We studied 47 patients with closed, displaced, diaphyseal fractures of the femur caused by blunt trauma, to determine the incidence of associated knee injuries, particularly of the meniscus. After femoral nailing, all patients had an examination under anaesthesia and an arthroscopy. There were 12 medial
Aims. To identify unanswered questions about the prevention, diagnosis, treatment, and rehabilitation and delivery of care of first-time soft-tissue knee injuries (ligament injuries, patella dislocations,
We examined 36 consecutive patients with closed tibial plateau fractures under anaesthesia and by diagnostic and operative arthroscopy before treating them by closed or open reduction and internal fixation. Following the principle of Hohl (1967) (Fig. 1) there were 9 minimally displaced fractures (type I), 6 with local depression (type II), 13 with split depression (type III), 7 with total condylar depression (type IV), and one bicondylar comminuted upper tibial fracture (type V). Seventeen (47%) of knees were found to have associated
Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and
The April 2023 Research Roundup360 looks at: Ear protection for orthopaedic surgeons?; Has arthroscopic meniscectomy use changed in response to the evidence?; Time to positivity of cultures obtained for periprosthetic joint infection; Bisphosphonates for post-COVID-19 osteonecrosis of the femoral head; Missing missed fractures: is AI the answer?; Congenital insensitivity to pain and correction of the knee; YouTube and paediatric elbow injuries.
Aims. The best surgical strategy for the management of displaced bucket-handle (BH) meniscal tears in an anterior cruciate ligament (ACL)-deficient knee is unclear. Combining meniscal repair with ACL reconstruction (ACLR) is thought to improve meniscal healing rates; however, patients with displaced BH meniscal tears may lack extension. This leads some to advocate staged surgery to avoid postoperative stiffness and loss of range of motion (ROM) following ACLR. Methods. We reviewed the data for a consecutive series of 88 patients (mean age 27.1 years (15 to 49); 65 male (74%) and 23 female (26%)) who underwent single-stage repair of a displaced BH meniscal tear (67 medial (76%) and 21 lateral (24%)) with concomitant hamstring autograft ACLR. The patient-reported outcome measures (PROMs) EuroQol visual analogue scale (EQ-VAS), EuroQol five-dimension health questionnaire (EQ-5D), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), and Tegner score were recorded at final follow-up. A Kaplan-Meier survival analysis was performed to estimate meniscal repair survivorship. Analyses were performed with different cut-offs for meniscal and ACL injury-to-surgery time (within three weeks, three to ten weeks, and more than ten weeks). Results. Meniscal repair survivorship at a median final follow-up of 55 months (interquartile range (IQR) 24 to 91) was 82% (95% confidence interval 70 to 89). A total of 13 meniscus repairs failed (12 requiring meniscectomy and one requiring a further meniscal repair). At final follow-up, median PROMs were: EQ-VAS 85 (IQR 75 to 90), EQ-5D Index 0.84 (IQR 0.74 to 1.00), KOOS Pain 89 (IQR 80 to 94), KOOS Symptoms 82 (IQR 71 to 93), KOOS Activities of Daily Living 97 (IQR 91 to 100), KOOS Sport and Recreation 80 (IQR 65 to 90), KOOS Quality of Life 69 (IQR 53 to 86), IKDC 82.8 (IQR 67.8 to 90.8), and Tegner 6 (IQR 4 to 7). Two patients underwent revision ACLR following further injuries. One patient had an arthroscopic washout for infection at 11 days post-BH meniscal repair/ACLR. Four patients (4.5%) required a further procedure for stiffness, reduced ROM, and pain, and all were operated on within three weeks of
The April 2023 Children’s orthopaedics Roundup. 360. looks at: CT scan of the ipsilateral femoral neck in paediatric shaft fractures;
Aims.
We examined the menisci in 47 patients at the time of anterior cruciate ligament reconstruction. Twenty-one patients had abnormal menisci at a mean of 34 months after injury, but there was no difference between the Lysholm scores of patients with intact or damaged menisci. Eleven patients had a new
The role of arthroscopy in the treatment of soft-tissue
injuries associated with proximal tibial fractures remains debatable.
Our hypothesis was that MRI over-diagnoses clinically relevant associated
soft-tissue injuries. This prospective study involved 50 consecutive
patients who underwent surgical treatment for a split-depression fracture
of the lateral tibial condyle (AO/OTA type B3.1). The mean age of
patients was 50 years (23 to 86) and 27 (54%) were female. All patients
had MRI and arthroscopy. Arthroscopy identified 12 tears of the
lateral meniscus, including eight bucket-handle tears that were
sutured and four that were resected, as well as six tears of the
medial meniscus, of which five were resected. Lateral meniscal injuries
were diagnosed on MRI in four of 12 patients, yielding an overall
sensitivity of 33% (95% confidence interval (CI) 11 to 65). Specificity
was 76% (95% CI 59 to 88), with nine tears diagnosed among 38 menisci
that did not contain a tear. MRI identified medial meniscal injuries
in four of six patients, yielding an overall sensitivity of 67%
(95% CI 24 to 94). Specificity was 66% (95% CI 50 to 79), with 15
tears diagnosed in 44 menisci that did not contain tears. MRI appears to offer only a marginal benefit as the specificity
and sensitivity for diagnosing
We reviewed 5086 patients with a mean age of
30 years (9 to 69) undergoing primary reconstruction of the anterior cruciate
ligament (ACL) in order to determine the incidence of secondary
pathology with respect to the time between injury and reconstruction.
There was an increasing incidence of medial meniscal tears and chondral damage,
but not lateral meniscal tears, with increasing intervals before
surgery. The chances of requiring medial meniscal surgery was increased
by a factor of two if ACL reconstruction was delayed more than five
months, and increased by a factor of six if surgery was delayed
by >
12 months. The effect of delaying surgery on medial meniscal injury
was also pronounced in the patients aged <
17 years, where a
delay of five to 12 months doubled the odds of medial meniscal surgery
(odds ratio (OR) 2.0, p = 0.001) and a delay of >
12 months quadrupled
the odds (OR 4.3, p = 0.001). Increasing age was associated with
a greater odds of chondral damage (OR 4.6, p = 0.001) and medial meniscal
injury (OR 2.9, p = 0.001), but not lateral
Objectives.
To fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle. In this controlled laboratory study, we developed an original multiscale subject-specific finite element musculoskeletal framework model and integrated it with the tibiofemoral and patellofemoral joints with high-fidelity joint motion representations, to investigate the effects of 2.5° increases in PTS angles on joint dynamics and contact mechanics during the gait cycle.Aims
Methods
The purpose of this study is to determine an individual’s age-specific prevalence of total knee arthroplasty (TKA) after cruciate ligament surgery, and to identify clinical and genetic risk factors associated with undergoing TKA. This study was a retrospective case-control study using the UK Biobank to identify individuals reporting a history of cruciate ligament surgery. Data from verbal history and procedural codes recorded through the NHS were used to identify instances of TKA. Patient clinical and genetic data were used to identify risk factors for progression from cruciate ligament surgery to TKA. Individuals without a history of cruciate ligament reconstruction were used for comparison.Aims
Methods
This study aimed to investigate the role and mechanism of meniscal cell lysate (MCL) in fibroblast-like synoviocytes (FLSs) and osteoarthritis (OA). Meniscus and synovial tissue were collected from 14 patients with and without OA. MCL and FLS proteins were extracted and analyzed by liquid chromatography‒mass spectrometry (LC‒MS). The roles of MCL and adenine nucleotide translocase 3 (ANT3) in FLSs were examined by enzyme-linked immunosorbent assay (ELISA), flow cytometry, immunofluorescence, and transmission electron microscopy. Histological analysis was performed to determine ANT3 expression levels in a male mouse model.Aims
Methods
The biomechanical function of the anteromedial
(AM) and posterolateral (PL) bundles of the anterior cruciate ligament
(ACL) remains controversial. Some studies report that the AM bundle
stabilises the knee joint in anteroposterior (AP) translation and
rotational movement (both internal and external) to the same extent
as the PL bundle. Others conclude that the PL bundle is more important
than the AM in controlling rotational movement. The objective of this randomised cohort study involving 60 patients
(39 men and 21 women) with a mean age of 32.9 years (18 to 53) was
to evaluate the function of the AM and the PL bundles of the ACL
in both AP and rotational movements of the knee joint after single-bundle
and double-bundle ACL reconstruction using a computer navigation
system. In the double-bundle group the patients were also randomised
to have the AM or the PL bundle tensioned first, with knee laxity
measured after each stage of reconstruction. All patients had isolated
complete ACL tears, and the presence of a
The October 2024 Knee Roundup360 looks at: Managing the unexpected: treatment of intraoperative medial collateral ligament injuries; Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: secondary analysis of data from a randomized controlled trial; Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial; Cartilage regeneration and long-term survival in medial knee osteoarthritis patients treated with high tibial osteotomy and osteochondral autologous transfer system; Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes; Long-term outcomes of multiligament knee injuries in American football players.
Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular augmentation, and/or osteotomy. Although revision ACLr reliably restores knee stability and function, clinical outcomes and reoperation rates are worse than for primary ACLr. Cite this article: