This study examined pre-operative measures to predict post-operative biomechanical outcomes in total knee arthroplasty (TKA) patients. Twenty-eight patients (female=12/male=16, age=63.6±6.9, BMI=29.9±7.4 kg/m2) with knee osteoarthritis scheduled to undergo TKA were included. All surgeries were performed by the same surgeon (GD) with a subvastus approach. Patients visited the gait lab within one-month prior to surgery and 12 months following surgery. At the gait lab, patients completed the knee injury and osteoarthritis outcome score (KOOS), a timed up and go (TUG), maximum knee flexion and extension strength evaluation, and a walking task. Variables of interest included the five KOOS sub-scores, TUG time, maximum knee flexion and extension strength normalized to body weight, walking speed, and peak knee biomechanics variables (flexion angle, abduction moment, power absorption). A Pearson's correlation was used to identify significantly correlated variables which were then inputted into a multiple regression. No assumption violations for the multiple regression existed for any variables. Pre-operative knee flexion and extension strength, TUG time, and age were used in the multiple regression. The multiple regression model statistically significantly predicted peak knee abduction moment, post-operative walking speed, and post-operative knee flexion strength. All four variables added statistically significantly to the prediction p<.05. Pre-operative KOOS values did not correlate with any biomechanical indicators of post-operative success. Age, pre-operative knee flexion and extension strength, and TUG times predicted peak knee abduction moment, which is associated with medial knee joint loading. These findings stress the importance of pre-surgery condition, as stronger individuals achieved better post-operative biomechanical outcomes. Additionally, younger patients had better outcomes, suggesting that surgeons should not delay surgery in younger patients. This delay in surgery may prevent patients from achieving optimal outcomes. Future studies should utilize a hierarchical multiple regression to identify which variables are most predictive

Autologous micro-fragmented adipose tissue (MFAT) for the treatment of symptomatic knee osteoarthritis (OA) is gaining interest although there is still a lack of supportive data on safety and clinical efficacy. This study primarily aimed to identify patient- and pathology-related parameters to tighten patient selection criteria for future clinical MFAT application. Secondly, the overall (1) therapeutic response rate (TRR), (2) short-term clinical effect, (3) effect durability and (4) therapeutic safety was investigated at a minimal follow-up of 1 year. Sixty-four subjects (91 knees) with symptomatic knee OA (mild-severe on MRI) were enrolled in a prospective single-centre case series. Ethical approval was obtained from the local and academic ethical committee (#B300201733775). After liposuction, the adipose tissue was mechanically processed in a Lipogem® device which eventually produced 6–9cc MFAT. Subjects were clinically assessed by means of the KOOS, NRS, UCLA and EQ-5D at baseline and 1, 3, 6 and 12 months after injection. Adverse events were meticulously recorded. The TRR was defined according to the OMERACT-OARSI criteria. A baseline MRI was scored following the MOAKS system. Paired sample t-tests, independent t-test and Fischer's exact test were applied on appropriate variables. Multiple regression models were fit separately for patient-and pathology-specific factors. Significance level was set at α=0.05. The overall TRR was 66% at 3 months and 50% at 12 months after injection. Subgroup analysis revealed that specifically patients with no-mild bone marrow lesions (BML) had a TRR of 88% at 3 months and 75% at 12 months after MFAT injection. Therapy responders at these timepoints improved with 29.3±14.1 points and 30.8±15.3 points on KOOS pain, while non-responders deteriorated mildly. All clinical scores were significantly higher at follow-up compared to baseline (p<0.05). BMI (factor 0.17, p=0.002) and age (factor −0.48, p=0.048) were prognosticators for the TRR% at 1 month and for absolute KOOS pain improvement at 6 months, respectively. Posterior horn lesions (PHL) in the medial meniscus (p<0.001) and bone marrow lesions (p=0.003) were negative prognosticators for the TRR at respectively 6 and 12 months post-injection. An inflammatory reaction (pain, swelling or stiffness) to MFAT was reported in 79% knees and resolved spontaneously within 16.6±13.5 days after administration. The study showed a durable and satisfying TRR (up to 75% at 1 year in selected patients without BML) and clinical improvement after a single intra-articular injection with autologous MFAT. The availability of an index knee MRI is mandatory to select MFAT patients, preferably with no or mild BML and without PHL of the medial meniscus. High BMI and younger age are associated with better early outcomes. In comparison to other injection therapies such as cortisone, hyaluronic acid and PRP, MFAT appears very attractive with an effect durability of at least 1 year

Partial meniscectomy patients have a greater likelihood for the development of early osteoarthritis (OA). To prevent the onset of early OA, patient-specific treatment algorithms need to be created that predict patient risk to early OA after meniscectomy. The aim of this work was to identify patient-specific risk factors in partial meniscectomy patients that could potentially lead to early OA. Partial meniscectomy patients operated between 01/2017 and 12/2019 were evaluated in the study (n=317). Exclusion criteria were other pathologies or surgeries for the evaluated knee and meniscus (n = 114). Following informed consent, an online questionnaire containing demographics and the “Knee Injury and Osteoarthritis Outcome Score” (KOOS) questionnaire was sent to the patient. Based on the KOOS pain score, patients were classified into “low” (> 75) and “high” (< 75) risk patients, indicating risk to symptomatic OA. The “high risk” patients also underwent a follow-up including an MRI scan to understand whether they have developed early OA. From 203 participants, 96 patients responded to the questionnaire (116 did not respond) with 61 patients considered “low-risk” and 35 “high-risk” patients. Groups that showed a significant increased risk for OA were patients aged > 40 years, females, overweight (BMI >25 kg/m2 ≤ 30 kg/m2), and smokers (*p < 0.05). The “high-risk”-follow-up revealed a progression of early osteoarthritic cartilage changes in seven patients, with the remaining nineteen patients showing no changes in cartilage status or pain since time of operation. Additionally, eighteen patients in the high-risk group showed a varus or valgus axis deviation. Patient-specific factors for worse postoperative outcomes after partial meniscectomy and indicators for an “early OA” development were identified, providing the basis for a patient-specific treatment approach. Further analysis in a multicentre study and computational analysis of MRI scans is ongoing to develop a patient-specific treatment algorithm for meniscectomy patients

7–20 % of the patients with a total knee arthroplasty (TKA) are dissatisfied without an indication for revision. Therapeutic options for this patient population with mostly a lack of quadriceps strength are limited. The purpose of this study is to evaluate the effect of six weeks low load resistance training with blood flow restriction (BFR) on the clinical outcome in these unhappy TKA patients. Thirty-one unhappy TKA patients (of the scheduled fifty patients) without mechanical failure were included in this prospective study since 2022. The patients participate in a supervised resistance training combined with BFR, two times a week during nine weeks. Patients were evaluated by the Knee Osteoarthritis Outcome Score (KOOS), Knee Society Score: satisfaction (KSSs) and the Pain Catastrophizing Scale (PCS). Functionality was tested using the Six Minute Walk Test (6MWT) and the 30-Second Chair Stand Test (30CST). Follow-up took place at six weeks, three months and six months after the start. Six weeks training with BFR provided statistically significant improvements in all the KOOS subscales compared to the baseline, especially for symptoms (55.1 (±15.4) versus 48.0 (±16.5); p<0.001), activities in daily living (50.3 (±21.1) versus 43.7 (±17.2); p<0.00) and quality of life (24.6 (±18.5) versus 17.3 (±13.0); p<0.001). The PCS reduced from 27.4 (±11.0) to 23.2 (±11.4) at six weeks (p<0.01), whereas the KSSs increased from 11.8 (±6.5) to 14.9 (±7.6) (p=0.021). Both the 6MWT and the 30CST improved statistically significant from respectively 319.7 (±15.0) to 341.6m (±106.5) (p<0.01) and 8.6 (±3.9) to 9.3 times (±4.5) (p<0.01). Blood flow restriction appears to enhance the quality of life and functional performance of unhappy TKA patients. Based on these preliminary results, BFR seems to be a promising and valuable alternative for these TKA patients with limited therapeutic options

Background. Medial open wedge high tibial osteotomy (MOWHTO) has been accepted as a highly effective option for the treatment of medial unicompartmental osteoarthritis of the knee. Although pain in the medial joint line is significantly relieved after MOWHTO, some patients complain of pain over pes anserinus after the osteotomy, necessitating implant removal for pain relief. Purpose. The purpose of this study is to define the implant removal rate after MOWHTO due to patient complaints. Methods. 103 knees of 72 patients who underwent MOWHTO for medial unicompartmental osteoarthritis between 2010 and 2018 with a follow-up of at least 24 months were enrolled in the study. Patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Visual Analogue Score (VAS) for pain in the medial knee joint (VAS-MJ). All tests were performed before the surgery, at 12 months after surgery. VAS value for pain over pes anserinus (VAS-PA) was recorded at 12 months after MOWHTO and at 3 months after implant removal. Results. Mean follow-up was 31±5.4 months. TomoFix® medial high tibia plate (DePuy Synthes, Raynham, MA, USA) was used for the fixation of osteotomy in all cases. Significant improvement in KOOS, OKS and VAS-MJ were observed 12 months after MOWHTO. Average values of VAS-MJ and VAS-PA were 21.7±7.1 and 34±8.4, respectively. Implant removal was needed for 65 (63.1%) knees. There were no significant differences in regard of postoperative KOOS (p=0.134), OKS (p=0.287) and VAS-MJ (p=0.416) scores between patients for which implant removal was needed or not. VAS-PA value decreased significantly at 3 months after implant removal (p<0.001). Conclusion. A large portion of patients needed implant removal after MOWHTO to relieve pain over pes anserinus even if knee function was significantly improved. Lower profile plates may be preferred to avoid secondary implant removal surgery after MOWHTO

Abstract. Objectives. Exploring the relationship of gait function pre and post total knee replacement (TKR) in two groups of patients. Methods. Three-dimensional gait analysis was performed at Cardiff University, UK, and Karolinska University Hospital, Sweden, on 29 and 25 non-pathological (NP) volunteers, and 39 and 28 patients with end-stage knee osteoarthritis (OA), respectively. Patients were assessed pre and one-year post-TKR. Data reduction was performed via Principal Component (PC) analysis on twenty-four kinematic and kinetic waveforms in both NP and pre/post-TKR. Cardiff's and Karolinska's cohorts were analysed separately. The Cardiff Classifier, a classification system based on the Dempster-Shafer theory, was trained with the first 3 PCs of each variable for each cohort. The Classifier classifies each participant by assigning them a belief in NP, belief in OA (BOA) and belief in uncertainty, based on their biomechanical features. The correlation between patient's BOA values (range: 0–1, 0 indicates null BOA and 1 high BOA) pre and post-TKR was tested through Spearman's correlation coefficient in each cohort. The related-samples Wilcoxon signed-rank test (α=0.05) determined the significant changes in BOA in each cohort of patients. The Mann-Whitney U test (α=0.05) was run to explore differences between the patients’ cohorts. Results. There were no significant differences between patients’ cohorts in median age (p=0.096), height (p=0.673), weight (p=0.064) or KOOS sub-scores pre or post-TKR (p-value ranged 0.069 to 0.955) but Cardiff's patients had a significantly higher BMI (p=0.047). There was a significant, median decrease of 0.12 and 0.19 in the BOA pre to post TKR (p<0.001) in Cardiff's and Karolinska's patients, respectively. There was a statistically significant, strong positive correlation between the BOA pre and post-TKR (Cardiff:r. s. =0.706, p<0.001; Karolinska:r. s. =0.669, p<0.001). Conclusions. In two distinct cohorts of patients, having a more compromised gait function in end-stage knee OA was correlated with poorer gait function post-TKR

Introduction and Objective. Platelet-Rich-plasma (PRP) has been used in combination with stem cells, from different sources, with encouraging results both in vitro and in vivo in osteochondral defects management. Adipose-derived Stem Cells (ADSCs) represents an ideal resource for their ease of isolation, abundance, proliferation and differentiation properties into different cell lineages. Furthermore, Stem Cells in the adipose tissue are more numerous than from other sources. Aim of this study was to evaluate the potential of ADSCs in enhancing the effect of arthroscopic mesenchymal stimulation combined with infiltration of PRP. Materials and Methods. The study includes 82 patients. 41 patients were treated with knee arthroscopy, Steadman microfractures technique and intraoperative PRP infiltration, Group A. In the Group B, 41 patients were treated knee arthroscopy, Steadman microfractures and intraoperative infiltration of PRP and ADSCs (Group B). Group A was used as a control group. Inclusion criteria were: Age between 40 and 65 years, Outerbridge grade III-IV chondral lesions, Kellegren-Lawrence Grade I-II. Patient-reported outcome measures (PROMs) evaluated with KOOS, IKDC, VAS, SF-12 were assessed pre-operatively and at 3 weeks, 6 months, 1-year post-operative. 2 patients of Group A and 3 patients of Group B, with indication of Puddu plate removal after high tibial osteotomy (HTO), underwent an arthroscopic second look, after specific informed consent obtained. On this occasion, a bioptic sample was taken from the repair tissue of the chondral lesion previously treated with Steadman microfractures. Results. PROMs showed statistically significant improvement (p <0.05) with comparable results in both groups. The histological examination of the bioptic samples in Group B showed a repair tissue similar to hyaline cartilage, according to the International Cartilage Repair Society (ICRS) Visual Histological Assessment Scale. In Group A, the repair tissue was fibrocartilaginous. Conclusions. According to the PROMs and the histological results, showing repair tissue after Steadman microfractures qualitatively similar to hyaline cartilage, the combination of ADSCs and PRP could represent an excellent support to the arthroscopic treatment of focal chondral lesions and mild to moderate osteoarthritis

Introduction and Objective. Osteoarthritis of the knee joint is common in old age population in every part of world. Pain is the major source of disability in patients with osteoarthritis of the knee joint. Subchondral bone marrow is richly innervated with nociceptive pain fibers and may be a source of pain in patients with symptomatic degenerative joint disease. Current therapy for managing bone marrow oedema is core decompression (CD), combining core decompression and injection of hydroxyapatite cement or autologus chondrocyte supplementtion. But all of this work has been done in femoral head and authors documented good result with minimal complication. There are various studies in literature suggesting treatment to repair BME by restoring support and relieving abnormal stresses with accepted internal fixation and bone stimulating surgical techniques in relieving knee OA pain. In this study, we present efficacy of knee arthroscopy with adjunctive core decompression and supplementation with structural scaffold to improve self-rated visual analog scale (VAS) pain scores, rate of conversion to arthroplasty, and patient satisfaction levels. Materials and Methods. The study included patients aged between 40 and 75 years old, with pain in the knee for at least six months, associated with high-signal MRI lesion on T2 sequences, on the tibia or femur. Trephine was used as the bone decompression instrument. Trephine has a diameter of 8–10 mm and operation with trephine requires that a cortical incision window be made prior to decompression treatment, thus necessitating strict disinfection. This procedure was done under spinal anesthesia. After diagnostic arthroscopy, decompression was done under C –ARM in desired area on MRI. After decompression, defect was filled with Poly ester urea's scaffold impregnated with BMAC. Results. Patients were assessed using the visual analog pain scale and the KOOS score, one week before surgery and one, three, six, 12, and 24 weeks after the procedure. MRI images were analyzed Lesions were mapped and measured in the axial, coronal, and sagittal views to plan the injection site and the trajectory of the cannula used for the procedure. Radiographs using anteroposterior, profile, and Rosenberg views of the knee and lower limb were performed to classify the lesion according to the Kellgren-Lawrence classification and to assess lower limb alignment. Evaluation using the KOOS showed a mean total score in the preoperative period of 38.44 points and of 60.7, 59.08, 56.92, 64.40, and 71.36 points at one, three, six, 12, and 24 weeks after surgery, respectively. In the VAS assessment, mean was 7.8 points preoperatively and 2.8, 2.6, 2.5, 1.3, and 0.5 points in the same periods. Conclusions. Hence it can be Concluded that this new innovative technique has provided significant improvements in the parameters of pain and functional capacity in the short-term assessment

Introduction. Simultaneous correction of knee varus malalignment with medial open wedge high tibial osteotomy (MOWHTO) combined with anterior cruciate ligament (ACL) surgery aims to address symptomatic unicompartmental osteoarthritis in addition to restore knee stability in order to improve outcomes. The aim of this study is to present at least 5 years results of 32 patients who underwent simultaneous knee realignment osteotomy with ACL surgery. Methods. Patients with symptomatic instability due to chronic ACL deficiency or failed previous ACL surgery together with a varus malalignment of ≥6°, previous medial meniscectomy and symptomatic medial compartment pain who were treated with MOWHTO combined with ACL surgery were enrolled. ACL surgery was performed with the anatomical single bundle all-inside technique using TightRope. ®. RT (Arthrex, Naples, FL, USA) and MOWHTO using TomoFix. ®. medial high tibia plate (DePuy Synthes, Raynham, MA, USA) in all cases. Patients were evaluated preoperatively and at 6 months, 12 months and annually postoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Euroqol's Visual Analogue Score (VAS) for pain. Results. 32 patients (22 men and 10 women) with a mean age of 41.2 years and mean BMI of 28.6 kg/m. 2. , underwent the combined procedures. Tibiofemoral neutral re-alignment was achieved in all patients with HTO. Complete subjective and objective scores have been obtained in 84.4% of patients with at least 5 years of follow-up (mean 8.7 years). An improvement in total KOOS of 27.1 points (p<0.003), OKS of 15.1 (p<0.003) and VAS for pain of 24.7 points (p<0.001) were detected. No ACL reconstruction failure was noted. Complications consisted of one superficial wound infection and one delayed union. Plate removal was needed in 20 (62.5%) patients due to pes anserinus pain. Conclusions. Simultaneous restoration of coronal knee axis by applying HTO and stability by ACL reconstruction/revision were reported to offer excellent improvement in early outcomes in patients with ACL rupture and symptomatic unicompartmental osteoarthritis. The combined procedure requires careful pre-operative planning and is therefore technically challenging. However, by restoring the neutral axis and providing stability, it represents a good joint preserving alternative to arthroplasty for active middle-aged patients

INTRODUCTION. Osteoarthritis (OA) is a growing societal burden, due to the ageing population. Less invasive, less damaging, and cheaper methods for diagnosis are needed, and sound technology is an emerging tool in this field. AIMS. The aim of the current research was to: 1) investigate the potential of visual scalogram analysis of Acoustic Emission (AE) frequencies within the human audible range (20–20000 Hz) to diagnose knee OA, 2) correlate the qualitative visual scalogram analysis of the AE with OA symptoms, and 3) to do this based on information gathered during gait. METHODS. The analysis was carried out on a database collected during a prospective sound study on healthy and osteoarthritic knees. Sound recordings obtained with a contact microphone mounted on the patella and attached to a digital pre-amplifier, whilst patients were walking on a treadmill, were visualised, manually sampled, and transformed into scalograms. Features of the scalograms were described and qualitatively analysed through chi-squared tests for association with healthy or OA knees (knee status), and with severity of OA pain and functional symptoms and impact on quality of life (QoL), activities of daily living (ADL) and sports using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. RESULTS. 28 patients (56 knees) were included in the analysis. Our method provides a wide variety of different scalogram features: if no events were recorded, the scalogram was classified as “quiet” (Fig 1). In case of abnormal recordings, data analysis evaluated association with the total count of the three most common events that appeared: 1. Peak (Fig 2), 2. Scattered (Fig 3) or 3. Island (localized noise but not presenting as a peak) (Fig 4) – “scalogram features”. No association was found between global scalogram characteristics (quiet versus “any noise”) and knee status (healthy or OA) (χ. 2. =3.163, p=0.075), but was found between knee status and three specific scalogram features (χ. 2. =9.743, p=0.008). The strongest association was a higher frequency of the “scattered” feature in the OA group (χ. 2. =9.06, p=0.01). Scalogram characteristics had no significant association with the sports and recreation (χ. 2. =1.74, p=0.419) nor the activities of daily living (χ. 2. =1.80, p=0.406) KOOS subscales. Significant association was found between scalogram characteristic and the pain (χ. 2. =10.34, p=0.006), quality of life (χ. 2. =6.58, p=0.037), and symptoms (χ. 2. =7.54, p=0.023) subscales. CONCLUSION. Promising results from analysis of individual features and of KOOS subscales establish the potential of acoustic analysis in evaluation of OA knees. More analysis of the data is needed to better define the variety of scalogram features. The future consequences of this research would be the development of a fast and affordable, non-invasive, radiation-free and potentially portable approach to evaluation, diagnosis and longitudinal monitoring of knee disorders

The aim of this study was to determine the outcomes and survivorship of the Triathlon knee replacement at 7 years after surgery. A cohort of 266 patients receiving a Triathlon knee replacement were assessed before surgery and at 3 months, 1 year, 2 years, 3 years, 5 years and 7 years post-operation. Patient-reported outcomes were assessed using the WOMAC, KOOS Knee-Related Quality of Life scale, Satisfaction Scale and questions on kneeling ability and whether they regretted having the operation. Data on survivorship was collected from self-report and medical records. At 7 years after surgery, 32 patients were deceased, and 17 patients were withdrawn. Of the 217 patients remaining in the study, 164 (76%) returned a completed study questionnaire. At 7 years after surgery, 92% of patients reported an improvement in their WOMAC Pain score greater than the minimally clinically important improvement (defined as improvement of ≥9 points from before surgery) and 82% reported this in their WOMAC Function score (defined as improvement of ≥12 points). Knee-related quality of life was good, with a mean score of 66.8 (SD 26.0) (0–100 scale, worst to best). A high percentage of patients (89%) were somewhat or very satisfied with their outcome at 7 years. Survivorship with revision as the endpoint was 96.4% (95% CI 93.2–98.1%) at 7 years post-operation. Five percent of patients regretted having their operation and 68% reported much difficulty or an inability to kneel. In conclusion, this study observed good long-term patient outcomes and survivorship of the Triathlon knee replacement

The significance of physical activity (PA) assessment is widely acknowledged as it can aid in the understanding of pathologies. PA of knee osteoarthritis (KOA) patients has been assessed with varying methods, as it is a disease that is known to impair physical function and activity during daily life. Differences between methods have been described for general outcomes (sport participation or sedentary time), yet failed to describe common activities such as stair locomotion or sit-to-stand (STS) transfers. This study therefore aimed to determine the comparability of various methods to assess daily-life activities in KOA patients. Sixty-one clinically diagnosed KOA patients wore a tri-axial accelerometer (AX3, Axivity, UK) for one week during waking hours. Furthermore, they performed three physical function tests: a 40-m fast-paced walk test (WT), a timed up-and-go test (TUGT) and a 15 stair-climb test (SCT). Patients were also asked to fill out the Knee Osteoarthritis Outcome Score (KOOS), a KOA-specific questionnaire. Patients were slightly overweight (average BMI: 27.3±4.8 kg/m2), 60 (±10) years old and predominantly female (53%). The amount of daily level walking bouts was only weakly correlated with the WT performance, representing patients” walking capacity, (ρ=−0.33, p=0.01). Similarly, level-walking bouts during daily life correlated weakly with self-perceived walking capacity addressed by the KOOS (ρ=−0.36, p=0.01). For stair locomotion, a slightly different trend was seen. A moderate correlation was found (ρ=0.65, p<0.001), between the amount of ascending bouts and the objective functional test performance (SCT). However, the subjective assessment of stair ascending limitations (via the KOOS) correlated only weakly with both the functional test performance and the measured level of activity (ρ=−0.30 and −0.35, resp.). Comparable results were found for descending motions. STS transfers during daily life correlated moderately at best with the time to complete the TUGT (ρ=−0.43, p<0.01) and only weakly with the self-perceived effort of STS transfers (ρ=−0.26, p=0.04). Only weak correlations existed between subjective measures and objective parameters (for both functional tests and daily living activities), indicating that they assess different domains (e.g. self-perceived function vs. actual physical function). Furthermore, when comparing the two objective measures, correlation coefficients increased compared to the subjective methods, yet did not reach strong agreement. These findings suggest that addressing common activities of daily life either subjectively or objectively will result in different patient-related outcomes of a study. Assessment methods should therefore be chosen with caution and compared carefully with other studies

Introduction. Better functional outcomes, lower pain and better stability have been reported with knee designs which restore physiological knee kinematics. Also the ability of the TKA design to properly restore the physiological femoral rollback during knee flexion, has shown to be correlated with better restoration of the flexor/extensor mechanism, which is fundamental to the function of the human knee. The purpose of the study is to compare the kinematics of three different TKA designs, by evaluating knee motion during Activities of Daily Living. The second goal is to see if there is a correlation between the TKA kinematics and the patient reported outcomes. Methods. Ten patients of each design, who are at least 6 months after their Total Knee Replacement, will be included in this study. Seven satisfied and 3 dissatisfied patients will be selected for each design. In this study 5 different movements will be analysed: flexion/extension; Sitting on and rising from a chair, Stair climbing, descending stairs, Flexion and extension open chain and squatting. These movements will be captured with a fluoroscope. The 2D images that are obtained, will be matched with the 3D implants. This 3D image will be processed with custom-made software to be able to analyse the movement. Tibio-femoral contact points of the medial and lateral condyles, tibio-femoral axial rotation, determination of the pivot-point will be analysed and described. After this analysis, a correlation between the kinematics and the KOOS and KSS will be investigated. Results. (The results of the first six patients are shown, more patients are currently being tested.) The average weight-bearing ROM of the implants is 108.48° +/− 19.68°

Introduction. Ostochondral lesion of the knee is a common cause of chronic knee pain. Arthroscopic treatment with subcondral microfracture is a widespread technique leading to noticeable improvement of knee function and pain. To improve the effectiveness of this treatment options, we thought to add intra (PRF) or post-operative (PRP) growth factors. Platelet rich plasma (PRP) is obtained by centrifugation of the blood to produce a plasma with high concentration of platelets and growth factors. This latter represents a promising method to manage degenerative cartilage lesion and can be used postoperatively to improve clinical results of patients treated arthroscopically. Platelet Rich Fibrin (PRF) has been presented as a second-generation platelet concentrate, and it is used intraoperatively to cover the microfracuteres’ holes. No literature was found about using of PRF intraoperative in association with arthroscopic microfracture technique. The aim of this study is to compare clinical outcomes of the treatment of knee osteochondral lesion using arthroscopic microfracture technique alone or in association with PRF Intraoperative application using “Vivostat” system or with PRP “ReGen Lab” postoperative injection. Patients & Methods. 90 patients with clinical and radiographic evidence of osteochondral lesion of the medial or lateral compartment of the knee were enrolled. All patients received arthroscopic debridement and Microfractures and were randomised into 3 groups: 30 patients received microfractures and intraoperative PRF “Vivostat” injection(Group A), 30 patients received microfracture and 3 intra-articular injections of 5.5 mL PRP “Regen”(Group B), 30 patients received microfracture only. IKDC, KOOS and VAS score were administered to all patients before starting the treatment, at 1, 6 and 12 months from the end of the management. Results. Patients who received microfracture and PRF intraoperative application provided the best outcomes, showing a significant higher clinical scores (P<0.001) compared to the other two groups. Patients underwent PRP postoperative administration reported significant higher score than those undergoing arthroscopic microfracture alone (P<0.005), but lesser than Intraoperative PRF group at 6 months and 1 year follow up. Discussion/Conclusion. Treatment of osteochondral lesions of the knee using microfracture technique significantly improved functional and pain scores from the pre- to postoperatively time in the overall cohort. Intraoperative application of PRF shows significantly better outcome than postoperative PRP injections. However, additional treatment with intra-articular PRP injection as an adjunct to microfracture technique may offer better clinical outcomes over microfracture technique alone

Objectives

Whilst gait speed is variable between healthy and injured adults, the extent to which speed alone alters the 3D in vivo knee kinematics has not been fully described. The purpose of this prospective study was to understand better the spatiotemporal and 3D knee kinematic changes induced by slow compared with normal self-selected walking speeds within young healthy adults.