Knee Conditions Research Articles

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

CORR Synthesis: Can Guided Growth for Angular Deformity Correction Be Applied to Management of Pediatric Patellofemoral Instability?

Autogenous Osteochondral Grafting for Treatment of Knee Osteochondritis Dissecans: A Case Series Study.

Although some surgical techniques have been described for the operative treatment of unstable Osteochondritis dissecans (OCD) of the knee, outcomes are variable and are not satisfying totally. The aim of the present study is to evaluate the outcomes of autogenous osteochondral grafting for OCD of the knee. In a case series study, from June 2014 to July 2015, 16 patients with stage II-IV OCD (International Cartilage Repair Society (ICRS)) of the femoral condyle were investigated. Surgical intervention considered in cases of stage III (4 cases) and IV (2 cases) and in stage II (10 cases) ones that were nonresponsive to conservative treatment. At the initial and final visits, the IKDC, Lysholm score and Tegner activity scale were evaluated. The mean preoperative IKDC score (53.4) increased significantly following surgery (84.3) (P<0.001). Based on the IKDC grading system, before the operation, the knee status was graded as nearly normal, abnormal, and severely abnormal in 4, 10, and 2 patients, respectively. At final post-surgical follow up, 15 normal and 1 abnormal knee were documented (P<0.001). The mean Lysholm score increased from 44.3 per operatively to 86.3 (P<0.001).Tegner activity score improved from 2.8±1 pre operatively to 5.6±2 (P<0.001). Surgical treatment of unstable OCD using autogenous osteochondral graft shows successful outcomes. In addition to reliable fixation, it can enhance healing and convert an uncontained lesion to contained one appropriate for autogenous osteochondral grafting with healthy cartilage.

Effect of fall characteristics on the severity of hip impact during a fall on the ground from standing height.

We determined the magnitude of hip impact force that humans may experience in the event of a fall from standing height on the ground, in order to examine how the hip impact force was affected by characteristics of a fall. Twenty subjects mimicked a typical older adults' falls on a mat. Trials were acquired with three initial fall directions: forward, sideways, and backward. Trials were also acquired with three knee positions at the time of hip impact: knee together, knee on the mat, and free knee. During falls, attenuated vertical hip impact forces and corresponding depression of the mat were measured via a force plate placed under the mat and motion capture system, respectively. Using a mass-spring model, actual hip impact force and body stiffness during a fall on the ground were estimated. Hip impact force averaged 4.0kN (SD = 1.7). The hip impact force was associated with knee condition (F = 25.6, p < 0.005), but not with fall direction (F = 0.4, p = 0.599). Compared with "knee on the mat," hip impact force averaged 59% and 45% greater in "free knee" and "knee together," respectively (4.6 versus 2.9kN, p < 0.005; 4.3 versus 2.9kN, p < 0.005). However, the hip impact force did not differ between "free knee" and "knee together (4.6 versus 4.3kN, p = 0.554). Our results suggest that hip fracture risk during a fall decreases substantially, depending on how they land on the ground, informing the development of safe landing strategies to prevent fall-related hip fractures in older adults.

Lower Extremity Biomechanics During a Drop-Vertical Jump and Muscle Strength in Women With Patellofemoral Pain

Patellofemoral pain (PFP) is one of the most prevalent knee conditions observed in women. Current research suggests that individuals with PFP have altered muscle activity, kinematics, and kinetics during functional tasks. However, few authors have examined differences in lower extremity biomechanics in this population during the drop-vertical jump (DVJ). To determine how lower extremity electromyography, kinematics, and kinetics during a DVJ and lower extremity isometric strength differed between women with and those without PFP. Cross-sectional study. Laboratory. Fifteen healthy women (age = 20.23 ± 1.39 years, height = 169.32 ± 5.38 cm, mass = 67.73 ± 9.57 kg) and 15 women with PFP (age = 22.33 ± 3.49 years, height = 166.42 ± 6.01 cm, mass = 65.67 ± 13.75 kg). Three trials of a DVJ. Surface electromyography, kinematics, and kinetics were collected simultaneously during a DVJ. Lower extremity strength was measured isometrically. Independent-samples t tests were performed to assess group differences. Normalized muscle activity in the vastus medialis (healthy group = 120.84 ± 80.73, PFP group = 235.84 ± 152.29), gluteus maximus (healthy group = 43.81 ± 65.63, PFP group = 13.37 ± 13.55), and biceps femoris (healthy group = 36.68 ± 62.71, PFP group = 11.04 ± 8.9) during the landing phase of the DVJ differed between groups. Compared with healthy women, those with PFP completed the DVJ with greater hip internal-rotation moment (0.04 ± 0.28 N/kg versus 0.06 ± 0.14 N/kg, respectively) and had decreased knee-flexion excursion (76.76° ± 7.50° versus PFP = 74.14° ± 19.85°, respectively); they took less time to reach peak trunk flexion (0.19 ± 0.01 seconds versus 0.19 ± 0.02 seconds, respectively) and lateral trunk flexion (0.12 ± 0.07 seconds versus 0.11 ± 0.04 seconds, respectively). During the DVJ, women with PFP had increased hip internal-rotation moment and decreased knee-flexion excursion with less time to peak trunk flexion and lateral flexion. Muscle activation was increased in the vastus medialis but decreased in the gluteus maximus and biceps femoris. This suggests that altered motor-unit recruitment in the hip and thigh may result in changes in biomechanics during a DVJ that are often associated with an increased risk of injury.

Towards improving the identification of anterior cruciate ligament tears in primary point-of-care settings

BackgroundOnly a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool.MethodsElectronic medical records (EMRs) of individuals aged 15–45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL+) or denied (ACL−) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys (n = 17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI).ResultsOf 1512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15–45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated (Lachman test result) variables were superior for ACL tear diagnosis [accuracy; 0.95 (90,98), sensitivity; 0.97 (0.88,0.98), specificity; 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy; 84% (77,89), sensitivity; 0.60 (0.44,0.74), specificity; 0.95 (0.89,0.98)].ConclusionsA high proportion of individuals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.

Knee Joint and Quadriceps Dysfunction in Individuals With Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Meniscus Surgery: A Cross-Sectional Study.

While arthrogenous muscle inhibition associated with knee injuries is evident, the relative magnitude of functional deficiency related to each individual knee pathology is unclear. To compare the knee joint and quadriceps dysfunction among patients with anterior knee pain (AKP) without surgical history and those with surgical history (anterior cruciate ligament reconstruction [ACLR]; meniscus surgery) without current AKP, with matched healthy controls. Cross-sectional study. Laboratory. A total of 66 patients with knee pathologies and 30 controls. Pain perception and lower-extremity functional outcomes were assessed. Knee joint function was measured by replication tests. Quadriceps function was measured by strength, voluntary activation, and torque-generating capacity. Patients with AKP reported greater pain perception compared with the other knee conditions (4.3 vs 0.1 of 10 in Numeric Pain Rating Scale, P < .0001). Compared with the controls: (1)patients with AKP showed a greater error on knee-flexion replications at 75° (2.9° vs 5.4°, P = .002), (2)patients with AKP and ACLR showed less quadriceps strength (AKP: 3.3 vs 2.6N·m/kg, P = .002; ACLR: 3.3 vs 2.7N·m/kg, P = .02) and voluntary activation (AKP: 0.982 vs 0.928, P < .0001; ACLR: 0.982 vs 0.946, P = .003), and (3)all knee pathologies reported lower scores on functional outcomes (79 vs 65 of 80 points in Lower-Extremity Functional Scale, P < .0001) and showed less quadriceps torque-generating capacity (10.7 vs 7.8N·m/s/kg, P < .0001). Among the knee pathologies, patients with AKP showed less quadriceps voluntary activation compared with the patients with meniscus surgery (0.928 vs 0.964, P = .03). As patients with AKP had an additional impairment in knee joint flexion replications and reported a less score in functional outcomes, knee pain may produce a greater impact on functional deficiency.

Quantitative Evaluation of Dynamic Lateral Meniscal Extrusion After Radial Tear Repair

Background:Radial tears of the lateral meniscus frequently accompany acute anterior cruciate ligament (ACL) injuries and lead to increased joint stress and pathological meniscal extrusion (ME). The dynamic behavior of the lateral meniscus after radial tear repair with respect to ME has not been described.Purpose:To quantitatively assess dynamic lateral ME after all-inside radial tear repair.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent ACL reconstruction and all-inside radial tear repair of the lateral meniscus and had no history of contralateral knee injuries were included. Magnetic resonance imaging scans were acquired in loaded (50% of body weight) and unloaded conditions of both the injured and noninjured knees. A custom-made pneumatically driven knee brace was used for standardized knee positioning in 10° of flexion and with axial load application. Quantitative measures included the absolute lateral ME, meniscal body extrusion ratio, and Δ extrusion. Preoperative and postoperative unloaded extrusion data were compared by paired t tests. For postoperative data, the concomitant influence of the factors “leg” and “condition” were assessed through factorial analyses of variance.Results:A total of 10 patients with a mean follow-up of 47.9 months were enrolled. The intraclass correlation coefficient (ICC) confirmed good interrater reliability (ICC, 0.898) and excellent intrarater reliability (ICC, 0.976). In the unloaded injured leg, all-inside repair reduced ME from 3.15 ± 1.07 mm to 2.13 ± 0.61 mm (–32.4%; P = .033). Overall, load application led to a significant increase in ME (+0.34 mm [+21.8%]; P = .029). Significantly greater ME was observed in the injured knee (+1.10 mm [+93.2%]; P = .001) than in the noninjured knee. The condition × leg interaction was not significant (P = .795), suggesting that the compression-associated increase in ME did not differ significantly between the injured and noninjured knees.Conclusion:Lateral ME depends on the knee status and loading condition. All-inside repair of radial meniscal tears led to a reduction of extrusion with no alteration in dynamic lateral ME. Meniscus-preserving therapy is recommended in the case of a radial lateral meniscal tear to preserve its dynamic behavior.

KINESIOPHOBIA IS RELATED TO BRAIN ACTIVITY FOR KNEE MOTOR CONTROL IN PEDIATRIC PATIENTS WITH PATELLOFEMORAL PAIN

Background:Patellofemoral pain (PFP) is a chronic knee condition that affects over 1 in 4 physically-active girls. PFP symptomology contributes to dysfunctional motor control and heightened kinesiophobia (i.e., fear of pain/movement). Both chronic pain and kinesiophobia induce substantial changes throughout the central nervous system (CNS) in many populations who experience pain (e.g., low back pain), but such relationships have not been explored in pediatric patients with PFP. As current treatment approaches for PFP generally fail to provide complete symptom mitigation, identifying the mechanisms by which kinesiophobia exacerbate PFP and disrupt the CNS could provide mechanistic neural pathways to guide novel, brain-based treatments for pain relief.Hypothesis/Purpose:The purpose of this study was to determine the relationship between kinesiophobia and brain functional activation during a knee motor control task in pediatric patients with PFP.Methods:Girls clinically diagnosed with PFP (n = 15; 14.3 ± 3.2 yrs) were positioned supine in a 3 Tesla magnetic resonance imaging (MRI) scanner and completed a series of unilateral 45° knee extension/flexion movements during functional MRI (fMRI). Patients completed this open kinetic chain movement at a frequency of 1.2 Hz (Figure 1.1). Patients also completed the Tampa Scale of Kinesiophobia (TSK; scores range from 0 – 68, with scores greater than 37 indicating high kinesiophobia). Correlation analyses were performed to determine whether kinesiophobia was associated with brain activity during the motor task. Statistical corrections were made to account for multiple, voxel-wise comparisons.Results:Study patients exhibited high kinesiophobia, with a mean TSK score of 38.27 (SD = 5.79). Neuroimaging analyses revealed that greater kinesiophobia was directly associated with increased brain activity in a cluster located within the occipital pole/cuneus, supracalcarine cortex, and intracalcarine cortex (p < .001, z-max = 4.30; Figure 1).Conclusion:The results revealed that the degree of kinesiophobia was related to the magnitude of visual-related brain activity for knee motor control. As perceived fear of movement increases, patients with PFP may recruit additional visual resources to compensate for pain-disrupted somatosensory processing. Future interventions that promote sensorimotor engagement and reduce visual feedback for motor control (i.e., dynamic movements with occluded vision) may be beneficial to reorganize neural processes, decrease kinesiophobia, and restore an active lifestyle in young girls with PFP.Tables/Figures:Figure 1. Left: participant demonstrating the knee flexion/extension movement. Right: Greater kinesiophobia was associated with increased visual-related brain activity (yellow/orange clusters) during the open kinetic chain movement for patients with PFP.

Knee or Spine Surgery First? A Survey of Treatment Order for Patients With Concurrent Degenerative Knee and Lumbar Spinal Disorders

BackgroundTotal knee arthroplasty (TKA) and lumbar spine surgery have been reported to affect the outcomes of each other. There is insufficient evidence to guide the choice of treatment order for patients with both disorders that are equally symptomatic. MethodsFive clinical scenarios of concurrent, advanced, degenerative knee and lumbar spinal disorders were designed to survey surgeons’ choices of treatment order and rationale. The spinal disorder was consistently degenerative lumbar spinal stenosis, but the knee conditions varied to include (1) osteoarthritis (OA) with varus deformity, (2) OA with valgus deformity, (3) rheumatoid arthritis with a severe flexion contracture, (4) OA without deformity, and (5) bilateral OA with windswept deformities. The survey was distributed to selected clinical members of the Knee Society and Scoliosis Research Society in North America. The surgeons’ choices were compared among the 5 scenarios, and their comments were analyzed using text-mining. ResultsResponses were received from 42 of 74 (57%) knee arthroplasty surgeons and 55 of 100 (55%) spine surgeons. The percentages of knee arthroplasty surgeons recommending “TKA first” differed significantly among scenarios: 29%, 79%, 55%, 7%, and 81% for scenarios 1 through 5, respectively (P < .001). A similar pattern was noted for the spine surgeons. ConclusionFor patients with concurrent degenerative knee and lumbar spinal disorders, the severity and type of knee deformity influenced the preference of treatment order in both specialties. Severe valgus deformity and windswept deformities of the knee would drive the decision toward “TKA first.”

Osgood-Schlatter disease: a 2020 update of a common knee condition in children.

Osgood-Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children and adolescents resulting from a traction apophysitis of the tibial tubercle. While a peak in boys aged 12-15 years old was well documented, there seems to be no difference in sex distribution nowadays. This may result from increased participation of young females in high-impact sports. This review provides an up-to-date account on contemporary prophylaxis as well as diagnostic and therapeutic approaches. Numerous studies have examined risk factors for OSD. These include body weight, muscle tightness, muscle weakness during knee extension and flexibility of hamstring muscles. In particular, shortening of the rectus femoris may substantially alter biomechanical functions of the knee. Conservative management remains successful in over 90% of patients. However, if disabling symptoms and pain persistent after physeal closure, operative treatment may be necessary. OSD is a mostly self-limiting apophysitis of the tibial tubercle and the adjacent patella tendon in young active patients with open physis. Prevention strategies include quadriceps and hamstring stretching and therefore should be implemented in everyday practice routines for children who partake in regular sports activities.

An Analysis of Current Treatment Trends in Platelet-Rich Plasma Therapy in the Medicare Database.

Background:The use of platelet-rich plasma (PRP) in the Medicare population is not well described.Purpose:To investigate the national use of PRP among Medicare beneficiaries, including the incidence and conditions for which it was used in both operative and nonoperative settings, and determine charges to Medicare.Study Design:Descriptive epidemiology study.Methods:The Medicare Standard Analytical Files within the PearlDiver database were queried for PRP injections by use of Current Procedural Terminology (CPT) code 0232T from 2010 to 2014. A search of every associated International Classification of Diseases, 9th Revision, code and CPT code on the day of the injection was performed, and codes were broadly categorized as shoulder, knee, elbow, hip, and foot/ankle. These categories were then subdivided into 2 groups based on whether the injection was performed at the time of surgery or for a nonoperative condition. The patient data were analyzed by demographics and geographic region. In further analysis, the charges sent to Medicare for PRP injections were stratified by year and musculoskeletal site.Results:A total of 3654 PRP injections were coded for and administered during the study period; 57% of recipients were men and 33% were 65 to 69 years of age. We found that 42% of all PRP injections were administered in the southern geographic region. PRP injections were most commonly associated with shoulder diagnoses, followed closely by the foot and ankle and by the knee. The majority of injections given for shoulder conditions were performed at the time of surgery, whereas the majority of knee conditions treated with PRP were associated with nonoperative treatments. Annual charges to Medicare for PRP injections increased 400%, from $500,000 in 2010 to more than $2 million in 2014.Conclusion:The use and breadth of PRP therapy have increased substantially in Medicare beneficiaries. Further research is required to obtain a consensus on treatment recommendations for PRP use in this population in addition to strategies to obtain insurance reimbursement.

Gender and Ethnic Differences in Seeking Healthcare Plus Time of Recovery from Procedures for Shoulder and Knee Conditions

Gender and Ethnic Differences in Seeking Healthcare Plus Time of Recovery from Procedures for Shoulder and Knee Conditions

Tensor Fascia Latae Muscle Structure and Activation in Individuals With Lower Limb Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

Dysfunction of the tensor fascia latae (TFL) muscle is often clinically implicated in many musculoskeletal disorders. To systematically review the literature of the TFL muscle to determine whether there are differences in its structure and activation between individuals with and without lower limb musculoskeletal conditions. A comprehensive search in MEDLINE, EMBASE, CINHAL, and LILACS was undertaken from year of inception to 9 July 2019. Studies that directly investigated the structure or activity of the TFL muscle between individuals with a lower limb musculoskeletal condition and a pain-free control group. Seventeen studies were included (n = 556 participants), eight reporting structure and ten activation of the TFL muscle. Conditions included lateral hip pain, hip joint pathology, ACL injury, iliotibial band syndrome, and patellofemoral joint osteoarthritis. Meta-analysis identified with low confidence (p value = 0.07) a small tendency towards hypertrophy in the affected side of participants with hip joint diseases (SMD 0.37, 95% CI [- 0.02, 0.77]). Moderate effect sizes were found for a higher cross-sectional area of the TFL/sartorius ratio in abductor tendon tear (SMD 0.74; 95% CI [0.05, 1.43, p value = 0.04), and for a smaller body mass normalized TFL volume in patellofemoral joint osteoarthritis (SMD - 0.61; 95% CI [- 1.23, 0.00], p value = 0.05). Normalised electromyography(EMG) amplitude did not differ between groups for any condition, but when EMG was analysed as linear envelopes or synergies, some differences in pattern of TFL activation were observed between individuals with lateral hip pain and controls. Timing of TFL activation did not differ between individuals with knee conditions and controls. Common clinical assumptions of the role of TFL muscle in lower limb musculoskeletal conditions are not well investigated and poorly supported by current research. There are contradictory findings on the muscle size of TFL. Differing methodology in muscle activation studies precludes a clear interpretation for comparison between groups. CRD42017076160.

Quality of life, function and disability in individuals with chronic ankle symptoms: a cross-sectional online survey

BackgroundChronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL.MethodIndividuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history.ResultsA total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm− 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001).ConclusionIndividuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.

Total knee replacement without patellar resurfacing: about 60 cases

Lors de la mise en place d’une prothèse totale du genou (PTG), une des principales problématiques de la technique chirurgicale est le choix à faire entre la conservation de la patella ou son resurfaçage avec remplacement du cartilage patellaire par une prothèse. Cette problématique continue à faire l’objet d’une controverse au sein de la communauté orthopédique. Il n'y a pas de consensus clair sur la gestion optimale de la rotule pendant arthroplastie totale du genou (PTG). Ce travail est une étude rétrospective concernant 60 arthroplasties totales du genou sans resurfaçage de la rotule, implantées au Service de Chirurgie Traumatologique et Orthopédique (B) du CHU Hassan II de Fès, depuis janvier 2009 à décembre 2015. L’âge moyen de nos patients était de 58 ans avec des extrêmes allant de 20 ans à 80 ans. La prédominance féminine est nette avec 41 femmes soit (72%) et 16 hommes soit (28%). Cliniquement, nos malades se plaignaient de douleurs de type mécanique dans la majorité des cas et tous nos patients ont bénéficié d’un examen clinique et radiologique. Le score IKS a été utilisé pour évaluer l’état du genou avant et après l’intervention. L’acte opératoire a consisté en une arthroplastie totale du genou par prothèse totale du genou sans resurfaçage de la rotule. Les complications post-opératoires étaient marquées par 7 cas de douleur antérieur de genou, 2 cas d’infections cutanées superficielles traitées par une antibiothérapie adéquate et 3 cas de raideur. Aucun cas d’hématome ou de phlébite ou de sepsis n’a été signalé. Les résultats cliniques après un recul de 18 mois ont été satisfaisants. À la lumière de ces résultats, la conservation de la patella a permis d’obtenir des résultats très satisfaisants à moyen terme concernant la douleur et la fonction. De plus, les complications potentielles des prothèses patellaires ont été évitées. Une seule contrainte demeure concernant l’avenir de ces prothèses implantées sans resurfaçage est l’apparition ou parfois la persistance de la douleur antérieur du genou d’où la nécessité d’un resurfaçage secondaire.

KLOSURE: Closing in on open\u2013ended patient questionnaires with text mining

BackgroundKnee injury and Osteoarthritis Outcome Score (KOOS) is an instrument used to quantify patients’ perceptions about their knee condition and associated problems. It is administered as a 42-item closed-ended questionnaire in which patients are asked to self-assess five outcomes: pain, other symptoms, activities of daily living, sport and recreation activities, and quality of life. We developed KLOG as a 10-item open-ended version of the KOOS questionnaire in an attempt to obtain deeper insight into patients’ opinions including their unmet needs. However, the open–ended nature of the questionnaire incurs analytical overhead associated with the interpretation of responses. The goal of this study was to automate such analysis. We implemented KLOSURE as a system for mining free–text responses to the KLOG questionnaire. It consists of two subsystems, one concerned with feature extraction and the other one concerned with classification of feature vectors. Feature extraction is performed by a set of four modules whose main functionalities are linguistic pre-processing, sentiment analysis, named entity recognition and lexicon lookup respectively. Outputs produced by each module are combined into feature vectors. The structure of feature vectors will vary across the KLOG questions. Finally, Weka, a machine learning workbench, was used for classification of feature vectors.ResultsThe precision of the system varied between 62.8 and 95.3%, whereas the recall varied from 58.3 to 87.6% across the 10 questions. The overall performance in terms of F–measure varied between 59.0 and 91.3% with an average of 74.4% and a standard deviation of 8.8.ConclusionsWe demonstrated the feasibility of mining open-ended patient questionnaires. By automatically mapping free text answers onto a Likert scale, we can effectively measure the progress of rehabilitation over time. In comparison to traditional closed-ended questionnaires, our approach offers much richer information that can be utilised to support clinical decision making. In conclusion, we demonstrated how text mining can be used to combine the benefits of qualitative and quantitative analysis of patient experiences.

Systematic Review of Modular Bicompartmental Knee Arthroplasty for Medio-Patellofemoral Osteoarthritis

BackgroundWe aimed to locate, appraise, and synthesize the available literature to assess the functional outcome of modular bicompartmental knee arthroplasty (BKA) compared to total knee arthroplasty (TKA) for medio-patellofemoral osteoarthritis. MethodsAfter an extensive literature search based on electronic databases such as MEDLINE, EMBASE, CINAHL, and PubMed, and grey literature, 9 articles satisfied our selection criteria which included 1 randomized controlled trial, 1 prospective cohort, 3 retrospective cohort, and 4 case series. Narrative synthesis was performed due to clinical, methodological, and statistical heterogeneity among the included studies. ResultsThere were 331 participants (341 knees) in this systematic review. BKA group included 229 patients (239 knees) and TKA group included 102 patients (102 knees). The quality of included studies ranged from moderate to very low as per GRADE (grading of recommendations, assessment, development, and evaluation working group) score with low to high risk of bias. Most of the studies showed comparable functional outcome in BKA compared to TKA such as Knee Society Score, Knee Osteoarthritis and Outcome Score, Short Form-36 score, and revision surgery in short-term to midterm follow-up. BKA patients achieved better range of movement and forgotten knee status than TKA patients. It resulted in longer operative time, but less intraoperative blood loss. Long-term series showed 95.1% survivorship of BKA at 5 years and 58% at 17 years. ConclusionCurrent evidence suggests that modular BKA provides comparable functional outcome to TKA at short-term to midterm follow-up, however, with poor long-term survivorship.

Medial Wedge Opening High Tibial Osteotomy with an Extra Screw Fixation

AbstractMedial wedge opening high tibial osteotomy (MWOHTO) is effective for managing a variety of knee conditions, varus malalignment of the knee, either secondary to osteoarthritis or residual adolescent tibia vara, are among the indications, fixation may be done using different methods (Stables, T-plate, Budu plate, and TomoFix). We are describing our technique of performing (MWOHTO) fixed with titanium T plate supplemented with an extra screw from the lateral side which we call “extra-focal” screw to obtain biplanar fixation which may add to the rotational stability at the osteotomy site.

Influence of Medial Meniscus Bucket-Handle Repair in Setting of Anterior Cruciate Ligament Reconstruction on Tibiofemoral Contact Mechanics: A Biomechanical Study

To compare the impact of an inside-out repair versus meniscectomy of a medial meniscus bucket-handle tear in restoring native contact areas and pressures across the tibial plateaus in the setting of an anterior cruciate ligament (ACL) reconstruction (ACLR). Ten fresh-frozen cadaveric knees were tested in 6 knee conditions (1: intact; 2: ACL torn and bucket-handle tear of medial meniscus, flipped; 3: bucket-handle tear of medial meniscus, reduced; 4: bucket-handle tear of medial meniscus, repaired via inside-out vertical mattress suture technique; 5: ACLR with bone patella tendon bone autograft and bucket-handle repair; 6: ACLR and medial meniscus bucket-handle tear debridement) at 4 flexion angles (0°, 30°, 45°, and 60°), under a 1,000-N axial load. Contact area and pressure were measured with Tekscan sensors. ACLR with a concurrent medial meniscectomy for a medial meniscus bucket-handle tear resulted in significantly decreased contact area (P < .05) and increased mean and peak pressure in both the medial and lateral compartments across all tested flexion angles (P < .05). The ACLR with medial meniscectomy state also demonstrated significantly lower contact area than the bucket-handle repair state between 30° and 60° of flexion (all P < .05). Resection of a bucket-handle medial meniscus tear concurrent with an ACLR resulted in significant increases in mean and peak contact pressures in not only the medial but also the lateral compartment. Preservation of the medial meniscus in the face of a bucket-handle tear is essential to more closely restore native tibiofemoral biomechanics. The increased mean and peak tibiofemoral contact pressure seen with excision of a bucket-handle medial meniscus tear would over time result in increased cartilaginous degradation and resultant osteoarthritis. Decreasing both of these factors through concomitant ACLR and inside-out bucket-handle meniscal repairs should improve patient outcomes by restoring knee biomechanics and kinematics closer to that of the native state.

Kinematics and muscle forces in women with patellofemoral pain during the propulsion phase of the single leg triple hop test

BackgroundApproximately 25% of orthopedic knee conditions are related to patellofemoral pain (PFP), with young women being the most affected. It is thought that this condition is associated with modifications in the kinematics and muscle control patterns of the lower limb during weight-bearing support activities, which increases femur movement under the patella. ObjectivesTo compare kinematics and muscle induced acceleration patterns between PFP subjects and healthy controls during the preparation phase of the single leg triple hop test. Study designBiomechanical analysis was performed using OpenSim. Ten physically active women (23.2 ± 4 years, 59.3 ± 5.8 kg, and 1.63 ± 0.06 m) with no history of lower limb injury (CG) and 11 volunteers (23.5 ± 2 years, 55.4 ± 4.9 kg, and 1.66 ± 0.04 m) with PFP (PFPG) were recruited. The participants performed a series of single leg triple hop tests while the ground reaction forces and kinematic data were recorded. ResultsVector field statistical analysis indicated increased lumbar extension, anterior pelvic tilt, contralateral pelvic drop, and lower induced accelerations from the core and hip muscles in PFPG. ConclusionPFP volunteers presented with alterations in lumbar muscle control associated with a possible compensatory pelvic strategy to minimize knee extensor moment.