Lysholm Scale Research Articles

A choice of surgical approach for osteosynthesis in fractures of the lateral tibial condyle

Intention. To conduct a comparative analysis of the dynamics of the consolidation of intraarticular fractures of the posterolateral parts of the lateral tibial condyle, the anatomical and functional outcomes of surgical treatment of these patients after plate osteosynthesis with traditional anterolateral and posterolateral transfibular surgical approaches as well.Methodology. A comparative prospective study of the effectiveness of osteosynthesis in patients with fractures of the posterolateral part of lateral tibial condyle in two compatible clinical groups was performed in dynamics for periods of 7–10 days, 1, 3, 6 and 9 months after surgery. In the first group (25 patients), bone osteosynthesis was performed from traditional anterolateral approach (TALA), and in the second group (20 patients), from the posterolateral transfibular approach (PLTFA). The average duration of osteosynthesis operations was compared. The displacements of fragments of the articular surface of the lateral tibial condyle, the indices of the KSS and Lysholm scales, the results of measurements of the angle of flexion and valgus stress test of the knee joint were evaluated. Data processing was performed using the Data Analysis and Chart Master modules (Excel), the Basic Statistics / Tables module (Statistic for Windows) as well.Results and Discussion. In the PLTFA group, the average operation time was (81.0 ± 8.5) minutes (from 67 to 96 minutes), in the TALA group, the duration of operations was 35.8 % longer and averaged (110 ± 5.2) minutes (from 82 to 125 minutes) (p < 0.05). The values of the KSS and Lysholm scales in dynamics showed a steady and statistically significant (p < 0.01) increase with increasing time after surgery without significant differences between the groups. The angle of flexion of the knee joint increased more rapidly during the first three months, then the rate decreased from 6 to 9 months (p < 0.05) without significant differences between the groups. The frequency of displacements of fragments of the articular surface in the first group was statistically significantly (p < 0.05) higher than in the second group. Differences in the valgus-stress test indices in both groups reached a maximum after 9 months – 52 and 30 %, respectively.Conclusion. With PLTFA, surgery duration decreases, articular surface fragments are better reduced, and their subsequent displacement at the stages of treatment is less likely; therefore, this approach is preferable for osteosynthesis of fractures of the posterolateral parts of the lateral tibial condyle.

Mid-term results of arthroscopic remodelling combined with peripheral repair in children with unstable discoid meniscus

BackgroundThe traditional treatment of unstable symptomatic discoid meniscus (DM) has been total or subtotal meniscectomy. However, long-term studies show that the results are poor. The aim of this study was to evaluate the clinical outcomes and survival of arthroscopic saucerization combined with peripheral repair for the treatment of symptomatic discoid meniscus in children. MethodsPatients ≤18 years with DM and a peripheral lesion treated between January 2012 and January 2018 were analyzed. Clinical results were evaluated using the Ikeuchi, Pedi-IKDC and Lysholm scales. The survival analysis was performed with the Kaplan-Meier method. ResultsEighteen patients (18 knees) were treated in the evaluated period. The average age at the time of surgery was 11.1 ± 3.8 years. The average follow-up was 40.4 ± 21.2 months. An average of 3.4 ± 1 meniscal sutures (range, 2–6) was used. Repairs were carried out with a combination of inside-out and outside-inside techniques as dictated by the configuration of the injury. Sixteen patients could be evaluated functionally (2 lost of follow-up). Four patients presented mechanical symptoms. One was treated conservatively with physical therapy and three (18.8%) required further surgical treatment (subtotal meniscectomy). According to the Ikeuchi scale 12 (75%) had excellent results, 1 (6.2%) good and 3 (18.8%) poor (repair failure). The average Pedi-IKDC and Lysholm scores were 98.3 ± 2 and 98.7 ± 2.9 respectively at the last follow-up. The overall Kaplan-Meier survival probabilities after repair were 93.7% at 1 year, and 85.9% at 2 years. ConclusionsMid-term outcomes of saucerization in conjunction with meniscal repair are encouraging for children with a symptomatic unstable discoid meniscus.

Clinical and functional outcomes of early reconstruction of the collateral ligaments and delayed reconstruction of the cruciate ligaments in multi-ligament knee injury; a prospective, cross-sectional study

Background: Multi-ligament knee injury is common after knee dislocation. There are different approaches for treating multi-ligament knee injuries; however, choosing the best approach is a challenging issue. Objectives: This study aimed to investigate the efficacy of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments in multi-ligament knee injury. Methods: In this prospective study, 24 patients who had a grade 3 tear in one collateral ligament in addition to tears in two other knee ligaments were enrolled. At the first stage, collateral ligaments were reconstructed; after the patient gained full range of motion, reconstruction was done for the cruciate ligaments. Patients were followed-up for one year and postoperative evaluations were conducted through clinical tests, International Knee Documentation Committee scores, and Lysholm scales. Results: Twenty-four patients were entered into the final analysis. Synchronous injury of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posterolateral corner, and lateral collateral ligament had the highest frequency (37.5%). At the one-year follow-up, the average Lysholm and IKDC scores were 86.4 ± 3.5 and 83.8 ± 4, respectively. Range of motion was normal in all patients at the end of the study. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side. Conclusion: The results revealed that a two-stage surgery consisting of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments have good clinical and functional outcomes in multi-ligament knee injuries.

Resultados a mediano plazo de la remodelación artroscópica asociada a reparación periférica en niños con menisco discoide inestable

IntroductionThe traditional treatment of unstable symptomatic discoid meniscus has been total or subtotal meniscectomy. However, long-term studies show that the results are poor. The aim of this study was to evaluate the clinical outcomes and survival of arthroscopic saucerization combined with peripheral repair for the treatment of symptomatic discoid meniscus in children. MethodsPatients≤18 years with discoid meniscus and a peripheral lesion treated between January 2012 and January 2018 were analyzed. Clinical results were evaluated using the Ikeuchi, Pedi-IKDC and Lysholm scales. The survival analysis was performed with the Kaplan-Meier method. ResultsEighteen patients (18 knees) were treated in the evaluated period. The average age at the time of surgery was 11.1±3.8 years. The average follow-up was 40.4±21.2 months. An average of 3.4±1 meniscal sutures (range, 2 to 6) was used. Repairs were carried out with a combination of inside-out and outside-inside techniques as dictated by the configuration of the injury. Sixteen patients could be evaluated functionally (2 lost of follow-up). Four patients presented mechanical symptoms. One was treated conservatively with physical therapy and 3 (18.8%) required further surgical treatment (subtotal meniscectomy). According to the Ikeuchi scale 12 (75%) had excellent results, one (6.2%) good and 3 (18.8%) poor (repair failure). The average Pedi-IKDC and Lysholm scores were 98.3±2 and 98.7±2.9 respectively at the last follow-up. The overall Kaplan-Meier survival probabilities after repair were 93.7% at one year, and 85.9% at 2 years. ConclusionsMid-term outcomes of saucerization in conjunction with meniscal repair are encouraging for children with a symptomatic unstable discoid meniscus.

Efficacy of exercise rehabilitation in patients with knee osteoarthritis

Objective: To explore whether exercise could influence outcomes and improve life quality of patients with knee osteoarthritis. Methods: This study included 210 patients diagnosed with knee osteoarthritis from October to December 2018 in Shijiazhuang Derui Exercise Rehabilitation Medical Center. These patients were divided into two groups with random number table: experiment and control group. Patients in experimental group got exercise rehabilitation training and routine therapy,but patients in control group got routine treatment only that included physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs). We applied different kinds of measure to follow-up these patients,which included Lysholm scale, the Western Ontario and McMaster Osteoarthritis Index (WOMAC), SF-36 life quality questionnaire, and knee range of motion.The degree of pain and symptoms and the knee function and the quality of life in the two groups were recorded too. Paired sample t test was used to compare the data between the two groups. Results: There were 105 patients in each group, but 13 cases (12.4%) in experimental group and 6 patients (5.7%) in control group were lost,respectively.All the patients were followed up for (12.0±2.3) weeks. There was no significant differences in age, body mass index, gender between the two groups. At the final follow-up, the WOMAC score in the experiment group was 84.4±6.8, and it was 108.3±1.7 in the control group (t=-4.71, P<0.05);the Lysholm score of the experimental group was 65.5±4.7, and it was 41.2±1.4 in the control group (t=7.29, P<0.05); the knee range of motion in the experiment group and control group was 121°±7° and 114°±3°, respectively (t=1.83, P<0.05); the SF-36 score in the two groups was 90.0±2.8 and 75.6±1.5, respectively (t=6.15, P<0.05). Conclusion: Exercise rehabilitation plus routine therapy for patients with knee osteoarthritis can effectively improve outcome, promote functional recovery and improve quality of life.

Ultrasound-assisted Endoscopic Evacuation of Recurrent Calf Hematoma Following Anterior Cruciate Ligament Reconstruction. Case Study

Hematoma of the calf is a rare complication following anterior cruciate ligament reconstruction (ACLR). The golden standard method of its treatment is puncture and aspiration. More advanced procedures are needed in difficult cases, such as prolonged he-ma-tomas. Among the novel management choices is endoscopy with ultrasound guidance. The aim of the study was to present the management of a post-surgical hematoma of the calf using endoscopic and ultrasound-assisted surgery. A 48-year-old patient un-der-went arthroscopic ACLR grafted with hamstrings tendons (semitendinosus and gracilis). Due to a hematoma developing at the donor site, he experienced edema and paresthesiae of the calf and foot that enhanced over time. An open reoperation failed and symptoms recurred. A second reoperation was performed as an endoscopic and ultrasound-assisted mini-invasive procedure. Re-sults were assessed postoperatively using the IKDC 2000 and Lysholm questionnaires. An evident increase in IKDC 2000 Score (from 14.9 points after open surgery to 77.0 one week after endoscopic treatment) and Lysholm Scale (26 points after first surgery and 84 one week after endoscopic surgery) was observed after the mini-invasive procedure. Edema and paresthesiae of the affect-ed limb completely disappeared four weeks after endoscopy. No complications of the novel procedure were found. Accordingly, en-doscopic and ultrasound-assisted evacuation of a prolonged calf hematoma appears an effective minimally-invasive and tar-geted procedure.

Anatomical and Clinical Rationale for Posterolateral Transfibular Approach for Internal Fixation of the Posterolateral Column of the Tibial Plateau

Purpose of the study — to provide an anatomical rationale and evaluate the clinical application of posterolateral surgical approach with osteotomy of the fibular head for internal fixation of the posterior aspect of the lateral tibial condyle. Material and Methods. Anatomical topography research was performed on 14 lower limbs of 8 fresh cadavers. In the first series of research L-shaped plate was fixed on the posterolateral surface of lateral tibial condyle from the examined approach, then preparation was performed and measuring of distances from various parts of the plates to the common peroneal nerve and anterior tibial artery. In the second series the authors prepared histological topograms by transverse sectioning of plastinated specimens from the knee joint area after implantation of L-shaped buttress plates. Prospective observation clinical study included 20 patients who underwent internal fixation with L-shaped buttress plate from the examined approach for fracture of the posterolateral column of the tibial plateau, type 41В by AO classification. KSS and Lysholm scales were used to evaluate treatment outcomes at days 7–10 and in 1, 3, 6 and 9 months postoperatively. Data of the anatomical and clinical research was compared. Results. Compliance with the technique of posterolateral transfibular surgical approach allows to avoid risk of injury to the common peroneal nerve and anterior tibial arthery which on the specimen were always located safely away from implanted plates. All 20 clinical cases demonstrated good visualization of bone fragments and articular surface of the tibial plateau which ensured reliable reduction and fixation by L-shaped buttress plate. KSS excellent and good outcome scores amounted to 50% and 45%, respectively, while satisfactory score was reported in 5% of cases; Lysholm scale demonstrated 55% of excellent outcomes, 45% of good outcomes, and 5% of satisfactory outcomes. Safety of the approach was verified: no injuries to large blood vessels or iatrogenic neuropathies were reported as well as no large hematomas or infectious complications of the surgical wound in early postoperative period. Conclusion. Results of the present study proved the feasibility and safety of the posterolateral transfibular surgical approach for internal fixation procedures in patients with intraarticular fractures of posterolateral column of the tibial plateau.

Does MRI add value in general practice for patients with traumatic knee complaints? A 1-year randomised controlled trial

ObjectiveTo determine whether referral to MRI by the general practitioner (GP) is non-inferior to usual care (no access to MRI by GPs) in patients with traumatic knee complaints regarding knee-related...

Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel.

The objective of this study is to report the functional outcomes, complications, and reconstruction failure rate of patients undergoing posterolateral complex reconstruction with a single femoral tunnel technique. Patients with posterolateral complex injuries associated with injury of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), or both undergoing surgical treatment with the single femoral tunnel technique were included in the study. The International Knee Documentation Committee (IKDC) and Lysholm's scales were evaluated, in addition to age, gender, time between trauma and surgery, trauma type, range of motion (ROM) restrictions, peroneal nerve injury, and reconstruction failure. Sixty-six patients were included. Eighteen underwent ACL and posterolateral complex (PLC) reconstruction (group 1), 24 underwent ACL, PCL, and PLC reconstruction (group 2), and 24 underwent PCL and PLC reconstruction (group 3). The mean follow-up was 63 months. The subjective IKDC was 83.7 ± 14.6 for group 1, 74.3 ± 12.6 for group 2, and 66.3 ± 16.0 for group 3 (p < 0.001). The Lysholm's score was 87.1 ± 12.8 for group 1, 79.5 ± 15.0 for group 2, and 77.7 ± 15.2 for group 3 (p = 0.042). There were six reconstruction failures among the patients (9.1%) with no differences among the groups (p = 0.368). Female gender and reconstruction failure were associated with worse outcomes. Patients undergoing reconstruction of PLC structures with the single femoral tunnel technique achieved good functional outcomes and a failure rate similar to literature. Patients undergoing only combined ACL reconstruction showed better outcomes than patients undergoing combined PCL reconstruction. Female gender was associated with a worse functional outcome irrespective of the injury type.

Clinical experience with arthroscopic suture pull technique in isolated PCL avulsion injuries

Objectiveto assess twenty two cases of isolated PCL avulsion fractures from tibial insertion, arthroscopically treated with suture pull technique, and to evaluate achieved clinical outcomes in terms of radiographic laxometry (objective) and Lysholm scale (subjective). Material and methodStudy includes 22 cases operated between April 2014 and March 2017. Patients less than 18 years old, presentation after 3 weeks of injury, concomitant injury in the same limb, with open wounds or with comminuted avulsed fragment were excluded from the study. All cases were MRI proven. All arthroscopic suture fixation technique was used in all cases. Follow up was done at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Mean follow up was one year. Subjective complaints, Knee flexion, Lysholm score and stress radiographs were noted. ResultsAverage Lysholm score was 96.3. Seventeen patients had excellent results and Five had good results based on Lysholm scores. In two patients, grade 2 laxity (5–10 mm) was present on stress radiographs but there were no clinical complaints. All patients achieved osseous union and had no functional limitation. Three Patients developed arthrofibrosis initially but gained functional range later. ConclusionArthroscopic suture fixation method for PCL avulsion fracture from tibia is a good and safe method of choice for fixation.

DIFFERENT METHODS OF FIXATION OF SEMITENDINOSUS GRAFTS IN ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT

BACKGROUND: The Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the human body. Earlier treatment of ACL injury was mainly restricted to sportsmen, but has increased over the years because of awareness and accessibility to treatment facilities. Arthroscopic reconstruction is now the gold-standard for the treatment of ACL tear.&#x0D; MATERIALS AND METHODS: This study was conducted at IPGME &amp; R, Kolkata in the department of Orthopaedics, where forty patients with single knee injury were taken into consideration, the injury being more than two months old, in the age group 20-50 years, with clinically significant knee instabilities and confirmed on MR imaging.&#x0D; RESULTS: This was a prospective randomised study where 95% of the patients were male. The outcome was based on regaining pre-injury status and recovery was based on pre- and post-operative clinical and radiological findings and marked according to Tegner- Lysholm scale.&#x0D; CONCLUSION: Clinical and radiological (MRI) proved knee instabilities due to standardised Anterior Cruciate Ligament injury were best treated by arthroscopic repair using semi-tendinosus graft, which provided to be the gold-standard treatment protocol.&#x0D; Keywords: ACL Injury, Knee Instability, Arthroscopic Repair, Semitendinosus Graft.

Rehabilitación de ruptura de ligamento cruzado anterior en un futbolista

Se presenta caso de la rehabilitación pre y post – quirúrgica en la ruptura del ligamento cruzado anterior (LCA) en un futbolista. A las 24 semanas de tratamiento se obtiene una escala de Lysholm de 91 puntos. Se debe tratar al paciente de forma integral para asegurar una adecuada funcionalidad y el pronto regreso al deporte.

Safety and feasibility of using calcium phosphate hybridization method for quadriceps tendon-bone graft in anterior cruciate ligament reconstruction

BackgroundTo improve tendon-to-bone healing in anterior cruciate ligament (ACL) reconstruction, a novel technique via the calcium phosphate (CaP) hybridization method for tendon graft using an alternate soaking process was developed. The use of the CaP hybridization method for quadriceps tendon-bone (QTB) graft in ACL reconstruction has not been reported in previous studies. Thus, this clinical trial aimed to clarify the safety and feasibility of using CaP hybridization method for quadriceps tendon-bone (QTB) graft in ACL reconstruction. MethodsEight patients (average age, 41.6 ± 10.6 years; 2 men and 6 women) with unilateral ACL injury were included in this study. They underwent ACL reconstruction using QTB graft that hybridized CaP. The follow-up period was from 2 months to 4 years (average, 2.4 ± 1.5 years). Cases of adverse events, including tumor formation, infection, fracture, contracture, severe pain, and re-rupture, were recorded. Moreover, clinical results (KT-1000 arthrometry, pivot-shift test, International Knee Documentation Committee grade, Lysholm scale, and sports activity level), and images of graft and bone tunnel (magnetic resonance imaging, arthroscopic appearance, and computed tomography) were also evaluated. ResultsNo adverse events were observed in the follow-up periods. Postoperative clinical results showed improvement compared with the preoperative findings. The sports activity level after the surgery became equivalent to that before injury. There was no progression of bone tunnel enlargement. ConclusionsUsing the CaP hybridization method for QTB graft in ACL reconstruction was safe and feasible in the clinical trial. Moreover, this method may improve clinical outcomes. In the future, it is necessary to verify the effect of the CaP hybridization method for QTB graft in ACL reconstruction.

Korean Version of the Anterior Cruciate Ligament-Return to Sport after Injury Scale: Translation and Cross-cultural Adaptation.

BackgroundTo translate into Korean and culturally adapt the anterior cruciate ligament-return to sports after injury (ACL-RSI) scale assessing psychological readiness to return to sports after ACL reconstruction and to validate its psychometric properties.MethodsThe ACL-RSI scale was forward translated into Korean and back-translated into English for cultural adaptation according to the standardized guideline. For validation, the Korean version of the ACL-RSI (ACL-RSI Kr) was administered to patients who underwent ACL reconstruction. The following subjective questionnaires were also administered: International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Lysholm scale, Knee injury and Osteoarthritis Outcome Score (KOOS), and a Return to Sports Questionnaire. Test-retest reliability, internal consistency, content validity, construct validity, and discriminant validity of the ACL-RSI Kr were assessed.ResultsA total of 129 patients (102 men and 27 women) were included in the study. Their mean age was 28.3 years. The average follow-up duration was 13.2 months. Test-retest reliability was remarkable (intraclass correlation coefficient, 0.949), internal consistency was high (Cronbach's alpha, 0.932), and floor and ceiling effects were confirmed to be less than 10%. Construct validity assessed by correlation analysis with KOOS, IKDC-SKF, and Lysholm scale showed the correlation coefficients ranging from 0.169 to 0.679 (all p < 0.01). Compared with the Return to Sports Questionnaire, statistically significant difference was found in the ACL-RSI Kr between patients who received more than 7 points and less than 7 points (72.2 vs. 60.3, p = 0.025) for performance level scored using a 10-point Likert scale, proving its discriminative value.ConclusionsThe ACL-RSI Kr demonstrated good psychometric properties. This scale can be an excellent instrument for evaluating patient's psychological readiness to return to sports after ACL injury.

Study on musculuskeletal ultrasound features and correlation of knee osteoarthritis

To compare the correlation between musculoskeletal ultrasound features, dysfunction and X-ray findings in patients with knee osteoarthritis, and to analyze the pathological mechanism of soft tissue inflammation in knee osteoarthritis. Cross-sectional method was performed in this research (Evidence level: III). The patients with knee osteoarthritis were collected according to the screening criteria from September 2016 to January 2017 in Orthopedic clinic in our hospital. Musculoskeletal ultrasound and X-ray images were obtained and measured, knee function was measured by Lysholm scale. Pearson coefficient, t test and Wilcoxon were applied to analyze the correlation between soft tissue inflammation, knee dysfunction and X-ray features. Total 123 patients with knee osteoarthritis were recruited in this research. Soft tissue inflammation around knee had a high incidence in patients with knee osteoarthritis (infrapatellar fat pad inflammation 81%), and the synovial membrane thickness, joint effusion depth and meniscus bulging were beyond the normal range. Correlation analysis showed that the about Lysholm score and joint effusion depth had negative correlations with "Squat" score(r=-0.21, P=0.02). and Medial meniscus bulging had negative correlations with "Sustain" score(r=-0.26, P<0.01) and Lysholm total score (r=-0.19, P=0.04). Lateral meniscus bulging had a negative correlation with "Unstable" score (r=-0.22, P=0.02). The X-ray features, and medial joint space narrow had negative correlations with joint effusion depth(r=-0.27, P<0.01) and synovial membrane thickness(r=-0.17, P=0.007), and had a positive correlation with medial meniscus bulging. Medial joint space narrow was significantly correlated with patellar ligament inflammation and fat pad inflammation(P<0.05). Lateral joint space narrow was significantly correlated with patellar ligament inflammation(P=0.02). Soft tissue inflammation around the knee-a major pathological manifestation of knee osteoarthritis, has significant correlations with knee dysfunction and bony structure lesions, and affects the progression of knee osteoarthritis by damaging knee joint function and promoting the destruction of articular cartilage.

Anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft: a randomized controlled trial with 2\xa0years of follow-up

BackgroundTo improve tendon-to-bone healing in anterior cruciate ligament (ACL) reconstruction, a novel technique via calcium phosphate (CaP)-hybridized tendon graft using an alternate soaking process was developed. The purpose of this study was to evaluate the clinical results of anatomic single-bundle ACL reconstruction using the CaP-hybridized tendon graft with up to 2 years follow-up, and compare the outcome with conventional ACL reconstruction and preoperative data.MethodsNinety patients who required anatomic single-bundle ACL reconstruction were randomized to undergo either the CaP-hybridized tendon graft method (CaP group, n = 45) or the conventional method (conventional group, n = 45). At 1 and 2 years postoperatively, all patients were evaluated using KT-1000 arthrometry, pivot-shift test, International Knee Documentation Committee (IKDC) grade, Lysholm scale, and Tegner scale; at the same timepoints, bone tunnel enlargement was evaluated using computed tomography, and the tendon graft intensity was evaluated on magnetic resonance imaging. Tendon graft appearance was evaluated arthroscopically once after a period of up to 2 years postoperatively. Cases of re-rupture and adverse events were recorded in both groups.ResultsIn both groups, the KT-1000 arthrometry, pivot-shift test, IKDC grade, and Lysholm scale results at 1 and 2 years postoperatively were superior to preoperative data; these results did not significantly differ between groups at either timepoint. The rate of increase of the cross-sectional area of the femoral bone tunnel in the CaP group was smaller than that in the conventional group at 1 year postoperatively. The other results did not significantly differ between the two groups at any timepoint. There were two cases of re-rupture in the CaP group, and six cases of re-rupture in the conventional group. There were no adverse events during follow-up in either group.ConclusionsAnatomic single-bundle ACL reconstruction using a CaP-hybridized tendon graft was safe, and resulted in improved clinical outcomes at 2 years postoperatively compared with preoperative data; the outcomes were comparable with the conventional method. A longer follow-up is needed to clarify the clinical effects of the CaP-hybridized tendon graft in anatomic single-bundle ACL reconstruction.Trial registrationUMIN, UMIN000019788 Registered 14 November 2015—Retrospectively registered.

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity

ObjectiveTo evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis. MethodsFrom November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°–12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35kg/m2, and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n=56, mean age=39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n=73, mean age=41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring. ResultsThere was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR=8.64). ConclusionThe association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

Comparative Matched-Pair Analysis of Open-Wedge High Tibial Osteotomy With Versus Without an Injection of Adipose-Derived Mesenchymal Stem Cells for Varus Knee Osteoarthritis: Clinical and Second-Look Arthroscopic Results

Background: High tibial osteotomy (HTO) is reported to be an effective treatment for varus knee osteoarthritis (OA) by redistributing the load line within the knee joint. The cell-based tissue engineering approach using mesenchymal stem cells (MSCs) has addressed the issue of articular cartilage repair in knee OA. Purpose: This study aimed to compare the clinical, radiological, and second-look arthroscopic outcomes of open-wedge HTO with versus without an MSC injection and to identify the association between cartilage regeneration and HTO outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Among 271 patients treated with HTO for varus knee OA from September 2009 to April 2014, patients treated with HTO alone (conventional group; n = 50) were pair-matched with those who underwent HTO with an MSC injection (injection group; n = 50) based on sex, age, and lesion size. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score and Lysholm score. Radiological outcomes evaluated were the femorotibial angle and posterior tibial slope. At second-look arthroscopic surgery, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade. Results: At the time of second-look arthroscopic surgery (mean, 12.4 months [conventional group] and 12.7 months [injection group]), the mean IKDC and Lysholm scores in each group significantly improved: conventional group, from 38.4 ± 9.2 to 55.2 ± 15.0 and from 56.7 ± 12.2 to 79.6 ± 13.5, respectively; and injection group, from 36.5 ± 4.7 to 62.7 ± 14.1 and from 55.7 ± 11.9 to 80.6 ± 15.6, respectively (P < .001 for all). Clinical outcomes at final follow-up (mean, 38.8 months [conventional group] and 37.2 months [injection group]) further improved from 62.7 ± 14.1 to 64.8 ± 13.4 (IKDC) and from 80.6 ± 15.6 to 84.7 ± 16.1 (Lysholm) (P < .001 and P = .034, respectively) only in the injection group when compared with the values at second-look arthroscopic surgery. At final follow-up, there was a significant difference in the mean IKDC and Lysholm scores between groups (P = .049 and P = .041, respectively). Overall ICRS grades, which significantly correlated with clinical outcomes, were better in the injection group than in the conventional group. Radiological outcomes at final follow-up showed improved knee joint alignment relative to patients’ preoperative conditions but showed no significant correlation with clinical outcomes or ICRS grade in either group (P > .05 for all). Conclusion: The group that received an MSC injection scored better on the IKDC and Lysholm scales at final follow-up than the group that did not, although these differences were relatively small. When performing HTO for patients with varus knee OA, an MSC injection should be considered as an additional procedure for improved cartilage regeneration with better clinical outcomes.

Outcomes of simultaneous high tibial osteotomy and anterior cruciate ligament reconstruction in anterior cruciate ligament deficient knee with osteoarthritis

BackgroundWe aimed to evaluate clinical and radiological results after simultaneous open-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with medial uni-compartmental osteoarthritis (OA) and varus deformity.MethodsThis retrospective study was performed using data collected from 2005 to 2011 on a total of 24 patients who were diagnosed with ACL injury and medial unicompartmental OA with varus deformity, and who subsequently underwent simultaneous open-wedge HTO and arthroscopic ACL reconstruction. The mean follow-up duration was 5.2 years. For clinical outcomes, we evaluated Lysholm score, Tegner activity score, range of motion, Lachmann test, and pivot-shift test, and for radiological outcomes, we evaluated the degree of varus deformity, progression of medial OA, tibial posterior slope, anterior instability, and postoperative complication.ResultsThere were no limitations in range of motion found in any cases. Three patients showed progressive osteoarthritis on the medial compartment. The mechanical femorotibial angle was significantly corrected from varus 7.0 degrees to valgus 1.2 degrees, and the tibial posterior slope was not significantly changed. The Lysholm and Tegner activity scores were significantly improved after surgery (from 58 to 94 points on the Lysholm scale and from 4.0 to 5.3 points on the Tegner activity scale). Although the Lachman test and the pivot-shift test showed significant improvements after surgery, instability greater than Gr II was observed in three patients on the Lachman test and in four patients on the pivot-shift test. The side-to-side difference improved from 9.6 mm to 4.2 mm postoperatively as assessed using a Telos® arthrometer. There were no cases of nonunion or fixation loss.ConclusionsSimultaneous open-wedge HTO and ACL reconstruction in patients with ACL injury with medial compartmental OA showed satisfactory functional outcomes and postoperative activity level scores. However, some patients showed residual instability and progression of OA.

Neither significant osteoarthritic changes nor deteriorating subjective outcomes occur after hybrid fixation of osteochondritis dissecans in the young adult.

The goal of the fixation of painful osteochondritis dissecans of the femoral condyles in adults is to integrate the osteochondral fragment and thus achieve a normal hyaline cartilaginous coverage. The addition of a biological process to primary fixation may result in improved fragment integration (hybrid fixation). Osteochondral plugs may fulfil this role. The aim of this study was to evaluate long-term clinical and radiological results after hybrid fixation of unstable osteochondritis dissecans. The hypothesis was that the rate of secondary osteoarthritis would be low. Nine patients treated by hybrid fixation were retrospectively reviewed at a median follow-up of 10.1years (range 7-14). The median age at surgery was 21 (range 17-28). Six of them were evaluated as ICRS grade II and three, as ICRS grade III. The mean surface of the lesion was 4.5cm2. All patients were followed up clinically (IKDC, KOOS, Lysholm) and radiologically [Kellgren-Lawrence score (KL)]. During arthroscopic assessment at the time of screw removal (3 months after surgery), the fragments were stable, and autograft plugs were all well integrated. At the most recent follow-up visit, the median IKDC score was 85.8 (range 51.72-100), the KOOS score was 87.7 (52.4-100), and the Lysholm scale score was 89.8 (77-100). In 7 out of 9 patients, radiographs showed a joint space KL grade of 0 or 1. Hybrid fixation for treating osteochondritis dissecans lesions of the femoral condyles using mechanical and biological fixation provides healing of the osteochondral fragments with good long-term outcomes. No significant osteoarthritic change was seen with this technique at a mid-term follow-up. IV-case series.