Knee

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Lei Yao Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China

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Jie Cai West China School of Medicine, Sichuan University, Chengdu, Sichuan, China

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Junqiao Li Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China

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Yan Xiong Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China

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Jian Li Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China

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Objective

  • This study aimed to provide the evidence of the role of addition hyaluronic acid immediate after arthroscopy in pain relief and functional recovery.

Methods

  • A multiple databases search of the PubMed, the Cochrane Library, and Embase was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify randomized controlled trials that evaluate the effect the hyaluronic acid compared with placebo addition immediately after arthroscopy for degenerative arthropathy. Data related to postoperative pain using the visual analog scale, and functional scores, were extracted and analyzed using the RevMan software.

Results

  • A total of five randomized controlled trials were included in this study. All patients showed significant pain relief after surgery at 2 weeks and 2 months, but no statistically significant differences between the hyaluronic group and control group were observed at 2 weeks and 2 months, respectively. This meta-analysis did not find a difference of WOMAC score between the two groups at 2 weeks (MD: 3.07; 95% CI: −0.66 to 6.81; I2 =39%; P = 0.11) and 2 months (MD: 5.47; 95% CI: −0.69 to 11.62; I2 =57%; P = 0.08), respectively.

Conclusion

  • For patients with symptomatic degenerative arthropathy, adding hyaluronic acid immediately after arthroscopic surgery did not appear to provide patients with more pain relief and better functional recovery.

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Erdem Sahin Cankaya Orthopedics, Ankara, Turkiye

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Reha Tandogan Department of Orthopedics & Traumatology, Cankaya Orthopedics, Ankara, Turkiye & Halic University, Istanbul, Turkiye

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Michael Liebensteiner Orthopädie, Knie & Fuß im Zentrum, Innsbruck, Austria

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Guillaume Demey Lyon Ortho Clinic, Lyon, France

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Asim Kayaalp Department of Orthopedics & Traumatology, Cankaya Orthopedics, Ankara, Turkiye & Halic University, Istanbul, Turkiye

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  • Surgical intervention is the treatment of choice for recurrent lateral patellar instability.

  • Surgery should be considered for first time lateral patella dislocations with osteochondral fractures or underlying anatomical risk factors.

  • Primary repair and nonanatomical imbrications/reconstructions have fallen out of favor due to abnormal biomechanics and high rates of recurrence. Anatomical reconstruction of the MPFL using a variety of auto and allograft tissues have yielded good outcomes and low redislocation rates.

  • Physeal sparing MPFL reconstruction techniques under radiological control are safe and do not cause growth disturbance. Allografts may be indicated for hyperlax patients.

  • Although no clear cutoff points exist, correction of valgus and excessive femoral anteversion should be considered when indicated.

  • Osteochondral and chondral injuries are common and should be addressed during surgery for instability.

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Aline Van Oevelen Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium

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Arne Burssens Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium

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Nicola Krähenbühl Department of Orthopaedics, University Hospital Basel, Basel, Switzerland

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Alexej Barg Department of Orthopaedics and Trauma, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

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Bernhard Devos Bevernage Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium

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Emmanuel Audenaert Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
Department of Electromechanics, InViLab research group, University of Antwerp, Antwerp, Belgium
Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

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Beat Hintermann Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland

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Jan Victor Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium

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Purpose

  • Emerging reports suggest an important involvement of the ankle/hindfoot alignment in the outcome of knee osteotomy; however, a comprehensive overview is currently not available. Therefore, we systematically reviewed all studies investigating biomechanical and clinical outcomes related to the ankle/hindfoot following knee osteotomies.

Methods

  • A systematic literature search was conducted on PubMed, Web of Science, EMBASE and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on international prospective register of systematic reviews (PROSPERO) (CRD42021277189). Combining knee osteotomy and ankle/hindfoot alignment, all biomechanical and clinical studies were included. Studies investigating knee osteotomy in conjunction with total knee arthroplasty and case reports were excluded. The QUality Appraisal for Cadaveric Studies (QUACS) scale and Methodological Index for Non-Randomized Studies (MINORS) scores were used for quality assessment.

Results

  • Out of 3554 hits, 18 studies were confirmed eligible, including 770 subjects. The minority of studies (n = 3) assessed both high tibial- and distal femoral osteotomy. Following knee osteotomy, the mean tibiotalar contact pressure decreased (n = 4) except in the presence of a rigid subtalar joint (n = 1) or a talar tilt deformity (n = 1). Patient symptoms and/or radiographic alignment at the level of the ankle/hindfoot improved after knee osteotomy (n = 13). However, factors interfering with an optimal outcome were a small preoperative lateral distal tibia angle, a small hip–knee–ankle axis (HKA) angle, a large HKA correction (>14.5°) and a preexistent hindfoot deformity (>15.9°).

Conclusions

  • Osteotomies to correct knee deformity alter biomechanical and clinical outcomes at the level of the ankle/hindfoot. In general, these changes were beneficial, but several parameters were identified in association with deterioration of ankle/hindfoot symptoms following knee osteotomy.

Open access
Gautier Beckers Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
Personalized Arthroplasty Society, Atlanta, Georgia, USA

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Vincent Massé Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada

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Pascal-André Vendittoli Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada

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Mina W Morcos Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
Personalized Arthroplasty Society, Atlanta, Georgia, USA

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  • Advanced hemophilic knee arthropathy is a frequent and devastating manifestation of severe hemophilia with significant implications for activities of daily living.

  • Hemophilic arthropathy is caused by repeated bleeding, resulting in joint degeneration, pain, deformity and disability.

  • In patients with hemophilia and advanced disease, total knee arthroplasty (TKA) has proven to be the most successful intervention, improves physical function and reduces knee pain.

  • Hemophilic patients carry additional risks for complications and required specific pre/postoperative considerations. Expert treatment center should be used to improve patient outcome.

  • Hemophilic patients present significant surgical challenges such as joint destruction, bone loss, severe ankylosis and oligoarticular involvement. The surgeon performing the arthroplasty must be experienced to manage such problems.

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Marco Gupton MountainView Regional Medical Center, Orthopaedic Surgery Residency, Las Cruces, New Mexico, USA

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Jordan E Johnson MountainView Regional Medical Center, Orthopaedic Surgery Residency, Las Cruces, New Mexico, USA

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G Robert Cummings MountainView Regional Medical Center, Orthopaedic Surgery Residency, Las Cruces, New Mexico, USA

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Chenthuran Deivaraju Department of Orthopaedic Surgery, University of Minnesota, St Cloud, Minnesota, USA

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Purpose

  • To systematically review and analyze the data available in the literature to evaluate the role of patellofemoral overstuffing in affecting clinical outcomes following primary total knee arthroplasty.

Methods

  • A systematic literature review was conducted following the PRISMA guidelines. Only studies including primary total knee arthroplasty in the setting of osteoarthritis with a quantifiable method of measuring patellofemoral overstuffing using pre- and post-operative x-rays or advanced imaging, as well as reported subjective and/or objective patient outcomes in relation to patellofemoral overstuffing were included. Extracted data included patellofemoral overstuffing quantitative measurement method, outcome measurements, follow-up, patient demographics, author, and publication details. Descriptive analysis was provided for the available literature.

Results

  • There were six included articles with a total of 2325 TKAs assessed. All papers found no significant effect on clinical outcomes when the amount of PFJ overstuffing was within reason.

Conclusion

  • The amount of overstuffing that routinely takes place seems to be within tolerable limits and does not create a significant difference in clinical outcomes. Nevertheless, it is recommended to recreate the anatomic dimensions of the PFJ in order to best obtain a joint that is within this safe margin of error.

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Nicolás Franulic Hospital del Trabajador ACHS, Santiago, Chile
Hospital Militar de Santiago, Santiago, Chile

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José Tomas Muñoz Universidad de los Andes, Santiago, Chile

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Francisco Figueroa Hospital Sótero del Río, Santiago, Chile
Clínica Alemana - Universidad del Desarrollo, Santiago, Chile

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Piero Innocenti Hospital del Trabajador ACHS, Santiago, Chile

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Nicolás Gaggero Hospital del Trabajador ACHS, Santiago, Chile

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  • Lateral hinge fractures (LHF) are one of the most common complications of medial opening wedge high tibial osteotomy (MOWHTO), and are the leading cause of construct instability displacement, non-union, and varus recurrence after this procedure.

  • To date, Takeuchi’s classification is the most popular classification to describe this complication, and it can help surgeons to make intra and postoperative decisions.

  • Opening medial gap width is the most recognized factor related to LHF occurrence.

  • Recognizing the implications of LHF in patients’ clinical and radiographic results has led many authors to propose surgical tips and the use of osteosynthesis materials such as K-wires and screws for its prevention, which should be considered when identifying risk factors for LHF during preoperative planning.

  • The evidence for determining the optimal management of LHF is scarce and mostly supported by experts’ opinions and recommendations; therefore, studies are still needed to identify the most appropriate behavior when dealing with such a complication.

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Emanuele Diquattro Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Sonja Jahnke Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Medical School Brandenburg, Germany

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Francesco Traina Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Francesco Perdisa Department of Orthopaedics, Villa Erbosa Hospital, Bologna, Italy

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Roland Becker Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Medical School Brandenburg, Germany

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Sebastian Kopf Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Medical School Brandenburg, Germany

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  • Despite the general success of anterior cruciate ligament reconstructions (ACL-R), there are still studies reporting a high failure rate. Orthopedic surgeons are therefore increasingly confronted with the treatment of ACL retears, which are often accompanied by other lesions, such as meniscus tears and cartilage damage and which, if overlooked, can lead to poor postoperative clinical outcomes.

  • The literature shows a wide variety of causes for ACL-R failure. Main causes are further trauma and possible technical errors during surgery, among which the position of the femoral tunnel is thought to be one of the most important.

  • A successful postoperative outcome after ACL-revision surgery requires good preoperative planning, including a thorough evaluation of patient's medical history, e.g. instability during daily or sports activity, increased general joint laxity, and hints for a low-grade infection. A careful clinical examination should be performed. Additionally, comprehensive imaging is necessary. Besides a magnetic resonance imaging, a CT scan is helpful to determine location of tunnel apertures and to analyze for tunnel enlargement. A lateral knee radiograph is helpful to determine the tibial slope.

  • The range of surgical options for the treatment of ACL-R failure is broad today. Orthopedic surgeons and experts in Sports Medicine must deal with various possible associated injuries of the knee or unfavorable anatomical conditions for ACL-R.

  • The aim of this review was to highlight predictors and reasons of failures of ACL-R as well as describe diagnostic procedures to individualize treatment strategies for improved outcome after revision ACL-R.

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David Barrett School of Engineering Science, University of Southampton, United Kingdom
Instituto Clinico Citta Studi, Milan, Italy

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Angela Brivio Instituto Clinico Citta Studi, Milan, Italy
King Edward VII Hospital, London, UK

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  • The anterior part (third space) of the knee appears important in the soft tissue functional outcome following knee replacement surgery.

  • Native patellofemoral kinematics are complex and variable, and further understanding has led to prosthetic redesign.

  • Attention to soft tissue tension anteriorly (balancing the third space) during knee replacement may maximise post-operative function and avoid issues with understuffing and overstuffing.

  • Patellofemoral compression forces may now be measured dynamically during knee replacement, allowing an objective approach to balancing the third space.

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Sohrab Keyhani Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Mohammad Movahedinia Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Arash Sherafat Vaziri Center of Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran

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Mehran Soleymanha Orthopedic Surgery, Poursina Hospital Orthopaedic Research Center, Guilan University of Medical Sciences, Rasht, Iran

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Fardis Vosoughi Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

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Mohammad Tahami Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

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Robert F LaPrade Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA

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  • Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal.

  • Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures.

  • During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities.

  • The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications.

  • The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.

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Mark D Kohn Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington, USA

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Charles J Wolock Department of Biostatistics, University of Washington, Seattle, Washington, USA

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Isaac J Poulson School of Medicine, University of Washington, Seattle, Washington, USA

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Navin D Fernando Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington, USA

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Purpose

  • This investigation provides a rigorous systematic review of the postoperative outcomes of patients with and without chronic hepatitis C who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods

  • We queried PubMed, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science and the ‘gray’ literature, including supplemental materials, conference abstracts and proceedings as well as commentary published in various peer-reviewed journals from 1992 to present to evaluate studies that compared the postoperative outcomes of patients with and without chronic hepatitis C who underwent primary THA or TKA. This investigation was registered in the PROSPERO international prospective register of systematic reviews and follows the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In our literature search, we identified 14 articles that met our inclusion criteria and were included in our fixed-effects meta-analysis. The postoperative outcomes analyzed included periprosthetic joint infection (PJI), aseptic revision, non-homebound discharge and inpatient mortality.

Results

  • Our statistical analysis demonstrated a statistically significant increase in postoperative complications of patients with chronic hepatitis C who underwent primary THA or TKA including PJI (odds ratio (OR): 1.98, 95% CI: 1.86 – 2.10), aseptic revision (OR: 1.58, 95% CI: 1.50 – 1.67), non-homebound discharge (OR: 1.31, 95% CI: 1.28– 1.34) and inpatient mortality (OR: 9.37, 95% CI: 8.17 – 10.75).

Conclusion

  • This meta-analysis demonstrated a statistically significant increase in adverse postoperative complications in patients with chronic hepatitis C who underwent primary THA or TKA compared to patients without chronic hepatitis C.

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