Anteromedial Knee Research Articles

Peroneus Longus Tendon Autograft versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Comparative Study with a Mean Follow-up of Two Years.

Peroneus longus tendon can be a suitable alternative autograft for anterior cruciate ligament reconstruction (ACLR). The present study aimed to compare the clinical outcome and donor site morbidity in ACLR using peroneus longus tendon autograft versus hamstring tendon autograft. In a comparative cross-sectional study, ACLR was performed with quadrupled hamstring tendon autograft in 65 patients between 2017 and 2018, and in another group, peroneus longus tendon autograft was used for ACLR in 65 patients between 2018 and 2019. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The knee functional outcomes were assessed according to the Lysholm score and the International Knee Documentation Committee scale at preoperative and at the end of at least 2 years after the procedure. Moreover, graft diameter was measured intraoperatively. Thigh circumference, the American Orthopedic Foot and Ankle Score (AOFAS), The Foot & Ankle Disability Index (FADI), and ankle range of motion (ROM) were used to evaluate ankle donor site morbidities. A total of 130 patients (65 patients in each group) were evaluated with a minimum follow-up of 2 years (range 24-31 months). Both groups showed no significant differences in clinical outcomes and knee stability. The peroneus longus graft diameter was significantly larger than the hamstring diameter (P<0.001). Assessment of AOFAS, FADI, and ankle ROM showed no apparent ankle joint dysfunction in the peroneus longus tendon group. Faster knee extensions, less anteromedial knee pain, and thigh hypotrophy were observed in peroneus longus tendon patients. Peroneus longus tendon autograft can be an appropriate autograft for ACLR due to its strength, larger graft diameter, and avoiding potential complications of hamstring autograft obtained from the knee region.

Medial Collateral Ligament Reconstruction: A Gracilis Tenodesis for Anteromedial Knee Instability

The main principle of the present medial collateral ligament reconstruction technique is to address anteromedial knee instability. Therefore, we describe a gracilis tenodesis with 2 functional bundles to reconstruct the deep and superficial medial collateral ligament. The proposed technique may be performed as an isolated or combined procedure with anterior cruciate ligament reconstruction. Valgus instability in extension is a contraindication.

The “Figure of Four” Reconstruction of the Medial Collateral Ligaments in the Setting of Anteromedial Rotatory Knee Instability Using a Single Autograft

The deep medial collateral ligament plays an important role in controlling tibial external rotation and restrain anterior translation of the medial tibial plateau. Despite being the basic lesion of anteromedial knee instability as proposed by many authors, the majority of the medial side reconstructions do not restore the anatomy and the function of the deep medial collateral ligament. In this Technical Note, we describe a technique to reconstruct both the superficial and deep medial collateral ligament in the setting of anteromedial knee instability using a single peroneus longus autograft.

Functional Outcome and Pain Relief After Pulsed Radiofrequency of Saphenous Nerve in Medial Compartment Knee Osteoarthritis: A Randomised Double-Blind Trial

Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain relief in knee pain due to knee osteoarthritis (KOA). Since adductor canal (AC) contains other sensory nerves innervating the medial part of knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of medial compartment (KOA-MC). Methods: We conducted a randomised prospective study in 60 patients with anteromedial knee pain due to KOA-MC. Patients in group A received PRF-SN and those in group B, PRF-AC. Primary objectives were, comparison of pain by visual analogue scale (VAS) score and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores (OKS). Secondary objectives were, comparison of analgesic requirements using Medicine Quantification Scale (MQS) scale and block related complications. Intra group comparison was done by Analysis of variance (ANOVA). Inter group normally distributed data was assessed by student's t-test, non-normally distributed and ordinal data by Mann-Whitney U-test and categorical data by Chi-square test. A p value of &lt; 0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12 and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN however, duration of pain relief was not significantly different.

Total knee arthroplasty versus unicompartmental knee arthroplasty in management of anteromedial knee osteoarthritis: a randomized clinical trial

Background: Both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are options to manage anteromedial knee osteoarthritis. This study’s aim was to determine the functional outcome, time taken to walk without support, and postoperative complications after either TKA or UKA in treatment of anteromedial knee osteoarthritis. Methods: A prospective randomized cohort study was performed at a level 1 academic center on 60 patients with mean age of 56.2 yr who had isolated anteromedial knee osteoarthritis. Thirty patients were managed by UKA (group 1), and the other thirty patients were managed by TKA (group 2). Diagnosis was confirmed by plain radiographs (anteroposterior standing, lateral, skyline, stress varus, and valgus views). Follow-up was done for at least 12 mo postoperatively. Results: Mean preoperative functional Knee Society Score (KSS) was 65.83 and 62.67 for group 1 and group 2, respectively. Mean functional KSS after 1 yr was 86.3 for group 1 and 84.6 for group 2. In group 1, one patient developed lateral joint line pain, and another patient developed postoperative blood loss of more than 400 mL. In group 2, one patient developed pattelofemoral pain, and another patient developed postoperative blood loss of more than 400 mL. The mean time that it took for patients to walk without support was 1.6 wk in group 1 and 1.93 wk for group 2. Conclusions: Both UKA and TKA have the same functional outcome for treatment of anteromedial knee osteoarthritis and the same rate of complications, but early postoperative rehabilitation is better in patients managed by UKA. Level of Evidence: Level I.

Knee Defect Reconstruction Using the Distally Based Anterolateral Thigh Flap Based on the Reverse Flow from the Oblique Branch of the Lateral Circumflex Femoral Artery.

Reconstruction of soft tissue defects around the knee is challenging, and the most common solution is to use various locoregional flaps or, in some difficult cases, a free flap. The distally based anterolateral thigh (dALT) flap is a commonly used flap that relies on reverse blood flow from the descending branch of the lateral circumflex femoral artery (d-LCFA). Here, we present the case of an anteromedial knee reconstruction using a dALT flap after resection of a pleomorphic undifferentiated sarcoma. The tumor resection resulted in a 14 × 7 cm defect, and a dALT flap, measuring 20 × 8 cm was elevated. During the surgery, we found a robust oblique branch of the LCFA (o-LCFA) sending off two sizable perforators to the anterolateral thigh region, whereas the d-LCFA was relatively small with no usable perforators. Therefore, we harvested a dALT flap relying on reverse flow from the o-LCFA. The patient's postoperative course was uneventful, and the flap survived without complications. This report demonstrates that reverse flow from the o-LCFA may be an alternative to nourish a dALT flap in cases where the d-LCFA is hypoplastic or suitable perforators from the d-LCFA are unavailable.

Examining the Bone Bruise Patterns in Multiligament Knee Injuries With Peroneal Nerve Injury

Background: Tibiofemoral bone bruise patterns seen on magnetic resonance imaging (MRI) are associated with ligamentous injuries in the acutely injured knee. Bone bruise patterns in multiligament knee injuries (MLKIs) and particularly their association with common peroneal nerve (CPN) injuries are not well described. Purpose: To analyze the tibiofemoral bone bruise patterns in MLKIs with and without peroneal nerve injury. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified 123 patients treated for an acute MLKI at a level 1 trauma center between January 2001 and March 2021. Patients were grouped into injury subtypes using the Schenck classification. Within this cohort, patients with clinically documented complete (motor and sensory loss) and/or partial CPN palsies on physical examination were identified. Imaging criteria required an MRI scan on a 1.5 or 3 Tesla scanner within 30 days of the initial MLKI. Images were retrospectively interpreted for bone bruising patterns by 2 board-certified musculoskeletal radiologists. The location of the bone bruises was mapped on fat-suppressed T2-weighted coronal and sagittal images. Bruise patterns were compared among patients with and without CPN injury. Results: Of the 108 patients with a MLKI who met the a priori inclusion criteria, 26 (24.1%) were found to have a CPN injury (N = 20 complete; N = 6 partial) on physical examination. For CPN-injured patients, the most common mechanism of injury was high-energy trauma (N = 19 [73%]). The presence of a grade 3 posterolateral corner (PLC) injury (N = 25; odds ratio [OR], 23.81 [95% CI, 3.08-184.1]; P = .0024), anteromedial femoral condyle bone bruising (N = 24; OR, 21.9 [95% CI, 3.40-202.9]; P < .001), or a documented knee dislocation (N = 16; OR, 3.45 [95% CI, 1.38-8.62]; P = .007) was significantly associated with the presence of a CPN injury. Of the 26 patients with CPN injury, 24 (92.3%) had at least 1 anteromedial femoral condyle bone bruise. All 20 (100%) patients with complete CPN injury also had at least 1 anteromedial femoral condyle bone bruise on MRI. In our MLKI cohort, the presence of anteromedial femoral condyle bone bruising had a sensitivity of 92.3% and a specificity of 64.6% for the presence of CPN injury on physical examination. Conclusion: In our MLKI cohort, the presence of a grade 3 PLC injury had the greatest association with CPN injury. Additionally, anteromedial femoral condyle bone bruising on MRI was a highly sensitive finding that was significantly correlated with CPN injury on physical examination. The high prevalence of grade 3 PLC injuries and anteromedial tibiofemoral bone bruising suggests that these MLKIs with CPN injuries most commonly occurred from a hyperextension-varus mechanism caused by a high-energy blow to the anteromedial knee.

Clinical and Radiographic Workup of Medial and Lateral Knee Ligament Injuries

The medial and lateral knee ligament complexes play an important role in valgus, varus, and rotational stability. Three primary medial structures, the superficial medial collateral ligament, the deep medial collateral ligament, and the posterior oblique ligament, contribute to dynamic medial and anteromedial knee stability. Three primary lateral structures, the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament, contribute to static lateral and posterolateral knee stability. Historically, injuries to these ligament complexes can be challenging to diagnose and treat. An understanding of the specific anatomy, biomechanical properties, physical examination, and imaging is paramount for making an accurate clinical diagnosis as well as determining optimal surgical and nonsurgical management in the setting of injury to these structures. The following review will highlight evidence based physical examination techniques and imaging and/or stress radiography protocols available in order to achieve an accurate diagnosis and optimal treatment for medial and lateral knee ligament injuries.

MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

The main principles of the present medial collateral ligament (MCL) reconstruction techniques are (1) to approximate the natural anatomy and (2) to restore the main passive restraining structures in anteromedial and posteromedial knee instability. Therefore, we describe a technique using a flat tendon graft instead of tubular grafts with point-to-point bone fixation. Moreover, we address the deep MCL, a relevant restraint to anteromedial instability.

A Double-Blind, Placebo-Controlled Study of Ultrasound-Guided Pulsed Radiofrequency Treatment of the Saphenous Nerve for Refractory Osteoarthritis-Associated Knee Pain

While the efficacy of pulsed radiofrequency (PRF) for shoulder pain has been demonstrated, its efficacy on the saphenous nerves for knee osteoarthritis (OA)-associated pain has only been reported in observational studies. The aim of this study was to compare saphenous nerve PRF to placebo for knee OA-associated pain. Patients, practitioners, and outcome assessor-blinded randomized placebo-controlled trial. Pain management clinics at 2 hospitals in Japan. Patients were randomly allocated to the PRF (n = 37) or placebo group (n = 33). Patients aged 40-85 years with refractory anteromedial knee pain. PRF in the saphenous nerve under ultrasound guidance. The placebo group underwent the same procedure, but with motor stimulation. The primary endpoint was the average pain intensity measured using the visual analog scale (VAS) at the 12-week post-treatment visit; secondary outcomes included the average VAS at 1 and 4 weeks, and pain intensities at rest, in flexion, at standing, and at walking. Other secondary outcomes were knee pain, symptoms, activities of daily living, knee-related quality of life, mobility, range of motion, and adverse events. In the PRF group, the mean VAS score was 52.41 ± 26.17 at 12 weeks, while in the sham group, the mean VAS score was 63.06 ± 27.12 (P < 0.05). There were no significant differences between the groups in any of the secondary outcomes. Patients with comorbidities were excluded from this study. The follow-up time was limited to 12 weeks. Ultrasound-guided saphenous nerve PRF proved to be effective for at least 12 weeks in patients with knee OA and showed no adverse events.

Single stage management of chronic posterolateral knee dislocation in a middle-aged man - A Case Report.

Background: Posterolateral knee dislocation rarely occur and might not reduce due to buttonholing of the Femoral condyle into the anteromedial knee joint capsule. These are complex injuries without any clear guidelines in terms of management.&#x0D; Case presentation: 40-year-old male presented with posterolateral knee dislocation due to a road traffic accident. Patient was having posterior cruciate ligament (PCL) injury along with posterolateral corner instability supported by clinical examination and confirmed with radiologic investigations.&#x0D; Management and Results: Patient was managed with single-stage arthroscopic reconstruction of PCL followed by open posterolateral corner ligaments reconstruction. Postoperatively patient had positive functional outcomes with satisfactory international knee documentation committee subjective knee form (IKDC) scores.&#x0D; Conclusion: Posterolateral Corner Injury (PLC) injury with associated PCL injury showed positive results when managed in a single-stage procedure.

Diagnostics of infrapatellar saphenous neuralgia\u2014a reversible cause of chronic anteromedial pain following knee surgery

ObjectivesTo evaluate the impact of diagnostic nerve block and ultrasound findings on therapeutic choices and predict the outcome after concomitant surgery in patients with suspected neuropathy of the infrapatellar branch of the saphenous nerve (IPBSN).MethodsFifty-five patients following knee surgery with suspicion of IPBSN neuralgia were retrospectively included. Ultrasound reports were assessed for neuroma and postsurgical scarring (yes/no). Responders and non-responders were assigned following anesthetic injection of the IPBSN. The type of procedure (neurectomy/interventional pain procedure/other than nerve-associated therapy) and pain score at initial follow-up were recorded and patients were assigned as positive (full pain relief) or negative (partial/no pain relief) to therapeutic nerve treatment. Factors associated with a relevant visual analog scale (VAS) reduction were assessed using uni- and multivariate logistic regression models and chi-square for quantitative and qualitative variables (p ≤ 0.05).ResultsResponders (37/55) more often had an entrapment or an evident neuroma of the IPBSN (97% vs. 6%). A positive Hoffmann-Tinel sign (p = 0.002) and the absence of knee joint instability (p = 0.029) predicted a positive response of the diagnostic nerve block (90%; 26/29). In the follow-up after therapeutic nerve treatment, all patients with full pain relief showed neuromas or entrapment of the IPBSN. Patients negatively responding to therapeutic nerve treatment more frequently showed an additional knee joint instability (25% vs. 4%).ConclusionSelective denervation for neuropathic knee pain is beneficial in selected patients with significant VAS reduction after diagnostic nerve block. Non-responders following diagnostic nerve block but sonographic evidence of IPBSN pathologies need to be evaluated for other causes such as knee joint instability.Key Points• Sonographic diagnosis of neuroma or entrapment of the IPBSN is frequently seen in patients with anteromedial knee pain and leads to a good response to diagnostic nerve block following knee surgery.• The vast majority of patients with clinical signs of IPBSN neuropathy and response to a diagnostic nerve block sustained full pain relief following therapeutic nerve treatment.• Patients not responding to therapeutic IPBSN treatment have to be evaluated for other causes of anteromedial knee pain such as knee joint instability.

A TRIATHLETE WITH MEDIAL MENISCUS TEAR AND SUBCHONDRAL INSUFFICIENCY FRACTURE

Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. If diagnosed early, SIFK can be treated conservatively with non-weight bearing ambulation. If left untreated, this disease may lead to catastrophic complications such as subchondral fragment detachment and fragmentation or subchondral collapse which will warrant the need for surgical intervention. The author reports a 44-year-old triathlete that presented with complaint of a trivial left anteromedial knee pain for one-year duration. This disease presented at an unusual site of the medial tibial condyle. Moreover, the patient is a healthy triathlete that does not have any predisposing factors for SIFK. Magnetic resonance imaging showed subchondral insufficiency fracture of the medial tibial condyle with a complex multi-directional medial meniscus tear in the same knee. Could the undiagnosed medial meniscus injury be the causation leading to the development of SIFK? Here, the author will summarize the literature on various clinical features, work-up and management of SIFK.

A triathlete with medial meniscus tear and subchondral insufficiency fracture

Subchondral insufficiency fracture of the knee (SIFK) is an important differential diagnosis for knee pain. If diagnosed early, SIFK can be treated conservatively with non-weight bearing ambulation. If left untreated, this disease may lead to catastrophic complications such as subchondral fragment detachment and fragmentation or subchondral collapse which will warrant the need for surgical intervention. The author reports a 44-year-old triathlete that presented with complaint of a trivial left anteromedial knee pain for one-year duration. This disease presented at an unusual site of the medial tibial condyle. Moreover, the patient is a healthy triathlete that does not have any predisposing factors for SIFK. Magnetic resonance imaging showed subchondral insufficiency fracture of the medial tibial condyle with a complex multi-directional medial meniscus tear in the same knee. Could the undiagnosed medial meniscus injury be the causation leading to the development of SIFK? Here, the author will summarize the literature on various clinical features, work-up and management of SIFK.

A novel radiographic technique to assess 180° rotational spin of the Oxford unicompartmental knee mobile bearing

The recognition of anteromedial knee arthritis as a distinct early clinicopathological entity has led to a resurgence in medial unicompartment knee arthroplasty (UKA). Symptomatic knee pain caused by 180° rotational spin of the mobile bearing of the Oxford Knee is an unrecognized and therefore under-reported complication of UKA. Whilst the post-operative radiographic criteria for optimal positioning of UKA is well described in the available literature, this isn't the case for assessing antero-posterior (AP) orientation of the mobile-bearing. Following a literature review, we describe a novel radiographic technique that can consistently assess AP orientation, and as a result, diagnose 180° rotational spin of the mobile-bearing. This technique overcomes the radiological challenge of superimposition of the radiopaque markers with the lateral edge of the tibial tray. The modified oblique view results in clear visualization of the metallic rod embedded in the polyethylene, away from the lateral edge of the tibial tray. An anteriorly viewed metallic rod would indicate a well oriented mobile bearing. However, if the metallic beads are visualized anteriorly without dislocation, the component would have spun 180°. Clinicians should have a high index of suspicion for 180° spin to have occurred in patients with posterior dislocation with or without spontaneous reduction. We recommend bearing exchange±revision arthroplasty for symptomatic patients. The modified oblique view is now part of our immediate post-operative XR protocol and repeated for any patient who re-presents symptomatically at any stage following the index procedure.

Anterior Cruciate Ligament Deficiency is Not Always a Contraindication for Medial Unicompartmental Knee Arthroplasty: A Retrospective Study in Nondesigner’s Japanese Hospital

BackgroundAn intact anterior cruciate ligament (ACL) is thought to be prerequisite for successful unicompartmental knee arthroplasty (UKA), but recent studies reported successful midterm results of UKA in ACL-deficient (ACLD) knees. We hypothesized that ACLD is not always a contraindication for medial UKA when preoperative radiographs showed typical anteromedial knee patterns. MethodsFrom April 2012 to March 2016, 401 Oxford mobile-bearing UKAs in 282 patients were retrospectively identified from our database. Patients whose ACL was severely damaged, but preoperative X-rays showed typical anteromedial osteoarthritis patterns, were categorized into the ACLD group. From intraoperative data, those whose ACL was intact were categorized into the ACL functional (ACLF) group. There were 32 and 369 knees in the ACLD and ACLF groups, respectively, and mean follow-up periods were 66.1 and 63.8 months for the ACLD and ACLF groups, respectively. We compared the postoperative clinical outcome and component survivorship, with an endpoint of component revision, between ACLD groups and ACLF groups. ResultsIn both groups, the Oxford knee score, Knee Society score, Tegner activity score, and knee range of motion in extension were improved after surgery. The UKA component survival rate at five years was 100% in the ACLD group and 98.9% in the ACLF group. There were no significant differences between the groups. ConclusionMid-term clinical outcomes of Oxford mobile-bearing UKA in ACLD knees were similar to those in ACLF knees. ACL deficiency is not always a contraindication for medial unicompartmental knee arthroplasty in patients with typical anteromedial osteoarthritis radiographs.

Higher Body Mass Index Is Associated With Biochemical Changes in Knee Articular Cartilage After Marathon Running: A Quantitative T2-Relaxation MRI Study

Background:More than 30 million individuals participate in marathon running every year worldwide. As the popularity of marathon running continues to increase, it is essential for the purposes of injury prevention to understand the effects of marathon running on the knee cartilage.Purpose:To investigate the immediate effects of marathon running on knee articular cartilage and to determine the relationship between body mass index and cartilage biochemical composition.Study Design:Descriptive laboratory study.Methods:T2-relaxation magnetic resonance imaging (MRI) of knees in 18 nonprofessional marathoners (mean age, 35.6 ± 6.4 years) was performed before and after a full-length marathon. Three-dimensional models of the knee articular cartilage were reconstructed and divided into different regions of interest. The 3-dimensional models were then applied to corresponding T2-relaxation MRI maps to calculate T2 values in each region of interest. The mean values of the T2-relaxation times in each region of interest before and after the marathon were compared by use of the paired Student t test. The Pearson correlation coefficient between T2 change and runner body mass index (BMI) was calculated.Results:Postmarathon T2-relaxation times were significantly higher than premarathon values for patellofemoral cartilage (32.6 ± 12.1 vs 34.1 ± 10.9 ms; P < .01) and medial tibial cartilage (35.6 ± 11.7 vs 34.6 ± 12.0 ms; P = .01). The greatest increase was observed in the anterior part of the medial tibial cartilage. No statistically significant changes were seen in the T2-relaxation times of the lateral tibial and femoral cartilage. Postmarathon T2-relaxation elevation in the anteromedial knee tibiofemoral joint cartilage strongly correlated with body weight (R = 0.6746; P = .03) and BMI (R = 0.6989; P = .001). Changes in T2-relaxation times did not correlate with marathon time, height, age, or sex in any regions of interest.Conclusion:Marathon running leads to immediate postmarathon elevated T2-relaxation values within knee articular cartilage, suggesting biochemical content alteration. Additionally, runners with higher BMI may have greater changes in cartilage biochemical composition after a marathon. Further studies should investigate whether these changes are sustained over time to determine the relationship between immediate biochemical changes in cartilage composition and cartilage degeneration.Clinical Relevance:Runners with a higher BMI may carry a higher risk of anteromedial tibiofemoral cartilage degeneration compared with runners with lower BMI.

Outcomes of cementless fixation in medial unicompartmental knee arthroplasty: review of recent literature.

Medial unicompartmental knee arthroplasty (UKA) is considered the most effective treatment for anteromedial knee osteoarthritis. Cementless fixation of UKA was developed to reduce aseptic loosening. We performed a review of the recent literature to assess the latest outcomes of cementless UKA. A review of English literature was performed on Medline through Pubmed. Retrospective or prospective studies with at least 2years of follow-up (FU) and at least 20 patients were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Survival rate, revision rate, time for revision, incidence of radiolucent lines and reasons for revision (such as aseptic loosening, osteoarthritis progression, bearing dislocation or periprosthetic fracture) were extrapolated from the papers. Nineteen articles were included in the review, only 2 with a level of evidence of I. A total of 3432 UKA with a FU range of 24-132months were analyzed. The studies showed good clinical and functional outcomes. In 12 studies, survival rate were more than 90%. Revision rate for aseptic loosening were lower than 2% for 15 studies. Cementless UKA represents a surgical option allowing low revision rate. Further high-quality long-term studies would better clarify complications, clinical and radiological results of this promising fixation method.

Oxford partial knee replacement: Early follow up results in young verses elderly age group patients

BackgroundAge related knee arthritis usually begins with early medial compartment changes in majority of cases. Later on, lateral and patellofemoral compartment involvement occurs. Oxford unicondylar knee replacement is preferable in patients with isolated anteromedial knee arthritis. MethodsThe study involves retrospective review of 112 cases performed over a period of two years at a tertiary care center. It includes comparative analysis of operative and functional results of Oxford unicondylar knee arthroplasty in young (age<60 years) verses elderly (age.>60 years) age group patients. Preoperative radiographic assessment involves full length hip to knee radiographs taken in standing position before surgery and at one year follow up. Special views assessment was done, includes valgus and varus stress views and merchant views. ResultsAnalysis shows no significant difference between the two groups for BMI, blood loss, duration of surgery and post-surgery correction in mechanical axis. Statistically significant differences (P < 0.05) was observed in parameters like average duration of hospital stay, rate of complications seen and duration of rehabilitation period. ConclusionOxford unicondylar knee replacement is associated with relatively less morbidity, better early rehabilitation and improvement of knee score in late period. Age not appears to be a contraindication for oxford unicondylar knee arthroplasty. However several key outcome parameters like speed of recovery, return to work, revision rate, complications, mortality rate, and functional outcomes must be discussed with patient before surgery.

Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: randomized volunteer trial

Background and objectivesFor pain relief after total knee arthroplasty (TKA), an injection at the midthigh level may produce analgesia inferior to that of a femoral nerve block as the anterior...