Hospital For Special Surgery Score Research Articles

Effect of intramuscular vs intra-articular betamethasone injection on pain and inflammatory factors among patients with severe traumatic knee osteoarthritis.

The aim of this study was to comprehensively investigate the clinical efficacy of intraoperative local joint injection and intramuscular injection of betamethasone in patients with severe traumatic knee osteoarthritis (KOA). 80 patients with severe traumatic KOA undergoing total knee arthroplasty were retrospectively recruited and rolled into S1 group (intra-articular injection of ropivacaine + betamethasone and isotonic saline mixture at joint incision), S2 group (muscle local injection of betamethasone before incision closure, simultaneously intra-articular injection of ropivacaine + isotonic saline mixture at joint incision), and D group (intra-articular injection of ropivacaine + isotonic saline mixture at the joint incision). Visual analog scale (VAS) score, serum inflammatory factors (IFs), hospital for special surgery (HSS)score, Pittsburgh sleep quality index (PSQI), and adverse reaction events (AREs) were analyzed. Pain scores of patients in all three groups decreased drastically over time on postoperative days (PDs) 1, 2, and 3, with the scores in S1 and S2 groups markedly inferior to D group (P < 0.05). HSS scores of patients in S1 and S2 groups at postoperative months 1, 3, and 6 were considerably superior to those in D group (P < 0.05). PSQI scores of patients in S1 and S2 groups at postoperative months 1, 3, and 6 were notably inferior to those in D group (P < 0.05). Both intraoperative local joint injection and muscle injection of betamethasone are effective in patients with severe traumatic KOA.

Surgical treatment of AO/OTA 41B3 and 41C tibial plateau fractures with a temporary bi-frame fixator combined with the MIPPO technique

BackgroundThis study evaluated the clinical effects of the use of a temporary bi-frame fixator in conjunction with minimally invasive percutaneous plate osteosynthesis (MIPPO) for treating AO/OTA 41B3 and 41C tibial plateau fractures (TPFs).MethodsThis was a retrospective analysis of 30 patients with TPFs affected by vertical compression seen from October 2019 to October 2020. All patients were treated with a bi-frame fixator to correct the vertical shortening deformity, with the MIPPO technique used after reduction. All patients underwent routine examinations at 1, 3, 6, 12 and 24months postoperatively and then annually. Clinical parameters assessed included the Hospital for Special Surgery score (HSS), number of assistants, intraoperative hemorrhage, intraoperative fluoroscopy frequency, length of hospital stay, and time to fracture healing. Radiographic findings were assessed using Rasmussen scores.ResultsAll patients had satisfactory fracture reduction on postoperative imaging. The average operating time was 112.03 ± 20.9 min, with 15.79 ± 3.45 fluoroscopic exposures; the average blood loss was 66.63 ± 10.88 mL, the average length of hospital stay was 12.86 ± 5.11 days, and the average fracture healing time was 10.33 ± 1.48 weeks. The mean follow-up time was 23.18 ± 2.59 months. At the last follow-up, the Rasmussen anatomical score was excellent in 22 (75.3%) patients, good in 5 (16.7%), and fair in 3 (10%). The average HSS was 65.7 ± 3.26, 82.26 ± 2.28, and 87.66 ± 2.4 after 1, 6, and 12 months, respectively, and it was 92.56 ± 2.96 at the last follow-up (F = 1073.073, P < 0.001). No complications occurred in any patient during follow-up.ConclusionFor AO/OTA 41B3 and 41C fractures of the tibial plateau, the use of a temporary bi-frame fixator combined with the MIPPO technique can correct the compressed displacement, reduce soft tissue damage, and facilitate surgical reduction, which aid the recovery of joint function.

Effects of tranexamic acid on postoperative knee activity and stress, and inflammation cytokines in patients undergoing total knee arthroplasty.

Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, with postoperative bleeding and the inflammation-stress response being key factors that influence its outcomes. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in controlling perioperative bleeding. This study was to examine the effects of different doses of TXA on postoperative knee mobility and the inflammation-stress response in patients undergoing TKA METHODS: Ninety-eight patients undergoing unilateral TKA were randomly grouped based on the dose of TXA administered: 10mg/kg (AG), 15mg/kg (BG), and 20mg/kg (CG). The bleeding, coagulation function, inflammation-stress cytokines, pain visual analogue scale (VAS) scores, knee mobility, and knee function hospital for special surgery (HSS) scores of the subjects were compared. As the dose of TXA increased, the postoperative drainage volume, hidden bleeding, and total bleeding in TKA patients decreased, the levels of inflammatory factors interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were reduced, the levels of stress factors malondialdehyde (MDA), angiotensin II (Ang II), and cortisol (Cor) were reduced, pain VAS scores decreased, and knee mobility increased, with an increase in functional HSS scores (P < 0.05). The administration of 20mg/kg TXA in TKA patients visibly reduced bleeding following operation, improved the inflammation-stress response, and enhanced the function of the affected knee, which is beneficial to the postoperative recovery process.

Efficacy of Different Doses of Intra-Articular Tranexamic Acid for Reducing Blood Loss and Lower Limb Swelling After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial.

Both blood loss and lower extremity swelling after total knee arthroplasty (TKA) can affect a patient's postoperative recovery. The aim of this trial was to investigate whether different doses of intra-articular tranexamic acid (TXA) can reduce blood loss and postoperative lower limb swelling. In a prospective, randomized-controlled trial, a total of 225 patients were randomly assigned to three groups from September 2020 through January 2021: intra-articular injections of 3 g, 1 g of TXA, or placebo (saline solution). The primary outcome indicators were perioperative blood loss and decreased hemoglobin levels. The secondary outcome indicators were lower extremity swelling, functional recovery indicators (hospital for special surgery [HSS] scores, range of motion), visual analog scale [VAS] scores, and transfusion rates and safety outcomes, including thromboembolic events, incidence of wound-related complications, and length of hospital stay. One-way analysis of variance (ANOVA), post hoc Bonferroni correction, Pearson chi-square test and Fisher exact test were used for statistical analysis. Postoperative blood loss was lower in the 1 and 3 g TXA groups (754.00 ± 409.67 mL and 568.70 ± 408.27 mL, respectively) than in the placebo group (977.32 ± 418.69 mL) (p < 0.001). The maximum postoperative decrease in hemoglobin was lower in the 1 and 3 g TXA groups (2.4 ± 0.9 and 1.8 ± 0.9 g/dL, respectively) than in the placebo group (3.1 ± 1.2 g/dL) (p < 0.001). On postoperative Days 1, 2, and 3, the TXA group presented significantly reduced thigh, suprapatellar, and calf swelling and significantly reduced pain scores during exercise. Compared with that in the low-dose group, perioperative blood loss was further reduced in the high-dose TXA group (p = 0.006). However, while patients in the TXA group had improved pain scores, Hospital for Special Surgery scores, and joint range of motion at postoperative rest, these differences were not statistically significant. There were no significant differences in thromboembolic events or complication rates among the three groups. Topical TXA in total knee arthroplasty was effective in reducing postoperative blood loss by 24%-43% and in reducing postoperative lower extremity swelling and pain during exercise. Higher doses (3 g) of TXA further controlled perioperative blood loss without affecting postoperative lower extremity swelling, and there was no increase in the incidence of related complications during follow-up. This study was a single-center, prospective, randomized controlled trial (RCT). The trial was approved by the Clinical Trials and Biomedical Ethics Committee at our institution (number: 2018.676), all participants provided written informed consent, and the trial was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2000035271).

The role of the medial head of the gastrocnemius myocutaneous flap transfer in the management of prosthesis exposure and deep joint infection following total knee arthroplasty

BackgroundThere is a lack of effective and innovative treatment for patients with prosthesis exposure and deep joint infection following total knee arthroplasty. This study explores the application of the medial head of the gastrocnemius myocutaneous flap transfer in these conditions, offering new therapeutic strategies for clinical practice.MethodsClinical data of 68 patients with prosthesis exposure and deep joint infection following total knee arthroplasty were included and retrospectively analyzed. Patients were divided into one study group (n = 35, received medial head of the gastrocnemius myocutaneous flap transfer and vacuum sealing drainage) and one control group (n = 33, received vacuum sealing drainage). The total effective rates, visual analogue scale (VAS), Hospital for Special Surgery score (HSS), knee joint function, activity, inflammatory reactions, safety, and recurrence rate were compared between the two groups.ResultsThe total effective rate in the study group was higher than that in the control group. VAS scores in the study group were lower at 3 and 7 days after treatment. HSS scores were higher in the study group after treatment. The study group showed lower levels of hs-CRP and IL-6 after treatment. At 1 month and 3 months after treatment, the study group exhibited higher knee joint activity. There was no difference in the incidence of adverse reactions between the two groups, and the study group had a lower recurrence rate.ConclusionMedial head of the gastrocnemius myocutaneous flap transfer effectively improves knee joint function and activity, reduces pain, alleviates inflammatory reactions, and has fewer adverse reactions and a lower recurrence rate.

Analysis of influencing factors and construction of nomogram prediction model of postoperative kinesiophobia in patients undergoing total knee arthroplasty.

To explore the influencing factors of kinesiophobia and to establish a nomogram prediction model. A retrospective observational study was conducted in 354 patients who underwent TKA in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from December 2019 to December 2022. Sociodemographic characteristics, anesthesia methods, Tampa Scale for Kinesiophobia (TSK), numeric rating scale (NRS), hospital for special surgery (HSS), activities of daily living (ADL), and self-rating anxiety scale (SAS) were reviewed and analyzed. Logistic regression analysis was used to identify the influencing factors of kinesiophobia, and a nomogram model was established based on the identified influencing factors and verified by consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Incidence of kinesiophobia in patients who received TEAS combined with western medicine (dexmedetomidine and remifentanil) was significantly lower than that in patients who received western medicine alone. The logistic regression analysis showed that family monthly income level, HSS, ADL, and combined TEAS and western medicine approach were independent protective factors for kinesiophobia (all P<0.05). The degree of pain and anxiety were independent risk factors for kinesiophobia (both P<0.05). A nomogram model was constructed with C-index of 0.721 (0.658, 0.784), and the area under curve (AUC) was 0.748 (95 %CI: 0.685-0.807). The calibration curve also showed good consistency between actual observations and nomogram model predictions. Family monthly income level, anesthesia methods, NRS, HSS, ADL, and SAS scores are influencing factors of kinesiophobia, and the nomogram model can be useful for predicting postoperative kinesiophobia.

Construction and Application Effect Analysis of Orthopedic Pain Care Ward under Multi-Disciplinary Cooperation Model

Aims/Background A multidisciplinary team (MDT) approach is a nurse-led pain management method that involves collaboration with staff from other departments. The purpose of this paper was to discuss the construction and application effect of a pain care ward in orthopedics utilizing the MDT approach. Methods A retrospective analysis of case data was conducted, selecting 90 patients with hip joint fractures who underwent hip replacement arthroplasty (HRA) at our hospital between February 2021 and February 2024. The patients were divided into two groups based on the nursing methods: a control group (n = 43), which received a conventional analgesic management program, and an intervention group (n = 47), which received the same conventional analgesic management program along with the implementation of an orthopedic pain care ward under the MDT approach. The study compared the pain knowledge and attitudes of the responsible nurses in both groups through questionnaires. Additionally, the accuracy of pain assessments and the awareness rates of patients’ pain-related health education were evaluated and compared between the two groups. Furthermore, the effectiveness of pain intervention, range of motion (ROM), and Hospital for Special Surgery (HSS) scores before and after the intervention were analyzed. The incidence of complications and overall nursing satisfaction were also compared between the two groups. Results The general knowledge, pain assessment, drug analgesia, comprehensive application, and total scores of nurses in the intervention group were significantly higher than those in the control group (p &lt; 0.05). The accuracy rate of nurses’ pain assessments and the awareness rate of patients’ pain health education in the intervention group were 91.49% and 93.62%, respectively, both significantly higher than the 72.09% and 79.07% observed in the control group (p &lt; 0.05). The total effective rate of pain intervention in the intervention group was 74.47%, significantly higher than the 53.49% in the control group (p &lt; 0.05). After the intervention, both the ROM and HSS scores in the intervention group were significantly higher than those in the control group (p &lt; 0.05). The overall incidence of complications in the intervention group was 6.38%, significantly lower than the 20.93% in the control group (p &lt; 0.05). Finally, the total satisfaction rate with nursing care in the intervention group was 91.49%, significantly higher than the 74.42% in the control group (p &lt; 0.05). Conclusion The construction and application of an MDT pain care ward can effectively enhance the accuracy of nurses’ pain assessments, increase patients’ awareness of pain-related health education, and improve the efficiency of pain interventions. Additionally, it can lead to better joint mobility and improved hip function, promoting the sustainable development of the pain care ward. These improvements contribute to higher patient satisfaction and enrich the quality of nursing services.

Effect of femoral prosthesis flexion angle on unicompartmental knee arthroplasty with mobile platform

ObjectiveTo investigate the effect of the flexion angle of a femoral prosthesis on the postoperative clinical outcome of patients with knee osteoarthritis who are undergoing unicompartmental knee arthroplasty.MethodsPatients were divided into three groups according to the flexion angle of the femoral prosthesis following unicompartmental knee arthroplasty. Group A comprised patients with a flexion angle of the femur prosthesis of less than 5°, Group B included those with a flexion angle of 5° to 10°, and Group C consisted of patients with a flexion angle of the femur prosthesis greater than 10°. The basic clinical data, visual analog scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM) were subjected to statistical analysis and comparison between the groups.ResultsNo significant differences were observed in the basic data of the patients in each group. The ROM and VAS scores for the knee in the first month following unicompartmental knee arthroplasty in groups B and C were significantly greater than those in group A. The HSS scores for the knee joint in Group B indicated superior outcomes in the initial postoperative month and the third postoperative month, as evidenced by the WOMAC scores, which demonstrated a statistically significant difference between Group B and the other two groups within the six-month postoperative period.ConclusionThe short-term recovery of patients in Group B was the fastest. These results provide a new reference for the installation of femoral prostheses in unicompartmental knee arthroplasty.

Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis on randomized control trials

ObjectivesThis review aimed to compare the efficacy and safety of enhanced recovery after surgery (ERAS) versus traditional care in patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsAll randomized controlled trials (RCTs) were acquired via a comprehensive search of multiple databases. A meta-analysis was performed using Cochrane Collaboration's RevMan 5.4 software to calculate effect sizes. ResultsThis meta-analysis included 850 patients in the ERAS group and 845 patients in the control group (patients who received traditional care). The outcomes suggested no significant difference in operative time, intraoperative blood loss, visual analogue scale, 30-day readmission rate, and mortality rate between the two groups. However, the ERAS group was associated with a significant decrease in transfusion rate, hospital length of stay, and postoperative complications. Moreover, the ERAS group had higher Hospital for Special Surgery scores and satisfaction rates. ConclusionsPatients who underwent THA and TKA would benefit more from ERAS than traditional care.

Comprehensive classification and its value of capitellar cartilage injury concomitant with radial head fracture

BackgroundThere are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value.MethodsAccording to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb.ResultsMason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11–26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%.ConclusionDifferent types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome.

Schatzker IV tibial plateau fractures involving the posterolateral column: Higher incidence of lateral meniscus and anterior cruciate ligament injuries with suboptimal postoperative outcomes

BackgroundCurrent literature offers scant insights into Schatzker IV tibial plateau fractures (TPFs) that affect the posterolateral (PL) column. This study seeks to elucidate the prevalence of meniscal and ligamentous injuries in the knee, as well as the clinical outcomes, in Schatzker IV TPF cases, both with and without PL column involvement. MethodsWe conducted a retrospective analysis of clinical and imaging data from patients with Schatzker IV TPFs who received surgical treatment at our institution between January 2018 and January 2022. Patient demographics and surgical details were meticulously documented. The study participants were categorized into two groups based on the involvement of the PL column in the Schatzker IV TPF. Group A comprised patients without PL column fractures, whereas Group B included those with such fractures. We compared soft tissue injuries affecting knee stability, namely meniscal and ligamentous injuries, between two groups using Magnetic Resonance Imaging (MRI) and surgical records. Further, Group B was divided into subgroups based on the presence or absence of knee subluxation. Within Group B, we measured the lateral plateau depression (LPD) and lateral plateau widening (LPW). Additionally, we investigated the frequency of meniscus entrapment in patients with PL column fractures. Clinical outcomes were assessed using The American Hospital for Special Surgery (HSS) and Rasmussen scores. ResultsThe study comprised 66 patients with Schatzker IV TPFs. Of these, 12 patients had no PL column fracture, while 54 had a PL column fracture. Group B demonstrated a 57.4 % and 64.8 % incidence of lateral meniscus (LM) and anterior cruciate ligament (ACL) injuries, respectively, significantly higher than that in Group A (25 %, 8.3 %) (p = 0.044, p < 0.001). Within Group B, those with knee subluxation showed a marked increase in LPD (14.5 ± 5.3 mm) and LPW (9.3 ± 4.9 mm), correlating with a higher rate of meniscus entrapment (76.0 %) (p < 0.001). Patients in Group B had lower HSS and Rasmussen scores compared to Group A (p = 0.048, p = 0.006). ConclusionThis investigation reveals that Schatzker IV TPFs involving the PL column are highly associated with increased rates of LM and ACL injuries. Additionally, these fractures correlate with a greater likelihood of knee subluxation and meniscus entrapment, ultimately leading to poorer prognostic outcomes.

Related Factors and Risk Prediction of Chronic Pain after Knee Replacement.

This study aimed to explore potential risk factors associated with chronic pain after total knee arthroplasty (TKA) and to establish the risk prediction model of chronic postoperative pain (CPSP). This study retrospectively analyzed the clinical data of 160 patients who underwent TKA in our hospital between January 2021 and January 2024. Relevant data such as the baseline characteristics, past medical history, CPSP condition, and pain numerical rating scale (NRS) were retrieved from the medical information system. Logistic regression analysis was performed on the risk factors affecting the postoperative CPSP of the patients. The identified risk factors were incorporated to develop a risk-prediction model. Among the 160 patients, 67 (41.88%) had CPSP at or around the operation incision. The NRS pain score was significantly higher in the CPSP group than in the non-CPSP group during exercise preoperative and 3 months post-operation. Furthermore, the CPSP group had a higher NRS score than the non-CPSP group at rest 3 months after the procedure (p < 0.05). We observed that the preoperative NRS score, preoperative hospital for special surgery (HSS) score, postoperative functional training, and postoperative adverse events were the independent factors influencing the occurrence of CPSP after TKA (p < 0.05). Additionally, there was a significant positive correlation between preoperative NRS score, postoperative adverse events, and CPSP pain severity, and a significant negative correlation between preoperative HSS score, postoperative functional training, and CPSP pain severity (p < 0.05). The receiver operating characteristic (ROC) curve had excellent calibration and prediction capabilities for the predictive model of CPSP after TKA, with the area under the curve (AUC) of 0.868 (95% CI: 0.811-0.925). In this study, the predictive model of CPSP risk for patients after TKA surgery was initially constructed, which can help medical staff predict the risk of CPSP in patients after surgery individually, thereby preventing the occurrence of CPSP.

Intra-articular injection of chitosan combined with low-dose glucocorticoid for the treatment of knee osteoarthritis in early and middle stages.

This study explores the clinical efficacy of intra-articular injection of chitosan combined with low-dose glucocorticoid for the treatment of knee osteoarthritis in early and middle stages. The visual analog scale (VAS) score, Lysholm score, Hospital for Special Surgery (HSS) score, and changes in the levels of inflammatory cytokines IL-1, IL-6, and TNF-α in the joint fluid before and after treatment in the 3 groups were compared, and the clinical efficacy was evaluated. All cases were followed up, with a follow-up time of 7 to 12 months, and no lost cases. The horizontal comparison showed that the VAS score, Lysholm score, HSS score, and levels of inflammatory cytokines IL-1, IL-6, and TNF-α in the joint fluid after treatment in each group were better than before treatment, and the difference was statistically significant (P < .05). The longitudinal comparison showed that there was no significant difference in VAS score, Lysholm score, HSS score and levels of inflammatory cytokines IL-1, IL-6, and TNF-α in synovial fluid among the 3 groups before treatment (P > .05); However, after treatment, there were significant differences among the 3 groups (P < .05), group C was better than group A and group B, group B was better than group A, and the differences were statistically significant (P < .05). The difference in clinical efficacy among the 3 groups was statistically significant (P < .05). The clinical efficacy of chitosan combined with low-dose glucocorticoid intra-articular injection in the treatment of knee osteoarthritis in early and middle stages is significant, with the characteristics of small trauma, rapid onset, and lasting efficacy, and it avoids the adverse reactions of topical or oral nonsteroidal anti-inflammatory drugs. As a first-line treatment option, it is recommended for promotion and use in clinical practice.

Evaluation of healing after arthroscopic repair of lateral meniscal tears around the popliteal hiatus

BackgroundThe popliteal hiatus stabilizes the lateral meniscus (LM). Variable failure rates for LM repairs have been reported in knees with lateral meniscal tears (LMTs), which may be attributable to low vascularity around the popliteal hiatus. An effective repair method is essential to enhance the biological healing and stability of LMTs around the popliteal hiatus. HypothesisArthroscopic repair of LMTs, including the popliteus tendon around the popliteal hiatus, is expected to produce a low reoperation rate and effective treatment, both clinically and radiographically. Material and methodsFrom June 2011 to August 2020, 93 patients (mean age 27.9 ± 13.5 years) who underwent arthroscopic repair of LMTs including the popliteus tendon around the popliteal hiatus were enrolled. Patients with LMTs were divided into three groups: isolated LMTs, discoid LMTs, and LMTs with ACL injury. Patients had a minimum clinical follow-up of 2 years (mean 37.9 ± 19.3 months) and Tegner activity, Lysholm knee, and Hospital for Special Surgery (HSS) scores were evaluated for all patients. The widths of the popliteal hiatus and LM extrusion were measured on the sagittal and coronal planes using preoperative and postoperative magnetic resonance imaging (MRI). ResultsThe Tegner activity (2.6 ± 1.2–4.5 ± 1.3), Lysholm (67.9 ± 14.2–88.1 ± 6.4), and HSS scores (79.8 ± 11.5–93.7 ± 5.1) were significantly improved in all knees (p < 0.001). The width of the popliteal hiatus measured on MRI was significantly decreased, when comparing the preoperative and postoperative MRI for all knees (sagittal plane, 2.9 ± 1.4–1.5 ± 0.5 mm; coronal plane, 3.8 ± 2.5 to 1.9 ± 1.0 mm) (p < 0.05). The LM extrusion measured on the sagittal plane of postoperative MRI was also significantly reduced after arthroscopic repair (24.8 ± 3.1–23.7 ± 2.8 mm) (p = 0.001). Five reoperations (5/93, 5.3%) were performed, suggesting a clinical failure. ConclusionArthroscopic repair of isolated, discoid and post-traumatic LMTs including the popliteus tendon around the popliteal hiatus, is an effective surgical treatment for LM stabilization. Level of evidenceLevel IV, retrospective series.

Comparison of Functional Outcomes of Unilateral Periarticular Locking Plate, Hybrid Dual Plates, and Classic Dual Buttress Plates in the Treatment of Bicondylar Tibial Plateau Fractures

Background: Bicondylar tibial plateau fractures (TPFs) present challenges in management due to articular surface involvement and soft-tissue complexities. The optimal fixation method for these fractures remains unclear. Objectives: This study aimed to compare the functional outcomes of bicondylar TPFs treated with unilateral periarticular locking plates, hybrid dual plates (locking plate and buttress plate), or classic dual buttress plates. Materials and Methods: A retrospective cohort study was conducted on 59 patients with bicondylar TPFs (Schatzker types V and VI) treated at three Level I trauma centers between 2008 and 2015. Functional outcomes were assessed using the Hospital for Special Surgery (HSS) Knee Score and the Oxford Knee Score. Results: Locking plate groups (unilateral and hybrid) demonstrated a higher percentage of excellent outcomes in HSS Knee Scores at 3 and 6 months postoperatively (p = 0.0291 and p = 0.0446, respectively) and Oxford Knee Scores at 6 months (p = 0.0253) compared to the classic dual buttress plate group. Unilateral plating showed a significantly higher percentage of excellent HSS scores at 6 months. Conclusions: The use of locking plates, either unilateral or hybrid, is associated with a higher likelihood of achieving excellent functional outcomes in bicondylar TPFs at 3 and 6 months postoperatively. Level of Evidence: Therapeutic Level III evidence, indicating a retrospective comparative study.

Does the femoral component design modified in consideration of Asian anatomical characteristics fit better than the conventional design for Korean femora in reality?

IntroductionWe aimed to investigate the anatomical and clinical advantages of an Asian-specific femoral component design with a high femoral aspect ratio, compared with the conventional femoral component design.Materials and methodsA retrospective analysis of the operation and outpatient clinic records of 239 knees operated on using an anatomically modified femoral component design (MFCD, Group A) and 153 knees operated on using a conventional femoral component design (CFCD, Group B) in Korean patients was performed. Three subgroups were created based on the mediolateral size of the two different femoral component designs. The geometric accommodation of each femoral component was assessed using intraoperatively measured femoral posterior condylar resection and posterior condylar trimming amounts. Clinical outcomes were assessed using a range of motion (ROM) and patient-reported outcome measurements.ResultsIn the comparison between Groups A and B, the mean combined bilateral posterior condylar trimming (XPCT) was 2.91 [2SD: − 4.12–9.94] and 1.45 [2SD: − 5.89–8.80], and the median XPCT was 3 and 1.5. In the largest subgroup (subgroup 2), Groups A and B included 100 and 112 patients, all six posterior condylar resection and trimming parameters were significantly larger in Group A. Preoperative and postoperative ROM and Hospital for Special Surgery scores were similar between the two groups. Preoperative Western Ontario and McMaster Universities Arthritis Index (WOMAC) was higher in Group A. However, postoperative WOMAC was similar between the groups. Perioperative improvement in WOMAC index was significantly greater in Group B.ConclusionsThe Asian-specific femoral component design resulted in more resection and trimming of the femoral posterior condyle than the conventional design despite it was not associated with different clinical outcomes. Surgeons should be aware of unexpected excessive posterior condylar resection and formation of large flexion gap when using femoral component design with high femoral aspect ratio.

Long-term surgical outcomes of open reduction and internal fixation (ORIF) in patients with Hoffa-like tibial plateau fractures: a clinical study and analysis.

The Hoffa-like tibial plateau fracture is a rare intra-articular fracture and few studies have investigated its curative effect after treatment. We aimed to focus on patients with Hoffa-like tibial plateau fractures based on a large sample population and to evaluate their long-term surgical outcomes treated with open reduction and internal fixation (ORIF). Between August 2017 and September 2020, a period in which 3256 tibial plateau fractures were treated in five trauma centres. Among them, patients with Hoffa-like tibial plateau fractures who treated with ORIF were retrospectively reviewed. Baseline characteristics, operative information, imaging findings, functional scores and any complications were accurately recorded. Each patient was followed for at least three years. Hoffa-like tibial plateau fractures account for approximately 0.9% (29/3256) of all tibial plateau fractures, including 19 males and ten females with a mean age of 45.8 years. After surgery, all patients obtained anatomical reduction of the fractures and none experienced reduction loss. The final Hospital for Special Surgery score (HSS) was improved compared to one year postoperatively (92.76 ± 3.52 versus 89.03 ± 3.81, P < 0.01). No significant differences (P > 0.05) were found in VAS pain score, Rasmussen score, tibial plateau angle (TPA), and posterior slope angle (PSA) between one year and final follow-up. No serious postoperative complications occurred during the treatment and follow-up. Long-term follow-up results showed that patients with Hoffa-like tibial plateau fractures can achieve stable fracture fixation, low postoperative complications, excellent radiographic findings and good functional recovery with ORIF.

KNEE DEFORMITIES AND KNEE REPLACEMENTS IN SAUDI POPULATION: OUR EXPERIENCE AND LITERATURE REVIEW

It takes precise alignment, adequate balance, and deformity correction to accomplish a successful total knee arthroplasty (TKA). In main TKA, this can be successfully achieved with a posterior stabilized (PS) design, either with or without sub-periosteal release. However, severe abnormalities with a major bone defect, stiffness, and instability are often associated with these disorders in some circumstances, such as knee osteoarthritis. Additional restrictive prostheses are required since it is extremely difficult to balance these anomalies with soft tissue release alone, even after main TKA. In this situation, the constrained condylar knee (CCK) design is the optimum choice. This studys primary objectives were to characterize the clinical outcomes, function recovery, and complications of patients who underwent primary CCK-TKA for severe knee osteoarthritis related knee deformity. The secondary aim was to find out the mid-term prostheses survival. Methods: Between March 2021 and March 2022, 36 consecutive patients with knee osteoarthritis had cemented primary CCK-TKA. Twenty-Eight women and eight men, totaling 36 patients, had at least a 6 month follow-up for this retrospective analysis. We used the Knee Society Score (KSS), the Hospital for Special Surgery (HSS) score, and the roentgenographic evaluation form to assess the patients. The survival of prosthesis was assessed using Kaplan-Meiers survival analysis. The patients follow-up periods averaged 12 month. The KSS knee score rose from 44 points (23–68) to 91 points (76–100) following surgery [P &lt; 0.001]. Following the procedure, the mean KSS functional score rose from 20–75 points to 91 points (65–100) [P &lt; 0.001]. The average HSS score rose from 51 points (27–83) to 91 points (75–100) following surgery [P &lt; 0.001]. The average range of motion (ROM) also increased after surgery, going from 68.09° ± 35.99° (0°–120°) to 113.68° ± 8.90° (100°–130°) [P &lt; 0.001]. The average hip-knee-ankle (HKA) angle was 180.24° ± 1.77° (175°–184°) following surgery, compared to 176.88° ± 14.48° (135°–199°) before to surgery. Radiolucencies were seen in thirteen knees, mostly on the tibial side. After an average follow-up of 12 month, 94.7% of prosthesis were still in use. Despite severe deformity, instability, and stiffness at a relatively young age, the mid-term follow-up of primary CCK-TKA in knee osteoarthritis gives satisfactory clinical and functional outcomes with 94.7% prosthesis survival. However, there are a few issues.

Surgical fixation methods for tibial plateau fractures.

Tibial plateau fractures, which are intra-articular injuries of the knee joint, are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. The most common treatment for complex tibial plateau fractures is surgical fixation. Additionally, orthopaedic surgeons often use bone defect fillers to address bone defects caused by the injury. Currently, there is no consensus on the best method of fixation and on whether bone defect fillers are necessary. To assess the benefits and harms of different surgical interventions and bone defect fillers for treating tibial plateau fractures. We searched CENTRAL, MEDLINE, Embase, and trial registries up to March 2023. We also searched conference proceedings and the grey literature. We included randomised controlled trials (RCTs) and quasi-RCTs comparing surgical interventions for treating tibial plateau fractures and different types of filler for bone defects. Two review authors independently screened search results, selected studies, extracted data, and assessed risk of bias. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Our primary outcomes (and the specific measures we considered most relevant) were generic quality of life (general health score in the 36-item Short-Form Health Survey (SF-36)), patient-reported lower limb function (Hospital for Special Surgery (HSS) score), and adverse events (frequency of unplanned reoperation). We used GRADE to assess the certainty of evidence. We included 15 trials in the review, with a total of 948 adult participants. Nine trials compared different types of fixation, and six trials evaluated different types of bone graft substitutes. All 15 trials were small and at high risk of bias. We considered most available evidence to be of very low certainty, meaning we have very little confidence in the results. Only limited pooling was possible. One trial compared circular fixation combined with insertion of percutaneous screws (hybrid fixation) versus standard open reduction and internal fixation (ORIF) in 82 people with open or closed Schatzker types V or VI tibial plateau fractures. At 24 months' follow-up, hybrid fixation compared with ORIF may have little or no effect on SF-36 general health score (MD 6 points higher, 95% CI 7.7 points lower to 19.7 points higher; 66 participants), patient-reported lower limb function according to the HSS score (MD 7 points higher, 95% CI 2.4 points lower to 16.4 points higher; 66 participants), or frequency of unplanned reoperation (RR 0.78, 95% CI 0.45 to 1.32; 83 fractures (82 participants)). However, the evidence for all three outcomes is very uncertain. Three trials (with 242 participants) compared single-plating ORIF versus double-plating ORIF. There may be little to know difference in patient-reported lower limb function (HSS score) at 24 months' follow-up in people who undergo single-plating ORIF compared with those who undergo double-plating ORIF (MD 0.2 points higher, 95% CI 2.12 points lower to 2.52 points higher; 1 study, 84 participants), but the evidence is very uncertain. There were no data for quality of life or unplanned reoperation at 24 months' follow-up. Six trials (including 368 participants) compared bone substitute versus autologous bone graft (autograft) for managing bone defects. No trials reported SF-36 general health score, HSS score, or frequency of unplanned reoperation at 24 months' follow-up. There is insufficient evidence to ascertain the best method of fixation or the best method of addressing bone defects during surgery in people with tibial plateau fractures. Further well-designed RCTs with larger sample sizes are warranted.

Scraping therapy for knee osteoarthritis: a systematic review and Meta-analysis.

To systematically evaluate the efficacy of scraping therapy on knee osteoarthritis (KOA). A computerized search was conducted in several databases, including PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang, and Chinese BioMedical Literature Database, from the establishment date of these databases to April 9, 2023. Randomized controlled trials (RCTs) on scraping therapy for KOA were collected in accordance with the "Participants-Intervention-Control-Outcome-Study design" criteria. The methodological evaluation of the included studies was carried out using RoB 2.0, and Meta-analysis was conducted using RevMan. The Grades of Recommendations Assessment, Development and Evaluation (GRADE System) was applied to grade the quality of evidence. A total of 12 RCTs with 997 subjects were included in the Meta-analysis. Results indicated that compared with the control group, the scraping therapy treatment group exhibited increased Lysholm scores [mean difference (MD) = 4.96, 95% confidence intervals (CI) (3.18, 6.74), P < 0.000 01] and Hospital for Special Surgery scores [MD= 8.35, 95% CI(3.92, 12.78), P =0.0002] and decreased visual analog scale scores [MD = -2.11, 95% CI(-3.79, -0.44), P =0.01] and Western Ontario and McMaster University Osteoarthritis Index scores [MD= -6.77, 95% CI(-8.99, -4.56), P < 0.000 01)]. The quality of evidence obtained in this Meta-analysis was low according to the GRADE system. The available evidence suggests that scraping therapy may have certain clinical efficacy in the treatment of KOA. However, further high-quality RCTs are needed to confirm the findings.