Anterior Knee Research Articles

The analgesic effect of continuous adductor canal block combined with popliteal plexus block for total knee arthroplasty: a randomized controlled trial.

This study aimed to confirm the hypothesis that continuous ACB (CACB) combined with a popliteal plexus block (PPB) can improve posterior knee pain, reduce nalbuphine consumption, and shorten the length of hospital stay. Patients who underwent TKA were allocated to the CACB + sham block (SHAM) or CACB + PPB groups. The primary outcome was the maximum pain score originating from the posterior knee within 4h after TKA. Secondary outcomes included the maximum pain score originating from the posterior and anterior knees within 72h after TKA, range of motion on postoperative day (POD) 1-3, postoperative nalbuphine consumption within 72h of surgery, length of hospital stay, and complications. The maximum pain score of the posterior knee was lower in the CACB + PPB group than in the CACB + SHAM group within 0-12h after surgery. Nalbuphine consumption within 24h after surgery was lower in the CACB + PPB group than in the CACB + SHAM group. The range of motion was better in the CACB + PPB group than in the CACB + SHAM group on POD1 and 2. The length of hospital stay was shorter in the CACB + PPB group than in the CACB + SHAM group. The incidence of clinical significant nausea and vomiting was lower in the CACB + PPB group than in the CACB + SHAM group. This study found that PPB combined with CACB could relieve pain in the posterior knee within at least 12h after TKA, reduce nalbuphine consumption within 24h after TKA, improve the range of motion on POD1 and 2, and shorten the length of hospital stay for patients who underwent TKA.

Bizarre Parosteal Osteochondromatous Proliferation With Malignant Transformation and Metastases.

A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was treated with re-resection at the time of TKA. The BPOP reoccurred a second time and underwent malignant transformation to a fungating high-grade pleomorphic sarcoma with metastatic lesions. This case highlights the rare potential of a previously benign BPOP to undergo malignant transformation after recurrence. A wide margin resection may be considered primarily when surgery is indicated to prevent recurrence and its potential sequelae. [Orthopedics. 202x;4x(x):xx-xx.].

Preliminary Application of Infrared Thermography to Monitoring of Skin Temperature Asymmetries in Professional Padel Players.

The aim of the present study was to evaluate skin temperature (Tsk) asymmetries, using infrared thermography, in professional padel players before (PRE), after (POST) and 10 min after training (POST10), and their relationship with perceptual variables and training characteristics. Thermal images were taken of 10 players before, after and 10 min after a standardized technical training. After training, Tsk of the dominant side was higher than before training in the anterior forearm (30.8 ± 0.4 °C vs. 29.1 ± 1.2 °C, p < 0.01; ES = 1.9), anterior shoulder (31.6 ± 0.6 °C vs. 30.9 ± 0.6 °C, p < 0.05; ES = 1.0) posterior arm (29.5 ± 1.0 °C vs. 28.3 ± 1.2 °C, p < 0.05; ES = 1.0), and posterior forearm (30.8 ± 0.9 °C vs. 29.3 ± 1.6 °C, p < 0.05; ES = 1.1). Likewise, these differences were significant POST10 in the anterior arm, anterior forearm, anterior shoulder, posterior arm and posterior forearm. Comparing the different moments of measurement (PRE, POST and POST10), the temperature was higher POST10 in all the regions analyzed except for the shoulder, abdominals, and lower back. Also, correlations were found between fatigue variation and temperature variation between limbs (Tsk dominance), and no correlation was found except between age and posterior thigh (|r| = 0.69; p < 0.05), and between the racket mass and anterior knee (|r| = 0.81; p < 0.01). In conclusion, infrared thermography allows monitoring of skin asymmetries between limbs in professional padel players, but these asymmetries were not related to overall fatigue variation, overall pain variation, years of experience and training hours.

The suprapatellar fat pad: A histotopographic comparative study.

The suprapatellar fat pad is an adipose tissue located in the anterior knee whose role in osteoarthritis is still debated. Considering that anatomy drives function, the aim of this histotopographic study was to investigate the specific morphological features of the suprapatellar fat pad versus the infrapatellar fat pad in the absence of osteoarthritis, for a broad comparative analysis. Suprapatellar fat pad and infrapatellar fat pad tissue samples (n = 10/group) underwent microscopical/immunohistochemical staining and transmission electron microscopy analysis; thus, tissue-specific characteristics (i.e., vessels and nerve endings presence, lobuli, adipocytes features, septa), including extracellular matrix proteins prevalence (collagens, elastic fibers), were focused. Multiphoton microscopy was also adopted to evaluate collagen fiber orientation within the samples by Fast Fourier Transform (coherency calculation). The absence of inflammation was confirmed, and comparable counted vessels and nerve endings were shown. Like the infrapatellar fat pad, the suprapatellar fat pad appeared as a white adipose tissue with lobuli and septa of comparable diameter and thickness, respectively. Tissue main characteristics were also proved by both semithin sections and transmission electron microscopy analysis. The suprapatellar fat pad adipocytes were roundish and with a smaller area, perimeter, and major axis than that of the infrapatellar fat pad. The collagen fibers surrounding them showed no significant difference in collagen type I and significantly higher values for collagen type III in the infrapatellar fat pad group. Regarding the septa, elastic fiber content was statistically comparable between the two groups, even though more represented by the suprapatellar fat pad. Total collagen was significantly higher in the infrapatellar fat pad and comparing collagen type I and type III they were similarly represented in the whole cohort despite collagen type I appearing to be higher in the infrapatellar fat pad than in the suprapatellar fat pad and vice versa for collagen type III. Second harmonic generation microscopy confirmed through coherency calculation an anisotropic distribution of septa collagen fibers. From a mechanical point of view, the different morphological characteristics determined a major stiffness for the infrapatellar fat pad with respect to the suprapatellar fat pad. This study provides, for the first time, a topographic description of the suprapatellar fat pad compared to the infrapatellar fat pad; differences between the two groups may be attributed to a different anatomical location within the knee; the results gathered here may be useful for a more complete interpretation of osteoarthritis disease, involving not only cartilage but the whole joint.

Consequences of anterior knee pain after anterior cruciate ligament reconstruction: A 2015-2020 cohort study.

Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) graft aims to stabilise the knee, but it may bring some complications like anterior knee (AKP) pain that can have consequences on the functional aspect of this surgery. The aim of this study was to compare isokinetic knee strength and functional outcomes between patients with and without AKP following an ACLR using HT graft during the first-year post-surgery. Three hundred and thirty subjects operated by ACLR using hamstring tendon graft were included in our retrospective cohort and divided into two groups: a group with AKP (AKP+ group) and one without AKP (AKP-group). In our population, 14.8% of the patients had AKP. At 4 post-operative months, subjects with pain had lower isokinetic strength limb symmetry index (LSI) for knee flexors and extensors, and a lower Lysholm score than subjects without pain (p < 0.0001). These differences did not persist at 7 post-operative months, and there was no difference in the one-leg hop test. After multivariate analysis, we highlighted the impact of time on the evolution of these parameters. Yet, the exact definition of AKP after ACLR remains to be clearly defined since an imprecise diagnosis may lead to inappropriate management. Pre-operative information about this type of complication, which evolves favourably with time, could be useful for patients. Indeed, AKP can occur after ACLR, even if a HT graft has been used, compared to other surgical procedures using the knee extensor apparatus as patellar tendon graft (AKP is associated with the donor site morbidity). In case of AKP after ACLR, monitoring the muscle inhibition by isokinetic tests may enable clinicians to adapt the retraining and the return to sport.

Near-Infrared Spectroscopy measurements are reliable for studying patellar bone hemodynamics and affected by venous occlusion, but not by skin compression

PurposeAccording to the homeostasis model, patellofemoral pain (PFP) results from disturbed homeostasis due to vascular insufficiency in the anterior knee. Near-Infrared Spectroscopy (NIRS) measures relative changes in concentrations (in µmol/cm2) of (de-)oxygenated hemoglobine (HHb and O2Hb). The aims were to: 1) investigate the characteristics of the NIRS signal derived from the patella during experiments affecting hemodynamics in healthy controls, and 2) determine the test–retest reliability of NIRS in positions clinically relevant for PFP patients.MethodsTwo experiments were conducted on 10 healthy controls and analysed using Student’s t-test. Reliability (ICC2,1) was evaluated for two activities (‘Prolonged Sitting’ and ‘Stair Descent’) in five PFP patients and 15 healthy controls, performed twice within five days.ResultsThe NIRS signal (HHb and O2Hb) showed a statistically significant increase (p < .001 – .002) on all optodes (30, 35, 40 mm) during ‘Venous Occlusion’ (M = 1.0 – 2.0), while it showed no statistically significant change (p = .075 – .61) during ‘Skin Compression’ (M = -0.9 – 0.9) on the 30 and 35 mm optode. Reliability of NIRS (HHb and O2Hb) ranged from moderate to almost perfect (ICC2,1 = .47 – .95) on the 30 mm optode for ‘Prolonged Sitting’, and from moderate to substantial (ICC2,1 = .50 – .68) on the 35 mm optode for ‘Stair Descent’.ConclusionsPatella NIRS measurements are affected by venous occlusion, but not by skin compression, and are sufficiently reliable as research application to compare real-time patellar bone hemodynamics. These insights may assist to improve effectiveness of evidence-based treatment strategies for PFP.Trial registrationISRCTN Trial Registration under number: 90377123.

Total Knee Arthroplasty Complicated by Diffuse Large B-Cell Lymphoma

A 74-year-old male with a prior left total knee arthroplasty presented with deformity, loosening, pain, and stiffness associated with multiple raised, erythematous, cutaneous nodules about the anterior knee. Workup was concerning for infection, but the skin nodules were atypical. The patient was sent for biopsy which revealed cutaneous diffuse large B-cell lymphoma. The revision surgery was delayed, and the patient underwent chemotherapy/radiation with complete resolution of his lymphoma. He then underwent a successful aseptic revision total knee arthroplasty. Proper identification and treatment of rare cutaneous skin lesions about a prior surgical site can limit morbidity and result in more desirable outcomes.

32315 Postoperative care consideration: Cold panniculitis induced by cooling device after knee surgery

A 52-year-old female presented with 1-week history of an asymptomatic eruption on the right knee. This started as blanched patches that progressed over a few days to raised urticarial papules. Prior to the onset of the eruption, she had been using a cold therapy device on this knee for 3 weeks after arthroscopy and medial meniscus repair. On examination, there were smooth indurated round papules localized to the right anterior knee. A punch biopsy was obtained revealing a superficial and deep perivascular lymphocytic infiltrate extending into the subcutis, consistent with cold panniculitis.

32315 Postoperative care consideration: Cold panniculitis induced by cooling device after knee surgery

A 52-year-old woman presented with 1-week history of an asymptomatic eruption on the right knee. This started as blanched patches which progressed over a few days to raised urticarial papules. Prior to the onset of the eruption, she had been using a cold therapy device on this knee for three weeks after arthroscopy and medial meniscus repair. On examination, there were smooth indurated round papules localized to the right anterior knee. A punch biopsy was obtained revealing a superficial and deep perivascular lymphocytic infiltrate extending into the subcutis, consistent with cold panniculitis. Cold panniculitis refers to inflammation of the fat following exposure to very cold temperatures. It is most common in the cheeks of young children but has rarely been reported in adults, including in female equestrians and after use of ice packs for chronic lower back pain. There has also been a report of cold panniculitis after use of a cold device after shoulder surgery. Treatment frequently involves removing the source of thermal injury. Our patient was instructed to stop using her cold therapy device and over time her lesions resolved. Given the development and increased availability of such devices, it is possible a similar clinical picture may present more frequently in dermatology clinics in the future.

MR imaging characteristics of Morel-Lavallee lesions in pediatric patients

Aim: Morel-Lavallée syndrome (MLS) is a serious posttraumatic soft tissue injury in which the subcutaneous tissues are separated from the underlying fascia by glove-finger (closed type) peeling and replaced by a cavity filled with hematoma and fat. It is most commonly seen in the trochanter major, but it can also be found in the flank, hip, and lumbodorsal regions. The goal of this study is to define the typical findings of MLS in order to avoid misdiagnosis and delay in patient treatment.&#x0D; Material and Method: This retrospective study was approved by the Institutional Review Board. Informed consent was waived due to the retrospective nature of the study. Between 2015 and 2021, MR images and clinical follow-ups of 22 pediatric patients with clinical and radiological Morel-Lavallée lesions (MLL) were reviewed retrospectively. All patients were evaluated using 1.5T or 3T power MR devices (Siemens Healthineers, Erlangen, Germany).&#x0D; Results: Of 22 patients diagnosed with MLS, 77% (n=17) were male and 23% (n=5) were female. Patients ranged in age from 7 to 18 years, with a mean of 13.2 years (+/-2,3). The locations of MLL were knee (77%, n=17, 15 patients had anterior knee and 2 patients had posterior knee involvement), hip (14%, n=3) and thigh (9%, n=2) in order of frequency. These lesions all had a similar ovoid shape. The majority of patients (18/22) received solely conservative management but three patients underwent percutaneous drainage. &#x0D; Conclusion: In our study, the importance of differential diagnosis of MLL from traumatic collections and the importance of MRI findings in diagnosis and treatment were discussed. Accurate diagnosis and treatment of MLL are critical, as the lesion's size may increase as a result of delayed treatment, causing skin necrosis and denervation due to the mass effect.

Influence of Hamstring Facilitatory Taping on Knee Muscle Activation and Dynamic Balance in Patients with Anterior Cruciate Ligament Deficient Knee

Influence of Hamstring Facilitatory Taping on Knee Muscle Activation and Dynamic Balance in Patients with Anterior Cruciate Ligament Deficient Knee

Effects of Resistance Training on Skin Temperature and Its Relationship with Central Nervous System (CNS) Activation.

The aim of this work was to relate the activation of the sympathetic and parasympathetic nervous systems with the skin temperature (Tsk) of the lower limbs after a resistance training exercise. Under controlled conditions, the average Tsk in the areas of the anterior and posterior thighs, knees and legs was obtained with a thermal imager and the parasympathetic and sympathetic activation was registered with an Omegawave® device on 20 healthy and trained male volunteers (25.39 ± 8.21 years) before exercise, immediately after standard resistance training (3 exercises (2 quadriceps + 1 hamstrings) × 4 sets × 10 repetitions (70% 1RM), 90-sec recovery) and after 20 min of recovery. The results showed a significant effect of exercise and recovery on Tsk in all regions of interest (ROIs) considered (p < 0.05) and strong inverse relationships between sympathetic and parasympathetic activation values. Significant results were found for the total variation of Tsk (p < 0.05) with highly positive values for subjects with lower sympathetic activation and almost null or even negative values for those with higher sympathetic activation. Sympathetic activity was a significant predictor of total Tsk variation in the anterior thigh, posterior thigh and anterior knee but not in the posterior knee, anterior leg, and posterior leg. Baseline Tsk was a significant predictor of total Tsk variation the all ROIs except in the posterior knee. Tsk measured by thermography could be used to estimate the level of participation of muscle areas in exercise and registering the level of sympathetic activation before exercise could be interesting in predicting the athlete’s physiological response to strength training.

Patelofemoralni zglob - morfologija, displazija i uticaj na rani nastanak hondromalacije patele

The patellofemoral joint, the anterior compartment of the knee, undergoes the earliest degenerative changes throughout life and joint morphology is of great importance in the appearance of pain in the anterior knee and chondromalacia of the patella. Chondromalacia of the patella is a progressive disease with a change in normal morphology and structure, with the formation of minor or major defects in the cartilage itself and represents a significant socioeconomic problem because it occurs in young, physically active people. Quadriceps wasting, patellofemoral crepitus, and effusion are obvious clinical indications. In addition, radiological examinations are also necessary for diagnosis. Magnetic resonance imaging (MRI) is a non-invasive diagnostic method, which promises a unique ability to potentially identify cartilage lesions.

Postoperative Factors Affecting Walking and Stair Climbing Ability of Patients after Anterior Cruciate Ligament Function-preserving Total Knee Arthroplasty

Postoperative Factors Affecting Walking and Stair Climbing Ability of Patients after Anterior Cruciate Ligament Function-preserving Total Knee Arthroplasty

Relationship between Histological Changes of the Anterior Cruciate Ligament and Knee Function in Osteoarthritis Patients

Relationship between Histological Changes of the Anterior Cruciate Ligament and Knee Function in Osteoarthritis Patients

Psychological barriers negotiated by athletes returning to soccer (football) after anterior cruciate ligament reconstructive surgery

ABSTRACT The aim of this qualitative study was to understand the psychological barriers that athletes returning to soccer (football) following anterior cruciate ligament knee reconstruction surgery faced and how they negotiated these barriers. Thematic analysis was used analyse online, open-ended survey data within the framework of self-determination theory. Two themes of ‘Fear of Re-injury' and ‘Self-Help’ respectively represented what barriers athletes faced when returning to soccer and how they were reportedly managed. Novel findings included identifying connections between athlete demographics, individual circumstances, perceived psychological barriers and needs, and their self-derived mental strategy. It also highlighted the need for athletes, coaches, and sports personnel to be educated and trained on the benefits of sports psychology during the return to sport phase, particularly when injuries occur at the local, recreational, non-professional levels of soccer.

Expenditure of early initiation of neuromuscle electrical stimulation after orthopedic surgeries on the hip and knee joints (literature review)

Every year the number of cases of anterior cruciate ligament reconstruction, total hip and knee arthroplasty increases. This leads to the improvement of rehabilitation protocols for patients after surgery to quickly restore normal range of motion and return to normal life. Objective. Provide physical therapists with an evidence-based resource that can guide clinical decision making, thereby enabling clinicians to make effective use of electrical stimulation to improve muscle function in patients after orthopedic operations and increase awareness of the range of applications for neuromuscular electrical stimulation (NMES). Metods. Electronic databases PMC, PUBMED and SCOPUS were used to search the relevant literature, which was published in the period from the creation of databases to December 2020. Additional articles were identified by analyzing bibliographies in systematic reviews. We have reviewed the full text of selected articles to confirm that all included studies meet the stated objectives of the review. Results. In patients after orthopedic surgery on the hip and knee joints, the inclusion of NMES in standard physical therapy significantly increases the strength of the quadriceps muscle compared to conventional physical therapy. Early activation can be helpful to avoid suppression of quadriceps function and atrophy, provide the patient with the most effective course of rehabilitation, and return to active life after anterior cruciate ligament reconstruction or knee arthroplasty. It is also advisable to use NMES as an alternative mechanical prevention of deep vein thrombosis and edema in the early period after hip arthroplasty. In the presented studies, patients tolerated NMES well even when it initiated on 1–2 postoperative days. However, no standardized NMES protocols reported in the literature, so the choice of stimulation parameters is at the discretion of the physician and usually depends on the individual tolerability of the patients.

Effect of menstrual cycle phase, menstrual irregularities and hormonal contraceptive use on anterior knee laxity and non-contact anterior cruciate ligament injury occurrence in women: a protocol for a systematic review and meta-analysis

Exercising women report three to six times more ACL tears than men, which happen, in the majority of cases, with a non-contact mechanism. This sex disparity has, in part, been...

Midline versus anterolateral incisions for total knee arthroplasty-a systematic review and analysis of the angiosomes of the knee.

The most common incision for total knee arthroplasty is the anterior midline incision; however, it is commonly associated with lateral knee numbness, kneeling difficulties and restricted flexion range. We sought to review the literature regarding the neurovascular supply and angiosomes over the anterior knee, and evaluate the anterolateral incision as a viable alternative for knee arthroplasty. A systematic review of the literature was performed searching PUBMED, MEDLINE and EMBASE to evaluate the incisions available for total knee arthroplasty with respect to neurological function, kneeling ability and complications. Ten studies were identified evaluating midline or anterolateral incisions for total knee arthroplasty, with a total of 664 knees for analysis. Mean patient age was 68 years (45-88), and average length of followup was 1year. A total of 586 had an anterior midline incision and 78 had an anterolateral incision. A total of 62% of anterior midline incisions sustained altered sensation compared to 15% (12/78) of anterolateral incisions (p < 0.0001). Incision length was similar in both groups (19.8cm midline vs. 20.8 cm anterolateral). Wound dehiscence was not significantly different between the two groups being 8.3% for midline incisions, and 2.5% for anterolateral incisions (p=0.153). Kneeling ability was reported in two studies which reported an improved ability to kneel with an anterolateral incision. The lateral parapatellar incision respects the neurovascular anatomy of the knee and offers a significant reduction in sensory changes, better kneeling ability and similar rates of wound problems to a standard midline incision and should be considered as a viable alternative for knee arthroplasty.

Acute Knee Injury During Professional Basketball Tournament In A ‘Bubble’ Setting

HISTORY: A 30 year-old professional male basketball athlete experienced sharp left knee pain after planting extended leg with knee in slight flexion during an abrupt defensive movement in a game. He immediately fell down holding left knee due to intense pain. Pain was ‘relieved’ after knee was placed in extension, but reported knee feeling ‘weird’. Prior to injury, athlete reported history of left patellar tendinitis 2 years prior treated conservatively, lack of strengthening program for 4 months in 2020 due to COVID pandemic, intense pre-bubble preparations consisting of 2-a-day full court basketball sessions, and a strenuous game schedule during the ‘bubble’. Prior left knee X-Ray remarkable for Patella Alta. He was treated for right patellar tendinitis and adductor strain during the bubble. He also suffered a suspected left knee contusion in a game 3 days prior that was gradually improving towards the day of injury. PHYSICAL EXAMINATION: Anterior left knee swelling and indentation on initial inspection. No tenderness to palpation on anterior knee after physician placed knee in extension. Able to perform left knee flexion, but markedly limited knee extension and mobility during walking. Further Inspection revealed indentation in below patella with knee flexion. Quadriceps contraction revealed anterior tilting of inferior pole of patella. Unable to perform straight leg raise test due to difficulty lifting knee. Negative Lachman’s, Valgus and Varus Stress Tests. DIFFERENTIAL DIAGNOSIS: Patellar Tendon Rupture, Patellar Dislocation, ACL Tear. TEST AND RESULTS: Diagnostic Ultrasound remarkable for hypoechoic region at proximal patellar tendon at insertion suggestive of discontinuity of the tendon. MRI confirmed full thickness tear of patellar tendon. FINAL WORKING DIAGNOSIS: Left Patellar Tendon Tear TREATMENT AND OUTCOMES: Left knee initially placed in full extension with ‘medial’ pull of patella due to initial suspicion of patellar dislocation. Athlete then immobilized in full extension until follow up with Orthopaedic Surgeon. Underwent left patellar tendon repair within 1 week of injury. Acute rehabilitation course consisted of immobilization of brace at 30 degrees with gradual range of motion exercises, light quadriceps strengthening and pain management modalities.