Knee Function Research Articles

Personal and Social Correlates of Self-Reported Physical Activity in Individuals With a History of Anterior Cruciate Ligament Reconstruction

Physical activity is negatively impacted after anterior cruciate ligament (ACL) injury and subsequent reconstruction. Previous evidence suggests that individuals with a history of ACL reconstruction (ACLR) may experience additional barriers to sport and physical activity participation. The purpose of this study was to identify personal and social factors (physical literacy, social support, and knee function) that are predictive of self-reported physical activity in individuals with a history of ACLR. Bivariate analyses determined that elements of physical literacy and knee function were positively correlated with self-reported physical activity. The final stepwise linear regression model demonstrated that the PLAYself Physical Literacy Self-description subsection accounted for 12.2% of the variance of self-reported physical activity (p = .003). The significant effect of the PLAYself Physical Literacy Self-description remained (p = .002) even when additional demographic covariates (age, time since ACLR, and sex) were added to the model. Findings suggest that physical literacy may be a salient factor to consider for promoting physical activity after ACLR.

Associations and change in knee function, pain, and biomarkers of bone- and cartilage degradation in individuals with knee osteoarthritis

Associations and change in knee function, pain, and biomarkers of bone- and cartilage degradation in individuals with knee osteoarthritis

Effect of Core Exercises on Clinical and Functional Outcomes After Total Knee Arthroplasty in Individuals With Knee Osteoarthritis: A Systematic Review.

Core muscles constitute the centre of the kinetic chain, and core exercises have been effective in improving outcomes in many postsurgical lower extremity musculoskeletal conditions. However, the literature on the implementation of core exercises after TKA has not been summarised. The objective was to review the evidence on the effect of core exercises on clinical and functional outcomes after TKA in individuals with knee osteoarthritis (OA). PubMed, Scopus, CINAHL, Web of Science, the Cochrane Library, and ProQuest databases were explored with appropriate keywords for studies published on the effect of core exercises on TKA from inception to 1 April 2024. Two authors independently screened the titles and abstracts and full-texts, and a third author solved the discrepancies. Risk of bias assessment was done with the Joanna Briggs Critical Appraisal tool. The final articles were systematically summarised. A total of 1485 records were retrieved. Sixty-four articles were included for screening full-texts, and four articles were ultimately included. Core exercises were administered for three to 6weeks. The administration of core exercises along with the standard knee rehabilitation programme significantly improved balance, mobility, knee function, transverse abdominis muscle thickness, transversus abdominis contraction, and quality of life after TKA (p<0.05). Core exercises can be administered as an adjunct to standard rehabilitation programs to improve clinical and functional outcomes after TKA. However, there is a dearth of literature in this domain, and more studies are warranted. PROSPERO Registration Number: CRD42024542992.

Outcomes of total knee arthroplasty combined with the modified "overlap" technique in the treatment of knee osteoarthritis with permanent patellar dislocation

Objective: To investigate the clinical outcomes of total knee arthroplasty (TKA) combined with the modified "overlap" technique in the treatment of end-stage knee osteoarthritis with fixed patellar dislocation. Methods: This is a retrospective case series study. Clinical data of 19 patients (22 knees) who underwent TKA combined with the modified "overlap" technique for the treatment of end-stage knee osteoarthritis with permanent patellar dislocation from January 2011 to January 2022 in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The cohort included 5 males (6 knees) and 14 females (16 knees), with an age of (60.6±12.2) years (range:33 to 77 years) and a body mass index of (25.4±4.1) kg/m² (range:20.0 to 33.0 kg/m²). Among them, 11 cases (12 knee) had valgus deformity, with Keblish classification showing mild in 2 cases (2 knees), moderate in 6 cases (6 knees), and severe in 4 cases (4 knees). All cases were treated using a medial parapatellar approach, with lateral retinaculum release combined with the "overlap" technique to restore the patellar trajectory. Knee function was evaluated using the American Knee Society (KSS) Score. Paired sample t tests were used for intergroup comparisons. Results: All patients successfully completed the surgery. Postoperatively, patellar dislocation, knee valgus deformity, flexion contracture deformity, and extensor lag were all corrected. All patients were followed up, with a follow-up duration of (63.8±35.2) months (range:24 to 136 months). One patient experienced periprosthetic infection 2 weeks postoperatively, 1 patient had recurrent patellar dislocation 2 months postoperatively, 1 patient developed knee stiffness 3 months postoperatively and underwent closed manipulation. No other patients exhibited signs of patellar dislocation or subluxation. At the last follow-up, the KSS clinical score improved from (36.4±12.7) points preoperatively to (83.4±6.3) points postoperatively (t=-15.15, P<0.01), and the KSS functional score improved from (30.7±11.1) points preoperatively to (77.6±8.3) points postoperatively (t=-14.37, P<0.01). The range of motion of the knee increased from 81.7°±19.6° preoperatively to 107.6°±12.5° postoperatively (t=-4.85, P<0.01). Conclusion: TKA combined with the modified "overlap" technique is an effective surgical option for the treatment of end-stage knee osteoarthritis with permanent patellar dislocation, demonstrating satisfactory clinical outcomes.

Anterior Cruciate Ligament Reconstruction in Young Athletes: A Comprehensive Review of Lateral Extra-Articular Tenodesis and Anterolateral Ligament Reconstruction Techniques.

Anterior cruciate ligament (ACL) injuries are prevalent among young athletes and pose significant challenges due to their impact on immediate and long-term knee function. Traditional ACL reconstruction techniques, while effective, may not always meet the unique needs of this population, particularly given their high physical demands and the risk of future complications. This review evaluates two advanced surgical techniques - lateral extra-articular tenodesis (LEAT) and anterolateral ligament (ALL) reconstruction - as potential enhancements to conventional ACL reconstruction. LEAT involves augmenting knee stability by addressing lateral compartment issues, while ALL reconstruction focuses on reconstructing the ALL to improve overall knee function. The review compares these techniques regarding surgical procedures, clinical outcomes, biomechanical effectiveness, and complications. LEAT and ALL reconstruction are examined for their impact on recovery, return-to-sport rates, and long-term knee health, highlighting their advantages and limitations. Findings suggest that both techniques offer promising benefits, with the potential for improved outcomes compared to traditional methods. However, the effectiveness of each technique can vary based on individual factors and the specific demands of different sports. Further research is needed to fully understand the long-term implications and refine these approaches. This review aims to guide clinical decision-making and optimize treatment strategies for young athletes with ACL injuries, enhancing their prospects for a successful return to athletic activity.

Pain Reduction With Oral Methotrexate in Knee Osteoarthritis : A Randomized, Placebo-Controlled Clinical Trial.

Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain. To assess symptomatic benefits of methotrexate in knee OA (KOA). A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41). 15 secondary care musculoskeletal clinics in the United Kingdom. A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion. Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia. The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs). A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren-Lawrence grade 3 to 4) were randomly assigned to methotrexate (n = 77) or placebo (n = 78). Follow-up was 86% (n = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2). Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance. Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months. Versus Arthritis.

Prospective Assessment of Outcomes After Femoral Condyle Osteochondral Allograft Transplantation With Concurrent Meniscus Allograft Transplantation.

Osteochondral allograft transplantation (OCAT) and meniscus allograft transplantation (MAT) have each become more commonly implemented for the treatment of young to middle-aged patients with complex knee pathology. Evidence regarding tibiofemoral OCAT in the setting of concurrent MAT is limited. The purpose of this study was to characterize outcomes for femoral condyle OCAT with concurrent MAT (OCAT+MAT) in the ipsilateral compartment of patients after evidence-based shifts in practice. It was hypothesized that OCAT+MAT would be associated with successful outcomes characterized by statistically significant and clinically meaningful improvements in patient-reported outcome measures (PROMs) of knee pain and function in >80% of patients for at least 2 years after transplantation. Case series; Level of evidence, 4. With institutional review board approval and documented informed consent, patients who underwent primary OCAT+MAT between 2016 and 2020 and enrolled in a lifelong registry for prospective collection of outcomes after OCAT were included. Patients with minimum 2-year follow-up data regarding complications, failures, adherence, and PROMs were analyzed. Patients who required OCAT and/or MAT revision or conversion to arthroplasty were defined as experiencing treatment failures. A total of 23 consecutive patients (mean age, 37.1 years; mean body mass index, 28 kg/m2; 14 men) met the inclusion criteria, with a mean follow-up of 51 months (range, 24-86 months). The initial treatment success rate was 78% based on 5 initial treatment failures, and the overall success rate was 83% based on a successful revision OCAT. All failures occurred in the medial compartment. Older patient age (42.2 vs 32.1 years; P = .046) and nonadherence to postoperative restriction and rehabilitation protocols (P = .033; odds ratio, 14) were significant risk factors for treatment failure. All measured PROMs achieved significant improvements (P < .001) and minimum clinically important differences at a minimum of 2 years postoperatively. OCAT+MAT was associated with successful short- to mid-term outcomes in 83% of cases. Evidence-based shifts in practice were implemented before the enrollment of this patient cohort. Older patients and those who were not adherent to postoperative restriction and rehabilitation protocols had a significantly higher risk for treatment failure and subsequent conversion to arthroplasty.

Assessing the Impact of Psychological Readiness on Performance and Symmetry in Functional Testing After ACL Reconstruction in Pediatric and Adolescent Patients.

Readiness for return to sports involves both physical and psychological aspects of recovery; however, the relationship between psychological and physical variables after anterior cruciate ligament (ACL) reconstruction (ACLR) is poorly understood. ACLR patients with a higher psychological readiness would demonstrate better functional testing results at 6 months. Cross-sectional study; Level of evidence, 3. Participants were evaluated at 6 months after ACLR with various patient-reported outcome metrics: Hospital for Special Surgery Pediatric Functional Activity Brief Scale, pediatric or adult International Knee Documentation Committee Questionnaire (IKDC), Patient-Reported Outcomes Measurement Information System (PROMIS) - Psychological Stress Experience and ACL - Return to Sport After Injury (ACL-RSI) scale. Functional testing included quadriceps, hamstrings, and gluteal strength testing; Y-balance test; single-leg single hop, crossover hop, and triple hop tests; and timed 6-m hop test. Pearson correlation coefficient and multivariable regression were used to determine associations between the limb symmetry index (LSI) on functional testing and patient-reported outcomes. Those with LSI deficits <20% (better performance) were compared with those with deficits >20% (worse performance). A total of 229 participants (89 male, 140 female) with a median age of 17 years (range, 10.3-30.6 years) were enrolled. IKDC had a moderate negative correlation with PROMIS - Psychological Stress Experience (r = -0.39; 95% CI = -0.49, -0.27; P < .001) and a moderate positive correlation with ACL-RSI (r = 0.55; 95% CI = 0.46, 0.64; P < .001). A total of 151 patients completed functional testing. ACL-RSI demonstrated a positive correlation with single-hop LSI (r = 0.21; 95% CI = 0.05, 0.35; P = .01) and timed 6-m hop (r = 0.28; 95% CI, 0.42; P = .001). When adjusting for sex, age, and graft type, patients who had <20% deficit on the single-hop test scored 16.6 points higher on ACL-RSI (P = .001), and those with <20% deficit on crossover hop testing scored a mean 13.9 points higher on ACL-RSI (P = .04). Higher psychological readiness for return to sport was associated with better performance and greater symmetry on hop testing 6 months after ACLR, suggesting a potential link between physical and psychological recovery.

Anterior cruciate ligament reconstruction in the elderly: 5-Year follow-up study

BackgroundOlder adults remain active for longer and continue sports and activities that require rotation on one leg later in life. The rate of anterior cruciate ligament (ACL) tears is therefore increasing in those over 40 years old, with an associated increase in the rate of surgical reconstruction (ACLR), but there is limited literature on its effectiveness. Our aim was to compare the outcomes of elderly patients who have undergone ACLR with those of a younger group of patients. Materials and MethodsPatients who underwent ACLR with bone-patella tendon-bone grafting (BPTB) at a level I trauma center between 2015 and 2017 were included in the study with a 5-year follow-up. Patients were divided into 4 groups: below 40 years, 40–49 years, 50–59 years and over 60 years. The graft function was evaluated by the International Knee Documentation Committee (IKDC) Objective Score, the anteroposterior (AP) displacement was measured by arthrometer (KT-1000; MEDMetric) and the Lysholm scale was used for subjective evaluation. Results195 patients were included in the final analysis. The IKDC score showed significantly poorer scores in the 50–59 years and over 60 years group than in the younger groups, however in 83 % and 66 % of cases reached normal or nearly normal grades, respectively. A significant difference was found in the knee AP displacement (measured in mm) between the below 40 years group and 50–59 years as well as over 60 years old groups; however, the number of graft failure (laxity >5 mm) and elongation (>3 mm) did not increased in these senior groups. The patient-reported Lysholm scores in the 40–49 years, 50–59 years and 60 years groups was lower than in the below 40 years group, but the average score was “good”. ConclusionsThe long-term results of ACL reconstruction in older athletes are comparable to those of younger patients, both in terms of knee function and patient satisfaction. Furthermore, there is no difference in outcomes for older patients over the age of 40 compared to those in their 50 s or even 60 s. There is still insufficient published evidence to define an upper age limit for ACL reconstruction in older athletes.

Outcomes of Surgical Treatment for Multiligament Knee Injuries in a Cohort Including Competitive Athletes With Long-Term Follow-Up.

There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature. To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period. Case series; Level of evidence, 4. We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression. Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up. Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.

Association between folate intake and radiographic progression, pain function scores in subjects with radiographic knee osteoarthritis: Data from the osteoarthritis initiative.

Folate has an important role in the functioning of the musculoskeletal system, including modulation of inflammation, immunity, cartilage regeneration, prevention of osteoporosis, and maintenance of muscle strength, but evidence on the association between folate intake and knee pain, functional scores, and radiographic progression in patients with knee osteoarthritis (OA) is still limited. Our population-based cohort was extracted from the osteoarthritis initiative (OAI), focusing on individuals with prevalent radiographic knee OA (with a Kellgren-Lawrence score ≥2). Folate consumption was determined using the food frequency questionnaire. Data regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and radiographic readings were collected over 48 months. We analyzed the compiled data using generalized additive mixed models. Our cohort consisted of 1472 OA patients (626 men and 846 women, mean [SD] age 62.35 [8.92]). At the 48-month follow-up, we observed a significant correlation between higher folate intake and a slower progression of knee pain and functional scores, as evidenced by a statistically significant decrease in the WOMAC total score, WOMAC pain subscale score, and WOMAC function/disability subscale score (p < .05). The fully adjusted models estimated a reduction of -0.028 points per 50 μg/1000 kcal of daily folate intake on the WOMAC pain subscale, -0.117 points on the WOMAC function subscale, and -0.160 points on the total WOMAC scale. Furthermore, our nonparametric fit analysis suggested that a higher intake of folate might decelerate the radiographic progression of OA. Stratified analyses indicated that an increase in folate consumption might particularly benefit men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake. Higher folate intake is correlated with improved knee function and reduced pain in patients with knee OA and might deter the radiographic progression of OA. The benefits appear to be more pronounced in men, older adults, overweight and obese individuals, and those with a higher dietary fiber intake.

Posterior Cruciate Ligament Avulsion Fracture of Tibia: Fixation with Screw and Augmentation Using Ethibond Suture for Improved Clinical Outcomes.

The posterior cruciate ligament (PCL) is a vital structure in knee biomechanics, and its avulsion fractures present a unique challenge. This prospective cohort study was conducted at Grant Government Medical College and JJ Hospital, Mumbai, aimed to assess the clinical outcomes of open reduction and internal fixation (ORIF) utilizing cancellous screws and ethibond suture augmentation for PCL avulsion fractures. PCL avulsion fractures often result from traumatic incidents, such as road traffic accidents, and are associated with complications if left untreated. Patients aged 20-45 years with isolated PCL avulsion fractures, confirmed by clinical and radiological assessments, were included. Seven eligible patients underwent ORIF, and outcomes were evaluated through clinical assessments, radiological imaging, and the Lysholm knee scoring system. Follow-ups were conducted for a mean time of 13.2 months, assessing stability, range of motion, and complications. The study demonstrated a mean post-operative Lysholm score of 93.8, significantly improved from the pre-operative score of 49.6. Post-operative knee flexion averaged 125.2°. Fracture healing was observed in all cases, and complications were minimal. The study provides evidence of the effectiveness of ORIF with ethibond suture augmentation for PCL avulsion fractures. The study concludes that the proposed surgical technique yields positive outcomes, including enhanced knee functionality, successful fracture healing, and minimal complications. This approach, combining cancellous screws and ethibond suture augmentation, presents a promising option for the management of PCL avulsion fractures, contributing to the diverse landscape of effective treatment modalities.

Comparative analysis and validation of posterior cruciate ligament management in mobile-bearing total knee arthroplasty: Meta-analysis and animal study.

Total knee arthroplasty (TKA) is an effective treatment for end-stage knee joint diseases. The debate over preserving or sacrificing the posterior cruciate ligament (PCL) in mobile-bearing TKA (MB TKA) still needs to be solved due to the lack of high-quality evidence, particularly meta-analyses comparing these techniques. This study aims to conduct a meta-analysis to compare the outcomes of PCL retention (CR) and PCL sacrifice (PS) in terms of clinical and functional knee scores, range of motion, complication rates, and revision rates and to validate these findings through animal experiments. A comprehensive search was conducted using MEDLINE, Cochrane, and Embase databases. Relevant studies were selected for the meta-analysis using RevMan 5.3. Additionally, an animal experiment using Sprague-Dawley rats simulated MB TKA to compare the effects of PCL retention and sacrifice surgeries. 12 studies were included in the meta-analysis. No significant differences were found between CR and PS techniques regarding HSS, KSS, KSFS, WOMAC, ROM, and medial/lateral instability. However, CR MB showed slight superiority in NKJS, while PS MB had better outcomes in complication and revision rates. In the animal study, CR rats exhibited significant early postoperative inflammation, but both groups' knee structures gradually normalized. The meta-analysis indicates that PCL retention (CR MB) and sacrifice (PS MB) have similar effects on various clinical and functional knee scores. However, PS MB is significantly better at reducing complications and revision rates. The animal experiment confirms PS MB's advantages in reducing inflammation and promoting joint recovery. Despite the strong evidence, long-term follow-up and larger-scale randomized controlled trials are necessary to confirm these findings.

The role of functional knee axis calibration in the presence of rotational malalignment in the lower limbs

The role of functional knee axis calibration in the presence of rotational malalignment in the lower limbs

CT of Periarticular Adult Knee Fractures: Classification and Management Implications.

Periarticular knee fractures, which include fractures of the distal femur, tibial plateau, and patella, account for 5%-10% of musculoskeletal injuries encountered in trauma centers and emergency rooms. These injuries are frequently complex, with articular surface involvement. Surgical principles center on reconstruction of the articular surface as well as restoration of limb length, alignment, and rotation to reestablish functional knee biomechanics. Fixation principles are guided by fracture morphology, and thus, CT with multiplanar reformats and volume rendering is routinely used to help plan surgical intervention. Fractures involving the distal femur, tibial plateau, and patella have distinct management considerations. This comprehensive CT primer of periarticular knee fractures promotes succinct and clinically relevant reporting as well as optimized communication with orthopedic trauma surgeon colleagues by tying fracture type and key CT findings with surgical decision making. Fracture patterns are presented within commonly employed fracture classification systems, rooted in specific biomechanical principles. Fracture typing of distal femur fractures and patellar fractures is performed using Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classification schemes. Tibial plateau fractures are graded using the Schatzker system, informed by a newer explicitly CT-based three-column concept. For each anatomic region, the fracture pattern helps determine the surgical access required, whether bone grafting is warranted, and the choice of hardware that achieves suitable functional outcomes while minimizing the risk of articular collapse and accelerated osteoarthritis. Emphasis is also placed on recognizing bony avulsive patterns that suggest ligament injury to help guide stress testing in the early acute period. ©RSNA, 2024 Supplemental material is available for this article.

Comparative Study on Basic Physical Fitness, Isokinetic Knee and Trunk Muscle Function by SAQ Level of Male College Students

Comparative Study on Basic Physical Fitness, Isokinetic Knee and Trunk Muscle Function by SAQ Level of Male College Students

ADVANCES IN NON-SURGICAL MANAGEMENT OF GONARTHROSIS: A SYSTEMATIC REVIEW

Objectives: Knee osteoarthritis (KOA) is typically the result of wear and tear andprogressive loss of articular cartilage and may eventually lead to disability. Treatment forKOA begins with conservative methods and progresses to surgical treatmentoptions when conservative treatment fails. This systematic review aims to highlight the latestadvancements in non-surgical interventions to improve the management of this commonmusculoskeletal disorder. Methods: A comprehensive search of sources available in both English and Frenchencompassing various databases such as PubMed, Google Scholar, and relevant medicaljournals in addition to recommendations provided by prominent organizations(EULAR, ACR, SFR, SOFMER, OARSI, ESCEO, NICE, PANLAR, AAOS). Inclusion criteria were good quality systematic reviews, meta-analyses, practice guidelinesexcludingsurgicalKOA treatment. Results:We thoroughly examined a large set of 545 articles and meticulously selected 117 for detailed analysis. This carefully selected set comprised randomized controlled trials, consensus statements, international guidelines, systematic reviews, meta-analyses, cohort studies, and reviews. Qualitative synthesis revealed widely approved nonpharmacological therapies such as information/education programs, weight loss, and physicalactivity. Most agreed on pharmacological therapies were oral and local NSAIDs, Paracetamol, and intra articular corticosteroid injection. Other treatment options were subject to controversy. Conclusion:Various options are available for the treatment of KOA. However, KOA remains a commonglobal health challenge, affecting millions and compromising the quality of life through pain, functional limitations, and associated morbidities. A comprehensive and personalized approach seems crucial in order to reduce pain, improve knee function over the long term.

How Does the Position of the Wedge Influence the Tibial Slope After High Tibial Osteotomy?

Open-wedge high tibial osteotomy often results in an increase in the tibial slope. Factors responsible for this increase are not clearly defined. The purpose of this study is to assess the influence of the position of the wedge on the changes of the tibial slope. This monocentric retrospective study included 87 patients with symptomatic isolated medial osteoarthritis of the knee. All patients were operated with open-wedge high tibial osteotomy with locked plate fixation. Tibial slope was measured on lateral x-ray of the tibia referring to posterior tibial cortex. The position of the wedge was estimated by measuring the distance between the posterior tibial cortex and the posterior lower part of the wedge. Measurements were performed by the same observer using Carestream® software. Data were analyzed with the SPSS 20 statistical software. Mean tibial slope was 6,03° preoperatively and 5,98° postoperatively with a non-significant decrease of 0,05°. Mean distance between the wedge and the posterior tibial cortex was 9,02mm, there was a significant correlation between this distance and the change in tibial slope (p&lt;0,001) (R=0,73). However, there was no significant correlation between preoperative varus, degree of correction, age or BMI and changes in tibial slope. So, we recommend, during open-wedge high tibial osteotomy, to place the wedge in the posterior part of the osteotomy to avoid an increase in tibial slope and ensure better knee function.

Outcomes after multiligament knee injury worsen over time: A systematic review and meta-analysis.

Multiligament knee injuries (MLKIs) are devastating injuries that can have life-long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction techniqueand reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow-up. Four databases were queried for surgical outcome-based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2-year follow-up. Technique articles, nonoperative treatment, arthroplasty, pediatricand review articles were excluded. Study characteristics including design, number of patients, age, follow-up period, anatomical regionand posterior-cruciate ligament (PCL)-based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random-effects model analysis was performed. After the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow-up was 4.06 years (range 2-12.7). The mean Lysholm score at 2-yearfollow-up was 86.09 [95% confidence interval [CI]: 82.90-89.28], with a yearly decrease of -0.80 [95% CI: -1.47 -0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56-86.14], with a yearly decrease of -1.99 [95% CI: -3.14 -0.84] (p < 0.001). Non-PCL-based injuries had a higher IKDC 83.69 [75.55-91.82] vs. 75.00 [70.75-79.26] (p = 0.03) and Lysholm score 90.84 [87.10-94.58] versus 84.35 [82.18-86.52] (p < 0.01) than PCL-based injuries, respectively. According to the present systematic review and meta-analysis of MLKIs with minimum 2-year follow-ups, the patients who suffered an MLKI can expect to retain around 80-85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL-based injuries at 2 years postoperative. Level IV meta-analysis.

Application of sports rehabilitation training in mobile edge computing to treatment of patients with knee arthritis

According to the data of the National Bureau of Statistics, in 2019, the proportion of elderly people aged 65 and above in the total population reached 12.6%, and with the acceleration of the aging process, the incidence of knee osteoarthritis has increased significantly. According to the Chinese Journal of Orthopedics, the number of patients with knee osteoarthritis is growing at a rate of 6% every year, and there are more than 100 million patients with knee osteoarthritis in China, which significantly affects the quality of life of middle-aged and elderly people. This paper uses mobile edge computing technology and nanotubes to cooperate with reasonable sports to study the rehabilitation of patients with knee arthritis in the rehabilitation stage. The subjects of the study were 60 patients with knee arthritis, and the 60 patients were divided into 4 groups: group A used nanotubes and exercise rehabilitation training; group B used nanotubes but no exercise rehabilitation training; group C did not use nanotubes Tube, but sports rehabilitation training after the operation; D does not use nanotubes, and does not perform sports rehabilitation training after the operation. The 4 groups of patients performed routine exercises on the basis of rehabilitation exercise care. The study lasted for six months, with the 60 patients assessed monthly on their self-care ability, knee function and quality of life. Self-care ability was assessed by the Barthel Index (BI), knee function was assessed by the Knee Score Scale (KSS), and quality of life was assessed by the SF-36 Health questionnaire. The experimental results showed that all indexes of group A were higher than those of group B, KSS value was 2 higher than that of control group, ADL (activities of daily living) comprehensive value was 0.4 higher than that of control group, and SF-36 (The Short-From-36 Health Survey) value was 0.8 higher than that of control group. The self-care ability and health status of patients who performed balance exercises were significantly higher than those who did not perform balance exercises. The quality of life of patients who used nanotubes was significantly higher than that of those who did not. Therefore, the method of using nanotubes in combination with exercise rehabilitation training can restore the function of patients with knee arthritis and promote high quality of life.