Significant Difference In Lysholm Score Research Articles

Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty

This study examined the effect of preoperative anxiety level on postoperative pain, opioid and nonopioid analgesic use requirements and joint function in patients undergoing primary knee arthroplasty for knee osteoarthritis. 106 patients were included in the study. Situational anxiety score (STAI-S) and trait anxiety score (STAI-T) were divided into two groups as below and above 40. Visual analog scale (VAS), Lysholm scores, and anxiety levels were assessed preoperatively, at the third and sixth month postoperatively to investigate their effects on the use of opioid and non-opioid drugs during the postoperative period. For those with low situational and trait anxiety scores, the median duration of hospital stays was significantly shorter compared to those with high anxiety scores. In groups where anxiety levels were initially low, the median anxiety levels at the postoperative 3rd month were also observed to be lower compared to the other group. In the same groups, the median VAS values and the median Lysholm knee scores were significantly better both preoperatively and at the postoperative 3rd month compared to the other group. There was no significant difference in Lysholm score between the two groups at the 6th postoperative month. Similarly, in the preoperative period, groups with low anxiety levels had a significantly lower median usage of both opioids and non-opioids compared to the other group. These findings suggest that high preoperative anxiety may have a negative effect on functional outcomes in the early postoperative period, but this effect disappeared at 6 months. It can be concluded that reducing preoperative anxiety may have a positive effect on early outcomes. We believe that preoperative psychological evaluation and treatment can increase the satisfaction level in patients undergoing total knee arthroplasty (TKA).

The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study.

This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.

Combined Anterior Cruciate Ligament Reconstruction (ACLR) and Lateral Extraarticular Tenodesis Using Modified Lemaire Technique versus ACLR alone : A Meta-Analysis of Clinical Outcomes

Introduction: Anterior cruciate ligament (ACL) rupture was the most common injury that occurred in the knee. Reconstruction was the most common operative management used. After primary ACL reconstruction, a rerupture can be devastating. Several extraarticular procedures have been proposed to resolve rotatory instability, such as tenodesis. We determined to conduct a meta-analysis comparing ACL reconstruction (ACLR) with lateral extraarticular tenodesis (LET) using the modified Lemaire technique and evaluated the risk of failure or re-rupture rate and the outcome. Method: We conducted a meta-analysis based on The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search was conducted in June 2022 on several databases: PubMed, EBSCOHost, Scopus, ScienceDirect, and WileyOnline using Boolean operators focusing on PICO (Population, Intervention, Control, Outcome). Included studies will be extracted for characteristics such as author and study year, location, design, sample characteristics, failure (graft or clinical failure), and outcome (KOOS score, functional outcome, clinical outcome). Studies will be qualitatively and quantitatively evaluated using Review Manager 5.4 or equivalent. Result: Search was conducted and resulted in the five final studies with 797 patients. ACLR + LET has a lower risk of failure or re-rupture ratio than ACLR alone (RR= 0.44; 95% CI 0.26 – 0.75; I2=9%; p= 0.003). There were differences in the KOOS pain score, ADL score, sports score and QOL score with mean difference of 0.20 (95% CI 0.10, 0.30; I2=0%; p &lt;0.0001), -0.20 (95% CI -0.26, -0.13; I2=0%; p &lt;0.00001), 0.20 (95% CI 0.02, 0.38; I2=0%; p= 0.03), and 0.50 (95% CI 0.29, 0.71; I2=0%; p&lt; 0.00001) respectively. Furthermore, there was a significant mean difference in the International Knee Documentation Committee score of 0.70 (95% CI 0.57, 0.83; I2=0%; p &lt;0.000001). However, there were no significant differences in Lysholm score, and Tegner score between groups. Conclusion: LET was considered adequate in adjunction to ACLR, to minimize rerupture rate, and to improve stability and laxity of the knee to improve clinical outcome

A comparison of functional knee outcomes post-arthroscopic anterior cruciate ligament (ACL) reconstruction using hamstring and peroneus longus (PL) autograft

Background: Hamstring autograft (HA) is the most common graft used in ACL reconstruction procedures. However, harvesting HA could weaken the secondary stabilizer of the knee joint. Peroneus longus grafts (PL) is a novel option secondary to hamstring graft with less morbidity at the knee joint. We intended to determine whether peroneus longus autograft (PL) is a comparable alternative to hamstring autograft for ACL Reconstruction. Methods: 84 patients were grouped into "hamstring" (n = 51) and "peroneus longus" (n = 33) groups, with a mean age of 26.2 ± 5.9 in the Hamstring group and a mean age of 26.4 ± 6.6 in peroneus group. We obtain secondary data from the medical records of several hospitals in Makassar. Results: There was a significant difference in Lysholm score (p&lt;0.05) in the hamstring group with peroneus at 6 months and 12 months postoperatively for IKDC score, anterior translation, Power Grading Flexi-Extension, ROM on flexion, and extension. In addition, in muscle atrophy, the Hamstring group compared to the peroneus group also showed a significant difference (p=0.001). Conclusion: The study's results did not show significant differences between the hamstring and peroneus groups other than atrophy of thigh muscles in the hamstring group. Based on the results of this study, we conclude peroneus longus graft is one of the graft options in ACL reconstruction surgery.

Functional Outcome of Anterior Cruciate Ligament Reconstruction by Tibial Attachment Preserving versus Sacrificing Hamstring Graft Technique- A Prospective Interventional Study

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft– tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student’s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value &lt;0.05 was considered to be significant. Results: The mean age of patients in group A was 30.73±10.02 years whereas in group B it was 29.54±9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23±8.37, at 12 week score was 86.85±5.93 and at 24 week score was 95.58±4.91. For group B, mean Lysholm score at 6 weeks was 74.15±5.82, at 12 weeks score was 87.46±5.95 and at 24 weeks score was 96.92±3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p&lt;0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. Conclusion: ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft.

Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review

IntroductionTwo major techniques are used to repair complete quadriceps tendon ruptures, transosseous tunnel (TT) and the suture anchor (SA). There are multiple studies comparing the biomechanical outcomes of repairs performed with TT or SA. Our purpose was to compare the clinical outcomes following quadriceps tendon repair using SA and TT fixation techniques. MethodsThree major search engines were used with predetermined keyword searches to perform a systematic review of literature. These studies were independently scanned by two reviewers using PRISMA criterion. All included studies had to include at least one of the following outcome measures: range of motion (ROM), Lysholm score, complications, and/or re-ruptures. ResultsUsing three major search engines, 1039 articles were identified. After removing duplicates and screening for inclusion, 49 articles were reviewed. Two independent reviewers searched the studies to meet the inclusion criteria, and eight studies were selected. These eight studies included 156 knees in the TT group and 54 knees in the SA group. The TT group had a significantly better ROM after QT repair (132.5° versus 127.0°, p = 0.02). There was no significant difference in Lysholm scores between the TT group (92.6) and SA group (91.0, p = 0.11). There were significantly more complications in SA groups (9.3% versus 1.3%, p = 0.013), but not a significant difference in re-rupture rate between those undergoing SA vs. TT repair (3.7% versus 0%, p = 0.065). The SA group had a significantly higher age at time of surgery (63.62 vs. 54.32) ConclusionThe current study suggests that, following quadriceps tendon rupture, there are no significant differences in functional outcome between TT and SA techniques. Those undergoing TT repair attained a statistically significantly greater final ROM but this difference may not be clinically relevant. There was a statistically significantly higher rate of post-operative complications using SA technique.

The comparison of clinical outcomes of popliteal tendon recess and reconstruction technique

Objective To compare the objective and subjective clinical outcomes of recess procedure versus popliteal tendon reconstruction in patients with posterolateral corner injury. Methods From January 2012 to January 2017, patients who were eligible for inclusion in this study if they 1) had acute posterolateral rotational instability (PLRI) and were treated surgically in our institution, 2) were followed for a minimum of 2 years with examination under anesthesia results. The mean age was 34.5±7.4 years (range 20-45 years). According to Fanelli's classification, there were 31 type A, 17 type B and 6 type C cases. There were 26 patients in reconstruction group and 28 patients in recess group. Outcomes included subjective scoring systems (Lysholm score, Tegner score and International Knee Documentation Committee (IKDC) subjective score), knee stability examinations (the side-to-side difference (SSD) of tibial external rotation angle by dial test, posterior and varus stress radiograph) and second-look arthroscopic lateral gutter drive-through test during hardware removal operation. Results The mean follow-up duration was 30.2±4.9 months in reconstruction group and 32.2±9.9 months in recess group. At the final follow-up, there were no significant differences in Lysholm scores (reconstruction group: 70.1±15.5, recess group: 70.0±10.2; t=0.089, P=0.926), Tegner scores (reconstruction group: 3(2, 5), recess group: 2(1, 4); U=395.522, P=0.156), or IKDC subjective scores (reconstruction group: 74.8±19.3, recess group: 71.2±17.6; t=0.381, P=0.722) between the groups. No significant difference in SSD on posterior stress radiography (reconstruction group: 4.1±3.4 mm, recess group: 4.7±2.6 mm; t=0.918, P=0.345) or medial stress radiography (reconstruction group: 4.0±1.7 mm, recess group: 3.8±1.9 mm; t=0.208, P=0.820) was observed. There was no significant difference on SSD of dial test (reconstruction group: 1.5°±4.2°, recess group: 1.1°±4.0°, t=0.586, P=0.565). No positive lateral gutter drive-through test was observed in all groups. Conclusion Both recess procedure and popliteal tendon reconstructions significantly improve the knee stability and subjective outcomes of patients with PLRI. In a comparison with popliteal tendon reconstruction, the recess procedure has similar subjective and objective clinical outcomes. Key words: Collateral ligaments; Tendon injuries; Arthroscopy; Reconstructive surgical procedures

Platelet rich plasma intra-articular and extra-articular injection for the treatment of knee osteoarthritis

To observe clinical effects of platelet-rich plasma (PRP) intra-articular and extra-articular injection for patients with knee osteoarthritis (KOA), and analyze its safety and clinical efficacy. From January to December 2017, 48 patients with KOA were randomly divided into observation group and control group, 24 cases in each group. The observation group was treated with intra-articular injection of PRP (2 ml) and extra-articular injection of PRP (2 ml), once a week, for three times, including 8 males and 16 females with an average of (58.04±7.87) years old ranging from 43 to 68 years old, the courses of disease ranged from 1 to 8 years with an average of (4.69±1.96) years, the body mass index (BMI) was (24.53±5.26) kg/m 2 . The control group was treated with intra-articular injection of sodium hyaluronate (20 mg), extra-articular injection of analgesic drug (2 ml for one point), once a week, for three times, including 7 males and 17 females with an average of (60.54±8.93) years old ranging from 47 to 72 years old, the courses of disease ranged from 1.5 to 9 years with an average of (5.27±1.68) years, BMI was (23.47±4.62) kg/m 2 . VAS score and Lysholm score before operation and the 1st, 6th month after treatment were compared between two groups. All patients were followed up at least 6 months without occurrence serious adverse reactions or complications. VAS score in observation group and control group before treatment and 1st, 6th month after treatment were 7.35±1.47, 4.15±1.52, 2.26±1.02 and 7.51±1.39, 3.84±1.76, 3.66±1.18, respectively; VAS score in obsevation group was lower than that of control group at 6 months after treatment. Lysholm score in observation group and control group before treatment and 1st, 6th month after treatment were 55.21±5.78, 79.16±7.25, 85.45±6.87 and 54.65± 6.40, 77.58±6.94, 82.34±7.12. There were significant differences in Lysholm score before and after injection between two groups (P<0.05) . There was no significant difference in Lysholm score between two groups at 1 month after treatment (P>0.05), while Lysholm score in observation group was better than that of control group at 6 months after treatment (P<0.05) . Intra-articular and extra-articular injection of PRP could relieve pain symptoms and improve function of knee joint with higher safety, although the short-term effect is not significantly different from traditional treatment, its medium-long-term effect is stable. It is a safe and effective method for the treatment of knee osteoarthritis.

Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing.

The purpose of this study was to evaluate the clinical outcomes and meniscus healing after arthroscopic repair of horizontal-cleavage meniscus tears, compared with vertical-longitudinal meniscus tears. This was a retrospective review of a consecutive series of 52 meniscal repairs for horizontal-cleavage tears (n = 27) or vertical-longitudinal tears (n = 25); the groups were compared with respect to clinical symptoms and meniscal healing. Arthroscopic meniscal repair was performed using the inside-out technique with a marrow-stimulating technique. Clinical symptoms were evaluated using the Lysholm score and Knee injury and osteoarthritis outcome score (KOOS). Meniscus healing was evaluated by MRI. The mean follow-up periods were 35.4 ± 8.9months in the horizontal-cleavage tear group and 39.8 ± 8.3months in the vertical-longitudinal tear group. There were no significant differences in Lysholm score and KOOS, including each subscale, between the horizontal-cleavage tear- and vertical-longitudinal tear-groups at the final follow-up. At the final follow-up, MRI meniscus grades 0 and 1 were significantly more frequent in the vertical-longitudinal tear-group than in the horizontal-cleavage tear-group, while grade 3 was significantly more frequent in the horizontal-cleavage tear group than in the vertical-longitudinal tear group (p < 0.0001). Although meniscus healing of horizontal-cleavage tears may be poor, arthroscopic repair should be considered for horizontal-cleavage tears because it does provide good clinical outcomes. IV.

Arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint

To explore clinical effect of arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint. From July 2014 to December 2017, 33 patients with lateral meniscal cyst of knee joint were treated by arthroscopic cysts removal and wire-guided suture, including 13 males and 20 females, aged from 20 to 55 years old with an average age of(36.23 ±2.30) years old, the courses of disease ranged from 3 to 14 months with an average of(4.60±0.83) months; Preoperative MRI examination was clear diagnosed. There were 14 cysts on anterior horn, 18 cysts on meniscal body and 1 cyst on posterior horn;all cysts were solitary, and 3 of them were multilocular. Lysholm score and GLASOW score of knee joint function and clinical efficacy were observed before and after operation at 6 months. All patients were followed up form 6 to 24 months with an average of (7.5±1.2) months. Preoperative symptoms disappeared or significantly alleviated, and all incisions were healed by intention without complication and neurovascular injury. MRI showed meniscal tear areas and cystic defective areas healed, cyst was not recurrenced, healing time ranged form 8 to 12 weeks with an average of (9.6±1.6) weeks, and patients recovered their daily life and exercise. There was significant difference in Lysholm score before operation (61.12±4.35) and after operation at 6 momths(91.32±3.36)(t=46.11, P<0.01);according to GLASOW assessment, 31 patients with excellent recovery, and 2 good. Arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint could reserve meniscus, repair injury of meniscus, recover knee joint function after operation, and is worth popularizing.

Does Donor Age of Nonirradiated Achilles Tendon Allograft Influence Mid-Term Results of Revision ACL Reconstruction?

Purpose The purpose of the present study was to investigate if the donor age of nonirradiated Achilles tendon allograft could influence the clinical results of revision anterior cruciate ligament (ACL) reconstruction. Methods All patients that underwent ACL revision between 2004 and 2008 with at least 4 years of follow-up were included. For all the patients that met the inclusion criteria, the age of the graft donor was obtained from the tissue bank. Lysholm score was administered to patients that met inclusion criteria. In addition, patients were divided in two groups based on the donor age (<45 years vs. ≥45 years), and the baseline characteristics and outcomes were compared. Results Fifty-two patients were evaluated at a mean 4.8 ± 0.8 years follow-up with Lysholm score. The Lysholm significantly improved from 62.3 ± 6.6 at preoperative status to 84.4 ± 12.3 at final follow-up. The mean donor age was 48.7 ± 8.4 years; a significant difference in Lysholm score was noted between patients that received an allograft with a donor age <45 years (14 patients; 27%) and those receiving an allograft with a donor age ≥45 years (38; 73%) (89.5 ± 3.2 vs. 80.1 ± 11.1, respectively; p = 0.0469). The multiple regression model showed the donor age, the final follow-up, and the preoperative Lysholm score as significant predictors of postoperative Lysholm score ( p < 0.0002). Conclusion Donor age of nonirradiated Achilles tendon allograft influenced the mid-term results of revision ACL reconstruction, thus advising the use of grafts from young donors. Level of Evidence Level III, retrospective comparative study.

Efficacy of arthroscopic surgery for discoid lateral meniscus injury in knee joint: a self-control study

Background and objectives: Discoid meniscus injury is a rare form of abnormal meniscus morphology with unknown pathogenesis. The complete disc-shaped meniscus is more prone than incomplete disc-shaped meniscus to tearing and adverse reactions such as joint degeneration and osteochondritis. Moreover, its clinical efficacy is not satisfactory. Arthroscopic meniscus surgery can enhance the stability of the meniscus and provide sufficient cushioning pressure to prevent recurrent meniscal tears. Therefore, this study will investigate the efficacy of arthroscopic surgery for discoid meniscus injury in knee joint and analyze risk factors that influence the efficacy of arthroscopic surgery. Methods: This single-center, self-control study will include 196 patients with discoid meniscus injury who will receive arthroscopic meniscus repair (Stryker) from December 2018 to December 2019 at the Department of Sports Trauma and Arthroscopy, First Affiliated Hospital of Anhui Medical University of China. This surgical procedure will include meniscus plasty and subtotal meniscectomy. After surgery, all included patients will be followed up for 6–18 months. Surgical efficacy will be evaluated by Lysholm score. Patients will be divided into an excellent-and-good group (Lysholm score ≥ 85) and a poor group (Lysholm score Results: The primary outcome measure of this study is the change in excellent-and-good rate of Lysholm score that reflects knee joint function measured at the last follow-up in patients undergoing arthroscopic meniscus surgery. Secondary outcome measures are Lysholm score; Outerbridge grade of chondral lesion; knee joint morphology by magnetic resonance images before surgery and at the last follow-up; age, sex, lesion region, and course of disease before surgery; and incidence of adverse reactions at the last follow-up. Clinical data from 115 patients with discoid meniscus injury (150 knees) who received treatment from April 2015 to September 2016 were retrospectively analyzed. Six to eighteen months of follow-up of 115 patients revealed a significant difference in Lysholm scores before surgery (65.80 ± 9.39) and at the last follow-up (89.15 ± 7.45; P Conclusion: Results from this study hope to confirm that arthroscopic surgery for discoid meniscus injury is a definitive treatment technique. Patient age and the degree of chondral lesion are closely related with efficacy, so it is recommended that patients with symptomatic discoid meniscus injury undergo surgery as soon as possible. Ethics and trial registration: This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Anhui Medical University (approval No. PJ2018-02-03) on February 5, 2018. The version of the study protocol is 1.0. Patients and their family members will volunteer to participate in this study. Written informed consent will be obtained from each patient. This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019182) on October 30, 2018.

Clinical Outcomes of Meniscal Allograft Transplantation With or Without Other Procedures: A Systematic Review and Meta-analysis

Background: While additional procedures correcting accompanying pathological conditions can improve the clinical outcomes of meniscal allograft transplantation (MAT), whether those outcomes are comparable or poorer than those of isolated MAT has yet to be clarified. Purpose: To evaluate whether there is a difference in clinical outcomes between isolated MAT and MAT combined with other procedures (combined MAT). Study Design: Meta-analysis and systematic review. Methods: For the comparison of clinical outcomes between isolated MAT and combined MAT, the authors searched MEDLINE, Embase, and the Cochrane Library. Studies that separately reported the clinical outcomes of isolated MAT and combined MAT were included. Clinical outcomes were evaluated in terms of patient-reported outcomes (PROs) and complication, reoperation, survivorship, and failure rates. We conducted a meta-analysis of the PROs that were used in more than 3 studies. Results: A total of 24 studies were included in this study. In the meta-analysis, no significant differences in Lysholm scores (95% CI, –5.92 to 1.55; P = .25), Tegner activity scores (95% CI, –0.54 to 0.22; P = .41), International Knee Documentation Committee subjective scores (95% CI, –5.67 to 3.37; P = .62), and visual analog scale scores (95% CI, –0.15 to 0.94; P = .16) were observed between isolated MAT and combined MAT. For PROs that were not included in the meta-analysis, most studies reported no significant difference between the 2 groups. As for the survivorship and failure rates, studies showed varying outcomes. Four studies reported that additional procedures did not affect MAT failure or survivorship. However, 3 studies reported that ligament surgery, realignment osteotomy, and osteochondral autograft transfer were risk factors of failure. One study reported that the medial MAT group in which high tibial osteotomy was performed showed a higher survival rate than the isolated medial MAT group. Conclusion: Overall, there seems to be no significant difference between the postoperative PROs in terms of isolated MAT and combined MAT. However, more data are required to verify the effects of osteotomy and cartilage procedures on the clinical outcomes of MAT. We could not draw conclusions about the differences in complication, reoperation, survivorship, and failure rates between the 2 groups because we did not obtain sufficient data.

Case-control study on the effect of core strength training on the function of anterior cruciate ligament reconstruction

To observe the effect of core strength training on knee joint function and postural stability after anterior cruciate ligament reconstruction (ACLR). A total of 80 ACLR patients were randomly allocated into conventional rehabilitation training group and core strength training group from May 2013 to May 2015 with 40 patients in each group. The patients in conventional rehabilitation training group underwent conventional ACLR rehabilitation training, in which 28 males and 12 females. The mean age was(30.5±5.2) years old(ranged, 22 to 42 years old). The mean BMI was(23.8±2.4) kg/m²(ranged, 18.2 to 25.9 kg/m²). Thirty patients had injuries on the dominant side and 10 patients had injuries on the non-dominant side. The core strength training group received conventional ACLR rehabilitation training and core strength training, in which 31 males and 9 females. The mean age was(31.1±4.8) years old(ranged, 21 to 45 years old). The mean BMI was(24.1±2.7) kg/m²(ranged, 18.5 to 26.1 kg/m²) . Twenty-seven patients had injuries on the dominant side and 13 patients had injuries on the non-dominant side. The Lysholm score, tibial anterior transition measured by KT-1000 before and after treatment, and the Star Excursion Balance Test results after treatment were compared between the two groups. Six months after rehabilitation training, the tibial anterior transition of the conventional rehabilitation training group and the core strength training group were(3.4±1.0) mm and(3.3±1.2) mm respectively, which were less than(12.1±1.8) mm and(12.5±2.0) mm before treatment. But there was no significant difference in anterior tibial translation between two groups(P>0.05). The Lysholm score of the conventional rehabilitation training group and the core strength training group were 91.8±4.3 and 92.1±3.9 individually, which were higher than 69.2±5.8 and 70.2±5.1 before treatment. But there was no significant difference in Lysholm score between two groups(P>0.05). Six months after rehabilitation training, the results of Star Excursion Balance Test showed the reach distance with the support in the injured side and healthy side in the core strength training group were greater than that of the conventional rehabilitation training group in the eight directions(P<0.05). The core strength training could improve the dynamic balance of ACLR patients.

CURATIVE EFFECT OF HUMAN UMBILICAL CORD MESENCHYMAL STEM CELLS BY INTRA-ARTICULAR INJECTION FOR DEGENERATIVE KNEE OSTEOARTHRITIS

To investigate the safety and efficacy of human umbilical cord mesenchymal stem cells (MSCs) by intra-articular injection for degenerative knee osteoarthritis. Between January 2015 and January 2016, 36 patients with moderate or severe degenerative knee osteoarthritis were randomly devided into 2 groups (n=18). Intra-articular injection of 2.5-3.0 mL human umbilical cord MSCs suspension containing (2-3)×107 cells was performed once a month for 2 times as a course of treatment in the cell treatment group; sodium hyaluronate by intra-articular injection was used once a week for 5 times as a course of treatment in the control group. There was no significant difference in gender, age, body mass index, side, stage of osteoarthritis, course of disease, and preoperative Lysholm score of the knee joint, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and SF-36 scale score between 2 groups (P>0.05). The clinical efficacy was evaluated by SF-36 scale score, Lysholm score, and WOMAC score. All patients of 2 groups received a course of treatment. The patients were followed up for 6 months. After injection, the incidences of pain and swelling in the cell treatment group were significantly higher than those in the control group (χ2=16.200, P=0.000; χ2=11.688, P=0.000), but no significant difference was found in the incidence of effusion (χ2=2.118, P=0.146). In the cell treatment group, Lysholm score at 1-6 months after treatment, WOMAC score and SF-36 scale score at 2-6 months after treatment were significantly better when compared with scores before treatment (P<0.05), and no recurrence of knee pain was observed during follow-up. In the control group, there was no significant difference in Lysholm score and SF-36 scale score between pre- and post-treatment (P>0.05); there were significant differences in WOMAC score between pre-treatment and at 1, 2, 3 months after treatment (P<0.05); at 3 months after treatment, 11 patients had joint pain symptoms again. No significant difference was found in the knee joint function score and SF-36 scale score at 1 and 2 months after treatment between 2 groups (P>0.05), but the scores of the cell treatment group were significantly better than those of the control group at 3 and 6 months (P<0.05). It can significantly improve the joint function and quality of life to use intra-articular injection of human umbilical cord MSCs for treating degenerative knee osteoarthritis. It takes effect after 1 month and the treatment effect can be sustained for 6 months.

Results of multiple ligament injured knees operated by three different strategies.

Background:Multiple ligament injured knee is generally described for a scenario when at least 2 of the 4 major ligaments are ruptured. The most effective treatment for these injuries remains controversial. This study presents the clinical outcome of 3 surgical strategies based on personalized treatment.Materials and Methods:Thirty two patients with multiple ligament injured knee were treated by 3 surgical strategies in the acute phase. (1) One-stage: Twelve patients treated by repair and reconstruction of all ruptured ligaments in a single operation. (2) Staged: Eleven patients treated by repair or reconstruction of the extraarticular (EA) ligaments and then intraarticular ligaments in 2nd stage. (3) EA ligament repair: Nine patients underwent only EA ligaments repair.Results:The patients were followed up for an average of 34.7 ± 12.1 months. Significant improvements in knee stabilities (P < 0.01), Lysholm score (P < 0.01) and International Knee Documentation Committee grade (P < 0.01) were noticed in all groups. Of the 32 patients, none had gross mal alignment or gait abnormalities at the latest followup. Comparing the 3 groups, a significant difference in Lysholm score was shown between the one stage group and the EA repair group (P = 0.040); additionally, significant differences were found in 2 subscales of knee injury and osteoarthritis outcome score (P < 0.05).Conclusion:Satisfactory clinical and functional outcomes could be achieved adopting the 3 surgical strategies based on personalized treatment. However, a combination of EA repair and intraarticular repair or reconstruction might be more reasonable options for the young and active patients.

A case of bilateral posterior medial meniscus root tear: Partial menisectomy versus pull-out suture repair

The meniscal roots are sites where the knee meniscus attaches to the central tibial plateau, adjacent to the tibial insertions of the cruciate ligaments. Medial meniscus root tears (MMRTs) are commonly associated with other intra-articular pathology and have a debilitating effect on knee kinematics due to loss of circumferential hoop stresses. Many surgical options for repair have been described in the literature including partial or total menisectomy, pullout sutures and suture anchors. We present a unique case of a 27 year old female who sustained a bilateral posterior horn MMRT. One knee was repaired using the pullout suture technique and the other knee underwent partial menisectomy. We found no significant difference in Lysholm scores in the short or medium term between the two methods. To our knowledge, this is the first reported case of a bilateral medial meniscus root tear.

Comparison of MRI Results of Grafts Obtained by Unilateral Anterior Cruciate Ligament Reconstruction Either Using Anteromedial Portal Only or Transtibial Method with Contralateral Healthy Knee

Objectives:Our aim is to compare graft angles and tibial tunnel insertion in patients undergone single bundle ligament reconstruction using anatomical anteromedial (AM) and transtibial (TT) method with the contralateral healthy knee by using MR imaging. And to investigate correlation of this evaluation with functional results.Methods:We investigated 96 knees of 48 patients undergone anterior cruciate ligament (ACL) reconstruction with AM or TT method. 23 of 48 patients were operated with AM method. These patients were named as Group A. 25 patients were operated with TT method and named as group B. MRI was taken for both knees in each group postoperatively at the mean 10.47 (9-15) and 11.72 (9-17) months, respectively. Angle between ACL graft and anatomical axis of tibia in coronal and sagittal plane, [Sagittal ACL graft angle (SAGA), Frontal ACL graft angle (FAGA)], middle insertion point on tibial articular surface, [ Sagittal ACL middle point (SGMP), Frontal ACL tibial tunnel middle point (FTMP), and Sagittal ACL tibial tunnel middle point(STMP)] was assessed by three orthopaedic surgeons. Values in both groups, inter observer, values between operated and healthy knees and differences between two groups were statistically evaluated. Functional scores between operated and healthy knees were evaluated with the Lysholm scoring system.Results:Inter observer results were statistically significant in group A between operated and healthy knees for 1st and 2nd observers in SAGA values and for 1st and 3rd, and 2nd and 3rd observers in FAGA values (p<0.05). In group B there was statistically significant difference in SAGA values for 1st and 2nd, and for 2nd and 3rd observers and in FTMP values for 1st and 3rd, and 2nd and 3rd observers (p<0.05). Statistically significant difference was detected between SAGA, FAGA and SGMP values of operated and healthy knees of A and B groups in all three observers’ evaluation (p<0.05). No statistically significant difference was detected between STMP values of operated knees and SGMP values of healthy knees in both groups (p>0.05). Statistically significant difference was detected between SAGA and FAGA values of operated knees in both groups (p<0.05). There was statistically significant difference in Lysholm scores between group A and B (p<0.05). Nonetheless there was no statistically significant difference between the Lysholm scores of operated knees in A and B groups (p>0.05).Conclusion:ACL reconstruction surgery with TT and AM methods do not provide anatomical reconstruction in Sagittal plane. Moreover, functional results were not as good as contralateral healthy knees. Although tibial tunnel was in anatomical position in both TT and AM methods, the posterior insertion of graft is thought to be the result of anterior placement of interference screw.

Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up

PurposeTo compare long-term functional and radiological outcome following microfracture technique (MF) versus osteochondral autologous transplantation (OAT) mosaicplasty for treating focal chondral lesions of the knee. MethodsTwenty-five patients (mean age 32.3 years, SD 7.7) with a full-thickness (International Cartilage Repair Society grade 3 or 4) chondral lesion of the articulating surface of the femur were randomized to either MF (n = 11) or OAT mosaicplasty (n = 14). At a median follow-up of 9.8 years (range 4.9–11.4), the patients were evaluated using Lysholm score (n = 25), Knee Injury and Osteoarthritis Outcome Score (KOOS, n = 25), isokinetic quadriceps measurement and hamstring strength measurement (n = 22) and standing radiographs (n = 23).ResultsThere were no significant differences in Lysholm score, KOOS, isokinetic muscle strength or radiographic osteoarthritis between MF-treated patients and OAT mosaicplasty-treated patients at follow-up. Mean Lysholm score at follow-up was 69.7 [95 % confidence interval (CI), 55.1–84.4] for the MF group and 62.6 (95 % CI, 52.6–72.6) for the OAT mosaicplasty group.ConclusionAt long-term follow-up, there were no significant differences between patients treated with MF and patients treated with OAT mosaicplasty in patient-reported outcomes, muscle strength or radiological outcome.Level of evidenceTherapeutic study, Level II.

A comparative study of tunnel enlargement after anterior cruciate ligament reconstruction with autologous and allogenic tendons

Objective To investigate the changes of bone tunnel and differences of clinical outcomes after anterior cruciate ligament (ACL) reconstruction with hamstring tendons from autografts and allografts. Methods The study involved in 61 patients with ACL injury undergone arthroscopic ACL reconstruction from June 2008 to November 2009.According to ACL graft differences,61 patients were assigned to two groups,ie,Group A ( reconstruction with tendon allografts,n =27 ) and Group B ( reconstruction with tendon autografts,n =34).MRI examination was performed one week and 6-12 months post-operatively to measure the sagittal bone tunnel diameters at the aperture location,at the location of 1cm away from the aperture and at the widest location of tunnel.Taking the bone tunnel diameter at each location one week post-operatively as the measurement criteria,the differences of bone tunnel diameters at each corresponding location were analyzed statistically.Lysholm score was used to evaluate the clinical effects in the two groups. Results Group A and B were followed up for average 8.4 months and 8.5 months,respectively.Pre-operative clinical data of the two groups had no significant difference.MRI follow-up showed that the tunnel diameters at femoral side and tibial side both had different degree of enlargement.Meanwhile,the enlargement degree at the tibial side was larger than that at the femoral side,with no statistical differences of the two groups regarding tunnel enlargement of the three measurement locations at femoral and tibial sides.Joint stability in all patients was good.The two groups showed no significant difference in Lysholm score after operation ( P ＞ 0.05 ). Conclusions Graft difference is a factor for bone tunnel enlargement after ACL surgery.Autologous and allogenic tendons show no difference in their role in bone tunnel enlargement after ACL surgery or correlation with clinical effects. Key words: Anterior cruciate ligament; Arthroscopy; Transplantation; Knee joint