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1.
Ryo Shimizu Nobuo Adachi Minoru Ishifuro Atsuo Nakamae Masakazu Ishikawa Masataka Deie Mitsuo Ochi 《The Knee》2017,24(5):1055-1066
Background
The purpose of this study was to evaluate bone tunnel changes following anterior cruciate ligament (ACL) reconstruction during the early postoperative period using computed tomography (CT), and to understand the impact of postoperative immobilization on these changes.Methods
Twenty patients who underwent double-bundle ACL reconstruction using hamstring tendon autografts were included. We subcategorized patients into two groups: patients who underwent isolated ACL reconstruction and had three days of knee immobilization (Group A, n = 10); and patients with concomitant meniscus injuries who underwent ACL reconstruction and meniscus repair simultaneously (Group B, n = 10) had their knees immobilized for two weeks after surgery. Bone tunnel enlargement was evaluated using CT imaging at one to three days, two weeks, one month, three months and six months after surgery. The cross-sectional area of the femoral and tibial tunnels was measured, and enlargement rate was calculated. The tunnel center location at two weeks after surgery was also evaluated.Results
The mean cross-sectional area adjacent to the joint space of the femoral and tibial tunnels significantly increased immediately after surgery, especially in the first month (P < 0.01). However, after one to six months they were not increased (P > 0.01). There was no significant difference in tunnel enlargement rate between group A and B. Tunnel center location changed even in the first two weeks.Conclusions
Bone tunnel enlargement following double-bundle ACL reconstruction occurred at an earlier time point after surgery than anticipated. Postoperative immobilization could not prevent bone tunnel enlargement, but might prevent tunnel migration. 相似文献2.
Makoto Asaeda Masataka Deie Naoto Fujita Yoshifumi Kono Chiaki Terai Wataru Kuwahara Hodaka Watanabe Hiroaki Kimura Nobuo Adachi Toru Sunagawa Mitsuo Ochi 《The Knee》2017,24(2):280-288
Background
The aim of our study was to evaluate the effects of gender on recovery of knee joint biomechanics over the stance phase of gait after reconstruction of the anterior cruciate ligament (ACL).Methods
Gait parameters and knee joint kinematics and kinetics were compared in 32 patients (16 male and 16 female) who underwent ACL reconstruction for a unilateral ACL deficiency, with comparison to an age-, height-, and weight-matched Control group. Knee flexion, adduction and tibial rotation angles were measured and knee extension and abduction moment was calculated by inverse dynamics methods.Results
Females exhibited more tibial external rotation, in both the Control and ACL groups (P < 0.05), which was not changed after ACL reconstruction. Prior to reconstruction, sagittal plane biomechanics were changed, in both males and females, compared to the Control groups (P < 0.05). These abnormal sagittal plane mechanics were recovered at 12 months, but not six months post-reconstruction.Conclusions
We identified gender-based differences in tibial rotation that influenced the kinematics and kinetics of the knee over the stance phase of gait, both pre-operatively and post-ACL reconstruction. Evaluation of biomechanical effects of ACL injury, before and after reconstruction, should be separately evaluated for females and males. 相似文献3.
Background
The effects of retaining residual bundles on surgical outcomes has not been observed, so we evaluated the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture in this study.Purpose
To evaluate the effects of preoperative knee laxity on clinical outcomes after partial anterior cruciate ligament (ACL) reconstruction for partial ACL rupture.Methods
The data of 47 patients, who had partial ACL rupture and underwent partial ACL reconstruction, were retrospectively analyzed. According to preoperative kneelax arthrometer and pivot shift test, the 47 patients were divided into group A (kneelax arthrometer ≤ 5 mm and pivot shift test < II grade, n = 26) and group B (kneelax arthrometer > 5 mm and/or pivot shift test ≥ II grade, n = 21). The minimum follow-up duration lasted 2 years. The clinical outcomes were evaluated using IKDC (International Knee Documentation Committee) scoring systems, Lysholm knee scoring scale, Tegner activity rating, Lachman test, Pivot shift test and the kneelax arthrometer.Results
The function and stability examinations for the affected knee joint were significantly improved in both groups after partial ACL reconstruction as compared with preoperative ones (all P < 0.01). There were no significant differences in the post-operative Lysholm and Tegner scores, Lachman and Pivot shift test results between both groups (all P > 0.05). However, there were significant differences between the two groups in terms of the post-operative IKDC scoring system and kneelax arthrometer examination result (all P < 0.05).Conclusions
In the patients with partial ACL rupture, the mechanical strength of the remnant ligament has significant influence on the therapeutic effects of partial reconstruction. The patients with kneelax arthrometer > 5 mm and/or pivot shift test ≥ II grade still have anterior instability in the affected knee after partial reconstruction. 相似文献4.
Ravi Gupta Anil Kapoor Naveen Mittal Ashwani Soni Sourabh Khatri Gladson David Masih 《The Knee》2018,25(6):1051-1056
Background
The role of an intact meniscus in providing mechanical stability to the knee of anterior cruciate ligament (ACL) deficient and ACL reconstructed patients has not been well studied.Methods
This was a prospective cohort study. A total of 205 patients undergoing ACL reconstruction were enrolled, of which 61 had normal menisci, 49 had a tear in the posterior horn of the medial meniscus (PHMM) (tear < 40% of width?=?19; > 40% of width?=?30), 35 had a tear in the lateral meniscus (< 40% of width?=?15; > 40%?=?20), 13 had a tear in the body and/or anterior horn of the medial meniscus (< 40% of width?=?6; > 40%?=?7) and 47 patients had a tear in both menisci. Patients with a tear in both menisci were excluded. The anterior translation of the tibia (ATT) was calculated preoperatively and postoperatively at three months and six months using KT-1000. Partial meniscectomy was performed in all unstable meniscal tears.Results
The mean age at the time of surgery was 25.2?±?5.1?years. Patients with a normal meniscus showed side to side difference in KT-1000 of 4.8?±?2.5?mm whereas those with a < 40% tear and > 40% tear in PHMM had a difference of 5.36?±?3.07?mm (P?=?0.46) and 7.08?±?2.78?mm (P?=?0.0002), respectively. Patients with a lateral meniscus < 40% and > 40% tear had a mean difference of 5.68?±?2.96?mm (P?=?0.22) and 5.95?±?2.39?mm (P?=?0.09), respectively. Patients with body and/or anterior horn of medial meniscus < 40% and > 40% had a difference of 5.41?±?1.11?mm (P?=?0.59) and 5.78?±?2.38?mm (P?=?0.35), respectively. At three months and six months KT-1000 differences of 2.3?±?1.2?mm and 2.1?±?1.2?mm were seen in patients with normal meniscus; 2.26?±?1.51?mm and 2.16?±?0.9?mm with partial meniscectomy of the PHMM < 40%; 2.65?±?1.53?mm and 2.4?±?1.35?mm with partial meniscectomy of the PHMM > 40%; 2.27?±?1.19?mm and 2.07?±?1.52?mm with partial meniscectomy of the lateral meniscus < 40%; and 2.27?±?1.44?mm and 2.07?±?1.14?mm with partial meniscectomy of the lateral meniscus > 40%; 2.55?±?1.56?mm and 1.91?±?1.09?mm with partial meniscectomy in body and/or anterior horn of medial meniscus < 40% and 2.07?±?1.81 and 2.14?±?1.10?mm with partial meniscectomy in body and/or anterior horn of medial meniscus > 40% (P?>?0.05).Conclusion
PHMM acts as a secondary stabilizer of the knee joint in the absence of functional ACL. There is no effect of partial meniscectomy on mechanical stability of the knee in ACL reconstructed patients. Medial or lateral partial meniscectomy performed at the time of ACL reconstruction does not affect the stability of ACL reconstructed knee. However, the presence of a concomitant tear in PHMM is associated with increased instability in ACL deficient knee. 相似文献5.
Background
Medial meniscus posterior root tear (MMPRT) has been reported to play a key role in the development of spontaneous osteonecrosis of the knee (SONK) and osteoarthritis (OA) of the knee. However, little is known about the differences in the development of SONK and OA after MMPRT. The purpose of this study was to investigate the factors contributing to the development of these conditions.Methods
We evaluated the existence of MMPRT and the extent of medial meniscal extrusion in preoperative magnetic resonance images and proximal tibial morphology in radiographs of 45 patients with SONK and 104 patients with OA who underwent knee surgery.Results
There were no significant differences in age, gender, height, weight, and body mass index between the two groups. The incidence of MMPRT and the mean posterior tibial slope (PTS) were significantly higher in SONK than in OA patients (62.2% versus 34.3%, P = 0.002, and 12.8° versus 10.5°, P < 0.001, respectively). The mean extent of meniscal extrusion was larger in OA than in SONK patients (7.5 mm versus 5.3 mm, P < 0.001). The mean tibial varus angle was 4.8° in SONK and 5.4° in OA, with no significant difference between the two (P = 0.088). Multivariable logistic regression analysis showed that compared with OA, SONK was more closely associated with the existence of MMPRT and had a smaller extent of medial meniscus extrusion and higher PTS.Conclusion
MMRPT and higher PTS were more closely associated with the development of SONK than with that of OA. 相似文献6.
Background
The purpose of this study was to compare the clinical outcomes and second-look arthroscopic findings of remnant preservation technique with those of conventional anterior cruciate ligament (ACL) reconstruction in single bundle ACL reconstructions.Methods
One hundred sixty two consecutive patients underwent ACL reconstruction by one surgeon, with 93 patients receiving remnant preservation technique (Group A) and 69 patients receiving conventional ACL reconstruction (Group B). The mean follow-up was 15 months. Clinical outcomes were assessed using Lysholm scores and the International Knee Documentation Committee form (IKDC form) evaluation. Post-operative knee stability was evaluated through manual knee laxity evaluation, pivot-shift test, and a Telos device.Results
Differences in post-operative stability (manual knee laxity, pivot shift test and Telos device) were not significant between the groups (p = 0.681, p = 0.610, p = 0.696). And also no significant differences were noted with respect to the IKDC form and the latest Lysholm scores. But in the second-look arthroscopic findings, synovial coverage was confirmed to be excellent in 36% (22/61) of Group A patients and 23% (7/30) of Group B patients.Conclusions
ACL reconstruction with both techniques was found to result in acceptable stability, clinical outcomes and second-look arthroscopic findings. With regard to synovial coverage, the remnant reservation techniques were found to be superior to conventional ACL reconstruction.Level of evidence
Level III, retrospective comparative study. 相似文献7.
Byung Hoon Lee Rajat Jangir Hun Yeong Kim Jung Min Shin Minho Chang Kwon Kim Joon Ho Wang 《The Knee》2017,24(3):580-587
Backgroud
To determine whether anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) can restore the native ACL volume, and whether the volume change after reconstruction affects clinical outcomes and re-rupture rates following the contemporary techniques.Methods
Eighty patients undergoing anatomic DB-ACLR using transportal or outside-in technique were prospectively evaluated with magnetic resonance imaging (MRI) before and after surgery. The ACL volumes were determined from 3-D models constructed by applying reverse engineering software. In all participants, measured reconstructed ACL volume were compared with the ACL on the opposite uninjured side. Participants were divided into two groups according to the volume of reconstructed graft; larger volume than native ACL of contra-lateral side (Group 1) or smaller (Group 2).Results
The mean ACL volume on the reconstructed side (1726.5 mm3, 982.1 - 2733.8) was significantly smaller than that on the uninjured opposite side (1857.6 mm3, 958.2 - 2871.5) (P < 0.001). A total of 31 patients in Group 1 and 49 in Group 2 showed no significant difference of improvement in the clinical outcome scales at the postoperative two-year follow-up (Lysholm knee score, P = 0.830, Tegner activity score, P = 0.848). Four patients with ACL re-rupture during the two-year follow-up after reconstruction had smaller reconstructed ACL volumes than native ligament on the opposite site.Conclusion
Anatomic DB-ACLR technique restored the graft volume rather smaller than the volume of the native ACL. Based on the volumetric consideration, graft reconstructed by anatomic DB-ACLR might have increased probability of re-rupture due to its smaller volume related to native ACL on the contralateral side. 相似文献8.
Ryan T. Lewinson Chad P. Maag Victor M.Y. Lun J. Preston Wiley Chirag Patel Darren J. Stefanyshyn 《The Knee》2017,24(1):31-39
Background
Clinical effectiveness of lateral wedges for knee osteoarthritis is inconsistent across studies. One explanation is that knee loading is not fully described by the peak frontal-plane knee moment. The purpose of this study was to propose a 3D resultant approach to describing moments at the knee and evaluate how this moment changes in response to lateral wedges.Methods
Walking gait analysis was performed on 20 individuals with knee osteoarthritis, in their own shoes, with and without a six millimeter lateral wedge insole. Frontal-plane and 3D resultant moments were calculated for each participant and footwear condition. Paired t-tests identified differences between footwear conditions, correlations identified relationships between frontal-plane and 3D resultant moments, and regressions assessed relationships between moments and pain.Results
Significant reductions to peak frontal-plane moments (p = 0.001) and 3D resultant moments at the same time point (p = 0.042) were observed with lateral wedges. While an overall significant correlation was observed between change in frontal-plane moments and change in 3D resultant moments with a lateral wedge (r = 0.68, p = 0.001), 5/20 participants experienced disparate results where the frontal-plane moment was reduced yet the 3D moment increased.Conclusions
While lateral wedges alter frontal-plane moment magnitude, the direction of change does not always correspond to the direction of change observed in the 3D resultant moment. Thus resultant knee load may sometimes increase with lateral wedges.Clinical relevance
Future prospective studies should evaluate if changes in 3D resultant moments, and thus total knee load, offer an explanation as to why some participants do not experience clinical benefit from lateral wedges. 相似文献9.
Background
Knee osteoarthritis has a lifetime risk of nearly one in two, with obese individuals being most susceptible. While exercise is universally recognized as a critical component for management, unsafe or ineffective exercise frequently leads to exacerbation of joint symptoms.Aim
Evaluate the effect of a 12 week lower body positive pressure (LBPP) supported low-load treadmill walking program on knee pain, joint function, and performance of daily activities in patients with knee osteoarthritis (OA).Design
Prospective, observational, repeated measures investigation.Setting
Community based, multidisciplinary musculoskeletal medicine clinic.Patients
Thirty-one patients, aged 50–75, with a BMI ≥ 25 kg/m2 and radiographic confirmed mild to moderate knee OA.Intervention
Twelve week LBPP treadmill walking exercise regimen.Outcome measures
The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Canadian Occupational Performance Measure (COPM) were used to quantify joint symptoms and patient function; isokinetic thigh muscle strength was evaluated; and a 10-point VAS was used to quantify acute knee pain while walking. Baseline and follow-up data were compared in order to examine the effect of the 12 week exercise intervention.Results
There was a significant difference between baseline and follow-up data: KOOS and COPM scores both improved; thigh muscle strength increased; and acute knee pain during full weight bearing walking diminished significantly.Conclusions
Participation in a 12 week LBPP supported treadmill walking exercise regimen significantly enhanced patient function and quality of life, as well as the ability to perform activities of daily living that patient's self-identified as being important, yet difficult to perform. 相似文献10.
Background
There are unanswered questions about knee–ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee–ankle alignment after TKA.Methods
The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis.Results
The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (P < 0.05). The pre-operative malalignment of the knee was corrected (P < 0.05), and the ankle tilt angle was accordingly improved in the operative side after TKA (P < 0.05). In addition, TKA had little effect on knee–ankle alignment on the non-operative side (P > 0.05).Conclusion
These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA.Level of evidence
Level III. 相似文献11.
Erdal Uzun Abdulhamit Misir Turan Bilge Kizkapan Mustafa Ozcamdalli Soner Akkurt Ahmet Guney 《The Knee》2018,25(1):109-117
Background
There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction.Methods
A total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments in- cluded physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior–posterior knee movement.Results
Mean follow-up duration was 61 (34–85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P = 0.001 vs. P = 0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P = 0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P = 0.55). Red–red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66 mm (range, four to six) and 5.2 mm (range, two to seven), respectively.Conclusion
Concurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red–red zone appeared to be associated with better outcomes. 相似文献12.
Background
Postoperative extension deficits following anterior cruciate ligament (ACL) reconstruction can cause major limitation during daily life. The purpose of this study was to evaluate the efficiency of an all-arthroscopic approach and posterior capsule release for the treatment of persistent knee extension deficits following ACL reconstruction.Methods
Between 2009 and 2013 a total of 10 patients with knee flexion contractures after ACL reconstruction were assessed following an all-arthroscopic approach and posterior capsulotomy. The clinical outcomes were reviewed using the range of motion (ROM), Tegner Activity Level, Lysholm score and visual analogue pain scale (VAS).Results
Four women and six men with a median age of 34 years (range: 17 to 49 years) were included in the study. The median follow-up period was 25 months (range: 14 to 69 months). The median preoperative extension deficit was 15° (range: 10 to 20°) compared to the normal contralateral knee. Postoperatively at final follow-up the median extension deficit was one degree (range: 0 to five degrees) (P < 0.01). The median preoperative Lysholm score improved from 52 (range: 32 to 67) to 92 (range: 84 to 100) postoperatively (P < 0.01), while the median Tegner Activity Level improved from three (range: two to six) to six (range: three to seven) respectively (P < 0.02). The median VAS status for pain decreased from five (range: one to 10) to one (range: 0 to three) (P < 0.01). No complications were observed.Conclusions
Arthroscopic posterior capsulotomy is a safe and effective additional procedure in the treatment of persistent knee extension deficits following ACL reconstruction with excellent results regarding ROM and subjective outcomes.Level of evidence
Level IV. 相似文献13.
Christian Scheele Matthias F. Pietschmann Christian Schröder Thomas Grupp Melanie Holderied Volmar Jansson Peter E. Müller 《The Knee》2017,24(2):402-408
Background
Unicompartmental total knee arthroplasty (UKA) is a well-established treatment option for unicondylar osteoarthritis, and generally leads to better functional results than tricompartimental total knee arthroplasty (TKA). However, revision rates of UKAs are reported as being higher; a major reason for this is aseptic loosening of the tibial component due to implant–cement–bone interface fatigue. The objective of this study was to determine the effects of trabecular bone preparation, prior to implantation of tibial UKAs, on morphological and biomechanical outcomes in a cadaver study.Methods
Cemented UKAs were performed in 18 human cadaver knees after the bone bed was cleaned using pulsed lavage (Group A), conventional brush (Group B) or no cleaning at all (Group C, control). Morphologic cement penetration and primary stability were measured.Results
The area proportion under the tibial component without visible cement penetration was significantly higher in Group C (21.9%, SD 11.9) than in both Group A (7.1%, SD 5.8), and Group B (6.5%, SD 4.2) (P = 0.007). The overall cement penetration depth did not differ between groups. However, in the posterior part, cement penetration depth was significantly higher in Group B (1.9 mm, SD 0.3) than in both Group A (1.3 mm, SD 0.3) and Group C (1.4 mm, SD 0.3) (P = 0.015). The mode of preparation did not show a substantial effect on primary stability tested under dynamic compression-shear test conditions (P = 0.910).Conclusion
Bone preparation significantly enhances cement interdigitation. The application of a brush shows similar results compared with the application of pulsed lavage. 相似文献14.
Background
The main objective of the study was to determine if excessive body weight and meniscal destabilization cause knee articular cartilage damage and changes in meniscal histology indicative of knee osteoarthritis (OA).Methods
Forty female Lewis rats were randomly assigned to regular diet sham surgery, regular diet medial meniscus destabilization (DMM) surgery, high-fat diet sham surgery, or high-fat diet DMM surgery. Surgical intervention occurred four weeks after diet initiation. Rats were sacrificed four weeks post-surgery. Progression of OA was evaluated in femoral condyles and tibial plateaus using the Osteoarthritis Research Society International (OARSI) scoring system by two blinded scorers. Ossification of menisci was evaluated with digitized histological slides using a grid.Results
DMM surgery had greater OARSI scores than sham surgery for all knee surfaces in both diet groups (all P?<?0.004). The high-fat diet sham surgery group had greater OARSI scores than the regular diet sham surgery group on all knee surfaces (all P?<?0.02). Histological evaluation showed the lateral meniscus had more bone than the medial meniscus, but there was no relationship between diet or surgery groups and amount of bone in the meniscus.Conclusions
Results suggested excessive body weight may contribute to spontaneous onset of OA and emphasized the importance of preventative care in those at risk of developing OA. 相似文献15.
Du Hyun Ro Hyuk-soo Han Seong Hwan Kim Yoon-Ho Kwak Jae-Young Park Myung Chul Lee 《The Knee》2018,25(2):249-255
Background
The goals of this study were (1) to document the gait pattern of patients with unilateral knee osteoarthritis (OA), (2) to determine the knee adduction moment (KAM) changes in the non-operated knee, and (3) to identify the predictors of change in KAM in the non-operated knee.Methods
The study recruited 23 patients with advanced unilateral knee OA. The preoperative Kellgren–Lawrence (KL) grade of the non-operated knee was one or two; non-operated knee pain, rated using a numeric rating scale (NRS), was less than three out of 10 points. We used a commercial gait analysis system to evaluate kinetics and kinematics. Radiological and gait measurements at the two-year follow-up were compared with baseline data.Results
The preoperative asymmetrical gait cycle characterized by elongation of the stance phase of the non-operated knee became symmetrical after TKA. The average KAM of the non-operated knee increased (P = 0.010) and it was best predicted by the baseline mechanical axis of the non-operated knee. If the baseline mechanical axis was varus four degrees or above (varus group), the average KAM increased by 0.64 (% body weight × height, P = 0.015), while for varus less than four degrees (non-varus group), KAM was unchanged. The KL grade was increased in the varus group (P = 0.020) but it was unchanged in the non-varus group. Average pain NRS score was also higher (P = 0.044) in the varus group.Conclusions
Close follow-up is necessary for patients with a baseline varus deformity of the non-operated knee because of the higher possibility of developing pain, subsequent arthritis and increased joint loading of the non-operated knee.Level of evidence
III, retrospective cohort study. 相似文献16.
Gap formation following primary repair of the anterior cruciate ligament: A biomechanical evaluation
Background
Historically, inconsistent and unpredictable results of open primary anterior cruciate ligament (ACL) repair were reported. Recently, however, good results of arthroscopic primary ACL repair of proximal tears have been reported. Purpose of this study was to assess the direct postoperative gap formation and maximum failure load following simulated knee motion after primary ACL repair.Methods
Six matched-paired human cadaveric knees (mean age: 52 years, range: 48 to 56 years) were used. After primary proximal ACL repair with either suture button fixation or suture anchor fixation, knees were cycled five, 50 and 100 times with a simulated active quadriceps force. Gap formation between the femoral wall and ligament was measured using a digital caliper and maximum failure load was tested.Results
Gap formation after five, 50 and 100 cycles of the knee were 0.30 mm (± 0.23), 0.75 mm (± 0.55) and 0.97 mm (± 0.70), respectively, with no significant differences between both fixation techniques. The overall maximum failure load was 243 N (± 143) with no difference between both techniques. Most common failure mode was slipping of suture from the fixation.Conclusion
Following proximal ACL repair, gap formation of approximately one millimeter was measured after repetitious knee cycling with mean maximum failure load of 243 N. These findings are likely to be sufficient for careful early active range of motion (ROM) when extrapolating from other available studies. Future studies with second-look arthroscopy are necessary to assess the gap formation and healing in patients treated with primary repair. 相似文献17.
Background
Types of mechanoreceptors may differ between the medial and lateral menisci, suggesting that postural stability may differ between patients with medial and lateral meniscus tears. However, to date, postural stability has not been compared in patients with medial and lateral meniscus tears. This study used stabilometry to compare postural stability in patients with medial and lateral meniscus tears.Methods
Postural stability and thigh muscle strength were assessed in 24 patients with medial and 18 patients with lateral meniscus tears. Postural stability was determined by measuring the anteroposterior (APSI), mediolateral (MLSI), and overall (OSI) stability indices using stabilometry. Maximal torque (60°/s) of the quadriceps and hamstring was evaluated using an isokinetic testing device.Results
The three stability indices, OSI, APSI, and MLSI, in both involved and uninvolved knees were all significantly greater in patients with lateral than with medial meniscus tears.(P < 0.001 for all OSI, APSI, and MLSI in both involved and uninvolved knees, except for P = 0.005 for MLSI of involved knees). In patients with medial meniscus tears, both OSI (1.4 ± 0.4 vs. 1.1 ± 0.4, P = 0.037) and MLSI (0.9 ± 0.3 vs. 0.8 ± 0.3, P = 0.041) were significantly higher on the injured than the uninjured side. In patients with lateral meniscus tears, none of the stability indices differed significantly between injured and uninjured knee joints.Conclusion
Postural stability of both the injured and uninjured knee joints was poorer in patients with lateral than with medial meniscus tears. 相似文献18.
Yoshinori Ishii Hideo Noguchi Junko Sato Hana Ishii Koji Todoroki Shin-ichi Toyabe 《The Knee》2017,24(5):1153-1159
Background
Proximal tibial bone mineral density (BMD) has been studied for its potential impact on subsidence and loosening of the tibial component after total knee arthroplasty (TKA). However, no known studies of proximal tibial BMD after TKA have evaluated the effect of major impact factors such as body weight (BW), muscle strength, and level of activity. We aim to determine whether factors such as level of activity, quadriceps strength, BW, gender, age, and prosthetic design affect proximal tibial BMD over the mid- to long-term following TKA.Methods
We evaluated 36 patients (72 knees) who were undergoing bilateral TKA performed by a single surgeon. Median follow up time was 115 months (range, 60–211 months) for a minimum of five years. We measured BMD in the proximal tibia and used a hand-held dynamometer to measure quadriceps isometric strength, recording the maximum value of three measurements for each patient.Results
Univariate analyses using Spearman's correlation coefficient for continuous variables revealed a weak negative correlation between age and BMD (r = ? 0.316, P = 0.007) and a moderate positive correlation between BW and BMD (r = 0.430, P < 0.001). However, no significant correlations were found between the other factors above and BMD for continuous and discrete variables. Based on multivariate analyses, only BW had a significant effect on BMD (β = 0.342, P = 0.003).Conclusions
BW is the most impact factor on the proximal tibial BMD after mid- to long-term follow up TKA. Therefore, the management of BW may contribute to prevention of decline of tibial BMD for TKA patients owing to aging. 相似文献19.
Joshua S. Everhart John D. Higgins Sarah G. Poland Moneer M. Abouljoud David C. Flanigan 《The Knee》2018,25(6):1142-1150
Purpose
The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40?years or older.Methods
A systematic search was performed, and 225 meniscus repair outcome studies on adults were identified in the English literature. Included studies reported either individual patient data with at least one patient age ≥ 40?years or summary data with all patients' age ≥ 40?years. Failure rates were determined based on previously reported risk factors (regardless of age) including concomitant anterior cruciate ligament (ACL) reconstruction (ACLR), tear location, and tear pattern.Results
Meniscus repair outcomes for 148 patients from 11 studies were included (125 inside-out repairs and 23 all-inside repairs). The overall failure rate was 10% (15/148) and ranged from 0 to 23% in individual studies with more than one patient age ≥ 40?years. One comparative study of patients over versus under age 40?years was identified, with no difference in failure rates between groups. Most tears were peripheral tears with avascular extension (nine-percent overall failure rate) or without avascular extension (nine-percent failure rate). Among studies that reported tear pattern, overall failure rates for vertical-longitudinal or bucket handle tears were nine percent and complex and/or horizontal tears were 23%. Repairs with concomitant ACL reconstruction had a five-percent overall failure rate versus 15% in ACL intact patients.Conclusion
Meniscus repair failure rates in patients age 40?years and older are comparable to rates quoted for younger patients.Level of evidence
Level IV. Systematic review of Level III and IV studies. 相似文献20.