study was to compare rates of unintentional gracilis (Gr) harvest or premature tendon amputation with these approaches. We also sought to compare operative times and patient-reported outcome measures (PROMs) between both groups and between those with only semitendinosus (ST) grafts or with combined ST and Gr grafts. Patients who underwent ACLR wit...
Source: Journal of Knee Surgery - November 16, 2018 Category: Orthopaedics Authors: Shu, Henry T. Bodendorfer, Blake M. Michaelson, Evan M. Argintar, Evan H. Tags: Original Article Source Type: research

Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear
J Knee Surg DOI: 10.1055/s-0038-1675783The incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was ...
Source: Journal of Knee Surgery - November 16, 2018 Category: Orthopaedics Authors: Kun-Hui, Chen En-Rung, Chiang Hsin-Yi, Wang Hsiao-Li, Ma Tags: Original Article Source Type: research

Demographics and Clinical Outcomes of Patients Undergoing Anterior Cruciate Ligament Reconstruction with a Planned or Unplanned Hybrid Graft
J Knee Surg DOI: 10.1055/s-0038-1675785The purpose of this study was to report the demographics and clinical outcomes of patients at our institution following anterior cruciate ligament reconstruction (ACLR) with a planned or unplanned hybrid autograft–allograft. At a minimum 2-year follow-up, patients at our institution who had undergone primary ACLR with a planned (P) or unplanned (U) hybrid graft using fresh-frozen allografts were contacted to complete a survey containing the Knee Injury and Osteoarthritis Outcome Score, Subjective International Knee Documentation Committee score, Single Assessment Numeric Evaluat...
Source: Journal of Knee Surgery - November 16, 2018 Category: Orthopaedics Authors: Kraeutler, Matthew J. Houck, Darby A. Carver, Trevor J. Bravman, Jonathan T. Vidal, Armando F. McCarty, Eric C. Tags: Original Article Source Type: research

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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