Recovery Of Knee Function Research Articles

Rehabilitation of the knee following ACL repair and reconstruction: A review of clinical best practices

Background and Study Aim. ACL reconstruction is the surgical replacement of the anterior cruciate ligament with a tissue graft to restore knee function. To avoid problems including edema, loss of range of motion, muscle weakness, poor balance, and recovery of knee function, rehabilitation treatment should be performed after surgery. Immediate implementation of open kinetic chain exercises, use of criterion-based progressions for various activities such as running, sprinting, and plyometrics, and implementation of a secondary prevention program. This clinical practice review is to discuss the parameters associated with the rate of phase repair for ACL repair and to guide therapists according to the parameters of postoperative healing. Material and Methods. The patient presented with a knee brace still in place, swelling and incision marks above the patella, and atrophy of the dextra quadrisep muscle, the patient still had difficulty bending and straightening his right knee, and used crutches to help him walk. The modalities given are massage, electrotherapy (TENS), various exercises (exercise therapy), stretching, and cryotherapy. Results. There are five phases of rehabilitation: maximal protection, moderate protection, minimum protection (initial strengthening), Neuromuscular Control and Functional Training (strengthening-cardiovascular conditioning), and maintenance and Return to Activity (controlled agility-advanced conditioning). These stages are to help reduce swelling, increase joint range of motion, increase muscle strength, and reduce pain. Conclusion. Periodization theory should be fundamentally understood by sports rehabilitation professionals, especially physical therapists and sports medicine physicians. So that a safe and organized postoperative procedure can be established.

Evaluation of Clinical Outcomes in Sport Participants Undergoing Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the most common musculoskeletal injuries. Evaluating the clinical outcomes of the ACL reconstruction (ACLR) procedure is essential to provide information regarding the benefits of this procedure. This study aimed to assess the clinical outcomes of patients who underwent ACLR at Prof. Dr. R. D. Kandou Hospital Manado. This was a retrospective study. Secondary data were collected from all athlete patients who underwent ACLR. The ACLR procedure was performed by a single operator following the standard arthroscopic procedure. All grafts used Hamstring grafts (gracilis and semitendinosus). Suspense fixation was done using a button, while tibial fixation was done with interference fixation (bioabsorbable screw). Patients were evaluated over a short period, specifically at three months, six months, and nine months. Outcome parameters were assessed using the Visual Analog Scale (VAS), Range of Motion (ROM), Lachman test, Anterior Drawer test, and Knee Functional Score (KFS). Any complications that arose were documented. The results showed that among 21 patients at Prof. Dr. R. D. Kandou Hospital Manado, it was found that ACL injuries were more common in physically active men, especially in the age group of 26-30 years. Most patients who underwent ACLR had serious injuries that required immediate treatment. Hamstring graft was the most common choice (85.7%). Knee stiffness was the most common complication and required special attention during the rehabilitation program. Based on KFS, most patients successfully achieved good knee function recovery. There was a decrease in the VAS score reflecting the effectiveness of the procedure in reducing postoperative pain. There was an increase in the KSS reflecting the success of ACLR in restoring knee stability and function to almost normal levels. In conclusion, anterior cruciate ligament reconstruction in sport participants showed significant improvements in knee mobility and pain reduction, with low complications. Keywords: anterior cruciate ligament injury; anterior cruciate ligament reconstruction; graft fixation

Effects of Neuromuscular Electrical Stimulation on Quadriceps Femoris Muscle Strength and Knee Joint Function in Patients After ACL Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Quadriceps weakness is a common barrier to effective rehabilitation after anterior cruciate ligament (ACL) surgery. Neuromuscular electrical stimulation (NMES)-the application of electrical currents to induce muscle contraction-has been used as part of the postoperative rehabilitation regimen. To investigate the effects of NMES on the recovery of quadriceps strength and knee function after ACL surgery. Systematic review; Level of evidence, 1. A search was conducted in the Web of Science, Embase, Cochrane Library, and PubMed databases between inception and August 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were randomized controlled trials of patients undergoing NMES as postoperative rehabilitation after ACL reconstruction or repair, with standard physical therapy as the control intervention. The quality of the included studies was assessed according to the Cochrane Collaboration risk-of-bias tool. Lower limb function was assessed qualitatively, and standardized mean differences (SMDs) in muscle strength and Lysholm scores were analyzed quantitatively and pooled using a random-effects model. Eleven studies (N = 202 patients) met our inclusion criteria. The meta-analysis of muscle strength values, which included 9 studies, showed that patients who underwent physical rehabilitation with adjunctive NMES had better recovery and improvement in quadriceps muscle strength compared with standard physical therapy at both short- and long-term follow-ups (≤6 weeks: SMD, 0.53 [95% CI, 0.27-0.79] vs >6 weeks: SMD, 0.59 [95% CI, 0.18-0.99]; p < 0.001). Moreover, subgroup analyses showed that earlier physical rehabilitation with the assistance of NMES resulted in better muscle strength recovery (≤1 week: SMD, 1.48 [95% CI, 0.80-2.17] vs >1 week: SMD, 0.44 [95% CI, 0.21-0.67]; p < 0.001). The meta-analysis of Lysholm scores, which included 3 studies, did not indicate any significant differences between the assisted NMES and control groups. Our study demonstrated that in both short- and long-term follow-up studies, postoperative rehabilitation with NMES after ACL surgery significantly increased quadriceps muscle strength compared with standard rehabilitation alone.

A Prospective Study on Knee Function Recovery After Total Knee Arthroplasty: A Comparison of Active and Passive Exercise and Pain Assessment

目的： 本研究的目的是确定术后疼痛水平是否降低，并检查主动和被动运动对全膝关节置换术 （TKA） 后膝关节功能恢复的影响。方法： 采用前瞻性研究设计，将我院接受 TKA 的 204 例患者随机分配到连续被动运动 （CPM） 组或受控主动运动 （CAM） 组，每组 102 例患者。两组都接受了两组相同的标准锻炼方案。所有患者在术前、术后和出院后均进行评估。评估指标包括运动范围 （ROM）、西安大略大学和麦克马斯特大学骨关节炎指数 （WOMAC）、视觉模拟量表 （VAS）、膝关节社会功能评分 （KSS） 和简式健康调查 （SF-36）。结果： 术后 1.5 个月和 3 个月，两组屈曲角度差异有统计学意义 （P&lt;0.05）。术后 3 个月和 6 个月，结果显示使用 WOMAC 评分的组疼痛评分存在统计学意义差异 （P&lt;0.05）。其他指标显示两组都有所改善。结论： CAM 组和 CPM 组均显著改善了 TKA 后患者的恢复情况;然而，CAM 组在膝关节屈曲、疼痛缓解和生活质量改善方面表现出卓越的结果。

Comparison of the effects of high tibial osteotomy with and without a tourniquet

BackgroundTourniquets are routinely employed to achieve hemostasis in modern limb surgeries. Nevertheless, the precise role and benefits of tourniquets in high tibial osteotomy (HTO) surgeries remain understudied. The aim of this study was to assess the application of tourniquets in high-tibial osteotomy procedures.MethodsThis was a prospective study of patients who underwent HTO surgery at an identical hospital. The participants were randomly assigned into two groups: Group A, with a tourniquet (n = 43); and Group B, without a tourniquet (n = 43). The same surgical technique and postoperative care were employed for both groups of patients. Knee range of motion (ROM) and pain were assessed by utilizing a visual analogue scale (VAS) after exercise and maximum calf circumference, and postoperative Hospital for Special Surgery (HSS) score, as well as inflammatory markers including CRP and IL-6, were adopted to compare and analyse the recovery of knee function in the two groups of patients following surgery.ResultsAll participants were followed up for a period exceeding three months. No cases of vascular or nerve injuries were observed during surgery in either group. Moreover, there was no statistically significant difference in total blood loss volume throughout treatment or haemoglobin or haematocrit levels (P > 0.05). furthermore, Group A underwent a shorter operation than Group B did (P < 0.05). Group B demonstrated decreased postoperative visual analog scale (VAS) pain levels, calf swelling (P < 0.05), increased early knee range of motion (P < 0.05), and diminished release of blood inflammation markers(IL-6 and CRP) (P < 0.05).ConclusionThe application of tourniquets in HTO surgery reduces intraoperative blood loss and shortens the operative time yet does not substantially affect total bleeding. Nonetheless, the absence of a tourniquet resulted in reduced postoperative pain and facilitated early rehabilitation of knee function.

Effects of Anterior Cruciate Ligament Reconstruction Timing on Post-Operative Motor Performance and Proprioception.

Objective To evaluate the effects of anterior cruciate ligament (ACL) reconstruction timing on the motor performance and proprioception by clinical evaluation as well as proprioception and motor performance tests on the patients more than 2 years after ACL reconstruction. Methods The patients who underwent ACL reconstruction in the National Institute of Sports Medicine,General Administration of Sport of China from January 2015 to January 2021 and met the inclusion criteria were followed up,and the postoperative data were collected retrospectively.Fifty-six patients who met the inclusion criteria were included in this study and categorized into two groups:early surgery (n=28,who underwent ACL reconstruction ≤3 weeks after injury) and delayed surgery (n=28,who underwent ACL reconstruction >3 weeks after injury).The basic information,clinical evaluation results,proprioception,and motor performance were compared between the two groups. Results The ACL return to sport after injury scale (ACL-RSI) score in the early surgery group was higher than that in the delayed surgery group [(68.68±22.04)scores vs. (55.82±24.87)scores,P=0.045].There was no difference in the range of motion of the knee joint,the positive rate of pivot shift test,or the scores of Tegner,Marx,Lysholm,knee injury and osteoarthritis outcome score (KOOS),and international knee documentation committee (IKDC) between the two groups (all P>0.05).Although there was no significant difference in range of motion of the knee joint between the two groups,the proportion of knee flexion and extension affected in the early surgery group was smaller than that in the delayed surgery group.Neither motor performance (isokinetic strength test,Y-balance test,and single-leg jump test) nor proprioception had difference between the two groups (all P>0.05). Conclusions Early ACL reconstruction outperformed delayed ACL reconstruction in improving the psychological health,emotions,and confidence in returning to sport,accelerating functional recovery of the patients.The timing of ACL reconstruction has no significant effect on the short-term postoperative knee stability,knee function,motor performance,or proprioceptive recovery of the patients.Early ACL reconstruction is recommended for improving the clinical outcomes.

Volume and Distribution of Early Knee Effusion After TKA with a PEEK-Based Knee Prosthesis: Correlation with Changes in Serum Inflammation Marker Levels, Knee Functional Score, and Range of Motion.

Early knee effusion is a common phenomenon after total knee arthroplasty (TKA), with potential clinical implications. Unlike traditional alloy knee prostheses, the polyetheretherketone (PEEK) knee system has radiographic transparency on magnetic resonance (MR) scans, which allows analysis of prosthetic knee effusion. We aimed to identify the distribution and volume of knee effusion after TKA with the PEEK prosthesis with use of MR imaging and to analyze whether dynamic changes in effusion were correlated with serum inflammatory marker changes and knee function recovery. Nine patients with osteoarthritis who were 59 to 74 years old underwent unilateral TKA with the PEEK prosthesis between June 2021 and August 2021. Dynamic early postoperative changes in the volume and distribution of knee effusion were evaluated with use of 3D MR stereoscopic images. Serum inflammatory markers were measured via blood tests, and joint function was evaluated with use of the subjective functional score of the Knee Society Score (KSS) and knee range of motion (ROM). Linear regression analyses were performed to assess for correlations between knee effusion volume and inflammatory markers and between knee effusion volume and joint function. The mean serum inflammatory marker levels increased significantly at 1 week after TKA with the PEEK prosthesis and then gradually decreased with time from 1 to 6 months. The mean total knee effusion volume gradually decreased over time. Concurrently, the mean KSS subjective functional score and mean knee ROM improved with time. Total knee effusion volume was positively correlated with C-reactive protein level (R2 = 0.16; p = 0.007) and negatively correlated with the change in KSS score between the preoperative and postoperative time points (R2 = 0.19; p = 0.003). Using the 1-week total knee effusion volume as a reference, a positive correlation was observed between the reduction in total knee effusion volume and the actual value of the ROM (R2 = 0.36; p = 0.0001) from 3 to 24 months postoperatively. Through 3D MR imaging, the precise distribution and volume of, and dynamic changes in, knee effusion after TKA with the PEEK prosthesis were confirmed and were found to be correlated with inflammation and joint function in the early postoperative period. The results demonstrate the potential clinical benefit of the PEEK-based knee system for future use. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Magnesium sulphate and sodium bicarbonate as additives for periarticular local infiltration analgesia improve pain management after unicompartmental knee arthroplasty: a prospective, double-blind, randomized controlled trial

BackgroundPeriarticular local infiltration analgesia (LIA) has become a widely used method for postoperative pain management after unicompartmental knee arthroplasty (UKA). However, the efficacy of using magnesium sulphate or sodium bicarbonate in LIA cocktails during UKA is not yet clear. The present study aimed to evaluate whether the modified LIA has advantages in pain control and joint function recovery after UKA surgery.MethodsSixty-one patients who underwent UKA were enrolled and randomly assigned to receive periarticular infiltration of a modified cocktail (comprising ropivacaine, epinephrine, dexamethasone, magnesium sulphate, and sodium bicarbonate) or a conventional cocktail (comprising ropivacaine, epinephrine, dexamethasone, ketorolac, and morphine). The outcomes included the consumption of patient-controlled intravenous analgesia (PCIA) medication used for postoperative analgesia, pain score, early joint functional recovery, discharge time, and complication rates.ResultsIn the first 12 h after surgery, the conventional cocktail was not superior to the modified cocktail in terms of visual analogue scale (VAS) scores. However, beginning on the second postoperative day, the analgesic effect was significantly prolonged in the modified group, leading to lower VAS scores and better knee functional recovery. Additionally, patients in the modified group required less pain medication via PCIA, both within the first 24 h and cumulatively up to 48 h after surgery. Both groups had similar rates of complications.ConclusionsThe present modification of a conventional cocktail significantly prolonged the analgesic effect and reduced pain medication consumption after UKA surgery, which was associated with better functional recovery in the early postoperative days.Trial registrationChinese Clinical Trial Registry, ChiCTR2200060500. 21 March 2023.

Effectiveness of lower tibial tunnel placement combined with internal tension relieving suture in posterior cruciate ligament reconstruction

To compare the effectiveness between lower tibial tunnel placement combined with internal tension relieving suture and simple lower tibial tunnel placement for posterior cruciate ligament (PCL) reconstruction. The clinical data of 83 patients with simple PCL injury who met the selection criteria between January 2014 and February 2022 were retrospectively analyzed. Among them, 44 patients underwent PCL reconstruction through lower tibial tunnel placement combined with internal tension relieving suture (tension relieving suture group), and 39 patients underwent PCL reconstruction through simple lower tibial tunnel placement (control group). Baseline characteristics, including gender, age, body mass index, side of injury, cause of injury, preoperative side-to-side difference (SSD) in posterior tibial translation, visual analogue scale (VAS) score, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores (including symptom, daily activities, and knee function scores) were compared between the two groups, showing no significant difference ( P>0.05). The operation time and intraoperative blood loss were recorded and compared between the two groups. The effectiveness was evaluated by Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, SSD in posterior tibial translation before operation and at last follow-up, the patient satisfaction at last follow-up, and the postoperative graft recovery was evaluated by MRI. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 12-60 months, and there was no significant difference between the two groups ( P>0.05). Postoperative MRI showed that the graft was in good condition, and the reconstructed PCL graft had good signal, continuity, and tension. During the follow-up, there was no complication such as re-rupture or donor site discomfort in both groups. At last follow-up, the Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, and SSD in posterior tibial translation significantly improved in both groups when compared with those before operation ( P<0.05). The changes of Lysholm score, Tegner score, IKDC knee symptom score, and SSD in posterior tibial translation between pre- and post-operation were significantly superior in the tension relieving suture group compared to the control group ( P<0.05). However, no significant difference was found between the two groups in the changes of VAS score, knee ROM, IKDC daily activities score or knee function score between pre- and post-operation, and the satisfaction score ( P>0.05). Lower tibial tunnel placement combined with internal tension relieving suture PCL reconstruction represents a more effective surgical approach for improving postoperative laxity of PCL and knee function recovery comparing to simple lower tibial tunnel placement PCL reconstruction.

Comparing the subvastus and medial parapatellar approaches in total knee replacement

Background: This study aimed to compare the outcomes of the subvastus and medial parapatellar approaches in total knee replacement (TKR), focusing on postoperative pain, knee function recovery, quadriceps strength, hospital stay, complications, and patient satisfaction. Methods: This prospective comparative clinical trial was conducted over 18 months at a tertiary care hospital. A total of 120 patients, aged 50-75 years with knee osteoarthritis, were divided into two groups, group A (subvastus approach) and group B (medial parapatellar approach). Pain, range of motion (ROM), quadriceps strength, length of hospital stay, complications, and patient satisfaction were evaluated postoperatively at 1, 3, 6, and 12 months. Data were analyzed using SPSS, with significance set at p&lt;0.05. Results: Group A showed significantly lower pain at 1 and 3 months, with VAS scores of 4.1 and 2.8, respectively (p&lt;0.05). ROM was significantly greater in Group A at 1 and 3 months (105.2° and 120.8°, p&lt;0.05). Quadriceps strength improved faster in group A at 3 months (MMT score: 4.0, p=0.04). Group A also had a shorter hospital stay (4.5 vs 5.8 days, p=0.01). Complications and long-term satisfaction were similar across both groups. Conclusion: The subvastus approach offers advantages in early recovery, including reduced pain, quicker ROM recovery, and shorter hospital stays. However, long-term outcomes are comparable between both approaches.

The Effect and Long-term Prognosis of Different Suturing Methods for Meniscus Repair Under Knee Arthroscopy.

This study aims to evaluate the efficacy and long-term prognosis of all-inside and outside-in suturing methods for meniscus repair under knee arthroscopy. A retrospective analysis was conducted on 120 patients with meniscus injuries who underwent surgical treatment at Yuhuan People's Hospital, Department of Joint Surgery, from January 2019 to March 2021. Based on the suturing method, patients were assigned into two groups: Group A (64 cases, all-inside suturing) and Group B (56 cases, outside-in suturing). Surgical indicators and adverse events were recorded for both cohorts. The variances in proprioception before and after surgery, International Knee Documentation Committee (IKDC) scores, Lysholm scores, knee range of motion (ROM), and Visual Analogue Scale (VAS) pain scores were compared between the two groups. Group A had significantly shorter operative time, postoperative immobilization, and hospital stay compared to Group B (p < 0.05). The overall incidence of adverse events was 12.50% in Group A and 16.07% in Group B, with no significant difference between the groups (p > 0.05). There were no substantial differences in preoperative knee proprioception difference values, IKDC scores, Lysholm scores, VAS scores, and knee ROM between the two groups (p > 0.05). At three months postoperatively, Group A exhibited lower proprioception difference values at 15°C, 45°C, and 75°C angles compared to Group B (p < 0.05). Additionally, at three months and three years postoperatively, Group A showed higher IKDC scores, Lysholm scores, and ROM and lower VAS scores compared to Group B (p < 0.05). Compared to the outside-in suturing approach, the all-inside suturing method for treating meniscus damage is more effective. It attenuates operative time, postoperative immobilization time, and hospital stay, ameliorates knee proprioception, promotes knee function recovery, alleviates pain, and is safe and reliable.

Impact of enhanced recovery after surgery on postoperative blood management following primary total knee arthroplasty: a propensity score-matched analysis.

To evaluate the efficacy of blood management in patients underwent unilateral Total Knee Arthroplasty (TKA)under an enhanced recovery after surgery (ERAS) program. Patients underwent unilateral TKA from January 2019 to October 2023 in a university hospital were retrospectively studied. A total of 200 cases were selected in the analysis. After matching with propensity scoring, 51 patients in each group were included. The postoperative Haemoglobin (Hb), albumin (Alb), C-reactive protein (CRP), total length of stay (LOS), and estimated blood loss after operation were compared between the two groups. Clinical outcomes including Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF-12, and Oxford Knee Score (OKS) were also compared atsixweek and threemonth follow-up. The results showed that the Hb of the ERAS group was significantly higher than those of the non-ERAS group (P < 0.05) on the third postoperative. The mean CRP level was lower, LOS was shorter, and Alb level was higher in the ERAS group compared to that in the non-ERAS group (P < 0.05). The clinical outcomes such as WOMAC and OKS, SF-12 scores were higher in the ERAS group at both follow-up. ERAS protocol effectively minimizes perioperative blood loss and supports optimal nutrient levels in patients. ERAS management significantly contributes to the postoperative recovery of knee function in patients undergoing primary total knee arthroplasty.

Analysis of rehabilitation effect of electroacupuncture for patients after total knee arthroplasty

Purpose To investigate the effect of electroacupuncture on the rehabilitation of patients after total knee arthroplasty (TKA). Materials and methods Eighty patients with knee osteoarthritis who underwent total knee arthroplasty randomly divided into two groups, with 40 patients in each group. The control group was treated with traditional rehabilitation methods. In addition to traditional rehabilitation treatment, patients in the experimental group received electroacupuncture after operation, while patients in the control group received fake electroacupuncture. Both groups started electroacupuncture treatment and fake electroacupuncture treatment on the third day after operation for 10 consecutive days Data of patients in both groups were collected before surgery, three days after surgery, two weeks after surgery and one month after surgery, including the visual analogue scale(VAS), Knee Society Score (KSS) and range of motion (ROM) Results Compared with before treatment, after the treatment cycle, the VAS, KSS and ROM of both groups were significantly improved (p = 0.001, p = 0.001). Compared with the control group, the ROM and KSS of the experimental group were significantly improved at two weeks after surgery and one month after surgery, and the VAS was significantly decreased, with statistical significance (p < 0.05). Conclusions Electroacupuncture therapy has a positive effect on the recovery of patients after total knee arthroplasty, which can alleviate the pain after total knee arthroplasty, promote the recovery of knee function, which is worthy of clinical promotion.

Application of sensory and motor training in AIDET communication mode in patients after knee arthroplasty.

Patients with knee arthroplasty often have problems such as slow recovery of knee function, which may cause negative emotions and affect their postoperative rehabilitation. The application of sensory and motor training in the Acknowledge, Introduce, Duration, Evaluation, Thank You (AIDET) communication mode in patients after knee arthroplasty can provide reference for the selection of postoperative rehabilitation training measures. To explore the sensory and motor training effects in AIDET communication mode on knee function recovery and resilience of patients after knee arthroplasty. One hundred patients who underwent knee arthroplasty at our hospital between January 2022 and January 2024 were randomly divided into two groups. The control group (n = 50) received routine rehabilitation training. In the observation group (n = 50), the AIDET communication mode was used to perform sensory and motor training, in addition to routine rehabilitation training. The rehabilitation training was administered for 8 weeks. After surgery, knee function, balance ability, walking ability, proprioception, and resilience were compared between the two groups. The New York Hospital for Special Surgery knee scores of the observation group at the time of discharge and 8 weeks after intervention were (65.23 ± 6.84, 84.53 ± 5.27), which was higher than those of the control group (61.03 ± 7.15, 74.92 ± 6.52) (P < 0.05). The balance ability of the observation group at the time of discharge and 8 weeks after the intervention was higher than that of the control group, the time of time up to go test was shorter than that of the control group, and proprioceptive function was higher than that of the control group (P < 0.05). The resilience level in the observation group after the intervention was higher than that in the control group (P < 0.05). Sensory and motor training in AIDET communication mode promotes knee function recovery of patients after knee arthroplasty, improves their limb walking ability and balance function, and increases their resilience level.

Reliable prediction of implant size and axial alignment in AI-based 3D preoperative planning for total knee arthroplasty

The size and axial alignment of prostheses, when planned during total knee replacement (TKA) are critical for recovery of knee function and improvement of knee pain symptoms. This research aims to study the effect of artificial intelligence (AI)-based preoperative three dimensional (3D) planning technology on prosthesis size and axial alignment planning in TKA, and to compare its advantages with two dimensional (2D) X-ray template measurement technology. A total of 60 patients with knee osteoarthritis (KOA) who underwent TKA for the first time were included in the AI (n = 30) and 2D (n = 30) groups. The preoperative and postoperative prosthesis size, femoral valgus correction angle (VCA) and hip-knee-ankle angle (HKA) were recorded and compared between the two groups. The results of the University of Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the American Knee Association Score (AKS) were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The accuracy of prosthesis size, VCA and HKA prediction in AI group was significantly higher than that in 2D group (P < 0.05). The WOMAC and AKS scores in AI group at 3 months, 6 months and 12 months after surgery were better than those in 2D group (P < 0.05). Both groups showed significant improvement in WOMAC and AKS scores at 12 months follow-up. AI-based preoperative 3D planning technique has more reliable planning effect for prosthesis size and axial alignment in TKA.

Effect of different degrees of primary varus knee on short-term effectiveness of anterior cruciate ligament reconstruction

To investigate whether different degrees of primary varus knee affect joint function and stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. A clinical data of 160 patients with primary varus knee, who were admitted between January 2020 and December 2021 and met the selection criteria, was retrospectively analyzed. All patients underwent primary ACL reconstruction using autologous single-bundle hamstring tendon. Patients were divided into three groups based on the hip-knee-ankle angle (HKA): group A (64 patients with HKA 0°-3°), group B (55 patients with HKA 3°-6°), and group C (41 patients with HKA 6°-9°). Except for the significant difference in HKA among the three groups ( P<0.05), baseline data such as age, gender, affected side, body mass index, interval between injury and operation, Kellgren-Lawrence grading, posterior tibial slope, proportion of combined meniscal injuries, Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) objective score, anterior drawer test, Lachman test, pivot shift test, and the results of KT1000 (side-to-side difference, SSD) showed no significant difference ( P>0.05). At last follow-up, joint stability was assessed through the anterior drawer test, Lachman test, pivot shift test, and SSD; joint function was evaluated using the Tegner score, Lysholm score, and IKDC objective score. All incisions in the three groups healed by first intention after operation. All patients were followed up 24-31 months, with an average of 26 months; there was no significant difference in the follow-up time among the three groups ( Z=0.675, P=0.714). At last follow-up, the knee stability and functional assessment indicators in each group significantly improved when compared to preoperative ones ( P<0.05); there was no significant difference among the three groups ( P>0.05) in terms of the anterior drawer test, Lachman test, pivot shift test, IKDC objective scores, and the changes of the Lysholm scores and Tegner scores. The Kellgren-Lawrence grading and HKA at last follow-up were consistent with preoperative results in the three groups. Varying degrees of primary varus knee do not affect early knee joint stability and functional recovery after ACL reconstruction, and there is no significant difference in effectiveness between different degrees of varus knee.

Management of Medial Femorotibial Knee Osteoarthritis in Conjunction with Anterior Cruciate Ligament Deficiency: Technical Note and Literature Review.

In recent years, there has been increased interest in the management of medial femorotibial knee osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency. Traditional treatment modalities included conservative therapy, high tibial osteotomy with or without ACL reconstruction, and total knee replacement. Since younger patients with higher physical demands are more likely to suffer from this pathological condition, reduced invasiveness, faster recovery time, and improved knee kinematics are preferred to allow for satisfying clinical and functional outcomes. Thus, a new surgical strategy combining medial unicompartmental knee replacement (UKR) and ACL reconstruction has been proposed to allow bone stock preservation, to reduce surgical morbidity and recovery time, and ultimately to improve joint kinematics and clinical outcomes. Based on the data present in the literature, in the setting of unicompartmental OA in association with ACL deficiency, UKR combined with ACL reconstruction provided encouraging early results. Studies evaluating the outcomes of combined ACL reconstruction and UKR demonstrate promising results in select patient populations. Improved knee stability, pain relief, functional recovery, and patient satisfaction improved after surgery. Moreover, the combined approach offered advantages such as reduced surgical trauma, faster rehabilitation, and preservation of native knee anatomy compared with traditional treatment strategies. However, still, high-level studies on this topic are lacking; therefore, more comparative studies reporting long-term outcomes are needed to support the potential of this combined procedure to become mainstream. In this paper, we discuss the relevant features and rationale behind the indications and technique of this combined surgical procedure, to help surgeons choose the correct therapeutic approach for a patient with concomitant medial OA and ACL insufficiency. Continued advancements in surgical techniques, patient selection criteria, and rehabilitation strategies will further enhance the success of this combined approach, offering hope to individuals with concomitant ACL injuries and unicompartmental knee OA.

Short-Term Outcomes of Total Knee Arthroplasty Using a Conventional, Computer-Assisted, and Robotic Technique: A Pilot Clinical Trial.

Background: Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. Methods: This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan-Meier curves, with revision surgery as the endpoint. Results: While all three groups showed significant improvements in knee function postoperatively (p < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, p = 0.011). Conclusion: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis's long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA.

Combination of Gukang Capsule and Vitamin D2 Accelerates the Recovery of Knee Function in Elderly Patients with Knee Osteoarthritis

This study assessed the effectiveness of the combined use of the Gukang capsule and vitamin D2 for treating elderly patients with knee osteoarthritis. A total of 126 patients admitted to the Second Hospital of Tangshan between March 2021 and March 2023 were recruited. All patients were treated with loxoprofen sodium tablets. Additionally, group 1 was treated with a vitamin D2 soft capsule, group 2 with a Gukang capsule, and group 3 with a vitamin D2 soft capsule+Gukang capsule. The total effective rate in group 3 (95.23%) was significantly higher compared to groups 1 and 2 (76.19% and 73.80%, respectively; P &lt; 0.05). After treatment, the visual analogue scale score, inflammation level, and levels of cartilage metabolic factors in group 3 were significantly lower compared to groups 1 and 2 (P &lt; 0.05). After treatment, the Hospital for Special Surgery and Lysholm scores were elevated in all three groups, and those in group 3 were significantly higher than those in groups 1 and 2 (P &lt; 0.05). There was no difference in the incidence of adverse reactions among the three groups (P &gt; 0.05).Overall, Gukang capsule + vitamin D2 can reduce inflammation, improve cartilage metabolism, accelerate knee function recovery, and improve the clinical effect in elderly patients with knee osteoarthritis.

FUNCTIONAL OUTCOME AMONG PATIENTS WITH ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH ENDO-BUTTON AT GHURKI TRUST TEACHING HOSPITAL POST 6 MONTHS-A SINGLE CENTERED SURVEY

Background of the Study: To assess the functional outcome among patients with arthroscopic ACL reconstruction with endo-button at Ghurki Trust Teaching Hospital post 6 months. Methodology: A single centered survey was conducted on 67 patients with arthroscopic AC Ligament reconstruction using Hamstring auto-graft (Semitendinosus-Gracilis tendons) after 6 months and evaluated for functional outcome. The data was collected from Ghurki Trust Teaching Hospital. The sampling procedure utilized was non-probability sampling. Functional outcome was assessed using subjective form of IKDC score. Data was analyzed using SPSS version 23. Results: Out of 67 patients, all were male. The pre-operative subjective IKDC scoring was less than 30 and post-operative mean IKDC scoring is 73.92. On the basis of findings of study, significant improvement was observed after ACL reconstruction post 6 months. Conclusion: ACL reconstruction shows significant improvement in knee function and significant recovery of preoperative functional status. Keywords: Anterior cruciate ligament reconstruction, international knee documentation score, functional outcome, arthroscopy, endobutton, hamstring tendon, ligament injury