KOOS Scores Research Articles

Long term outcomes of computer navigated lateral opening wedge distal femoral osteotomy for lateral compartment knee arthrosis

Introduction:Osteotomy of the distal femur (DFO) to address symptomatic degeneration in the knee is a well-established procedure with good results reported in the literature . Broadly the osteotomy is based on either an opening or a closing wedge alignment technique. Several patient related parameters including age, gender, body mass index (BMI) and surgical factors such as osteotomy site, gap, and fixation technique amongst others have been demonstrated to influence the outcome of DFO. Preoperative planning based on imaging is vital to assess the type and extent of deformity correction to be undertaken in order to achieve optimal alignment. Computer-assisted surgery (CAS) has been extensively used as dynamic intraoperative alignment aid in knee arthroplasty providing good outcomes. Several investigators in the current literature have utilised computer navigation in proximal tibial osteotomy and reported improved accuracy in realising the planned alignment. However there is paucity of studies reporting the long-term outcomes of distal femur lateral opening-wedge (DFLOWO) using computer navigation. Through our study we aim to report on the long-term outcomes and survivorship of computer navigated DFLOWO.Hypotheses:We hypothesize that use of computer navigation will improve the survivorship of distal femoral osteotomy.Methods:Ethics committee approval was obtained for this study. Due consent was taken for the use of data from all the patients for this study. A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated lateral opening wedge distal femoral osteotomy from December 2006 to November 2012 was performed. Consecutive patients of lateral compartment knee arthrosis aged less than 55 years who failed to respond to conservative management were included in the study. Patients who had end stage arthritis with fixed flexion deformity of > 15 degrees, < 90 degrees of knee flexion or who did not consent for the procedure were excluded.Included patients were operated by one of the three senior surgeons attached to our research institute. The included patients were followed up with clinical and radiological evaluation at regular intervals (6 weeks / 6 months / 1 year / 5years). The final follow-up for the included patients was done using email questionnaire of the patient reported outcomes measures. Conversion to either UKA or TKA during the follow-up was the end point. Additionally, this information was verified from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) databaseResults:19 DFLOWO with mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1º (2-11º) valgus to mean 2.1º (0.5º - 3º) varus. IKDC scores improved from mean of 39 pre-op to 53 at the mean long-term follow-up of 9.1 years. KOOS scores at the long-term follow-up were pain-71, symptoms-56, activities of daily living-82, sports and recreation-59, quality of life-43. Survivorship of DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 ICRS cartilage degeneration in the medial compartment of knee and >7⁰ pre-operative valgus deformity strongly correlated with conversion to TKA at the long-term follow-up (r - 0.66).Conclusion:Computer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7 degrees pre-operative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.

Two-stage bone and meniscus allograft and autologous chondrocytes implant for unicompartmental osteoarthritis: midterm results.

We analyzed the clinical and radiographic evolution of patients with knee unicompartmental osteoarthritis and axis alteration and osteochondral lesions in the femoral condyle, treated with tibial plateau and meniscus allograft and cultured autologous chondrocyte implantation in the femur in two steps. To analyze the clinical results with the first patients treated with this two-stage technique to avoid knee prosthesis in patients with unicompartmental osteoarthritis. Sixteen patients, average age 56years, were included in a cohort study. We performed an osteotomy with tibia plateau allograft, including the meniscus. In a second surgery, the chondrocyte fibrin scaffold was placed in the femur. Clinical symptoms and function were measured using KSSR and KOOS scores. Wilcoxon's test was performed to compare the results over the 2-year follow-up period. Mean KSSR before surgery was 35.69 (SD: 3.75) points, rising to 67 (SD: 15.42) at 3months, 95.88 at 12months (SD: 2.68) and 96.31 at 24months (SD: 2.24). The KOOS before surgery was 65.14 (SD: 16.34), rising to 72.68 after 3months (SD: 19.15), 76.68 at 12months (SD: 18.92) and 64.28 at 24months (SD: 11.79). Four of 5 patients returned to engaging in the activity that they had stopped practicing. Three patients experienced collapse of the tibia allograft, and they needed later a prosthesis. Simultaneous tibia plateau allograft and autologous chondrocyte implantation in the femur, after correction of the angular deformity, were performed, restoring the anatomy of the medial compartment and knee function in 82% of the patients 2years after the operation. IV.

Assessment of the Patellofemoral Joint Condition and the Possibility of Its Functional Improvement after the Closed Fractures of the Patella

Relevance. The patellar fractures are relatively rare. Their clinical significance is associated with the fact that they can cause the development of severe patellofemoral pain syndrome. Lateral retinaculum release was introduced into clinical practice in 1970s for treating this syndrome and since was widely used. The biomechanical validity of this operation has been proven experimentally, but the role of lateral release in the prevention of patellofemoral arthritis progression and concomitant pain after patellar fractures remains poorly understood. The purpose of the study was to improve the results of the patellar fractures surgery by combining osteosynthesis with lateral retinaculum release. Materials and Methods. This was a non-randomized, cohort, open-label prospective study with retrospective control. The treatment results of the patients with closed patellar fractures were analyzed. The prospective group (n = 45) was formed sequentially during 2018–2019. The retrospective control group (n = 41) was selected from the database of the city center of traumatology according to the inclusion criteria. The difference between both group was that in the patients of the prospective group, open osteosynthesis of the patella with wire segments and a stretching wire loop was combined with minimally invasive release of the lateral retinaculum. The function of the operated knee joint was assessed in 12 months after the surgery by the KOOS. The magnitude of the patellar articular surface discongruence was measured by x-rays; the stage of patellofemoral arthritis was classified by Iwano. The statistical analysis included the calculation of medians, means, absence/presence differences in groups indicators, correlation analysis of the measured variables. Results. The comparing groups were heterogeneous in gender, age, and types of fractures: the prospective group comprised 18 women (49.7±14.7 years), 27 men (45.1±11.2 years), the retrospective 13 women (50.2±12.3 years), 28 men (41.9±10.7 years). In the prospective group, compared with retrospective, the 34-C1, 34-C2 fractures were prevailed. The null hypothesis about the equality of KOOS indicators and the stage of patellofemoral arthritis in both groups was rejected at the p0.05 significance level. The patients of the prospective group had better KOOS indicators. The Spearman’s correlation analysis revealed a positive relationship between KOOS scores in the range 0.26 to 0.41 and a negative correlation between the stage of arthritis (-0.29) and lateral release. Conclusion. Testing the null hypothesis that there was no difference between the KOOS scores between the prospective and control groups confirmed its inconsistency. The beneficial effect of lateral release on the knee function was demonstrated in the mid-term results of the patellar fractures osteosynthesis.

Unicompartmental versus total knee arthroplasty in the same patient

Despite good clinical outcomes, unicompartmental knee arthroplasty (UKA) still rises con-cerns as treatment for isolated medial knee arthritis, to the point that total knee arthroplasty (TKA) is still largely perceived as the best solution. The purpose of this study is to compare clinical results and survivorship rates of two different options for isolated medial arthritis in the same patient, UKA versus TKA, at a mid-term follow-up.Materials and methods. We retrospectively reviewed 22 patients with isolated medial arthritis treated with UKA in the period between 2004 and 2013, who had previously un-dergone TKA on the other knee. The mean follow-up was 9.2 years for UKA. The inclusion criteria were that preoperative KSS and KOOS scores were similar or presumed similar for both knees, and that the same degree of osteoarthritis affected both knees. Results. Clinical evaluation was carried on according to KSS and KOOS scores. At the final follow-up at 9.2 years, clinical outcomes between UKA and TKA were very similar. Significantly better results were, however, seen in range of motion (ROM) for UKA implants. Among patients invited to choose between the two procedures, 10 expressed no preference, 8 indicated a preference for UKA, and 4 for TKA. Final survivorship at 9.2 years follow-up was 95% for UKA and 100% for TKA.Conclusions. No differences were reported between TKA and UKA in terms of KSS and KOOS scores at a mid term follow-up, while significantly better results were detected for UKA considering ROM.

Arthroscopic reconstruction of anterior cruciate ligament with autologous ipsilateral peroneus longus tendon

To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction with the autologous ipsilateral peroneus longus tendon (PLT) under arthroscopy. A retrospective study was conducted on 35 patients with ACL rupture who underwent ACL reconstruction with autologous ipsilateral PLT under arthroscopy between October 2017 and October 2018. There were 19 males and 16 females with an average age of 43.4 years (range, 18-60 years), with 20 cases of left knee and 15 cases of right knee. The causes of injury included traffic accident in 14 cases, falling injury in 13 cases, and sports injury in 8 cases. The time from injury to operation ranged from 3 to 9 days (mean, 4.7 days). The patients suffered from swelling, pain, and limited mobility of knee joint before operation. The anterior drawer test, Lachman test, and pivot-shift test were positive before operation, whereas MRI was taken to confirm the ACL rupture. After operation, the patients were followed up every 3 months until the knee joint's function returned to normal. MRI and X-ray films were used to observe the tendon-bone healing as well as the position of Endobutton suspension plate and hollow nail. The anterior drawer test, Lachman test, and pivot-shift test were conducted to observe the improvement of knee joint mobility. The functional improvements were evaluated by the International Knee Documents Committee (IKDC) score, Lysholm score, knee injury and osteoarthritis (KOOS) score. All the 35 patients were followed up 12-18 months, with an average of 14.2 months. The incisions healed by first intention, and no complications such as infection, joint stiffness, and rerupture occurred. Postoperative anterior drawer test, Lachman test, and pivot-shift test turned to be negative of all patients. MRI showed that the ACL was continuous, and the tendon-bone in the distal femur tunnel and proximal tibia tunnel recovered well after operation. X-ray films showed that the positions of Endobutton suspension plate and hollow nail were stable. The IKDC, Lysholm, and KOOS scores at 3, 6, and 12 months after operation were significantly improved when compared with those before operation, and the scores were further improved with time after operation ( P<0.05). For patients with ACL rupture, ACL reconstruction with the autologous ipsilateral PLT under arthroscopy has satisfactory effectiveness of quick recovery, good function, and great stability.

Comparison Of Quadriceps Thickness And Strength, And Knee Function Between Individuals With Acl Reconstruction And Healthy Individuals

PURPOSE: To compare quadriceps thickness and strength, and self-reported knee function between individuals with ACL reconstruction (ACLR) and healthy individuals METHODS: 24 individuals who returned to sport after ACLR and 18 healthy individuals were included in this study. The ACLR group were divided into 2 groups according to time after surgery: <2 years after surgery (n=12) and >5 years after surgery (n=11). Vastus medialis obliquus (VMO), vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) muscle thickness were measured by ultrasound. Quadriceps peak torque at 60°/s and 180°/s were measured by isokinetic system, IKDC and KOOS scores were used to evaluate self-reported knee function. One way ANOVA was performed for statistical analysis RESULTS: VMO and VM muscle thickness were different between groups (p=0.01, p=0.003). ACLR group whose time after surgery <2 years had thicker VMO and VM compared to ACLR group whose time after surgery >5 years (p=0.02) and healthy group (p=0.02). There was no difference between groups in RF and VL muscle thickness (p>0.05). Quadriceps strength was also greater in ACLR group whose time after surgery <2 years at 60°/s (p=0.005) and 180°/s (p<0.001). IKDC and KOOS scores were greater in healthy group and ACLR group whose time after surgery <2 years compared to ACLR group >5 years after surgery (p<0.05). CONCLUSIONS: Time after surgery seems to affect quadriceps size and function, and self-reported knee function in individuals with ACLR. Better outcomes in ACLR groups whose time to surgery lower than 2 years may be due to post-operative rehabilitation effect. Decrease in self-reported knee function in long term after ACLR may not related to quadriceps muscle size and strength.

Meniscal and Articular Cartilage Predictors of Outcome following Revision ACL Reconstruction: A 6-Year Follow-up Study

Objectives:Previous work has shown that having a lateral meniscectomy prior to revision ACL surgery, as well as grade 3-4 chondral damage to the trochlea at the time of revision ACL surgery results in poorer outcomes at 2 years. Alternatively, meniscal or articular cartilage (AC) pathology documented at the time of a revision surgery were not found to be significant risk factors for 2-year activity levels. The purpose of this study was to follow this cohort for a longer time period, to determine if either meniscal and/or articular cartilage pathology noted at the time of revision ACL surgery significantly affects a patient’s activity level, sports function, and OA symptoms at 6-year follow-up.Methods:Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 6 years and asked to complete the identical set of outcome instruments.Regression analysis was used to control for age, gender, BMI, smoking status, activity level, baseline outcome scores, revision number, time since their last ACL reconstruction, graft choice, and previous and current meniscal and articular cartilage pathology, in order to assess the meniscal and AC pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction.Results:1234 patients met the inclusion criteria and were successfully enrolled, with 716 (58%) males and a median cohort age of 26 years. The median time since their last ACL reconstruction was 3.4 years. Surgeons noted previous pathology in the medial meniscus (39%), lateral meniscus (20%), and articular surfaces (12%) at the time of revision surgery. Surgeons reported current pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (MFC; 43%), lateral femoral condyle (LFC; 29%), medial tibial plateau (MTP; 11%), lateral tibial plateau (LTP; 17%), patella (30%), and trochlea (21%). At 6 years, follow-up was obtained on 77% (949/1234). Previous and current meniscal pathology (both medial and lateral), as well as current AC pathology (in the MFC, LTP, trochlea, and patella) were found to be significant drivers of poorer outcomes at 6 years. The most consistent cartilage-related factors driving outcome in revision patients were either a previous or current repair or excision of the medial meniscus and patellofemoral AC pathology. Six-year Marx activity levels were negatively impacted by having either a repair or an excision of the medial meniscus (odds ratio range =0.58-66; 95% CI=0.38-0.91; p=0.01) or having grade 3-4 patellar chondrosis (OR=0.57; 95% CI= 0.35-0.95; p=0.03). Conversely, 6-year activity levels significantly improved by having either a lateral meniscus repair or excision (OR=1.49-2.22; 95% CI=1.07-4.04; p=0.005). Previous medial or lateral meniscal pathology negatively affected all KOOS subscales except for sports/recreation (p<0.05). Articular pathology significantly impaired KOOS symptoms, sports/recreation and the quality of life subscales (p<0.05). The KOOS sports/recreation subscale was significantly affected by articular cartilage pathology (LTP, patella, trochlea; p<0.03). Lower baseline outcome scores, lower baseline activity level, and being a smoker all significantly increased the odds of reporting poorer clinical outcomes at 6 years.Conclusion:Meniscal and articular cartilage pathology was found to have a larger impact at 6 years following revision ACL surgery, as compared to 2-year follow-up. In contrast to 2-year follow-up, incidence of medial meniscal and AC pathology at the time of a patient’s revision surgery were found to significantly diminish a patient’s activity level at 6 years, whereas the incidence of lateral meniscal repair or excision was found to improve a patient’s activity level. Having a previous medial meniscal repair or excision or exhibiting grade 2-4 chondral damage noted at the time of ACL revision reconstruction results in poorer IKDC and KOOS scores and worse WOMAC pain and ADL scores at 6 years following revision surgery.

Females Have Earlier Muscle Strength and Functional Recovery After Bridge-Enhanced Anterior Cruciate Ligament Repair.

Background: While a sex effect on outcomes following anterior cruciate ligament (ACL) reconstruction surgery has been previously documented, less is known following bridge-enhanced ACL repair (BEAR). We hypothesized that female sex would have significantly worse early functional outcomes and higher retear rates following primary repair of the ACL enhanced with a tissue-engineered scaffold. Methods: Sixty-five patients (28 males and 37 females), age 14-35 with a complete ACL tear underwent primary repair of the ACL enhanced with a tissue-engineered scaffold (bridge-enhanced ACL repair) within 45 days of injury. International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome (KOOS) scores, as well as instrumented anteroposterior (AP) laxity through KT-1000 testing and functional outcome measures were obtained at time points up to 2 years postoperatively and compared between males and females using mixed model repeated measures analyses and chi square tests. Results: There was no significant sex difference on the postoperative IKDC Subjective Score at 3, 6, 12, or 24 months or any of the five KOOS scores at 12 and 24 months. Instrumented AP laxity testing demonstrated mean (standard deviation) side-to-side differences that were similar in the two sexes at 2 years; 1.7 (2.7) mm and 1.5 (3.7) mm in females and males, respectively, p = 0.72. At 6 months postoperatively, males had a larger deficit in hamstring strength on the operated leg (14.0% vs. 1.7%; p = 0.03) and a larger deficit in quadriceps strength on the operated leg (11.3% vs. 2.0%; p = 0.004); however, no sex difference was noted at 12 or 24 months. Females demonstrated superior single leg hop testing at 6 and 12 months ([91.3% vs. 78.1%, p = 0.001], [96.9% vs. 87.0%, p = 0.01] respectively). There were no significant sex differences on ipsilateral (males; 14.3% vs. females; 13.9%, p = 1.00) or contralateral (males; 3.6% vs. females; 2.8%, p = 1.00) ACL reinjury rates. Conclusions: Female subjects had better hamstring and quadriceps strength indices at 6 months than males as well as better hop test results at the 6 and 12-month time period. Despite this, there was no significant sex difference on patient-reported outcomes and objective AP laxity testing at time points up to 2 years postoperatively. Impact statement This is the first study comparing sex specific outcomes following the bridge-enhanced ACL repair technique (BEAR). The results of this study suggest that females have earlier recovery of both muscle strength and functional outcomes compared to their male counterparts. This is an important finding when considering future modifications to postoperative care and rehabilitation in females and males following this tissue-engineered BEAR technique.

Clinical improvement is significantly better with spheroid-based autologous chondrocyte implantation (ACI) manufactured with more stringent cell culture criteria

Background & Aim Background Spherox (CO.DON AG) is an autologous chondrocyte implantation (ACI) product, based on spheroid technology and consist of human autologous matrix-associated chondrocytes. From a cartilage biopsy, chondrocytes are isolated, expanded in vitro and subsequently transferred to a 3D cultivation phase. The tendency of primary chondrocytes to dedifferentiate during cultivation and the high biologic variability caused by the autologous nature of the starting material makes it challenging to design a manufacturing process that performs consistently and delivers products that meet their intended function and the high quality criteria for cell-based ATMPs. Aim The current study was set up to identify critical process parameter that could have a negative effect on the efficacy of the final product and subsequently justify the operational ranges of the manufacturing process using clinical data. Methods, Results & Conclusion Methods Correlation analyses were conducted between process parameters and clinical improvement data of 120 patients from Phase II and III treated with ACI (KOOS score, 1 year follow-up). Results This approach identified cell culture time as a critical process parameter that negatively correlates with the product's efficacy. Subsequent analyses of the Phase III patients that were treated with chondrocyte spheroids that have been manufactured with shorter monolayer and spheroid cultivation times showed a higher average clinical improvement as well as a higher responder rate compared to the total group. In addition, retrospective analyses demonstrated superiority for the treatment with short-cultivated chondrocyte spheroids over micro-fracture treatment. Conclusion These findings underscore the need to use clinical data to optimize the manufacturing process for autologous cell-based therapies. We expect that restricting the cultivation times during manufacturing minimizes the production of suboptimal batches, thus ensuring an efficacious product.

The arthroscopic popliteus bypass reconstruction for posterolateral instabilities of the knee - clinical results &gt; 2 year follow up

Aims and Objectives:Injuries of the posterior cruciate ligament (PCL) are most often accompanied by injuries of the posterolateral corner (PLC) and the ligamentum collaterale fibulare (LCL). This leads to a combined dorsal- and external rotational instability. Prior to this study a novel arthroscopic technique was developed to treat posterolateral injuries (Popliteus Bypass Graft). To date, there are no long term results reported for arthroscopic techniques to treat these injuries. This study evaluated the clinical outcome of patients undergoing this surgery with a minimum follow up of 2 years.Materials and Methods:In the ongoing study, 47 patients with posterolateral instabilities of the knee were treated with an arthroscopic reconstruction of the popliteus bypass graft in combination with a PCL reconstruction. Patients with a minimum follow up of 2 years were included in this study. The clinical outcome was evaluated by subjective and objective scores for stability, pain and activity level: Lysholm, Tegner, KOOS, Dial test, subjective scores (0-10) for function (0 good, 10 poor) und pain (0 no pain, 10 intense pain). The dorsal stability was measured with the rolimeter.Results:At the time of the abstract submission 17 patients where evaluated. The mean age at the time of the operation was 36.8 (±15.5) years, the mean BMI was 27.7 (±5.5). The mean time from the injury to the treatment was 6.9 (±5.3) months. The mean follow up time was 46.35 (±12.7) months. The mean postoperative Lysholm score was 88.7 (± 13.4). The mean Tegner score was 6.0 (±2.2) preoperative and changed to 5.3 (±2.2) postoperative. The KOOS score was evaluated for pain 87.2 (±19.5), symptoms 92.5 (±11.1), daily activity 89.2 (±16.9), function 73.1 (±28.9) and life quality 78.5 (±21.7). The mean Rolimeter measurement for the uninjured knee was 7.16mm (±2.2) compared to the operated side with 8,18mm (±1.7). The VAS score for function was 1.6 (±2.1) and 1.6 (±2.2) for pain.Conclusion:The arthroscopic reconstruction of posterolateral injuries provides good clinical and subjective results after a minimum follow up of 2 years.

Repair of large condylar osteochondral defects of the knee by collagen scaffold. Minimum two-year outcomes

IntroductionCollagen scaffolds are a good surgical option for covering large focal osteochondral defects in the knee. In the recent literature there is a wide range of patient profiles and chondral defect treatments (chondral and osteochondral defects, associated procedures, etc.). The aim of the present study was to evaluate clinical and imaging outcomes with collagen scaffolds and to assess any correlation between medium-term clinical outcome and MRI features. The hypothesis was that there is no correlation between clinical outcome and MRI after 2 years postoperatively. Material and methodsA single-center retrospective observational study included all patients receiving a MaioRegen® scaffold for large painful focal osteochondral defect of the femoral condyle. There were 17 patients, with a mean age of 28±9 years. Defect locations comprised 12 medial femoral condyles, 4 lateral femoral condyles and 1 lateral tibial plateau. Mean defect area was 4.5±1.4cm2. All patients were evaluated clinically and on KOOS and objective and subjective IKDC scales, with MRI at last follow-up. ResultsAt a mean follow-up of 46±17 months, mean subjective IKDC was 67.8±23; KOOS scores were: symptoms, 78±22; pain, 78±23; function, 85±20; sports, 66±27; and activities of daily living, 59±25. MRI MOCART score revealed incomplete scaffold healing in 21.4% of cases, with variable signal intensity within regenerated tissue. Functional scores did not correlate with reconstruction aspect on MRI. Discussion/Conclusion3D collagen scaffolds yield good medium-term clinical outcomes in large osteochondral defects of the knee. There is, however, a discrepancy between MRI features of the recipient site and objective and subjective clinical scores. These scaffolds may be a good option for treating large focal osteochondral defects in knees of young patients, but MRI does not provide satisfactory medium-term assessment.

Opioid use is associated with worse knee osteoarthritis at baseline and faster progression of degenerative changes: data from the osteoarthritis initiative (OAI)

Purpose: Despite current guidelines, opioids are frequently prescribed as pain medication for symptom control in osteoarthritis (OA). While chondrotoxicity of different subtypes of opioids is investigated and discussed in recent studies, the impact of opioid medication itself on progression of OA has not been clarified. Thus, the aim of this study was to investigate associations between opioid use with structural and clinical characteristic of OA of the knee using cross-sectional and longitudinal analyses, with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) and WOMAC and KOOS scores as outcomes.

Minimal important change values on the Knee injury and Osteoarthritis Outome Score (KOOS) predict future Quality Adjusted Life Years (QALYS) in 3,187 patients following acl reconstruction

Purpose: The Knee injury and Osteoarthritis Outcome Score (KOOS) is one of the most widely used self-reported outcome measures in populations with knee injury and osteoarthritis. A 10-point difference on the KOOS represents a minimal important change and a clinically meaningful difference. However, the impact of a 10-point difference on the KOOS on future health-related quality of life outcomes is unknown. The most important health-related quality of life-derived outcome for informing priority setting for resource allocation to healthcare interventions is Quality Adjusted Life Years (QALY), which are typically derived from longitudinal patient-reported outcomes and used in cost-utility (cost-effectiveness) analysis. This study aimed to investigate the extent to which KOOS scores predicted QALYs in a population following anterior cruciate ligament reconstruction (ACLR). Methods: Data from the Swedish Knee Ligament Registry, a nationwide registry comprising >90% of ACLRs performed in Sweden, were collected prospectively between 2005-2016. Main inclusion criteria consisted of primary ACLR and age >12 years. Patient-reported outcomes of KOOS and European Quality of Life-5 Dimensions (EQ5D) were administered preoperatively and at 1-, 2-, and 5-year follow-ups. The primary outcome for the current analysis was QALYs accrued between 1-5 years post-ACLR derived from EQ-5D assessments using an area under the curve approach. The KOOS4 outcome was used to combine the mean scores for four of the five KOOS subscales, covering pain, symptoms, sport/recreation difficulty, and knee-related quality of life at 1-year postoperatively (0=worst, 100=best). Generalised linear models (Gaussian family) examined associations between 1-year KOOS4 and i) EQ-5D scores at each follow-up and ii) QALYs over a 4-year time horizon (i.e. 1- to 5-years). Results: A total of 3,187 participants (mean age 29 years, 53% male) with complete 1-, 2-, and 5-year follow-up data were included, totalling 12,748 follow-up years. A 10-point greater KOOS4 score (i.e. clinically important difference) at 1-year post-ACLR, was associated with higher EQ-5D multi-attribute utility score of 0.07 (95%CI 0.0.07-0.08) at 1-year (r2=48%, p<0.001), 0.05 (0.05-0.06) at 2-years (r2=27%, p<0.001), and 0.04 (0.04-0.05) at 5-years (r2=18%, p<0.0001). A 10-point higher KOOS4 at 1-year resulted in an additional 0.21 (0.20-0.22) QALYs accrued over the following 4-years. Conclusions: These results from a large national sample suggest that a clinically important improvement in KOOS4 of 10-points within the first year after ACLR would be associated with an additional 0.21 QALYs over the following 4-years. These findings are important for informing future cost-utility (cost-effectiveness using cost-per-QALY) modelling of benefits associated with interventions that improve patient outcomes after ACLR and in other populations using the KOOS.

Statistical validity and reliability of the Persian version of the Western Ontario Meniscal Evaluation Tool (WOMET) according to the COSMIN checklist

BackgroundThe Western Ontario Meniscal Evaluation Tool (WOMET) is the only questionnaire available to assess quality of life in patients with isolated meniscal injuries. The aims of this study were to prepare the Persian version of the WOMET (PWOMET) and validate it in Iranian patients with isolated meniscal tears.MethodsIn the first stage, the English version of WOMET was translated into Persian. Content validity, and qualitative and quantitative (impact score) face validity were tested by specialists and in a sample of 30 patients. In the second stage, PWOMET was assessed for the evaluation of psychometric properties in 100 patients with isolated meniscal injury and 50 healthy people based on the COSMIN checklist. Construct validity was tested based on structural validity (factor analysis) and hypothesis testing. Correlation with the total scores on the SF-36, IKDC and KOOS were used for concurrent criterion validity. Test-retest reliability and internal consistency were calculated using intraclass correlation coefficient (ICC) and Cronbach’s alpha, respectively. In addition the standard error of measurement (SEM) and smallest detectable change were calculated. Interpretability was investigated as the ceiling and floor effects and minimal important difference.ResultsThe PWOMET had acceptable qualitative face validity and content validity. The impact score (quantitative face validity) was more than 1.5 for all items. For construct validity, structural validity (factor analysis) and hypothesis testing ability were confirmed. Correlations between the PWOMET total score and IKDC, SF-36, KOOS scores were 0.61, 0.54 and 0.63, respectively (p < 0.001), thus confirming concurrent criterion validity. The intraclass correlation coefficient, Cronbach’s alpha, SEM and smallest detectable change for the PWOMET were 0.73, 0.89, 9.43 and 26.13, respectively. The PWOMET had no ceiling or floor effects, and minimal important difference was 9.07.ConclusionThe PWOMET provides valid and reliable scores for assessment of the quality of life in patients with isolated meniscal injury.

Paediatric proximal ACL tears managed with direct ACL repair is safe, effective and has excellent short-term outcomes.

Anterior cruciate ligament (ACL) surgery in the paediatric population has long been a challenge. Non-operative treatment will result in persistent instability which can lead to chondral and meniscal injuries. The results of primary open ACL repair are poor. Concerns of growth plate disturbance with transphyseal techniques and issues with relatively small-diameter grafts in Tanner 1 and 2 patients, which are inadequate, have contributed to these challenges. With advancing instrumentation, there is renewed interest in ACL repair. The minimally invasive approach of arthroscopic primary ACL repair retains the native ligament. The objective and subjective outcomes at 2years are presented. Paediatric patients, less than 16years of age, presenting acutely with complete proximal ACL ruptures underwent direct arthroscopic ACL repair, reinforced by a temporary internal brace, which was subsequently removed after 3months. Patient-reported outcome measures including the Lysholm, Tegner and KOOS scores were collected at 6months, 1year and 2years post-operatively. Twenty patients (age 6-16) completed data at 2years post-operatively. There were no failures, no complications and no growth disturbance out to 2years. The 2-year postoperative outcomes; Lysholm 95 (90-100), Tegner 7 (6-10), KOOS-Child 96.5 (88.9-100) demonstrated statistically significant improvements following surgery (p < 0.001). Objective measurements with an accelerometer did not demonstrate any significant side-to-side difference. ACL repair for proximal ACL tears in the paediatric population demonstrates the potential for excellent outcomes at short-term follow-up. This presents an attractive alternative to ACL reconstruction when an adequate ACL remnant permits direct repair. Our results demonstrate that paediatric ACL repair is safe and effective.

Clinical outcome is significantly better with spheroid-based autologous chondrocyte implantation manufactured with more stringent cell culture criteria

Spherox (CO.DON AG) is an autologous chondrocyte implantation (ACI) product, consisting of spheroids of human autologous matrix-associated chondrocytes. The tendency of primary chondrocytes to dedifferentiate during cultivation and the high biologic variability caused by the autologous nature of the starting material makes it challenging to design a manufacturing process that performs consistently and delivers products that meet their intended function and the high quality criteria for cell-based ATMPs. The current study was submitted during the European authorization procedure, and addresses the requirement to justify the operational ranges of the manufacturing process using clinical data. In order to define the operational ranges, statistical correlation analyses were conducted between process parameters and clinical improvement data of 120 patients from Phase II and III treated with ACI (KOOS score, 1 year follow-up). This approach identified cell culture time as a critical process parameter that negatively correlates with the product's efficacy. Subsequent analyses of the Phase III patients that were treated with chondrocyte spheroids that have been manufactured with shorter monolayer and spheroid cultivation times showed a higher average clinical improvement as well as a higher responder rate compared to the total group. In addition, retrospective analyses demonstrated superiority for the treatment with short-cultivated chondrocyte spheroids over micro-fracture treatment. These findings underscore the need to use clinical data to optimize the manufacturing process for autologous cell-based therapies. We expect that restricting the cultivation times during manufacturing minimizes the production of suboptimal batches, thus ensuring an efficacious product.

Arthroscopic Debridement Versus Platelet Rich Plasma Injection in Treatment of Moderate knee Osteoarthritis.

Background: Knee osteoarthritis (OA) is considered the most common disease affecting knee joint. Various strategies are utilized to decrease the symptoms of knee OA, like analgesics, physiotherapy, intra-articular glucocorticoids and hyaluronic acid [HA] injection as well as arthroscopic debridement (AD). New ‌studies have concentrated on new lines of treatment that stimulate damage improving and healing process of the cartilage, including mainly platelet-rich plasma (PRP) injection as a growth factors complex.Aim: Because of the high incidence of OA and its complications, this article aimed to study the effect of AD and PRP injection on patients with knee OA.Methods: This controlled randomized clinical trial involved 20 patients with moderate knee OA. In the PRP group (n = 10), three intra-articular injections at 10-days interval were applied and compared to AD group (n = 10). All patients were prospectively evaluated before and after 6 months of the treatment by KOOS score.Results: After at least 6-months follow-up, KOOS score was significantly improved in PRP group compared to the AD group (P < 0.05). All parameters were improved in the PRP group.Conclusion: The study suggested that injection of PRP is more effective toward reducing pain and symptoms, with improvement of the daily living function, quality of life and function in sport and recreation. PRP is a method of choice in patients with mild to moderate knee OA, whom not responding to classical treatment options.

Open-Wedge High Tibial Osteotomy Associated With Lipogems® Intra-Articular Injection For The Treatment Of Varus Knee Osteoarthritis - Retrospective Study.

Background and aim:Open-wedge high tibial osteotomy (HTO) is a good choice in the treatment of varus knee medial osteoarthritis, with the restore of the correct mechanical axis of the lower limb. Autologous adipose derived stem cells (aASCs) are used in cartilage regeneration and in the treatment of early osteoarthritis. Aim of this study is to retrospectively analyze clinical (and radiological) results in two populations of patients with initial varus medial knee osteoarthritis, treated with HTO, with or without associated intra-articular injection of aASCs.Methods:In this study we analyze 85 patients treated with HTO for varus knee osteoarthritis with or without Lipogems® intra-articular injection. It was used of a single model of HTO plate. No associated procedure was performed.Results:Significant improvement in the daily life activity assessment (KOOS score) was observed in the group treated also with aASCs compared with group treated with isolated HTO.Conclusions:We suggest, in these patients, the surgical indication of an open-wedge high tibial osteotomy (HTO) and simultaneous injection with aASCs associated procedure to improve cartilage regeneration, with clinical improvement. (www.actabiomedica.it)

D vitamini eksikliğinin yaşlı hastalarda osteoartrit ve kemik mineral dansitesi üzerine etkisi.

Purpose: We aimed to determine the effect of inadequate vitamin D level on osteoartritis (OA) and bone mineral density (BMD) in female and male elderly patients with early and late stage OA with different BMD, and also the relationship between vitamin D and knee function scores in female and male OA patients.Materials and Methods: One hundred and fortytwo female and one hundred thirty-five male knee OA patients were enrolled in the study. The knee OA was classified as early and late stage. WOMAC score, KOOS score, BMD and Vitamin D levels were measured. Results: Vitamin D levels patients were statistically significantly lower in female OA than male OA group. Calcium and phosphorus levels were significantly higher in female OA patients than male OA group. There was no difference between vitamin D, vitamin B12, calcium, phosphorus, WOMAC score and KOOS scores in early and late stage OA patients with osteoporosis, osteopenia and normal BMD. WOMAC score was significantly higher in male patients with osteoporosis early stage and late stage OA than patients with osteopenia and normal BMD. The age odds ratio (OR) was 1,047 (95% CI = 1,009-1,086) in female OA patients, and OR was 1.090 (95% CI = 1,021-1,163) in male OA patients.Conclusion: Vitamin D supplementation may be said increase BMD, slow down the progression of osteoporosis, reduce pain, but have no effect on OA progression and knee function scores.

Focal metallic inlay resurfacing prosthesis in articular cartilage defects: short-term results of 118 patients and 2 different implants.

The goal of this study was to share our experience with two different inlay metallic implants in the treatment of knee cartilage defects and to analyze their effects on functional scores. This retrospective study included 118 patients operated on for focal full-thickness knee cartilage lesions, who were treated with a focal metallic inlay resurfacing prosthesis. A cobalt-chromium (Co-Cr) resurfacing implant was applied to 73 patients with a knee chondral lesion, and a biosynthetic implant was applied to 45. All patients were evaluated preoperatively and postoperatively using the KOOS, VAS, and Tegner activity scores. The group with the Co-Cr-resurfacing implant showed a significantly greater improvement (p < 0.001) in the Tegner and VAS scores at the 2-year follow-up examination. The KOOS scores were similar in both groups. Median patient age was similar in both groups. All patients had a follow-up of at least 2years. The preoperative and postoperative scores were compared and significant improvements (p < 0.001) were observed. The biosynthetic implant had a higher revision rate. In the univariate analysis, age and type of implant were significantly associated with revision surgery. In the multivariate Cox-regression analysis model, the type of implant was significantly associated with revision surgery. All the patients operated with the above-mentioned implants showed significant improvements in pain and activity scores. Despite the overall good clinical results, 17% of patients with a biosynthetic implant and > 6% of patients with Co-Cr-resurfacing implant required revision surgery. Age and implant type were the main risk factors associated with revision.