Journal of Knee Surgery

This study aimed to test and compare the biomechanical properties of three tibial fixation methods of anterior cruciate ligament (ACL) tendon grafts under cyclic load and load-to-failure testing in the bovine proximal tibiae, comprising (1) staple fixation alone, (2) interference screw fixation alone, and (3) interference screw fixation with a supplementary staple. Twenty-four bovine tibiae used in the study were divided into three groups (eight proximal tibiae in each group) based on tibial fixation methods of ACL tendon grafts: group A (a spiked ligament staple alone), group B (a cannulated interference screw alone), and group C (a cannulated interference screw with a supplementary staple)...

Total knee arthroplasty (TKA) risks persistent pain and long-term opioid use (LTO). The role of social determinants of health (SDoH) in LTO is not well established. We hypothesized that SDoH would be associated with postsurgical LTO after controlling for relevant demographic and clinical variables. This study utilized data from the Veterans Affairs Surgical Quality Improvement Program, VA Corporate Data Warehouse, and Centers for Medicare and Medicaid Services, including Veterans aged ≥ 65 who underwent elective TKA between 2013 and 2019 with no postsurgical complications or history of significant opioid use...

Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the midterm clinical performance of cementless TKA using a highly porous tibial baseplate compared with its cemented counterpart of the same system. We conducted a retrospective case-control study of 400 patients undergoing primary TKA that included 200 patients with cementless components matched for age and body mass index (BMI) to 200 patients with cemented implants of the same implant design with a 5-year follow-up...

The spacer block technique is widely used in medial fixed-bearing unicompartmental knee arthroplasty (UKA) for osteoarthritis (OA) and osteonecrosis (ON), while it is still unclear if there is any difference in the extension gap between UKAs for the two conditions. To clarify the question, the data from 87 consecutive patients (OA: 57 patients and ON: 30 patients) who underwent medial fixed-bearing UKA with the spacer block technique were retrospectively collected and analyzed. The component gap between the medial tibial osteotomy surface and the femoral trial prosthesis in extension was measured using a UKA tensor, and the preosteotomy gap was calculated in each condition...

The knee joint plays a pivotal role in mobility and stability during ambulatory and standing activities of daily living. Increased incidence of knee joint pathologies and resulting surgeries has led to a growing need to understand the kinematics and kinetics of the knee. In vivo, in silico, and in vitro testing domains provide researchers different avenues to explore the effects of surgical interactions on the knee. Recent hardware and software advancements have increased the flexibility of in vitro testing, opening further opportunities to answer clinical questions...

BACKGROUND: The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent study showed that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure non-surgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests...

The internet has introduced many resources frequently accessed by patients prior to orthopaedic visits. Recently, Chat Generative Pre-Trained Transformer, an artificial intelligence-based chat application, has become publicly and freely available. The interface uses deep learning technology to mimic human interaction and provide convincing answers to questions posed by users. With its rapidly expanding usership, it is reasonable to assume that patients will soon use this technology for preoperative education...

BACKGROUND: Postoperative flexion after unicompartmental knee arthroplasty might be predicted from the preoperative range of motion and other preoperative factors, but this has not been sufficiently investigated. METHODS: Between 2013 and 2017, 198 patients (198 knees) underwent unilateral knee arthroplasty with medial mobile-bearing unicompartmental knee arthroplasty. Range of motion was measured preoperatively and at the time of final follow-up. To investigate the accuracy of the prediction of preoperative to postoperative gain or loss of the flexion angle, we performed receiver operating characteristic analysis...

Meniscus allograft transplantation (MAT) is a proven treatment option for patients with symptomatic irreparable meniscus deficiency. When patients are adherent to prescribed post-operative restriction and rehabilitation protocols, outcomes after MAT are considered good to excellent. However, nonadherence to standard protocols is common and can be associated with undesirable outcomes and patient dissatisfaction. Based on demonstrated safety for early weightbearing following MAT in conjunction with significant advances in graft preservation and surgical techniques, our joint preservation center implemented a shift in practice towards accelerated weightbearing following MAT and designed this study to test the hypothesis that accelerated rehabilitation would be associated with superior adherence, patient-reported outcomes, and patient satisfaction, without diminishing patient safety, when compared to standard rehabilitation...

INTRODUCTION: The aim of this study was to reveal the influence of the morphological variations of the Blumensaat's line on antero-medial (AM) and postero-lateral (PL) femoral tunnel position in anatomical double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Fifty-three subjects undergoing anatomical double-bundle ACL reconstruction were included (29 female, 24 male: median age 27.4:14-50 y.o.). Using an inside-out transportal technique, the PL tunnel position was made on a line drawn vertically from the bottommost point of the lateral condyle at 90° of knee flexion, spanning a distance of 5 to 8 mm, to the edge of the joint cartilage...

INTRODUCTION: Femoral stemmed total knee arthroplasty (FS TKA) may be used in patients deemed higher risk for periprosthetic fracture (PPF) to reduce PPF risk. However, the cost effectiveness of FS TKA has not been defined. Using a risk modeling analysis, we investigate the cost effectiveness of FS in primary TKA compared to the implant cost of revision to distal femoral replacement (DFR) following PPF. METHODS: A model of risk categories was created representing patients at increasing fracture risk, ranging from 2...

This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR) derived hip-knee-ankle angle (HKAA) and intra-operative supine computer-assisted surgery (CAS) derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if weight-bearing alignment could be mimicked or inferred based on intra-operative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single centre by a single surgeon...

It is unclear if bracing is necessary after isolated medial patellofemoral ligament reconstruction (MPFLr) for recurrent patellar instability. We hypothesize that patients who did not use a brace will have similar outcomes to those who were braced postoperatively. A retrospective review of patients who underwent isolated MPFLr from January 2015 to September 2020 at a single institution was performed. Those with less than 6 weeks of follow-up were excluded. The braced group was provided a hinged-knee brace postoperatively until the return of quadriceps function, which was determined by the treating physical therapist (brace, "B"; no brace, "NB")...

Our study aims to determine the association between obesity and meniscal tears involving the posterior third of the medial meniscus and meniscal root tears. We conducted a 3-year retrospective review of isolated operatively treated meniscal injuries in adult patients performed by a single surgeon. Cases with concomitant pathology were excluded. Patient demographics, height, weight, and body mass index (BMI) were recorded and compared against location of meniscus tear noted via magnetic resonance imaging and arthroscopic imaging...

Bibliometric analysis plays a crucial role in elucidating publication trends and aids scholars in gauging the reach of prospective journals for their research dissemination. Concerns with impact factor (IF) have led us to examine the trends in IF, corrected IF (cIF), and Citescore in orthopaedic journals from 2016 to 2021 and compare them with internal medicine and general surgery journals. Journal IF and cIF were obtained from Journal Citation Reports and Citescore data from the Elsevier Scopus database for the years 2016 to 2021...

Shortcomings of fixation have been reported as a source of graft failure in anterior cruciate ligament (ACL) reconstruction. While interference screws have long been used as fixation devices for ACL reconstruction, they are not without complications. Previous studies have highlighted the use of bone void filler as a fixation method; however, no biomechanical comparisons using soft tissue grafts with interference screws exist to our knowledge. The purpose of this study is to evaluate the fixation strength of a calcium phosphate cement bone void filler compared with screw fixation in an ACL reconstruction bone replica model with human soft tissue grafts...

Drain use in total knee arthroplasty (TKA) remains controversial. Use has been associated with increased complications, particularly postoperative transfusion, infection, increased cost, and longer hospital stays. However, studies examining drain use were performed before widespread adoption of tranexamic acid (TXA), which markedly reduces transfusion without increasing venous thromboembolism events. We aim to investigate incidence of postoperative transfusion and 90-day return to the operating room (ROR) for hemarthrosis in TKA with use of drains and concomitant intravenous (IV) TXA...

Skin closure for total knee arthroplasty (TKA) typically focuses on promoting optimal healing, while preventing wound complications and infection, allowing for functionality and immediate ambulation, and providing for excellent cosmesis. In this systematic review and meta-analysis of the literature, we will focus on closure of the skin. Specifically, we assessed: (1) wound complication risk of different techniques and (2) closing time of different sutures/techniques. There were 20 reports on infection risk and closing time...

Clinical and radiographic characteristics of mucoid degeneration of the anterior cruciate ligament (MD-ACL) were poorly documented in previous literature. And the optimal management strategy for MD-ACL remains unclear. Here, we summarized the characteristics associated with MD-ACL, and evaluated the clinical outcome of conservative management to MD-ACL.A total of 18 knees in 18 patients diagnosed with MD-ACL were collected and reviewed retrospectively. Sixteen patients underwent conservative management and two patients underwent arthroscopic surgery...

We analyzed the intraoperative kinematics of total knee arthroplasty (TKA) using a navigation system to investigate the influence of different inserts on kinematics. This was a retrospective observational study. The Vanguard individualized design (ID) (33 patients, 33 knees) XP and anterior-stabilized (AS) inserts were used in TKA for osteoarthritis. Kinematic data were intraoperatively recorded. The range of motion, tibiofemoral rotational angle, anteroposterior translation of the femur, and varus-valgus laxity were compared between the two inserts (XP vs AS)...