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1.
N. Lefevre Y. Bohu J. F. Naouri S. Klouche S. Herman 《Knee surgery, sports traumatology, arthroscopy》2013,21(3):534-539
Purpose
Although the treatment of choice for acute proximal hamstring ruptures is now surgical repair, this technique is relatively new and requires further evaluation. Our hypothesis was that patients return to sports at the same level after surgical repair as before injury.Methods
From 2002 to 2011, a prospective observational study including 34 patients, mean age 39.3 ± 11.4 years old underwent surgical repair of an acute proximal hamstring rupture. Surgical, rehabilitation and follow-up protocols were standardized. Mean follow-up was 27.2 ± 22.9 months and there were no lost to follow-up. The primary outcome was the level of activity on the UCLA and Tegner scores.Results
The mean UCLA score was 9.1 ± 1.3 before injury and 8.7 ± 1.7 at the final follow-up (p = 0.03). The median Tegner activity level was 6 (range, 4–10) before injury and 6 (range, 3–10) at the final follow-up (p = 0.05). The two scores were correlated (r = 0.76, p = 0.00001). Patients returned to sports within a mean 5.7 ± 1.6 months, at the same level in 27 patients (79.4 %) and at a lower level in 7 patients (20.6 %). The average hamstring/quadriceps ratio at 240°/second was 54.7 ± 8.6 % which was positively correlated to the level of activity on the UCLA score (r = 0.49, n.s.). The level of satisfaction was related to their level of activity at the final follow-up (p = 0.03).Conclusion
Although surgical repair of acute proximal hamstring ruptures has significantly improved the functional prognosis of patients it remains a serious condition that can compromise future sports activities.Level of evidence
Case–control study, Level III. 相似文献2.
Thomas R. Niethammer Matthias F. Pietschmann Annie Horng Björn P. Roßbach Andreas Ficklscherer Volkmar Jansson Peter E. Müller 《Knee surgery, sports traumatology, arthroscopy》2014,22(6):1329-1336
Purpose
Graft hypertrophy is a major complication in the treatment for localized cartilage defects with autologous chondrocyte implantation (ACI) using periosteal flap and its further development, Novocart (a matrix-based ACI procedure). The aim of the present study is to investigate individual criteria for the development of graft hypertrophy by NOVOCART 3D implantation of the knee in the post-operative course of 2 years.Methods
Forty-one consecutive patients with 44 isolated cartilage defects of the knee were treated with NOVOCART 3D implants. Individual criteria and defect-associated criteria were collected. Follow-up MRIs were performed at 3, 6, 12 and 24 months. The NOVOCART 3D implants were measured and classified. The modified MOCART Score was used to evaluate quality and integration of the NOVOCART 3D implants in MRI.Results
Graft hypertrophy was observed in a total of 11 patients at all post-operative time points. We were able to show that NOVOCART 3D implantation of cartilage defects after acute trauma and osteochondritis dissecans (OCD) led to a significantly increased proportion of graft hypertrophy. No other individual criteria (age, gender, BMI) or defect-associated criteria (concomitant surgery, second-line treatment, defect size, fixation technique) showed any influence on the development of graft hypertrophy. The modified MOCART Score results revealed a significant post-operative improvement within 2 years.Conclusion
The aetiology of cartilage defects appears to have a relevant influence for the development of graft hypertrophy. Patients, who were treated with NOVOCART 3D implants after an acute event (acute trauma or OCD), are especially at risk for developing a graft hypertrophy in the post-operative course of two years.Level of evidence
Case series, Level IV. 相似文献3.
Kyung Tai Lee Jin Su Kim Ki Won Young Young Koo Lee Young Uk Park Yong Hoon Kim Hun Ki Cho 《Knee surgery, sports traumatology, arthroscopy》2013,21(6):1251-1260
Purpose
This study assessed the clinical results and second-look arthroscopy after fibrin matrix-mixed gel-type autologous chondrocyte implantation to treat osteochondral lesions of the talus.Methods
Chondrocytes were harvested from the cuboid surface of the calcaneus in 38 patients and cultured, and gel-type autologous chondrocyte implantation was performed with or without medial malleolar osteotomy. Preoperative American orthopedic foot and ankle society ankle-hind foot scores, visual analogue score, Hannover scoring system and subjective satisfaction were investigated, and the comparison of arthroscopic results (36/38, 94.7 %) and MRI investigation of chondral recovery was performed. Direct tenderness and relationship to the active daily life of the donor site was evaluated.Results
The preoperative mean ankle–hind foot scores (71 ± 14) and Hannover scoring system (65 ± 10) had increased to 91 ± 12 and 93 ± 14, respectively, at 24-month follow-up (p < 0.0001), and the preoperative visual analogue score of 58 mm had decreased to 21 mm (p < 0.0001). Regarding subjective satisfaction, 34 cases (89.5 %) reported excellent, good or fair. Chondral regeneration was analysed by second-look arthroscopy and MRI. Complications included one non-union and two delayed-unions of the osteotomy sites, and 9 ankles (9/31, 29.0 %) sustained damaged medial malleolar cartilage due to osteotomy. Marked symptoms at the biopsy site did not adversely affect the patient’s active daily life.Conclusions
Fibrin matrix-mixed gel-type autologous chondrocyte implantation using the cuboid surface of the calcaneus as a donor can be used for treating osteochondral lesions of the talus.Level of evidence
Therapeutic study, prospective case series, Level IV. 相似文献4.
Felix Porschke Marc Schnetzke Sara Aytac Stefan Studier-Fischer Paul Alfred Gruetzner Thorsten Guehring 《Knee surgery, sports traumatology, arthroscopy》2017,25(7):1995-2003
Purpose
Sports activity after surgical AC joint stabilisation has not been comprehensively evaluated to date. The aim of this study was to determine rate, level and time to return to sports after AC joint stabilisation and to identify the influence of overhead sports on post-operative sports activity.Methods
In this retrospective case series, a total of 68 patients with a high-grade AC joint dislocation (Rockwood type V) were stabilised using a single TightRope technique. Fifty-five patients (80.9 %) with median age of 42.0 (range, 18–65) years completed questionnaires regarding sports activity before and after surgery. Clinical outcome and complications were also evaluated. Forty-three patients participated in sports regularly before injury. Their sports activity was rated according to Allain, and non-overhead and overhead sports were differentiated.Results
At median follow-up of 24 (18–45) months, 41 of 43 patients (95.3 %) had returned to sports. 63 % returned to the same sports activity as before injury. 16.3 % needed to adapt the type of sports to reduce demanding activities. 11.6 % reduced the frequency and 32.5 % the intensity of sports. The median time to return to sports was 9.5 (3–18) months. Overhead athletes (Allain Type III and IV) had to reduce their sports activity significantly more often (11.8 vs. 53.8 %; p = 0.011) and needed more time to return to sports (9.5 vs. 4.5 months; p = 0.009).Conclusion
After stabilisation of AC joint dislocation, the majority of patients returned to sports after a substantial period of time. Overhead athletes, in particular, required more time and had to considerably reduce their sports activity. The findings impact therapeutic decision-making after AC joint injury and help with the prognosis and assessment of rehabilitation progress.Level of evidence
IV.5.
Alberto Siclari Gennaro Mascaro Chiara Gentili Christian Kaps Ranieri Cancedda Eugenio Boux 《Knee surgery, sports traumatology, arthroscopy》2014,22(6):1225-1234
Purpose
The aim of our study was to analyse the clinical and histological outcome after the treatment of focal cartilage defects in non-degenerative and degenerative knees with bone marrow stimulation and subsequent covering with a cell-free resorbable polyglycolic acid–hyaluronan (PGA-HA) implant immersed with autologous platelet-rich plasma (PRP).Methods
Fifty-two patients (mean age 44 years) with focal chondral defects in radiologically confirmed non-degenerative or degenerative knees were subjected to subchondral drilling arthroscopically. Subsequently, defects were covered with the PGA-HA implant immersed with autologous PRP. At 2-year follow-up, the patients’ situation was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and compared to the pre-operative situation and 3–12-month follow-up. Biopsies (n = 4) were harvested at 18–24 months after implantation and were analysed by histology and collagen type II immune staining.Results
At 1- and 2-year follow-up, the KOOS showed clinically meaningful and significant (p < 0.05) improvement in all subcategories compared to baseline and to 3-month follow-up. There were no differences in KOOS data obtained after 2 years compared to 1 year after the treatment. Histological analysis of the biopsy tissue showed hyaline-like to hyaline cartilage repair tissue that was rich in cells with a chondrocyte morphology, proteoglycans and type II collagen.Conclusions
Covering of focal cartilage defects with the PGA-HA implant and PRP after bone marrow stimulation improves the patients’ situation and has the potential to regenerate hyaline-like cartilage.Level of evidence
Case series, Level IV. 相似文献6.
Tiago Lazzaretti Fernandes Felipe Fregni Kayleen Weaver André Pedrinelli Gilberto Luis Camanho Arnaldo José Hernandez 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):97-103
Purpose
The purpose of this study was to radiographically investigate the influence of femoral tunnel placement in ACL reconstruction on early outcomes and return to sports due to anatomic and nonanatomic positioning.Methods
A prospective study was conducted from 2008 to 2010, with 86 athletes who underwent ACL reconstruction between anteromedial (AM) footprint and high AM position. Knee functional outcomes (IKDC objective and subjective, Tegner score, and Lysholm scale) return to sports and complications were analyzed at 6- and 12-month follow-up.Results
At follow-up, it was observed that tunnel projection along Blumensaat’s line was correlated with functional outcomes on Tegner scale (at 6 and 12 months) and IKDC subjective (at 12 months). There was a significant difference in mean tunnel projection along Blumensaat’s line when analyzing return to sports (73 ± 1.4 and 79 ± 1.7 %, respectively, for projections on return vs. no return to sports, p = 0.02) and complications (73 ± 1.3 vs. 78 ± 1.6 %, respectively, for projections on no complications vs. complications, p = 0.03). No differences were stated on coronal view. These correlations between tunnel positioning on functional outcomes could not be explained by demographic or baseline characteristics.Conclusion
The clinical relevance of this study is that tunnel positioning along AM footprint and high AM position represented by tunnel projection along Blumensaat’s line is associated with early return to sports on previous Tegner level and better functional outcome in athletes.Level of evidence
III. 相似文献7.
Hermann O. Mayr Paul Stüeken Ernst-Otto Münch Morris Wolter Anke Bernstein Norbert P. Suedkamp Amelie Stoehr 《Knee surgery, sports traumatology, arthroscopy》2014,22(5):1156-1162
Purpose
A controversial discussion is held on using stabilizing knee braces after anterior cruciate ligament (ACL) surgery. The current study investigated the influence of a stabilizing knee brace on results after ACL reconstruction using patellar tendon autografts.Methods
A prospective randomized study was started including 64 patients divided into two equal groups and treated with or without a stabilizing knee brace for 6 weeks post-operatively. A follow-up examination 4 years after operation comprised IKDC 2000, KT1000 measurement, a visual analogue pain scale (VAS; scores 0–10) and radiographic evaluation. The t test for independent and paired samples and the Pearson’s Chi-square test were used for statistical analysis (p < 0.05). The primary endpoint was the difference in IKDC classification.Results
Eighty-one per cent of the patients were examined 4 years post-operatively. IKDC 2000 subjective (brace group 90.5 ± 8.9, braceless group 93.2 ± 6.1) and objective results (brace A 30 %, B 56 %, C 16 %; braceless A 32 %, B 48 %, C 20 %) and instrumental measurement of anteroposterior laxity with KT1000 (brace 0.6 ± 2.4 mm, braceless 1.8 ± 3.4 mm) showed no significant differences. VAS pain results were significantly better in the braceless group at 1.0 ± 1.2 versus 1.9 ± 1.4 under sports activity or heavy physical work (p = 0.015). There were no radiographic differences concerning osteoarthritic findings and tunnel widening between the groups.Conclusion
Post-operative treatment with a stabilizing knee brace after ACL replacement showed no advantage over treatment without a brace at 4-year follow-up. The use of a knee-stabilizing brace after isolated ACL reconstruction with autologous patellar tendon graft is not recommended.Level of evidence
II. 相似文献8.
Peter C. Kreuz Sebastian Müller Christoph Erggelet Arvind von Keudell Thomas Tischer Christian Kaps Philipp Niemeyer Anja Hirschmüller 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):72-79
Purpose
The influence of gender on the biomechanical outcome after autologous chondrocyte implantation (ACI) including isokinetic muscle strength measurements has not been investigated. The present prospective study was performed to evaluate gender-specific differences in the biomechanical function 48 months after ACI.Methods
Fifty-two patients (mean age 35.6 ± 8.5 years) that met our inclusion criteria, underwent ACI with Bioseed C® and were evaluated with the KOOS score preoperatively, 6, 12 and 48 months after surgery. At final follow-up, 44 out of the 52 patients underwent biomechanical evaluation with isokinetic strength measurements of both knees. All data were evaluated separately for men and women and compared for each time interval using the Mann–Whitney U test.Results
Clinical scores improved significantly over the whole study period (p < 0.05). Male patients demonstrated significantly better scores during the follow-up in the KOOS score (p < 0.05). Isokinetic strength measurements after 48 months revealed a significant strength deficit of the treated knee in all test modes compared to the healthy extremity (p < 0.05). Furthermore, male patients achieved significantly higher strength values compared to female patients (p < 0.05).Conclusions
ACI is a viable treatment option for full-thickness chondral defects in the knee of both genders. Isokinetic muscle strength measures are significantly worse in women (p < 0.05), but physiological and may play a role for the explanation of gender-specific results after ACI.Level of evidence
II. 相似文献9.
Daniel Meyerkort Jay R. Ebert Timothy R. Ackland William B. Robertson Michael Fallon M. H. Zheng David J. Wood 《Knee surgery, sports traumatology, arthroscopy》2014,22(10):2522-2530
Purpose
Both autologous chondrocyte implantation (ACI) and tibial tubercle transfer (TTT) have been used to treat chondral defects in the patellofemoral joint resulting in clinical improvement. Our study investigates the magnetic resonance imaging (MRI) appearance of the matrix-induced autologous chondrocyte implantation (MACI) graft at 5-year follow-up to determine if it provides a durable treatment option in patients with an average age of 42 (standard deviation 11.6).Methods
Twenty-three patients were available for follow-up. Nine patients required realignment of the extensor mechanism with lateral release and TTT. The MRI magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to assess the graft status. Clinical outcomes were assessed at these time periods.Results
The mean weighted MOCART composite score improved from 2.87 at 3 months to 3.39 at 5 years, indicating an intact appearance in most grafts. Graft height measured >50 % of the adjacent native cartilage in 82 % of patients. Clinical improvement assessed by the Knee Injury and Osteoarthritis Outcome Score, SF-36 (PCS) and the 6-minute walk test was demonstrated between pre-operative scores and final 5-year follow-up. 91 % of patients would undergo MACI again. Correlation between MOCART and clinical scores were low in MACI to the patellofemoral joint. No significant difference was found in outcome between those that required realignment surgery compared with those that did not.Conclusion
Patellofemoral MACI provides a durable graft on MRI assessment at 5 years with resultant clinical improvement. Further work is needed to determine which defect locations may benefit most from this procedure.Level of evidence
IV. 相似文献10.
Nasef Mohamed Nasef Abdelatif 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2837-2842
Purpose
To determine the technical feasibility and preliminary clinical efficacy of performing simultaneous arthroscopic management in cases with combined posterior and anterior ankle pathologies utilizing previously described standard arthroscopic procedures within a single surgical sitting.Methods
Nineteen consecutive patients with combined anterior and posterior ankle pathologies were included in the current study, after at least 6 months of failed conservative managements. Combined standard posterior and anterior ankle arthroscopy was performed in all patients within the same surgical session; first with the patient in the prone position, then with the patient turned onto the supine position to perform the anterior procedure.Results
All patients were available for the follow-up; the median follow-up period was 33 months (range 22–61 months). No persistent neurological deficits or infections were recorded. The American Orthopedic Foot and Ankle Society Ankle and Hind foot Scale score significantly improved from 70.2 ± 15.2 points preoperatively to reach 93.0 ± 5.4 points at 1 year post-operatively (p < 0.001). Sixteen patients (84.2 %) returned to their previous activity levels.Conclusions
Combined arthroscopic management of concurrent posterior and anterior ankle pathologies within the same surgical session is initially clinically encouraging; it allows for an earlier return to activities of daily living without a significantly added morbidity.Level of evidence
Case series, Level IV. 相似文献11.
Tommy Frøseth Aae Per-Henrik Randsborg Hilde Lurås Asbjørn Årøen Øystein Bjerkestrand Lian 《Knee surgery, sports traumatology, arthroscopy》2018,26(4):1044-1052
Purpose
Focal cartilage defects in the knee may have devastating effect on the knee joint, where two of the main surgical treatment options are microfracture and autologous chondrocyte implantation. Comparative studies have failed to establish which method yields the best clinical results. A cost-effectiveness analysis of microfracture and autologous chondrocyte implantation would contribute to the clinical decision process.Methods
A PubMed search identifying level I and level II studies with 5 year follow-up was performed. With the data from these studies, decision trees with associated service provision and costs connected to the two different techniques were designed. In addition to hospital costs, we included costs connected to physiotherapy following surgery. To paint a broader cost picture, we also included indirect costs to the society due to productivity loss caused by work absence.Results
Four high-quality studies, with a follow-up of 5 years, met the inclusion criteria. A total of 319 patients were included, 170 undergoing microfracture and 149 autologous chondrocyte implantation. The re-operation rate was 23 (13.5%) following microfracture, and 18 (12.1%) for autologous chondrocyte implantation. Both groups achieved substantially better clinical scores at 5 years compared to baseline. Microfracture was more cost-effective when comparing all clinical scores.Conclusion
Microfracture is associated with both lower costs and lower cost per point increase in patient reported outcome measures. There is a need of well-designed, high-quality randomized controlled trials before reliable conclusions regarding cost-effectiveness in the long run is possible.Level of evidence
III.12.
Joseph N. Liu Michael E. Steinhaus Grant H. Garcia Brenda Chang Kara Fields David M. Dines Russell F. Warren Lawrence V. Gulotta 《Knee surgery, sports traumatology, arthroscopy》2018,26(1):100-112
Purpose
With increasing incidence and indications for shoulder arthroplasty, there is an increasing emphasis on the ability to return to sports. The main goal of this study was to determine the rate of return to sport after shoulder arthroplasty.Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review and meta-analysis. A search was performed on MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the Methodological Index for Nonrandomized Studies checklist. The main judgement outcome was the rate of return to sports activity after shoulder arthroplasty and the level of play upon return (identical or higher/lower level).Results
Thirteen studies were reviewed, including 944 patients (506 athletes), treated with shoulder arthroplasty at an average follow-up of 5.1 years (range, 0.5–12.6 years). The most common sports were swimming (n = 169), golf (n = 144), fitness sports (n = 71), and tennis (n = 63). The overall rate of return to sport was 85.1% (95% CI, 76.5–92.3%), including 72.3% (95% CI, 60.6–82.8%) returning to an equivalent or improved level of play, after 1–36 months. Patients undergoing anatomic total shoulder arthroplasty returned at a significantly higher rate (92.6%) compared to hemiarthroplasty (71.1%, p = 0.02) or reverse total shoulder arthroplasty (74.9%, p = 0.003).Conclusion
Most patients are able to return to one or more sports following shoulder arthroplasty, with anatomic total shoulder arthroplasty having the highest rate of return.Level of evidence
IV.13.
Nobuo Adachi Mitsuo Ochi Masataka Deie Atsuo Nakamae Goki Kamei Yuji Uchio Junji Iwasa 《Knee surgery, sports traumatology, arthroscopy》2014,22(6):1241-1248
Purpose
The purposes of this study were to evaluate early- to midterm clinical results after implantation of tissue-engineered cartilage-like tissue for the treatment for full-thickness cartilage defects of the knee and to identify the factors affecting the final clinical results.Methods
Tissue-engineered cartilage-like tissue was prepared by culturing autologous chondrocytes in atelocollagen gel for 3–4 weeks. A total of 73 knees of 72 patients with full-thickness cartilage defects were implanted with this tissue-engineered cartilage-like tissue. The follow-up of these patients for >5 years (range 5–11 years, median 8.0 years) is reported. The patients were evaluated clinically using a rating scale, as well as arthroscopically, biomechanically, and histologically. A modified magnetic resonance observation of cartilage repair tissue (MOCART) system was used to quantify the magnetic resonance imaging (MRI) findings of the lesions. The patient or defect factors influencing the final clinical outcomes were also investigated.Results
Clinical rating improved significantly after implantation of tissue-engineered cartilage-like tissue. Arthroscopic findings at 2 years after implantation were graded as normal or nearly normal according to the International Cartilage Repair Society (ICRS) scale in 64 of 73 knees (87.7 %). Biomechanically, stiffness of the graft almost equalled the surrounding normal cartilage (87.9–102.5 %) at 2 years after implantation. Histologically, overall assessment of the repaired tissue by ICRS Visual Assessment Scale II was 70.4 ± 20.8. The average MOCART score was 13.5 ± 11.3 (0–45) preoperatively, 66.6 ± 16.8 (10–90) at 1 year after implantation, 70.4 ± 16.1 (15–90) at 2 years after implantation, and 72.5 ± 17.4 (15–95) at the final follow-up, indicating that MRI results were maintained. Among the factors investigated, only arthroscopic grade of the repaired lesion at 2 years after implantation was significantly correlated with the final clinical scores.Conclusions
Implantation of tissue-engineered cartilage-like tissue for the cartilage defects of the knee was effective in short- to midterm post-operatively. This procedure can be proposed as one option for repairing full-thickness cartilage defect of the knee.Level of evidence
IV. 相似文献14.
Eric Hamrin Senorski Kristian Samuelsson Christoffer Thomeé Susanne Beischer Jón Karlsson Roland Thomeé 《Knee surgery, sports traumatology, arthroscopy》2017,25(5):1364-1374
Purpose
To characterise patients who returned to knee-strenuous sports after an anterior cruciate ligament (ACL) reconstruction.Methods
Data from isotonic tests of muscle function and patient-reported outcome measures, Tegner activity scale (Tegner and Lysholm in Clin Orthop Relat Res 198:43–49, 1985), physical activity scale, knee injury and osteoarthritis scale and knee self-efficacy scale were extracted from a registry. The 157 included patients, 15–30 years of age, had undergone primary ACL reconstruction and were all involved in knee-strenuous sports, i.e. pre-injury Tegner of 6 or higher. Return to sport was studied in two different ways: return to pre-injury Tegner and return to knee-strenuous sport (Tegner 6).Results
Fifty-two patients (33 %), who returned to pre-injury Tegner, 10 months after surgery, were characterised by better subjective knee function measured with the knee injury and osteoarthritis outcome score (p < 0.05), compared with patients who did not. These patients also had higher perceived self-efficacy of knee function (p < 0.01), measured with knee self-efficacy scale. Eighty-four patients (54 %) who returned to knee-strenuous sports, i.e. Tegner 6 or higher, were characterised by higher goals for physical activity (p < 0.01) and higher self-efficacy of future knee function (p < 0.05). Strength measurements showed that women who returned to sports were stronger in leg extension than women who did not. No differences were found in Limb Symmetry Index for knee strength or jumping ability.Conclusion
Patients who returned to sports after ACL reconstruction had better subjective knee function and higher self-efficacy of knee function. Results highlight that further emphasis should be placed at psychological factors during rehabilitation of patients after ACLR.Level of evidence
II.15.
David Martinčič Damjan Radosavljevič Matej Drobnič 《Knee surgery, sports traumatology, arthroscopy》2014,22(6):1277-1283
Purpose
This prospective study assessed the 10-year clinical outcomes of periosteum autologous chondrocyte implantation (ACI) due to cartilage lesions of the femoral condyles.Methods
Thirty-three of 45 patients (3 failures, 7 non-responders, 2 others) were available for clinical and radiographic evaluation at 2, 5, and 10 years. Patients were categorized into groups with focal cartilage lesions, osteochondritis dissecans (OCD), and cartilage lesions with simultaneous ACL reconstruction (ACL). Seven patients in the overall series required an arthroscopic re-intervention (3 ACI related, 4 ACI unrelated).Results
Subjective knee scores and activity scores were significantly improved at 2 years toward their pre-operative levels and then remained stable up to 10 years; however, patients did not reach their pre-injury activity levels. Upon 10-year examination, using the IKDC knee examination form, there were 15 normal, 11 nearly normal, 5 abnormal, and 2 severely abnormal knees. Radiographic evidence of osteoarthritis was found in 45 % of patients (5 focal lesions, 2 OCD, and 8 ACL).Conclusions
ACI provided safe and stable performance of operated knees over 10 years with a significant improvement toward pre-operative levels. Patients restrained from high-impact knee joint activities, post-surgery, and their knee radiographs demonstrated a high incidence of knee OA in trauma-related lesions. Optimal long-term performance is expected in localized, low-impact cartilage lesions of young patients.Level of evidence
Case series, Level IV. 相似文献16.
Mikael Sansone Mattias Ahldén Pall Jonasson Roland Thomeé Anders Falk Leif Swärd Jón Karlsson 《Knee surgery, sports traumatology, arthroscopy》2014,22(4):786-792
Purpose
There are several reports on the association between pubalgia and intra-articular hip disorders. The purpose of this study was to evaluate the long-term outcome in athletes who underwent tenotomy due to long-standing groin pain. A secondary purpose was evaluating the frequency of femoro-acetabular impingement (FAI) and its impact on the long-term outcome.Methods
Thirty-two high-level male athletes treated with adductor tenotomy, rectus abdominis tenotomy or both were included. At a median follow-up time of 6 years after the tenotomy, the subjects underwent standardised clinical examination, plain radiographs, completed web-based health-related patient-reported outcomes, including iHOT12, HAGOS (six subscales), EQ-5D (two subscales), HSAS for physical activity level and a VAS for overall hip function. Furthermore, patient satisfaction and return to sports were documented.Results
Twenty-four of the 32 (75 %) athletes were satisfied with the outcome of the tenotomy, and 22 of the athletes (69 %) were able to return to their pre-injury sport. Before the long-term follow-up, two of these satisfied athletes had undergone repeat surgery (one hip arthroscopy due to FAI and one repeat tenotomy). Of the 24 satisfied athletes, eight (33 %) had a positive hip impingement test at the follow-up. Of the remaining eight athletes not satisfied with the outcome, only one returned to their pre-injury sport and three had undergone hip arthroscopy prior to follow-up. Five had positive hip impingement tests which was significantly more frequently than in the satisfied group (p = 0.008). The group with a positive hip impingement test reported significantly more pain and symptoms, more hip problems during sports and physical activity, as well as lower hip-related quality of life according to the HAGOS scores (p < 0.05), at follow-up.Conclusion
Tenotomy for pubalgia yielded a satisfactory long-term outcome, with three of four athletes being able to return to their pre-injury sport. The athletes that did not return to their pre-injury sport had higher frequency of positive hip impingement test and inferior functional outcome compared with the athletes that did return to their pre-injury sport. It is therefore recommended that the hip should be carefully evaluated for hip impingement before tenotomy is considered as treatment for athletes with pubalgia.Level of evidence
Retrospective case series, Level IV. 相似文献17.
Alberto Vascellari Enrico Rebuzzi Stefano Schiavetti Nicolò Coletti 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):219-225
Purpose
The purpose of this study was to determine the safety of a new arthroscopic Matrix-induced autologous chondrocyte implant (MACI) technique with carbon dioxide insufflation utilized to improve visualization during the dry phase of the scaffold implant.Methods
Between 2004 and 2007, thirty patients were treated for symptomatic focal chondral lesions of the medial femoral condyle. All patients were monitored during surgery for gas embolism signs and symptoms and were evaluated preoperatively and at a median follow-up of 70.5 months (range 48–93 months) using the KOOS subjective evaluation score, the Lysholm function score, the Tegner activity scale for the knee, and the IKDC objective score.Results
No cases of intraoperative or postoperative symptoms or signs related to gas embolism or persistent subcutaneous emphysema were registered. Each subscale of the KOOS subjective score improved from preoperative to follow-up. The median Lysholm score was 50 (range 15–66) at baseline and 87.5 (range 54–100) at follow-up (p < 0.05). The median Tegner score was 2 (range 1–4) at baseline to 5 (range 2–7) at follow-up (p < 0.05).Conclusions
No complications registered, and the satisfactory clinical results achieved in this series suggest that carbon dioxide insufflation during arthroscopic MACI is a safe and accessible option to improve visualization during the dry phase of the scaffold implant on medial femoral condyles.Level of evidence
IV. 相似文献18.
Jennifer S. Howard Carl G. Mattacola David R. Mullineaux Robert A. English Christian Lattermann 《Knee surgery, sports traumatology, arthroscopy》2014,22(9):2163-2171
Purpose
Response shift is the phenomenon by which an individual’s standards for evaluation change over time. The purpose of this study was to determine whether patients undergoing autologous chondrocyte implantation (ACI) experience response shift.Methods
Forty-eight patients undergoing ACI participated. The “then-test” method was used to evaluate response shift in commonly used patient-reported outcome measures (PROMs)—the SF-36 Physical Component Scale (SF-36 PCS), WOMAC, IKDC, and Lysholm. Each PROM was completed pre- and 6 and 12 months post-surgery. At 6 and 12 months, an additional “then” version of each form was also completed. The “then” version was identical to the original except that patients were instructed to assess how they were prior to ACI. Traditional change, response shift adjusted change, and response shift magnitude were calculated at 6 and 12 months. T tests (p < 0.05) were used to compare traditional change to response-shift-adjusted change, and response shift magnitude values to previously established minimal detectable change.Results
There were no differences between traditional change and response-shift-adjusted change for any of the PROMs. The mean response shift magnitude value of the WOMAC at 6 months (15 ± 14, p = 0.047) was greater than the previously established minimal detectable change (10.9). The mean response shift magnitude value for the SF-36 PCS at 12 months (9.4 ± 6.8, p = 0.017) also exceeded the previously established minimal detectable change (6.6).Conclusions
There was no evidence of a group-level effect for response shift. These results support the validity of pre-test/post-test research designs in evaluating treatment effects. However, there is evidence that response shifts may occur on a patient-by-patient basis, and scores on the WOMAC and SF-36 in particular may be influenced by response shift.Level of evidence
II. 相似文献19.
Karl F. Schüttler Felix Haberhauer Markus Gesslein Thomas J. Heyse Jens Figiel Olaf Lorbach Turgay Efe Philip P. Roessler 《Knee surgery, sports traumatology, arthroscopy》2016,24(5):1478-1484
Purpose
The preservation of meniscal structure and function after segmental meniscal loss is of crucial importance to prevent early development of osteoarthritis. Implantation of artificial meniscal implants has been reported as a feasible treatment option. The purpose of this study was to assess the clinical and magnetic resonance imaging (MRI) results 4 years after implantation of a polyurethane scaffold for chronic segmental medial meniscus deficiency following partial medial meniscectomy.Methods
Eighteen patients received arthroscopic implantation of an Actifit® polyurethane meniscal implant (Orteq Sports Medicine, London, UK) for deficiency of the medial meniscus. Patients were followed at 6, 12, 24, and 48 months. Clinical outcome was assessed using established patient-reported outcome scores (KOOS, KSS, UCLA Activity Scale, VAS for pain). Radiological outcome was quantified by MRI scans after 6, 12, 24, and 48 months evaluating scaffold morphology, tissue integration, and status of the articular cartilage as well as signs of inflammation.Results
Median patient age was 32.5 years (range 17–49 years) with a median meniscal defect size of 44.5 mm (range 35–62 mm). Continuing improvement of the VAS and KSS Knee and Function Scores could be observed after 48 months compared to baseline, whereas improvement of the activity level according to UCLA continued only up to 24 months and decreased from there on. The KOOS Score showed significant improvement in all dimensions. MRI scans showed reappearance of bone bruises in two patients with scaffold extrusion. No significant changes in the articular cartilage could be perceived.Conclusion
Arthroscopic treatment for patients with chronic segmental meniscal loss using a polyurethane meniscal implant can achieve sustainable midterm results regarding pain reduction and knee function.Level of evidence
IV.20.
Noboru Shimada Masataka Deie Kazuhiko Hirata Yasuhiko Hiate Naoya Orita Daisuke Iwaki Yoshihiro Ito Hiroaki Kimura Evangelos Pappas Mitsuo Ochi 《Knee surgery, sports traumatology, arthroscopy》2016,24(8):2506-2511