Preoperative Flexion Research Articles

Preoperative Factors on Loss of Range of Motion after Posterior Cervical Foraminotomy.

Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2-C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.

Patient height is a predictive factor for good postoperative knee flexion after cruciate-retaining total knee arthroplasty with GRADIUS design.

A gradually reducing radius (GRADIUS) design implant can facilitate a smooth transition from stability through full range of motion in total knee arthroplasty (TKA). Nonetheless, patient-specific factors associated with good knee flexion remain unclear. This study aimed to determine the factors associated with good knee flexion after cruciate-retaining TKA with a GRADIUS prosthesis in an Asian population. This retrospective study included 135 patients that were stratified according to postoperative knee flexion angle (KFA) into Group F (⩾ 120∘; 85 patients [63.2%]) and Group NF (< 120∘; 50 patients [36.8%]). Patients in Group F were taller and had a lower body mass index (BMI) smaller preoperative hipkneeankle angle and better preoperative extension and flexion angle than Group NF patients. The multivariable analysis revealed that patients' height (odds ratio [OR]: 1.07, P= 0.0150), BMI (OR: 0.85, P= 0.0049), and preoperative flexion angle (OR: 1.06, P= 0.0008) predicted good KFA. The ROC curve analysis showed that the cutoff values of a good KFA were height 155.1 cm, BMI 22.1 kg/m2, and preoperative KFA 120∘. Patient height, BMI, and preoperative KFA were independent factors affecting good postoperative KFA in patients of Asian descent who underwent cruciate-retaining TKA with a GRADIUS design.

Association Between Overhang of the Posterior Femoral Condyle and Restricted Postoperative Knee Flexion Related to Patient-Reported Stiffness in Medial-Pivot Total Knee Arthroplasty

BackgroundThe primary aim of this study was to investigate the association between the posterior longitudinal overhang in the femoral condyle (PLOF) in medial-pivot total knee arthroplasty (TKA) and a change in knee flexion angle (change in flexion). MethodsThis retrospective cohort study included 148 knees undergoing medial-pivot TKA for medial knee osteoarthritis. The primary outcome was the change in flexion (c-flexion) preoperatively and 1-year postoperatively. The component positions were evaluated using 3-dimensional measurements, where the PLOF was measured for each medial and lateral femoral condyle. The secondary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index scores taken preoperatively and 2 years postoperatively. A multivariate regression analysis was performed to determine predictors of c-flexion and risk factors for negative c-flexion (less than 0°). Furthermore, a receiver operating characteristic curve was utilized to determine the threshold for negative c-flexion. ResultsThe mean c-flexion was −3.2° ± 8.7, and lateral PLOF was significantly associated with c-flexion (β = −0.52; P < 0.001). Larger preoperative flexion angles (odds ratio, 1.10; P < 0.001) and larger lateral PLOF (odds ratio, 1.69; P = 0.001) were risk factors for negative c-flexion, with thresholds of 129° and 1.1 mm, respectively (sensitivity, 0.79; specificity, 0.72). Additionally, patients who had negative c-flexion (n = 91) demonstrated less improvement in preoperative and 2-year postoperative Western Ontario and McMaster Universities Osteoarthritis Index stiffness subscores than patients who had positive c-flexion (0° or more; n = 57) (P = 0.01). ConclusionsA larger lateral PLOF was associated with decreased and negative c-flexion after medial-pivot TKA. Patients who had negative c-flexion demonstrated less improvement in knee stiffness. Surgical strategies aimed at minimizing lateral PLOF may enhance postoperative knee flexion and overall patient outcomes in medial-pivot TKA.

Postero-Central Slice Osteotomy of the Proximal Tibia: A Novel Technique for Correcting Resistant Tight Extension Gaps in Posterior-Stabilized Total Knee Arthroplasty for Varus Osteoarthritis

BackgroundThe aim of total knee arthroplasty (TKA) is to circumvent the pain due to advanced osteoarthritis of the knee joint and correct the limb alignment and biomechanics to improve patients’ quality of life. Apart from medio-lateral balancing, balancing flexion and extension gaps is a prerogative to achieve good results. This study proposes a novel surgical technique of postero-central slice osteotomy of the proximal tibia (PCSO-PT) for correcting tight extension gaps in posterior-stabilized knees and assesses its clinical and functional outcomes. MethodsA prospective study was conducted on 84 consecutive knees with tricompartmental osteoarthritis and varus deformity, requiring PCSO-PT during posterior-stabilized TKA between January 2016 and July 2018. Knee Society scores, flexion deformity, range of motion, antero-posterior instability, and complications were assessed at regular intervals for a minimum of 2 years postoperatively. ResultsResidual flexion deformities less than 11° after posterior capsular release were successfully corrected by the osteotomy. The mean preoperative flexion deformity of 18.1 ± 2.5° improved to 8.6 ± 2.2° intraoperatively after posterior capsular release from the femoral end and to 0.65 ± 0.76° intraoperatively immediately after the osteotomy, with no residual flexion deformity noted in any patient 6 weeks postoperatively. It had no negative effect on the significant post-TKA improvement of the mean Knee Society score from 32 ± 12 preoperatively to 94 ± 3 at the terminal follow-up. A direct correlation between preoperative flexion deformity and a resistant, tight extension gap (P = 0.003) was noted. There was no increase in coronal plane or sagittal plane instabilities in midflexion or on mobilization throughout the follow-up period, nor were any major adverse effects noted in this period. ConclusionsA PCSO-PT is an effective and safe alternative to overcoming tight extension during TKA after femoral-end capsular release, instead of capsular release from the tibial end or midcapsular region. Level of evidenceLevel IV, therapeutic study.

Radiocapitellar joint plasty for missed monteggia fracture with radial head deformity in children: a retrospective study.

The retrospective study reviewed the clinical and radiological outcomes of patients treated with radiocapitellar joint plasty. 10 children with missed Monteggia fracture (MMF) were reviewed. The average time from injury to operation was 20 months. The average age of children who underwent the operation was 10.5 years. 6 flat and 4 domed radial heads were included. 7 type I and 3 type III MMF were identified based on the Bado classification. All children with MMF were treated by open radial head reduction with radiocapitellar joint plasty and ulnar osteotomy (UO). The average union time was 4.9 ± 2.6 months. The average osteotomy angle to reduce the radial head was 15.7 ± 3.5°, and the average lengthening of the ulna was 8.2 ± 3.2 mm. The average preoperative flexion range of motion was 110.5 ± 9.1°, and the postoperative flexion range of motion was 138.8 ± 15.1° (p < 0.05). The average preoperative extension range of motion was 10.1 ± 3.2°, and the postoperative extension range of motion was 5.5 ± 3.3° (p < 0.05). The average preoperative pronation range of motion was 78.8 ± 8.7°, while the postoperative pronation range of motion was 81.1 ± 5.6° (p > 0.05). The average preoperative supination range of motion was 68.3 ± 9.7°, and the postoperative supination range of motion was 80.1 ± 7.8° (p < 0.05). The preoperative Kim score was 66.5 ± 10.9°, and the postoperative Kim score was 88.1 ± 12.6 (p < 0.05). The radial head was completely reduced in 9 patients, and subluxation in 1 patient. Osteoarthritis of the radiocapitellar joint was observed in 2 patients. Radiocapitellar joint plasty is effective surgical intervention for MMF with radial head deformity. It yields favorable functional outcomes while ensuring continued radial head reduction.

Thompson Versus Judet Techniques for Quadricepsplasty: A Systematic Review and Meta-analysis of Outcomes and Complications.

Quadricepsplasty has been used for over half a century to improve range of motion (ROM) in knees with severe arthrofibrosis. Various surgical techniques for quadricepsplasty exist, including Judet and Thompson, as well as novel minimally invasive approaches. The goal of this review was to compare outcomes between quadricepsplasty techniques for knee contractures. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Available databases were queried for all articles on quadricepsplasty. Outcomes included postoperative ROM, outcome scores, and complication rates. Secondarily, we summarized rehabilitation protocols and descriptions of all modified and novel techniques. Thirty-three articles comprising 797 patients were included in final analysis. Thirty-five percent of patients underwent Thompson quadricepsplasty, 36% underwent Judet, and 29% underwent other techniques. After Judet and Thompson quadricepsplasty, patients achieved a mean postoperative active flexion of 92.7° and 106.4°, respectively (p < 0.01). Complication rates after Judet and Thompson were 17% and 24%, respectively. Wound infection was the most frequently recorded complication after Judet, whereas extension lag predominated for Thompson. Both the Thompson and Judet quadricepsplasty techniques offer successful treatment options to restore functional knee ROM. Although the Thompson technique resulted in greater postoperative knee flexion compared with the Judet, the difference may be attributable to differences in preoperative flexion and time from injury to quadricepsplasty. Overall, the difference in flexion gained between the 2 techniques is comparable and clinically negligible. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic fibroarthrolysis and mobilization under anesthesia is a simple, reproducible, and satisfactory method for the treatment of patients with severe post-traumatic arthrofibrosis of the knee

ObjectiveTo evaluate the range of motion (ROM) of the knee in patients with severe post-traumatic knee arthrofibrosis after being treated with arthroscopic fibroarthrolysis (AFA) and manipulation under anesthesia (MUA). MethodsCase series of patients with severe post-traumatic knee arthrofibrosis who underwent AFL+MUA in a national referral center. The primary outcome to be assessed was ROM before and after surgery and then at 3-month intervals until a minimum follow-up of one year was completed. Results51 patients were included. The main injuries preceding the stiffness were tibial plateau fracture (37.3%), distal femur fracture (27.5%), and femoral shaft fracture (15.7%). Forty-five patients had severe flexion deficits with a median preoperative flexion of 70°. Intraoperative flexion significantly improved to 110°. Significant loss of flexion was observed at 3 and 6 months, however, patients regained ROM in the 9 and 12-month follow-ups. At discharge, 80% of the patients achieved flexion of 90° or more. There were 4 intraoperative complications and 3 reinterventions were performed. ConclusionAFA+MUA can help patients with severe post-traumatic knee arthrofibrosis to recover ROM in most cases. However, this procedure is not without risks and complications, therefore, careful consideration should be given to its indication and execution.

Prediction of Postoperative Range of Motion after Mobile-Bearing Medial Unicompartmental Knee Arthroplasty from the Preoperative Range of Motion and Other Preoperative Factors.

Postoperative flexion after unicompartmental knee arthroplasty might be predicted from the preoperative range of motion and other preoperative factors, but this has not been sufficiently investigated. Between 2013 and 2017, 198 patients (198 knees) underwent unilateral knee arthroplasty with medial mobile-bearing unicompartmental knee arthroplasty. Range of motion was measured preoperatively and at the time of final follow-up. To investigate the accuracy of the prediction of preoperative to postoperative gain or loss of the flexion angle, we performed receiver operating characteristic analysis. Logistic regression analysis was used to evaluate other predictive factors. Change in flexion angle was significantly strongly and negatively correlated with the preoperative flexion angle (R = - 0.688; 95% confidence interval: -0.755 to -0.607; p < 0.001). Preoperative flexion angle was suggested to be a significant predictor of gain or loss of the flexion angle with the area under the curve of 0.781; the cutoff value calculated using the Youden index was 140 degrees. Logistic regression analysis showed that in addition to the preoperative flexion angle of the operated side, the postoperative flexion range was significantly affected by the patient's height and by the preoperative flexion angle of the contralateral knee. If the preoperative flexion angle in Oxford mobile-bearing medial unicompartmental knee arthroplasty is <140 degrees, the postoperative flexion angle may be improved; if it exceeds 140 degrees, the postoperative flexion angle may worsen. This predictive ability is further improved by consideration of the patient's height and the range of motion on the contralateral side.

A clinical review of elbow ligament repairs and reconstructions in the acute and chronic settings

BackgroundThe ligamentous and osseous structures of the elbow joint are the major contributors to its inherent stability and damage to any of these structures can result in elbow instability. The aim of this study is to present objective and subjective outcomes following ligament repairs and/or reconstructions for acute elbow instability and chronic elbow instability. MethodsThis study included patients who underwent an elbow ligament repair and/or reconstruction for acute or chronic elbow instability. We performed a comprehensive retrospective data analysis of the patient's files, followed by a clinical examination and X-ray of these patients. ResultsWe identified 12 acute stabilizations and 22 stabilizations for chronic instability. Patients who underwent a stabilization for chronic instability had statistically significant improvements in their preoperative flexion and extension; 14.8 ± 6.4° and 5.9 ± 2.5°. Patients with chronic instability achieved better extension-flexion and pronation-supination arcs compared with their acute instability counterparts and this reached statistical significance. When the elbow pain and function scores were compared, we found stabilizations in the acute setting had better outcomes. There were two cases of postoperative instability, one in the acute instability group and one in the chronic instability group. ConclusionThis study provides evidence for elbow ligament repairs and reconstructions in both acute and chronic settings. It is an effective way of stabilizing the elbow joint in chronic instability patients, and results in an improvement in their overall range of motion. These patients achieved a greater range of motions compared with their acute instability counterparts.

A minimally invasive fixation for boxers fracture – fifth metacarpal neck using antegrade K wire fixation – functional outcome study

Background: Fifth metacarpal fractures are more common fractures in hand which are treated by conservative or surgical methods. Using retrograde k-wire fixation is associated with more complications due to damage to articular surface causing deformity or decreasing range of motion. Studies are done using single k-wire usage by antegrade technique, results vary due to k-wire complications and surgeon experience. Aims and Objectives: In this study, we are used a technique to bend a K wire in S-shaped fashion to negotiate through fracture to hold and reduce the fracture by rotating the tip of K-wire. Materials and Methods: This prospective study was done for fracture neck of fifth metacarpal presenting to outpatient department in 36 patients with dorsal angulation of more than 300 treated by passing a single k wire bent at the tip and shaft to form an S shape retrogradely with a follow-up period of 6 months following surgery. Results: Majority of injuries were in males in the dominant hand with a mean age group of 27.25 years. The mean pre-operative flexion angle of distal fragment was 44.11° (SD–4.12), and after the end of follow-up healing was achieved in all cases with a mean flexion angle improvement to 5.25° (SD–2.16). Disabilities of the arm, shoulder, and hand score measured at the end of study showed a mean of 6.25, and total active motions core showed excellent results in 25 cases (69.4%) cases and poor in 1 case (2.77%). Conclusion: This study emphasizes that bending a K wire in a lazy S fashion and passing antegradely will replicate results similar to using 2 K wires and have a better prognosis than retrograde wiring through the head of metacarpal. Furthermore, this procedure can be done in a primary care setting with minimal resources.

Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review.

This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. IV.

Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Occult Dorsal Wrist Ganglion Cysts Associated with Scapholunate Instability: Surgical Technique and Preliminary Clinical Results.

Background: This study aimed to evaluate our preliminary results and experience with the arthroscopic dorsal ligamentocapsulodesis in managing occult dorsal wrist ganglion cysts (ODGCs) associated with scapholunate (SL) instability. Methods: All patients who underwent arthroscopic dorsal ligamentocapsulodesis due to an ODGC with concomitant SL ligament tear were retrospectively reviewed. In addition to demographic data and length of follow-up, outcomes data that included range of motion, grip strength, modified Mayo wrist score (MMWS), complications and radiographs were collected. Results: The study included 18 patients (18 wrists; 10 female and 8 male). The mean age was 32 years (range: 19-48) and the mean follow-up was 34 months (range: 24-48). The mean preoperative extension deficit decreased from 5.5° (range: 0°-20°) to 2.7° (range: 0°-15°) at the final follow-up (p = 0.004). The mean preoperative flexion deficits decreased from 4.4° (range: 0°-15°) to 2.2° (range: 0°-10°) postoperatively (p = 0.003). The mean hand grip strength significantly increased from 27.7kg (range: 22-36) to 38.3kg (range: 31-46) at the final follow-up assessment (p < 0.001). The mean MMWS improved from 46 (range: 25-65) pre-operatively to 91 (range: 70-100) at the final follow-up (p = 0.0002). No major intra- or postoperative complications were observed. Conclusions: SL instability may have an important role in the aetiology of ODGCs, and arthroscopic dorsal ligamentocapsulodesis can provide pain relief and functional improvement without recurrence at the short- to mid-term follow-up in the treatment of ODGCs. Level of Evidence: Level IV (Therapeutic).

Facet-occiput slope angle: A novel predictor of cage placement feasibility during surgery in basilar invagination patients

Background and aimDirect posterior reduction and manipulation of the C1-2 joints, accompanied by placement of spacers, is the state-of-the-art technique for treating basilar invagination (BI) and atlantoaxial dislocation (AAD). The hindrance of occiput to reaching up to the true atlantoaxial facets (AAF) during the surgery remains challenging for cage placement. The aim of this study was to explore an objective and precise method of measuring the effect of the hindrance of occiput to reaching up to the true AAF and cage placement during surgery. MethodWe collected the clinico-imaging data of 58 patients with BI and AAD (Group A) who underwent surgery in our hospital, and 78 control cohorts (Group B) were retrieved retrospectively. We measured facet-occiput slope angle (FOSA) in midsagittal CT. Patients were positioned prone for surgery based on preoperative flexion O–C2a, and access to the true AAF was observed intraoperatively. The cut-off value of FOSA for the feasibility of cage placement in BI and AAD patients was appointed when access to the true AAF was impossible due to the hindrance of occiput during surgery. ResultsThe cut-off value of FOSA for the feasibility of cage placement was 34o with an area under the curve AUC of 0.800 (95 % CI: 0.672–0.928, P < 0.001) and the Youden index of 0.607. In patients with FOSA >34o, reaching up to the true AAF and 3D-printed cage placement was impossible. FOSA was negative in Group A and positive in Group B, significantly larger in females compared to males in both groups and significantly larger postoperatively in Group A. ConclusionFOSA can objectively measure the feasibility of cage placement when the patient is positioned prone per preoperative flexion O–C2a. A FOSA >34o is contraindication for cage placement.

Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction

Background: Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR. Purpose: To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months). Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded. Results: A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, –10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up (P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively (P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035). Conclusion: An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.

The clinical results of bi-cruciate vs posterior stabilized total knee arthroplasty for flexion contracture in osteoarthritic knee.

The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures. 59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flexⓇ; 76.3years, BMI 27.5) and 29 BCS-type TKAs (Journey IIⓇ; 72.5years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design. The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3mm for the PS group, and 1.8 ± 1.5mm for the BCS group, showing a significant difference (p = 0.04). The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.

PATELLA RESURFACING DOES NOT IMPROVE OUTCOMES IN PATIENTS WITH POSTOPERATIVE FLEXION CONTRACTURE AFTER PRIMARY TOTAL KNEE ARTHROPLASTY

Objective: Biomechanical studies have shown that flexion contracture leads to higher patellofemoral compressive forces with potentially poorer outcomes. We studied the outcome of primary knee arthroplasty with or without patella resurfacing in patients presenting with postoperative flexion contracture to determine if patella resurfacing improves the outcome. Materials and Methods: We retrospectively reviewed the registry data at the Singapore General Hospital from 1998-2014. Of 18074 primary knee replacements carried out, 665 knees were identified with postoperative flexion contracture greater than 10 degrees at 2 years follow-ups, out of which 562 knees were included in the study. One hundred and three patients were lost to follow-ups. All the infected cases were excluded from the study. Knees with patella resurfaced (227) were compared with knees with patella non-resurfaced (335) using Oxford Knee Score, Knee Society Clinical Scoring System, and SF-36. A handheld goniometer was used for measurements by an independent assessor and a physiotherapist. Analysis of factors for prognostic importance was performed using the R statistics. Results: At two years follow-ups, the non-resurfaced patella group had significantly higher median knee flexion compared to the resurfaced group. Age, male gender, preoperative flexion, and patella resurfacing were found to be significant predictors for knee flexion at two years. Outcome scores did not differ significantly between the two groups. Conclusion: No significant difference in outcome scores was observed in resurfaced versus non-resurfaced patella groups in patients with more than 10 degrees’ postoperative flexion contracture after primary knee arthroplasty. Keywords: Patella Resurfacing, Flexion contracture

Treatment of type II symptomatic ulnar styloid nonunions with reinsertion of the triangular fibrocartilage complex

PurposeThe purpose of this retrospective study was to introduce an alternative technique for the treatment of type II symptomatic ulnar styloid nonunion by the reinsertion of the triangular fibrocartilage complex and the ulnar collateral ligament.MethodsBetween March 2009 and May 2017, 45 patients (34 males and 11 females) suffering from the nonunion of type II ulnar styloid fractures all underwent the subperiosteal resection of the avulsed fragments and the reinsertion of the TFCC and ulnar collateral ligament. Outcome assessments included the ranges of motion of the wrist, grip strength, pain, and Mayo wrist score. The preoperative and postoperative parameters were compared. A P-value less than 0.05 was considered to be statistically significant.ResultThe mean follow-up period was 21.66 ± 7.93 months (range, 12 to 26 months). At the final follow-up, the mean preoperative flexion and extension were 79.32 ± 4.52° and 74.40 ± 4.36° respectively. The mean preoperative pain score, grip strength, and Mayo wrist score were 32.48 ± 4.00; 23.88 ± 8.38 kg, and 77.72 ± 8.31 respectively. The mean postoperative flexion and extension of the wrist were 80.56 ± 6.32° and 75.43 ± 3.12° respectively. The mean postoperative pain score, grip strength, and Mayo wrist score were 12.41 ± 3.27, 26.31 ± 8.30 kg, and 90.71 ± 7.97 respectively. There were significant differences in pain, grip strength, and Mayo wrist score (P < 0.05), but no significant differences concerning the range of motion of the wrist.ConclusionIn the treatment of the nonunion of type II ulnar styloid fractures, the resection of the avulsed fragments followed by the reinsertion of the TFCC and the ulnar collateral ligament with an anchor was a reliable alternative technique, bringing the satisfactory function of the wrist.

Severe patellofemoral arthritis does not compromise 6-month post-operative range of motion or function following unicondylar knee arthroplasty.

The presence of significant patellofemoral arthritis (PFA) is still considered a contraindication for unicondylar knee arthroplasty (UKA) by many surgeons. The purpose of this study was to determine if the presence of severe PFA at the time of UKA compromised early (< 6months) post-operative knee range of motion or functional outcomes. This retrospective review evaluated unilateral and bilateral UKA (323 patients; 418 knees) between 2015 and 2019. Procedures were grouped by degree of PFA present at the time of surgery, including mild PFA (Group 1; N = 266), moderate to severe PFA (Group 2; N = 101), and severe PFA with lateral compartment bone-on-bone contact (Group 3; N = 51). Knee range of motion and Knee Society Knee (KSS-K) and Function (KSS-F) scores were collected both before and at 6months following surgery. Group differences were evaluated with Kruskal-Wallis and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariable logistic regressions were performed to determine influential variables associated with post-operative knee flexion being ≤ 120° and presented as odds ratios (OR) and 95% confidence intervals (CI). Pre-operative flexion was lowest in Group 3 (p = 0.010) with 17.6% of knees having flexion ≤ 120°. Post-operative flexion was lowest in Group 3 (119.1° ± 8.4°, p = 0.003) with 19.6% knees having flexion ≤ 120° compared to 9.8% and 8.9% in Groups 1 and 2, respectively. No significant difference in KSS-F following surgery was found; all three groups demonstrated similar clinical improvement. Increased age (OR 1.089, CI 1.036-1.144; p = 0.001) and body mass index (OR 1.082, CI 1.006-1.163; p = 0.034) were found to be associated with post-operative knee flexion ≤ 120°, while high pre-operative flexion (OR 0.949, CI 0.921-0.978; p = 0.001) was found to be inversely associated with poor knee flexion following surgery. Patients with severe PFA demonstrate similar clinical improvement following UKA at 6months as patients with less severe PFA.

The effectiveness of penile curvature treatment by cavernous body rotation and plication of the tunica albuginea

BackgroundThere are several approaches to the surgical treatment of the penile curvature conditionally divided into three large groups: tunica albuginea plication (TAP), corpus cavernosum rotation (CR), and transplantation of various materials. The study aims to compare the effectiveness of TAP and CR techniques in the treatment of penile curvature. There was a prospective randomized study of the effectiveness of surgical treatment of patients with an established diagnosis of the penile curvature from 2017 to 2020 in Irkutsk, Russian Federation. The final analysis of the results included 22 cases.ResultsThe analysis of the comparative intergroup effectiveness of the treatment performed based on the criteria established in the study showed good treatment results in 8 (88.8%) patients in the CR group and 9 (69.2%) patients in the TAP group (p = 0.577). The other patients obtained satisfactory results. There were no negative outcomes. Simple logistic regression analysis showed that the preoperative flexion angle > 60 degrees (OR 2.7; 95% CI 0.12; 5.28; p = 0.040) was significant in predicting the complaints of penile shortening during TAP. Both methods are safe, effective, and bring minimal risk of complications.ConclusionThus, the effectiveness of both treatment methods is comparable. However, TAP surgery is not recommended for patients with an initial curvature of more than 60 degrees.

Favorable outcomes of posterior cruciate-stabilized inserts over ultracongruent inserts in total knee arthroplasty.

Posterior cruciate-stabilized (PS) and ultracongruent (UC) inserts are used during total knee arthroplasty (TKA), but superiority in gaining postoperative knee flexion and functionality remains contested. Therefore, this study compared postoperative outcomes between PS and UC inserts. A retrospective review evaluated unilateral or bilateral TKAs with PS or UC inserts from August 2011 to March 2020. Nonparametric statistics were performed to evaluate differences in patient demographics, pre- and postknee flexion and Knee Society Knee (KSS-K) and Function Score (KSS-F). Univariate and multivariable regressions were performed to evaluate the influence on postoperative knee flexion ≥ 120°, presented as odds ratios (OR) and 95% confidence intervals (CI). Patient demographics were not significantly different between the 577 PS and 399 UC knees evaluated. Postoperatively, a larger proportion of UC knees demonstrated knee flexion < 120° (36.0% vs. 18.6%, p < 0.001) and lower KSS-K (91.0 ± 8.7 vs. 91.6 ± 10.3, p < 0.001) and KSS-F (76.8 ± 21.6 vs. 79.9 ± 21.6, p = 0.007) than the PS group. The PS group had greater improvement in flexion angle (4.9° ± 14.9° vs. 1.0° ± 15.6°, p < 0.001) and KSS-F (27.3 ± 23.3 vs. 23.1 ± 25.3, p = 0.007) as compared to that of UC patients. Patients with preoperative flexion < 120° (OR 2.787, CI 2.066-3.761; p < 0.001), higher body mass index (OR 1.033, CI 1.006-1.061; p = 0.017) and UC insert (OR 2.461, CI 1.832-3.307; p < 0.001) were less likely to achieve flexion ≥ 120°. Favorable clinical and functional outcomes were noted in the PS group as compared to UC inserts in TKA. The greater improvement in overall knee flexion may suggest the PS insert may be especially appropriate for patients with lower preoperative range of motion. III, retrospective comparative study.