The Knee via MedWorm.com

Instructions for Authors

The Knee — Mon, 30 Jan 2012 05:54:05 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Mon, 30 Jan 2012 05:54:05 +0100

(Source: The Knee)

Editorial Board

The Knee — Mon, 30 Jan 2012 05:54:05 +0100

(Source: The Knee)

Contents List

The Knee — Mon, 30 Jan 2012 05:54:05 +0100

(Source: The Knee)

Instructions for Authors

The Knee — Mon, 19 Dec 2011 16:45:20 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Mon, 19 Dec 2011 16:45:20 +0100

(Source: The Knee)

Editorial Board

The Knee — Mon, 19 Dec 2011 16:45:19 +0100

(Source: The Knee)

Contents list

The Knee — Mon, 19 Dec 2011 16:45:19 +0100

(Source: The Knee)

Instructions for Authors

The Knee — Fri, 04 Nov 2011 02:12:55 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Fri, 04 Nov 2011 02:12:55 +0100

(Source: The Knee)

The use of national databases for the analyses of knee arthroplasty

The Knee — Fri, 04 Nov 2011 02:12:53 +0100

(Source: The Knee)

Editorial Board

The Knee — Fri, 04 Nov 2011 02:12:53 +0100

(Source: The Knee)

Contents List

The Knee — Fri, 04 Nov 2011 02:12:53 +0100

(Source: The Knee)

Instructions for Authors

The Knee — Mon, 29 Aug 2011 19:48:18 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Mon, 29 Aug 2011 19:48:18 +0100

(Source: The Knee)

Editorial Board

The Knee — Mon, 29 Aug 2011 19:48:15 +0100

(Source: The Knee)

Contents List

The Knee — Mon, 29 Aug 2011 19:48:15 +0100

(Source: The Knee)

Instructions for Authors

The Knee — Wed, 25 May 2011 16:56:13 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Wed, 25 May 2011 16:56:13 +0100

(Source: The Knee)

Editorial Board

The Knee — Wed, 25 May 2011 16:56:10 +0100

(Source: The Knee)

Contents List

The Knee — Wed, 25 May 2011 16:56:10 +0100

(Source: The Knee)

Distal femoral dome varus osteotomy: Surgical technique with minimal dissection and external fixation

The Knee — Wed, 11 May 2011 04:00:00 +0100

Conclusions: The technique improves function and reduces pain while facilitating early rehabilitation in 83% of cases. (Source: The Knee)

Instructions for Authors

The Knee — Fri, 22 Apr 2011 21:21:25 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Fri, 22 Apr 2011 21:21:25 +0100

(Source: The Knee)

Editorial Board

The Knee — Fri, 22 Apr 2011 21:21:20 +0100

(Source: The Knee)

Contents List

The Knee — Fri, 22 Apr 2011 21:21:20 +0100

(Source: The Knee)

Common peroneal nerve palsy associated with pseudotumour after total knee arthroplasty

The Knee — Mon, 18 Apr 2011 04:00:00 +0100

Abstract: Pseudotumours about the hip as a result of metal-on-metal wear debris are now widely reported. Nerve palsies associated with such lesions are less commonly described. To our knowledge no previous reports exist which describe pseudotumours about a total knee arthroplasty. The case of a metal-on-metal debris-induced pseudotumour about a total knee arthroplasty with an associated common peroneal nerve palsy is presented. The use of serum ion levels is discussed, specifically for the early detection and diagnosis of full-thickness polyethylene liner wear and subsequent revision options. (Source: The Knee)

Maximal voluntary isokinetic knee flexion torque is associated with femoral shaft bone strength indices in knee replacement patients

The Knee — Fri, 15 Apr 2011 04:00:00 +0100

Abstract: It is currently unknown whether knee replacement-associated bone loss is modified by rehabilitation programs. Thus, a sample of 45 (18 men and 25 women) persons with unilateral knee replacement were recruited; age 66 years (sd 6), height 169 cm (sd 8), body mass 83 kg (sd 15), time since operation 10 months (sd 4) to explore the associations between maximal torque/power in knee extension/flexion and femoral mid-shaft bone traits (Cortical cross-sectional area (CoA, mm2), cortical volumetric bone mineral density (CoD, mg/mm3) and bone bending strength index (SSI, mm3)). Bone traits were calculated from a single computed tomography slice from the femoral mid-shaft. Pain in the operated knee was assessed with the WOMAC questionnaire. Stepwise regression models were built for the ope...

Influence of offset stem couplers in femoral revision knee arthroplasty: A radiographic study

The Knee — Fri, 15 Apr 2011 04:00:00 +0100

Abstract: We questioned whether the use of offset femoral stem would result in modifying the posterior femoral condylar offset (PFCO) in revision knee arthroplasty (RTKA). We measured both PFCO and stem alignment on lateral radiographs of two cohorts: 91 knees with straight stems and 35 knees with offset coupled stems. A higher PCOR was observed in knees with an offset stem compared to knees with straight stem. Knees with an offset stem had a better alignment within the intramedullary canal. Our conclusion is that the use of a modular offset coupler with femoral stem in RTKA compared to a modular straight stem both increases the posterior condylar offset and improves alignment of the stem within the intramedullary canal. (Source: The Knee)

The Genesis II in primary total knee replacement: A systematic literature review of clinical outcomes

The Knee — Fri, 15 Apr 2011 04:00:00 +0100

In conclusion, the Genesis II exhibited good clinical performance with up to 11years follow-up, with an encouraging rate of survival and improvement in function. Additional studies with larger sample sizes and longer follow-up periods are needed to better understand the long-term performance of this implant. (Source: The Knee)

Clinical and radiological results 21years following successful, isolated, open meniscal repair in stable knee joints

The Knee — Thu, 14 Apr 2011 04:00:00 +0100

The objective was therefore to analyze the clinical and radiological outcomes of successful, isolated, open meniscal repairs with an intact ACL after a mean follow-up of 20.6years (range, 16–25) retrospectively in 26 patients.Clinical evaluation included objective (Lysholm, IKDC, Tegner) and subjective scores. Standard radiological assessment according to Ahlbäck's osteoarthritis classification and weight-bearing full-leg radiography for alignment were performed. Eight patients were excluded due to a re-rupture of the meniscus.In the 18 remaining patients (12 male, 6 female), the mean Lysholm and IKDC score was 97.8 points (range, 85–100) and 93% (range, 77–100) at the most recent follow-up, respectively. The Tegner activity scale averaged 4.2 (range, 3–7). Subjectively, 13 patien...

Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture

The Knee — Mon, 11 Apr 2011 04:00:00 +0100

Abstract: The posterolateral shearing tibial plateau fracture is uncommon in the literature, however with the increased usage of computer tomography (CT), the incidence of these fractures is no longer as low as previously thought. Few studies have concentrated on this fracture, least of all using a biomechanical model. The purpose of this study was to compare and analyse the biomechanical characteristics of four different types of internal fixation to stabilise the posterolateral shearing tibial plateau fracture. Forty synthetic tibiae (Synbone, right) simulated the posterolateral shearing fracture models and these were randomly assigned into four groups; Group A was fixed with two anterolateral lag screws, Group B with an anteromedial Limited Contact Dynamic Compression Plate (LC-DCP), Gr...

Does computer navigation system really improve early clinical outcomes after anterior cruciate ligament reconstruction? A meta-analysis and systematic review of randomized controlled trials

The Knee — Mon, 04 Apr 2011 04:00:00 +0100

Abstract: Inaccurate tunnel placement is an important cause of failure in conventional anterior cruciate ligament (ACL) reconstruction. Controversy currently exists over the usefulness of computer-assisted navigation systems in addressing this problem. Five randomized or quasi-randomized, controlled trials comparing computer-navigated versus conventional technique in ACL reconstructions until December 1, 2009 were identified through a systematical database search. The clinical outcomes of the trials were analyzed by Lachman test, pivot-shift test, International Knee Documentation Committee knee score, Lysholm score, and Tegner score. Mean difference or risk ratio with 95% confidence interval was calculated using a fixed-effects or random-effects model. Heterogeneity across the studies was ...

Patellar instability with increased knee flexion due to lateral femoral condyle distal dysplasia: A report of two cases

The Knee — Mon, 28 Mar 2011 04:00:00 +0100

We present two case reports with clinical and radiological assessment of the anatomical features at the distal lateral end of trochlea and femur in patients with patellar instability in higher knee flexion and how these findings could possibly be involved in the genesis of this rare type of patellar instability. Both patients underwent several (nine and seven) surgical procedures, but the patellar instability could not be successfully eliminated. Our hypothesis was that a short and flattened lateral distal condyle/trochlea may cause lateral patellar instability in higher flexion. We found considerable anatomical variations at the distal lateral femoral condyle and trochlea in both patients. Individually tailored surgical procedures were selected for each patient according to the documented...

Primary sarcoma of the anterior cruciate ligament — A case report

The Knee — Mon, 28 Mar 2011 04:00:00 +0100

We report the first case of an intraarticular CCSTA, in this case of the anterior cruciate ligament and describe the diagnostic and treatment challenges of intraarticular tumours of the knee. (Source: The Knee)

Acute compartment syndrome of the thigh following total knee arthroplasty

The Knee — Mon, 21 Mar 2011 04:00:00 +0100

Abstract: A 62year old man developed a compartment syndrome of the thigh after total knee arthroplasty. Twelve years previously he had a HTO of the same knee complicated by a compartment syndrome of the calf. The clinical diagnosis was confirmed with intracompartmental pressure measurement. Following fasciotomy pressures were normalized and further course was uncomplicated. Compartment syndrome of the thigh is a rare, but potentially devastating, complication following total knee arthroplasty. A previous compartment syndrome of the calf is identified as a risk factor. (Source: The Knee)

Natural distribution of the femoral mechanical–anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty

The Knee — Mon, 28 Feb 2011 05:00:00 +0100

This study analysed 174 pre-operative hip–knee–ankle radiographs of osteoarthritic knees (157 patients, 87 female and 70 male, mean age 70years and mean BMI 31.8). Measurements of mechanical femorotibial (MFT) and FMA angles were made. The mean FMA angle was 5.7° (SD 1.2°, range 2° to 9°). There was a statistically significant difference between the FMA angle for males and females with males tending to have larger FMA angles (p (Source: The Knee)

Mobile bearing UKA compared to fixed bearing TKA: A randomized prospective study

The Knee — Wed, 23 Feb 2011 05:00:00 +0100

Abstract: We prospectively evaluated a consecutive series of 56 patients with unicompartmental knee arthritis who underwent unicompartmental knee replacement or total knee arthroplasty and received an average of 52months of follow-up. These patients were enrolled in a prospective randomized clinical trial. There were no significant differences in the pre-operative parameters of both groups. All the patients were followed up and evaluated preoperatively and yearly, the data was collected and statistical analysis was performed. At an average of 52months after surgery the mean Knee Society score was 80.5 (range: 70–100) and 78.9 (range: 70–87) for Unicompartmental knee replacement and total knee arthroplasty, mean range of postoperative motion for TKA is 1150±40 and 1170±70 for the grou...

Outcome of total knee arthroplasty combined patelloplasty for end-stage type A hemophilic arthropathy

The Knee — Tue, 22 Feb 2011 05:00:00 +0100

Abstract: The aim of this study was to retrospectively evaluate the outcome of total knee arthroplasty for end-stage hemophilic arthropathy, based on effectiveness of operation, the specificity of surgical technique, the complications of TKA operation and the strategy of handling of patella. Nineteen patients (25 knees) with type A hemophilic arthropathy were treated with TKA from June 2003 to February 2010. Average patella thickness was 16.3±0.4mm and all patellas were treated by patelloplasty. The patient followed up data was recorded, which included the information of hospital for special surgery knee score(HSS), range of motion(ROM), post-operative complication, and anterior knee pain. The patients were followed for an average post-operative period of 41months (10 to 78months). The me...

Oxidation and fusion defects synergistically accelerate polyethylene failure in knee replacement

The Knee — Thu, 17 Feb 2011 05:00:00 +0100

Abstract: We have previously reported upon a cohort of patients with premature failure of such material and postulated upon the impact of abnormally high concentrations of type 2 fusion defects whereby there is a lack of particle cohesion due to incomplete diffusion. In vivo oxidation has been purported to underscore the premature failure of polyethylene. The mechanism of such remains poorly delineated. New data has now been obtained by determining substrata oxidative profiles of 10 failed Kinemax Plus modular tibial insert analyses in conjunction with fusion defect detection. The full thickness of a series of cores was analysed using infra-red spectroscopy to identify higher levels of oxidation in loaded used material at both the articulating and non-articulating regions. A comparison was...

Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity — A quasi-randomized trial

The Knee — Mon, 14 Feb 2011 05:00:00 +0100

Abstract: The purpose of this study was to compare the tibial rotational stability of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during a high-demand activity. Total of 66 subjects, (22 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 22 healthy control individuals) were examined in this study. Using a 9-camera motion analysis system, motion subjects were recorded performing during a drop landing and cutting. Using the point cluster technique, the internal-external tibial rotation of both knees was calculated. The mean maximum range of motion for each knee was evaluated for 3 groups (double-bundle group, single-bund...

Instructions for Authors

The Knee — Sat, 12 Feb 2011 19:47:53 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Sat, 12 Feb 2011 19:47:53 +0100

(Source: The Knee)

Editorial Board

The Knee — Sat, 12 Feb 2011 19:47:50 +0100

(Source: The Knee)

Contents List

The Knee — Sat, 12 Feb 2011 19:47:50 +0100

(Source: The Knee)

A quantitative assessment of varus thrust in patients with medial knee osteoarthritis

The Knee — Tue, 08 Feb 2011 05:00:00 +0100

In this study, we measured the thrust quantitatively using skin markers and examined the relationship to other static and dynamic parameters. Forty-four knees in 32 patients (mean age, 72years; range, 64–81years) who exhibited the radiographic OA at least grade 2 according to the Kellgren–Lawrence (K–L) scale were enrolled. Gait analysis was performed for each patient to measure the amount of thrust and knee adduction moment. The amounts of thrust in subjects with K–L grades 2 (25 knees), 3 (13 knees), and 4 (6 knees) were 2.4°(±1.3°), 2.8°(±1.4°), and 7.2°(±5.3°), respectively and the knee adduction moments were 3.6(±1.5) %BW⁎Ht, 3.9(±1.2) %BW⁎Ht and 6.9(±2.2%) BW⁎Ht, respectively. The amount of thrust also exhibited significant correlation to static radiographic...

Metal hypersensitivity in total knee arthroplasty: Revision surgery using a ceramic femoral component — A case report

The Knee — Thu, 03 Feb 2011 05:00:00 +0100

We present a case involving the revision of a total knee arthroplasty with a metal femoral component using a ceramic implant due to metal hypersensitivity. A 58-year-old female patient underwent total knee arthroplasty (TKA) with a standard metal bicondylar knee system. She suffered from persistent pain and strong limitations in her range of motion (ROM) associated with flexion during the early postoperative period. Arthroscopic arthrolysis of the knee joint and intensive active and passive physical treatment, in combination with a cortisone regime, temporarily increased the ROM and reduced pain. No signs of low grade infection or other causes of implant failure were evident. Histology of synovial tissue revealed lymphoplasmacellular fibrinous tissue, consistent with a type IV allergic rea...

Gender differences in distal femoral morphology and the role of gender specific implants in total knee replacement: A prospective clinical study

The Knee — Mon, 31 Jan 2011 05:00:00 +0100

Abstract: Gender differences in distal femoral morphology may affect femoral component fit using a standard range of prostheses. The clinical relevance of this is controversial.Standardised measurements were taken from the distal femora of 50 males and 50 females during total knee replacement (TKR). Corresponding measurements were taken from the respective gender specific and standard femoral components. No demographic differences were noted.Significant differences in both frequency and magnitude existed in the medial-lateral femoral component overhang between the sexes. In females, standard implants overhung at the anterior flange width (AFW) by >2mm in 24/50 (48%) and by >3mm in 17/50 (34%) (p2mm and 24/50 (48%) by >3mm (p2mm in 1/50 (2%). In females, gender specific implants overhung by...

Can single limb support objectively assess the functional severity of knee osteoarthritis?

The Knee — Thu, 27 Jan 2011 05:00:00 +0100

Abstract: There is a lack in objective measurements that can assess the symptoms of knee osteoarthritis (KOA). In a previous study it was shown that pain and function are in higher correlation with the single-limb support gait parameter than with radiographic KOA stage. Single limb support represents a phase in the gait cycle when the body weight is entirely supported by one limb, while the contra-lateral limb swings forward. The purpose of this study was to further examine the relationship between single-limb support and the level of pain and function in patients with KOA. 125 adults with bilateral KOA underwent a physical and radiographic evaluation, and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the SF-36 health survey. Patients walked baref...

Role of the anterior intermeniscal ligament in tibiofemoral contact mechanics during axial joint loading

The Knee — Tue, 25 Jan 2011 05:00:00 +0100

Abstract: The anterior intermeniscal ligament (AIML) is an anatomically distinct structure that connects the anterior horns of the medial and lateral menisci. We hypothesized that both menisci work together as a unit in converting axial joint loading into circumferential hoop stresses, due to intermeniscal attachments. Therefore, loss of the AIML could lead to increased tibiofemoral contact stress and predispose to arthritic change. In this cadaveric study, we compared tibiofemoral contact pressures on axial loading, before and after sectioning of the AIML. Five fresh frozen human cadaveric knees were mounted on a linear x–y motion table and loaded in extension under axial compression of 1800N (about 2.5 times body weight for a 70kg individual), using a materials testing machine. Tibiofe...

The Twin Peg Oxford partial knee replacement: The first 100 cases

The Knee — Fri, 21 Jan 2011 05:00:00 +0100

We present the clinical results of the first 100 patients who received the Twin Peg Oxford partial knee replacement which has a 15° extra femoral surface for contact in deep flexion, and has two pegs for more secure fixation. We measured the clinical outcome 2years after the medial unicompartmental arthroplasty using patient and surgeon derived outcome measures. The results showed a mean Oxford Knee Score of 41, a mean American Knee Society Objective Score of 93 and a Functional Score of 84, a mean range of motion of 130° and a high satisfaction rate. Results were significantly better in male patients. There were no deaths, infections, dislocations, fractures or revisions. There were no pathological radiolucencies suggestive of early loosening. We conclude that the Twin Peg Oxford partia...

Magnetic resonance imaging study of alteration of tibiofemoral joint articulation after posterior cruciate ligament injury

The Knee — Thu, 13 Jan 2011 05:00:00 +0100

Abstract: Cadaveric studies have shown that the posterior cruciate ligament (PCL) is an important constraint to posterior translation of the tibia. Arthroscopic studies have shown that chronic PCL injuries predispose to articular cartilage lesions in the medial compartment and the patellofemoral joint. The aim of the present study was to investigate sagittal plane articulation of the tibiofemoral joint of subjects with an isolated PCL injury.Magnetic resonance was used to generate sagittal images of 10 healthy knees and 10 knees with isolated PCL injuries. The subjects performed a supine leg press against a 150N load. Images were generated at 15° intervals as the knee flexed from 0 to 90°. The tibiofemoral contact and the flexion facet centre (FFC) were measured from the posterior tibial...

A biomechanical comparison of tibial back side fixation between suspensory and expansion mechanisms in trans-tibial posterior cruciate ligament reconstruction

The Knee — Thu, 13 Jan 2011 05:00:00 +0100

Abstract: Soft tissue grafts have attracted increasing attention in anterior cruciate ligament (ACL) reconstruction and offer a number of advantages Therefore, it can also be attractive for trans-tibial PCL reconstruction, if four-strand hamstring or two-strand tibialis grafts could be converted for this use. We intended to investigate the biomechanical properties of fixation devices that are frequently used for the soft tissue graft in the trans-tibial PCL reconstruction.Thirty-six fresh adult porcine knees were used in this study. Porcine digital extensor tendons were used as two-stranded soft tissue grafts. The tibial side of the PCL was fixed using a bio-TransFix of suspensory mechanism (TransFix system®: Arthrex, Naples, FL, USA) device (group I) or a RIGIDFIX of expansion mechanism ...

Effects of cyclic loading on the tensile properties of human patellar tendon

The Knee — Mon, 10 Jan 2011 05:00:00 +0100

Abstract: Bone–patellar tendon-bone (BPTB) graft is a popular choice for ACL reconstruction. These grafts are subjected to cyclic loading during the activities of daily living. Significant knee laxity is observed in reconstructed knee shortly after reconstruction. The source of this laxity is not clear. The change in the tensile properties of the graft due to cyclic loading can be one of the reasons for the change in knee laxity.Twenty patellar tendons from fresh frozen cadaver knees were cyclically loaded at a stress amplitude equivalent to 33% of the failure strength of the contralateral patellar tendon for 5000 cycles at 1.4Hz. They were then tested in tension to failure. Failure properties and the low load properties such as toe-region modulus were calculated. The results were compar...

The Rotaglide mobile bearing knee arthroplasty: A 10- to 13-year review from an independent centre

The Knee — Mon, 10 Jan 2011 05:00:00 +0100

Abstract: The Rotaglide knee arthroplasty has a highly congruent mobile meniscal bearing allowing both rotation and antero-posterior translation. We reviewed 137 consecutive primary arthroplasties in 120 patients at mean 11.1years (10–12.9) following surgery. No cases were lost to follow-up. Hospital for Special Surgery (HSS) and American Knee Society (AKSS) scores were recorded at a review clinic. Radiographs were assessed using the Knee Society's roentgenographic evaluation system.Forty-two patients had died, leaving 78 patients (87 knees) available for review. Sixty-four patients (70 knees) were assessed at a clinic and in 14 (17 knees) clinical outcomes were obtained via telephone and their most recent radiographs were assessed. There were three cases of aseptic loosening and one dee...

Complications following anterior cruciate ligament reconstruction in the English NHS

The Knee — Mon, 10 Jan 2011 05:00:00 +0100

Abstract: Unlike the English National Joint Registry (NJR) for arthroplasty, no surgeon driven national database currently exists for ligament surgery in England. Therefore information on outcome and adverse events following anterior cruciate ligament (ACL) surgery is limited to case series. This restricts the ability to make formal recommendations upon surgical care. Prospectively collected data, which is routinely collected on every NHS patient admitted to hospital in England, was analysed to determine national rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE) rate, 30-day wound infection and readmission rates following primary ACL reconstruction between March 2008 and February 2010 (13,941 operations, annual incidence 13.5 per 100,000 English popu...

Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability

The Knee — Fri, 07 Jan 2011 05:00:00 +0100

We report a technique for the intra-operative production of an antibiotic-impregnated cement spacer, reinforced with an intramedullary nail. The spacer is designed for use in cases where significant bone loss and/or ligamentous instability prevent the formation of a stable joint when using a conventional spacer during a two-stage revision knee arthroplasty. This technique has been performed in eleven patients. Nine patients have subsequently undergone a second-stage procedure. Two patients died of unrelated causes before a second-stage could be performed. In all but one case, the infection has been successfully eradicated and patients remain infection free at a mean follow-up of 32months (range 21–64months). We believe that the described technique is an effective alternative to the tradi...

Patients' attitudes and factors in their selection of grafts for anterior cruciate ligament reconstruction

The Knee — Thu, 06 Jan 2011 05:00:00 +0100

Abstract: Surgeon recommendation is the primary influence for patients choosing a graft for their ACL reconstruction. However, it is unknown if demographic factors also play a role. We hypothesize that education, age, and living in an urban setting may influence a patient's graft choice. Patients who had an ACL reconstruction from 2005 to 2009 were identified retrospectively, and received a written survey on their demographics and the factors affecting graft choice. They also rated their perception of those factors based on a Likert scale. Out of 471 surveys distributed, 151 responses were received. The mean follow-up time was 19months (range, 1 to 63months). Autograft was used in 57%. Surgeon recommendation was the primary factor in graft choice (63%). 87.4% of patients felt they made the...

A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty

The Knee — Mon, 03 Jan 2011 05:00:00 +0100

This study compares the clinical and radiological outcomes of minimally invasive and conventional exposure TKA using a meta-analysis. A search of published and unpublished literature was performed. Eighteen studies including 1582 TKAs were reviewed: 822 minimally invasive versus 760 conventional exposure TKAs. The findings of this study suggest that whilst incision length was significantly smaller in MIS (p=0.001), and flexion range of motion was significantly greater following MIS (p=0.01), there was no statistically significant differences in all other clinical or radiological outcomes between MIS or conventional approach TKA surgery (p>0.05). (Source: The Knee)

Analysis of Revision Anterior Cruciate Ligament Reconstruction according to the combined injury, degenerative change, and MRI findings

The Knee — Mon, 27 Dec 2010 05:00:00 +0100

Abstract: The purposes of this study were to analyze the results of revision ACL reconstruction, and to determine the effects of pre-revision combined injuries, degenerative changes, and post-revision magnetic resonance imaging (MRI) findings on clinical results.Forty patients (41 operations) were enrolled in this study. Clinical results and stabilities were evaluated. Radiological results were evaluated using Fairbank scale. For the subgroup analysis, Fairbank scale and preoperative combined injuries were used. Follow-up MRIs were also available for 31(75.6%) patients and we searched for relations between MRI findings and clinical results.Significant improvements in subjective, objective scores (p (Source: The Knee)

Upright MRI in kinematic assessment of the ACL-deficient knee

The Knee — Fri, 17 Dec 2010 05:00:00 +0100

This study set out to establish the optimal method of measuring femoro–tibial relations in an upright, weight-bearing environment in normal individuals and those with ACL deficiency. Upright, load bearing, MRI scans of both knees were evaluated by two methods, flexion facet centre (FFC) and femoro–tibial contact point (FTCP), in order to establish femoro–tibial relations in the sagittal plane throughout different angles of knee flexion. A group of healthy volunteers (n=5) and a group with unilateral ACL insufficiency (n=8) were studied. Abnormal femoro–tibial relations were found in all ACL-deficient knees (n=8): the lateral tibial plateau was anteriorly displaced in extension and early flexion and, coupled with smaller changes in the medical compartment, this constitutes internal ...

Arthroscopic ACL reconstruction with reverse “Y”-plasty grafts and fixation in the femur with either a bioabsorbable interference screw or an Endobutton

The Knee — Wed, 15 Dec 2010 05:00:00 +0100

Abstract: We propose a new reverse “Y”-plasty graft for use in anterior cruciate ligament (ACL) reconstruction that involves double tibial tunnels and a single femoral tunnel. With this technique, the hamstrings were used as autografts and fixed separately with bioabsorbable interference screws (group A) or Endobuttons (group B) in femurs. A prospective series of 63 patients underwent primary reconstruction of the ACL; all procedures were performed by the same surgeon. Group A included 35 patients (22 male, 13 female), with a mean age of 25.5 (17–40) years, who were followed up for 28.5 (12–48) months. Group B included 28 patients (17 male, 11 female), with a mean age of 24.3 (18–38) years, who were followed up for 29.5 (12–46) months. Lysholm, International Knee Documentation ...

Instructions for Authors

The Knee — Tue, 14 Dec 2010 11:02:55 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Tue, 14 Dec 2010 11:02:55 +0100

(Source: The Knee)

Editorial Board

The Knee — Tue, 14 Dec 2010 11:02:51 +0100

(Source: The Knee)

Contents List

The Knee — Tue, 14 Dec 2010 11:02:51 +0100

(Source: The Knee)

Total knee arthroplasty following medial opening wedge tibial osteotomy: Technical issues early clinical radiological results

The Knee — Thu, 09 Dec 2010 05:00:00 +0100

Abstract: Medial opening wedge high tibial osteotomy is a popular treatment option for medial compartment osteoarthritis of the knee. One of the proposed advantages is easier conversion to a total knee replacement compared to lateral closing wedge osteotomies, although there are few studies to support this. We reviewed the technical considerations in 36 knees in which conversion of a medial opening wedge osteotomy to total knee arthroplasty was performed, and contrasted these to previously reported studies of knee arthroplasty after closing lateral wedge or dome osteotomies. The clinical results in 33 patients (34 knees) with minimum 2 year follow-up (mean 3.4years, range 2 to 8years) were compared to a control group of 1315 knee arthroplasties performed without prior tibial osteotomy. Tot...

Activity level recovery after arthroscopic PCL reconstruction: A series of 21 patients with a mean follow-up of 29months

The Knee — Thu, 09 Dec 2010 05:00:00 +0100

This study aims to describe and to evaluate the outcome of an arthroscopic PCL anterolateral bundle reconstruction using a quadriceps tendon autograft. Our hypothesis is that knee stability and function can be restored using this technique allowing patients to resume their pre-injury level of activity. Between 2005 and 2008, 21 consecutive patients underwent an isolated PCL reconstruction and were evaluated after a mean follow-up of 29months (range 12–48). The mean time from injury to surgery was 28months. All patients were assessed pre- and post-operatively using IKDC evaluation, Tegner and Lysholm scores. The differential laxity was measured radiologically using the Telos® stress device. Pre-operatively, no patients were classified A or B on the IKDC objective score. At last follow-up...

Simultaneous anterior cruciate ligament reconstruction and computer-assisted open-wedge high tibial osteotomy: A report of eight cases

The Knee — Mon, 06 Dec 2010 05:00:00 +0100

Abstract: Eight patients, aged 37–50years, with chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis and varus deformity underwent simultaneous arthroscopic ACL reconstruction and open-wedge high tibial osteotomy controlled by a computer navigation system.Despite preoperative planning, the surgeon may need to choose a different osteotomy site during the procedure, invalidating the previous plans. The intraoperative wire control for osteotomies is not precise. The navigation system can help obtain precise alignment during high tibial osteotomy.The average preoperative mechanical axis was 7.5 of varum (sd±1.17°), the average postoperative axis was 1.2° of valgus (sd±1.04°) (p (Source: The Knee)

Extra-articular patellar dislocation with vertical axis rotation

The Knee — Thu, 25 Nov 2010 05:00:00 +0100

We report a 19-year-old boy with extra-articular patellar dislocation, and a successful reduction was done by manipulation under local anesthesia. We believe that the mechanism of lateral vertical dislocation is the fulcrum mechanism. (Source: The Knee)

Distraction osteogenesis as a salvage method in infected knee megaprostheses

The Knee — Mon, 22 Nov 2010 05:00:00 +0100

We present two cases of infected knee hinged megaprostheses. Both were treated by prosthesis removal and debridement of all surrounding infected bone and soft tissue, followed by distraction osteogenesis for the bridging of the large bone defect which had resulted. Implant removal and surgical debridement were combined with Ilizarov frame application and femoral and tibial osteotomies in a one-stage procedure, for commencing distraction osteogenesis. After bone transportation was completed, arthrodesis of the knee in both cases was successful. Two years after completion of the treatment, both patients demonstrate a stable knee arthrodesis and a satisfactory clinical result. The described treatment plan represents an effective salvage method in cases of infected knee megaprostheses that can...

Unicompartmental knee arthroplasties implanted for osteoarthritis with partial loss of joint space have high re-operation rates

The Knee — Fri, 19 Nov 2010 05:00:00 +0100

Abstract: The indications and contraindications for unicompartmental knee arthroplasty (UKA) are controversial. The aim of the study was to determine the risk factors for re-operation in our practice. A series of 113 medial UKAs with mean follow-up of 63months were reviewed retrospectively. Pre-operatively all knees had radiographic or arthroscopic evidence of severe cartilage damage. The re-operation rate was not related to age, gender, arthroscopic finding or body mass index. It was related to the joint space on pre-operative standing weight bearing radiographs taken in extension. The re-operation rate was 6 (95% CI 2.1–17, P2mm rather than ≤2mm. It was 8 (95% CI 2.8–22.5, P40% of the thickness of the lateral space. The ratio of pre-operative joint spaces has a greater influence on...

Failures of the Dual Articular knee prosthesis due to fracture of the polyethylene post

The Knee — Fri, 19 Nov 2010 05:00:00 +0100

Abstract: The Dual Articular (DA) total knee replacement was designed for revision and complex primary knee arthroplasty. A number of these knees failed due to fracture of the polyethylene post. We aimed to identify the proportion of DA prostheses that failed in this manner in our hospital.The hospital database was interrogated to identify all patients undergoing revision total knee replacement under the care of one surgeon from 1995 to 2007. Case notes were then reviewed to collect information about the history surrounding the knee surgery, and determine the patient's weight at the time of surgery. Telephone follow-up was carried out to obtain complete contemporary data.Forty-eight prostheses were implanted into 39 patients (21 male, 18 female). Thirty-two of the prostheses were DA and of...

Translational and rotational knee joint stability in anterior and posterior cruciate-retaining knee arthroplasty

The Knee — Mon, 15 Nov 2010 05:00:00 +0100

This study investigated passive translational and rotational stability properties of the intact knee joint, after bicruciate-retaining bi-compartmental knee arthroplasty (BKA) and after posterior cruciate retaining total knee arthroplasty (TKA). Fourteen human cadaveric knee specimens were used in this study, and a robotic manipulator with six-axis force/torque sensor was used to test the joint laxity in anterior–posterior translation, valgus–varus, and internal–external rotation. The results show the knee joint stability after bicruciate-retaining BKA is similar to that of the native knee. On the other hand, the PCL-retaining TKA results in inferior joint stability in valgus, varus, external rotation, anterior and, surprisingly, posterior directions. Our findings suggest that, provi...

The use of the LARS artificial ligament to augment a short or undersized ACL hamstrings tendon graft

The Knee — Wed, 10 Nov 2010 05:00:00 +0100

Abstract: The aim of this study is to evaluate the midterm results of using Ligament Advanced Reinforcement System (LARS) artificial ligament for augmentation of the short ( (Source: The Knee)

Spontaneous dislocation of a mobile-bearing polyethylene insert after posterior-stabilized rotating platform total knee arthroplasty: A case report

The Knee — Tue, 09 Nov 2010 05:00:00 +0100

We describe a dislocation after Scorpio mobile-bearing total knee arthroplasty. This system is a rotating platform posterior-stabilized design and utilizes a single post as part of the metal tibial tray. Only one locking ring inside the socket of the polyethylene insert secures a tight connection with the post. Spontaneous dislocation between the polyethylene insert and the metal tray occurred at 22months post surgery while rising from the supine position with slight knee flexion. Operative findings revealed failure of the locking ring and the original insert was replaced with a thicker insert. Our case and a duplicated saw bone model demonstrated that failure of the locking system resulted in the dislocation of the insert. (Source: The Knee)

The use of intra-operative image intensifier control for the ACL surgeon

The Knee — Tue, 09 Nov 2010 05:00:00 +0100

Abstract: Tunnel placement during anterior cruciate ligament reconstruction surgery is an important factor in determining the outcome of surgery. Tibial and femoral tunnel placement depends on the experience of the operating surgeon in order to achieve an isometric graft position. We performed a case series to study how often tunnel placement was adequate, as perceived by the surgeon, and if intra-operative image guidance could improve tunnel position. Over 3years, a single surgeon and his team operated on 55 patients using single bundle patellar tendon bone or hamstring graft. The surgeon placed the guidewires where he felt they would achieve an isometric graft position. A transtibial jig was used for femoral tunnel positioning. At each step, the guidewires were checked using an image int...

A review of how to conduct a surgical survey using a questionnaire

The Knee — Tue, 09 Nov 2010 00:00:00 +0100

Abstract: Health surveys using questionnaires facilitate the acquisition of information on the knowledge, behaviour, attitudes, perceptions and clinical history of a selected population. Their internal and external validities are threatened by poor design and low response rates. Numerous studies have investigated survey design and administration but care should be taken when generalising findings in different clinical and cultural settings. The current evidence-base suggests that no single mode of survey administration, such as postal, electronic or telephone, is superior to another. Whilst there is no evidence of an ideal response rate relationship to survey validity, response rates can be enhanced by including monetary incentives, providing a time cue, and repeat contact with non-respond...

The early results of gender-specific total knee arthroplasty in Thai patients

The Knee — Tue, 02 Nov 2010 04:00:00 +0100

Abstract: We prospectively evaluated a consecutive series of 314 patients (265 females and 49 males) who underwent unilateral TKA and received an average of 2years of follow-up. In all patients, a standard (STD) or a gender-specific (GS) femoral component was selected based on the presentation of intra-operative medio-lateral overhanging of the femoral cutting guide over the femoral condyle. There were no significant differences in the pre-operative parameters of both groups. At the last follow-up, both STD and GS groups had similarly improved KS clinical scores (92.9 vs. 92.1 points), function scores (89.5 vs. 89.7 points) and ROM (133.5° vs. 134.1°) with no difference in the rate of lateral retinacular release. The overall percentage of the GS component selection was 52.5% (165/314) an...

Two cases of synovial haemangioma of the knee joint: Gd-enhanced image features on MRI and arthroscopic excision

The Knee — Mon, 01 Nov 2010 04:00:00 +0100

Abstract: Synovial haemangioma of the knee joint is a relatively rare benign condition with around 200 reported cases. We have recently encountered two cases of synovial haemangioma of the knee joint which preoperative MRI had assessed as highly suspect and which arthroscopic resection and subsequent histological examinations confirmed as synovial hemangiomas. Published studies have identified the following as characteristic MRI features of synovial haemangioma: homogenous low intensity to iso-intensity on T1 sequence; and heterogeneous high intensity with low-intensity septa or spots within the lesion on T2 sequence. However, several other intra-knee disorders mimic these characteristics. In our two cases, we found that gadolinium (Gd)-enhanced images, which have been relatively rarely di...

A randomised controlled trial investigating the effect of posterior capsular stripping on knee flexion and range of motion in patients undergoing primary knee arthroplasty

The Knee — Mon, 01 Nov 2010 04:00:00 +0100

In this study, it was hypothesised that stripping of the posterior knee capsule could improve flexion and range of motion (ROM) following TKA.Patients who were undergoing TKA were prospectively randomised into two groups — one group (62 patients) were allocated stripping of the posterior knee capsule (PCS), the other group (66 patients) no stripping (no-PCS).The primary outcome was change in flexion and ROM compared to pre-operative measurements at three time points; after wound closure, 3months and 1year post-operatively. Secondary outcomes were absolute measurements of flexion, extension, ROM and complications. All operations were performed by a single surgeon using the same implant and technique. All patients received identical post-operative rehabilitation.There was a significant gai...

Opening- or closing-wedged high tibial osteotomy: A meta-analysis of clinical and radiological outcomes

The Knee — Mon, 01 Nov 2010 04:00:00 +0100

Abstract: High tibial osteotomy (HTO) has been advocated for the treatment of isolated medial compartment osteoarthritis of the knee. Debate remains over the superiority of performing a medial opening-wedge or lateral closing-wedge HTO. The purpose of this study was to compare the clinical and radiological outcomes, and complications of patients following opening-wedge compared to closing-wedge HTO. A systematic review was undertaken of published and unpublished literature databases from their inception to May 2010. Twelve papers reporting nine clinical trials were found to be suitable for meta-analysis comparing 324 opening-wedge HTOs to 318 closing-wedge HTOs. There was no difference in the incidence of infection, deep vein thrombosis, peroneal nerve palsy, non-union or revision to knee ...

Comparative outcome analysis of malpositioned and properly positioned fixation groups after hamstring autograft ACL reconstruction with femoral cross-pin fixation

The Knee — Mon, 01 Nov 2010 00:00:00 +0100

This study showed that some malpositions can occur with cross-pin femoral fixation. However, we obtained comparable good outcomes regardless of the fixation strategies if the initial fixation was correct. (Source: The Knee)

Instructions for Authors

The Knee — Sun, 24 Oct 2010 06:56:45 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Sun, 24 Oct 2010 06:56:45 +0100

(Source: The Knee)

Editorial Board

The Knee — Sun, 24 Oct 2010 06:56:43 +0100

(Source: The Knee)

Contents List

The Knee — Sun, 24 Oct 2010 06:56:43 +0100

(Source: The Knee)

An intraoperatively moulded PMMA prostheses like spacer for two-stage revision of infected total knee arthroplasty

The Knee — Fri, 15 Oct 2010 04:00:00 +0100

We report a series of 16 consecutive total knee arthroplasty (TKA) revision procedures for deep infection, treated with a newly developed intraoperatively moulded PMMA cement-prostheses-like spacer (CPLS). The standard treatment consisted of a two-stage protocol with initial explantation of the infected components combined with radical debridement, followed by implantation of a temporary cement spacer and final reimplantation of a new TKA. A sterilizeable Teflon tapered aluminium mould was developed for production of a custom made CPLS during the intervention. Stable implantation of the CPLS was achieved with a second cementation, allowing for correct alignment and ligament balancing. The spacer remained 3.5months on average until reimplantation of a TKA occurred. At time of reimplantation...

Intra-operative navigation of knee kinematics and the influence of osteoarthritis

The Knee — Thu, 14 Oct 2010 23:00:00 +0100

Summary: Intra-operative assessment of knee kinematics should optimise implantation of total knee arthroplasties. The purpose of this work was to validate the data delivered by an adapted navigation system in 10 healthy cadaver knees and to investigate the kinematics of 10 osteoarthritic (OA) knees in patients undergoing total knee replacement. The system displayed the magnitude of axial rotation, the position of the instantaneous centre of axial rotation and the displacements of the condyles. Successive cycles from full extension to 140° of flexion in the same knee produced a mean external rotation of 20°±10°, which was correlated to knee flexion (r=0.6±0.2 in healthy knees, r=0.8±0.2 in OA knees). The centre of axial rotation migrated posteriorly an average of 8.2mm in both groups....

The pathology of the end-stage osteoarthritic lesion of the knee: Potential role in cartilage repair

The Knee — Mon, 11 Oct 2010 04:00:00 +0100

Abstract: The purpose was to explore whether there were any pathological characteristics of the end-stage osteoarthritic sclerotic lesion that have potential to participate in cartilage repair.Specimens harvested following total knee surgery were examined for gross pathology including staining with Safranin O. Multiple small sections of the lesion were placed in tissue culture for 6weeks. Gross examination and photographic documentation was made at 3 and 6weeks. At 6weeks the specimens from culture were subject to histological examination. The pathology of the end-stage osteoarthritic lesion showed sclerotic bone, dead osteons, hypervascularity and scattered cartilaginous aggregates. Additional observations showed multiple pitting on the sclerotic surface, which histologically was related ...

Quantification of the difference between 3D CT and plain radiograph for measurement of the position of medial unicompartmental knee replacements

The Knee — Tue, 05 Oct 2010 23:00:00 +0100

Abstract: The aim of this study was to quantify the differences in measurements obtained from 3D Computed Tomography and plain radiograph, for the positioning of the tibial component of the Oxford unicompartmental knee replacement.Post-operative 3D Computed Tomography data and plain radiographs (long antero-posterior (AP) and short lateral) were obtained for 28 knees of patients who had undergone medial unicompartmental knee replacement. Parameters of the orientation/positioning of the tibial component: Varus/valgus, posterior tibial slope and rotation were measured with both modalities. Bland–Altman plots were used to calculate the 1.96 standard deviation limits of agreement (LOA) between imaging modalities. Intra class correlation was used to assess inter-method and inter-rater reliabi...

Bilateral total knee replacement in a congenital amputee with bilateral fibular deficiency

The Knee — Tue, 28 Sep 2010 04:00:00 +0100

We present the first ever reported case of bilateral total knee replacements in a congenital amputee with bilateral fibular deficiency. A 60year old woman with bilateral fibular hemimelia presented with advanced osteoarthritis in both her knees for which bilateral total knee replacements was performed. The left knee replacement was followed up at 12months and the right knee at 7years. Oxford knee scores improved from 14 to 40 for the left knee and were 37 for the right knee. She was able to walk independently to a distance beyond 400 m. Modification in the surgical procedure and postoperative rehabilitation is discussed. Mid-term follow-up of 7years reaffirms total knee replacement as a viable option for below knee amputees with knee osteoarthritis. (Source: The Knee)

Matched-pair total knee arthroplasty retrieval analysis: Oxidized zirconium vs. CoCrMo

The Knee — Tue, 28 Sep 2010 04:00:00 +0100

Abstract: Oxidized zirconium (OxZr) was introduced to serve as a ceramic surface for femoral components in TKA. The aim of this study was to compare retrieved OxZr components and corresponding PE inserts in matched comparison with conventional cobalt/chrome/molybdenum alloy (CoCrMo).Eleven retrieved posterior stabilized TKA with an OxZr femoral component were included. This included 6 implants from an earlier preliminary study. From a cohort of 56 retrieved TKA with conventional CoCrMo femoral components, pairs were matched according to duration of implantation, patient age, reason for revision, and BMI. Polyethylene inlays and femoral components were optically scored for in vivo damage.The average damage score of the tibial PE inserts was significantly lower with OxZr components (p=0.01)....

Cross-cultural adaptation of the Greek version of the Knee Outcome Survey – Activities of Daily Living Scale (KOS-ADLS)

The Knee — Tue, 28 Sep 2010 04:00:00 +0100

Abstract: The purpose of this study was to cross-culturally adapt and validate the Greek version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), a self-reported instrument used for patients with various knee pathological conditions including osteoarthritis. Ninety-four patients (57 males and 37 females) with a variety of pathological knee disorders and impairments being referred to physical therapy for evaluation and treatment were included in the study. For the crοss-cultural translation, a back-translation procedure was utilized by 3 bi-lingual translators. To assess test–retest reliability the patients were asked to complete the KOS-ADLS twice at initial visit; before and after physiotherapy treatment. To assess responsiveness, patients completed the KOS-ADLS at t...

The photographic knee pain map: Locating knee pain with an instrument developed for diagnostic, communication and research purposes

The Knee — Mon, 20 Sep 2010 04:00:00 +0100

Abstract: Pain maps are used to determine the location of pain. Knee pain maps have previously been described, but only one study has reported on reliability and none report validity. The present study describes the generation of a photographic knee pain map (PKPM) together with its validity and reliability. A photographic representation of a pair of knees was chosen by 26 patients, (66.7%) from a group of 39. The selected photograph was modified and a template of anatomical zones was generated. The opinions of 25 independent subject matter experts were canvassed and validity ratios calculated for these zones, ranged from 0.28 to 0.84. Hypothetical comparisons were made between the PKPM and an alternative knee pain map, in a cross-sectional group of 26 patients (35 knees). Convergent patte...

The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity

The Knee — Fri, 17 Sep 2010 04:00:00 +0100

Abstract: Information concerning the abilities of radiographic parameters to predict the symptoms of advanced osteoarthritis (OA) of the knee would be valuable, because plain knee radiographs are used as one of the primary tools for the selection of treatment modalities. We aimed to identify the radiographic predictors of symptom severity in patients with varus knee OA advanced enough to warrant total knee arthroplasty (TKA). In 341 knees with primary varus OA warranting TKA, pertinent radiographic features of the medial and lateral tibiofemoral joint (TFJ), and the patellofemoral joint (PFJ) were assessed separately and scored. In addition, TF alignment was assessed on standing full-limb radiographs. Symptoms and functions were evaluated using WOMAC pain and function scores. In the univar...

A meta-analysis of hamstring autografts versus bone–patellar tendon–bone autografts for reconstruction of the anterior cruciate ligament

The Knee — Thu, 16 Sep 2010 23:00:00 +0100

The objective of this study was to evaluate the effectiveness of hamstring (HT) autografts versus bone–patellar tendon–bone (BPTB) autografts for reconstruction of the anterior cruciate ligament (ACL). We searched the Cochrane Library, MEDLINE, EMBASE and the Chinese Biomedicine Database (CBM) for published randomised clinical trials (RCTs) relevant to ACL reconstruction comparing HT and BPTB autografts. Data analyses were performed with Cochrane Collaboration's RevMan 5.0. A total of 23 reports of 19 randomised controlled trials (RCTs) (1643 patients) met the inclusion criteria. Outcomes favouring BPTB autografts were found in terms of KT-1000 arithmometer values, negative rates of Lachman tests and negative rates of Pivot tests. Outcome measures that favoured HT autografts included a...

Sequential versus automated cutting guides in computer-assisted total knee arthroplasty

The Knee — Thu, 16 Sep 2010 04:00:00 +0100

Abstract: The accuracy and efficiency of automated cutting guides in CAS systems have not been previously compared with conventional CAS techniques. Therefore, it is not yet clear if these more advanced technologies are warranted. We hypothesized that a novel automated cutting guide with CAS for total knee arthroplasty would be more efficient and more accurate than conventional navigation with sequential cutting blocks. Twelve cadaver legs were used in total. Each leg was randomly assigned to either an automated guide positioning or a conventional freehand computer-navigated guide positioning. The guide positions postosseous fixation and the final bone-cut surfaces were digitized and compared to the targeted cutting planes. The final location of the impacted trial implant was also digitize...

Recurrent dissociation of the tibial insert after mini-subvastus posterior-stabilized total knee arthroplasty: A case report

The Knee — Tue, 14 Sep 2010 04:00:00 +0100

We report here on an unusual case of recurrent dissociation of a polyethylene tibial insert from its metal baseplate after high-flex posterior-stabilized (PS) Genesis II total knee arthroplasty with using the mini-subvastus approach. After the 1st episode of dissociation, which had happened 1month after the primary surgery, we changed the tibial insert and found damages on the dovetails and the post of the retrieved insert. Unfortunately, the patient suffered the same dissociation 1month after the tibial insert was changed. This case illustrates that incomplete seating of the insert due to limited surgical exposure and anterior impingement of the high-flex PS post may contribute to the risk of dissociation. (Source: The Knee)

The effectiveness of minimally invasive total knee arthroplasty to preserve quadriceps strength: A randomized controlled trial

The Knee — Tue, 14 Sep 2010 04:00:00 +0100

Abstract: We performed a single-center, randomized, double-blind study to compare muscle strength in patients who had undergone primary total knee arthroplasty (TKA), performed using either a minimally invasive or a conventional surgical technique. We evaluated 30 knees in healthy age-matched subjects, 22 knees after conventional TKA (conventional group), and 23 knees after minimally invasive surgery TKA (MIS group). The Hospital for Special Surgery (HSS) score, Oxford knee score (OKS), and isokinetic (60º/s) muscle strength were evaluated the day before surgery and 3, 6, and 12months after surgery. HSS and OKS improved significantly over time during follow-up (p0.05). The extensor peak torque (EPT) and flexor peak torque (FPT) improved significantly over time (p (Source: The Knee)

Three-dimensional kinematics during deep-flexion kneeling in mobile-bearing total knee arthroplasty

The Knee — Tue, 14 Sep 2010 04:00:00 +0100

Abstract: We performed an in vivo radiographic analysis of tibiofemoral and polyethylene (PE) insert motions during weight-bearing kneeling beyond 120° of flexion in one high-flexion knee arthroplasty design to determine if kinematics changed over time and if axial rotation occur between the PE insert and the tibial baseplate. Twenty knees implanted with a posterior-stabilized rotating-platform (RP) knee arthroplasty were postoperatively evaluated at 3, 6, and 12months. The averaged flexion angles were 122°, 129°, and 131° at 3, 6, and 12months, respectively, showing that the improvement of flexion was achieved up to 6months. The femoral condyles translated posteriorly from extension to maximum flexion. There was a significant increase in AP translation of femoral lateral condyle in th...

Technical note: Easy graft passage without posterior portals in PCL reconstruction

The Knee — Fri, 10 Sep 2010 04:00:00 +0100

Abstract: Graft passage during arthroscopically assisted, single-bundle transtibial PCL reconstruction is a technically demanding surgical procedure. We propose the use of a so called Deschamps clamp, originally designed for cerclage wire transport, in combination with a meniscal repair needle with an eye. This facilitates easy passage of a pull-through needle and obviates extensive debridement of the tibial insertion. Posterior portals are not needed. (Source: The Knee)

Secondary signs on static stress MRI in anterior cruciate ligament rupture

The Knee — Mon, 06 Sep 2010 23:00:00 +0100

Abstract: The MRI diagnosis of ACL rupture based on primary signs has variable rates of diagnostic accuracy. These signs observed on direct visualisation of the ACL include discontinuity of fibres, abnormal ligament contour and increased intrasubstance signal intensity. Secondary radiological signs of ACL rupture are increasingly being used. These indirect ancillary signs include PCL angle, translocation of the tibia relative to the femur and displacement of the posterior horns of the menisci. The aim of this study was to investigate if the application of static stress force to the knee will accentuate the secondary signs of ACL rupture on MRI.One hundred and forty-eight subjects (50 subjects with arthroscopically confirmed ACL rupture, 48 subjects with arthroscopically confirmed intact AC...

The importance to including objective functional outcomes in the clinical follow up of total knee arthroplasty patients

The Knee — Sun, 05 Sep 2010 23:00:00 +0100

This study investigated the suitability of AGA for measuring function in orthopaedic patients with symptomatic gonarthrosis listed for total knee arthroplasty (TKA) by investigating (a) the ability of AGA to distinguish patients from healthy subjects, (b) the sensitivity to gait changes of AGA in assessing recovery following total knee arthroplasty in a subpopulation, and (c) correlations between AGA parameters and clinical scales. Gait was assessed using AGA in 24 patients with symptomatic gonarthrosis listed for TKA, and in 24 healthy subjects. AGA parameters (e.g. speed, asymmetry) and clinical scales (e.g. KSS) were used to monitor progress in 12 patients 3months after TKA. The Mann–Whitney-U test, Receiver Operating Characteristic (ROC) curves, repeated measurement ANOVA and Pearson...

Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation

The Knee — Tue, 31 Aug 2010 23:00:00 +0100

Abstract: Despite several advantages of medial opening wedge high tibial osteotomy, this procedure has been noted to have a high rate of complications especially with the use of a spacer plate for fixation. We retrospectively evaluated the early complications of 138 medial opening wedge high tibial osteotomies done using autologous tricortical iliac bone graft and T-plate fixation(AO locking compression T-plate, Ti/3H 4.5–5.0mm, Synthes, Switzerland, Model No. 440.131 in 30 and low-profile locking T-plate and low-profile locking T-plate in 128 patients.At a mean follow-up of 36.8months (13 to 78), 26 knees (18.8%) developed complications. Complications varied from osteotomy site infection, loss of correction, broken screws and lateral tibial plateau fracture to joint fluid leakage, pseud...

Delayed intra-articular migration of the IntraFix outer sheath after anterior cruciate ligament reconstruction: A case report

The Knee — Sun, 29 Aug 2010 23:00:00 +0100

We describe a case of foreign body synovitis caused by delayed intra-articular migration of the outer sheath 5months after anterior cruciate ligament (ACL) reconstruction with a quadrupled tibialis allograft tendon using the IntraFix device for tibial fixation. The postoperative course was unremarkable. At 5months after surgery, the patient experienced a sudden catching sensation and a slight pain without any obvious twisting or trauma. At 6months after surgery, extension deficit was 20°. At arthroscopy, intra-articular migration of the outer sheath from the tibial tunnel and reactive synovitis were observed. The outer sheath in the joint and the inner screw in the tibial tunnel were removed successfully. The ACL graft was well incorporated under good tension. Patient was able to return t...

Preoperative proprioceptive training in patients with total knee arthroplasty

The Knee — Sun, 29 Aug 2010 23:00:00 +0100

Abstract: Proprioceptive deficiencies due to osteoarthritis and arthroplasty have been repeatedly reported. Proprioceptive training, which leads to an economisation of movements and supports energy-saving movement patterns, has become popular in athletes, but not in rehabilitation yet. The aim of this randomised phase IIb study was to evaluate whether preoperative proprioceptive training would influence postoperative balance and function in activities of daily life in patients undergoing total knee arthroplasty. Subjects with severe osteoarthritis of the knee scheduled for TKA were randomised to either a control group (CG) or a training group (TG). All patients were examined 6 weeks before and 6 weeks after TKA, patients of the TG also one day before surgery, i.e. after six weeks of preope...

Predicting dynamic knee joint load with clinical measures in people with medial knee osteoarthritis

The Knee — Sun, 29 Aug 2010 23:00:00 +0100

This study aimed to determine the ability of a combination of four clinical measures to predict KAM values.Three-dimensional motion analysis was used to calculate the peak KAM at a self-selected walking speed in 47 consecutive individuals with medial compartment knee OA and varus malalignment. Clinical predictors included: body mass; tibial angle measured using an inclinometer; walking speed; and visually observed trunk lean toward the affected limb during the stance phase of walking. Multiple linear regression was performed to predict KAM magnitudes using the four clinical measures. A regression model including body mass (41% explained variance), tibial angle (17% explained variance), and walking speed (9% explained variance) explained a total of 67% of variance in the peak KAM.Our study ...

Shod landing provides enhanced energy dissipation at the knee joint relative to barefoot landing from different heights

The Knee — Fri, 27 Aug 2010 04:00:00 +0100

This study sought to investigate biomechanical differences, in terms of knee kinematics, kinetics and energetics, between barefoot and shod landing from different heights. Twelve healthy male recreational athletes were recruited and instructed to perform double-leg landing from 0.3-m and 0.6-m heights in barefoot and shod conditions. The shoe model tested was Brooks Maximus II. Markers were placed on the subjects based on the Plug-in Gait Marker Set. Force-plates and motion-capture system were used to capture ground reaction force (GRF) and kinematics data respectively. 2×2-ANOVA (barefoot/shod condition×landing height) was performed to examine differences in knee kinematics, kinetics and energetics between barefoot and shod conditions from different landing heights. Peak GRF was not sig...

Human fetal anatomy of the posterior semimembranosus complex at the knee with special reference to the gastrocnemio-semimembranosus bursa

The Knee — Thu, 26 Aug 2010 23:00:00 +0100

We examined histological sections (transverse or sagittal) of the right or left knee in 13 mid-term human fetuses (12–25weeks of gestation). The medial head of the gastrocnemius provided an aponeurosis facing or attached to the muscles of the pes anserinus by 12weeks of gestation. The peritendinous tissue of the semimembranosus provided a bursa continuous with a laterally extending plate-like tissue by 15weeks, but sometimes the typical bursa was absent. The aponeurosis of the medial head consistently accompanied a bursa-like space (false bursa) surrounded by heterogenous structures including the popliteus and a wall of the semimembranosus bursa. Sagittal sections displayed notches on the medial head surface that received the semimembranosus and semitendinosus overriding the medial head ...

Investigating meniscal symptoms in patients with knee osteoarthritis—Is MRI an unnecessary investigation?

The Knee — Thu, 26 Aug 2010 23:00:00 +0100

Abstract: The aim of this study was to evaluate the relationship between radiographic knee osteoarthritis and the presence of a relevant meniscal tear detected on MRI in symptomatic patients over the age of 60.Seventy seven patients over the age of 60 who had been investigated with a knee MRI over a 1-year period were identified. Sixty patients had a full set of data available for analysis. Their plain radiographs were blindly graded for osteoarthritis using the Kellgren–Lawrence (K–L) scale. The indications for the MRI were subdivided into: meniscal symptoms, general knee pain and “other”. These indications were correlated with the K–L grade and result of the MRI.Overall, 40% of patients with a K–L grade of 0 had a meniscal tear compared to 89% of patients with a K–L score o...

Instructions for Authors

The Knee — Tue, 24 Aug 2010 07:17:58 +0100

(Source: The Knee)

British Association for Surgery of the Knee

The Knee — Tue, 24 Aug 2010 07:17:58 +0100

(Source: The Knee)

Editorial Board

The Knee — Tue, 24 Aug 2010 07:17:56 +0100

(Source: The Knee)

Contents List

The Knee — Tue, 24 Aug 2010 07:17:56 +0100

(Source: The Knee)

Human anterior cruciate ligament fibroblasts from immature patients have a stronger in vitro response to platelet concentrates than those from mature individuals

The Knee — Sun, 22 Aug 2010 23:00:00 +0100

Abstract: A number of recently published studies have established a substantial age dependence of the response of ACL fibroblasts to stimulation by platelet-rich plasma (PRP). Further in-depth research of this age dependence revealed negative effects on both histological and biomechanical results in a large animal model. However, while it has been postulated that this association could affect potential human applications negatively too it remains to be proven that the same effects occur in human cells. Thus it was the objective of this study to search for age dependence in human fibroblasts before further human experiments are done. Human fibroblasts were obtained from 10 immature and adolescent patients, based on a-priori power calculations, and cultured in a collagen-PRP composite. Three...

A case of anterior cruciate ligament tear accompanied by avulsion fractures of tibial tuberosity and Gerdy's tubercle

The Knee — Thu, 19 Aug 2010 04:00:00 +0100

Abstract: A 54-year-old man visited our clinic due to a painful swelling of his right knee. He had attempted a forceful kick by his right leg during a Sepak Takraw-like sports activity, only to fail to hit the ball. He felt a popping sense on the knee and collapsed, even without direct trauma. Imaging studies revealed a disruption of the anterior cruciate ligament (ACL), and separate avulsion fractures of the tibial tuberosity and Gerdy's tubercle. The fractures were stabilized by two cancellous screws, respectively. The intra-operative fluoroscopy demonstrated a manifest ACL insufficiency. A simultaneous reconstruction of the ligament was not performed. At 6months after surgery, he had no difficulty in his activities of daily living. The involved knee joint was believed to have undergone ...

Computer assisted knee arthrodesis in a primary case of septic arthritis: A case report

The Knee — Thu, 19 Aug 2010 04:00:00 +0100

We report a case of a 78year old patient with primary septic arthritis who was treated with knee arthrodesis using computer navigation. Use of computer navigation avoided violating the medullary canal and its associated risks. Also, it offered the advantage of making precise bone cuts in all the three planes, thus minimizing the risk of malalignment. At 3months, our patient showed good appositional contact of the bone ends, stable fusion, with no sign of infection and was mobilized with a simple brace. At 6months review, the patient was walking painlessly without support. We achieved a mechanical axis alignment of 0° and 11° flexion as planned. (Source: The Knee)

A case for one-stage revision in infected total knee arthroplasty?

The Knee — Thu, 19 Aug 2010 00:00:00 +0100

This article reviews the literature of two-stage and single stage revision and reports the senior author's experience with the latter. (Source: The Knee)

3D representation of the surface topography of normal and dysplastic trochlea using MRI