Knee Flexion Degree Research Articles

Two years follow-up of patients with knee varus deformity and medial meniscus extrusion after medial opening wedge high tibial osteotomy and arthroscopic meniscus centralization.

This is a retrospective study and aims to investigate the clinical outcomes of patients with knee varus deformity and extruded medial meniscus who underwent arthroscopic meniscus centralization and medial opening wedge high tibial osteotomy. A total of 24 patients were included in the trial, and arthroscopy intraoperative photographs and standing preoperative and postoperative radiographs were taken to analyze the mechanical tibiofemoral angle and tibial plateau inclination. Postoperative complications and knee motion were recorded, and the surgical results were evaluated using the knee society score. The study observed four cases of surgery-related complications among all patients, but no major complications were reported. The surgery significantly improved knee flexion degrees and total knee range of motion. Satisfactory outcomes were shown in postoperative radiographs and secondary intraoperative photographs. The knee score increased from 39.6 ± 10.0 to 80.1 ± 9.0, and the functional score improved from 48.1 ± 6.9 to 89.4 ± 5.5. The preoperative tibial plateau inclination was 5.3 ± 0.7, while the postoperative data showed a decrease to 4.2 ± 0.7. The preoperative mechanical tibiofemoral angle was - 7.7 ± 1.0, and it improved in all patients postoperatively to 2.8 ± 0.9. By alternating the knee biomechanics and significantly improving symptoms and quality of life, arthroscopic medial meniscus centralization and medial open wedge high tibial osteotomy units are confirmed to be an effective alternative treatment for knee varus deformity.

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

BackgroundMobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists.MethodsThis was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes.ResultsThere was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05).ConclusionsObjective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release.Study registrationChinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900024146.

Application and the Effect of the Triple Prerehabilitation Nursing Model in the Perioperative Period of Knee Arthroplasty in Diabetic Patients.

Objective The aim of the study was to explore the application and the effect of the triple prerehabilitation nursing model in the perioperative period of knee arthroplasty in diabetic patients. Methods The prospectively included 60 patients with diabetes who underwent total knee replacement were admitted from August 2021 to April 2022 and were divided into 2 groups according to the (1 : 1) ratio. The control group was mainly given routine nursing care. On the basis of the control group, the observation group received triple prerehabilitation nursing. The postoperative knee flexion, hospital for the special surgery knee score (HSS), the daily living ability (Barthel) score, the modified fall efficacy scale (MFES) score, the recovery of the lower-limb muscle strength, and the incidence of complications were compared between the two groups. Results The knee flexion degree and lower-limb muscle recovery of the observation group were better than those of the control group at 3 d, 7 d, and 14 d after operation (P < 0.05). The HSS score, Barthel score, and MFES score of the observation group were higher than those of the control group (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion The triple prerehabilitation nursing care for diabetic patients undergoing total knee replacement can promote the recovery of limb function.

The role of preoperative kinetic physical treatment in patients with complete rupture of the anterior cruciate ligament

AbstractIntroductionThe present research has highlighted the role of preoperative kinetic physical therapy in patients with complete rupture of the anterior cruciate ligament.Material and methodThe study took place at theFizionovaMedical Recovery Center in Târgu Mureș, for 12 weeks, between November 2020 and March 2021, on a sample of 20 subjects, aged between 21 and 45 years. The inclusion criterion was the anterior cruciate ligament reconstruction surgery. The research methods were largely experimental. Statistical analysis included elements of descriptive statistics (mean, median, standard deviation) and elements of inferential statistics. The Shapiro-Wilk test was applied to determine the distribution of the analyzed data series. For the comparison of means, the t-Student test for unpaired data was applied. For the comparison of medians, the Mann-Whitney test was applied for unpaired data.ResultsThe experimental group regained its knee flexion degrees earlier than the control group following the preoperative kinetic physical treatment.ConclusionOur investigation concluded that immediate postoperative recovery has significant importance on the knee’s functionality, which is much more challenging to recover in case of prolonged immobilization.

Comparison of Pain, Muscle Strength, and Functional Status Following Unicompartmental Knee Arthroplasty, Total Knee Arthroplasty, and Conservative Management of Gonarthrosis.

Treatment options and surgical decision for grade 3-4 gonarthrosis remains controversial. We aimed to compare the pain level, muscle strength, physical performance, lower extremity functions, and other physical activity levels between patients who underwent arthroplasty and those who received conservative management for grade 3-4 gonarthrosis. This prospective analytical observational study was conducted in a tertiary referral hospital. A total of 30 unicompartmental knee arthroplasty (UKA) and 30 total knee arthroplasty (TKA) patients as two different study groups and 30 patients were treated conservatively as the control group were included. The rehabilitation and complication rates were recorded. The values of the range of motion, quadriceps diameter, were measured and also the isokinetic muscle strength, pick-up, repeated sit-to-stand, stair ascending and descending, straight-line walking, timed up and go, and 20-m walk tests, the knee injury and osteoarthritis-outcome-score (KOOS), the hospital for special-surgery-knee-score (HSS), and Oxford-Knee-Score (OKS) were performed. Postoperative rehabilitation and complication rates were significantly higher in the TKA group compared to the UKA group (p = 0.029 and p = 0.026, respectively). Six months after the treatment, the knee extension muscle strength value at 180°/s, knee flexion degree, total work flexion, stair ascending, VAS at night, all KOOS symptom, pain and daily function and total scores in the UKA group was significantly different than the TKA and the control groups (p < 0.001). Total work extension values, knee flexion degree, in the control group were found to be significantly higher than the TKA group (p = 0.033, p < 0.001, respectively). The UKA was significantly superior to TKA and conservative treatment concerning pain, muscle strength, and quality of life. IIa.

Effects of body mass index on outcomes of total knee arthroplasty.

The aim of this study was to group the patients with total knee arthroplasty(TKA) surgery according to the World Health Organization (WHO) obesity classification and to evaluate the effects of body mass index (BMI) on complication rates, the functional and clinical outcomes of the patients after TKA. Between 2011 and 2018, 588 patients who underwent TKA by a single surgeon were retrospectively evaluated. According to WHO's classification criteria, 588 patients were divided into 5 groups such as normal (< 25.0kg/m2, n: 138, 23.4%), overweight (25.0-29.9kg/m2 n: 201, 34.1%), class I obese (30.0-34.9kg/m2 n: 124, 21%), class II obese (35-39.9kg/m2 n: 82, 13.9%) and class III obese (> 40kg/m2 n: 43 7.6%). Groups were compared in terms of age, sex, surgical side, follow-up period, case duration, prosthesis infection and aseptic prosthesis loosening rates, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm functional scores and knee flexion degrees. There was a statistically significant difference between the groups in terms of prosthesis infection or aseptic prosthesis loosening following TKA. The incidence of these complications increased as BMI increased (X2: 20,079, p: 0.01). Postoperative knee flexion degrees, KOOS and Lysholm scores were significantly different between the groups (p: 0.000). As BMI increased, clinical and functional outcomes deteriorated. Obesity is one of the most important risk factors for prosthesis infection and aseptic prosthesis loosening which can be seen after TKA. High BMI values also adversely affect clinical and functional outcomes after TKA.

PMS73 EFFECTIVENESS OF USING THE UNLOADER - ONE KNEE BRACE ON THE PHYSICAL ACTIVITY AMONG PERSONS WITH MEDIAL KNEE OSTEOARTHRITIS (OA)

Medial compartment knee osteoarthritis (OA) is a type of knee OA associated with low activity level, pain, and instability. Various orthotics aids are used to treat this pathology such as insole and Knee-valgus braces. The aim of our study is to examine the effects of using the knee-valgus brace in the treatment of medial compartment knee OA in Jordan. 35 patients (30 females and 5 males, mean age: 65±8years, and body weight: 85±14 kg) were recruited for this study. All recruited participants were diagnosed by a professional orthopedic surgeon. The Arabic version of the Western Ontario and McMaster University Osteoarthritis (WOMAC) index was used to evaluate the changes in pain, stiffness, and functional level. The total scores ranged from 0-96. Each participant filled in three WOMAC questionnaires; one before wearing the brace and the other two after one and two weeks of wearing the brace. The average total score of WOMAC accounted for 64, 40, and 31 before using the brace, one week after using the brace, and two weeks after using the brace, respectively. Thus, the total score of the WOMAC decreased significantly (p<0.05) after one week and two weeks of using the knee-valgus brace (39% and 52%, respectively) compared to the baseline. Moreover, the total WOMAC, pain, stiffness, and physical activity improved clinically based on the minimal clinical important difference (MCID>25) with wearing the knee-valgus brace for two weeks. Using the Unloader-One-Ossur-knee-valgus brace is an effective orthotics aid that can significantly improve pain, reduce stiffness, and increase the physical activity of the medial compartment knee OA patients. Furthermore, using the Unloader-One-Ossur-knee-valgus can improve the knee flexion degree that is required to achieve most of the daily activities among Arabic participants.

Clinical and Radiological Results of Oxford Phase-3 Medial Unicompartmental Knee Arthroplasty.

PurposeThe aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients.Materials and methodsSeventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up.ResultsThe average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p<0.05). Radiologically, there was no sign of arthritis on the unoperated side of the knee or failure of prosthesis detected. Before the operation, the average clinical KSS was 63.2 and improved to 91.4 after the operation. In addition, the average functional KSS was 54.9 before the operation and improved to 86.5 after the operation. The average knee flexion degree was 109.1 before the operation and there was an improvement to 123.6 degrees after the operation. Before the operation, the average HSS score was 67.5 (range, 52 to 75) and improved to 89.9 (range, 85 to 100) at the final control examination.ConclusionThis study supports the use of Oxford Phase 3 UKA, which has excellent clinical and radiological results in patients with medial knee arthritis.

Continuous adductor canal block following total knee arthroplasty provides a better analgesia compared to single shot: A prospective randomized controlled trial

ObjectiveThe aim of this study was to compare single-shot adductor canal block and continuous infusion adductor canal block techniques in total knee arthroplasty patients. MethodsWe prospectively randomized 123 patients who were scheduled for unilateral primary total knee arthroplasty surgery into single shot (n = 60; mean age: 67.1 ± 6.9 years) and continuous (n = 63; mean age: 66.9 ± 6.8 years) adductor canal block groups. Postoperative visual analog scale pain scores, need for additional opioids and functional results as; timed up and go test, the 30-s chair stand test, 5 times sit-to-stand test, the 6-min walking test, the time to active straight leg raise, time to walking upstairs, maximal flexion at the time of discharge, duration of stay in hospital were compared between the two groups. ResultsPain scores were lower in the continuous adductor canal block group as compared to the single-shot adductor canal block group throughout the postoperative period (p = 0.001). Rescue analgesia was required for 6 (10%) patients in the single shot group and for 1 (1.59%) patient in the continuous group (p = 0.044). Patients in the continuous adductor canal block group displayed better functional results than the single-shot adductor canal block group with respect to active straight-leg rise time (25.52 ± 4.56 h vs 30.47 ± 8.07 h, p = 0.001), 6-min walking test (74.52 ± 29.38 m vs 62.18 ± 33.32 m, p = 0.035) and maximal knee flexion degree at discharge (104.92 ± 5.35° vs 98.5 ± 7.55°, p = 0.001). There was no significant difference between the two groups for other functional and ambulation scores. ConclusionPain control following total knee arthroplasty was found to be better in those patients treated with continuous adductor canal block as compared to those treated with single-shot adductor canal block. Patients treated with continuous adductor canal block also displayed better ambulation and functional recovery following total knee arthroplasty. Level of evidenceLevel I, Therapeutic Study.

Ketamine and bupivacaine attenuate post-operative pain following total knee arthroplasty: A randomized clinical trial.

Total knee arthroplasty (TKA) is highly associated with post-operative pain. The present randomized trial aimed to explore the possible post-operative pain management by a different combination of analgesics or opioids (ketamine and bupivacaine) following TKA. A total of 84 patients were randomly divided into four groups. All subjects were anesthetized for TKA surgery and received post-operative pain management via intra-articular saline (control group; n=23), ketamine (2 mg/kg) infused with saline (ket group; n=21) bupivacaine (0.5 mg/kg) infused with saline (bupi group; n=20) or ketamine (2 mg/kg)+bupivacaine (0.5 mg/kg) infused with saline (ket+bupi group; n=20) at the end of the surgery. Additional, post-operative analgesia was infused with the aid of patient-controlled analgesia with morphine. A reduction in the levels of pain score (verbal rating scale and visual analog scale), opioid consumption, time of ambulation, hospital stay and adverse events were observed in the ket+bupi group compared with the other groups. Meanwhile, the satisfaction score and knee flexion degree were improved following treatment with the ket+bupi regimen. Therefore, the multimodal analgesic regimen (ket+bupi) may be useful in mitigating post-operative pain as and improving knee mobilization following TKA.

Effect of knee flexion position and combined application of tranexamic acid on blood loss following primary total knee arthroplasty: a prospective randomized controlled trial.

The aim of this study was to demonstrate the association between tranexamic acid (TXA)-combined application and knee flexion in the first 24hour post-operatively that could reduce total blood loss and transfusion need in patients undergoing total knee arthroplasty (TKA), without sacrificing safety. Ninety TKA patients were divided into three groups randomly: the flexion group: the knee was in 90° flexion position for the first 12hour post-surgery and kept at 60°for the next 12hour, combined with 1g TXA topical and 1g TXA intravenous application. The extension group: the knee was in fully extension position post-operatively, combined with topical and intravenous TXA application. The controlled group: the knee was in fully extension position post-operatively combined with single intravenous TXA application. The primary outcomes included blood loss variables and transfusion values. The secondary outcomes included post-operative hospital stay, knee flexion degree, complication rate, and hospital charge. The total blood loss and transfusion needs in the flexion group were significantly reduced in comparison with that in the extension group and controlled group. The post-operative knee flexion motion was significant higher in the flexion group than the other two groups. There was no difference among the three groups with regard to the rates of complications. Keeping the knee in flexion position combined with topical and intravenous TXA application in patients undergoing primary unilateral TKA significantly reduced post-operative bleeding and the transfusion rate compared with what was found after treatment with extension knee position or single intravenous TXA application. Therapeutic Level I.

Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study

The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups. In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90°. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60° and 180°/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees. No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180°/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (-4.2%) than in Group 1 (-23.1%). For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure. II.

Comparison of Continuous Epidural Analgesia and Continuous Femoral Analgesia on Postoperative Pain and Knee Rehabilitation after Total Knee Arthroplasty

This study assessed the efficacy of postoperative analgesia and rehabilitation scores of continuous epidural analgesia or continuous femoral analgesia after total knee arthroplasty. Thirty patients received epidural analgesia (Group E), whereas 30 patients received continuous femoral analgesia (Group F). Pain and rehabilitation scores, total bupivacaine consumption and rescue analgesic con- sumption were compared. Pain scores were similar between the two groups. Total bupivacaine consumption was significantly higher in Group F. One patient in Group E and 13 patients in Group F required for supplemental analgesics (p<0.05). Maximum knee flexion degrees were not differ - ent between the two groups. In this study, an effective pain control was obtained with both continuous epidural analgesia and continuous femoral analgesia after total knee arthroplasty.

A Study on the Differences of Quadriceps Femoris Activities by Knee Alignment during Isometric Contraction.

[Purpose] This study attempted to identify how genu varum or valgum affects the electromyographic activities of the vastus medialis, vastus lateralis, and rectus femoris during knee isometric contraction. [Subjects] Fifty-two healthy young adults were enrolled in this study. They were enrolled and classified into three groups by knee alignment conditions: the genu varum, genu valgum, and control groups. [Methods] The electromyographic activity ratio of the vastus medialis to the vastus lateralis and rectus femoris were calculated using the percentage of maximum voluntary contraction. The participants contracted their quadriceps during isometric contraction at 30 and 60° of knee flexion. [Results] The genu varum group had more activity in the vastus medialis than in the vastus lateralis and rectus femoris, whereas the genu valgum group had more activity in the vastus lateralis and rectus femoris than in the vastus medialis. There was a significant difference in the muscle activity ratio between the vastus medialis and vastus lateralis by angle of knee flexion degree only in the genu valgum. There were no significant differences in any of the three groups in terms of the muscle activity ratio of the vastus medialis to the rectus femoris by angle of knee flexion. [Conclusion] The quadriceps femoris was used for different strategies according to knee alignment during isometric contraction at 30 and 60°. This study suggests that rehabilitation training programs used to strengthen the quadriceps should consider the knee alignment conditions of the target subjects.

Investigation of body weight ratios on joint structures at different knee flexion angles in patients with unilateral knee arthroplasty

The study aims to determine body weight ratios between extremities in patients with unilateral total knee arthroplasty (TKA) at 12 months postoperatively at the static-standing position at 30, 60 and 90 degrees of knee flexion. The study included 52 female patients (mean age 65.6±10.6 years; range 40 to 83 years) who underwent unilateral primary TKA. The force-platform was used to calculate the body-weight ratios of the patients. Body weight ratios on the operated and non-operated limbs of the unilateral TKA patients were examined at standing-static position at 30, 60 and 90 degrees of knee flexion on the force-platform according to their age and body mass index (BMI). The pain levels of the patients were evaluated using the visual analog scale. It was found that unilateral TKA patients placed their body weight on the non-operated limb more at the standing-static position, and 30, 60 and 90 degrees of knee flexion at 12 months postoperatively (p<0.05). It was also found that as the knee flexion degree increased with age, so did TKA patients place their body weight on the nonoperated limb more (p<0.05), and that BMI had no effect on the load distribution difference over the two extremities (p>0.05). During the postoperative period, load asymmetry between the two extremities in patients with unilateral TKA remains the same due to advancing age. This accelerates the osteoarthritis process on the non-operated knee. It is concluded that the age factor should be taken into account while planning physiotherapy and rehabilitation programs for unilateral TKA patients and knee exercise programs aiming to place load over the operated limb should be arranged.

The influence of a single-radius-design on the knee stability

Prostheses with single radius (SR) design were supposed to be as good as the physiological kinematic and stability of the knee. This in-vitro biomechanical study compared SR to a multiple radius (MR) design on the one hand and seven left human knee specimens were used. The SR and MR knee prosthesis where implanted with a navigation system. We measured varus/valgus deviation of the mechanical axis and the deviation of the joint-line to the epicondyle-line in different knee flexion degrees (0°, 30°, 45°, 60° and 90°) with and without 15 Nm of varus and valgus stress. Without varus/valgus-stress in all three groups (physiological knee, SR and MR prosthesis) the results were located on the varus-site. The variation of the SR was less than the MR, without being significant. Under varus and valgus stress varus/valgus axis deviation constantly grew. From 0-60° no significant deviation between the two prosthesis models was found. At 90° flexion varus/valgus deviation with the SR component was significantly (p ⩽ 0.05) smaller compared to the MR design. This in-vitro study showed that the SR prosthesis is significantly more stable in the coronal plane than the MR in higher flexion degrees. This could have an improved effect on biomechanical stability with a higher clinical function after SR-TKA.

Brief Followup Report: Does High-flexion Total Knee Arthroplasty Allow Deep Flexion Safely in Asian Patients?

The long-term survivorship of TKA in Asian countries is comparable to that in Western countries. High-flexion TKA designs were introduced to improve flexion after TKA. However, several studies suggest high-flexion designs are at greater risk of femoral component loosening compared with conventional TKA designs. We previously reported a revision rate of 21% at 11 to 45 months; this report is intended as a followup to that study. Do implant survival and function decrease with time and do high-flexion activities increase the risk of premature failure? We prospectively followed 72 Nexgen LPS-flex fixed TKAs in 47 patients implanted by a single surgeon between March 2003 and September 2004. We determined the probability of survival using revision as an end point and compared survival between those who could and those who could not perform high-flexion activities. Minimum followup was 0.9 years (median, 6.5 years; range, 0.9-8.6 years). Twenty-five patients (33 knees) underwent revision for aseptic loosening of the femoral component at a mean of 4 years (range, 1-8 years). The probability of revision-free survival for aseptic loosening was 67% and 52% at 5 and 8 years, respectively. Eight-year cumulative survivorship was lower in patients capable of squatting, kneeling, or sitting crosslegged (31% compared with 78%). There were no differences in the pre- and postoperative mean Hospital for Special Surgery scores and maximum knee flexion degrees whether or not high-flexion activities could be achieved. Overall midterm high-flexion TKA survival in our Asian cohort was lower than that of conventional and other high-flexion designs. This unusually high rate of femoral component loosening was associated with postoperative high-flexion activities.

Effectiveness of a Footprint Guide to Establish an Anatomic Femoral Tunnel in Anterior Cruciate Ligament Reconstruction: Computed Tomography Evaluation in a Cadaveric Model

To compare drilling the femoral tunnel with an offset aimer and BullsEye guide (ConMed Linvatec, Largo, FL) to perform an anatomic single-bundle reconstruction of the anterior cruciate ligament (ACL) through the anteromedial portal. Seven matched pairs of cadaveric knees were studied. The intent was to drill the femoral tunnel anatomically in all cases. In group A the femoral tunnel was drilled arthroscopically with an offset aimer. In group B the femoral tunnel was drilled arthroscopically with the BullsEye guide. Two tunnels were drilled through the same entry point in each knee. One was done at 110° of knee flexion and the other at 130°. They were scanned by computed tomography and reconstructed 3-dimensionally. Volume-rendering software was used to document relations of the drilled tunnel to the bony anatomy and tunnel length. In group B the femoral tunnel was placed at the center of the femoral insertion site. The center of the tunnel was 9.4 mm from the high cartilage margin and 8.6 mm from the low cartilage margin. In group A the tunnels were placed deeper (5.4 mm and 12.6 mm, respectively) (P = .018). There were no differences in tunnel length for either knee flexion degree. Three of the tunnels drilled at 110° in group A compromised the posterior tunnel wall and measured less than 25 mm in length. Accurate placement in the center of the femoral footprint of the ACL is better accomplished with the BullsEye guide rather than 5-mm offset aimers. Five-millimeter offset aimers might cause posterior tunnel blowout and present the risk of obtaining short tunnels when performing oblique femoral tunnel placement through the anteromedial portal at 110° of knee flexion. The BullsEye guide might be better than standard offset aimers in the performance of anatomic single-bundle ACL reconstruction.

Effect of partial medial meniscectomy on the proprioceptive function of the knee

The aim of this study was to assess the proprioception of the partial meniscectomized knee and to assess if there is an effect on the knee proprioception. We performed a case-control study involving patients with meniscus tear at the posterior horn of medial meniscus. Group 1 composed of 19 patients, with an average age of 26.3 years, who were enrolled after sustaining an injury to the medial meniscus. Twenty healthy individuals, with an average age of 25.1, without history of knee injury, constituted Group 2. In order to document the proprioceptive capabilities of the knee, angle reproduction tests were performed. At a mean of 2 years after the surgery, there was no difference between the meniscectomized and healthy knee regarding the angle deviations in the lower flexion angles (15 degrees , 30 degrees , 45 degrees ). However, mean knee joint position sense (KJPS) at 60 degrees reproduction in Group 1 and 2 was 64.3 (SD 5.3) and 69.2 (SD 4.9), respectively. Concomitantly, mean KJPS at 75 degrees reproduction in Group 1 and 2 were 80.1 (SD 6.59) and 74.4 (SD 5.6), respectively. Paired t test showed a statistically significant difference between Group 1 and 2 when compared to control angle deviations at 60 degrees and 75 degrees reproductions (P < 0.05). KJPS of the patients in meniscectomized group was poorer than the patients in healthy knee group at 60 degrees and 75 degrees knee flexion degrees. Those results indicated that even a partial absence of menisci causes a deterioration of proprioceptive functions of the knee.

Effects of Total Knee Arthroplasty on Body Weight and Functional Outcome

[Purpose] We prospectively investigated the effects of arthroplasty surgery on body weight and the effects of obesity on functional outcomes and complications in patients with total knee arthroplasty (TKA). [Subjects] One hundred eighty-six TKA patients were divided into two groups [non-obese = body mass index (BMI) < 30 kg/m2 (n=70), and obese = BMI ≥ 30 kg/m2 (n=116)] according to preoperative BMI values. [Methods] Patients were evaluated preoperatively and at 12 months postoperatively with regard to BMI, knee function score, pain, range of knee flexion, and complications. There were no significant postoperative differences between the groups in pain, knee function score, range of knee flexion, and complications.[Results] A statistically significant postoperative improvement was found in all parameters (p<0.05) except for BMI. In the non-obese group, BMI was unchanged whereas in the obese group there was an increase in BMI after surgery. [Conclusion] The results of this study indicate that patients do not lose weight after arthroplasty surgery. However, arthroplasty surgery offers significant improvements in knee flexion degree, knee function scores, physical function and relief of pain for patients regardless of weight. Increased mobility and decreased pain will not automatically lead to weight reduction. Therefore obesity must be addressed as an independent disease.