关节镜配合微创治疗膝关节炎的临床疗效

目的：探讨关节镜配合微创治疗膝关节炎的临床疗效。方法采集2009年10月~2012年10月我院收治的膝关节炎患者100例,给予关节镜配合微创治疗膝关节炎治疗,术后给予肌肉锻炼、功能康复等治疗,术后随访6个月~2年,观察临床疗效。结果100例患者经关节镜配合微创治疗后,患者关节疼痛消失或明显减轻,平均随访1.3年,优秀率62%,总有效率93%。结论关节镜配合微创治疗膝关节炎,在具有手术切口小、术后感染少、术后并发症少等优点的同时能够取得良好的临床疗效。     

玻璃酸钠在膝骨性关节炎关节镜清理术后的应用

目的 探讨膝骨性关节炎关节镜清理术后应用玻璃酸钠腔内注射治疗的效果.方法 60例(76膝)膝骨性关节炎患者均采用关节镜清理术治疗,术后应用玻璃酸钠腔内注射治疗.结果 60例均获随访,时间5～12个月.优45膝,良21膝,可6膝,差4膝,优良率85.5%,有效率93.4%.结论 膝骨性关节炎关节镜清理术后配合应用玻璃酸钠腔内注射治疗效果明显.     

膝关节骨性关节炎的关节镜治疗体会

目的我科自2001～2005年4月对59例67膝的骨性关节炎（0A），进行关节镜检查及镜下清理术。方法镜检：膝关节骨性关节炎伴不同程度滑膜炎，滑膜皱壁粘连纤维片，关节软骨不同程度破坏。镜下清除增生滑膜，松解粘连，去除剥脱软骨、修复关节面。结果随访2月～4年，平均1.5年，术后综合评估2月～1年，优良率94％；1～2年，优良率79.2％；2年以上优良率54.8％。结论关节镜对膝关节骨性关节炎诊断能提供了比较全面的资料，并对骨性关节炎早期有良好疗效，具有创伤小、恢复快、并发症少和重复治疗等优点。     

膝关节镜下关节清理术加腔内注射透明质酸钠治疗骨性关节炎

目的探讨关节镜下清理术加腔内注射透明质酸钠治疗膝骨性关节炎的疗效。方法对78例88膝，膝关节骨性关节炎患者先用关节镜行清理术，待冲洗液清亮后向腔内注射透明质酸钠3ml。结果按疼痛、肿胀、关节活动度、步行能力、日常生活能力五项综合评分，随访8月-3年，优良率79．5％。结论关节镜下清理术可明确膝骨性关节炎的病变程度，有针对性的操作，同时注入透明质酸钠，可营养软骨，改变关节内环境，对治疗骨性关节炎具有肯定的疗效。     

关节镜微创治疗膝关节骨性关节炎的疗效观察

目的探讨关节镜下微创治疗膝关节骨性关节炎（OA）的疗效。方法对129例膝关节OA患者行关节镜检及有限化微创清理术,采用HSS膝关节评定系统及Denis疼痛测定法进行术后疗效评定。结果术后随访6～36个月,129例中104例患者临床症状明显缓解,关节功能改善,优良率达80.62%。结论关节镜有限微创清理术能有效缓解OA症状,改善关节功能,提高生活质量。     

旋转平台全膝置换术治疗治疗重症膝关节炎34例的临床观察

目的探讨旋转平台全膝置换治疗重症膝关节骨性关节炎的临床疗效。方法对2007年1月～2009年10月我院34例（41膝）人工旋转平台全膝置换术进行临床分析和总结,行HSS[5,6]膝关节评分系统进行分析。结果术后平均随访17个月（5～31个月）,手术前HSS（thehospitalforspecialsurgery）评分平均51分,手术后评分平均92分,手术优良率为91%。病人术后在膝关节疼痛,功能和活动度方面有明显改善。结论旋转平台全膝置换术对治疗重症膝关节炎有良好的疗效。     

全膝关节表面置换术治疗膝骨性关节炎

目的分析人工全膝表面置换（TKR）治疗膝骨性关节炎的临床效果。方法对15例20膝的膝骨性关节炎病例行人工膝关节置换术，单膝关节置换10例，双膝关节置5例，全部采用后方稳定性假体。结果随访10～48个月，平均11月，采用HSS评分系统进行分析，优13例，良1例，可1例，优良率86．7％。患者术后在疼痛、功能方面都有明显改善。结论TKR对治疗严重膝骨性关节炎效果满意，术中精确的截骨操作，正确的软组织松解，注重术中髌骨轨迹的纠正及术后指导康复是手术治疗成功的关键。     

选择性关节镜清理结合术后康复治疗膝骨性关节炎32例探讨

目的 探讨选择性膝关节骨性关节炎(OA)关节镜下清理结合术后康复治疗的疗效.方法 根据适应症,综合分析病人年龄、病史、临床体征、术前X片、及治疗情况,选择32例病人,行关节镜下选择性清理,结合术后主被动康复锻炼.结果 选择性关节镜有限化清理结合术后康复治疗膝骨性关节炎,根据KSS评分1评估临床效果,优14例,良11例,可4例,差3例,术后优良率达781% 结论严格掌握手术适应症,合理选择病人,行关节镜下选择、有限清理结合术后康复治疗膝骨性关节炎,可有效地缓解症状,改善功能,取得良好的治疗效果.     

关节置换与关节镜清理联合玻璃酸钠注射治疗膝骨性关节炎

背景:膝骨性关节炎的保守治疗为关节腔注射玻璃酸钠;手术治疗主要有关节镜清理、人工膝关节置换。目前关于骨关节炎治疗的研究多为各种单独治疗的疗效比较,而关于综合治疗的疗效尚少见。目的:观察膝关节置换与关节镜清理结合关节腔注射玻璃酸钠治疗膝骨性关节炎的效果。方法:选择符合膝骨性关节炎诊断标准的患者55例,年龄50~83岁。根据患者病情告知患者各种治疗的优缺点,由患者考虑后选择治疗方式。其中联合组23例,置换组32例。联合组采用关节镜清理联合关节腔注射玻璃酸钠治疗,1次/周,连续5周;置换组采用膝关节置换治疗。随访6~30个月,治疗前后均采用HSS膝关节评分评价膝骨性关节炎治疗效果。结果与结论:两组疗效综合评估,联合组优8例,良8例,优良率70%;置换组优23例,良7例,优良率94%。两组膝关节的活动度、疼痛、关节功能都有明显改善,但膝关节置换的疗效优于关节镜清理结合关节腔注射玻璃酸钠治疗(P0.05)。     

微创小切口治疗胫骨平台骨折的体会

目的 介绍微创小切口手术治疗胫骨平台骨折的体会.方法 介绍微创小切口治疗胫骨平台骨折的手术方法,对比传统手术切口与微创小切口治疗胫骨平台骨折的疗效分析.结果 随访6个月至两年,传统手术组86例,本组优良率占81.4%,失血量约500ml.微创小切口手术治疗19例,优良率占90%,失血量约200ml.结论 使用微创小切口手术治疗胫骨平台骨折创伤小,出血少,骨折愈合率高,并发症少,内固定可靠,与传统手术治疗相比可明显减少术后晚期膝关节强直等并发症.     

Similar early migration when comparing CR and PS in Triathlon™ TKA: A prospective randomised RSA trial

ObjectivesThe objective of this study was to compare the early migration of the cruciate retaining and posterior stabilising versions of the recently introduced Triathlon™ total knee system, with a view to predicting long term fixation performance.MethodsSixty patients were prospectively randomised to receive either Triathlon™ posterior stabilised cemented knee prosthesis or Triathlon™ cruciate retaining cemented knee prosthesis. Tibial component migration was measured by radiostereometric analysis postoperatively and at three months, one year and two years.Clinical outcome was measured by the American Knee Society Score and Knee Osteoarthritis and Injury Outcome Score.ResultsThere were no differences in rotation around the three coordinal axes or in the maximum total point motion (MTPM) during the two year follow-up. The posterior stabilised prosthesis had more posterior–anterior translation at three months and one year and more caudal–cranial translation at one year and two years. There were no differences in functional outcome between the groups.ConclusionThe tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability.Level of evidenceLevel I.Article summaryArticle focus:This was a prospective randomised trial aiming to compare the single radius posterior stabilised (PS) Triathlon™ total knee arthroplasty (TKA) to the cruciate retaining Triathlon™ TKA system with regard to fixation.Strengths and limitations of this study:Strength of this study was that it is a randomised prospective trial using an objective measuring tool. The sample size of 25–30 patients was reportedly sufficient for the screening of implants using RSA [1].Trial registration:ClinicalTrials.gov Identifier: NCT00436982.     

All-inside repair of bucket handle meniscus tears – Mid-term outcomes with postoperative magnetic resonance imaging

PurposeThe purpose of this study was to evaluate our results of bucket handle meniscus tear (BHMT) repairs with an all-inside repair technique using postoperative radiological imaging to evaluate meniscus reduction and healing and use them as criteria for evaluation of repair success.MethodsProspective recruitment of 20 patients with 21 BHMT repairs performed with an all-inside technique over a period from 2013 to 2015. All patients had an International Knee Documentation Committee (IKDC) Subjective Knee Form (SKF), Lysholm Score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Activity Level Scale obtained pre-operatively and at a minimum of 24 months after surgery. All patients had postoperative knee magnetic resonance imaging (MRI) performed between 18 and 24 months after surgery to assess the stability or failure of their repairs. At 5 years after surgery, the patients were assessed with regard to whether they had undergone repeat surgery or not.ResultsAt 2 years, the mean postoperative SKF, Lysholm and KOOS grand scores were 78.9, 88.5 and 86.8, respectively. The mean pre-injury Tegner Activity Scale was 7.6 and postoperatively it was 6.0. There was a significant difference in all pre- and postoperative outcome scores (P < 0.01).The postoperative MRIs showed that 19 of the 21 BHMT repairs had stable reduction of the tear fragment and two patients had displacement of the torn bucket handle fragment. At 5 years, one patient had undergone revision surgery.ConclusionBHMTs can be repaired with all-inside techniques with good results and successful outcomes.     

Clinical and radiological outcomes of robotic-assisted unicompartmental knee arthroplasty: Early lessons from the first 100 consecutive knees in 85 patients

IntroductionRobotic-assisted unicompartmental knee arthroplasty (UKA) is associated with improved component positioning and comparable short- and mid-term implant survivorship with manual UKA. This study aims to evaluate clinical and radiological outcomes following robotic-assisted UKA as well as any potential learning-curves associated with the introduction of such new technology.MethodsProspective study of patients undergoing robotic-assisted UKA. Outcome measures were patient-reported outcome measures (PROMs) including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) and Oxford Knee Score (OKS), complications, implant survivorship, component positioning and learning curve.ResultsEighty-five patients comprising 100 knees were recruited and followed up for 21.0 ± 4.3 months. At two years, there were significant and sustained improvements in PROMs and 100% implant survivorship rate. A high degree of implant accuracy was achieved with the robotic system. A cumulative learning curve of 20 cases was noted.ConclusionRobotic-assisted UKA achieves excellent implant accuracy and clinical outcomes in the short-term. Long-term follow up is needed to evaluate this relationship.     

Patient satisfaction needs as related to knee stability and objective findings after ACL reconstruction using the LARS artificial ligament

The purposes of this study are to compare patient satisfaction with the objective measurement of knee stability and assess early complications following ACL reconstruction using a LARS artificial ligament. Forty-seven patients were reviewed 8-45 months after surgery. Assessment was made by the Knee and Osteoarthritis Outcome Score for patient satisfaction, a modified International Knee Documentation Committee form for clinical knee stability, and a Telos stress radiography for PA stability. Complications were assessed at interview and were double-checked with charts. The LARS artificial ligament may be a safe device to reconstruct an ACL tear. Documenting mechanical stability of the knee is inadequate when reporting follow-up studies and a questionnaire assessing patient satisfaction should be added to provide a better picture of the outcome and results.     

Long-term results of arthroscopic medial reefing for patellar instability

BackgroundThe purpose of the study was to investigate the long-term outcomes of the all-inside arthroscopic medial reefing (AAMR) procedure for patellar instability and the factors that affect successful outcome.MethodsIn this retrospective study, AAMR with suture was performed in 16 knees of 15 patients who had at least one patellar dislocation and did not experience a decrease in pain and who did not have a major radiological bony abnormality. Preoperatively, Tegner and Lysholm scales were used; for the final evaluation Tegner, Lysholm, Kujala and Knee injury and Osteoarthritis Outcome Score (KOOS) were used.ResultsThe average age of the patients at the time of operation was 18 years (range: 11–36 years). The average follow-up time was 118.3 months (range: 85–143 months). Six of the 16 knees (37.5%) exhibited re-dislocation. Preoperatively, the mean Lysholm and Tegner were 66.5 and 4.0, respectively; and postoperatively increased to 89.3 (P = .001) and 4.66, respectively. At the final follow-up, mean Kujala was 89.3 (good), and mean KOOS was 91.4. In all patients with re-dislocation, fewer than four knots were used, and none of the patients with four knots exhibited re-dislocation. Re-dislocations occurred in two, two, one and one patients at two, three, five and eight years, respectively.ConclusionsThe AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.     

Cartilage repair examined by second-look arthroscopy following double-level osteotomy performed for osteoarthritic knees with severe varus deformity

BackgroundThe purpose of this study was to examine the status of cartilage repair by second-look arthroscopy following double-level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity.MethodsForty-seven consecutive knees in 33 patients who underwent DLO were included in the study. The surgical technique used was a minimally invasive DLO procedure combining lateral closed-wedge distal femoral and medial open-wedge high tibial osteotomies. In the second-look arthroscopic evaluation, the following grading system proposed by Koshino was adopted: Stage A, no repair; stage B, pink fibrous tissue with or without partial coverage with white fibrocartilage; and stage C, total coverage with cartilage. The findings corresponding to stage B or C were considered as repaired. Arthroscopic assessment was performed for each compartment. Clinical outcomes were evaluated using the validated outcome measures.ResultsThe mean age at surgery was 62.8 ± 6.2 years (range: 45–75 years), and the mean time period from DLO to second-look arthroscopy was 17.1 ± 5.0 months (range: 12–33 months). Cartilage repair to some extent was identified in over 90% of the medial femoral and tibial condyles, and 12.8% of the patellar facet. As for clinical scores, both Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form (IKDC) subjective scores significantly improved after surgery (P < 0.01).ConclusionsEvaluation of the present study subjects showed that DLO could induce cartilage repair in the majority of the affected femoral and tibial articular surfaces with significant clinical improvement. In the patellar facet, however, cartilage repair could be identified in only 12.8% of cases.     

Delaying ACL reconstruction beyond 6 months from injury impacts likelihood for clinically significant outcome improvement

BackgroundThe effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery.MethodsPatients undergoing primary ACLR between January 2017 and January 2018 with minimum one year follow-up were included. International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected. Multivariate logistic regression was performed for outcome achievement and risk of revision ACLR and Weibull parametric survival analysis was performed for relative time to outcome achievement. The level of significance was set at α = 0.05.Results379 patients were included of which, 140 patients sustained ACL injury greater than six months prior to surgery. This group of patients experienced reduced likelihood to achieve patient-acceptable symptomatic state (PASS) on the IKDC (p = 0.03), KOOS Pain (p = 0.01) and a greater likelihood to undergo revision ACLR (p = 0.001). There was no impact of surgical timing on minimal clinically important difference (MCID).ConclusionPatients with greater than 6 months from injury to ACLR reported reduced likelihood to achieve CSOs, delayed achievement of CSOs, and increased rates of revision surgery.     

The Medial Rotation Knee replacement: Clinical and radiological results of a multi-centre surveillance study at five years

BackgroundThe Medial Rotation Knee (MRK) has one of the lowest revision rates of total knee replacement designs in the National Joint Registry. While survival is one metric of performance of implants, patient-reported outcomes, combined with clinical and radiological evaluation, allow more complete analysis. We report the five-year results of a prospective, multi-centre surveillance study of the MRK.MethodsA 16-surgeon, three-centre series of 520 total knee replacements were performed in 486 patients, comprising 182 males and 304 females. The mean age was 70.3 years (46–96) and BMI 29.5 kg/m² (18–57). Study subjects were given questionnaires pre-operatively, at six months, and annually thereafter. Clinical and radiological reviews were scheduled pre-operatively, at six months, three and five years.ResultsAt five years, 395 of the original 486 patients (427 of 520 knees) remained under active review. Twenty-six patients (27 knees) had withdrawn, 44 patients/knees had died and one was excluded. Thirteen patients (14 knees) were lost to follow-up, but were not revised. Seven knees were revised, equating to a survival probability of 98.6% at five years. There were significant improvements in mean Oxford Knee Score (21.23–35.79), EQ-5D (0.440–0.694) and Knee Society Score (Knee 43.00–83.97; Function 49.45–71.39). Of the radiographs available for evaluation, radiolucency was identified in 25 knees (14.6%) with one case of osteolysis of the tibial component.ConclusionIn addition to excellent survivorship, mid-term patient-reported, clinical and radiological results at five years are satisfactory, and consistent with other medial pivot designs.     

Long-term clinical and radiological outcomes after multiligament knee injury using a delayed ligament reconstruction approach: A single-center experience

PurposeTo present long-term clinical and radiological results of patients treated with delayed reconstruction of multiligament knee injuries.MethodsClinical data from 26 patients (21 men, five women, mean age 27.44 years) were retrospectively reviewed. Patients were evaluated at final follow-up with the use of: The International Knee Documentation Committee score (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity level, Lysholm Knee Scoring Scale, EuroQol subjective knee evaluation form, and KT-2000 arthrometer. Mean follow-up time was 105.38 months. Both knees were radiographically evaluated for osteoarthritis according to the Kellgren–Lawrence classification.ResultsNo patient required mobilization under anesthesia for adhesion lysis at the immediate or later postoperative duration. There was no statistically significant difference in range of motion between the healthy and operated sides (P = 0.713). Mean time to final range of motion regain was 2.1 ± 0.4 months. Average KT-2000 side-to-side (operated vs. normal) difference was 2.03 ± 1.1 mm, and the difference was statistically significant (P = 0.007). The mean IKDC, KOOS, Lysholm, Tegner, and Euroqol-5D postoperative scores were 82.13 ± 17.5, 84.59 ± 16.8, 90.6 ± 6.4, 4.3 ± 1.3, and 80 ± 11.74, respectively. Multiple regression analysis showed that age and follow-up time had significant effects on each clinical score, except for the Lysholm and Tegner scores. Progression of osteoarthritic changes of the reconstructed knee and its contralateral side was significantly different (P = 0.003).ConclusionExcellent clinical results were reported from this center's long-term experience with delayed ligament reconstruction, and osteoarthritic changes of reconstructed knees were recorded.     

Correlation between patients' satisfaction and objective measurement of knee stability after ACL reconstruction using a patellar tendon autograft

We evaluated the relationship between patients' satisfaction and objective measurements of knee stability after reconstruction of the ACL using a patellar tendon autograft. An examination of 59 patients 2-7 years after surgery was carried out. Assessment was made by the Knee and Osteoarthritis Outcome Score for patient satisfaction, a modified International Knee Documentation Committee form for clinical knee stability and a Telos stress radiography for PA stability. The results show that patients' satisfaction was much greater than the objective evaluation would suggest. We conclude that documenting mechanical knee stability alone is inadequate for follow-up studies and a questionnaire assessing patient satisfaction should be added.