Postoperative Knee Range Of Motion Research Articles

Biceps femoris tenodesis revisited A prospective cohort study of concurrent anterior cruciate and postero-lateral corner reconstruction

PurposeWhen tendon allograft is not an option, knee posterolateral corner reconstruction by biceps femoris tenodesis gains increasing interest. This study investigated such question; “Does biceps femoris tenodesis result in clinical and functional outcomes comparable to Larsen fibular-based sling in concurrent posterolateral corner and anterior cruciate reconstruction? Patients & MethodsFrom October 2014 till December 2018, 19 patients of concurrent anterior cruciate and posterolateral corner injury were prospectively categorized according to posterolateral reconstruction technique into group-(A) of 10 patients managed by Larsen sling and group-(B) of 9 patients managed by biceps femoris tenodesis. Patients were evaluated for preoperative and 2-year postoperative knee range of motion, varus stress and prone dial tests, Lysholm and IKDC scores, return to work, and instability recurrence. ResultsStatistical analysis revealed matched demographics between groups. At mean of 29months postoperatively, average knee flexion was 146°; while extension loss didn't exceed 1° in both groups. There was no significant difference between groups in Lysholm and IKDC scores; (P-value= 0.710 and 0.210 respectively). ConclusionDespite it is non-anatomic technique, biceps femoris tenodesis can achieve clinical and functional outcomes comparable to Larsen fibular-based sling in concurrent posterolateral corner and anterior cruciate reconstruction; while offering advantages of simplicity and quickness and overcoming tendon graft unavailability.

Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen

PurposeDistal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%–10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. MethodsThis is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed. ResultsThe mean age of patients was 44.33 years (range 20–82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4–9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98⁰ (range 70⁰-120⁰). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90⁰ in 5 patients and 90⁰-120⁰ in rest of the patients, while 1 patient had extensor lag of 10⁰. One patient had implant failure and lost to follow-up; 3 patients had deep infection. ConclusionAn approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

Reporting Outcome and Evaluating the Efficacy of Biplanar Lateral Distal Femoral Osteotomy: Two Years Follow up Study

Introduction: Genu valgum could be approached by uniplanar or biplanar osteotomy in which site union and postoperative knee range of motion play important roles in technique selection.&#x0D; Methods: Study was performed on 30 cases including 14 males and 16 females. Two of them had severe genu varum deformity and 28 had genu valgum. Participants underwent biplanar lateral distal femoral osteotomy. Osteotomy requirement was assessed by Lateral distal femoral angle measurement.&#x0D; Results: Thirty patients underwent the biplanar procedure over the 4 years. Two years follow up showed complete union, full knee range of motion and within the acceptable alignment.&#x0D; Conclusion: Biplanar osteotomy is an effective method to create the wider inner cancellous surface to achieve better osteotomy site union and knee range of motion.

Effect of Graft Type on Thigh Circumference, Knee Range of Motion, and Lower-Extremity Strength in Pediatric and Adolescent Males Following Anterior Cruciate Ligament Reconstruction.

To treat anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) surgery is currently a standard of the care. However, effect of graft type including bone-patellar tendon-bone (BTB), hamstring tendon, or iliotibial band (ITB) on thigh size, knee range of motion (ROM), and muscle strength are understudied. To compare postoperative thigh circumference, knee ROM, and hip and thigh muscle strength in adolescent males who underwent ACLR, based on the 3 different autograft types: BTB, hamstring (HS), and ITB. Biomechanical laboratory. Male ACLR patients who are younger than 22 years of age (total N = 164). At 6- to 9-month postoperative visits, thigh circumference, knee ROM, and hip and thigh muscle strength were measured. Deficits of each variable between the uninvolved and ACLR limb were compared for pediatric and adolescent ACLR males in the BTB, HS, and ITB cohorts. Baseline characteristics, including physical demographics and meniscus tear status, were compared, and differences identified were treated as covariates and incorporated in analysis of covariance. Data were from 164 adolescent male ACLR patients [mean age 15.7 (1.2) years]. There were no statistical differences in thigh circumference, knee ROM, hip abductor, and hip-extensor strength among the 3 autografts. However, patients with BTB demonstrated 12.2% deficits in quadriceps strength compared with 0.5% surplus in HS patients (P = .002) and 1.2% deficits in ITB patients (P = .03). Patients with HS showed 31.7% deficits in hamstring strength compared with 5.4% deficits in BTB (P = .001) and 7.7% deficits in ITB (P = .001) groups at 6- to 9-month postoperative visits. Adolescent male ACLR patients with BTB and HS autografts demonstrated significant deficits in quadriceps and hamstring strength, respectively, at 6 to 9 months postoperatively. Minimal lower-extremity strength deficits were demonstrated in pediatric male ACLR patients undergoing ITB harvest.

Variables Determining the Postoperative Knee Range of Motion Following Cruciate-substituting Total Knee Replacement: A Prospective Study.

IntroductionRange of motion (ROM) is a major desirable outcome after total knee arthroplasty (TKA). The aim of our study is to analyze the variables determining postoperative knee ROM, following cruciate-substituting TKA of arthritic knees.MethodsOne-hundred fourteen patients out of a total of 158 patients were studied on the basis of the inclusion criteria. All patients underwent cruciate-substituting TKA in the period between September 2014 and September 2017. Variables such as age, sex, body mass index (BMI), preoperative ROM, mild-to-moderate knee deformity (in both the sagittal and coronal planes) and knee society score (KSS) were recorded for all the patients. The patients were evaluated at intervals and finally at the end of one-year post-surgery. The final ROM and KSS were noted. Data were analyzed in SPSS system using the Kruskal-Wallis test and Mann-Whitney U test.ResultsPatients with younger age (less than 60 years), more preoperative ROM, and less preoperative fixed flexion deformity (FFD) were found to have better postoperative ROM. The mean preoperative KSS was 42.14 ± 12.02, which improved to 90.86 ± 3.86 postoperatively. Other variables like gender, BMI, and preoperative coronal plane deformity of mild to moderate degree did not have a significant influence on postoperative ROM.ConclusionPostoperative expectations of ROM is an important factor for a successful outcome and is also related to patient satisfaction. Variables like younger age group (less than 60 years), better preoperative ROM and lower preoperative FFD are found to have a better postoperative ROM in patients undergoing cruciate-substituting TKA surgery.

The Perioperative Continuation of Aspirin in Patients Undergoing Arthroscopic Surgery of the Knee

Background: The perioperative withdrawal of aspirin increases the risk of cardiac, neurologic, and vascular thromboembolic events. The safety of continuing aspirin in patients undergoing knee arthroscopy is unknown. Hypothesis: Perioperative continuation of aspirin does not increase surgical complications or worsen outcomes in patients 50 years of age and older undergoing knee arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: This is a single-center, institutional review board–approved, prospective matched dual-cohort study comparing the surgical complication rates and postoperative outcomes of patients taking daily aspirin with those of unmedicated controls. Ninety patients who were 50 years of age or older and taking 81 mg or 325 mg daily aspirin were matched to 90 controls. Patients were matched on age, surgery type, and the use of a tourniquet. A complication was defined as bleeding, wound dehiscence, or wound infection requiring reoperation. Postoperative outcome measures including hematoma formation, extent of ecchymosis (mm), visual analog scale (VAS) scores for pain and swelling, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and postoperatively (10-14 days and 4-6 weeks). Results: There were no complications (0%) in either cohort. There was no difference in hematoma formation (aspirin, 1.8%; controls, 2.4%; P = .79), incidence of ecchymosis (aspirin, 17%; controls, 21%; P = .70), or the average extent of ecchymosis (aspirin, 124.6 mm; controls, 80.3 mm; P = .36) between patients taking aspirin and controls. There was no significant difference in pre- or postoperative knee range of motion between controls and patients taking aspirin. The KOOS subscores and VAS pain scores were similar between patients taking aspirin and controls at baseline and at follow-up. Conclusion: The perioperative continuation of daily aspirin in patients 50 years of age and older undergoing arthroscopic procedures of the knee is safe and does not result in an increased rate of bleeding or wound complications requiring reoperation. Continued aspirin use in patients 50 years of age and older had no significant effect on postoperative physical examination measures or patient-rated outcome scores.

Synthetic Mesh Allograft Reconstruction for Extensor Mechanism Insufficiency After Knee Arthroplasty.

Extensor mechanism (EM) insufficiency after knee arthroplasty is a rare but devastating complication resulting in severe disability. To date, primary repair and allograft reconstructive options have produced suboptimal results. A synthetic mesh allograft reconstruction technique has recently been introduced with promising outcomes. A retrospective chart review was performed to identify all patients who experienced EM failure after total or unicompartmental knee arthroplasty and subsequently underwent synthetic mesh EM reconstruction using a previously described technique. Patient demographics, pre- and postoperative knee range of motion and residual extensor lag, pre- and postoperative pain and functional outcome scores, and complications were extracted during the chart review. Twelve patients met inclusion criteria: 3 with patellar tendon and 9 with quadriceps tendon defects. At mean follow-up of 27.0 months, all patients were ambulatory, with a mean residual extensor lag of 12.9° (range, 0°-30°). Mean visual analog scale pain score decreased significantly after EM reconstruction: 4.6±2.3 (range, 1-8) preoperatively vs 1.8±2.4 (range, 0-7) postoperatively (P=.01). The mean Knee Society knee score improved from 41.5±11.1 (range, 21-57) preoperatively to 79.5±13.8 (range, 54-90) postoperatively (P<.0001). The mean Knee Society function score improved from 14.6±12.3 (range, 0-40) preoperatively to 64.2±27.1 (range, 5-95) postoperatively (P<.0001). One clinical failure occurred as a result of prosthetic joint infection. Synthetic mesh EM reconstruction effectively restores knee function for a variety of EM deficiencies following knee arthroplasty. [Orthopedics. 2019; 42(4):e385-e390.].

Addressing large tibial osseous defects in primary total knee arthroplasty using porous tantalum cones

BackgroundTibial osseous defects can present a serious challenge in primary total knee arthroplasty. We describe a technique of using porous tantalum cones along with primary arthroplasty implants to address large tibial osseous defects in primary total knee arthroplasty and present the short-term results. MethodsWe present 17 cases (15 patients) in which primary total knee implants and porous tantalum cones were used to address large tibial bony defects. Clinical results were evaluated using Knee Society Scores, pre- and postoperative knee range of motion, and serial radiographs. ResultsAt an average of 3.5 years of follow-up, all 17 knees had functioning implants with stable metaphyseal cones demonstrating radiographic evidence of osteointegration. At a minimum follow-up of two years, no patient had signs of osteolysis, instability, infection, or systemic complications. All 15 patients had excellent results with an average post-operative Knee Society Score of 94.6. Knee flexion improved by an average of 12.0° and knee extension improved to neutral in all patients. ConclusionPrimary total knee arthroplasty with porous tantalum cone augmentation produced excellent short-term results and should be considered an effective method for addressing large tibial osseous defects in primary total knee arthroplasty.

Pre-operative fixed flexion deformity a curse to the knee arthroplasty surgeon?

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to study the effect of preoperative flexion deformity on the postoperative knee range of motion following total knee arthroplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 28 knees were studied out of which twenty were osteoarthritis and eight were rheumatoid arthritis. Cruciate substituting and cruciate retaining implants were used. Patients above the age of 45 years with a minimum follow up period of two years from April 2010 were studied.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 28 knees had an average preoperative range of motion of 87.678. Patients with preoperative flexion deformity had postoperative range of motion of 97.5 degrees. The average postoperative flexion in 8 rheumatoid patients was 96.25 and 20 osteoarthritis patients was 107.462.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The average postoperative range of motion was 105.538. Patients with a higher pre-operative range of motion had higher postoperative range of motion. Rheumatoid patients had a significantly low range of motion when compared to osteoarthritis patients. Patients with increased fixed flexion deformity had a significantly low postoperative range of motion.&lt;/p&gt;

Heterotopic ossification around the knee after tibial nailing and ipsilateral antegrade and retrograde femoral nailing in the treatment of floating knee injuries.

Floating knee injuries are relatively uncommon injuries. We report the prevalence, location, and severity of heterotopic ossification (HO) around the knee in patients treated with antegrade tibial intramedullary nailing and ipsilateral antegrade versus retrograde femoral intramedullary nailing as well as how the severity of HO around the knee affects knee range of motion (ROM). From 2004 to 2014, 26 floating knee injuries were included. Radiographs were reviewed to determine presence, location, and severity of HO. Post-operative knee ROM was determined. A significantly higher prevalence of HO around the knee was detected in the retrograde group (90%) compared to the antegrade group (43%) (p = 0.028). There was a trend for more HO into the patellar tendon occurring in 29% of patients in the antegrade group and 74% in the retrograde group (p = 0.069). The severity of HO was higher for the retrograde group 1.6 ± 1.0 compared to the antegrade group 0.4 ± 0.5 (p = 0.004). There was poor correlation between HO severity and knee ROM. Treatment of floating knee injuries with a retrograde femoral nail was demonstrated to result in a greater likelihood of developing HO and a greater severity of HO around the knee than if treated with an antegrade femoral nail. However, this increased severity of HO is unlikely to affect ROM. III.

Dynamic Splinting in Children and Adolescents With Stiffness After Knee Surgery.

The purpose of this study was to investigate the indications and outcomes of dynamic splinting (DS) of the arthrofibrotic knee in the pediatric population. Seventy-four patients (41 males, 33 females) with postoperative arthrofibrosis treated with DS after an index knee surgery were reviewed. Median age was 13 years (range, 4 to 18 y), and median follow-up was 17 months (interquartile range, 10 to 28 mo). Demographics, index surgery procedure, preoperative and postoperative knee range of motion (ROM) measurements, treatment length and subsequent need for manipulation under anesthesia (MUA), and surgical lysis of adhesions (LOA) were evaluated. A ROM deficit was defined as lack of extension ≥10 degrees or lack of flexion <130 degrees. Successful improvement of ROM was defined as an increase of ≥10 degrees in flexion, extension, or both. There were 23 patients with flexion deficit only, 17 with extension deficit only, and 34 with combined flexion and extension deficits. Wilcoxon signed-rank test was used to assess median improvement in ROM. Patients were classified into 4 surgical groups: anterior cruciate ligament (ACL) reconstruction without meniscal repair (n=19), ACL reconstruction with meniscal repair (n=12), tibial spine fracture repair (n=21), and other (n=22). Multivariable logistic regression was used to identify independent predictors of failure of DS requiring MUA and LOA. A total of 57 patients with flexion deficits showed median improvement of 30 degrees in flexion (95% confidence interval, 0-90 degrees; P<0.001), and 51 patients with extension deficits showed median improvement of 7 degrees in extension (95% confidence interval, 0-60 degrees; P<0.001). DS was associated with ROM improvement in 84% and avoided the need for surgery in 58% of all 74 patients included in the study. Multivariate analysis of the ACL with meniscus repair subgroup revealed that each 1-month delay in DS treatment was associated with a 5-fold increased risk of undergoing a LOA (P=0.007). Thirty-six (63%) patients with flexion deficit avoided need for surgery, whereas 26 (51%) patients with extension deficits avoided surgery. Our data suggest that DS is an effective method to increase knee ROM and reduce the need for subsequent MUA/LOA in the pediatric and adolescent patient with arthrofibrosis after an index knee surgery. Level IV-retrospective case series.

Percutaneous Application of a Medial Plate for Dual Plate Stabilization of Supracondylar Femur Fractures.

Supracondylar femur fractures with segmental defects can be difficult fractures to treat. When associated with open wounds, these injuries can be associated with numerous complications including nonunion, malunion, infection, and arthrofibrosis. In this article, we review our algorithm for treating these fractures and highlight critical aspects of the process which differs from previous techniques described. We feel that this technique has specific benefits that mitigate infection risk and minimize additional soft-tissue insult without compromising stability. Our results demonstrate good postoperative knee range of motion, a high union rate, with low complication rates.

Research progress of larger flexion gap than extension gap in total knee arthroplasty

To summarize the progress of larger flexion gap than extension gap in total knee arthro-plasty (TKA). The domestic and foreign related literature about larger flexion gap than extension gap in TKA, and its impact factors, biomechanical and kinematic features, and clinical results were summarized. During TKA, to adjust the relations of flexion gap and extension gap is one of the key factors of successful operation. The biomechanical, kinematic, and clinical researches show that properly larger flexion gap than extension gap can improve both the postoperative knee range of motion and the satisfaction of patients, but does not affect the stability of the knee joint. However, there are also contrary findings. So adjustment of flexion gap and extension gap during TKA is still in dispute. Larger flexion gap than extension gap in TKA is a new joint space theory, and long-term clinical efficacy, operation skills, and related complications still need further study.

Effectiveness comparison of mobile-bearing and fixed-bearing prostheses in total knee arthroplasty for ten years follow-up

To compare the clinical results of mobile-bearing and fixed-bearing prostheses in total knee arthroplasty (TKA) during 10 years follow-up so as to provide a reference for clinical selection of TKA prosthesis. Between January 2002 and December 2005, 113 patients with osteoarthritis of the knee joint underwent primary TKA, and the clinical data were retrospectively analyzed. Mobile-bearing prosthesis was used in 47 cases (group A) and fixed-bearing prosthesis in 66 cases (group B). There was no significant difference in age, gender, body mass index, varus and flexion deformity of the knee, range of motion (ROM) of the knee, knee society score (KSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) between 2 groups before operation ( P>0.05), so the data were comparable. The operation time of groups A and B was (88.1±6.5) and (90.3±7.2) minutes respectively, showing no significant difference ( t=1.666, P=0.099). The wounds healed by first intention in all patients of both groups, and no postoperative early complications of incision infection and deep venous thrombosis occurred. The follow-up time was 10.2-12.3 years (mean, 10.8 years) in group A, and was 10.2-12.6 years (mean, 11.3 years) in group B. Revision was performed in 3 cases of group A and 4 cases of group B; the survival rates of prosthesis were 93.6% and 93.9% in groups A and B respectively, showing no significant difference ( χ2=0.005, P=0.944). The postoperative knee ROM, KSS score, and WOMAC score were significantly improved when compared with preoperative ones ( P<0.05). The knee ROM and KSS score of group B were significantly better than those of group A at 6 weeks after operation ( P<0.05), but no significant difference was found between 2 groups at 1, 3, and 10 years after operation ( P>0.05). The WOMAC score of group A was significantly better than that of group B at 10 years after operation ( t=2.086, P=0.037), but no significant difference was shown at 6 weeks, 1 year, and 3 years after operation ( P>0.05). At 10 years after operation, the excellent and good rate of KSS score was 87.2% in group A and was 84.8% in group B, showing no significant difference ( χ2=0.018, P=0.893). Good medium- and long-term clinical results can be achieved in TKA with both mobile-bearing and fixed-bearing prostheses. The TKA with fixed-bearing prosthesis is relatively simple with better early effectiveness of rehabilitation; and the TKA with mobile-bearing prosthesis could provide better long-term degree of satisfaction in WOMAC score, but a higher surgical skill and soft tissue balance techniques are needed.

Arthroscopic Treatment of Isolated Hoffa Fractures.

The goal of this study was to evaluate the results of a novel method, arthroscopic fixation of isolated Hoffa fractures.This is a prospective, case series and set at Level 1 trauma center. A total of eight patients with isolated Hoffa fractures who were operated by arthroscopic screw fixation method in the anterior posterior direction with 6.5 mm cannulated screws were followed up prospectively. Same surgical method used for all patients. All patients underwent the same rehabilitation program and active range of motion (ROM) exercises were started immediately. The International Knee Society (IKS) knee and functional scores, postoperative knee ROMs, and time of bone union were used as outcome measurements. Postoperative knee ROMs was compared with the contralateral healthy knee. The mean follow-up time was 29 months (26 - 41 months). At the final review, no significant difference (p = 0.159) was found between the ROM of healthy side and operated side of patients (153.1 ± 4.6 and 150 ± 3.8). The mean IKS knee and functional scores at 12 months were 87.2 ± 5.8 and 96.8 ± 3.7, respectively. Union was achieved in all patients at a mean duration of 3.8 months. Fracture side had no influence on the IKS knee scores, functional scores, and ROM (p = 0.846, p = 0.913, and p = 0.374, respectively). Concomitant intra-articular lesions identified in two patients (%25) during arthroscopy were one anterior cruciate ligament rupture and one medial meniscus tear. Patients undergoing arthroscopic Hoffa fracture fixation have excellent outcomes at average 29 months postoperatively with no apparent complications and no significant loss of ROM. Also 25% of patients had intra-articular injuries that were identified with arthroscopic technique that may have been missed with the open technique. The level of evidence was Level 4 (case series).

Digging Deeper into the Patello - Femoral Joint: Patello - Femoral Composite - A New Dimension for Overstuffing of Patello - Femoral Joint.

Patello-femoral complications are the most common complications in postoperative Total Knee Arthroplasty (TKA) patients especially overstuffing of Patello - Femoral Joint (PFJ). So, to study the effects of overstuffing of PFJ in postoperative TKA patients we put forth a new dimension - "PATELLO - FEMORAL COMPOSITE (PFC)". This is the maximum distance between anterior cortical line of femur shaft and the anterior cortex of patella with knee in full extension. To calculate chances of overstuffing of PFJ in postoperative TKA patients and document the effect of overstuffing of PFJ on the passive knee Range of Motion (ROM) in post- op TKA patients. This was a prospective observational study which included 51 consecutive primary TKAs. Preoperative and postoperative (24 weeks) passive knee ROM was measured. Preoperative and postoperative radiological parameters {PFC, Anterior Femur Offset (AFO), Patellar thickness (PT)} was recorded using Computed Tomography (CT) Scanogram image of patient in lateral view with knee in full extension and perfect overlap of both femur condyles, using DICOM format of the CT Scanogram image on the DICOM viewer. The postoperative PFC was more than its preoperative-value in 80.39% TKAs. Patients who had increased postoperative PFC had significantly less preoperative AFO. Female patients in our study had significantly less preoperative AFO compared to males. Thus, we deduced that female patients with lesser preoperative AFO undergoing TKA had increased postoperative PFC than male patients. PFC not only accounted for the overstuffing of the PFJ because of the patellar component, but also because of the femoral component; thus was a better measure of PFJ overstuffing compared to isolated PT. Passive knee ROM in the postoperative TKA patients approximately decreased by 2 degrees for every 1 mm increase in PFC compared to its preoperative-value in the patients with PFJ overstuffing. We conclude that overstuffing of the PFJ in postoperative TKA is present in 80.39% patients. Higher chances of postoperative PFJ over stuffing are present in female patients and those with thinner anterior cortex of distal femur. Postoperative passive knee ROM decreases significantly in patients with postoperative PFJ overstuffing (Every 1 mm increase in the postoperative PFC, passive knee ROM decreased by approximately 2 degrees).

Target range of motion for rehabilitation after total knee arthroplasty.

Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to 12 months after TKA, including intraoperative knee ROM after implantation, and to clarify a target ROM for rehabilitation after TKA.Patients and Methods: In total, 39 knee joints in 26 patients with osteoarthritis who underwent TKA (retaining the posterior cruciate ligament) were evaluated. Goniometry was used to measure the knee range of extension and flexion preoperatively; intraoperatively; at 1 and 2 weeks after TKA; and then at 1, 3, 6, and 12 months after TKA.Results: The postoperative extension range gradually improved up to a maximum at 6 months after TKA; there were no significant differences in the extension range between intraoperative and 6 months after TKA, intraoperative and 12 months after TKA, or 6 and 12 months after TKA. The postoperative flexion range gradually improved, with the maximum improvement observed at 3 months after TKA; there were no significant differences in the flexion range before TKA and 3, 6, and 12 months after TKA. There were no significant differences between flexion ROM measured at 3, 6, and 12 months after TKA.Conclusions: The changes in the knee range of extension plateaued 6 months after TKA, and those in the knee range of flexion plateaued 3 months after TKA. The target range of extension for rehabilitation from 6 months to 12 months after TKA was the intraoperative range, and the target range of flexion for rehabilitation from 3 months to 12 months after TKA was the preoperative range.

Comparing the Effects of Two Tourniquet Times on Pain and Knee Range of Motion after Internal Plate Fixation of Tibia Fractures

Background: Tourniquet is used in limb surgeries in order to create a clear blood-free surgical filed. Despite its considerable benefits, tourniquet has potential risks such as neuromuscular injuries, decreased joint range of motion, and pain. Present study was made to compare the effects of two tourniquet times on pain and knee range of motion after internal plate fixation of tibia fractures. Methods: This randomized controlled trial was performed on forty patients with acute closed extra-articular tibia fractures who were candidates for internal plate fixation. The patients were conveniently recruited and randomly allocated to groups A and B. In group A, tourniquet was deflated after tibial fixation and before wound closure while in group B, it was deflated after wound closure and compression dressing. The level of pain as well as knee range of motion were measured before, 24 hours after, and fourteen days after the surgery using a 30 cm goniometer and a 0-10 visual analogue scale, respectively. Results: Pain intensity score in group A was significantly lower than group B both at 24 hours and fourteen days after the surgery. Knee range of motion in group A was also significantly greater than group B at 24 hours after the surgery. However, fourteen days after the surgery, there was no significant difference between the groups regarding knee range of motion. Conclusion: Tourniquet deflation before wound closure is associated with lower levels of postoperative pain and greater postoperative knee range of motion among patients undergoing internal plate fixation of tibia fractures. Possible explanations for these findings are faster reperfusion, reduced duration of ischemia, and slighter ischemic and mechanical injuries to nerves, muscles, and the skin.

Clinical Outcomes of Patients with Valgus Deformity Undergoing Minimally Invasive Total Knee Arthroplasty Through the Medial Approach.

Objective: The purpose of this study was to compare the clinical outcomes between patients with a valgus or varus deformity undergoing minimally invasive total knee arthroplasty through the medial approach.Methods:The patients were classified into 2 groups according to the preoperative femorotibial angle measured on an anteroposterior long leg roentgenogram. The valgus group comprised of 26 knees in 21 patients with a femorotibial angle <170° (163.5 ± 5.7), and the varus group comprised of 24 knees in 21 patients with a femorotibial angle >190° (195.9 ± 5.5). The following background variables were compared between the groups: age at the time of the operation, sex, causative disease, preoperative femoral mechanical–anatomical angle, and postoperative knee range of motion, Knee Society score, femorotibial angle, and implant position.Results:There were significant differences between the valgus and varus groups in the age (68.0 ± 6.9 vs 75.8 ± 6.2 years), percentage of males (23.8% vs 0%), percentage with rheumatoid arthritis (61.9% vs 4.8%), and preoperative femoral mechanical–anatomical angle (6.2 ± 1.0° vs 7.4 ± 2.1°). Clinical outcome variables of postoperative femorotibial angle (173.1 ± 3.9° vs 175.2 ± 1.6°) and α angle (96.6 ± 3.1° vs 95.0 ± 1.9°) also differed.Conclusion:It was assumed that over-valgus resection of the femur is a contributory factor to residual valgus alignment. However, knee range of motion and Knee Society score did not differ between the groups. We suggest that minimally invasive total knee arthroplasty through the medial approach is one of the treatment options for patients with valgus deformity.

Muscle strength and knee range of motion after femoral lengthening

Background and purpose — Femoral lengthening may result in decrease in knee range of motion (ROM) and quadriceps and hamstring muscle weakness. We evaluated preoperative and postoperative knee ROM, hamstring muscle strength, and quadriceps muscle strength in a diverse group of patients undergoing femoral lengthening. We hypothesized that lengthening would not result in a significant change in knee ROM or muscle strength.Patients and methods — This prospective study of 48 patients (mean age 27 (9–60) years) compared ROM and muscle strength before and after femoral lengthening. Patient age, amount of lengthening, percent lengthening, level of osteotomy, fixation time, and method of lengthening were also evaluated regarding knee ROM and strength. The average length of follow-up was 2.9 (2.0–4.7) years.Results — Mean amount of lengthening was 5.2 (2.4–11.0) cm. The difference between preoperative and final knee flexion ROM was 2° for the overall group. Congenital shortening cases lost an average of 5% or 6° of terminal knee flexion, developmental cases lost an average of 3% or 4°, and posttraumatic cases regained all motion. The difference in quadriceps strength at 45° preoperatively and after lengthening was not statistically or clinically significant (2.7 Nm; p = 0.06). Age, amount of lengthening, percent lengthening, osteotomy level, fixation time, and lengthening method had no statistically significant influence on knee ROM or quadriceps strength at final follow-up.Interpretation — Most variables had no effect on ROM or strength, and higher age did not appear to be a limiting factor for femoral lengthening. Patients with congenital causes were most affected in terms of knee flexion.