Mean KOOS Score Research Articles

Good mid- to long-term outcomes after meniscus bucket-handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction.

To evaluate mid- to long-term clinical outcomes after arthroscopic bucket-handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty-five patients with an average follow-up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post-operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. The failure rate was 9%. Medial BHMT repair showed superior post-operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post-operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow-up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post-operative outcome measures was observed but did not reach statistical significance for most items. Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow-up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level IV (retrospective case series).

Role of placental membrane in ACL graft healing – A series of 18 patients

IntroductionACL injuries are common and the standard treatment remains to be ACL reconstruction. Controversy still remains around graft ligamentisation and various methods have been experimented to augment this process. In this series we discuss the outcome of using dehydrated umbilical cord derived membrane in ACL reconstruction. Material and methodA prospective Level IV analysis of outcome in 30 consecutive patients of complete isolated ACL tear presenting to us between May 2022 to September 2022 was done. There was no age or sex restriction. Revision cases were excluded from this series. ACL reconstruction was done using standard all inside technique using the ipsilateral semitendinosus graft which was wrapped with dehydrated umbilical cord derived membrane (5*3 cm2) after soaking in normal saline (Cord Thick - Life Cell; LifeCell international private limited, Chennai, Tamil Nadu, India) and secured with Monocryl 3-0 sutures in a continuous manner. Results18 patients completed the one year follow up and were analysed for final results. Eleven of the patients followed up were females and seven males, with an average age of 30.3 years.The average VAS score at 6 weeks was 2.2. The mean KOOS score at the follow up visits were 72.3, 82.3, 90.7, 95.8. The mean SANE score reported at 6 weeks, 3 months, 6 months and 1 year were 68.8, 80, 87.5, 95.1.The follow up MRI's confirmed good ligamentisation of the graft even as early as 6 weeks with minimal fluid in the tunnel. ConclusionThe use of dehydrated umbilical cord derived membrane augmentation to potentiate graft integration in ACL reconstruction seems promising and helps improve patient outcomes.

Management of periprosthetic femoral fractures following total knee arthroplasties using locking plates or intramedullary nailing. Comparative study of 567 cases

IntroductionProximal femur fractures in elderly patients pose a common problem that requires surgical management. The main objective of this study was to compare the results of treatment by locked plate (LP) and by anterograde (AIN) or retrograde (RIN) intramedullary nailing. The secondary objective was to analyze the complications related to each group. The hypothesis of this study was that the radiological and clinical results of each group were comparable. Materials and methodsThe data of 438 patients from 8 centers were studied retrospectively with 365 LP and 69 cases of intramedullary nailing (49 AIN and 20 RIN). The groups were comparable in terms of mean age (75±2years), mean preoperative Parker score (5.3±0.5) and mean KOOS score (74±2). Most patients lived at home before their fracture [n=375 (86%)]. At follow-up, the joint range of motion, the KOOS and Parker scores, living premises, the time required to regain full weight-bearing, the time required for consolidation as well as the reduction alignment: frontal, sagittal, horizontal. ResultsThe average follow-up was: 79±2weeks (65 to 82). The functional and radiological results were comparable, although nailing allowed a faster return to weight-bearing (1±2weeks for nailing versus 7±2weeks for LP, p=0.048) and a better postoperative Parker score (5.5±0.5 for nailing versus 4.7±0.2 for LP, p=0.045). Rotational malalignment in femoral nailing was often in the direction of internal rotation, compared to the LP (p=0.045). Complications were comparable with the exception of mortality, which was more frequent for LP [22.5% in the LP group versus 13% in the nailing group (p=0.045)]. Complications were categorized as: mechanical complications 6.8% of LP, 5.7% of nailing (p>0.05), infections [11% of LP, 5.8% of nailing (p>0.05)], surgical revisions [2% of LP, 10% of nailing (p>0.05)]. Discussion and conclusionThe hypothesis was refuted. These results show that nailing conferred a faster recovery of weight-bearing, a better Parker score, and is associated with a lower mortality rate. The morbidity rate is comparable between the two techniques. Indeed, when the indication for osteosynthesis by LP or by nailing is made, and both choices are technically justifiable, it would be prudent to favor the technique, which carries the least risk, which in this case is nailing. This conclusion must, however, be taken in to consideration with regard to the reduced number of nailing. A larger series of nailing, particularly retrograde, would be necessary to be able to confirm this last difference between the 2 groups. Level of evidenceIV; comparative retrospective study.

Efficacy of Cal-Cemex as bone substitute for tibial plateau fractures

BackgroundVarious factors influence treatment and outcomes in tibial plateau fractures. Bone defects are among them. Many materials have been proposed to address this problem: allograft, bone–cements and various bone substitutes (BSM). Cal-Cemex (β-tricalciophosphate and polymethylmethacrylate) is a new hybrid bi-component BSM. A retrospective multicenter study was conducted based on the clinical experience of three European Hospitals, to demonstrate its clinical effectiveness, versatility and safety.Materials and MethodsFrom December 2016 to March 2022, 45 displaced tibial plateau fractures were treated with internal fixation and augmentation using Cal-Cemex. The average age was 55.9 years. According to Schatzker classification, we included 13 type II, 24 type III, 3 type V and 4 type VI fractures. The postoperative follow-up (FU) consisted of clinical and radiological examinations at 6 and 12 weeks and 1 year after surgery. A CT scan was performed preoperatively and 1 year after surgery. Full weight bearing was permitted after less than 6 weeks. Clinical data were collected from patient charts, while functional data were evaluated using the Rasmussen knee function score, the KOOS score and the Hospital for Special Surgery knee rating score (HSS), to evaluate the range of motion, axis and functionality of the knee.ResultsThe average FU was 42.8 months. CT scans taken at 1 year demonstrated a good surface osteointegration without radiolucent lines or osteolysis with good evidence of interdigitation and even bone ingrowth. At 1-year FU, the mean Rasmussen score was 24.7, the mean KOOS score was 90.7 and the mean HSS was 89.9 and the average full weight-bearing period 34.9. No patients had hardware failure or fracture secondary displacement.DiscussionCal-Cemex combines biological features and good mechanical performances. It guarantees biocompatibility and osteoconductivity, although it is not fully reabsorbable; β-tricalciophosphate component gives macro- and microporosity that allow fluids to penetrate inside the material, to stimulate bone ingrowth.ConclusionsThe study suggests that Cal-Cemex is an option for tibial plateau fractures, where augmentation and support are necessary for early full weight bearing. The absence of major complications, ease of application, the possibility to cut and perforate this material support its extensive use in bone augmentation for trauma cases.

129 Evaluating Long-Term (≫5 Years) Patient Reported Outcome Measures and Kneeling Function in Patients with Tibial Intramedullary Nails

Abstract Aim 1) To assess the long-term (>5 years) patient reported outcome measures (PROMs) and kneeling ability in patients with tibial intra-medullary nails (IMNs). 2) To correlate the PROMs with superior and anterior IMN cortex protrusion, measured radiologically. Method 129 patients, from one UK centre, were invited to participate by completing a KOOS score, Kujala score, EQ-5D-5L and a four-posture kneeling assessment. Superior and anterior IMN prominence was measured using lateral radiographs. Pearson’s two-tailed correlation test was performed using SPSS v28. Results 45 patients responded to the questionnaire. 81.8% of patients were satisfied with their surgery. 20.5% of patients experienced daily AKP. The mean Kujala score was 80.7 (74.5, 86.8). The mean KOOS score was 83.2 (77.9, 88.5), 83.9 (78.3, 89.5), 85.8 (79.6, 92.0), 70.7 (60.8, 80.7) and 72.8 (64.8, 80.8) for symptoms, pain, daily living, sport and quality of life, respectively. Participants found the praying position and high flexion kneel the most difficult postures, with pain being the most common limiting factor. More than half of participants found all four kneeling postures easy to achieve. No significant correlation was found between the overall KOOS or Kujala score and nail-plateau distance (p = 0.408, p = 0.979), nail-anterior cortex distance (p = 0.552, p = 0.492) or the overall nail prominence (p = 0.608, p = 729). Conclusions AKP effects a subset of patients more than five years post-tibial IMN, limiting their ability to kneel. Most patients experience little or no pain with good knee functionality. Tibial IMN prominence does not seem to be associated with AKP in our sample.

Two-Year Survivorship and Outcomes of a Three-Dimensional Printed Metaphyseal Cone in the Setting of Revision Total Knee Arthroplasty.

Poor metaphyseal fixation secondary to bone loss in revision total knee arthroplasty (TKA) continues to be challenging. One technique to increase implant stability is the use of novel three-dimensional (3D) printed titanium metaphyseal cones with adjunctive stems for added fixation. However, the survival of these novel constructs is poorly understood. Therefore, we sought to examine 3D-printed titanium metaphyseal cone components in revision TKA for aseptic as well as septic reasons and aimed to evaluate: (1) revision-free survivorships; (2) patient-reported outcomes measures (PROMs); (3) postoperative medical complications; and (4) radiographic outcomes. A consecutive series of 62 patients who underwent revision TKA with use of a titanium metaphyseal cone at a single institution between September 1, 2015 and May 31, 2021 were examined. The patients had a minimum follow-up period of 2 years (mean, 40 months, range, 24-72 months). PROMS included Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS-JR) scores at baseline and last clinical follow-up. Overall, when excluding infections, the combined implant survivorship was 96% (52 out of 54), while it was 95% (35 out of 57) for aseptic revisions and 100% (17 out of 17) for septic revisions. Reasons for revisions within the aseptic revision cohort included loosening (5%) as well as periprosthetic joint infections (PJIs) (7.5%). All failures following an index septic revision were due to PJI. Mean KOOS scores at baseline as well as at final follow-up was 43 points (range, 16-80) and 70 points (range, 34-100), respectively. None of the patients had medical complications. Other than the loosening reported (only femoral component), of the surviving patients no patients had evidence of progressive radiolucencies. The use of titanium cones in revision TKA provides good revision-free survivorship at 2 years. Further research is warranted on the longer-term survivorship of 3D-printed titanium cones. The current study has found that 3D-printed titanium cones can be incorporated as part of the revision knee surgeon's armamentarium.

Percutaneous surgery with balloon for tibial plateau fractures, results with a minimum of 5 years of follow-up

Tibial plateau fracture is a frequent entity for which surgical management is difficult both surgically and postoperatively, with multiple complications and often delayed recovery. The challenge lies in the anatomical reduction of the joint, the limitation of complications and the rapid functional recovery. Tuberoplasty appears to be an innovative technique that meets current expectations.The objective is to evaluate the reliability of tuberoplasty in reducing surgical risks and improving postoperative clinical results.This single-centre retrospective study included 30 patients with depressed tibial plateau fractures who underwent tuberoplasty from September 2011 to March 2014. Reduction analysis was performed by comparing pre-operative and post-operative depression from computed tomography (CT) data. Clinical outcomes were assessed by measuring flexion joint ranges, time to weight-bearing, KOOS questionnaire and a pangonogram.The mean depression was 7.4mm pre-operatively and 2.6mm [0;9] post-operatively, with 47% (14/30) having a residual depression of 2mm or less. Mean flexion at 6 weeks was 103° [30; 130]. Partial and total weight-bearing were allowed on day 47 [3; 150] and day 58 [20; 150], respectively. The mean KOOS score was 25.43 [1.15; 62.30] at a minimum of 5 years after surgery and the mean axis was 176.54° [172; 180]. There was one case of thrombophlebitis and one sensory-motor deficit in the common fibular nerve territory.The reduction of the tibial plateau observed in our study from tuberoplasty is in line with the literature results obtained from a conventional approach. Our results indicate that tuberoplasty is stable in the long term, has good functional results and early recovery with few complications. This preliminary study presents results that need to be investigated in a prospective randomised double-blind study.

Comparison of morbidity-mortality and functional results between implant exchange and internal fixation by plate for periprosthetic femoral fracture in total knee arthroplasty: A 52-case series

IntroductionSurgical options for periprosthetic femoral fracture in total knee arthroplasty (TKA) are controversial. The present retrospective study compared morbidity, mortality and functional results between implant exchange (group IE) and internal fixation by plate (group IF). The study hypothesis was that implant exchange does not give rise to more complications than plate fixation and that functional results are equivalent. MethodsFifty-two femoral fractures in contact with a TKA implant were studied. The IE and IF groups (n 32 and 20, respectively), were comparable for age, gender and ASA score. Mean age was 80.5 years (range, 53–96 years). Morbidity and mortality were assessed on Clavien score; functional assessment used the KOOS questionnaire. ResultsMortality was 50% in group IF and 40% in group IE (p=0.4817). One patient was lost to follow-up. Complications were seen in 15 group IF patients (48.4%) versus 5 in group IE (26.3%) (p=0.14760), with infection in 5 (16.1%) and 2 patients (10.5%) respectively (p=0.69475). In both groups, 9 patients (i.e., 28.1% and 40% respectively) showed grade 2 complications (p=1). Revision surgery was performed in 8 grade 3b patients (25%) in the IF group and in 3 (15%) in the IE group (p=1). Mean KOOS score was 40 (range, 20–72) in IF and 65 (range, 50–93) in IE (p=0.0004). ConclusionMorbidity and mortality were comparable between implant exchange and plate fixation for periprosthetic femoral fracture in TKA. KOOS functional scores were better with implant exchange. Implant exchange may be suited to complex fracture with stable implant. Level of evidenceIV, observational study.

All-Inside Arthroscopic Repair For Longitudinal Meniscal Tears: Clinical and Functional Results

Meniscal injuries are a common challenge in orthopaedic surgery. Depending on their location and the patient’s age and functional needs, they can be treated either conservatively or surgically. A surgical approach can consist of arthroscopic meniscectomy or meniscal suture. The latter is the treatment of choice in case of lesions involving the red-red or red-white areas of the meniscus, especially for young high-demanding patients. We report here our experience with the repair of longitudinal meniscal tears using the all-inside technique with the Fast-Fix™ 360 Meniscal Repair System (Smith & Nephew Endoscopy, Andover, MA). We retrospectively evaluated 20 consecutive cases of longitudinal meniscal tears. In 4 cases, concomitant ACL rupture was diagnosed and treated alongside the meniscal repair. All patients underwent periodic clinical evaluations. At the latest check-up, their functional outcomes were rated according to the Tegner-Lysholm Knee and KOOS scoring scales. The mean Tegner-Lysholm Knee score was 84.85 (44-100) and the mean KOOS score was 88.58. No failure or major complications were observed. Furthermore, a negative statistical association was observed between age at surgery and the post-operative Tegner-Lysholm Knee score (coef. = -1.01189 [-1.942073,-0.0817063], p = 0.035). This relation, independent of gender, meniscus involved, eventual associated ACL reconstruction, and chondral injury, suggests that functional outcomes worsen with increasing patient age. Our results suggest that the arthroscopic all-inside suture is both safe and effective in cases of longitudinal meniscal tear, considering the good post-operative functionality and low rates of local complications and surgical failures.

Restricted kinematic alignment leads to uncompromised osseointegration of cementless total knee arthroplasty

PurposeWhile kinematic alignment (KA) total knee arthroplasty (TKA) with cemented implants has been shown to provide equivalent or better results than mechanical alignment, its combination with cementless fixation has not yet been documented. The purpose of this study is to report (1) revision rate and causes, (2) clinical results based on patient report outcome measures (PROMs), and (3) radiological signs of implant dysfunction in patients with an uncemented TKA implanted with restricted KA (rKA), after a minimum follow-up of 2 years.MethodsThis study included the first 100 consecutive uncemented cruciate retaining TKAs implanted between November 2015 and February 2018 by a single surgeon following rKA principles. At last follow-up, all adverse events and PROMs assessed by WOMAC, KOOS, and FJS scores were documented. Radiographic evaluation was performed to identify signs of implant loosening.ResultsAfter a mean follow-up of 49 months (32, 60), no implant revision was performed for aseptic loosening. Three revisions were performed: one for malalignment, one for a deep infection, and one for instability. The mean WOMAC score was 20.1 (0–79, 21.3), the mean KOOS score was 71.5 (19.0–96.6, 19.8), and the mean FJS score was 65.9 (0–100, 29.6). No radiological evidence of implant aseptic loosening or osteolysis was identified.ConclusionThis study shows that in 99% of our cases, rKA combined with the tested cementless TKA implant allowed for adequate secondary fixation and good functional outcomes in the short term. Favourable mid- to long-term implant survivorship is anticipated.Level of evidenceIII.

4316 Preoperative Goal-setting by Patients is Correlated with Baseline and Not 6-week Outcomes following Total Knee Arthroplasty (TKA)

OBJECTIVES/GOALS: Patient beliefs and goals can facilitate discussion of recovery expectations, patient-provider collaboration and maximization of goal achievement. In this study, we sought to address an evidence gap and examine the association of preoperative self-assessment of goals with preoperative and 6-week knee function and gait speed among total knee arthroplasty (TKA) patients. METHODS/STUDY POPULATION: We conducted a secondary analysis of data from the VERITAS randomized, controlled trial conducted from 11/2016-03/2018 that included adults age ≥ 18 years with scheduled and completed unilateral TKA followed by post-surgical physical therapy. Patients rated their ability to perform various activities of daily living goals scaled from 0 (unable to perform) to 10 (full performance). Patients were categorized by pre-surgical (baseline) goal rating: low = 0-2, intermediate = 3-4, and high = 5-10. Outcomes including gait speed and the KOOS were assessed within 10 days prior to surgery and 6-weeks post-surgery. Descriptive statistics and outcomes were compared for patients by preoperative goal rating using Chi-square or Fisher’s exact tests and ANOVA or Kruskal-Wallis tests as appropriate. RESULTS/ANTICIPATED RESULTS: Of 288 patients (mean age 65±8; 62.5% women; 82% white), 102 had a low goal rating (GR), 86 intermediate, and 99 high. Patients with low GR preoperatively generally had lower baseline mean scores than intermediate and high GR patients, respectively, on the KOOS (33.9/35.6/39.8; p<0.001) and lower gait speed (m/s) compared to intermediate and high GR patients at baseline (0.9/1.1/1.0; p = 0.009). The low, intermediate, and high GR groups, respectively, showed no difference across mean KOOS scores (61.0/61.2/61.9; p = 0.63) or gait speed (m/s) (1.0/1.0/1.0, p = 0.33) at 6 weeks postoperative. DISCUSSION/SIGNIFICANCE OF IMPACT: In this study, adults who perceived greater difficulty with a pre-selected activity goal, exhibited lower function prior to TKA but showed no differences in function 6-weeks after surgery. Follow-up studies will describe the association between goal-setting preoperatively and patient goal attainment and satisfaction following surgery.

Meniscal repair associated with a partial meniscectomy for treating complex horizontal cleavage tears in young patients may lead to excellent long-term outcomes.

While open repair of horizontal meniscal tears in young active patients has shown good results at mid- and long-term follow-up, complex horizontal tears (cleavage associated with meniscal flaps) are often treated by arthroscopic subtotal meniscectomy. The aim of this study was to evaluate long-term outcomes after arthroscopic removal of meniscal flaps associated with an open meniscal repair for treating complex lesions in young active patients. The hypothesis was that this salvage procedure would be efficient in such rare cases. Fourteen patients underwent an arthroscopic partial meniscectomy associated with an open meniscal repair to treat a painful complex horizontal meniscal cleavage between 2005 and 2010. There were two females and 12 males with a median age of 28.4years (range 15-48years). Patients were assessed by KOOS and IKDC scores, return to sport and the need for a secondary meniscectomy. Thirty patients were evaluated at a median follow-up of 8.5years (range 7-12years). One patient required revision of a partial meniscectomy and one other a meniscal replacement (15% failure rate). All other patients showed improvement with regard to their symptoms and returned to sports, ten (91%) of them at the same level. The mean IKDC subjective score was 86.1 (± 10.9). The mean KOOS scores were: pain 91.4 (± 7.5), symptoms 91.4 (± 10.2), daily activity 97.1 (± 4), sports 84.4 (± 20.7) and quality of life 84 (± 14.2). For six patients, scores at median follow-up of 2.6years were available and compared to newly obtained data. IKDC score at 8.6years follow-up was not significantly different. KOOS scores for daily activity and sports were maintained. Even in the presence of a complex lesion, horizontal cleavage can be repaired in young patients with good subjective and objective outcomes and a low rate of long-term failure as with other meniscal lesions in young active patients. IV.

Anterior knee pain following BPTB graft harvest. Reality or overhyped

IntroductionThe patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population. Material and MethodIn a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated. ResultsForty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients. ConclusionIt is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients. Level of EvidenceLevel IV.

Development of a pilot cartilage surgery register

BackgroundNorway has no prospective surveillance system to monitor the outcome of knee cartilage surgery. In 2004 the Norwegian Registry of Knee Ligament (NKLR) was successfully established, and has yielded useful information on the treatment of patients with both knee ligament and combined knee injuries. Patients with focal cartilage defects (FCDs) in their knees have reduced function and the treatment is difficult. There are geographical variations in treatment, and the generalizability from randomized controlled studies is low. These patients would benefit from a standardized long-time follow-up through a cartilage surgery register.The aim of the present study was to describe the development and report baseline challenges during the setting up of a pilot of a knee cartilage surgery register.MethodsThe study was designed as a prospective cohort study in the form of a register. Patients with full-thickness FCDs in the knee with International Cartilage Repair Society (ICRS) grade 3–4 on arthroscopy were included. The pilot included two hospitals; Oslo University Hospital (OUS), Ullevål and Akershus University Hospital (Ahus).ResultsWe registered 58 patients with isolated FCDs, whereas 16 additional patients with full-thickness FCDs were registered through the NKLR. The patient cohort of patients with isolated FCDs consisted of 65% men and had a mean age of 29.8 years. The data are incomplete and the compliance varies from 18 to 73%. The distribution of mean KOOS scores were similar to previous patient cohorts with FCDs, with low scores for the KOOS Sport/Recreation and Quality of Life subscales.ConclusionThe level of compliance demonstrated a large difference between the two participating hospitals. The compliance for the isolated FCDs were low in both locations, although it reached an acceptable level in one hospital when patients with combined injuries from the NKLR were included. The forms were incompletely filled out by the surgeons postoperatively and need to be revised prior the establishment of a nation-wide register.

Early Clinical Outcomes Associated with a Novel Osteochondral Allograft Transplantation System in the Knee

Background. Osteochondral defects of the knee are a common finding at the time of arthroscopic intervention. Purpose/Hypothesis. To report our outcomes after utilizing a new technique of osteochondral allograft transplantation for focal cartilage defects. Study Design. Case series. Methods. All patients treated with osteochondral allograft transplantation with a Zimmer Chondrofix plug (Zimmer Inc., Warsaw, IN) for focal cartilage defects over a 12-month period were followed up at a minimum of 24 months. Failures were documented and radiographs were evaluated. Results. 61 knees (58 patients) underwent grafting. Three cases were lost to follow-up. In the remaining 58 cases the average age was 40 (range 18–59). At a mean follow-up of 28 months (range 24–36), there were 5 failures requiring further surgery. Mean KOOS scores in the Pain, Symptoms, ADL, Sports, and Quality of Life dimensions were 82, 79, 84, 66, and 58, respectively. Radiographs demonstrated maintenance of the subchondral bone without graft absorption or subsidence. Conclusions. Our observations suggest that osteochondral allograft transplantation leads to a satisfactory activity level and function at early follow-up while avoiding the inherent complexities associated with other cartilage restoration techniques. Longer follow-up is warranted to monitor the subchondral bone, articular surface, and patient outcome measures.

Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity

PurposeOver the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers. MethodsWe conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up. ResultsMean follow-up was 18.2±6 months (12–28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59–100), UCLA score was 7.3±1.6 (4–10) and Tegner score was 4.6±1.3 (3–6). Mean KOOS score was 77±15 (54–97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement. ConclusionIn our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by isolated antero-posterior screwing provides excellent clinical and radiological results. The anteromedial incision has a dual advantage of anatomical reduction, tibial spine fixation (in 80% of our cases) and posteromedial fragment reduction.

Kinematic TKA using navigation: Surgical technique and initial results

BackgroundKinematic alignment for total knee arthroplasty (TKA) may be one way of improving outcomes. Previous studies have either used patient-specific instrumentation, which adds cost, or standard instrumentation, which provides no intraoperative feedback on resection alignment. HypothesisTo determine if computer navigation could reproduce native patient anatomy and simplify ligament balance during TKA whilst giving satisfactory improvements in functional scores at early follow-up. Materials and methodsComputer navigation was used for kinematic distal femoral and proximal tibial cuts in 100 consecutive and unselected TKAs. Resections were modified only if measured angles fell outside a pre-defined safe range of combined coronal orientation within±3 degrees of neutral and/or independent femoral or tibial cuts within±5 degrees. Pre- and postoperative measurements of the hip-knee-ankle (HKA) angle, the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) were taken using long-leg standing radiographs. Clinical evaluation was with the WOMAC and KOOS scales. ResultsMean follow-up was 2.4 years (range 1.0–3.7, SD 0.8). The mean pre-op LDFA was 2.1 degrees valgus (9.2 valgus to 3.7 varus, SD 2.5) and 1.8 degrees valgus post-op (5.7 valgus to 4.2 varus, SD 2.0) (P=0.41). The mean pre-op MPTA was 3.0 degrees varus (10.6 valgus to 10.2 varus, SD 3.2) and 2.4 degrees varus post-op (4.0 valgus to 6.8 varus, SD 2.2) (P=0.03). The mean WOMAC score improved from 49.4 (29–85, SD 12.8) to 24.7 (0–73, SD 16.5) (P<0.001) and the mean KOOS score from 37.1 (7.2–77.2, SD 13.0) to 65.1 (26.8–100, SD 16) (P<0.001). Five knees (5%) required additional ligament release, four with valgus OA and one with varus OA. Two knees (2%) required lateral retinacular release for patellar tracking. DiscussionComputer navigation for kinematic TKA provides the operating surgeon with full control and feedback at each step, whilst also allowing partial correction of more extreme anatomy that might be unsuitable for recreation during TKA. This technique helps to preserve ligament isometry and produces satisfactory improvements in functional scores. Level of evidenceIV (retrospective case series review).

Optimal gait retraining strategies in patients with knee osteoarthritis

Main topics: Rehabilitation; Experimental studies in human movement science Introduction and aim: Progression of knee osteoarthritis (OA) seems related to a high external knee adduction moment (EKAM) during gait [1,2], which can be reduced by gait retraining [3]. In healthy adults, lateral trunk lean and medializing the knee during gait reduce the EKAM effectively, although the optimal strategy seems individually dependent [3]. We aimed to determine which strategy reduces the EKAM most in patients with knee OA, and if the same strategy is most effective for all patients. Patients/materials and methods: Twenty-eight patients with radiographically diagnosed medial tibio-femoral knee OA underwent 3D gait analysis. Comfortable walking, lateral trunk lean towards the affected leg during the stance phase (Trunk Lean), and medializing the knee at initial contact (Medial Thrust) were investigated. Knee moments and kinematics of the knee and the trunk were calculated. Gait retraining strategies were assessed by comparison of EKAMpeak and impulse relative to comfortablewalking. Results: Most patients (age: 60.1±6.1 years, height: 1.71±0.10m, weight: 77.9±12.7 kg, mean KOOS-score: 46.3, KOOS subscales: pain (55.5), symptoms (52.5), daily activities (60.8), sport/recreation (26.8), knee-related QoL (36)) could finish the protocol without reporting any difficulties. One patient could not perform Medial Thrust due to knee pain. Fig. 1 shows the EKAM for all conditions. In both retraining strategies, EKAM was reduced significantly for early stance peak (MT: −0.07±0.01Nm/Bw·Ht, TL: −0.08±0.01Nm/Bw·Ht) and impulse (MT: −0.18±0.01Nms/Bw·Ht, TL: −0.03±0.01Nms/Bw·Ht). In 15 patients, Trunk Lean reduced overall EKAM peak the most (−0.09±0.04Nm/Bw·Ht). In 12 patients this was true for Medial Thrust (−0.13±0.07Nm/Bw·Ht). In the Medial Thrust group, leaning the trunk was significantly less effective than medializing the knee (p=0.005). In the Trunk Lean group, medializing the knee was significantly less effective than leaning the trunk (p=0.001). Changes in trunk angle and knee adduction angle as a result of retraining were similar between the groups (p>0.288). Discussion and conclusions: Medial Thrust and Trunk Lean effectively reduce the early stance EKAM peak and impulse during gait in patients with medial tibio-femoral knee OA. Even if the gait retraining instructions are not executed differently, the effectiveness of gait retraining strategies in reducing peak EKAM depends Fig. 1. EKAM for all conditions. Grey areas represent 95% CI for Normal Walking.

Assessment of Outcomes of Treatment of Fractures of Distal Femur with a Locking Plate Taking into Account Factors Influencing the Result.

The aim of this paper is to evaluate the results of treatment of distal femoral fractures (DFF) fixed with locking plates and analysis of factors that influence the final outcome. The patients were treated at the Department of Traumatology and Orthopedics, Military Medical Institute in Warsaw, and the Department of Orthopedics and Traumatology, 4th Military Research Hospital in Wroclaw. We analysed 39 patients with 42 fractures of the distal femur. Treatment results were analysed using the KOOS and KSS scales. Factors influencing the outcome were also investigated. Statistical analysis was performed using STATISTICA v. 10. Mean KOOS scores indicate a predominance of poor outcomes, while mean KSS scores indicate good outcomes. Treatment outcomes were significantly influenced by pain and limited mobility. 1. Subjective evaluation of treatment of fractures of the distal femur using the KOOS scale per form edworse than a clinical evaluation using the KSS. 2. Post-operative management should emphasise pain relief and restoration of the performance of the treated lower limb to ensure good mobility without crutches. 3. Despite the use of modern operational methods of fracture fixation, treatment of distal femur fractures is still a challenge.

Objectively measured physical activity and one-year change in symptoms among individuals with radiographically confirmed knee osteoarthritis

Objectively measured physical activity and one-year change in symptoms among individuals with radiographically confirmed knee osteoarthritis