Knee Injury And Osteoarthritis Outcome Score Scores Research Articles

A Randomized, Double-Blind, Placebo-Controlled Study Investigating the Safety And Efficacy of a Herbal Formulation on Knee Joint Function in Adults with Knee Osteoarthritis.

Background: Current treatments for osteoarthritis (OA) pain and stiffness have limitations, including adverse effects. Therefore, effective and safe complementary or alternative therapies are needed. Dietary supplement GJ 191, comprising Epimedium, Dioscorea, and Salvia miltiorrhiza extracts, may address this need. Methods: This randomized, double-blind, placebo-controlled study investigated GJ 191 supplementation on knee OA symptoms. Seventy-two adults (40-75 years) with mild to moderate knee OA and mild to moderate knee pain were enrolled. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Pain Visual Analog Scale (VAS), Quality of Life questionnaire, knee joint range of motion, serum C-reactive protein, and rescue medication use were assessed. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores were computed using KOOS scores. Results: Decreases in WOMAC pain scores were reported by both GJ 191 and placebo groups after 6 (-1.78 ± 2.71 and -1.34 ± 1.93, respectively; p < 0.01) and 12 (-2.31 ± 2.83 and -1.59 ± 2.69, respectively; p < 0.01) weeks, with no significant difference between groups. There were decreases in WOMAC stiffness scores for participants supplemented with GJ 191 by 0.53 ± 1.22 and 0.72 ± 1.46 (p ≤0.02) after 6 and 12 weeks, respectively, with respective decreases of 0.81 ± 1.51 and 0.75 ± 1.85 (p ≤0.03) for those on placebo. Significant improvements in current pain, as assessed by the Pain VAS, and bodily pain were reported by the GJ 191 group after 6 and 12 weeks, while the placebo group only reported significant improvements in these measures after 12 weeks. GJ 191 supplementation was safe and well tolerated. Conclusion: There was no significant difference in pain and stiffness scores between GJ 191 and placebo over the 12 weeks. While both groups reported improvements in WOMAC pain from baseline, improvements in current and bodily pain were experienced sooner with GJ 191 than placebo and were sustained over the study period. GJ 191 supplementation was safe and well tolerated. (CTR#: NCT04395547).

Patient characteristics influencing knee injury and osteoarthritis outcome scores vary with time from patellar dislocation and number of dislocations

ObjectivesDemographic characteristics of the patient population influence patient reported outcome measures (PROMs) following patellar dislocations. The time from injury and number of dislocations can also vary within the patient population. The hypothesis of the study is that characteristics of the patient population influencing Knee injury and Osteoarthritis Outcome Score (KOOS) measures of pain, function, and quality of life vary with time from patellar dislocation and number of dislocations. MethodsOutcome scores were evaluated for subjects in four groups: within five months of a first patellar dislocation (first-time group, n ​= ​24), within five months of a recurrent dislocation (multiple group, n ​= ​15), five to twelve months after a first dislocation (post-acute group, n ​= ​14), and two years or longer after a first dislocation (two-year group, n ​= ​14). For each group, KOOS pain, physical function, and quality of life scores were compared between males and females. KOOS scores were also correlated against age, body mass index (BMI), and time since first and most recent dislocation. ResultsFor the first-time dislocation group, physical function, and quality of life scores were higher for men than women (p ​< ​0.05). For the multiple dislocation group, pain and physical function improved as BMI decreased (p ​< ​0.025), while quality of life improved as age decreased (p ​= ​0.014). For the post-acute group, all three scores improved as BMI decreased (p ​< ​0.05). For the two-year group, all three scores worsened as time since first dislocation increased (p ​< ​0.01). ConclusionsFollowing patellar dislocation, relationships between characteristics of the patient population and PROMs vary with time from injury and number of dislocations. In the acute phase following a first dislocation, PROMs likely reflect the traumatic injury. Based on relationships with BMI, outcomes likely reflect functional capacity of the knee in the acute phase of multiple dislocations and post-acute phase of a first dislocation. After multiple years, progressive degradation of the knee over time seems to influence PROMs. Level of evidenceRetrospective study with more than one negative criterion (Level 4).

Similar two‐year improvement in patient‐reported outcomes in patients 40 years and older with outerbridge grade III and IV lesions following ACL reconstruction

AbstractPurposeThis study aims to evaluate clinical and patient‐reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes.MethodsA total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren–Lawrence (KL) grading and postoperative complication rates over a 2‐year period.ResultsAverage increase in KOOS and SANE scores were 21.2 19.9 and 23.5 31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight‐bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p &lt; 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL‐grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2‐year period to their counterparts (p = 0.598 and p = 0.643, respectively).ConclusionThere is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient‐reported outcomes for ACLR.Level of EvidenceLevel IV

The Use of Radiosynovectomy Using Yttrium-90 as an Adjunct to Mechanical Synovectomy for Pigmented Villonodular Synovitis: How Effective Is This?

Introduction Pigmented villonodular synovitis (PVNS) or giant cell tumour of the tendon sheath (GCTT) is a rare disorder involving the proliferation of the synovium in any joint; however, the knee, hip, and ankle joints are most commonly targeted. The aim of this study is to follow the short-term outcomes of the treatment of patients with PVNS of the knee managed by intra-articular injection of yttrium-90 or radiosynovectomy (RS) aloneand a combination of RS and arthroscopic/open debulking synovectomy. Methods A cohort of eight knees from six patients was included in this study, including three knees treated with combined arthroscopic synovectomy and RS, and five knees treated with RS alone. Patients were asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire before attending their three-month follow-up appointment. Their answers were collated and scores were calculated using the designated specific equation. Results Our results demonstrate that although patients in the combined arthroscopic synovectomy and RSarm possess on average higher pain scores and symptoms than those who underwent RSalone, the combined therapy had higher scores in activities of daily living (ADLs), sports and recreation (Sport-Rec), quality of life (QoL), and overall KOOS scores. Conclusion Neoadjuvant arthroscopic mechanical debridement is a safe and quick procedure with minimal side effects, with improved overall KOOS scores.

Functional outcome after bicompartmental knee replacement for medial and patellofemoral osteoarthritis.

Total knee arthroplasty (TKA) is used for tricompartmental knee osteoarthritis, while unicompartmental knee arthroplasty (UKA) is preferred for unicompartmental knee osteoarthritis. Bicompartmental knee arthroplasty (BKA) aims to address 2 knee compartments by combining 2 UKA's or 1 UKA with a patellofemoral replacement. This study examines the clinical outcomes of BKA, focusing on pain alleviation and knee function. The aim of this study is to report the functional outcome of BKA and see if this aligns with BKA outcomes from literature in terms of patient reported outcome measurements (PROMs) and range of motion (ROM) after a 2-year follow-up. Additionally, radiographic alignment, implant survivorship, adverse events and length of stay are secondary outcomes. This is a cohort study of 21 patients who underwent BKA for medial and patellofemoral osteoarthritis. The patients had follow-up for at least 2 years postoperatively. PROMs were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Oxford Knee Score, Western Ontario and McMaster University Osteoarthritis index (WOMAC) and the Visual Analogue Scale (VAS). ROM was measured using a goniometer. Pre- and postoperative radiographic coronal alignment was measured using standard full leg radiographs. Patient demographics, implant survivorship, length of stay and adverse events were recorded. Twenty-one patients (23 knees) were included, with a mean follow-up of 41 months (standard deviation [SD] 12 months; range 24-59 months). Patient-reported outcome measures (PROMs) demonstrated significant improvements, with 80% achieving good to excellent OKS and KSS scores. KOOS scores were similar to scores found in literature. The WOMAC score was higher in our results compared to other authors. Which indicates worse outcome. The mean preoperative hip-knee-ankle angle (HKAA) was 2.4 degrees varus (SD 1.9 degrees; range 1.2 degrees valgus - 6.1 degrees varus), while the mean postoperative HKAA was 0.3 degrees valgus (SD 2.8 degrees; range 4.6 degrees valgus - 5.6 degrees varus) (p < 0.001). Postoperative range of motion averaged 117 degrees (SD 10 degrees; range 98-132). BKA shows promise in alleviating pain and improving knee function in patients with medial and patellofemoral osteoarthritis. Challenges include the risk of revision and technical difficulties during surgery. Comparative studies suggest similar outcomes between BKA and TKA, with potential advantages for younger, more active patients. Further research, particularly randomized trials with larger cohorts, is necessary to elucidate the long-term benefits and drawbacks of BKA compared to other knee arthroplasty options.

The effect of intra-articular autologous protein solution on knee osteoarthritis symptoms.

Knee osteoarthritis (OA) is characterized by a chronic inflammatory process involving multiple cytokine pathways, leading to articular cartilage degeneration. Intra-articular therapies using pharmaceutical or autologous anti-inflammatory factors offer potential non-surgical treatment options. Autologous protein solution (APS) is one such product that uses the patient's blood to produce a concentrate of cells and anti-inflammatory cytokines. This study evaluated the effect of a specific APS intra-articular injection (nSTRIDE) on patient-reported outcome measures compared to saline in moderate knee OA. A parallel, double-blinded, placebo-controlled randomized controlled trial was conducted, where patients with unilateral moderate knee OA (Kellgren-Lawrence grade 2 or 3) received either nSTRIDE or saline (placebo) injection to their symptomatic knee. The primary outcome was the difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months post-intervention. Secondary outcomes included WOMAC component scores, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analogue scale (VAS) scores at all follow-up timepoints (three, six, and 12 months). A total of 40 patients were analyzed (21 nSTRIDE; 19 saline) in the study. No significant difference was found between nSTRIDE and saline groups for WOMAC total score at 12 months (mean difference -10.4 (95% CI -24.4 to 3.6; p = 0.141). There were no significant differences in WOMAC or KOOS scores across all timepoints. VAS scores favoured the saline group for both rest and worst pain scales at 12 months post-injection (mean difference (worst) 12 months 21.5 (95% CI 6.2 to 36.8; p = 0.008); mean difference (rest) 12 months 17.8 (95% CI 2.2 to 33.4; p = 0.026)). There were no adverse events recorded in either study group. Our study demonstrates no significant differences between nSTRIDE and saline groups in KOOS and WOMAC scores over time. Notably, APS injection resulted in significantly worse pain symptoms at 12 months compared to saline injection.

Increased Cellular Dosage of Bone Marrow Aspiration Concentrate Does Not Translate to Increased Clinical Effectiveness in Knee Osteoarthritis: A Phase I Dose Escalation Study.

Knee osteoarthritis (KOA), a chronic degenerative disease, significantly impairs quality of life due to pain and mobility limitations. Traditional treatments focus on symptom management without addressing the underlying disease progression, leading to a growing interest in regenerative medicine approaches. Bone marrow aspirate concentrate (BMAC), rich in mesenchymal stem cells and growth factors, has shown potential for cartilage repair and symptom relief in KOA. Despite promising outcomes, the optimal BMAC dosage for knee OA treatment remains undetermined. This study aims to evaluate the clinical efficacy and safety of varying BMAC dosages in knee OA treatment. This prospective controlled dose-escalation study involved 75 patients with early-stage knee OA, categorized into three groups based on BMAC dosage administered 10 × 106 cells (low-dose group), 50 × 106 cells (medium-dose group), or 100 × 106 cells (high-dose group). All the patients underwent a single intra-articular injection of BMAC and were monitored over a year. The primary outcomes include Visual Analog Scale (VAS) for pain and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for joint function recorded at baseline, 1, 3, 6, and 12months post-intervention. Adverse events were also documented. Significant clinical improvements in VAS and KOOS scores were noted across all groups at all time points compared to the baseline. However, these improvements did not significantly differ between dosage groups throughout the follow-up period. Adverse effects were minimal and primarily consisted of transient post-injection pain and effusion, with no dose-dependent increase in complications. BMAC treatment for knee OA is safe and demonstrates potential for significant pain relief and functional improvement, irrespective of the dosage administered within the tested range. The lack of significant differences among varying dosages suggests a plateau in therapeutic efficacy beyond a certain threshold. Further research is necessary on the long-term outcomes to optimize the dosing strategy.

Experience in the production and clinical application of the cell-based medicinal product Easytense® for the repair of cartilage defects of the human knee

INTRODUCTION. The current cell-based cartilage repair methods, such as autologous chondrocyte transplantation, are not sufficiently effective, and the surgery is painful and traumatic. Therefore, there is a need for a more effective cell therapy product with a minimally invasive surgical procedure for its implantation into the patient.AIM. This study aimed to develop a manufacturing technology for the production of an autologous cell-based medicinal product (CBMP) comprising three-dimensional structures (3D-spheroids) based on chondrocytes isolated from the patient’s cartilage tissue, as well as to evaluate its clinical efficacy.MATERIALS AND METHODS. Autologous chondrocytes isolated from the patient’s cartilage biopsy were propagated in monolayer culture to obtain the required number of cells. Subsequently, the chondrocytes were cultivated on plates with a non-adhesive coating to form 3D spheroids. All CBMP production steps were performed under aseptic conditions in cell culture isolators. The authors used phase-contrast microscopy and immunohistochemical staining with specific fluorescence-labelled antibodies to characterise chondrocyte phenotypes at different stages of cultivation. Genetic stability was controlled by karyotyping. The efficacy of Easytense® was evaluated in a clinical trial using specialised functional tests and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. The primary efficacy endpoint was a change in the overall score on the Knee Injury and Osteoarthritis Outcome Score (KOOS).RESULTS. A manufacturing technology without using animal sera, growth factors, cytokines, or other additives was developed for the production of the autologous CBMP Easytense®. Karyological data confirmed that the chondrocytes retained genetic stability for 3 passages in monolayer culture. When cultured as 3D spheroids, the chondrocytes produced cartilage extracellular matrix proteins (type II collagen, aggrecan), thus acquiring the ability to repair damaged cartilage. The clinical trial demonstrated a statistically significant improvement in knee cartilage 12 months after the transplantation of 3D spheroids derived from autologous chondrocytes. The mean change in the overall KOOS score was 23.8±15.9.CONCLUSIONS. The clinical trial results indicate that Easytense® is highly effective for cartilage repair. Based on these results, the CBMP has been granted marketing authorisation and introduced into clinical practice in the Russian Federation. Easytense® has the potential to replace endoprosthetics and expensive surgeries abroad.

Exercise Therapy versus Arthroscopic Partial Meniscectomy for Degenerative Meniscal Tear in Middle Aged Patients

Background: Degenerative meniscal tears are prevalent among middle-aged individuals, often leading to significant knee pain and functional impairment. The effectiveness of non-surgical interventions, such as exercise therapy, compared to arthroscopic partial meniscectomy (APM), remains a key area of research in managing this condition. Objective: To compare the efficacy of exercise therapy versus APM in improving pain relief, functional outcomes, and patient satisfaction in middle-aged patients with degenerative meniscal tears. Methods: This randomized control trial was conducted at Lahore General Hospital from May to November 2023, enrolling 80 patients aged 40 to 60 years with confirmed symptomatic degenerative meniscal tears via MRI. Participants were randomly assigned to receive either exercise therapy or APM. Outcomes were assessed using the visual analog scale (VAS) for pain and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for functionality. Results: The study included 80 participants, with mean ages of 52.09 ± 4.31 years in the exercise group and 52.98 ± 3.43 years in the APM group. Initial VAS scores were 6.5 and 6.7 respectively. Post-treatment, the exercise group reported a VAS score of 5.2, and the APM group 5.0 (p=0.345). KOOS scores were 80 in the exercise group and 82 in the APM group (p=0.421). The return to activity rates were 75% for the exercise group and 80% for the APM group (p=0.632). Conclusion: Both exercise therapy and APM provided comparable pain relief, functional improvements, and high patient satisfaction in the treatment of degenerative meniscal tears in middle-aged patients.

The Effectiveness of Herbal Poultice in Relieving Pain and Flexibility in Osteoarthritis Patients

Knee osteoarthritis (OA) is a chronic condition that causes joint degradation and primarily affects the elderly, reducing their quality of life and physical movements. The objective of this study was to determine the efficacy of Thai herbal poultice in relieving pain in OA patients. A single-blind, randomized controlled trial was conducted amongst OA patients at Integrative medicine clinic, Chulabhorn International College of Medicine, Thammasat University, Thailand. Participants were randomly allocated to the Thai herbal poultice or the diclofenac gel group (N=30). The main outcomes were evaluated using visual analog scale (VAS), isokinetic testing, goniometer, and knee injury and osteoarthritis outcome scores (KOOS) at different time assessment. Data were analyzed by the paired t-test and analysis of variance (ANOVA). Thai herbal poultice and diclofenac group showed a significant difference in both the VAS pain scores, extension and flexion as well as KOOS scores (P &lt; 0.01 in both groups). In addition, when compared to diclofenac group, Thai herbal poultice group were significantly improve pain score at the sixth time point following the intervention (P &lt; 0.01). Furthermore, no patients have experienced allergic reactions to therapies. In conclusion, Thai herbal poultice showed more efficiency in reducing pain scores than diclofenac gel without causing undesirable side effects.

The Impact of Pes Planus on Knee Function and Its Association with Medial Compartment Knee Osteoarthritis.

Pes planus, commonly known as flat foot, is characterized by the lowering of the medial longitudinal arch of the foot, leading to alterations in lower limb biomechanics and potential pain and injury. This condition can affect the mechanical alignment and dynamic function of the lower limb, potentially contributing to the development and progression of knee osteoarthritis (OA). This study aims to investigate the association between pes planus and medial compartment knee OA as well as its impact on the knee functional score. This cross-sectional study included 165 patients aged 20-72 years. Inclusion criteria were individuals with unilateral or bilateral flat feet, while exclusion criteria were other foot conditions, history of knee or ankle surgeries, rheumatoid arthritis, and limb length discrepancies. Clinical assessments included knee joint tenderness, foot arch measurement using the foot arch index, and radiographic evaluations of Meary's angle and tibiofemoral (TF) angle. The knee injury and osteoarthritis outcome score (KOOS) was used to assess knee function. The study population had a mean age of 43.98 ± 13.17 years. Meary's angle ranged from 5 to 19° (mean 9.46), and the foot arch index ranged from 0.220 to 0.520 (mean 0.33). The TF angle ranged from 1.7 to 7.5° (mean 4.98). KOOS scores varied from 10 to 100 (mean 62.40). Patients with more severe flat feet (higher Meary's angle and foot arch index) had significantly lower KOOS scores, indicating worse knee function and greater pain. The correlations between foot arch index, Meary's angle, and KOOS scores were statistically significant (P = 0.001). This study demonstrates a strong association between flat foot severity and knee OA. Increased Meary's angle and foot arch index were correlated with worsened knee function and increased pain, as measured by KOOS scores. These findings highlight the importance of assessing foot posture in patients with medial compartment OA and suggest that early intervention and orthotic management could be beneficial in mitigating the progression and severity of knee OA in patients with pes planus.

An observational retrospective study on safety and functional outcomes of arthroscopic anterior cruciate ligament reconstruction using Sironix suture button and interference screw

Background: Anterior cruciate ligament (ACL) injury is a persistent orthopaedic condition that affects a wide spectrum of people. ACL reconstruction (ACL-R) stands out as the primary treatment option. Graft fixation with suture buttons and interference screws has proven to be a highly successful and reliable method for ACL-R. In this context, our research aims to assess the safety and functional outcomes of patients who underwent arthroscopic ACL-R using the Sironix suture button and interference screw. Methods: This was a retrospective observational study. Patients who underwent arthroscopic ACL-R using Sironix suture button and interference screw (January 2018-March 2022) were included in the study. Functional outcomes of patients were evaluated using the international knee documentation committee (IKDC) assessment, the Tegner activity scale (TAS), the Lysholm knee scoring scale, the modified knee injury and osteoarthritis outcome score (KOOS) quality of life subscale, and the single assessment numerical evaluation (SANE) score. Adverse events, if any, were recorded. Results: All patients achieved excellent outcome measures for IKDC, Tegner, Lysholm, KOOS, and SANE scores. The mean (SD) IKDC score was 88.76 (7.16), Tegner activity score was 5.9 (1.13), while the Lysholm score was 96.9 (6.56). The overall KOOS score was 93.7 (7.52), and the overall SANE score for the affected joint was 94.5 (7.22). Conclusions: Arthroscopic ACL-R using Sironix implants (Helysis titanium interference screw, Helysis PLDLA+β-TCP interference screw, Infiloop fixed loop UHMWPE suture titanium button, Proloop adjustable loop UHMWPE suture Titanium button, and Titanium suture disc) demonstrated safety and good functional outcomes.

Improved Patient-reported Outcomes in Patients Aged 16 and Younger at Two Years After Anterior Cruciate Ligament Reconstruction Despite Relatively High Rates of Reinjury and Repeat Surgery.

Anterior cruciate ligament reconstruction (ACLR) in adolescent patients, particularly those aged 16 and under, are increasingly common procedure that lacks robust clinical and patient-reported outcome (PRO) data. The purpose of this study was to report 2-year PROs of patients receiving ACLR aged 16 or younger using the single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome score (KOOS). Secondary aims included characterizing treatment characteristics, return to sport (RTS), and clinical outcomes. The institutional PRO database was queried for patients receiving ACLR from 2009 to 2020. Patients aged older than 16, revision procedures, concomitant ligament repairs/reconstructions, and patients without full outcome data at 2 years were excluded. Outcomes over 2 years after ACLR included SANE, KOOS, reinjuries, reoperations, and time to RTS. A total of 98 patients were included with an average age of 15.0 years. Most patients were females (77.6%). Bone-tendon-bone autograft (69.4%) was the most used. Average RTS was 8.7 months (range: 4.8 to 24.0mo), with 90% of patients eventually returning to sport. A total of 23 patients (23.5%) experienced a reinjury and 24.5% (n = 24) underwent reoperation. Timing to RTS was not associated with reinjury, but patients who returned between 9.5 and 13.7 months did not sustain reinjuries. Mean KOOS and SANE scores at 2 years were 87.1 and 89.1, respectively, with an average improvement of +18.4 and +22.9, respectively. Change in KOOS was negatively impacted by reinjury to the anterior cruciate ligament graft and reoperation (anterior cruciate ligament failure: +10.0 vs 19.3, P = 0.081, respectively; reoperation: +13.2 vs +20.1, P = 0.051, respectively), though these did not reach statistical significance. Patients experienced improved SANE and KOOS scores after ACLR. Rates of reinjury and reoperation were relatively high and negatively impacted PRO scores but were not associated with the timing of RTS. Adolescent patients should be counseled regarding the risk of subsequent ipsilateral and contralateral knee injury after ACLR. Level IV-case series.

A Comparative Study of Anterior Cruciate Ligament Reconstruction Versus Conservative Treatment.

Background The anterior cruciate ligament (ACL) rupture is a common injury with an incidence of 68.6 in 100,000 patients per year. Despite extensive research on ACL rupture, there are insufficient high-quality studies to determine clear treatment strategies for adults lacking the ACL. This study aims to examine the functional differences between surgical and conservative treatment based on the quality of the surgical process. Methodology In this prospective, comparative study, a total of 136 patients aged between 18 and 35 years were enrolled per inclusion and exclusion criteria. Using the lottery system, patients were dividedinto the following two groups: group A (n = 71) and group B (n = 65). Group A was treated with arthroscopic ACL reconstruction and rehabilitation, whereas group B was treated conservatively (rehabilitation). Patient data, including age, sex, body mass index, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Level (TAL) score, and complications were recorded and compared. Results The demographic data were comparable, where males had dominancy in both groups. The mean IKDC and KOOS scores were higher in group A at all follow-ups compared to group B. The scores gradually increased at every follow-up till six months. At the final follow-up, the IKDC and KOOS scores were higher in group A than in group B, and a significant difference was observed among both groups. The TAL score also gradually increased at every follow-up till 6 months. At the final follow-up, the TAL score was higher in group A than in group B, with a significant difference between the two groups (p = 0.0032). Complications in both groups were comparable. Conclusions This study showed that both the conservatively treated group and the rebuilt group had identical outcomes, with the exception of the conservative group having greater objectively quantifiable instability. However, at the final follow-up, patients reported feeling just as satisfied with their knee without surgery, demonstrating no subjective difference in activity levels or functional outcomes. Therefore, non-athletes with an ACL-insufficient knee should still choose conservative treatment.

Clinical outcome of iterative meniscal suture after ACL reconstruction at a minimum of 2 years’ follow-up

IntroductionFailure rates in meniscal suture associated to ACL reconstruction range from 10 to 26.9%, often leading to meniscectomy. In young patients, the wish to conserve the meniscus may lead to iterative suture, if the lesion allows. There are no data available for clinical results of repeat meniscal suture at the same site as the primary lesion in a stabilized knee. The immediate socioeconomic cost, compared to meniscectomy, needs to be taken into account, and benefit needs to be demonstrated. The main aim of the present study was to assess the rate of secondary meniscectomy after iterative meniscal suture in stabilized knees. The study hypothesis was that failure rates are higher in iterative isolated meniscal suture after ligament reconstruction than in primary repair. Material and methodsThis single-center retrospective study analyzed patients receiving iterative meniscal suture on stable knee, between 2009 and 2019, with a minimum 26 months’ follow-up. Twenty-three patients were analyzed: 15 male, 8 female; mean age at iterative suture, 28.1±7.9 years (range, 14–49 years); mean BMI, 24.2±2.9kg/m2 (range, 19–31). Mean time to recurrence was 38.9±25.1 months (range, 6–93 months). Initial ACL graft used the patellar ligament in 69.6% of cases (n=16) and the hamstrings in 30.4% (n=7). Mean differential laximetry before iterative suture was 1.7±0.3mm (range, 1.2–2.3mm). Iterative suture was in the medial meniscus in 69.6% of cases (16/23) and in the lateral meniscus in 30.4% (7/23). Risk factors for failure, defined by requirement for meniscectomy, were assessed. Functional results were assessed on Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Tegner score. ResultsThe failure rate was 48% (11/23), incorporating all lesions together. Bucket-handle tear was most frequently associated with failure (91%; p<0.01). There was significant improvement after iterative suture in subjective IKDC score (51.6±15.2 vs. 81.3±15.6; p<0.001) and KOOS scores: symptoms and stiffness, 66.6±13.7 vs. 91.1±7.53 (p<0.001); pain, 79.2±12.7 vs. 93.4±7.4 (p<0.01); function, 91.3±11.2 vs. 97.9±4.44 (p<0.001); quality of life, 38.1±23.2 vs. 62.3±30.1 (p<0.001). ConclusionThe failure rate for iterative meniscal suture on stabilized knee was 48%. Bucket-handle tear was a major risk factor for failure (91%). Despite these high failure rates, functional results systematically improved. Level of evidenceIV.

Satisfactory outcomes after one-stage revision anterior cruciate ligament reconstruction using rectangular tunnel technique.

One-stage revision anterior cruciate ligament reconstruction (ACLR) with the anatomic rectangular tunnel (RT) technique using bone-patellar tendon-bone (BTB) grafts results in anatomically precise tunnel placement and secure graft fixation. This study evaluated knee joint laxity and clinical outcomes in terms of femoral tunnel overlap. It was hypothesised that there would be no significant differences in knee joint laxity or clinical outcomes regardless of femoral tunnel overlap. Between 2012 and 2021, a single surgeon conducted 196 one-stage revision ACLRs with the RT technique using BTB grafts. Patients were divided based on the presence of femoral tunnel overlap. Knee joint laxity was evaluated using the Lachman test, pivot shift test, and side-to-side difference measured with a KT-1000 arthrometer. Clinical outcomes were assessed using the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Knee Examination Form 2000. Knee joint laxity and clinical outcomes were compared between groups after a median follow-up of 2.5years (range 2.0-8.0). The study included 30 and 73 patients in the overlap and non-overlap groups, respectively. No significant differences were observed in the results of the Lachman test, pivot shift test, or KT-1000 arthrometer as well as in the Lysholm, KOOS, or IKDC scores between the two groups. Based on the IKDC scores, all patients were graded as normal or nearly normal. One-stage revision ACLR with the RT technique using BTB grafts improved knee joint laxity and had favourable clinical outcomes regardless of femoral tunnel overlap. To achieve optimal results in one-stage revision ACLR, it is crucial to create a tunnel within the anatomical attachment area and ensure proper graft fixation and tensioning. III.

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty.

The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes. This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coefficient. During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients. Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies. IV, retrospective case series.

Medial meniscal repair in stable knees: Survival rate and risk factors for failure at a minimum of 5 years

IntroductionThe menisci play a major role in the protection of the knee against osteoarthritis. A medial meniscus (MM) tear occurring in a stable knee is more at risk of repair failure than a suture concomitant with reconstruction of the anterior cruciate ligament. HypothesisThe survival of MM sutures in stable knees depends on the type of lesion. Materials and methodsThis retrospective study was carried out as part of the 2022 Francophone Arthroscopy Society's symposium, across 10 centers (Bordeaux-Mérignac, Caen, Lille, Lille Louvière, Lyon, Marseille, Toulouse, Saint-Étienne, Strasbourg and Versailles) including medial meniscus sutures in stable knees performed before the end of 2017 (minimum 5 years of follow-up) with a collection of demographic, imaging, suture and postoperative protocol data, and a functional evaluation using the Knee injury and Osteoarthritis Outcome score (KOOS). The aim of this study was to analyze the medial meniscus sutures in stable knees and to evaluate their survival and their risk factors for failure according to the type of lesion; failure being defined by the use of a meniscectomy. ResultsThree-hundred and sixty-seven MM sutures, including 122 bucket-handle tears, were included. The KOOS score was improved by the meniscal suture by an average of 22.2 points for each sub-score (p<0.05), with an improvement, which was more marked for the bucket-handle tears. The failure rate, defined by revision surgery by meniscectomy, was 33% on average (42% for bucket-handles tears, 26% for others). The probability of survival was reduced for bucket-handle tears (62% at 5 years versus 77% for the other types). For all lesions, the main risk factor identified for failure was immediate weight-bearing [OR=3.6 (1.62; 7.98), p=0.0016]. Smoking was a failure risk factor for bucket-handle tears [OR=5.76 (1.81; 18.35), p=0.003]. ConclusionMM sutures in stable knees improve knee function but present a different risk of failure depending on the type of lesion treated with a higher risk of failure for bucket-handle tears with the need for caution to be applied with regards to weight-bearing and smoking. Level of evidenceIV; retrospective series.

Inflammatory biomarkers in patients with painful knee osteoarthritis: exploring the potential link to chronic postoperative pain after total knee arthroplasty-a secondary analysis.

Total knee arthroplasty (TKA) is the end-stage treatment of knee osteoarthritis (OA), and approximately 20% of patients experience chronic postoperative pain. Studies indicate that inflammatory biomarkers might be associated with pain in OA and potentially linked to the development of chronic postoperative pain after TKA. This study aimed to (1) evaluate preoperative serum levels of inflammatory biomarkers in patients with OA and healthy control subjects, (2) investigate preoperative differences of inflammatory biomarker profiles in subgroups of patients, and (3) compare subgroups of patients with and without postoperative pain 12 months after surgery. Serum samples from patients with OA scheduled for TKA (n = 127) and healthy participants (n = 39) were analyzed. Patients completed the Knee-injury-and-Osteoarthritis-Outcome-Score (KOOS) questionnaire and rated their clinical pain intensity using a visual analog scale (VAS) before and 12 months after TKA. Hierarchical cluster analysis and Orthogonal Partial Least Squares Discriminant Analysis were used to compare groups (patients vs control subjects) and to identify subgroups of patients in relation to postoperative outcomes. Difference in preoperative and postoperative VAS and KOOS scores were compared across subgroups. Twelve inflammatory markers were differentially expressed in patients when compared with control subjects. Cluster analysis identified 2 subgroups of patients with 23 proteins being significantly different ( P < 0.01). The 12-months postoperative VAS and KOOS scores were significantly different between subgroups of patients ( P < 0.05). This study identified differences in specific inflammatory biomarker profiles when comparing patients with OA and control subjects. Cluster analysis identified 2 subgroups of patients with OA, with one subgroup demonstrating comparatively worse 12-month postoperative pain intensity and function scores.

Treatment with CR500® improves algofunctional scores in patients with knee osteoarthritis: a post-market confirmatory interventional, single arm clinical investigation

BackgroundKnee osteoarthritis (OA) is a progressive and degenerative condition. Several pharmacological and non-pharmacological treatments are able to improve the OA symptoms and the structural characteristics of the affected joints. Among these, infiltrative therapy with hyaluronic acid (HA) is the most used and consolidated procedure for the pain management. The addition of skin conditioning peptides to HA promotes the cartilage remodeling processes and a better permeation of the HA-based gel containing a peptide mixture, CR500®. Furthermore, the topic route of administration is convenient over the routinely used intra-articular injective procedures. In this study, the effectiveness of CR500® was evaluated in terms of improvement of the algo-functional symptoms related to unilateral knee OA.Methods38 mild and moderate OA patients were enrolled at a screening visit (V-1), treated at baseline visit (V1), and then continued the topical application of CR500® twice a week for 4 weeks, and followed-up for 3 visits (V2-V4) from week 2 to 4. Lequesne Knee Index (LKI) and Knee injury and Osteoarthritis Outcome Score (KOOS) were collected. Synovial fluid was collected and used for the quantification of neoepitope of type II collagen (C2C), C-terminal telopeptide of type II collagen (CTX-II), type II collagen propeptide (CPII), tumor necrosis factor alpha (TNFα) and HA. The expression of CD11c and CD206 was evaluated on cell pellets.ResultsThree patients were excluded, thus 35 patients were included in the analysis. The treatment with CR500® was safe and well tolerated, with 7.9% patients had mild adverse events, not related to the device. The LKI total score showed a significant decrease from V1 to V4. KOOS score also showed a significant improvement of patient condition at V2, V3 and V4 in comparison with V1 for all subscales, except for KOOS sport subscale which improved only from V3. At V1 a negative correlation among KOOS pain subscale values and C2C, CPII and TNFα levels was observed, as well as a positive correlation between KOOS pain subscale and CD11c/CD206 ratio.ConclusionCR500® is safe and appear to be effective in improving pain and function in OA patients during the 4 weeks of treatment.Trial registrationClinicalTrials.gov ID: NCT05661162. This trial was registered on 22/12/2022.