Changes In Knee Function Research Articles

Associations and change in knee function, pain, and biomarkers of bone- and cartilage degradation in individuals with knee osteoarthritis

Associations and change in knee function, pain, and biomarkers of bone- and cartilage degradation in individuals with knee osteoarthritis

Trends and associations between kinesiophobia and knee function from preoperatively to three and six months postoperatively in patients post-ACL reconstruction surgery

ObjectiveThis study aimed to clarify the relationship between the transition of kinesiophobia and knee joint function from the preoperative period to three months postoperative, the time to resume running, six months post-ACLR, and the goal time to resume sports. Methods54 patients who underwent initial ACLR were included in this study. The Tampa Scale for Kinesiophobia-11 (TSK-11) was used to assess kinesiophobia. One-way ANOVA was performed for the preoperative, three-month postoperative, and six-month postoperative endpoints. To examine changes in knee function associated with changes in TSK-11, we calculated correlations between the differences at each time point. ResultsTSK-11 decreased significantly at both three and six months postoperatively compared with the preoperative level, but there was no significant change between three months and six months postoperatively. Similar to the decrease in TSK-11 from preoperatively to three and six months postoperatively, there was an improvement in flexion ROM, Pain, Subjective knee function, but none of these changed significantly from three to six months postoperatively. ConclusionThere may be significant improvements in knee function associated with TSK-11 reduction up to three months postoperatively.

Does an Adductor Canal Block Influence Patient-Reported Outcomes at One Year Following Total Knee Arthroplasty?

Introduction Total knee arthroplasty (TKA) for osteoarthritis is performed to improve knee function and quality of life. Adductor canal block (ACB) (with posterior capsule local anaesthetic) and periarticular local anaesthetic infiltration (LA) alonearecommon methods used for post-operative pain control following TKA. The primary aim of this study was to investigate the influence of ACB compared to LA alone on knee function at one year in patients undergoing primary TKA. The secondary aims were to investigate the influence on health-related quality of life (HRQoL), patient satisfaction at one year, and length of stay (LOS) in hospital following TKA. Methods During a three-year period, 1396 patients who underwent TKA at the study centre completed pre-operative and one-year post-operative questionnaires. Data collected included patient demographics, co-morbidities, LOS, Oxford Knee Score (OKS), EuroQol 5-Dimension (EQ-5D) and satisfaction scores. Patients who had a spinal anaesthetic (n=1096) with either ACB (with posterior capsule local anaesthetic) (n=224) and LA infiltration alone (n=872) were compared. Results There was a significant improvement in pre-operative to one-year post-operative knee function as measured by OKS overall (15.1, p<0.001), however there was no significant difference between ACB and LA groups (p=0.37). There was no significant difference in change (p=0.43) or one-year post-operative (p=0.70) HRQoL, as measured by EQ-5D. There was also no significant difference in one-year patient satisfaction between groups (p=0.57). There was no significant difference in median LOS between groups (four days with ACB, four days with LA), although patients younger than 55 yearsundergoing ACB had a statistically significant median of one day reduced LOS compared with the LA group (p=0.01). Conclusions ACB when compared with LA alone was not associated with a difference in change in knee function, HRQoL, or patient satisfaction at one year following TKA. There was also no difference between groups in length of stay post-operatively. However, ACB was associated with a shorter length of stay in patients younger than 55, and this may be a group that would benefit from this intervention.

Knee pivot location in asymptomatic older adults

Representative data of asymptomatic, native-knee kinematics is important when studying changes in knee function across the lifespan. High-speed stereo radiography (HSSR) provides a reliable measure of knee kinematics to <1 mm of translation and 1° of rotation, but studies often have limited statistical power to make comparisons between groups or measure the contribution of individual variability. The purpose of this study is to examine in vivo condylar kinematics to quantify the transverse center-of-rotation, or pivot, location across the flexion range and challenge the medial-pivot paradigm in asymptomatic knee kinematics. We quantified the pivot location during supine leg press, knee extension, standing lunge, and gait for 53 middle-aged and older adults (27 men; 26 women: 50.8 ± 7.0 yrs, 1.75 ± 0.1 m, 79.1 ± 15.4 kg). A central- to medial-pivot location was identified for all activities with increased knee flexion associated with posterior translation of the center-of-rotation. The association between knee angle and anterior-posterior center-of-rotation location was not as strong as the relation between medial–lateral and anterior-posterior location, excluding gait. The Pearson’s correlation for gait was stronger between knee angle and anterior-posterior center-of-rotation location (P < 0.001) than medial–lateral and anterior-posterior location (P = 0.0122). Individual variability accounted for a measurable proportion in variance explained of center-of-rotation location. Unique to gait, the lateral translation of center-of-rotation location resulted in the anterior translation of center-of-rotation at <10° knee flexion. Furthermore, no association between vertical ground-reaction force and center-of-rotation was identified.

Patient-Reported Quality of Life Before and After Total Knee Arthroplasty: A Multicenter Observational Study.

PurposeTo compare patients’ self-reported health-related quality of life (HRQoL) before and after total knee arthroplasty (TKA) and determine factors contributing to any heterogeneity in HRQoL.Patients and MethodsThis prospective multicenter observational study included 404 patients with knee osteoarthritis who underwent TKA between April 1, 2019 and December 30, 2019 and whose HRQoL was assessed preoperatively and 7 days and 1, 3, and 6 months postoperatively. Sociodemographic characteristics were assessed using a General Information Questionnaire, disability using the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS), resting pain using the visual analogue scale (Pain-VAS), and HRQoL using the European Quality of Life Five Dimension Five Level (EQ-5D-5L) scale. The growth mixture model was used to identify group heterogeneity in the developmental trajectories of KOOS-PS, Pain-VAS, and EQ5D5L. Logistic regression was used to explore the factors influencing the developmental trajectories of factors affecting the developmental trajectory of HRQoL.ResultsThe mean EQ-5D-5L score improved from 0.69 preoperatively to 0.90 at 6 months postoperatively. Longitudinal heterogeneity in HRQoL was observed in patients during recovery: 1) patients with a small and slow improvement in HRQoL and 2) patients who showed marked and rapid improvement in HRQoL. The main characteristics of the latter group were decreasing VAS pain scores, a monthly family income >2000 CNY (100 CNY equals approximately 14.9 USD), exercising for <30 min daily, and better knee function at baseline. Baseline knee function and change in knee function were significantly associated with the percentage change in HRQoL.ConclusionHRQoL improved considerably after TKA. However, there was heterogeneity in the changes in HRQoL depending on patients’ socioeconomic status, exercise, and baseline knee function. Dynamic tracking of the HRQoL of TKA patients and timely provision of rehabilitation guidance will promote continuous improvement of the HRQoL of TKA patients.

New Viscoelastic Hydrogel Hymovis MO.RE. Single Intra-articular Injection for the Treatment of Knee Osteoarthritis in Sportsmen: Safety and Efficacy Study Results.

Viscosupplementation by hyaluronic acid (HA) is recommended for non-surgical management of knee osteoarthritis (OA). This study investigated the efficacy and safety of a single i.a. (32 mg/4 ml) Hymovis MO.RE. injection, a new HA derivative hydrogel, for the treatment of adult regular sports players affected by knee OA arising from overuse injuries. Patients were prospectively enrolled if regularly practicing sports and diagnosed with Kellgren-Lawrence grade I-III OA. They received a single Hymovis MO.RE. intra-articular (i.a.) injection and were evaluated 30, 90, 180, and 360 days thereafter. The assessment involved measuring changes in knee function, pain, the activity of daily living (ADL), and quality of life (QOL) by using the Knee injury and Osteoarthritis Outcome Score (KOOS), GAIT analysis, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for knee pain (WOMAC A) and function (WOMAC C), and a visual analogue scale (VAS) pain score. The study involved thirty-one patients, 23 women and eight men, whose median age was 49. KOOS function subscore, as well as GAIT cadence and velocity, showed a statistically significant increase at each time-point after injection (p < 0.0001). WOMAC, KOOS pain, symptoms, ADL, and QOL scores also significantly improved at all control visits. No severe adverse events or treatment-related events were detected. A single Hymovis MO.RE. (32 mg/4 ml) intra-articular injection provides a rapid, lasting, and safe response in regular sports players affected by knee OA, possibly representing a viable therapeutic option for this demanding patient subgroup. Further investigations are necessary to confirm these findings.

Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial)

IntroductionHigh tibial osteotomy (HTO) is a treatment of choice for active adult with knee osteoarthritis. With advancement in CT imaging with three-dimensional (3D) model reconstruction, virtual planning and 3D printing,...

Longitudinal changes in specific muscle strength but not in muscle anatomical cross-sectional areas is associated with change in knee function - data from the osteoarthritis initiative (OAI)

Purpose: A positive and concurrent association between longitudinal change in knee function (worsening or improvement ≥6 [minimal clinically important difference (MCID)] on the WOMAC function score during Y2→Y4) and change in isometric extensor muscle strength was previously reported. Although muscle anatomical cross-sectional areas (ACSAs) or muscle mass have been shown to be moderately related to muscle strength, it is unknown whether function-related change in muscle strength depends on concordant change in ACSAs or specific strength (e.g.

Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions

ObjectivesTo examine the ability of surgeons to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy (APM) and exercise therapy in middle-aged patients.Design and settingElectronic survey. Orthopaedic...

Longitudinal Change in Thigh Muscle Strength Prior to and Concurrent With Minimum Clinically Important Worsening or Improvement in Knee Function: Data From the Osteoarthritis Initiative.

To investigate whether a clinically relevant change in knee function in patients with or at risk for osteoarthritis (OA) of the knee is associated with concurrent or prior change in thigh muscle strength. Participants in the Osteoarthritis Initiative (n = 2,675 [1,485 women and 1,190 men]) with available measurements of isometric muscle strength at baseline, 2-year follow-up, and 4-year follow-up were grouped into those with greater than minimum clinically important worsening (score of ≥6 [of a possible 68] on the Western Ontario and McMaster Universities Osteoarthritis Index function subscale) between 2-year follow-up and 4-year follow-up, those with greater than minimum clinically important improvement, and those without relevant change. Changes in isometric muscle strength concurrent with function change (between 2-year follow-up and 4-year follow-up) and preceding function change (between baseline and 2-year follow-up), with 95% confidence intervals (95% CIs), were determined, and differences between groups were assessed by analysis of covariance. Concurrent loss in extensor muscle strength in participants with worsening knee function during the 2-year follow-up-4-year follow-up period differed significantly from that in participants without change in knee function (-4.6% [95% CI -6.8, -2.4] and -2.2% [95% CI -3.0, -1.4], respectively; P = 0.03), as did the concurrent increase in strength among those with functional improvement (2.2% [95% CI -0.3, 4.7]; P < 0.0001). This increase in strength among subjects with improved function remained significantly different from the change in subjects with no change in function after adjustment for covariates, but was preceded by a greater loss in strength (-7.7% [95% CI -10.3, -5.0], P = 0.02) during the baseline-year 2 period compared to those without change in function during the year 2-year 4 period (-4.3% [95% CI -5.2, -3.4]). The decrease in strength during the baseline-year 2 period in those with worsening knee function during the year 2-year 4 period (-4.5% [95% CI -6.9, -2.2]) did not differ significantly from that in patients without a change in function (P = 0.87). No differences in changes in flexor muscle strength were observed between groups. These findings suggest that there is a positive concurrent longitudinal association between change in extensor muscle strength and worsening/improvement in knee function in patients with knee OA. However, a corresponding change in thigh muscle strength preceding the change in function was not observed.

Changes in Knee Osteoarthritis, Symptoms, and Function After Anterior Cruciate Ligament Reconstruction

Background: Progression of tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA) and changes in knee function more than 15 years after anterior cruciate ligament reconstruction (ACLR) are not well understood. Purpose: To examine the progression of knee OA and changes in symptoms and function in isolated and combined injuries from 15 to 20 years after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 210 subjects with ACLR were prospectively followed. At the 15- and 20-year follow-ups, radiographs were obtained and classified by the Kellgren and Lawrence (K-L) grading system. Symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) as well as isokinetic quadriceps and hamstring muscle strength tests. Results: There were 168 subjects (80%) who returned for the 20-year follow-up, with a mean (±SD) age of 45 ± 9 years, mean body mass index of 27 ± 4, and median Tegner activity level of 4 (range, 0-9). The prevalence of radiographic TF and PF OA at the 20-year follow-up was 42% and 21%, respectively. Patients with ACL injuries and other combined injuries had significantly higher prevalence of radiographic TF OA compared with those who had isolated ACL injury (P < .0001). There was a 13% increase in radiographic TF OA (P = .001) and an 8% increase in PF OA (P = .015) from the 15- to the 20-year follow-up. A significant deterioration in knee symptoms and function was observed on the KOOS subscales (P ≤ .01), with the exception of quality of life (P = .14), as well as a decrease in quadriceps muscle strength and hamstring muscle strength (P < .0001). Conclusion: The prevalence of radiographic TF and PF OA was 42% and 21%, respectively. A significantly higher prevalence of TF OA was found for subjects with combined injuries compared with those who had isolated ACL injury. The majority of the subjects were stable radiographically over the 5 years between follow-ups. A statistically significant deterioration in symptoms and function was noted, but the mean changes were of questionable clinical importance.

Low- Versus High-Intensity Plyometric Exercise During Rehabilitation After Anterior Cruciate Ligament Reconstruction

Background: Plyometric exercise is used during rehabilitation after anterior cruciate ligament (ACL) reconstruction to facilitate the return to sports participation. However, clinical outcomes have not been examined, and high loads on the lower extremity could be detrimental to knee articular cartilage. Purpose: To compare the immediate effect of low- and high-intensity plyometric exercise during rehabilitation after ACL reconstruction on knee function, articular cartilage metabolism, and other clinically relevant measures. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Twenty-four patients who underwent unilateral ACL reconstruction (mean, 14.3 weeks after surgery; range, 12.1-17.7 weeks) were assigned to 8 weeks (16 visits) of low- or high-intensity plyometric exercise consisting of running, jumping, and agility activities. Groups were distinguished by the expected magnitude of vertical ground-reaction forces. Testing was conducted before and after the intervention. Primary outcomes were self-reported knee function (International Knee Documentation Committee [IKDC] subjective knee form) and a biomarker of articular cartilage degradation (urine concentrations of crosslinked C-telopeptide fragments of type II collagen [uCTX-II]). Secondary outcomes included additional biomarkers of articular cartilage metabolism (urinary concentrations of the neoepitope of type II collagen cleavage at the C-terminal three-quarter–length fragment [uC2C], serum concentrations of the C-terminal propeptide of newly formed type II collagen [sCPII]) and inflammation (tumor necrosis factor–α), functional performance (maximal vertical jump and single-legged hop), knee impairments (anterior knee laxity, average knee pain intensity, normalized quadriceps strength, quadriceps symmetry index), and psychosocial status (kinesiophobia, knee activity self-efficacy, pain catastrophizing). The change in each measure was compared between groups. Values before and after the intervention were compared with the groups combined. Results: The groups did not significantly differ in the change of any primary or secondary outcome measure. Of interest, sCPII concentrations tended to change in opposite directions (mean ± SD: low-intensity group, 28.7 ± 185.5 ng/mL; high-intensity group, −200.6 ± 255.0 ng/mL; P = .097; Cohen d = 1.03). Across groups, significant changes after the intervention were increased the IKDC score, vertical jump height, normalized quadriceps strength, quadriceps symmetry index, and knee activity self-efficacy and decreased average knee pain intensity. Conclusion: No significant differences were detected between the low- and high-intensity plyometric exercise groups. Across both groups, plyometric exercise induced positive changes in knee function, knee impairments, and psychosocial status that would support the return to sports participation after ACL reconstruction. The effect of plyometric exercise intensity on articular cartilage requires further evaluation. Registration Number: Clinicaltrials.gov NCT01851655

Relationship between pain, physical performance, knee extension muscle strength and osteoarthritis severity in patients with osteoarthritis

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A351 those with functional improvement differed significantly from those without change in WOMAC function scores (p<0.001). During BL/Y2, extensor muscle strength decreased by 4.6% in those with worsening knee function (during Y2/Y4), decreased by 7.7% in those with improvement in knee function, and decreased by 4.3% in those without change in knee function (Figure 1). The longitudinal loss in extensor muscle strength during BL/Y2 in those with worsening function during Y2/Y4 did not differ significantly from those without function change (p1⁄40.92), but the decrease in strength during BL/Y2 in those with functional improvement during Y2/Y4 was significantly greater than in those without change in function scores (p<0.05) (Figure 1). The above observations did not differ between men and women (data not shown). There were no differences between changes in flexor muscle strength across the above groups (Figure 1), neither concurrent with the WOMAC function changes nor during the 2 year period

Inter- and intrarater reliability of four single-legged hop tests and isokinetic muscle torque measurements in children.

Single-legged hop tests and isokinetic muscle torque are common outcome measures in the evaluation of knee function. The reliability of the single-legged hop tests in children has not been documented. The aim was to examine inter- and intrarater reliability of four single-legged hop tests and isokinetic muscle torque measurements in children. Twenty-eight sports-active children (12.4 ± 0.3 years old) were tested three times in two test sessions separated by 1 week. They performed four single-legged hop tests and concentric isokinetic torque measurements during knee extension and flexion. Inter- and intrarater reliability were calculated using the intraclass correlation coefficient (ICC 2,1). Relative terms of the standard error of measurement (SEM %) and smallest real difference(SRD %) were emphasized to allow comparison between the different variables. Twenty-six children were included for statistical analysis. ICCs for inter- and intrarater reliability were moderate to high for the hop tests (0.62-.91) and isokinetic measurements (0.76-0.87). SEMs % were low for the hop tests (3.9-7.4 %) and the isokinetic measurements (5.2-8.9 %). SRDs % were 20.5 % or less for the hop tests, 15.7 % or less for knee extension, and 24.6 % or less for knee flexion. The single-legged hop tests and isokinetic muscle torque measurements demonstrated moderate-to high reliability with low measurement error in sports-active children. A change above 20.5 % for the single-legged hop tests, 15.7 % for knee extension, and 24.6 % for knee flexion is necessary to represent a real change in knee function. Level of evidence III.

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Case series. To evaluate the feasibility of an active rehabilitation program for patients with knee full-thickness articular cartilage lesions. No studies have yet evaluated the effect of active rehabilitation in patients with knee full-thickness articular cartilage lesions or compared the effects of active rehabilitation to those of surgical interventions. As an initial step, the feasibility of such a program needs to be described. Forty-eight patients with a knee full-thickness articular cartilage lesion and a Lysholm score below 75 participated in a 3-month active rehabilitation program consisting of cardiovascular training, knee and hip progressive resistance training, and neuromuscular training. Feasibility was determined by monitoring adherence to the program, clinical changes in knee function, load progression, and adverse events. Patients were tested before and after completing the rehabilitation program by using patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation Form 2000) and isokinetic muscle strength and hop tests. To monitor adherence, load progression, and adverse events, patients responded to an online survey and kept training diaries. The average adherence rate to the rehabilitation program was 83%. Four patients (9%) showed adverse events, as they could not perform the exercises due to pain and effusion. Significant and clinically meaningful improvement was found, based on changes on the International Knee Documentation Committee Subjective Knee Evaluation Form 2000, the Knee injury and Osteoarthritis Outcome Score quality of life subscale, isokinetic muscle strength, and hop performance (P<.05), with small to large effect sizes (standardized response mean, 0.3-1.22). The combination of a high adherence rate, clinically meaningful changes, and positive load progression and the occurrence of only a few adverse events support the potential usefulness of this program for patients with knee full-thickness cartilage lesions. This study was registered with the public trial registry ClinicalTrials.gov (NCT00885729). Therapy, level 4.

Functional outcomes following a non-operative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 12 years and younger. A prospective cohort with 2 years follow-up

BackgroundThe methodological quality of studies on treatment of anterior cruciate ligament (ACL) injuries in skeletally immature children after ACL injury is low, and no prospective studies have evaluated the functional...

The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction

The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741.

A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury

Prospective cohort study without a control group. Firstly, to present our 5-week progressive exercise therapy program in the early stage after anterior cruciate ligament (ACL) injury. Secondly, to evaluate changes in knee function after completion of the program for patients with ACL injury in general and also when classified as potential copers or noncopers, and, finally, to examine potential adverse events. Few studies concerning early-stage ACL rehabilitation protocols exist. Consequently, little is known about the tolerance for, and outcomes from, short-term exercise therapy programs in the early stage after injury. One-hundred patients were included in a 5-week progressive exercise therapy program, within 3 months after injury. Knee function before and after completion of the program was evaluated from isokinetic quadriceps and hamstrings muscle strength tests, 4 single-leg hop tests, 2 different self-assessment questionnaires, and a global rating of knee function. A 2-way mixed-model analysis of variance was conducted to evaluate changes from pretest to posttest for the limb symmetry index for muscle strength and single-leg hop tests, and the change in scores for the patient-reported questionnaires. In addition, absolute values and the standardized response mean for muscle strength and single-leg hop tests were calculated at pretest and posttest for the injured and uninjured limb. Adverse events during the 5-week period were recorded. The progressive 5-week exercise therapy program led to significant improvements (P<.05) in knee function from pretest to posttest both for patients classified as potential copers and noncopers. Standardized response mean values for changes in muscle strength and single-leg hop performance from pretest to posttest for the injured limb were moderate to strong (0.49-0.84), indicating the observed improvements to be clinically relevant. Adverse events occurred in 3.9% of the patients. Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation, either to improve knee function before ACL reconstruction or as a first step in further nonoperative management. Therapy, level 2b.

Knee Function and Prevalence of Knee Osteoarthritis after Anterior Cruciate Ligament Reconstruction

Background Few prospective long-term studies of more than 10 years have reported changes in knee function and radiologic outcomes after anterior cruciate ligament (ACL) reconstruction. Purpose To examine changes in knee function from 6 months to 10 to 15 years after ACL reconstruction and to compare knee function outcomes over time for subjects with isolated ACL injury with those with combined ACL and meniscal injury and/or chondral lesion. Furthermore, the aim was to compare the prevalence of radiographic and symptomatic radiographic knee osteoarthritis between subjects with isolated ACL injuries and those with combined ACL and meniscal and/or chondral lesions 10 to 15 years after ACL reconstruction. Study Design Cohort study; Level of evidence, 2. Methods Follow-up evaluations were performed on 221 subjects at 6 months, 1 year, 2 years, and 10 to 15 years after ACL reconstruction with bone-patellar tendon-bone autograft. Outcome measurements were KT-1000 arthrometer, Lachman and pivot shift tests, Cincinnati knee score, isokinetic muscle strength tests, hop tests, visual analog scale for pain, Tegner activity scale, and the Kellgren and Lawrence classification. Results One hundred eighty-one subjects (82%) were evaluated at the 10- to 15-year follow-up. A significant improvement over time was revealed for all prospective outcomes of knee function. No significant differences in knee function over time were detected between the isolated and combined injury groups. Subjects with combined injury had significantly higher prevalence of radiographic knee osteoarthritis compared with those with isolated injury (80% and 62%, P = .008), but no significant group differences were shown for symptomatic radiographic knee osteoarthritis (46% and 32%, P = .053). Conclusion An overall improvement in knee function outcomes was detected from 6 months to 10 to 15 years after ACL reconstruction for both those with isolated and combined ACL injury, but significantly higher prevalence of radiographic knee osteoarthritis was found for those with combined injuries.

Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique versus Matrix-Associated Autologous Chondrocyte Implantation

Background Autologous chondrocyte implantation (ACI) is frequently used to treat symptomatic defects of the articular cartilage. Purpose To test whether matrix-associated autologous chondrocyte implantation or the original periosteal flap technique provides superior outcomes in terms of clinical efficacy and safety. Study Design Randomized controlled trial; Level of evidence, 2. Methods Twenty-one patients (mean age, 29.3 ± 9.1 years) with symptomatic isolated full-thickness cartilage defects (mean 4.1 ± 09 cm2) at the femoral condyle were randomized to matrix-associated autologous chondrocyte implantation or the original periosteal flap technique. The primary outcome parameter was the postoperative change in knee function as assessed by the International Knee Documentation Committee (IKDC) score at 12 months after ACI. In addition, the IKDC score was assessed at 3, 6, 12, and 24 months after surgery. Secondary outcome parameters were postoperative changes in health related quality of life (Short Form-36 Health Survey), knee functionality (Lysholm and Gillquist score), and physical activity (Tegner Activity Score) at 3, 6, 12, and 24 months after ACI. Magnetic resonance imaging was performed to evaluate the cartilage 6, 12, and 24 months after ACI and rated using the Magnetic Resonance Observation of Cartilage Repair Tissue score. Adverse events were recorded to assess safety. Results The primary outcome parameter showed improvement of patients 1 year after autologous chondrocyte implantation, but there was no difference between the periosteal flap technique and matrix-associated ACI (P = .5573); 2 years after ACI, a similar result was found (P = .4994). The study groups did not show differences in the Short Form-36 categories and in knee functionality as assessed by Tegner Activity Score 12 months (P = .4063) and 24 months (P = .1043) after ACI. There was a significant difference in the Lysholm and Gillquist score at 12 months (P = .0449) and 24 months (P = .0487) favoring the periosteal flap technique group. At 6 months after surgery, a significantly lower Magnetic Resonance Observation of Cartilage Repair score was obtained in the matrix-associated ACI group (P = .0123), corresponding to more normal magnetic resonance imaging diagnostic findings. Twelve and 24 months after ACI, the differences between the 2 groups were not significant (12 months, P = .2065; 24 months, P = .6926). Adverse events were related to knee problems such as transplant delamination, development of an osseous spur, osteochondral dissection, and transplant hypertrophy. Systemic (allergic, toxic, or autoimmune) reactions did not occur. Conclusion There was no difference in the efficacy between the original and the advanced ACI technique 12 and 24 months after surgery regarding International Knee Documentation Committee, Tegner Activity Score, and Short Form-36; however, with respect to the Lysholm and Gillquist score, better efficacy was observed in the periosteal flap technique group.