Improvement In Knee Scores Research Articles

MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTY: BENEFITS AND RISKS OF SIMULTANEOUS BILATERAL KNEE SURGERY

AbstractIntroductionIn patients with bilateral unicompartmental knee osteoarthritis, simultaneous bilateral surgery is cost effective, with both patient-specific and wider socioeconomic benefits. There are concerns however regarding higher complication rates with bilateral knee surgery. This study compares simultaneous bilateral unicompartmental knee arthroplasty (UKA), to single side UKA in terms of complications and outcomes.MethodologyThis is a retrospective case-control study of single side medial UKA patients (controls) and simultaneous bilateral medial UKA patients (cases). All patients underwent surgery between 2018 and 2022 by a single surgeon. The two cohorts were compared for perioperative blood loss (PBL), length of stay (LOS), complications (infections, blood clots, wound problems), Oxford Knee Score improvement (OKS) and revision surgery, with a follow-up period of up to 5 years.Results64 patients were followed up comprising 55 controls and 9 cases. Average length of stay for controls was 1.55 days and 2.22 days for cases (p=0.03). Average haemoglobin drop was 7.5g/l in controls and 12.8g/l in cases (p=0.04). The OKS improvement was comparable in both groups (p=0.95) with no complications and no revision surgery in either group.ConclusionThe statistically significant differences in PBL and LOS were not clinically relevant. There were no blood transfusions and postoperative haemoglobin was within normal range in more than 60% of cases. Simultaneous bilateral unicompartmental knee arthroplasty is a financially favourable and safe option for patients with bilateral knee medial unicompartmental osteoarthritis.

Comparison of the effects of acupotomy and acupuncture on knee osteoarthritis: A systematic review and meta-analysis

Background and purposeAcupotomy and acupuncture are both treatments for knee osteoarthritis symptoms. However, acupotomy also has the additional anatomical effect of dissecting inflamed tissue. The problem this study aims to address is whether acupotomy is a better treatment than acupuncture in treating knee osteoarthritis. MethodsWe searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Airiti Library, and Wanfang Data databases from inception to March 2022 for randomized controlled clinical trials (RCTs) comparing the effects of acupotomy and acupuncture in patients with knee osteoarthritis. ResultsIn total, we identified 43 RCTs in this meta-analysis. Compared to the acupuncture group, acupotomy had a higher cure rate (odds ratio (OR) 2.94, 95% confidence interval (CI) 2.36 to 3.65), indicating a better improvement in daily activity function. Acupotomy was also more effective in pain relief and knee score improvement. However, some RCTs indicated that adverse events in the acupotomy group were greater than in the acupuncture group (OR 1.23, 95% CI 0.42 to 3.60). ConclusionOur findings indicated that acupotomy was a more effective treatment for knee osteoarthritis than acupuncture. However, most of the included RCTs had moderate risk of bias, meaning that more high-quality RCTs were needed.

The functional impact of home-based self-rehabilitation following arthroscopic meniscus root repair

BackgroundCorona virus infectious pandemic makes outdoors rehabilitation a potential hazard. Patient education to perform simple home-based exercises seems to be an interesting and sometimes a mandatory option. This study provides a comparison between the conventional and home-based virtual rehabilitation after surgical repair of medial meniscus root tears.MethodsIn this prospective study, all patients who underwent medial meniscus posterior root repair with a modified trans-tibial pull-out technique from March 2019 to March 2021 were evaluated. Those who underwent surgery after December 2019 were trained to perform self-rehabilitation. The rest had undergone outdoors specialized rehabilitation according to a unified protocol and these were used as a historical control group. All patients were followed up for a minimum of 2 year after surgery. Final Lysholm scores were utilized to compare functional outcomes after considering the effect of age, body mass index and time from surgery by multivariate linear regression analysis.ResultsForty-three consecutive patients with medial meniscal root tears were studied. Thirty-nine (90.7%) were women and 4 (9.3%) were men. The mean age of participants was 53.2 ± 8.1 years. The total Lysholm knee score, and all its items were significantly improved in both groups at a two-year follow-up (p < 0.05), except the “Using cane or crutches” item (p = 0.065). Nevertheless, the final Lysholm knee score improvement was higher in patients who performed outdoors specialized rehabilitation and in patients with shorter time-to-surgery.ConclusionRegardless of age and gender, home-based rehabilitation after meniscal root repair with the modified trans-tibial pull-out technique improved the patients’ function at a two-year follow-up. Nonetheless, this effect was still significantly lower than that of the outdoors specialized rehabilitation. Future work is required to clarify basic protocols for home-based tele-rehabilitation programs and determine clinical, radiological and functional results.Level of evidenceLevel IV, therapeutic, historically controlled study.

Translated article] Implementation of a rapid recovery protocol in total knee arthroplasty. A randomised controlled trial

BackgroundRapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery programme compared to our classic protocol. Patients and methodsWe performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4–6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal.All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made 1 month after discharge. Minimum follow-up was of 6 months. ResultsA total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, haemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford knee score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%).Significancy was found on time of ischaemia (C: 81.29min; RP: 85.35min; p=.03), need for morphine shots (C: 19.7%; RP: 38.6%; p=.007), hospital stay (C: 3.84 days; RP: 2.54 days, p<.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; p<.0001). ConclusionRapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

Implantación de un protocolo de recuperación precoz en artroplastia total de rodilla. Ensayo clínico aleatorizado

BackgroundRapid recovery (RP) in total knee arthroplasty may increase the functionality while reducing costs. The aim of this study is to prove the benefits of a rapid recovery program compared to our classic protocol. Patients and methodsWe performed a RCT (NCT03823573) in patients undergoing otal knee arthroplasty. Intervention group (RP protocol) received local infiltration of levo-bupivacaine in the periarticular tissue and supervized ambulation 4-6h after surgery. Control (C) group received a femoral nerve block with levo-bupivacaine, while a drain was used. Ambulation after its removal.All the patients completed an Oxford Knee Score prior to surgery and 6 months after discharge. An ecodoppler to assess the presence of deep vein thrombosis was made one month after discharge. Minimum follow-up was of 6 months. ResultsA total of 175 patients were included in the trial (92 patients in the control group, 83 patients in the RP group). There were no differences in sex, age, implanted prosthesis, hemoglobin drop, need for transfusion, range of motion on discharge (C: 82.6°, RP: 85°) and at the end of the follow-up (C: 105.1, RP: 106.6), Oxford Knee Score improvement (C: 17.5 points; RP: 19.3 points), patient satisfaction or re-admissions at the emergency department (C: 7.6%; RP: 10.8%).Significancy was found on time of ischemia (C: 81.29min; RP: 85.35min; P=0.03), need for morphine shots (C: 19.7%; RP: 38.6%; P=0.007), hospital stay (C: 3.84 days; RP: 2.54 days, P<0.0001) and time until ambulation (C: 2.46 days; RP: 0.23 days; P<0.0001). ConclusionRapid recovery protocols can reduce hospital stay without increasing complications or need for re-admission.

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.

Total versus partial knee replacement in patients with medial compartment knee osteoarthritis: the TOPKAT RCT.

Late-stage medial compartment knee osteoarthritis can be treated using total knee replacement or partial (unicompartmental) knee replacement. There is high variation in treatment choice and insufficient evidence to guide selection. To assess the clinical effectiveness and cost-effectiveness of partial knee replacement compared with total knee replacement in patients with medial compartment knee osteoarthritis. The findings are intended to guide surgical decision-making for patients, surgeons and health-care providers. This was a randomised, multicentre, pragmatic comparative effectiveness trial that included an expertise component. The target sample size was 500 patients. A web-based randomisation system was used to allocate treatments. Twenty-seven NHS hospitals (68 surgeons). Patients with medial compartment knee osteoarthritis. The trial compared the overall management strategy of partial knee replacement treatment with total knee replacement treatment. No specified brand or subtype of implant was investigated. The Oxford Knee Score at 5 years was the primary end point. Secondary outcomes included activity scores, global health measures, transition items, patient satisfaction (Lund Score) and complications (including reoperation, revision and composite 'failure' - defined by minimal Oxford Knee Score improvement and/or reoperation). Cost-effectiveness was also assessed. A total of 528 patients were randomised (partial knee replacement, n = 264; total knee replacement, n = 264). The follow-up primary outcome response rate at 5 years was 88% and both operations had good outcomes. There was no significant difference between groups in mean Oxford Knee Score at 5 years (difference 1.04, 95% confidence interval -0.42 to 2.50). An area under the curve analysis of the Oxford Knee Score at 5 years showed benefit in favour of partial knee replacement over total knee replacement, but the difference was within the minimal clinically important difference [mean 36.6 (standard deviation 8.3) (n = 233), mean 35.1 (standard deviation 9.1) (n = 231), respectively]. Secondary outcome measures showed consistent patterns of benefit in the direction of partial knee replacement compared with total knee replacement although most differences were small and non-significant. Patient-reported improvement (transition) and reflection (would you have the operation again?) showed statistically significant superiority for partial knee replacement only, but both of these variables could be influenced by the lack of blinding. The frequency of reoperation (including revision) by treatment received was similar for both groups: 22 out of 245 for partial knee replacement and 28 out of 269 for total knee replacement patients. Revision rates at 5 years were 10 out of 245 for partial knee replacement and 8 out of 269 for total knee replacement. There were 28 'failures' of partial knee replacement and 38 'failures' of total knee replacement (as defined by composite outcome). Beyond 1 year, partial knee replacement was cost-effective compared with total knee replacement, being associated with greater health benefits (measured using quality-adjusted life-years) and lower health-care costs, reflecting lower costs of the index surgery and subsequent health-care use. It was not possible to blind patients in this study and there was some non-compliance with the allocated treatment interventions. Surgeons providing partial knee replacement were relatively experienced with the procedure. Both total knee replacement and partial knee replacement are effective, offer similar clinical outcomes and have similar reoperation and complication rates. Some patient-reported measures of treatment approval were significantly higher for partial knee replacement than for total knee replacement. Partial knee replacement was more cost-effective (more effective and cost saving) than total knee replacement at 5 years. Further (10-year) follow-up is in progress to assess the longer-term stability of these findings. Current Controlled Trials ISRCTN03013488 and ClinicalTrials.gov NCT01352247. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 20. See the NIHR Journals Library website for further project information.

Clinical outcomes and patient satisfaction after total knee arthroplasty: a follow-up of the first 50 cases by a single surgeon.

ObjectiveTo examine the association between single-surgeon learning curve and clinical outcomes following total knee arthroplasty (TKA).MethodsThis prospective study included the first consecutive patients undergoing TKA conducted by the same surgeon using the JOURNEY II Bi-Cruciate Stabilized Knee System (Smith & Nephew, Andover, MA, USA). Patients were assessed preoperatively, and at three months and one year postoperatively using Oxford Knee Score (OKS), Knee Society Score (KSS) and Knee Function Score (KFS). Outcomes were statistically analysed using sequential patient cohorts.ResultsFifty patients were grouped into five sequential cohorts of 10 patients each. All patients showed significant improvement in postoperative knee scores following TKA. There was a trend toward increased improvement in knee scores in the later patient cohorts, at the three-month and 1-year follow-up.ConclusionsThe single-surgeon learning curve for minimally invasive TKA had a small effect on knee satisfaction scores at 3 months and 1 year following surgery in the first 50 consecutive cases, and only minor complications were encountered. A larger trial is necessary to draw generalizable conclusions regarding patient outcomes during surgeon learning.

Efficacy of a Virtual Arthroscopic Simulator for Orthopaedic Surgery Residents by Year in Training.

Background:Virtual reality arthroscopic simulators are an attractive option for resident training and are increasingly used across training programs. However, no study has analyzed the utility of simulators for trainees based on their level of training/postgraduate year (PGY).Purpose/Hypothesis:The primary aim of this study was to determine the utility of the ArthroS arthroscopic simulator for orthopaedic trainees based on their level of training. We hypothesized that residents at all levels would show similar improvements in performance after completion of the training modules.Study Design:Descriptive laboratory study.Methods:Eighteen orthopaedic surgery residents performed diagnostic knee and shoulder tasks on the ArthroS simulator. Participants completed a series of training modules and then repeated the diagnostic tasks. Correlation coefficients (r2) were calculated for improvements in the mean composite score (based on the Imperial Global Arthroscopy Rating Scale [IGARS]) as a function of PGY.Results:The mean improvement in the composite score for participants as a whole was 11.2 ± 10.0 points (P = .0003) for the knee simulator and 14.9 ± 10.9 points (P = .0352) for the shoulder simulator. When broken down by PGY, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. Analysis of variance for the score improvement variable among the different PGY groups yielded an f value of 1.640 (P = .2258) for the knee simulator data and an f value of 0.2292 (P = .917) for the shoulder simulator data. The correlation coefficient (r2) was –0.866 for the knee score improvement and 0.887 for the shoulder score improvement.Conclusion:Residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic surgery skills.Clinical Relevance:The current study adds to mounting evidence supporting virtual arthroscopic simulator–based training for orthopaedic residents. Most significantly, this study also provides a baseline for evidence-based targeted use of arthroscopic simulators based on resident training level.

Long term outcome analysis of fixed bearing total knee arthroplasty

Introduction: Survivorship of TKA is directly related to appropriate alignment and balance. Surgeons should evaluate the biomechanics of knee alignment and determine the proper position of the implant. Malalignment of total knee prostheses has been implicated in few difficulties, including tibiofemoral instability, patellofemoral instability, patellar fracture, stiffness, accelerated polyethylene wear, and implant loosening. The aim of this study is to analyse the long term follow up of functional and radiological results of twenty cases of fixed bearing Total Knee Arthroplasty prospectively done in our institute during the period April 2008 to September 2009. Materials & Methods: This is a prospective study done in our department form 2008- 2009 which included total knee arthroplasty done for bicompartmental osteoarthritis without gross deformity. 20 cases were included in the study. The age range was 32 to 65 years. There were 5 male patients and 15 female patients. The accuracy of component position was assessed by mechanical axis restoration, coronal tibio femoral angle, sagittal femoral angle, posterior tibial slope by X-ray and the transepicondylar line-posterior condyle component angle by CT. We used Depuy PFC fixed bearing knee in 17 patients, Stryker knee in 2 patients and Indus knee in 1 patient. Knee society score was used to measure the functional outcome of the surgery. Results: The average postoperative flexion in the rheumatoid group was 105.4 degrees and in the osteoarthritis group was 115.8 degrees. There was no incidence of periprosthetic fractures. No patients had neurological deficit or dislocations. One case had valgus instability postoperatively. In our study all our patients showed an improvement in knee score with mean preop score of 50.4 (range: 46-57) improved to 75.6 (range: 65-88). 2 patients had excellent score (80-100).16 patients had good score (70-79) and 2 patients had fair results (60-69). No patients had maltracking of patella clinically.one patient with anterior knee pain and two patients with limited flexion post operatively were evaluated with axial view of knee. There were no evidence of patellar tilt or subluxation. No patients had loosening and osteolysis noted around the femoral and tibial components. No implant needed to be revised during the period of study. There was no incidence of superficial or deep infection. Of the 20 patients 18 cases returned to their premorbid condition. Two patients who were rheumatoid has persistent pain. The average follow up was 9.2 years (range 8.4 to 10.7 years). Conclusion: In patients with ideal placement of the components i.e. with mechanical axis and the rotational alignment accurate better knee flexion and knee score was obtained provided other factors are normal. We conclude that the correct positioning of the components both axially and rotationally improves the functional outcome of fixed bearing knee in low demand patients with an excellent long term clinical outcome.

Efficacy of an Arthroscopic Virtual Based Simulator for Orthopedic Surgery Residents by Year in Training

Objectives:Arthroscopic virtual-reality stimulators are an attractive option for resident training and are increasing across training programs. However, no study has analyzed the utility of the simulator for trainees based on their post-graduate level of training (PGY-level). The primary aim of this study was to determine the utility of the ArthroSTM arthroscopic simulator for orthopedic trainees based on their level of training (to determine at what point in training the simulator offers the most benefit for trainees). We hypothesized that all levels would show similar improvements in performance following completion of the training modules.Methods:Eighteen orthopedic surgery residents performed pre-training diagnostic knee and shoulder tasks on the ArthoSTM simulator. Subjects completed a series of training modules, then repeated the diagnostic tasks. Mean composite scores were calculated. Group differences for discrete variables were evaluated using ANOVA (analysis of variance). Correlation coefficients (R2) were calculated for improvements in mean composite score as a function of subject year-in-training.Results:Average improvement in composite score for participants as a whole was 11.2 points [SD 10; p-value 0.0003] for the knee simulator and 14.9 points [SD 10.9; p-value 0.0352] for the shoulder simulator. When broken down by PGY-level, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. ANOVA for the score improvement variable in the knee simulator data amongst the different PGY-groups yielded an f-value of 1.640 (p-value 0.2258) and that for the shoulder simulator data amongst the different PGY-groups yielded an f-value of 0.2292 (p-value 0.917). The correlation coefficient (r2) was -0.866 for the knee score improvement and 0.887 for the shoulder score improvement (Image 1).Conclusion:We found that residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic skills. Most importantly, we report for the first time that the knee simulator appears to be more beneficial for junior residents, while the shoulder simulator appears to be more beneficial for senior residents. Our study adds to the mounting evidence supporting virtual arthroscopic simulator-based training for orthopedic surgery residents.

Distal femoral osteotomy using a lateral opening wedge technique

To shift the weight-bearing axis of the lower limb medially by opening alateral-based metaphyseal osteotomy at the distal femur. Femoral-based valgus malalignment and symptomatic lateral unicompartimental osteoarthritis, lateral hyperpression syndrome, cartilage therapy of the lateral compartment, lateral meniscal replacement/transplantation, medial instability with valgus thrust, reconstruction of the medial collateral ligament, patellar instability and/or maltracking. Advanced cartilage damage (>grade2) or subtotal meniscal loss of the medial compartment, age >65years (relative), nicotine abuse, body mass index >30, flexion contracture >25°, corrections with awedge base >10 mm in case of congenital deformities, inflammatory or septic arthritis, severe osteoporosis. Lateral approach to the distal femur; biplanar osteotomy (frontal+ axial osteotomy), gradual opening of the osteotomy, osteotomy fixation with alocking plate. Free range of motion. Partial weight bearing with 20 kg for 2weeks, followed by progressive weight bearing thereafter. Mean improvement of knee scores from 20-30points and mean 10-year survival rate of 80% in patients with lateral unicompartimental osteoarthritis. Mean complication rate of 9%.

Does Kinesiology Taping Improve the Early Postoperative Outcomes in Anterior Cruciate Ligament Reconstruction? A Randomized Controlled Study

The efficacy of kinesiology taping in arthroscopic knee surgery has not been reported. The objective of this study is to investigate the efficacy of kinesiology taping in the early postoperative phase after anterior cruciate ligament reconstruction (ACLR). We hypothesized that kinesiology taping reduces knee pain and swelling and improves knee range of movement and functional outcome. Randomized controlled study. Primary Institutional Hospital. Sixty subjects who underwent an elective ACLR with or without concurrent meniscectomy were randomized into intervention (with kinesiology taping postsurgery) and control groups. Subjects from both groups received standardized postoperative physiotherapy. Subjects from the intervention group received additional kinesiology taping on the first and second weeks postsurgery, each application lasting 5 days. Pain visual analogue score (VAS), total range of motion (ROM) of the knee, Lysholm-Tegner scale, and mid patella circumferential girth were measured before the surgery and at the first, second, and sixth week postsurgery. Within each group, statistically significant differences were found in all study parameters in both groups. Comparison of the study parameters between both groups revealed no statistical significance at various time points except the reduction of pain in the taping group in the early postoperative phase (between the first and second week) (P < 0.05). This is the first randomized controlled study investigating the efficacy of kinesiology taping in arthroscopic knee surgery. Our study showed that kinesiology taping reduced pain in the early postoperative period after ACLR. There was no statistical significance in the reduction of swelling or improvement of knee score and total range of motion with kinesiology taping.

Prospective study of the anterior cruciate ligament reconstruction associated with high tibial opening wedge osteotomy in knee arthritis associated with instability.

Chronic ACL insufficiency with associated varus malalignment due to knee osteoarthritis (OA) is challenging to treat surgically. A combined ACL reconstruction (ACLR) with medial open wedge high tibial osteotomy (HTO) without using any metallic implant for HTO is an effective technique. All the patients attending the outpatient department ACL injury and with associated medial compartment OA (Kellegren's grade 2 and grade 3) were considered for inclusion in the study. Forty patients who met inclusion criteria were included in the study. Simultaneous ACLR (single bundle of quadrupled hamstring graft fixed with Endobutton on femoral side and biointerference screw on the tibial side) along with medial opening wedge osteotomy (with tricalcium phosphate wedge) was done. The patients were assessed with IKDC, KOOS scores and any change in anterior tibial translation was also checked. The combined procedure showed mean varus angle correction of 9° (10.5-1.5°), and the mechanical axis of the knee was restored from an average of 172-181.5°. There was a significant improvement in knee score (KOOS and IKDC) after the surgery (p<0.05). The average time for the radiological union of the osteotomy was 3.56 months. The anterior tibial translation was improved. No intraoperative complications and slippage of the synthetic graft were noted in any case. Combined ACLR with HTO (using TCP wedge, without any hardware) is a reliable method that prevents rapid progression of OA. It reliably corrects varus deformity and obviates the use of any hardware.

Patient Satisfaction and Functional Outcomes Following Secondary Patellar Resurfacing.

When secondary patellar resurfacing is performed, a uniformly and widely used scoring system that is validated for anterior knee pain caused by a retropatellar degeneration will give more insight into the results of this procedure. The cause of anterior knee pain following total knee arthroplasty (TKA) is not always related to the patella itself. Other causes have been identified, such as an insufficient posterior cruciate ligament in the case of a posterior cruciate-retaining TKA or an internally rotated femoral and/or tibial component. Treatment of anterior knee pain following primary TKA with secondary patellar resurfacing is a controversial procedure with uncertain outcomes. The purpose of this study is to systematically review the available peer-reviewed literature on patient satisfaction and functional outcomes of secondary resurfacing. The authors performed a systematic computerized database search of the Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE in October 2014. The quality of the included studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 15 articles met the inclusion criteria. In total, 148 (64%) of 232 patients were satisfied with the outcomes of secondary patellar resurfacing. A statistically significant improvement in knee scores was noted in all 9 studies that reported functional outcomes, although no clinically significant improvement in knee scores was observed. Reported complications include infections and impaired wound healing, patellar instability, and patellar fracture. Because the available evidence is of generally low quality, the results of this systematic review only support a weak recommendation for secondary patellar resurfacing if patient satisfaction and clinically important improvement of functional outcomes are the desired endpoints. [Orthopedics.2016; 39(5):e850-e856.].

Midterm Results of Comprehensive Surgical Reconstruction Including Sulcus-Deepening Trochleoplasty in Recurrent Patellar Dislocations With High-Grade Trochlear Dysplasia

Background: Trochlear dysplasia is one of the most consistent anatomic factors that can lead to recurrent patellar dislocations. Various trochleoplasty procedures have been described to treat patellar dislocations in high-grade dysplasia by creating a new congruent trochlea. Purpose: To present the midterm efficacy and outcome of the sulcus-deepening trochleoplasty procedure in patients with recurrent patellar dislocations due to high-grade trochlear dysplasia. The clinical evaluation results, the amount of radiological correction, and the prevalence of arthritis were recorded. Study Design: Case series; Level of evidence, 4. Methods: A total of 27 skeletally mature patients (31 knees) with recurrent patellar dislocations due to high-grade trochlear dysplasia without any previous surgery were retrospectively included from September 1993 to September 2006. All patients underwent sulcus-deepening trochleoplasty combined with a bony and/or soft tissue procedure according to concomitant etiological factors to patellar dislocations: medial patellofemoral ligament reconstruction (16.1%), vastus medialis obliquus plasty (83.8%), tibial tuberosity distalization (51.6%), tibial tuberosity medialization (67.7%), and lateral retinaculum release (67.6%). Mean follow-up was 7 years (range, 2-9 years). Results: The mean sulcus angle decreased significantly (P < .01) from 152° ± 16° preoperatively to 141° ± 9° postoperatively, tibial tuberosity–trochlear groove distance decreased significantly (P < .001) from 19 ± 4 mm to 12 ± 5 mm, and patellar tilt decreased significantly (P < .001) from 37° ± 7° to 15° ± 8°. No recurrence was observed, and there was no case of stiffness. Apprehension signs remained positive in 19.3% of the cases, patellar tracking was normal in all cases, and the lateral patellar glide test finding was negative in 96.8%. The mean preoperative International Knee Documentation Committee (IKDC) score was 51 (range, 25-80), and the mean postoperative IKDC score was 82 (range, 40-100) (P < .001), while the mean Kujala score improved from a preoperative 59 (range, 28-81) to 87 (range, 49-100) postoperatively (P < .001). There was no radiographic evidence of patellofemoral arthritis at the latest follow-up. Conclusion: Sulcus-deepening trochleoplasty is a valid option for the primary surgical treatment of carefully selected patients with recurrent patellar dislocations with high-grade trochlear dysplasia type B and D. Concomitant etiological factors must be cautiously corrected in an associated procedure. Midterm follow-up showed satisfactory restoration of patellar stability and improvement of knee scores with no complication of subsequent arthritis.

Meniscal scaffolds: Early experience and review of the literature

IntroductionMeniscal scaffold implants support the in-growth of new "meniscus like" tissue with the aim of alleviating post-meniscectomy knee pain and preventing further articular cartilage degeneration. Patients and methodsTwenty-three patients underwent meniscal scaffold implantation (14 medial, 9 lateral) with either the Menaflex (ReGen Biologics) (n=12) or Actifit (Orteq) (n=11) scaffolds. Minimum follow-up was 1year with a mean of 24.1months (18–27) for the Menaflex and 14.7months (12–18) for the Actifit groups. Mean age at surgery was 35years (17–47) with a mean Outerbridge grade of 1.9 in the affected compartment. Eight (36%) underwent concurrent osteotomy, ligament reconstruction or microfracture of the tibial plateau. KOOS, Lysholm, Tegner activity and IKDC scores were collected pre-operatively and at six-month interval post-surgery. Assessment of the reconstruction was obtained with MRI scanning and arthroscopy. One scaffold tore and was revised at 19months post-operatively. ResultsTwenty-one out of 23 (91.3%) had a significant improvement in knee scores when compared to pre-surgery levels at latest follow-up. Second-look arthroscopy in 14 at 1-year post-implantation showed variable amounts of regenerative tissue. There was no progression in chondral wear noted on repeat MRI scanning. ConclusionTreatment with meniscal scaffold implants can provide good pain relief for the post-meniscectomy knee following partial meniscectomy. Longer follow-up is required to ascertain whether they also prevent the progressive chondral wear associated with a post-meniscectomy knee.

PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY

Background: Patellar resurfacing during total knee arthroplasty remains controversial. We aimed to evaluate the effectiveness of this technique through an evaluation of the current literature. Methods: We performed a meta-analysis of randomized controlled trials comparing total knee arthroplasties performed with and without patellar resurfacing. Outcomes of interest included the number of reoperations, the prevalence of postoperative anterior knee pain, and the improvement in various knee scores. Results: Ten trials assessing 1223 knees were eligible. The absolute risk of reoperation was reduced by 4.6% (95% confidence interval, 1.9% to 7.3%) in the patellar resurfacing arm (between-study heterogeneity, p < 0.01; I2 = 60%), implying that one would have to resurface twenty-two patellae (95% confidence interval, fourteen to fifty-two patellae) in order to prevent one reoperation. Patellar resurfacing reduced the absolute risk of postoperative anterior knee pain by 13.8% (95% confidence interval, 6.4% to 21.2%), implying that one would have to resurface seven patellae (95% confidence interval, five to sixteen patellae) in order to prevent one case of postoperative anterior knee pain. Only four trials provided adequate data for a quantitative synthesis of the changes in the various knee scores; on the basis of those four trials, there was no difference in the mean improvement in the knee scores (standardized mean difference, 0.03; 95% confidence interval, -0.50 to 0.56). Conclusions: The available evidence indicates that patellar resurfacing reduces the risks of reoperation and anterior knee pain after total knee arthroplasty. The observed effects are clinically important despite their modest magnitude. Additional, carefully designed randomized trials are required to strengthen this claim. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Cruciate-retaining Total Knee Arthroplasty at 5 to 7 Years Followup

Cruciate-retaining total knee implants may improve postoperative function in total knee arthroplasty, but whether patients experience good restoration of kinematics, undue wear, or increased revision rates is debatable. I evaluated clinical results, radiographs, and survival rates of the NexGen posterior cruciate-retaining implant at 5-7 years followup in 251 knees (198 patients) in a prospective, consecutive total knee replacement series done from 1996-1997. A consistent improvement in knee scores and range of motion was observed from preoperative evaluation through 5 years followup. Alignment remained constant and knee stability did not deteriorate. Knee Society scores were good or excellent for 90% of patients. The average range of motion was 123 degrees, and 73% of patients achieved a mean range of motion of 116 degrees -130 degrees. Mean physical quality of life measures improved from preoperative evaluation to the last followup. There were no complete or progressive radiolucencies. Four screw radiolucencies had progressive increases in diameter. Survival of the implant at 7 years was more than 98%. The NexGen posterior cruciate-retaining implant provided satisfactory kinematic and clinical results with no substantive polyethylene wear. Therapeutic study, Level II-2 (poor-quality randomized controlled trial). See the Guidelines for Authors for a complete description of levels of evidence.

A Study of Effectiveness of Knee Arthroscopy After Knee Arthroplasty

The purpose of this study was to investigate the outcome of arthroscopy in painful knee arthroplasty without evidence of infection, fracture, wear, and component loosening or malposition that had been refractory to conservative treatment. In addition, a literature review of 498 cases (MEDLINE 1966 to 2002) was performed. Case series. From 1997 to 2000, 27 patients (20 women, 7 men) had undergone arthroscopies because of poor results following total knee arthroplasty. Before the operation, the patients had suffered symptoms for an average of 11 months (range, 3 to 41 months). The average onset of symptoms after knee arthroplasty was 26 months (range, 3 to 59 months). The average patient age was 70 years (range, 42 to 81 years) and the average follow-up was 34 months (range, 24 to 52 months). At the initial operation, 19 patients had received total condylar surface replacement and 8 had received hemireplacement. Patients were evaluated using the Knee Society rating system. A review of the literature was performed by initial identification of the articles from a MEDLINE database followed by the use of cross references. All of the patients were available for follow-up. Eighteen of the 27 procedures resulted in an improvement in the patient's knee score. The average Knee Society ratings increased from 71 points before arthroscopy to 85 at follow-up for the knee score. The average functional scores were 69 and 83 points, respectively. The Knee Society pain score improved from 32 to 41 points. Nine patients underwent a subsequent open revision after arthroscopic diagnosis or treatment. Operative diagnoses included arthrofibrosis, impinging hypertrophic synovitis, impinging posterior cruciate ligament stump, prosthesis loosening or wear, symptomatic pseudomeniscus, an infrapatellar spur, and meniscal rupture. There was 1 infection as a complication associated with the arthroscopic procedure. Arthroscopic treatment of painful knee arthroplasty provides reliable expectations for improvement in function, decrease in pain, and improvement in knee scores for most patients. Level IV, Case Series.