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exQuery : Knee Surgery & Related Research(구 대한슬관절학회지) <간행물 < KISS

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대한슬관절학회> Knee Surgery & Related Research(구 대한슬관절학회지)

Knee Surgery & Related Research(구 대한슬관절학회지) update

  • : 대한슬관절학회
  • : 의약학분야  >  정형외과학
  • : KCI등재
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  • : 연속간행물
  • : 월간
  • : 2234-0726
  • : 2234-2451
  • : 대한슬관절학회지(~2010) → knee surgery & related research(2011~)

수록정보
34권0호(2022) |수록논문 수 : 39
간행물 제목
34권0호(2022년 08월) 수록논문
최근 권호 논문
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1Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation

저자 : Jussi P. Repo , Mikko M. Uimonen , Mika T. Nevalainen , Heikki Nurmi , Ville T. Ponkilainen , Antti Tuominen , Juha Paloneva

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Purpose: We examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation.
Methods: Patients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS).
Results: During 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures.
Conclusion: The removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The shortterm outcomes are encouraging.
Level of evidence: Level IV, retrospective case series.

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2A comparison of healing and complication rates between common flaps utilized in total knee arthroplasty: a review of the literature

저자 : Akhil A. Chandra , Filippo Romanelli , Alex Tang , Luke Menken , Maximilian Zhang , Adam Feintisch , Frank A. Liporace , Richard S. Yoon

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-14 (14 pages)

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Background: Flap reconstruction with perforator, fasciocutaneous, muscular, and/or free microvascular flaps is utilized to cover wound defects and improve vascularization and antibiotic/nutrient delivery. Flap use in revision procedures for total knee arthroplasty has been explored previously; however, current data are limited and studies comparing healing and complication rates between different flap types are lacking.
Methods: A literature review was performed using PubMed on 13 January 2022. Studies were included if they reported healing and complication rates for either gastrocnemius, rectus abdominis, latissimus dorsi, fasciocutaneous, chimeric, or gracilis flaps in the setting of revision total knee arthroplasty (TKA).
Results: The final cohort included gastrocnemius (n = 421, healing rate 73.8%, complication rate 59.9%), gracilis (n = 9, healing rate 93%, complication rate 55.6%), latissimus dorsi (n = 41, healing rate 67%, complication rate 46.3%), rectus abdominis (n = 3, healing rate 100%, complication rate 0%), fasciocutaneous (n = 78, healing rate 70%, complication rate 19.2%), and chimeric flaps (n = 4, healing rate 100%, complication rate 25%). There was no significant difference when comparing healing rates across flap types (p = 0.39). There was a significant difference when comparing complication rates across flap types (p < 0.0001), with a significant difference being noted between gastrocnemius and fasciocutaneous complication rates (p < 0.0001). All other comparisons between flap types by complication rate were not significantly different.
Conclusions: Gastrocnemius flaps are the workhorse flap in the setting of revision TKA, as evidenced by this review. Healing rates did not vary significantly across flap types, which suggests that determining the appropriate flap for coverage of soft-tissue defects in revision TKA should be driven by defect size and location as well as physician experience and patient tolerance.

KCI등재

3Implant survivorship, functional outcomes and complications with the use of rotating hinge knee implants: a systematic review

저자 : Joshua Xu , Lennart Von Fritsch , Shiraz A. Sabah , Andrew J. Price , Abtin Alvand

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-11 (11 pages)

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Background: With more complex primary and revision total knee arthroplasty procedures there is often the need to use more constrained prostheses. This study aims to investigate patient-relevant outcomes following primary and revision rotating-hinged total knee arthroplasty.
Methods: Electronic searches were performed using four databases from their date of inception to January 2021. Relevant studies were identified, with data extracted and analysed using PRIMSA guidelines.
Results: Nineteen studies were included, producing a cohort of 568 primary and 413 revision rotating hinge total knee arthroplasties (TKAs). Survival was assessed at 1-, 5-, and 10-year post-implantation. Sensitivity analyses based on person-time incidence ratios (PTIRs) were prespecified for studies not reporting survival at these timepoints. From the primary hinge TKA cohort, the median survival at 1 year was 93.4% and at 10 years it was 87%. The PTIR at long-term follow-up of this primary cohort was 1.07 (95% CI 0.4-1.7) per 100 person-years. From the revision hinge TKA cohort, the median survival at 1 year was 79.6%, and at 10 years it was 65.1%. The PTIR at long term-follow-up of this revision cohort was 1.55 (95% CI 0.9-2.3) per 100 person-years. Post-operative flexion range of motion (ROM) was 110° for primary hinge TKA and 103° for revision hinge TKA. Compared with baseline, the Knee Society Score (KSS) and Knee Society Function Score (KSFS) improved for both groups post-operatively (primary: KSS 17 to 86, KSFS 28 to 58; revision: KSS 37 to 82, KSFS 34 to 61).
Conclusion: The quality of the evidence for patient-relevant outcomes following hinged knee arthroplasty was limited. While there is the potential for high early revision rates, where successful, large functional benefits may be achieved.

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4Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review

저자 : Suraj Kohli , Jonas Schwenck , Ian Barlow

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds.
Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature.
Results: Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3-31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0-11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI.
Conclusion: The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data.

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5Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty

저자 : Goki Kamei , Shigeki Ishibashi , Koki Yoshioka , Satoru Sakurai , Hiroyuki Inoue , Yu Mochizuki , Masakazu Ishikawa , Nobuo Adachi

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA.
Materials and methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PSTKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination.
Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158).
Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.

KCI등재

6Risk factors and trajectories of opioid use following total knee replacement

저자 : Ralph Ward , David Taber , Haley Gonzales , Mulugeta Gebregziabher , William Basco , Jenna Mccauley , Patrick Mauldin , Sarah Ball

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-11 (11 pages)

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Background: Opioids are commonly used to manage orthopedic pain in those undergoing total knee arthroplasty (TKA). There are limited studies assessing patterns of perioperative opioid use and risk factors for chronic use in patients undergoing TKA.
Methods: This is a retrospective longitudinal cohort study of Medicaid enrollees undergoing TKA between 2014 and 2017 using de-identified medical and pharmacy claims. The primary outcome was chronic opioid use (opioid prescription filled 90-270 days following TKA). Trajectory group membership was determined by identifying distinct groups of patients with similar patterns of daily morphine milligram equivalent (MME) values during the postsurgery follow-up period.
Results: In total, 1666 TKA surgeries performed in 1507 patients were included; 69% of patients were classified as chronic opioid users. Multivariable analyses identified prior opioid use, high opioid doses during the month after TKA, concomitant mood therapies and benzodiazepines, and comorbid conditions as important risk factors. Group-based trajectory analysis identified five distinct post-TKA surgery opioid use phenotypes with several key characteristics predicting group membership.
Conclusions: This large-scale analysis demonstrated that chronic opioid use was common after TKA surgery and established several important risk factors for chronic use following TKA. Novel analysis revealed five distinct opioid use trajectories and identified key characteristics to help guide clinicians when determining perioperative opioid use. Results demonstrate that interventional studies attempting to reduce opioids after TKA are needed if reductions in long-term use are to be realized in this high-risk patient population.

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7Analysis of changes in tibial torsion angle on open-wedge high tibial osteotomy depending on the osteotomy level

저자 : In-soo Song , Junhan Kwon

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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Purpose: This study evaluated the tibial torsional angle changes of 72 knees before and after open-wedge high tibial osteotomy (OWHTO) and compared the results according to the osteotomy level.
Materials and methods: Seventy patients (72 knees) with Kellgren-Lawrence grade 3 underwent OWHTO. Demographic data, operation procedures, and measurement of mechanical tibiofemoral angle (mTFA), anatomical tibiofemoral angle (aTFA), tibial torsional angle (TTA), and pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. The authors analyzed TTA changes between 30 knees with high-level osteotomy (group A) and 42 knees with low-level osteotomy (group B).
Results: The changes of TTAs in the subjects of 72 knees went from 29.26 ± 5.6° preoperative mean to 25.36 ± 6.4° postoperative mean (p = 0.032). The postoperative TTAs of group A (mean 27.4 ± 4.8°) and B (mean 25.7 ± 4.9°) were statistically significant (p < 0.01). Preoperative Lysholm and IKDC scores of 72 knees had means of 49.1 ± 3.5 and 49.0 ± 15.2, respectively, and postoperative means of 85.7 ± 8.56 and 78.0 ± 17.6, respectively, which were statistically significant (p < 0.01).
Conclusions: Changes of TTA with internal rotation of distal tibia were observed following OWHTO. High-level osteotomy on the proximal tibia's lateral cortex had less internal rotation of the distal tibia than low-level osteotomy.

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8Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

저자 : Andrew S. Bi , Dhruv S. Shankar , Kinjal D. Vasavada , Nina D. Fisher , Eric J. Strauss , Michael J. Alaia , Kirk A. Campbell

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Background: Patient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR.
Methods: We conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p-values less than 0.05 were considered significant.
Results: The cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12-56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p > 0.05). Absence of antibiotic PRAs was predictive of higher VAS (p < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p > 0.05).
Conclusions: In conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.

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9A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

저자 : Trevor Simcox , Vivek Singh , Christian T. Oakley , Omid S. Barzideh , Ran Schwarzkopf , Joshua C. Rozell

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-10 (10 pages)

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Background: While technology-assisted total knee arthroplasty (TA-TKA) improves implant positioning, whether it confers improved clinical outcomes remains inconclusive. We sought to examine national TA-TKA utilization trends and to compare outcomes between TA-TKA and unassisted TKA (U-TKA).
Methods: Patients who underwent primary, elective TKA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Demographic, perioperative, and 30-day outcomes were collected. Patients were stratified on the basis of whether they underwent TA-TKA, which included computer navigation and robotics, or U-TKA. The proportion of patients undergoing TKA using TA-TKA was calculated. One-to-one propensity-score matching paired patients undergoing TA-TKA or U-TKA. Independent samples t-tests and Mann-Whitney U tests were used to compare continuous variables, and chi-squared tests were used to compare categorical variables.
Results: Of the 402,284 TKA patients, 10,429 (2.6%) cases were performed using TA-TKA. Comparing the unmatched TA-TKA and U-TKA groups, race (p < 0.001), smoking status (p = 0.050), baseline functional status (p < 0.001), and body mass index (BMI) (p < 0.001) significantly differed. Propensity-score matching yielded 8633 TA-TKA and U-TKA pairs. The TA-TKA cohort had shorter hospital length of stay (LOS) (2.7 ± 2.5 versus 2.8 ± 1.9 days, p = 0.017) but similar operative times (92.4 ± 33.4 versus 92.6 ± 39.8 min, p = 0.670). Compared with the U-TKA group, the TA-TKA group had lower major complication (7.6% versus 9.4%, p < 0.001) and transfusion (3.9% versus 5.1%, p < 0.001) rates and higher rates of discharge to home (73.9% versus 70.4%, p < 0.001). Reoperation and readmission rates did not significantly differ between groups.
Conclusions: TA-TKA utilization remains low among orthopedic surgeons. Compared with U-TKA, TA-TKA yielded improved perioperative and 30-day outcomes. Nonetheless, surgeons must consider the benefits and drawbacks of TA-TKA when determining the proper surgical technique and technology for each patient.
Level III evidence: Retrospective cohort study.

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10Correction to: Botulinum toxin injections as a salvage therapy is beneficial for management of patellofemoral pain syndrome

저자 : Yuval Kesary , Vivek Singh , Tal Frenkel , Rutenberg , Arie Greenberg , Shmuel Dekel , Ran Schwarzkopf , Nimrod Snir

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-2 (2 pages)

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1Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation

저자 : Jussi P. Repo , Mikko M. Uimonen , Mika T. Nevalainen , Heikki Nurmi , Ville T. Ponkilainen , Antti Tuominen , Juha Paloneva

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Purpose: We examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation.
Methods: Patients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS).
Results: During 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures.
Conclusion: The removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The shortterm outcomes are encouraging.
Level of evidence: Level IV, retrospective case series.

KCI등재

2A comparison of healing and complication rates between common flaps utilized in total knee arthroplasty: a review of the literature

저자 : Akhil A. Chandra , Filippo Romanelli , Alex Tang , Luke Menken , Maximilian Zhang , Adam Feintisch , Frank A. Liporace , Richard S. Yoon

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-14 (14 pages)

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Background: Flap reconstruction with perforator, fasciocutaneous, muscular, and/or free microvascular flaps is utilized to cover wound defects and improve vascularization and antibiotic/nutrient delivery. Flap use in revision procedures for total knee arthroplasty has been explored previously; however, current data are limited and studies comparing healing and complication rates between different flap types are lacking.
Methods: A literature review was performed using PubMed on 13 January 2022. Studies were included if they reported healing and complication rates for either gastrocnemius, rectus abdominis, latissimus dorsi, fasciocutaneous, chimeric, or gracilis flaps in the setting of revision total knee arthroplasty (TKA).
Results: The final cohort included gastrocnemius (n = 421, healing rate 73.8%, complication rate 59.9%), gracilis (n = 9, healing rate 93%, complication rate 55.6%), latissimus dorsi (n = 41, healing rate 67%, complication rate 46.3%), rectus abdominis (n = 3, healing rate 100%, complication rate 0%), fasciocutaneous (n = 78, healing rate 70%, complication rate 19.2%), and chimeric flaps (n = 4, healing rate 100%, complication rate 25%). There was no significant difference when comparing healing rates across flap types (p = 0.39). There was a significant difference when comparing complication rates across flap types (p < 0.0001), with a significant difference being noted between gastrocnemius and fasciocutaneous complication rates (p < 0.0001). All other comparisons between flap types by complication rate were not significantly different.
Conclusions: Gastrocnemius flaps are the workhorse flap in the setting of revision TKA, as evidenced by this review. Healing rates did not vary significantly across flap types, which suggests that determining the appropriate flap for coverage of soft-tissue defects in revision TKA should be driven by defect size and location as well as physician experience and patient tolerance.

KCI등재

3Implant survivorship, functional outcomes and complications with the use of rotating hinge knee implants: a systematic review

저자 : Joshua Xu , Lennart Von Fritsch , Shiraz A. Sabah , Andrew J. Price , Abtin Alvand

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-11 (11 pages)

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Background: With more complex primary and revision total knee arthroplasty procedures there is often the need to use more constrained prostheses. This study aims to investigate patient-relevant outcomes following primary and revision rotating-hinged total knee arthroplasty.
Methods: Electronic searches were performed using four databases from their date of inception to January 2021. Relevant studies were identified, with data extracted and analysed using PRIMSA guidelines.
Results: Nineteen studies were included, producing a cohort of 568 primary and 413 revision rotating hinge total knee arthroplasties (TKAs). Survival was assessed at 1-, 5-, and 10-year post-implantation. Sensitivity analyses based on person-time incidence ratios (PTIRs) were prespecified for studies not reporting survival at these timepoints. From the primary hinge TKA cohort, the median survival at 1 year was 93.4% and at 10 years it was 87%. The PTIR at long-term follow-up of this primary cohort was 1.07 (95% CI 0.4-1.7) per 100 person-years. From the revision hinge TKA cohort, the median survival at 1 year was 79.6%, and at 10 years it was 65.1%. The PTIR at long term-follow-up of this revision cohort was 1.55 (95% CI 0.9-2.3) per 100 person-years. Post-operative flexion range of motion (ROM) was 110° for primary hinge TKA and 103° for revision hinge TKA. Compared with baseline, the Knee Society Score (KSS) and Knee Society Function Score (KSFS) improved for both groups post-operatively (primary: KSS 17 to 86, KSFS 28 to 58; revision: KSS 37 to 82, KSFS 34 to 61).
Conclusion: The quality of the evidence for patient-relevant outcomes following hinged knee arthroplasty was limited. While there is the potential for high early revision rates, where successful, large functional benefits may be achieved.

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4Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review

저자 : Suraj Kohli , Jonas Schwenck , Ian Barlow

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds.
Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature.
Results: Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3-31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0-11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI.
Conclusion: The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data.

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5Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty

저자 : Goki Kamei , Shigeki Ishibashi , Koki Yoshioka , Satoru Sakurai , Hiroyuki Inoue , Yu Mochizuki , Masakazu Ishikawa , Nobuo Adachi

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA.
Materials and methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PSTKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination.
Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158).
Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.

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6Risk factors and trajectories of opioid use following total knee replacement

저자 : Ralph Ward , David Taber , Haley Gonzales , Mulugeta Gebregziabher , William Basco , Jenna Mccauley , Patrick Mauldin , Sarah Ball

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-11 (11 pages)

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Background: Opioids are commonly used to manage orthopedic pain in those undergoing total knee arthroplasty (TKA). There are limited studies assessing patterns of perioperative opioid use and risk factors for chronic use in patients undergoing TKA.
Methods: This is a retrospective longitudinal cohort study of Medicaid enrollees undergoing TKA between 2014 and 2017 using de-identified medical and pharmacy claims. The primary outcome was chronic opioid use (opioid prescription filled 90-270 days following TKA). Trajectory group membership was determined by identifying distinct groups of patients with similar patterns of daily morphine milligram equivalent (MME) values during the postsurgery follow-up period.
Results: In total, 1666 TKA surgeries performed in 1507 patients were included; 69% of patients were classified as chronic opioid users. Multivariable analyses identified prior opioid use, high opioid doses during the month after TKA, concomitant mood therapies and benzodiazepines, and comorbid conditions as important risk factors. Group-based trajectory analysis identified five distinct post-TKA surgery opioid use phenotypes with several key characteristics predicting group membership.
Conclusions: This large-scale analysis demonstrated that chronic opioid use was common after TKA surgery and established several important risk factors for chronic use following TKA. Novel analysis revealed five distinct opioid use trajectories and identified key characteristics to help guide clinicians when determining perioperative opioid use. Results demonstrate that interventional studies attempting to reduce opioids after TKA are needed if reductions in long-term use are to be realized in this high-risk patient population.

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7Analysis of changes in tibial torsion angle on open-wedge high tibial osteotomy depending on the osteotomy level

저자 : In-soo Song , Junhan Kwon

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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Purpose: This study evaluated the tibial torsional angle changes of 72 knees before and after open-wedge high tibial osteotomy (OWHTO) and compared the results according to the osteotomy level.
Materials and methods: Seventy patients (72 knees) with Kellgren-Lawrence grade 3 underwent OWHTO. Demographic data, operation procedures, and measurement of mechanical tibiofemoral angle (mTFA), anatomical tibiofemoral angle (aTFA), tibial torsional angle (TTA), and pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. The authors analyzed TTA changes between 30 knees with high-level osteotomy (group A) and 42 knees with low-level osteotomy (group B).
Results: The changes of TTAs in the subjects of 72 knees went from 29.26 ± 5.6° preoperative mean to 25.36 ± 6.4° postoperative mean (p = 0.032). The postoperative TTAs of group A (mean 27.4 ± 4.8°) and B (mean 25.7 ± 4.9°) were statistically significant (p < 0.01). Preoperative Lysholm and IKDC scores of 72 knees had means of 49.1 ± 3.5 and 49.0 ± 15.2, respectively, and postoperative means of 85.7 ± 8.56 and 78.0 ± 17.6, respectively, which were statistically significant (p < 0.01).
Conclusions: Changes of TTA with internal rotation of distal tibia were observed following OWHTO. High-level osteotomy on the proximal tibia's lateral cortex had less internal rotation of the distal tibia than low-level osteotomy.

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8Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

저자 : Andrew S. Bi , Dhruv S. Shankar , Kinjal D. Vasavada , Nina D. Fisher , Eric J. Strauss , Michael J. Alaia , Kirk A. Campbell

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Background: Patient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR.
Methods: We conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p-values less than 0.05 were considered significant.
Results: The cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12-56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p > 0.05). Absence of antibiotic PRAs was predictive of higher VAS (p < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p > 0.05).
Conclusions: In conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.

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9A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

저자 : Trevor Simcox , Vivek Singh , Christian T. Oakley , Omid S. Barzideh , Ran Schwarzkopf , Joshua C. Rozell

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-10 (10 pages)

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Background: While technology-assisted total knee arthroplasty (TA-TKA) improves implant positioning, whether it confers improved clinical outcomes remains inconclusive. We sought to examine national TA-TKA utilization trends and to compare outcomes between TA-TKA and unassisted TKA (U-TKA).
Methods: Patients who underwent primary, elective TKA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Demographic, perioperative, and 30-day outcomes were collected. Patients were stratified on the basis of whether they underwent TA-TKA, which included computer navigation and robotics, or U-TKA. The proportion of patients undergoing TKA using TA-TKA was calculated. One-to-one propensity-score matching paired patients undergoing TA-TKA or U-TKA. Independent samples t-tests and Mann-Whitney U tests were used to compare continuous variables, and chi-squared tests were used to compare categorical variables.
Results: Of the 402,284 TKA patients, 10,429 (2.6%) cases were performed using TA-TKA. Comparing the unmatched TA-TKA and U-TKA groups, race (p < 0.001), smoking status (p = 0.050), baseline functional status (p < 0.001), and body mass index (BMI) (p < 0.001) significantly differed. Propensity-score matching yielded 8633 TA-TKA and U-TKA pairs. The TA-TKA cohort had shorter hospital length of stay (LOS) (2.7 ± 2.5 versus 2.8 ± 1.9 days, p = 0.017) but similar operative times (92.4 ± 33.4 versus 92.6 ± 39.8 min, p = 0.670). Compared with the U-TKA group, the TA-TKA group had lower major complication (7.6% versus 9.4%, p < 0.001) and transfusion (3.9% versus 5.1%, p < 0.001) rates and higher rates of discharge to home (73.9% versus 70.4%, p < 0.001). Reoperation and readmission rates did not significantly differ between groups.
Conclusions: TA-TKA utilization remains low among orthopedic surgeons. Compared with U-TKA, TA-TKA yielded improved perioperative and 30-day outcomes. Nonetheless, surgeons must consider the benefits and drawbacks of TA-TKA when determining the proper surgical technique and technology for each patient.
Level III evidence: Retrospective cohort study.

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10Correction to: Botulinum toxin injections as a salvage therapy is beneficial for management of patellofemoral pain syndrome

저자 : Yuval Kesary , Vivek Singh , Tal Frenkel , Rutenberg , Arie Greenberg , Shmuel Dekel , Ran Schwarzkopf , Nimrod Snir

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-2 (2 pages)

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