共查询到20条相似文献，搜索用时 31 毫秒
1.
Jodie A. McClelland Kate E. Webster Alankar A. Ramteke Julian A. Feller 《The Knee》2017,24(3):651-656
Background
Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated.Methods
This study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants.Results
Standing lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P < 0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P < 0.01).Conclusions
In summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA. 相似文献2.
Michael Worlicek Benedikt Moser Günther Maderbacher Raphael Zentner Florian Zeman Joachim Grifka Armin Keshmiri 《The Knee》2017,24(4):711-717
Background
Patellofemoral instability may lead to osteoarthritis, anterior knee pain, and patellar luxation. The purpose of this study was to conduct an exploratory investigation into the difference of patellar kinematics of healthy knees during extension/flexion cycles in neutral, varus and valgus alignment.Methods
The three-dimensional patellar kinematics of 10 lower extremities of whole body cadavers were examined during passive motion, in neutral position, and under valgus and varus stress. Kinematics was recorded by means of an optical computer navigation system.Results
The study samples did not significantly differ with regard to mediolateral patellar shift and epicondylar distance. Varus stress led to significantly higher external rotation than valgus stress (P = 0.04) and to a significantly higher lateral patellar tilt than neutral position (P = 0.016) and valgus stress (P = 0.016). No difference was found between valgus stress and neutral position.Conclusion
Analysis of tibiofemoral alignment alone is insufficient for predicting patellar kinematics. 相似文献3.
Richard Niehaus David Schilter Paolo Fornaciari Christian Weinand Marcus Boyd Marcel Ziswiler Stefan Ehrendorfer 《The Knee》2017,24(3):518-524
Background
With the aim of improving component alignment and outcome in total knee arthroplasty (TKA), several computer-assisted devices (CAD) have been developed.Methods
In February 2014, the present unit started to use a new imageless navigation system with accelerometric pods within the surgical field for all primary TKAs; there was no need for optical trackers or cameras. This paper presents the results of the first 72 TKAs using this iAssist system in 71 prospectively collected and retrospectively analyzed patients. It analyzed component positioning in standard and full-length leg x-rays.Results
The mean age of the patients was 70 years (range 52–88). The center of hip, knee and ankle (mechanical axes) deviated on average 0.5° (standard deviation (SD) of 1.8) valgus from the targeted straight alignment. Three TKAs had > 3° deviation (i.e. four degree varus, five degree and seven degree valgus). The frontal tibial tray alignment was an average of 89.9° (range 86.4–100.1°, SD ± 2.0) with the target being 90°, and the sagittal slope was as targeted at 85.0° (range 78.4–88.8°, SD ± 1.7).Conclusions
This CAD facilitated good mechanical alignment and reproducible accuracy in component positioning. Pods clipped onto cutting jigs within the surgical field provided simple and accurate navigation, with little extra time needed for calibration and no need for optical trackers or pre-operative imaging. 相似文献4.
Youngjun Kim Byung Hoon Lee Kinde Mekuria Hyunchul Cho Sehyung Park Joon Ho Wang Deukhee Lee 《The Knee》2017,24(2):329-339
Background
Recently, surgical navigation systems have been widely used to improve the results of various orthopaedic surgeries. However, surgical navigation has not been successful in anterior cruciate ligament reconstruction, owing to its inaccuracy and inconvenience. This study investigated the registration of preoperative and intraoperative data, which are the key components in improving accuracy of the navigation system.Methods
An accurate registration method was proposed using new optical tracking markers and landmark retake. A surgical planning and navigation system for anterior cruciate ligament reconstruction was developed and implemented. The accuracy of the proposed system has been evaluated using phantoms and eight cadaveric knees. The present study investigated only the registration accuracy excluding the errors of optical tracking hardware and surgeon.Results
The target registration errors of femoral tunnelling for anterior cruciate ligament reconstruction in phantoms were found to be 0.24 ± 0.03 mm and 0.19 ± 0.10° for the tunnel entry position and tunnel direction, respectively. The target registration errors measured using cadavers were 0.9 mm and 1.94°, respectively.Conclusions
The preclinical experimental results showed that the proposed methods enhanced the registration accuracy of the developed system. As the system becomes more accurate, surgeons could more precisely position and orient the femoral and tibial tunnels to their original anatomical locations. 相似文献5.
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6.
Raul Mayr Vinzenz Smekal Christian Koidl Christian Coppola Josef Fritz Ansgar Rudisch Christof Kranewitter René Attal 《The Knee》2017,24(5):1047-1054
Background
Tunnel widening after anterior cruciate ligament reconstruction (ACLR) is influenced by the surgical and fixation techniques used. Computed tomography (CT) is the most accurate image modality for assessing tunnel widening, but magnetic resonance imaging (MRI) might also be reliable for tunnel volume measurements. In the present study tunnel widening after ACLR using biodegradable interference screw fixation was compared with all-inside ACLR using button fixation, with tunnel volume changes being measured on CT and MRI scans.Study design
Randomized controlled trial; Level of evidence, 2.Methods
Thirty-three patients were randomly assigned to hamstring ACLR using a biodegradable interference screw or all-inside cortical button fixation. CT and MRI scanning were done at the time of surgery and six months after. Tunnel volume changes were calculated and compared.Results
On CT, femoral tunnel volumes changed from the postoperative state (100%) to 119.8% with screw fixation and 143.2% with button fixation (P = 0.023). The changes in tibial tunnel volumes were not significant (113.9% vs. 117.7%). The changes in bone tunnel volume measured on MRI were comparable with those on CT only for tunnels with interference screws. Tibial tunnels with button fixation were significantly underestimated on MRI scanning (P = 0.018).Conclusions
All-inside ACLR using cortical button fixation results in increased femoral tunnel widening in comparison with ACLR with biodegradable interference screw fixation. MRI represents a reliable imaging modality for future studies investigating tunnel widening with interference screw fixation. 相似文献7.
Optimization of sagittal and coronal planes with robotic-assisted unicompartmental knee arthroplasty
Michael A. Gaudiani Benedict U. Nwachukwu Jayesh V. Baviskar Mrinal Sharma Anil S. Ranawat 《The Knee》2017,24(4):837-843
Background
One of the anatomic goals of total knee arthroplasty (TKA) is optimizing in the coronal and sagittal plane. Accurate alignments of both planes have been correlated to functional outcome and range of motion. There is a paucity of evidence on the accuracy of unicompartmental knee arthroplasty (UKA) in balancing biplanar knee alignment – specifically sagittal plane alignment. Because robotic assisted UKA has an advantage of more accurately manipulating sagittal plane for optimal alignment and kinematics based on pre-operative and intraoperative CT planning we assessed the accuracy.Methods
We reviewed the clinical and radiographic information of 94 robotic assisted UKA surgeries for balancing of sagittal and coronal knee anatomy using radiographic parameters, such as posterior condylar offset ratio (PCOR), posterior tibial slope (PTS), femoral-tibial angle, and joint line.Results
In the sagittal plane, we found no significant difference between pre and postoperative PCOR values. As planned, PTS was significantly lower after UKA compared to the native knee (4.91° vs 2.28°; p < 0.0001). In the coronal plane, there was no significant difference in the joint line however pre and post-operative mechanical axis were significantly different (5.43°± 2.58 of varus vs. 2.76°± 2.14 of varus; p < 0.0001).Conclusion
This study attempts to quantify sagittal and coronal plane alignment after robotic assisted UKA. More attention should be paid to the role of sagittal plane alignment after UKA. We believe modifying posterior tibial slope, while maintaining PCOR is fundamental in achieving native kinematics and optimizing range of motion in the sagittal plane. This may be best-accomplished using robotic techniques for UKA. 相似文献8.
Suguru Nakamura Yukihide Minoda Shigeru Nakagawa Yoshinori Kadoya Susumu Takemura Akio Kobayashi Shigekazu Mizokawa Yoichi Ohta Sinji Takahashi Kazumasa Yamamura Hiroaki Nakamura 《The Knee》2017,24(2):434-438
Background
The medial pivot total knee prosthesis with alumina ceramic femoral components was introduced to reproduce physiological knee kinematics and reduce polyethylene wear. The five-year clinical outcomes of alumina medial pivot total knee arthroplasties (TKA) have previously been reported. The purpose of this study was to provide the longer-term clinical results at a minimum follow-up of 10 years.Methods
The clinical results of 70 alumina medial pivot TKA in 51 consecutive patients, with a minimum follow-up period of 10 years, were evaluated.Results
Mean follow-up was 11.8 years (range 10 to 13). Alumina medial pivot TKAs improved the patients' Knee Society knee scores, function scores, and postoperative ranges of motion compared with their pre-operative statuses (P < 0.05 for each). Revision surgery was required in one knee due to a postoperative fracture of the tibial plateau after a fall that occurred two years postoperatively. Osteolysis and femoral component loosening was identified in one case after the initial five-year time point of analysis. The survival rate was 99.1% at 10 years.Conclusions
This study demonstrated excellent clinical results for patients receiving the alumina medial pivot prosthesis at a minimum follow-up period of 10 years. 相似文献9.
Charles Rivière Matthieu Ollivier Damien Girerd Jean Noël Argenson Sébastien Parratte 《The Knee》2017,24(3):627-633
Background
A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait. Therefore, the aim of our study is to assess the relationship between the standing and the dynamic (gait activity) HKAs.Methods
A prospective study on a cohort of 35 patients treated with a posterior-stabilized TKA for primary osteoarthritis. Three months after surgery each patient had a long-leg radiograph and the limb was classified as neutrally aligned (17 patients), varus aligned (nine patients), or valgus aligned (four patients). Patients then performed a gait analysis for level walking.Results
Standing HKA has a moderate correlation with the peak dynamic varus (r = 0.318, p = 0.001) and the mean and peak adduction moments (r = 0.31 and r = ? 0.352 respectively). No significant correlation between standing HKA and the mean dynamic coronal alignment (r = 0.14, p = 0.449). No differences were found for dynamic frontal parameters (dynamic HKA and adduction moment) between patients defined as neutrally or varus aligned.Conclusions
The standing HKA after TKA was of little value to predict dynamic behaviour of the limb during gait, this may explain why standing coronal alignment after TKA may have limited influence on long-term implant fixation and wear. 相似文献10.
Young Gon Na Moon Jong Chang Sang Hwa Eom Seok Jin Kim Seong Cheol Park Tae Kyun Kim 《The Knee》2017,24(1):63-69
Background
We aimed to determine whether coronal alignment measured on the single-limb stance (SLS) radiographs differs from those on the double-limb stance (DLS) images. We also investigated whether the size of such differences was affected by the knee pathology, lower limb alignment, and geometry of the tibia or femur.Methods
We measured coronal alignment with mechanical tibiofemoral angle (MTFA) on the DLS and SLS radiographs in patients with posterolateral rotatory instability (PLRI, 30 knees), osteoarthritis (OA) with varus deformity who were scheduled for high tibial osteotomy (HTO) (60 knees), and in normal control (60 knees). The measurements on the SLS radiographs were compared with those on DLS images and the size of the differences were compared between the three groups. The correlation between the radiograph-related differences of coronal alignment and the limb alignment or geometry of tibia/femur was investigated. In the OA group, the size of the radiograph-related differences before HTO were compared with those after surgery.Results
The coronal alignment on the SLS radiographs indicated varus accentuation compared to those on the DLS radiographs in the PLRI and OA groups (1.6 and 2.4°, respectively), while it was negligible in the normal group. Greater varus inclination of the tibial plateau was related to greater varus accentuation (r = 0.249). The HTO decreased the extent of varus accentuation in the OA group (reduction of varus accentuation = 1.5°).Conclusions
Coronal alignment on the SLS radiograph is different from static alignment measured on the DLS radiograph, which may reflect dynamic alignment. 相似文献11.
Ki-Mo Jang Hong Chul Lim Seung-Beom Han Chandong Jeong Seul-Gi Kim Ji-Hoon Bae 《The Knee》2017,24(3):641-650
Background
A new instrument system has been introduced to improve the accuracy and reproducibility of implant positioning in Oxford® unicompartmental knee arthroplasty (UKA). This study aimed to determine if the new instrumentation could improve postoperative implant positioning and limb alignment, and reduce the occurrence of outliers in Oxford® UKA.Methods
A total of 77 cases of Oxford® UKA with the new instrumentation were included. Individual matching for the conventional instrument group was performed according to age, sex, and body mass index. Postoperative radiological variables, including the hip-knee-ankle angle and the varus/valgus and flexion/extension angles of the femoral and tibial implants, were measured and compared between the new instrumentation group and the conventional group. The outliers in implant positions and postoperative complications were also compared.Results
No significant between-group differences were observed in terms of lower limb alignment and tibial implant alignment. However, statistically significant differences were identified in the varus/valgus and flexion/extension angles of the femoral implant (P = 0.01 and P < 0.001, respectively). More outliers were observed in the flexion/extension angles of the femoral and tibial implants in the new instrumentation group. Eight meniscal bearing dislocations and three lateral compartmental degenerative changes were found in the conventional group, while there were two meniscal bearing dislocations in the new instrumentation group during the study period.Conclusion
The present study did not confirm any benefit of the new instrument system in terms of postoperative limb alignment, positioning of the implant, or reducing outliers beyond the use of the conventional instruments. 相似文献12.
Matthew T. Houdek Maurizio Scorianz Cody C. Wyles Robert T. Trousdale Franklin H. Sim Michael J. Taunton 《The Knee》2017,24(4):851-855
Background
Pigmented villonodular synovitis (PVNS) is a rare, benign proliferation of the synovium, commonly affecting the knee. Arthroplasty can successfully manage arthrosis in this population; however, outcome data is limited. The purpose of this study was to investigate the oncologic and functional outcome of patients undergoing total knee arthroplasty (TKA) in the setting of PVNS.Methods
48 patients were identified at our institution with histologically confirmed PVNS that subsequently received TKA. The cohort consisted of 28 females and 20 males with a mean age and body mass index of 61 years and 29.2 kg/m2. 37 patients had “active” disease, defined as diffuse in 40 patients and focal in eight. Mean follow-up was 14 years.Results
The 10-year disease free-survival was 88%. Recurrence occurred in 6 patients and was treated with synovectomy and revision arthroplasty (n = 4), local excision (n = 1) and transfemoral amputation (n = 1). 25 patients sustained at least 1 complication, most commonly decreased knee range of motion. Complications resulted in revision TKA in 10 patients (21%). There was no difference (P = 0.74) between mean pre- and postoperative ROM; however, there was a significant reduction in the number of patients with a flexion contracture > 15° (P = 0.03). The mean Knee Society score and functional score significantly improved following surgery (P < 0.001).Conclusions
This study indicates arthroplasty in the setting of PVNS improves patient function and reduces the presence of flexion contractures. Patients with a history of PVNS should be cautioned when undergoing arthroplasty on the elevated risk of subsequent procedures.Level of evidence
Level III. 相似文献13.
George A. Macheras Spyridon P. Galanakos Panagiotis Lepetsos Panagiotis P. Anastasopoulos Stamatios A. Papadakis 《The Knee》2017,24(2):447-453
Background
The ideal total knee arthroplasty (TKA) should provide maximum range of motion and functional stability for all desired daily activities and, if possible, to replicate normal knee kinematics and function. The ADVANCE® Medial Pivot (AMP) Knee System was designed with a highly congruent medial compartment and a less conforming lateral compartment to more closely mimic the kinematics of the normal knee and to offer more stability through out of range of motion (ROM). The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of this TKA system.Methods
Three hundred and twenty-five (325) patients (347 knees) with knee osteoarthritis underwent a TKA using the AMP prosthesis in our Department. For evaluation, objective and subjective clinical rating systems along with radiograph series were used. The average follow-up was 15.2 years.Results
All patients showed a statistically significant improvement (p < 0.0005) in the Knee Society clinical rating system, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, SF-12® questionnaire, and Oxford knee score. The majority of patients (94%) were able to perform age-appropriate activities with a mean knee flexion of 120° (range, 105°–135°) at final follow-up. Survival analysis showed a cumulative success rate of 98.8% at 17 years.Conclusion
The obtained results demonstrate excellent long-term clinical outcome for this knee design. 相似文献14.
Andreas Voss Sangmin Ryan Shin Akira M. Murakami Mark P. Cote Andrea Achtnich Elmar Herbst Anthony A. Schepsis Cory Edgar 《The Knee》2017,24(5):1247-1255
Background
Trochlear dysplasia is an important risk factor associated with patellofemoral instability, but it remains difficult to classify with consistency. Currently there is no objective way to quantify the dysplasia. The purpose of this study is to define and quantify objectively the trochlear morphology by volume and length via computed tomography (CT).Methods
One-hundred control patients (136 knees) were retrospectively reviewed and compared to 36 consecutive patients (72 knees) who were treated surgically for recurrent patellar instability and known trochlear dysplasia based on a lateral radiograph. Trochlear morphology was analyzed from a pre-operative CT and data presented as trochlear sulcus volume trochlear length. To determine where along the trochlear length dysplasia is most variable, the trochlear length was radiographically divided into thirds, volume was quantified along that section and compared to control trochlear.Results
A significant difference in trochlear morphology exists between cohorts, volume (1.98 vs 3.77 cm3) and length (31.97 vs 34.66 mm) (p < 0.05). However, there appears to be a gender based difference in trochlea morphology. The trochlea volumetric analysis between the female cohorts (L: 2.02 cm3 vs. 2.94 cm3, R: 1.95 cm3 vs. 2.93 cm3) demonstrated significantly less volume in instability patients (p < 0.001). The proximal third of the trochlear contributed the majority of dysplasia difference determined by comparing mean trochlear volume, 95% of the difference. This difference decreased in distal sections, 53% and 32% respectively.Conclusion
This reproducible technique can be used to quantify the trochlea morphology, in order to describe the severity of a dysplasia. 相似文献15.
Mona Hommada Arsène Mekinian Pierre-Yves Brillet Sébastien Abad Claire Larroche Robin Dhôte Olivier Fain Michael Soussan 《Autoimmunity reviews》2017,16(11):1131-1137
Objectives
To assess the detection rate of aortitis in giant cell arteritis (GCA) with fluorodeoxyglucose positron emission tomography/computed tomography (PET) and to compare the findings with CT angiography (CTA).Methods
Fifty-two GCA patients and 27 controls were included. GCA patients had a PET scan at diagnosis (35/52) or during relapse (17/52). Concomitant CTA was performed in 35/52 patients. Aortitis was defined as FDG uptake higher than the liver for PET and wall thickness ≥ 3 mm for CTA. Agreement between PET and CTA was evaluated by the kappa coefficient and Spearman correlation coefficient.Results
Aortitis was diagnosed using PET in 40% (14/35) of patients at diagnosis and in 0% of controls (0/27). Agreement was perfect between PET and CT at a patient-based level, and very good at a vascular segment-based level (kappa: 0.72 to 1). PET was positive in 35% (6/17) of patients scanned during GCA relapse, showing aortitis (n = 4) and/or articular uptake (n = 4). Discrepancies between PET and CT were observed only in relapsing GCA (n = 3). Correlation between the maximum standardized uptake value and wall thickness was moderate at diagnosis (r: 0.57 to 0.7) and not statistically significant during relapse.Conclusions
The detection rate of aortitis in GCA patients using PET is 40%, approximately in the range of CTA rates, suggesting that the two techniques have similar sensitivity. PET seems valuable in relapsing GCA, allowing the detection of vascular and articular activities. 相似文献16.
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17.
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18.
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19.
Background
Whether early or delayed surgical intervention in patients with multi-ligament injuries results in better outcomes, is of current and controversial debate.Purpose
The purpose of this study was to perform a meta-analysis comparing early versus late surgical treatment of multi-ligament knee injuries.Methods
We performed a systematic review of Medline, Embase, Scopus, and Google Scholar to identify relevant studies in the English and German literature. Eligibility criteria included studies comparing early or delayed surgical interventions for multi-ligament knee injuries, with a minimum follow-up of two years, reporting the primary clinical outcome using a validated functional scoring system and range of motion. Exclusion criteria were patients treated with multi-trauma, head injury, non-union, lower extremity fractures, or a documented history of previous knee injuries. Publication bias was assessed by funnel plot, and the risk of bias was established using the Cochrane Collaboration's risk of bias tool. Heterogeneity was assessed using χ2 and I2 statistic.Results
Eight studies (n = 260 patients) were included in the analysis. 149 patients were treated early with a mean of 10.6 days; 111 patients were treated late with a mean of 294 days. The pooled estimate for clinical outcome demonstrated that early surgery resulted in significantly higher Lysholm scores (SMD 0.669, 95% CI: 0.379 to 0.959, p = 0.0001, I2 = 0%). Thirty-one per cent of all patients with early surgery had a normal or near normal knee, whereas only 15% of patients with late reconstruction reported the knee to be normal or near normal. The pooled estimates for total ROM did not demonstrate a significant difference between the groups (SMD 0.113, 95% CI: ? 0.271 to 0.498, p = 0.564, I2 = 35.57%).Conclusions
The results of this meta-analysis suggest that early surgical intervention in multi-ligament injuries of the knee produces a significantly superior clinical outcome, compared to late reconstruction. Although an overall trend of improved total range of knee motion was also demonstrated, this was very small and unlikely to be clinically relevant.Level of evidence
Level 4; Systematic review and meta-analysis. 相似文献20.
Byung Hoon Lee Chul Won Ha Sang Won Moon Minho Chang Hun Yeong Kim Sin Hyung Park Joon Ho Wang 《The Knee》2017,24(2):362-371