International Knee Documentation Committee Knee Research Articles

Effectiveness of lower tibial tunnel placement combined with internal tension relieving suture in posterior cruciate ligament reconstruction

To compare the effectiveness between lower tibial tunnel placement combined with internal tension relieving suture and simple lower tibial tunnel placement for posterior cruciate ligament (PCL) reconstruction. The clinical data of 83 patients with simple PCL injury who met the selection criteria between January 2014 and February 2022 were retrospectively analyzed. Among them, 44 patients underwent PCL reconstruction through lower tibial tunnel placement combined with internal tension relieving suture (tension relieving suture group), and 39 patients underwent PCL reconstruction through simple lower tibial tunnel placement (control group). Baseline characteristics, including gender, age, body mass index, side of injury, cause of injury, preoperative side-to-side difference (SSD) in posterior tibial translation, visual analogue scale (VAS) score, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores (including symptom, daily activities, and knee function scores) were compared between the two groups, showing no significant difference ( P>0.05). The operation time and intraoperative blood loss were recorded and compared between the two groups. The effectiveness was evaluated by Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, SSD in posterior tibial translation before operation and at last follow-up, the patient satisfaction at last follow-up, and the postoperative graft recovery was evaluated by MRI. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 12-60 months, and there was no significant difference between the two groups ( P>0.05). Postoperative MRI showed that the graft was in good condition, and the reconstructed PCL graft had good signal, continuity, and tension. During the follow-up, there was no complication such as re-rupture or donor site discomfort in both groups. At last follow-up, the Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, and SSD in posterior tibial translation significantly improved in both groups when compared with those before operation ( P<0.05). The changes of Lysholm score, Tegner score, IKDC knee symptom score, and SSD in posterior tibial translation between pre- and post-operation were significantly superior in the tension relieving suture group compared to the control group ( P<0.05). However, no significant difference was found between the two groups in the changes of VAS score, knee ROM, IKDC daily activities score or knee function score between pre- and post-operation, and the satisfaction score ( P>0.05). Lower tibial tunnel placement combined with internal tension relieving suture PCL reconstruction represents a more effective surgical approach for improving postoperative laxity of PCL and knee function recovery comparing to simple lower tibial tunnel placement PCL reconstruction.

Application of anterior region suture of popliteal hiatus in treatment of discoid lateral meniscus injury with instability in popliteal tendon region

To discuss the application of anterior region suture of the popliteal hiatus (PH) under arthroscopy in the treatment of discoid lateral meniscus (DLM) injury with instability in the popliteal tendon region. The clinical data of 53 patients (56 knees) with DLM injury who met the selection criteria between March 2014 and November 2022 were retrospectively analyzed. There were 15 males and 38 females, aged 8-55 years with an average age of 36.5 years. Fourteen cases had a history of trauma, while the remaining 39 cases had no clear history of trauma. The disease duration ranged from 1 day to 6 years, with an average duration of 15.6 months. According to the Watanabe classification, there were 40 knees of complete type and 16 knees of incomplete type. The preoperative International Knee Documentation Committee (IKDC) knee joint score was 51.2±8.3, the Lysholm score was 59.6±11.2, and the visual analogue scale (VAS) score was 4.7±1.3. After the arthroscopic meniscal plasty, the instability of the popliteal tendon region meniscus was checked by probing traction. Subsequently, the Out-inside technique or a combination of Out-inside and All-inside techniques was used to suture the anterior region of the PH. The stability of the meniscus after suturing was assessed, and if necessary, further suturing using the All-inside technique at the posterior region of the PH, the posterior horn of the meniscus, and using the Out-inside technique at the anterior horn of the meniscus was performed. Postoperative complications were recorded. The effectiveness was evaluated using pre- and post-operative IKDC scores, Lysholm scores, and VAS scores. After operation, knee joint pain, crepitus, and locking disappeared, with McMurray and grinding tests turning negative. All patients were followed up 12-93 months with an average of 57.5 months. There was no complication such as common peroneal nerve injury, deep vein thrombosis of the lower limbs, joint infection, or joint stiffness. At last follow-up, the IKDC knee joint score was 76.7±5.5, the Lysholm score was 94.0±4.1, and the VAS score was 1.1±0.8. The differences compared with preoperative scores were significant ( t=-22.090, P<0.001; t=-23.704, P<0.001; t=19.767, P<0.001). Suturing of the anterior region of the PH is crucial in the treatment of DLM injury with instability in the popliteal tendon region.

Comparison of Primary Repair of the Anterior Cruciate Ligament and Anterolateral Structures to Reconstruction and Lateral Extra-articular Tenodesis at 2-Year Follow-up

Background: Lateral extra-articular procedures have been effective in reducing graft rupture rates after anterior cruciate ligament (ACL) reconstruction (ACLR), but the evidence supporting their role in ACL repair is sparse. Purpose/Hypothesis: The purpose was to compare clinical and radiological outcomes of ACLR and lateral extra-articular tenodesis (LET) (ACLR+LET) against combined repair of the ACL and anterolateral (AL) structures (ACL+AL Repair). It was hypothesized that patients undergoing ACL+AL Repair would have noninferior clinical and radiological outcomes with respect to International Knee Documentation Committee (IKDC) scores, knee laxity parameters, and magnetic resonance imaging (MRI) characteristics. Furthermore, it was hypothesized that patients undergoing repair would have significantly better Forgotten Joint Score–12 (FJS-12) values and shorter times to return to the preinjury level of sport, without any increase in the rate of ipsilateral second ACL injury. Study Design: Cohort study; Level of evidence, 2. Methods: Consecutive patients evaluated with an acute ACL tear were considered for study eligibility. ACLR+LET was only performed when intraoperative tear characteristics contraindicated ACL repair. Patient-reported outcome measures such as the IKDC score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS); reinjury rates; anteroposterior side-to-side laxity difference; and MRI characteristics were reported at a minimum follow-up of 2 years. The noninferiority study was based on the IKDC subjective score; side-to-side anteroposterior laxity difference; and signal-to-noise quotient (SNQ). The noninferiority margins were defined using the existing literature. An a priori sample size calculation was performed using the IKDC subjective score as the primary outcome measure. Results: A total of 100 patients (47 ACLR+LET, 53 ACL+AL Repair) with a mean follow-up of 25.2 months (range, 24-31 months) were enrolled and underwent surgery within 15 days of injury. At the final follow-up, the differences between groups with respect to the IKDC score, anteroposterior side-to-side laxity difference, and SNQ did not exceed noninferiority thresholds. ACL+AL Repair was associated with a shorter time to return to the preinjury level of sport (ACL+AL Repair: mean, 6.4 months; ACLR+LET: mean, 9.5 months; P < .01), better FJS-12 values (ACL+AL Repair: mean, 91.4; ACLR+LET: mean, 97.4; P = .04), and a higher proportion of patients achieving the Patient Acceptable Symptom State (PASS) for the KOOS subdomains studied (Symptoms: 90.2% vs 67.4%, P = .005; Sport and Recreation: 94.1% vs 67.4%, P < .001; Quality of Life: 92.2% vs 73.9%, P = .01). There were no significant differences between groups with respect to ipsilateral second ACL injury rates (ACL+AL Repair group, 3.8% and ACLR+LET group, 2.1% [n = 1]; P = .63). Conclusion: ACL+AL Repair yielded clinical outcomes that were noninferior to (or not significantly different from) ACLR+LET with respect to IKDC subjective, Tegner activity level, and Lysholm scores; knee laxity parameters; graft maturity; and rates of failure and reoperation. However, there were significant advantages of ACL+AL Repair, including a shorter duration of time to return to the preinjury level of sport, better FJS-12 values, and a higher proportion of patients achieving PASS for KOOS subdomains studied (Symptoms, Sport and Recreation, Quality of Life).

Comparison of Functional Outcomes of an Anterior Cruciate Ligament (ACL) Reconstruction Using a Peroneus Longus Graft as an Alternative to the Hamstring Tendon Graft.

Background Ever since the arthroscopic reconstruction of the anterior cruciate ligament (ACL) has begun, the use of the peroneus longus (PL) graft for primary ACL reconstruction (ACLR) has never been thought of. There is very little literature on it. Hence, our study aims to compare the functional outcomes, knee stability, donor site morbidity, and assessment of thigh muscle wasting in patients with ACL injury managed by arthroscopic single bundle reconstruction with peroneus longus tendon (PLT) and hamstring tendons (HT), respectively. Methods All adults aged 16-50 years of either gender presenting with symptoms of symptomatic ACL deficiency were admitted for arthroscopic single-bundle ACLR and allocated into two groups (peroneus longus and hamstring tendon). Functional scores (International Knee Documentation Committee (IKDC), Lysholm score), clinical knee evaluation (anterior drawer, Lachman, and pivot shift test), donor site morbidity (American Orthopedic Foot and Ankle Society ankle hindfoot score (AOFAS)), and thigh circumference were recorded preoperatively and at six months and one year postoperatively. The same post-op rehabilitation protocol was followed in both groups. Results One hundred and ninety-four patients (hamstring n = 96, peroneus n = 98) met the inclusion criteria. There were no significant differences between the preoperative, six-month postoperative, and one-year postoperative scores between the hamstring and peroneus longus groups in the IKDC (p=0.356) and Lysholm knee score (p=0.289). The mean for the AOFAS was 99.05 ± 3.56 and 99.80 ± 0.70 in the PLT and HT groups, respectively, showing no statistical difference, with a significant improvement in thigh muscle wasting among the PLT group at final follow-up (p < 0.001). Conclusion We observed similar knee stability and functional outcomes and no obvious donor site morbidity among both groups. These patients also had better responses to physiotherapy in recovering from their thigh muscle wasting. So, we can recommend that a PL graft can be a safe, viable, and effective option for usual arthroscopic single-bundle ACL reconstruction.

What's New in Sports Medicine.

What's New in Sports Medicine.

Interlinked Hamstrings for Combined Anterolateral and Anterior Cruciate Ligament Reconstruction: A Novel Technique for ALL.

Anterolateral ligament (ALL) reconstruction provides rotational stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. The aim of this study was to assess the outcome of patients who underwent combined ACL and ALL reconstruction with a novel anatomic technique using hamstring tendon autograft and fixed loop suspensory device. From 2016 to 2018, 25 patients who underwent combined reconstruction of ACL and ALL in our Institution were evaluated retrospectively. International Knee Documentation Committee (IKDC) Score, Tegner Lysholm Knee Score, grade of pivot shift was assessed at a final follow-up. Mean follow-up was 31.5months (28-42). Mean IKDC (81.5) and Tegner Lysholm (82.8) Knee Scores improved significantly at a final follow-up, with all knees demonstrating negative pivot shift. All patients had good outcomes at 2years follow-up with no graft failure and with no residual instability. ACL and ALL reconstruction using this technique described for the anterolateral instability of the knee was satisfactory in our patients. This technique is simple, easily reproducible and avoids additional implants for ALL in the tibia. IV.

Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients.

The purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale scores for the operative knee and the rest of the body, Marx Activity Rating Scale, as well as measures of met expectations, improvement, and satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Patients who refilled a postoperative opioid prescription were compared with those who did not, and TMEs were calculated for those who refilled (Refill TMEs). One hundred twenty-nine patients (67%) refilled at least one postoperative opioid prescription. Black race, older age, higher average body mass index (BMI), smoking, greater medical comorbidities, preoperative opioid use, lower income, government insurance, and knee arthroplasty were associated with refilling opioids. Greater Refill TMEs was associated with black or white race, older age, higher average BMI, smoking, greater medical comorbidities, preoperative opioid use, government insurance, and unemployment. Refilling opioids and greater Refill TMEs were associated with worse postoperative scores on most patient-reported outcome measures 2 years after knee surgery. However, refilling opioids and greater Refill TMEs did not have a significant association with improvement after surgery. Multivariable analysis controlling for potential confounding variables confirmed that greater postoperative Refill TMEs independently predicted worse 2-year PROMIS Physical Function, 2-year PROMIS Pain Interference, and 2-year IKDC knee function scores. Postoperative refill of opioids was associated with worse 2-year patient-reported outcomes in a dose-dependent fashion. These findings reinforce the importance of counseling patients regarding opioid use and optimizing opioid-sparing pain management postoperatively.

Measures of Adult Knee Function.

Measures of Adult Knee Function.

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn.

Background:The “killer turn” effect after posterior cruciate ligament (PCL) reconstruction is a problem that can lead to graft laxity or failure. Solutions for this situation are currently lacking.Purpose:To evaluate the clinical outcomes of a modified procedure for PCL reconstruction and quantify the killer turn using 3-dimensional (3D) computed tomography (CT).Study design:Case series; Level of evidence, 4.Methods:A total of 15 patients underwent modified PCL reconstruction with the tibial aperture below the center of the PCL footprint. Next, 2 virtual tibial tunnels with anatomic and proximal tibial apertures were created on 3D CT. All patients were assessed according to the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, side-to-side difference (SSD) in tibial posterior translation using stress radiography, and 3D gait analysis.Results:The modified tibial tunnel showed 2 significantly gentler turns (superior, 109.87° ± 10.12°; inferior, 151.25° ± 9.07°) compared with those reconstructed with anatomic (91.33° ± 7.28°; P < .001 for both comparisons) and proximal (99° ± 7.92°; P = .023 and P < .001, respectively) tibial apertures. The distance from the footprint to the tibial aperture was 16.49 ± 3.73 mm. All patient-reported outcome scores (mean ± SD) improved from pre- to postoperatively: Lysholm score, from 46.4 ± 18.87 to 83.47 ± 10.54 (P < .001); Tegner score, from 2.47 ± 1.85 to 6.07 ± 1.58 (P < .001); IKDC sports activities score, from 19 ± 9.90 to 33.07 ± 5.35 (P < .001); and IKDC knee symptoms score, from 17.87 ± 6.31 to 25.67 ± 3.66 (P < .001). The mean SSD improved from 9.15 ± 2.27 mm preoperatively to 4.20 ± 2.31 mm postoperatively (P < .001). The reconstructed knee showed significantly more adduction (by 1.642°), less flexion (by 1.285°), and more lateral translation (by 0.279 mm) than that of the intact knee (P < .001 for all).Conclusion:Lowering the tibial aperture during PCL reconstruction reduced the killer turn, and the clinical outcomes remained satisfactory. However, SSD and clinical outcomes were similar to those of previously described techniques using an anatomic tibial tunnel.

The clinical efficacy of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint

Objective: To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint. Methods: A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability. Results: The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively (t=46.80, P=0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively(t=10.46, P=0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively (t=24.59, P=0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively(t=18.34, P=0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative(P<0.05). Conclusion: Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study

ObjectivesTo examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a...

Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy.

To compare the radiological bone union rate after medial opening wedge high tibial osteotomy (MOW-HTO) and stabilization using a TomoFix™ plate (Synthes, Oberdorf, Switzerland) in three patient groups. Retrospective analysis of 137 knees that underwent MOW-HTO between January 2014 and January 2017 was using a TomoFix™ plate. Osteotomy gaps were filled with β-tricalcium phosphate (β-TCP) (group A), left unfilled (group B), and subject to autologous bone graft and β-TCP (group C). Radiological bone union using simple radiography was determined by a modified version of the Brosset et al. osteotomy filling index. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Lysholm score. Statistical analyses using the Chi-square and ANOVA tests were performed between the groups. The mean time for radiological bone union was 8.3 ± 3.1 months in group A, 7.2 ± 3.2 in group B and 3.4 ± 1.5 in group C (p = 0.001). There was statistically significant faster bone union in Group C. If the opening distance was more than 10mm, group A united in 8.6 ± 3.6months, group B in 8.8 ± 3.4, and group C in 3.5 ± 1.7 (p = 0.001). IKDC and Lysholm knee scores improved significantly (p = 0.004 for IKDC and 0.001 for Lysholm knee scores) in group C when compared to groups A and B at sixth month follow-up. At final follow-up, there was no difference in IKDC and Lysholm knee scores. Less delayed union occurred in group C. MOW-HTO with autologous bone graft and β-TCP had the fastest radiological bone union and best clinical scores at 6month follow-up. Retrospective comparative study, Level III.

Functional double-bundle anterior cruciate ligament reconstruction using hamstring tendon autografts with preserved insertions is an effective treatment for tibiofemoral instability.

The aim of this study was to introduce a modified anatomical anterior cruciate ligament reconstruction using functional double bundles (F-DBACLR), which achieved sequential tensioning at all flexion angles postoperatively, and compare its clinical outcomes with the anatomical single-bundle technique (A-SBACLR). A total of 156 patients with an ACL injury underwent ACLR (A-SB group, n = 78; F-DB group, n = 78). All operations were performed by anatomically identifying the ACL footprints and fixing the graft at a pre-determined degree of knee flexion. Two observers blinded to the patient identities examined the patients preoperatively and during follow-up (median 28.2months; range 26-31 months). Multiple subjective and objective clinical evaluation tests and assessment of clinical outcomes concerning the translational and rotational stability of the knee including the International Knee Documentation Committee (IKDC) questionnaire, Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, KT-1000 laxity measurements, Lachman test and pivot-shift test were performed preoperatively and postoperatively. Preoperatively, no differences were found between the two groups. During the 2-year observation period, patients in the F-DB group revealed better clinical outcomes in terms of the Tegner Activity Scale Score, IKDC, KOOS and Lysholm Knee Scoring Scale. Similar results were shown in regard to the translational stability in both groups, while the F-DB group had more rotational stability at 2years of follow-up. The clinical outcomes indicated that F-DBACLR is clinically practicable and advantageous in the treatment of the ACL-deficient knee. II.

Graft Choice and the Incidence of Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Causal Analysis From a Cohort of 541 Patients

Background: Anterior cruciate ligament (ACL) reconstruction is important to prevent knee osteoarthritis. Neither of the 2 most common graft techniques—the patellar tendon (PT) or hamstring tendon (HS) graft—has demonstrated superiority in terms of the long-term osteoarthritis rate. Hypothesis: Based on the International Knee Documentation Committee (IKDC) radiographic grading system, PT grafts decrease the incidence of osteoarthritis by providing better knee stability as compared with HS grafts over 12 years of follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: All adults with a first ACL rupture who underwent surgery with a PT or HS graft technique between January 2002 and December 2003 were included in the 2014 French Society of Orthopedic Surgery and Traumatology Symposium database. Baseline characteristics were collected. The primary endpoint was the occurrence of moderate to severe osteoarthritis in each group. The secondary endpoints included clinical subjective evaluations by the IKDC score and Knee injury and Osteoarthritis Outcome Score. To control the differences in baseline characteristics, the data were analyzed with propensity score matching. Results: In the cohort, 541 patients from 18 centers were included: 311 PT and 230 HS ACL reconstructions. The baseline characteristics were similar after inverse probability weighting treatment (IPWT). The occurrence of osteoarthritis was similar after IPWT (19.3% for PT and 19.6% for HS, P = .94). Age at surgery >29 years and IKDC osteoarthritis stage B at the index surgery were identified as risk factors for moderate to severe osteoarthritis. Most functional outcomes were significantly higher in the HS group; however, the difference between groups remained <10 points. Of the 106 patients who needed a medial meniscectomy, the proportion of patients with moderate to severe osteoarthritis was much higher in the HS group (43.5% vs 18.3%, P = .006). However, after IPWT, the difference was not statistically significant. Conclusion: At 12 years of follow-up, neither graft technique was superior to the other in terms of the rate of osteoarthritis.

Comparison of KD3-M and KD3-L Multiligamentous Knee Injuries and Analysis of Predictive Factors That Influence the Outcomes of Single-Stage Reconstruction in KD3 Injuries.

Background:The knee dislocation–3 (KD3) injury pattern is the most common form of multiligamentous injury. Medial KD3 (KD3-M) and lateral KD3 (KD3-L) are 2 anatomically different varieties of this injury.Purpose:To compare the surgical outcomes of KD3-M and KD3-L multiligamentous knee injury patterns and to determine the factors that could influence the outcomes after single-stage reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:A cohort of 45 patients with multiligamentous knee injuries (31 KD3-M, 14 KD3-L) who were operated on between 2011 and 2015 were compared. The cruciate ligaments were reconstructed, and the collateral ligaments were managed either conservatively or surgically depending on intraoperative laxity, tissue condition, injury site, and chronicity. The mean follow-up was 36 months (range, 24-72 months). The International Knee Documentation Committee (IKDC) score, Lysholm score, knee flexion range of motion (ROM), and laxity on stress radiographs were compared. Various factors likely to influence the outcomes were also analyzed.Results:The mean IKDC score, Lysholm score, and knee flexion ROM for the 45 patients were 74.74, 87.66, and 126.78°, respectively. There was no significant difference between the KD3-M and KD3-L groups in terms of the postoperative IKDC score (P = .768), Lysholm score (P = .689), knee flexion ROM (P = .798), and laxity on stress radiographs (P = .011). Patients with a transient dislocation had better outcomes (76.51, 89.41, and 128.61°, respectively) than those with a frank dislocation (67.62, 80.66, and 119.44°) (P = .037, .007, and .043). The acute group had better outcomes (77.00, 89.51, and 127.86°) when compared with the subacute (66.26, 86.00, and 121.00°) and chronic groups (67.40, 76.40, and 125.00°) (P = .045, .006, and .486). Regression analysis showed the influence of these factors on outcomes. The presence or absence of dislocations, time frame in which surgery was performed, and follow-up duration were found to influence the outcome. All other factors had no bearing on outcomes. Two patients had knee stiffness and underwent arthrolysis.Conclusion:Despite anatomic and biomechanical differences between KD3-M and KD3-L injuries, single-stage management did not produce any significant difference in results. The presence of a frank dislocation, delay in surgery, and duration of follow-up were found to influence outcomes.

Arthroscopic treatment of displaced tibial eminence fractures using wire loop technique

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. We conducted a study to analyze the results of arthroscopic assisted wire loop technique for treatment of tibial spine avulsion in adults and pediatric patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; From June 2011 to December 2016, 52 patients with tibial spine fractures were surgically treated with arthroscopic reduction and wire loop fixation. Forty-four patients were adults and eight were in their pediatric age group. The age group ranged from 9 years to 52 years with the mean age of 26.2 years. 28 patients were type 2 and 24 were of type 3 fracture as classified by Myeres and Mckeever’s classification. The final analysis was done using clinical tests, radiological evaluation and International Knee Documentation Committee (IKDC) and Lysholm score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At final follow-up, the mean IKDC and Lysholm knee scores were, 92 and 93 respectively. All patients had a complete functional recovery and were able to return to work and to resume their activities.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Arthroscopic wire loop fixation is an excellent method for tibial eminence fracture in adults and children which gives excellent results in form of control tension on ACL on each side of avulsed fragment and also gives adequate mechanical strength for early rehabilitation.&lt;/p&gt;

Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions: Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.

Clinical efficacy of multiple prevention measures against infection following anterior cruciate ligament reconstruction

Background: A postoperative infection is one serious complication of an anterior cruciate ligament (ACL) reconstruction. Multiple infection prevention measures have been used before and after surgery, and their clinical efficacy was evaluated in this study. Methods: This study enrolled 54 patients admitted to our hospital from January 2015 to June 2017 who underwent arthroscopic ACL reconstructions with hamstring tendons. One day before the surgery, the bilateral thighs and skin were washed using a potassium permanganate solution before and after bathing, separately. Aseptic surgical films containing iodine and disposable arthroscopic waterproof sterile drapes were used in the surgery. In addition, all the instruments used during the tendon transplantation were soaked and rinsed in a saline solution containing vancomycin. The Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) knee evaluation, and Tegner Activity Scale were administered before the surgery, 3 and 6 months after the surgery, and at the last follow-up. The averages of the scores at different stages were calculated. All the patients received a magnetic resonance imaging examination 3 months after the surgery. Results: The patients were followed-up for 6 to 18 months (average = 10±1.4), and no infections or other complications were found among them. When compared with the preoperative scores, the Lysholm score, IKDC knee evaluation score, and Tegner score were all significantly increased after the operation. Conclusion: With multiple prevention measures adopted, no postoperative infections occurred in the patients, and the knee function recovered well. This suggests the success of the anti-infective therapy following the ACL reconstructions.

Results of Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts: Objective Factors Associated With the Development of Osteoarthritis at 20 to 33 Years After Surgery

Background: Few studies exist that report objective radiographic and physical examination results at >20 years after anterior cruciate ligament (ACL) reconstruction. Hypothesis: The risk of osteoarthritis (OA) at >20 years after surgery would be statistically significantly higher if an increased severity of factors was present. Study Design: Cohort study; Level of evidence, 2. Methods: Between 1982 and 1994, 1428 knees met the inclusion criteria of being primary ACL surgery, having no existing OA or other ligamentous laxity, and having no known graft tear. Prospective data analyzed included demographics; meniscus and articular cartilage status; ratings of bilateral standing posteroanterior weightbearing, lateral, and Merchant view radiographs; KT-1000 arthrometer measurements; and range of motion measurements. Radiographs were graded for joint space narrowing, sclerosis, and osteophytes according to International Knee Documentation Committee (IKDC) criteria. Multivariate and univariate logistic models were used to determine the effect of potential predictors on the odds of having radiographic evidence of OA. IKDC and Cincinnati Knee Rating System (CKRS) subjective surveys were conducted. Results: A minimum 20-year objective follow-up was obtained for 423 knees at a mean of 22.5 ± 2.1 years postoperatively. If a patient lacked normal extension or flexion at discharge, the odds of lacking normal extension or flexion at follow-up were 19.7 and 7.97, respectively (P < .001). Radiographic ratings were normal for 35.2%, nearly normal for 36.2%, abnormal for 20.1%, and severely abnormal for 8.5%. Multivariate analysis showed that the predictive factors for the presence of OA in the long-term were medial meniscectomy, older age at surgery, and less than normal knee extension at discharge. The odds ratios for statistically significant factors for the presence of any OA at follow-up were 2.02 for knee extension loss at discharge, 2.98 for medial meniscectomy, 1.65 for lateral meniscectomy, 1.06 for age at follow-up, 1.62 for chronic injury type, and 2.17 for articular cartilage damage. The IKDC and CKRS subjective scores were progressively and statistically significantly lower as the level of OA was greater. Conclusion: The prevalence rate of developing moderate to severe OA at >20 years after ACL reconstruction was 28.6%. Significant factors predictive of OA in the long-term were older age at surgery, medial meniscectomy, and knee extension loss.

Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation.

Background:Avulsion fractures of the tibial intercondylar eminence are fairly common injuries requiring surgery for the optimal functional outcome. The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory device.Material and Methods:Five patients with type 2 and 3 displaced tibial intercondylar eminence fractures who received an arthroscopically assisted fixation using a double button device were enrolled from 2011 to 2012. Clinical assessment included the patient demographics, cause of injury, the delay before surgery, time for surgery, time to return to work and sport, the International Knee Documentation Committee (IKDC) and Lysholm knee scores. Stability was measured with the KT-2000 arthrometer with a force of 134 N. A side to side difference on the KT-2000 examination superior to 3 mm was considered as a significant and abnormal increase in the anterior translation. Radiological examination consisted of anteroposterior and lateral radiographs, as well as computed tomography (CT) scan of the affected knee. Clinical and radiological followup was done at 1, 2, 3, 6, and 12 months postoperatively and at final followup. CT-scan was performed before surgery and at 3 months followup.Results:The median age of patients was 31 years. Mean followup was 27 ± 5.1 months. The average delay before surgery was 3 days. At final followup, the mean IKDC and Lysholm knee scores were, 93.9 and 94.5 respectively. All patients had a complete functional recovery and were able to return to work and to resume their sport activities. No secondary surgeries were required to remove hardware. No complication was noted. Bony union was achieved in all patients.Conclusion:The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.