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1.
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2.
Fabian van de Bunt Kaj S. Emanuel Thomas Wijffels Peter N. Kooren Idsart Kingma Theodoor H. Smit 《The Knee》2017,24(4):718-725
Background
To properly study knee kinetics, kinematics and the effects of injury and surgical treatment in vitro, the knee should be constrained as little as possible, while imposing physiological loads. A novel dynamic biomechanical knee system (BKS) is presented here. The aim of this study was to test the feasibility and reproducibility of the system and demonstrate its features with an Anterior Cruciate Ligament (ACL) lesion model.Methods
Six goat knees were used in the current study. Flexion and extension simulating gait was imposed by a servo-motor, while normal joint load was applied by two artificial muscles. Intra-class correlation coefficients (ICCs) were assessed for inter-test measures, while paired t-tests were performed for comparison between intact knees and knees with ACL-lesion.Results
The ICC's for inter-test measures based on all six goat knees were excellent: varus/valgus: ICC = 0.93; rotation: ICC = 0.94 (all p < 0.01), and translation in frontal (x)-, side (y)- and upward (z)-direction (ICC = 0.90, 0.88 & 0.94) (all p < 0.01). A significant increase in joint center movement was found in knees after creating an ACL-lesion (p = 0.018): translation increased more than two-fold in frontal (p = 0.016), side (p = 0.004) and upward (p = 0.018) direction.Conclusions
Five degrees of motion were reproducibly assessed in the intact joint, suggesting that the goat knee may find its natural pathway when loaded in the BKS. The novel five-degrees-of-freedom knee system allows a detailed study of the effect of a diversity of defects and surgical treatments on knee biomechanics under physiological loading conditions. 相似文献3.
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4.
Mark De Ste Croix Youssif O. ElNagar John Iga Francisco Ayala David James 《The Knee》2017,24(4):745-750
Background
Females are two to eight times more likely to suffer a non-contact injury compared with males thus the purpose of this study was to explore the influence of joint angle and movement velocity on sex differences in the functional hamstring to quadriceps ratio (H/QFUNC).Methods
Isokinetic concentric and eccentric torque were determined in 110 participants (55 males and 55 females) through a 90° range of movement at 60, 120, and 240°/s. Testing was performed with the hip flexed at 10°. The H/QFUNC was determined at three specific joint angles (15, 30 and 45° flexion) and where peak torque occurred for concentric knee extension.Results
A significant interaction effect (P < 0.01) for sex and joint angle was observed with women demonstrating a lower H/QFUNC than males, especially at more extended knee positions. A significant sex by velocity interaction (P < 0.01) indicated a lower H/QFUNC in women as velocity increased. Significant main effects (P < 0.01) indicated that irrespective of sex the H/QFUNC increased as the knee extends and velocity increases.Conclusion
Given the reduced H/QFUNC in females compared to males at more extended knee positions and faster velocities, this may contribute to the observed sex bias in reported injury rates. 相似文献5.
Sam K Yasen Zakk M Borton Alistair I Eyre-Brook Harry C Palmer Stewart T Cotterill Mike J Risebury Adrian J Wilson 《The Knee》2017,24(1):55-62
Background
This paper reports the outcomes of patients undergoing ACL reconstruction using a TransLateral single bundle, all-inside hamstring technique at a minimum of two year follow-up.Methods
The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory fixation devices. Femoral and tibial sockets are produced using a retrograde drill. The graft is deployed, fixed and tensioned on both tibia and femur. Patients were evaluated preoperatively using the KOOS, Lysholm and Tegner scores and at six, 12 and 24 months postoperatively. Objective assessment of knee laxity was performed using the KT-1000 along with goniometric measurement of range or motion.Results
One hundred and eight patients, mean age 30.9 years (range 15 to 61) were included. Mean follow-up 49.8 months (range 30–66). The mean increase in KOOS at two years was 30.3 points; Lysholm, 33.1 points; Tegner Activity scale, 2.0 levels. These were all statistically significant (p < 0.001). Range of motion in the reconstructed knee approximated the uninjured knee by 12 months and was restored by two years. KT-1000 showed significant reduction in side-side difference to no more than 2.4 mm at all postoperative time points (p < 0.001). Re-rupture rate in this series was 6.5%, all following episodes of significant additional postoperative trauma to the knee.Conclusions
TransLateral all-inside ACL reconstruction demonstrates good medium term subjective and objective outcomes with a low complication and failure rate. 相似文献6.
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7.
Clinical and radiologic evaluation of medial epicondylar osteotomy for varus total knee arthroplasty
Background
In varus total knee arthroplasty (TKA), a pathologic contracture of the medial soft tissue should be released for ligament balancing. A medial epicondylar osteotomy has been performed as an alternative method for this. The purpose of this study was to demonstrate the clinical and radiologic results of medial epicondylar osteotomy for varus TKA, focusing on the union type of osteotomy site.Methods
The study retrospectively evaluated 61 cases with a mean femorotibial angle of 10.4° varus and a mean flexion contracture angle of 8.5 ± 9.8°. Intraoperative medial and lateral gap difference in extension and 90° flexion was accepted at < 2 mm. Clinical outcomes (Knee Society Scores, range of motion) and radiologic outcomes (coronal alignment and valgus stability) were compared between the two groups divided by the union type of osteotomy site (bony union or fibrous union).Results
The clinical and radiologic outcomes were significantly improved at the latest follow-up. Bony union was achieved in 39 (63.9%) patients, whereas 22 patients showed fibrous union. There was no difference in the varus–valgus angle on the stress radiographs between the bony union and fibrous union group (1.6 ± 1.2° vs. 1.6 ± 0.8°, P < 0.916). The Knee Society Scores (knee, function), range of motion and radiographic alignment did not differ between the two groups.Conclusion
Medial epicondylar osteotomy was a good option for gap balancing during TKA, as it provided satisfactory clinical and radiological results, regardless of union type of the osteotomy site. 相似文献8.
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9.
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10.
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11.
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12.
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13.
Aim
(1) Characterize knee joint moments and peak knee flexion moment timing during kneeling transitions, with the intent of identifying high-risk postures. (2) Determine whether safety footwear worn by kneeling workers (construction workers, tile setters, masons, roofers) alters high flexion kneeling mechanics.Methods
Fifteen males performed high flexion kneeling transitions. Kinetics and kinematics were analyzed for differences in ascent and descent in the lead and trail legs.Results
Mean ± standard deviation peak external knee adduction and flexion moments during transitions ranged from 1.01 ± 0.31 to 2.04 ± 0.66% body weight times height (BW 1 Ht) and from 3.33 to 12.6% BW 1 Ht respectively. The lead leg experienced significantly higher adduction moments compared to the trail leg during descent, when work boots were worn (interaction, p = 0.005). There was a main effect of leg (higher lead vs. trail) on the internal rotation moment in both descent (p = 0.0119) and ascent (p = 0.0129) phases.Conclusion
Peak external knee adduction moments during transitions did not exceed those exhibited during level walking, thus increased knee adduction moment magnitude is likely not a main factor in the development of knee OA in occupational kneelers. Additionally, work boots only significantly increased the adduction moment in the lead leg during descent. In cases where one knee is painful, diseased, or injured, the unaffected knee should be used as the lead leg during asymmetric bilateral kneeling. Peak flexion moments occurred at flexion angles above the maximum flexion angle exhibited during walking (approximately 60°), supporting the theory that the loading of atypical surfaces may aid disease development or progression. 相似文献14.
Background
This work aimed to evaluate the changes in the femoral posterior condylar offset (PCO) and tibial slope after posterior cruciate ligament (PCL)-substituting total knee arthroplasty (TKA), and to address the presence of any interactive effect between the two on knee flexion.Methods
Fifty-two PCL-substituting TKAs were performed using a posterior referencing system. Three-dimensional reconstructed computed tomographic (CT) images were used to evaluate PCO and tibial slope before and after arthroplasty. Range of motion and clinical scores were evaluated at a mean of 3.1 years postoperatively. Multivariate linear model with interaction terms was used to evaluate and compare the relationships among changes in PCO, tibial slope, and postoperative knee flexion angles.Results
The degree of change in PCO was greater in the lateral condyle than in the medial condyle (3.1 ± 2.5 mm and ? 0.5 ± 2.8 mm, respectively). Postoperative medial and lateral tibial slopes were 1.4° ± 1.8 and 1.4° ± 2.0, respectively. The mean degree of postoperative knee flexion was 125°. Analysis with interaction terms and covariate adjustment demonstrated that medial PCO and tibial slope were significantly related to knee flexion with interactive effect (P = 0.011). In cases with < 3° posterior tibial slope, the postoperative PCO was positively correlated to the degree of knee flexion angle. However, in cases with > 3° tibial slope, PCO was negatively correlated to knee flexion.Conclusion
Medial femoral PCO and tibial slope showed interactive effect on knee flexion after PCL-substituting TKAs. Reconstitution of the proper PCO and avoiding excessive tibial slope may be necessary. 相似文献15.
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16.
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17.
Takeo Nagura Yasuo Niki Kengo Harato Takeshi Mochizuki Yoshimori Kiriyama 《The Knee》2017,24(2):250-257
Background
Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee.Methods
Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3 months following surgery. A cut-off moment was determined as mean + 1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed.Results
Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm.Conclusions
The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery. 相似文献18.
Christopher J. Maugans Matthew G. Scuderi Frederick W. Werner Stefanos F. Haddad John P. Cannizzaro 《The Knee》2017,24(2):264-270
Purpose
The purpose of this study was to determine whether a modified step-cut tibial tubercle osteotomy (Maquet–Fulkerson hybrid) might produce comparable or better results than a standard oblique anteromedialization tibial tubercle osteotomy (Fulkerson type) and thus warrant the surgical need for additional cuts.Methods
Six pairs of cadaveric knees were evaluated prior to and after tibial tubercle osteotomies. Simulation was done via a shallow knee bend simulator through 20 to 70° of knee flexion for the intact specimens and following the surgical procedures. The variables tested were trochlear contact forces and pressures and patellar motion.Results
Testing showed a decreased force (P = 0.027), peak contact pressure (P = 0.01) and contact area (P = 0.034) on the lateral trochlea of the femur for both types of osteotomies. There was no significant difference in the lateral femoral peak pressure or in the medial femoral peak pressure between the oblique cut and the step-cut. Also, there was no difference in patellar motion after either procedure.Conclusion
We conclude that both osteotomies decrease lateral patellofemoral trochlear pressure. The oblique osteotomy may decrease lateral pressure to a greater extent. Regarding biomechanical testing, there was no demonstrable advantage to performing a step-cut osteotomy. 相似文献19.
Madeline Simon Chloe Parizek Jennifer E. Earl-Boehm David M. Bazett-Jones 《The Knee》2018,25(6):1057-1064
Background
The aim was to determine reliability and validity of frontal plane projection angle (FPPA) and visual assessments (VA) in both males and females.Methods
Fifty-four participants (30 females) performed lateral step-downs while kinematics were recorded by two-dimensional and three-dimensional analyses. Two raters viewed the videos, extracted images, and measured the FPPA (quantitative). Using the videos, the raters also categorized (qualitative VA) each participant's motion as demonstrating dynamic valgus (> 10° valgus), dynamic varus (> 10° varus), or no change. Reliability was assessed for FPPA and VA using intraclass correlation coefficients and Kappa, respectively. Validity was determined by comparing the FPPA to three-dimensional measures (Pearson correlations) and comparing the VA to both FPPA and standard reference 3D kinematics (Kappa).Results
FPPA showed good-excellent reliability (ICC?=?0.850–0.998). VA showed minimal–moderate reliability (κ?=?0.370–0.766). The FPPA showed large correlations (r?=?? 0.514–0.531) with hip adduction in both sexes but only a moderate relationship with knee abduction in males (r?=?0.427–0.445). VA showed no-weak (κ?=?0.153–0.475) and weak-moderate (κ?=?0.455–0.698) agreement compared to FPPA and no-weak (κ?=?? 0.300–0.183) and no-minimal (κ?=?? 0.078–0.027) disagreement compared to the reference standard 3D kinematics in males and females, respectively.Conclusion
The quantitative FPPA is more reliable and valid than qualitative VA of frontal knee plane motion. 相似文献20.
Michael Worlicek Benedikt Moser Günther Maderbacher Raphael Zentner Florian Zeman Joachim Grifka Armin Keshmiri 《The Knee》2017,24(4):711-717